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Step 2 > Cardiology (Step up son) > Flashcards

Cardiology (Step up son) Flashcards

1
Q

What is the most common site of coronary occlusion?

A

Left Anterior Descending artery

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2
Q

What does the Posterior Descending artery branch off of?

A

Right coronary artery (70%)
Left Circumflex artery (10%)
An anastomosis of the RCA and Circumflex (20%)

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3
Q

What increases stroke volume? (6 things)

A 
Catecholamine release
Increase intracellular Calcium
Decrease in extracellular Sodium
Digoxin use
Anxiety
Exercise
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4
Q

By remembering how digoxin works, two of the other causes of increased stroke volume can be remembered. How does digoxin work?

A

Digoxin inhibits Na/K-pump. Leading to increased intracellular sodium (thus decreased extracellular sodium) which causes increased intracellular calcium

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5
Q

What decreases stroke volume?

A

Beta-blockers
Heart failure (chicken vs. egg)
Acidosis
Hypoxia

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6
Q

What is the Fick Principle? What does it determine

A

(Rate of O2 use) / ([O2]a – [O2]v)

Cardiac Output…just follow the units

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7
Q

Which increases first to increase CO during exercise, SV or HR?

A

SV increases first, then HR

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8
Q

What equations can be used to determine Mean Arterial Pressure?

A

CO x TPR

Diastolic pressure + 1/3 pulse pressure

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9
Q

When is an exercise stress test complete?

A

85% expected max HR (220-age)
Angina like symptoms
Signs of ischemia on ECG

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10
Q

What can be done if an exercise stress test results are ambiguous?

A

Nuclear exercise test (inject thallium-201 or tech-99)

Exercise stress test with echo

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11
Q

What is used in pharm stress testing? When is this done?

A

Dobutamine

Comorbidities

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12
Q

PET myocardial imaging can be done…

A

…gives 3D images

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13
Q

What is the gold standard in identifying CAD?

A

Coronary angiography

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14
Q

What is the most common cause of hypercholesterolemia?

A

Most cases are acquired

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15
Q

When they say/show high levels of serum homocysteine, what should you think about?

A

Atherosclerosis (3x risk of significant amount)

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16
Q

For the bulk of the cholesterol meds, what are the common side effects?

A

Muscle damage/pain

Increased LFTs

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17
Q

Person has substernal chest pain with activity that is relieved with rest. What do they have? How should they be treated? How should they be diagnosed?

A 
Angina pectoris (Prinzmetal if d/t vasospasm) [until proven otherwise]
GERD, esophageal spasm, etc.

Nitroglycerin and rest

Stress test (exercise vs pharm) or nuclear

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18
Q

Patient previously diagnosed with CAD presents with worsening symptoms–now having symptoms at rest–and decreased response to treatment. What are the likely causes?

A

Plaque rupture*
Hemorrhage
Thrombosis

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19
Q

Patient previously diagnosed with CAD presents with worsening symptoms–now having symptoms at rest–and decreased response to treatment. What should be done in-patient? What is seen on ECG?

A

ECG and serial cardiac enzymes

ST depression*
T-wave flattening/inversion

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20
Q

Patient previously diagnosed with CAD presents with worsening symptoms–now having symptoms at rest–and decreased response to treatment. What treatment should be done regardless of whether PCI is planned?

A

MONA BS

M-Morphine
O-Oxygen
N-Nitroglycerin
A-Aspirin

B-Beta blocker
S-Statin (preferably before PCI)

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21
Q

Patient previously diagnosed with CAD presents with worsening symptoms–now having symptoms at rest–and decreased response to treatment. What should be added to MONA BS if PCI is planned?

A

GPIIb/IIIa inhibitor

Unfractioned heparin

22
Q

What are the GPIIb/IIIa inhibitors?

A

Abciximab
Tirofiban
Eptifibatide

23
Q

Patient previously diagnosed with CAD presents with worsening symptoms–now having symptoms at rest–and decreased response to treatment. What should be added to MONA BS if PCI is NOT planned?

A

Clopidogrel or ticagrelor

LMWH

24
Q

Patient previously diagnosed with CAD presents with worsening symptoms–now having symptoms at rest–and decreased response to treatment. What electrolytes should be monitored?

A

Potassium > 4mEq/L

Magnesium > 2mEq/L

25
Q

What are two examples of PCI?

A

Percutaneous Transluminal Coronary Angioplasty (PTCA)

Coronary Artery Bypass Graft (CABG)

26
Q

When is PTCA done?

A

When patient is unresponsive to medications

27
Q

When is CABG recommended?

A

Left main stenosis >50%
Three-vessel disease
History of CAD and DM

28
Q

Which vessels are commonly used for CABG?

A

Saphenous vein

Internal mammary artery

29
Q

When does CK-MB increase post-MI? When does it peak? when does it decrease?

A

2-12hrs

12-40hrs

24-72hrs

30
Q

When does LDH increase post-MI? When does it peak?

A

6-24hrs

3-6 days

…rarely used

31
Q

When does Trop-I increase post-MI? When does it peak? When does it decrease?

A

2-3hrs

6hrs
gradually decreases over 7 days

32
Q

What medications have been proven to decrease mortality post-MI?

A

Low-dose ASA
Beta-blocker
ACEI or ARB

33
Q

When have thrombolytics been proven to decrease mortality?

A

Within 12hrs of MI

34
Q

When should amiodarone be used post-MI?

A

For Vtach

35
Q

When is the greatest risk of cardiac death post-MI? What are the most common causes?

A

The first few hours post-MI

Vtach
Vfib
Cardiogenic shock

36
Q

A patient has an MI and everything seems to be going well. Then the patient dies 4-8 days later. Why?

A

Ventricular wall rupture

37
Q

Mobitz I (Wenckebach) is a second degree heart block. What causes it? When is treatment necessary?

A

Caused by intranodal* or His bundle conduction defect
Drugs (beta-blockers, digoxin, ccb’s)
Increased vagal tone

Tx is necessary with symptomatic bradycardia (pacemaker)

38
Q

Mobitz II is caused by what? How is it treated? What is the concern?

A

Infranodal conduction problem (bundle of His or Purkinje fibers)

Ventricular pacemaker

Progression to 3rd degree block

39
Q

Patient presents with concern for syncope or similar. What should be considered? How can it be treated?

A

3rd degree heart block

No AV blocking drugs
Ventricular pacemaker

40
Q

Who typically gets paroxysmal supraventricular tachycardia?

A

Young patients with healthy hearts

41
Q

How can PSVTs be treated?

A

Carotid massage
Valsalva maneuver
IV adenosine

In case of hemo instability, cardioversion or CCBs

Catheter ablation for long-term control in symptomatic patients

42
Q

What is the technical definition of Vtach?

A

3+ PVCs

43
Q

What is the MoA for class I antiarrhythmics?

A

Sodium channel blockers

44
Q

There are two drugs in each of the three types of class I antiarrhythmics. How can they be remembered? What are they?

A

Quarter Pounder with Lettuce and Tomato, Fries Please

Quinidine Procainamide Lidocaine Tocainide Flecainide Propafenone

45
Q

What can quinidine and procainamide be used to treat?

A

PSVT
Afib
Aflut
Vtach

46
Q

What can lidocaine and tocainide be used to treat?

A

Vtach

47
Q

What can flecainide and propafenone be used to treat?

A

PSVT
Afib
Aflutter

48
Q

What are the class II antiarrhythmics? What can they be used to treat?

A

Beta-blockers

PVC
PSVT
Afib
Aflutter
Vtach
49
Q

Class III antiarrhythmics are potassium channel blockers. What are they? What can they treat?

A

Amiodarone
Sotalol
Bretylium

Afib
Aflut
Vtach (except bretylium)

50
Q

The class IV antiarrhythmics are CCBs. What are they? What can they treat?

A

Verapamil
Diltiazem

PSVT
MAT
Afib
Aflut

51
Q

What drugs have been proved to decrease mortality of CHF?

A

ACEI
Beta-blockers
Spironolactone

52
Q

What can cause right sided HF?

A

Left sided HF

COPD –> RVH –> Right sided HF ( cor pulmonale)

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