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CFPC exam KM > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

BP Goals: ABMP 24h monitor

A

<130/80

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2
Q

BP Goals: ambulatory mean wake

A

<135/85

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3
Q

BP Goals: HBPM

A

<135/85

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4
Q

BP Goals: AOBP

A

<135/85

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5
Q

BP Goals: Non-AOBP / OBPM

A

<140/90

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6
Q

HTN emergency

A

HTN encephalopathy
Acute aortic dissection
Acute LVF
ACS
AKI
ICH
CVS
Pre-eclampsia

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7
Q

Secondary cause BP risks: Fibromuscular dysplasia

A

Resistant >/ 3 meds
>1.5cm renal asymmetry
Abdo bruits w/o artherosclerosis
FMD other vascular area
Fam hx

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8
Q

Secondary cause BP risks: Renovascular

A

Sudden onset / worsening <30 or >55 y/o
Abdo bruit
Resistant >/ 3 meds
Increased Cr >/ 30% on ACEi/ARB
Arterosclerosis
Pul edema with increased BP

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9
Q

Secondary cause BP risks: Hyperaldosteronism

A

K+ </3.5 or <3 if not diuretic
Resistant to >/ 3 meds
Incidental adrenal adenoma

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10
Q

Secondary cause BP risks: Pheochromocytoma

A

Paroxysmal/ severe BP >/ 180/110
Refractory to meds
Catecholamine excess - H/A, sweating, palpitations, panic attacks, pallor, HTN triggered by b-blocker and MAOI
Incidental adrenal mass

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11
Q

Fibromuscular dysplasia- ix

A

MRA and CTA - if + screen cervicocephalic intracranial aneurysm

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12
Q

Renovascular - ix/tx

A

Ix:
Captopril-enhanced radioisotope renal scan -egfr >60
Doppler
CT-angio
MRA - egfr >30
Tx:
Stent/angioplasty if uncontrolled hen, acute pul edema, decreased cr

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13
Q

Hyperaldosteronism - ix

A

Plasma aldosterone and plasma renin

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14
Q

Pheochromocytoma - ix

A

MRI
24h urine total metanephrine
+urinary metanephrine:Cr ratio

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15
Q

BP goal for diabetes or renal transplant

A

<130/80

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16
Q

How often to screen for HTN

A

If >40 or risk factors yearly
If 18-39 every 3-5 years

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17
Q

ACEi / ARB contraindications and interactions

A

bilateral renal artery stenosis
angiodema
pregnancy

K sparing diuretic
Lithium

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18
Q

BB contraindications and interactions

A

asthma
2nd/3rd degree HB
uncompensated HF
severe PAD

CCB
Antidiabetic

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19
Q

CCB contraindications and interactions

A

recent mi with pul ede
sick sinus syndrome
2nd/3rd degree HB

BB
Grape fruit juice

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20
Q

Thiazide contraindications

A

Gout

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21
Q

ACEi / ARB side effects

A

cough
angioedema
acute renal failure

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22
Q

BB side effects

A

ed
bronchospasm
insomnia
decreased exercise tolerance

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23
Q

CCB side effects

A

edema
flushing
dyspnea/pul edem in LVD

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24
Q

Thiazide side effects

A

renal failure
hypokalaemia

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25
Q

1st choice anti-HTN in CAD

A

acei/arb

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26
Q

1st choice anti-HTN in stable angina no chf/mi

A

beta blocker

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27
Q

1st choice anti-HTN in recent mi

A

betablocker + acei (Arb)

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28
Q

1st choice anti-HTN in hfref

A

betablocker + acei (Arb)

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29
Q

1st choice anti-HTN in LVD

A

acei

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30
Q

1st choice anti-HTN in afib

A

acei (arb)

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31
Q

1st choice anti-HTN in cerebrovascular disease

A

acei + thiazide

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32
Q

1st choice anti-HTN in CKD

A

acei

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33
Q

1st choice anti-HTN in renal transplant

A

d-ccb or arb

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34
Q

1st choice anti-HTN in diabetes

A

acei

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35
Q

Number to decrease BP if over - in embolic stroke

A

> 220/120

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36
Q

Number to decrease BP if over - in hemorrhagic stroke

A

> 180/100

37
Q

Causes of induced hypertension

A

P - pheochromocytoma, polycythemia, pre and ecamplsia
R - renovascular
E - endocrine: hypertsh, cushing, aldosteronism
S - substance: estrogen, caffeine, decongestants, cocacine, sympathemometics, etoh
S - structural - coarctation, arteriosclerosis
U - upper motor neuron problem - elevated icp
R - renoparenchymal - glomerulonephritis, dm nephropathy
E - essential, error in cuff size

38
Q

HTN physical exam and what you’re looking for

A

Vitals - bmi, bp, hr
Fundoscopy - arteriolar changes
Neck exam - carotid bruits, thyroid
Cardiopulmonary - chf/lvf, intrascapular murmur
Abdo - palpable kidneys, renal bruit
Neuro - stroke
Pulse/legs - PVD, edema

39
Q

Initial HTN investigations

A

Urinalysis
Lytes
Cr
FBG/A1C
Choestrol
ECG
Urinary albumin - if diabetic
Echo - if suspected CAD or LVD
bHCG if indicated

40
Q

When to bring MAP down 20-25% in HTN emergency and tx

A

encephalopathy - iv labetolol
pul ede - iv enalapril or nitro infusion

41
Q

Goal bp and tx in aortic dissection if no hypo perfusion

A

Systolic BP < 110
Tx:
Nitropresside
Esmolol infusion
Labetolol infusion

42
Q

Who to screen for dyslipidemia

A

Men and women >/ 40 or postmenopausal

Any age if:
Fam hx
Arterosclerosis
AAA
DM
HTN
Smoking
Clinical signs: corneal arcus, xanthelasma, xanthoma
Fam hx premature CVD
CKD
Diabetes
Inflammatory diseases
HIV
ED
COPD
Hx of HTN in pregnancy

43
Q

Statin indicated conditions

A

Diabetes >40 y/o, >30 y/o for 15 years, microvascular disease.
CKD age >50 and eGFR <60 or ACR>3.
Atheroscelrotic cardiovascular disease. AAA.

44
Q

Cholestrol levels and risk to start statin with treatment target

A

Low Risk (FRS <10%)
Treatment advised if LDL-C >=5.00
mmol/L
Treatment target: >50% reduction LDL-C

Intermediate Risk (FRS 10-19%)
Treatment advised if LDL-C >=3.50 mmol/L OR Non-HDL-C >=4.30 mmol/L OR ApoB >=1.20 g/L.
Consider treatment for men >=50 and women >=60 yrs with one additional CV risk factor.
Treatment targets: LDL-C <2.00 mmol/L OR decrease by >50% OR Non-HDL-C <2.60 mmol/L OR ApoB <0.8 g/L

High Risk (FRS >=20% or presence of high risk features)
Treatment advised in all patients
Treatment targets: LDL-C <2.00 mmol/L OR decrease by >50% OR Non-HDL-C <2.60 mmol/L OR ApoB <0.8 g/L

45
Q

VF / pulseness VT meds

A

After 1st shock - Epinephrine 1mg q3-5mins - increased myocardial and cerebral flow
After 2nd shock - Amiodarone 300mg x 1 then 150mg x1 OR lidocaine 1-1.5mg/kg x 1 then 0.5-0.75mg/kg x 1 afterwards

46
Q

Asystole/PEA meds

A

Epinephrine 1mg q3-5 mins

47
Q

Bradycardia meds

A

If symptomatic then atropine 0.5mg IV q3-5 min (max 3mg) but should not delay pacing. Can also consider dopamine, epinephrine or transcutaneous pacing.

48
Q

Tachycardia meds

A

Symptomatic - cardiovert with sedation if you can

Narrow complex - vasovagal, adenosine 6mg IV push wait 2 min then repeat 12mg, consider CCB or b-blocker.

Wide complex - consider precordial thump, amidarone.

49
Q

Reversal causes cardiac arrest

A

Hydrogen ion excess
Hyper/hypokalaemia
Hypovolemia
Hypothermia
Tension pneumothorax
Tamponade
Thrombsis
Toxins

50
Q

Things that mean unstable in tacky/bradycardia

A

Hypotension
Altered mental status
Signs of shock
Chest discomfort
Acute HF

51
Q

When do to elective cardioversion in AF and what to do prior

A

Valvular AF
or NVAF <12h and CVA <6 months
or NVAF 12-48h and CHADS >/2 oe
NVAF >48h

OAC >/ 3 weeks
TEE to exclude thrombus

Following you give oca for 4 weeks then based on CHADS-65

52
Q

What is the CHADS2 score

A

Anticoag in AF score:

Congestive heart failure - 1
Hypertension - 1
Age >75 - 1
Diabetes - 1
Stroke or TIA - 2

53
Q

When to do urgent cardio version and treatment after

A

Hemodynamically unstable acute AF
or NVAF <12h and no recent CVA
or NVAF 12-48h and CHADS2 0-1

Give OAC ASAP

Following you give oca for 4 weeks then based on CHADS-65

54
Q

Rhythm control AF

A

Amiodarone - cannot use if AV condition, liver dx or QT prolongation
Sotalol - cannot use HF, risk QTp
Dronedarone - cannot use HF, permanent AF
Flecanide/Propafenone - cannot use 2rd/3rd AV block, HF, LVH, CAD, severe hepatic or renal failure

55
Q

Rate control AF

A

Betablocker - avoid in asthma, COPD, bradycardia, 2/3rd degree HB
ND-CCB - avoid LVEF <40%
Add Digoxin

If difficult then consider rhythm control or pacemaker / ablation

56
Q

What is CHADS-65 score

A

Score for paroxysmal or persistent af/flutter:
Age >/65 - YES - OAC
CHADS2 >/1 - YES - OAC
CAD or PAD - YES - ASA +/- clopidogrel or rivaroxaban

If no to all then no antithrombotic

57
Q

What is the HASBLED score

A

1 point for each
HTN (SBP >160)
Abnormal LFTS/CR >200
Stoke
Bleeding/anaemia
Labile INR
Elderly >65
Druhs or alcohol (aspirin/plavix)

58
Q

When to start DOAC after CVA

A

TIA - day 1
NIHSS <8 - day 3
NIHSS 8-15 - day 8
NIHSS >15 - day 12 to 14

59
Q

Precipitating factors of heart failure

A

Forgetting meds / meds that worsen - BB, CBC, NAID, TZD, chemo toxins
Arrhythmia/anemia - afib and anaemia
Ischemia/infection - CAD, pneumonia, myocarditis, influenza
Lifestyle - increased salt, alcohol, fluid intake
Upregulation - pregnancy, hyperTSH, steroids
Renal failure - increased preload, CKD
Embolism - increased right sided afterload, PE
Stenosis - worsening AS, RAS

60
Q

Heart failure meds: BB

A

Double q2-4 week
Best started dry
Specialist initiates NYHA >/ III

61
Q

Heart failure meds: ACEi

A

Double q1-2 week
Best started wet
Continue if Cr increased less than 30%

62
Q

Heart failure meds: Digoxin

A

Monitor Cr, K

63
Q

Typical regime for HFrEF

A

BB+MRA+SGLT2i+ARNI (or ACEi/ARB)

64
Q

Additional HFrEF if HR >70 and sinus

A

consider ivabradine

65
Q

Additional HFrEF if recent hospitalisation for HF

A

consider vericiguat

66
Q

Additional HFrEF if black on optimal therapy or intolerant ARNI/ACEi/AR
B

A

consider hydralazine/nitrates

67
Q

Additional HFrEF if suboptimal AF control or persistent symptoms

A

consider digoxin

68
Q

Typical regime for HFpEF

A

Control HTN
ACEi/ARB +/- BB
MRA is K <5 + eGFR >30

69
Q

Follow up times for HF

A

Acute change - 1 to 2 days
Med change and unstable - 7 days
Med change and stable - 2 weeks
Stable and optimised - 3 to 6 months

70
Q

Classification of ACS - STEMI

A

Elevation of ST >/ 1mm in 2 consectutive leads of >/ 2mm in V2+V3, can also have Q waves

71
Q

Classification of ACS - NSTEMI

A

no ST elevation
no Q waves
+ trop

72
Q

Classification of ACS - unstable angina

A

myocardial damage, no ECG or blood work changes

73
Q

Murmur that may be heard in ACS

A

S3 gallop
mitral regurgitation

74
Q

ACS complications

A

Cardiac Rupture
Arrhythmia
Shock
Hypertension / heart failure
Pericarditis / pulmonary rales
Aneurysm
DVT

75
Q

Work up for stable chest pain and what to look for

A
  • ECG - Look for ST, new LBBB, new Q wave
  • Labs - CBC (anemia), INR, lipids, FBG/A1C, LFTs, Cr, lytes
  • CXR - CHF, cardiomegaly, pneumonia, pneumothorax
  • Stress test
  • Echo
  • Angio - if high risk, diagnosis unclear and positive stress test
76
Q

What is the TIMI score for NSTE-ACS score (thombolysis in mi)

A

Age >/65
Markers elevated
ECG - st depression
Risk factors >/3 - increased lipids, htn, t2dm, smoker, fam hx, obesity
Ischemic chest pain >/2 episodes in past 24h
Coronary stenosis - hx >/ 50%
Aspirin - usage in last 7 days

1 point each
risk of cardiac event in 14 days:
</2 = 3%
4 = 7%
5 = 12%
>/6 = 19%

77
Q

What is the HEART score

A

Risk cardiac event in 4-6 weeks:
0 - 1 - 2
History: slightly suspicious - moderate - highly
ECG: normal - nonspecific repoloarization - st dep
Age: <45 - 46-64 - >65
Risk factors: none - 1 to 2 - >3
Troponin: normal - 1 to 3 x normal limit - >/3

</ 3: low - 1.5%
4-6: intermediate - 16%
>7: high - 50%

78
Q

First line (and alt) medications for ischemic heart disease

A
  • Nitro PRN
  • BB - target HR<70
    (long acting ccb if bb CI - PR >0.24, 2nd/3rd HB, asthma, reactive airway)
  • Statin
  • ASA
    (Clopidogrel is ASA CI)
79
Q

Other medications to consider in ischemic heart disease and when

A
  • ACEi - LVEF <40, HTN, DM, CKD, ant STEMI
    (ARB if CI)
  • Ticagrelor (Clopidogrel)
    if any:
  • NSTE-ACS
  • Fibrinolysis
  • Stent
  • Elective PCI
  • Afib and elecrive PCI
80
Q

Acute management ACS chest pain

A

Morphine 3-5mg after maxing anti-ischemia meds
Oxygen if sat <90
ASA 160-325mg or clopidogrel 300mg if CI
Nitro 1-2 speay q5minx3

81
Q

Other causes of increased trop

A

HF
malignancy
pericarditis
PE
renal failure
sepsis
stroke
SAH

82
Q

Which leads of ECG represent which part of the heart

A

Septal: V1, V2
Anterior: V3, V4
Lateral: V5, V6
Inferior: II, III, aVF
High lateral: I, aVL
Posterior: tall R wave and ST depression V1, V2

83
Q

Acute meds for ACS

A
  • ASA 162-325mg chewed x1 then continue 81-325mg indefinitely
  • Ticagrelor 180mg x1 then 90mg BID usually for 1 year
  • Anticoagulant continue for atleast 48h or until PCI performed
  • Betablocker initiate within 24h if no HF/ low output, risk of cardiogenic shock or CI.
  • ACEi initiate in 24h if LVEF <40%, HTN, DM, CKD, ant stemi
84
Q

Conservative vs invavsive management in NSTE-ACS

A

Immediate invasive <2h: refractory angina, s+s HF, hemodynamic instability, recurrent angina/ischaemic at rest, sustained VT/VF

Conservative/ischemia guided: TIMI </1, gracw < 109, low tn-neg female

Early invasive <24h: none of above, presumed new ST depression

Delayed invasive 25-72h: none of above but has DM/CRI, EF <40%, early post-infarct angina, PCI within 6m, propr CABG, TIMI >/2

85
Q

STEMI management

A

If symptoms <12h - 24H consider PCI or fibrinolytic

  1. PCI - goal for contact <120min
    - ASA, P2Y12 inhibitor, anticoag
  2. Fibrinolytic: Give ASA, clopidogrel anticoagulant
    - Absolute CI: ICH, cerebral lesion, malig, head/facial trauma <3m, ishcemic stroke <3m, active bleed, aortic dissection, intracranial/intraspinal surg <2m, severe uncontrolled HTN
    - Relative CI: hx poorly controlled HTN, current BP >180/110, current OAC, ischemic stroke >3m, recent internal bleed <4wk, major sx <3wk, pregnancy, active peptic ulcer, dementia
  3. CABG (urgent): if ongoing ischemia, cardiogenic shock, severe HF and not candidate for PCI or fibrinolytic. Rx ASA, discontinue P2Y12 atleast 24h, prefer 5 days
  4. Conservative - ASA, PsY12, anticoag, BB, statin, consider ACEi
86
Q

Causes of pericarditis

A

Idiopathic
Infectious
Inflammatory
Metabolic
Cardiovascular
Drugs
Trauma
Malignancy

87
Q

Signs of cardiac tamponade

A

Hypotension
Pulsus paradoxical
Tachycardia
Elevated JVP

88
Q

Pericarditis treatment

A
  1. Anti-inflammatory 7-14d, then taper 1-2 weeks
    - Aspirin 650 q4h
    - Ibuprofen 400mg q6h
  2. Corticosteroids for refractory
  3. Colchicine 0.5mg BID with NSAID for recurrent
89
Q

When is rhythm control preferred in AF

A

New diagnosis <1 year
Highly symptomatic, significant QOL impairment
Multiple reoccurrences
Difficult to achieve rate control
Arrhythmia induced cardiomyopathy

CFPC exam KM (16 decks)

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