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Family Medicine EOR > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

what is stable angina vs unstable angina

A
  • stable = typical, predictable chest pain occuring during exercise that releives with rest or NTG
  • unstable = unexpected, caused by sudded slowed or narrowed bloodvessels, does NOT go away w rest/NTG
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2
Q

what causes prinzmetal angina

A

vasospasms

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3
Q

what is the tx for prinzmetal angina

A

CCB and NTG

mimics STEMI on EKG and MC in middle aged women

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4
Q

what EKG changes would you see in the following timespans after an MI
* minutes/hours
* 1-2 days
* 7-10 days
* months

A
  • minutes/hours - ST elevation
  • 1-2 days - ST elevation, inverted T wave, Q wave
  • 7-10 days - ST flattening, Q wave
  • months - persistent Q wave
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5
Q

which cardiac biomarker would you use to identify a repeat MI in a patient who just suffered an MI 2 days ago

A

myoglobin (returns to normal after 36ish hours)

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6
Q

after undergoing a PCI what medications should be initiated

A

ASA + clopidegrol

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7
Q

what is the diagnostic study of choice for carotid artery stenosis

A

CT angiography (carotid angiography)

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8
Q

what is the treatment for carotid artery stenosis

A

revascularization via stenting or endarterectomy

mostly for patients >50% stenosis and symptomatic

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9
Q

what is the diagnostic of choice for ALL valvular heart diseases

A

echo

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10
Q

If you wanna learn about valve murmurs and treatments, do the surgery EOR valvular heart dz card set

A

okie dokie

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11
Q

what anticoagulation is used for mechanical valves

A

lifelong warfarin

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12
Q

what is the goal INR for warfarin

A

2.5-3.5

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13
Q

what is the anticoagulation for a tissue valve replacement

A

ASA for 10+ years

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14
Q

when you see aschoff body, what should you think of

A

rheumatic heart disease

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15
Q

which valve does rheumatic heart disease MC effect

A

mitral

followed by atrial

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16
Q

what is the major criteria for rheumatic heart disease

A

2 major OR 1 major and 2 minor

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17
Q

what is the treatment of rheumatic heart disease

A

PCN

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18
Q

How do you determine HR on EKG

A

Large box method:
3 boxes = 100bpm
4 boxes = 75 bpm
5 boxes = 60 bpm
6 boxes = 50 bpm

small box method:
1500 divided by number of small boxes

For IRREGULAR rhythms:
count R waves over 10 second period and multiply by 6

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19
Q

What is sinus arrhythmia

A

irregular rate with normal rhythm. P-P wave intervals are present but vary.

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20
Q

treatment of sinus bradycardia

A

none if asymptomatic, atropine can increase HR, but pacemaker is definitive

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21
Q

sick sinus syndrome

A

recurrent supraventricular arrhythmias and bradycardia

supraventricular = narrow QRS, tachy at 180-220, regular rhythm.

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22
Q

etiology of sick sinus syndrome

A

medications or autonomic malfunction

problems with the Sinoatrial (SA) node. (remember this is the pacemaker of the heart)

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23
Q

treatment of stable vs unstable sick sinus syndrome

A

stable + asymptomatic: observation
stable + symptomatic: pacemaker
Unstable: urgent atropine and cardiac pacing.

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24
Q

treatment of sinus tachycardia

A

beta blockers

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25
Q

heart blocks

A

-first degree: PR interval >0.2 seconds (5 lil box)
-second degree type 1: longer, longer, longer, drop
-second degree type 2: randomly dropped beats
-third degree: no correlation between atria and ventricles (p-p normal, not in line though)

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26
Q

treatment of heart blocks

A

-first degree and mobitz 1: none
-mobitz 2 and 3rd degree: pacemaker
Also, Atropine? (2nd and 3rd)

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27
Q

what is a PAC

A

premature beat followed by normal QRS, P wave has different morphology

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28
Q

treatment of PAC

A

-beta blockers or CCB

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29
Q

what is a PVC

A

Premature beat with a wide QRS and a compensatory pause afterward

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30
Q

What is SVT

A

Rapid, narrow regular beats caused by irregular electrical impulses in the atria

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31
Q

treatment of SVT

A

-mechanical measures (valsalva)
-adenosine
-cardioversion if the patient is hemodynamically unstable

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32
Q

treatment of afib

A

-rate control (BB, CCB, digoxin)
-rhythm control (flecanide, amiodarone, sotolol)
-anticoagulation (ASA, Xinhibs, warfarin)

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33
Q

how to determine who needs anticoagulation with afib?

A

CHADS2-VASc
-CHF
-HTN
-over 75 (2)
-DM
-prior stroke (2)
-vascular disease
-between 65-74
-female

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34
Q

CHADS2-VASc score interpretation

A

VASc score interpretation
-0: no antithrombotic therapy needed
-1: ASA or oral anticoagulation
-2: full anticoagulation

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35
Q

what is the difference between a-fib and a-flutter

A
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36
Q

treatment of atrial flutter

A

-catheter based radiofrequency ablation
-anticoagulation same as afib

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37
Q

etiology of junctional arrhythmias

A

-digoxin toxicity
-electrolyte abnormalities

junctional = inverted p wave, no p wave, or post QRS p wave

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38
Q

treatment of junctional arrhythmias

A

treat underlying cause

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39
Q

sustained vs nonsustained Vtach

A

-nonsustained: less than 30 seconds
-sustained: greater than 30 seconds

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40
Q

what is brugada syndrome

A

genetic heart disorder that impairs electrical system of the heart via faulty sodium channels. Increases risk of SCA

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41
Q

brugada syndrome EKG

A

incomplete right bundle branch block and ST-segment elevations

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42
Q

management of brugada

A

ICD

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43
Q

management of acute sustained VT

A

-if unstable: cardioversion
-stable: amiodarone

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44
Q

Treatment of nonsustained VT

A

-with heart disease: BB
-without heart disease: BB only if symptoms

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45
Q

treatment of vfib

A

immediate defibrillation

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46
Q

s/s of cardiac tamponade

A

-JVD
-muffled heart sounds
-hypotension
-kussmauls sign
-pulsus paradoxus

47
Q

kussmauls sign

A

increase in JVD on inspiration

48
Q

pulsus paradoxus

A

inspiratory systolic fall in arterial pressure

49
Q

EKG of tamponade

A

electrical alternans

50
Q

chest xray of tamponade

A

waterbottle heart

51
Q

angina pectoris

A

used to describe chest discomfort related to ischemia

52
Q

most sensitive cardiac marker

A

Troponin I

53
Q

most sensitive early marker for MI

A

myoglobin

54
Q

initial management of all ACS

A

-chewable ASA
-NTG
-oxygen if needed (</= 94%)
-morphine if pain isn’t managed by NTG

(MONA)

55
Q

if using TPA what anticoagulants and antiplatelets should be used

A

-plavix
-lovenox

56
Q

if doing PCI what anticoagulants and antiplatelets should be used

A

-brilinta (ticagrelor)
-UFH

57
Q

timeline for STEMI management

A

-30 minutes for fibrinolytics
-120 minutes for PCI

58
Q

presentation of heart failure

A

-DOE
-PND
-orthopnea
-s3 heart sound
-JVD
-peripheral edema
-ascites

59
Q

diagnosis of heart failure

A

-CXR: cardiomegaly, interstitial edema
-BNP
-echo

60
Q

treatment of heart failure

A

-lasix
-ace/arb
-BB
-SGLT2

61
Q

treatment of hypertensive heart failure

A

-NTG
-then lasix

62
Q

treatment of cardiogenic shock

A

-oxygen
-250-500mL of IV fluids
-vasopressors

63
Q

NYHA classification of heart failure

A

Class I: symptoms only occur with vigorous activities
II: symptoms with prolonged or moderate exertion, slight limitation of activities
III: symptoms occur during ADLs, markedly limiting
IV: symptoms occur at rest

64
Q

ACC/AHA classification of heart failure

A

-A: high risk of heart failure
-B: structural heart defect but no symptoms
-C: structural changes and symptoms
-D: advanced disease causing hospitalization

65
Q

management for HFpEF vs HFrEF

A

-HFpEF: lifestyle modifications and diuretics
-HFrEF: combination of multiple meds

66
Q

s/s of acute decompensated HF

A

-pulmonary edema
-pink frothy sputum
-diaphoresis and cyanosis
-inspiratory rales

67
Q

management of acute decompensated HF

A

-stabilize
-IV lasix
-NTG

68
Q

presentation of cardiogenic shock

A

-cool, clammy skin
-tachycardia
-hypotension

69
Q

what is endocarditis

A

an infection of the hearts inner lining (endocardium)

70
Q

MC source of bacterial endocarditis

A

oral procedures

specifically oral infections like gingivitis

71
Q

MC organism of native valve endocarditis

A

staph aureus

72
Q

diseases that increase the risk of endocarditis

A

-rheumatic fever
-congenital heart diseases
-MVP
-degenerative heart disease

73
Q

MC organism for prosthetic valve endocarditis

A

staph epidermis

74
Q

MC valve affected by IVDU endocarditis

A

tricuspid

75
Q

s/s of endocarditis

A

-FROM JANE

-Fever, chills, weakness, SOB
-Roth spots
-Osler nodes
-Murmur (new regurgitant)
-petechiae
-splinter hemorrhages
-janeway lesions

anemia, nail hemorrhages, emboli

76
Q

what is the diagnostic criteria for endocarditis

A

2 major OR 1 major + 2 minor OR 5 minor

77
Q

what are the major criteria for endocarditis

A
  • 2 positive blood cultures
  • echo showing valve disease
  • new regurgitant murmur
78
Q

what are the minor criteria for endocarditis

A
  • predisposing condition
  • fever
  • vascular/embolic symptoms
  • immunologic signs
  • 1 positive blood culture
79
Q

janeway lesions

A

painless patched on palms or soles caused by emboli

80
Q

osler nodes

A

painful lesions on pads of fingers or toes caused by vasculitis

81
Q

diagnosis of endocarditis

A

-CBC
-blood cultures
-echo

82
Q

tx of endocarditis
-native valve
-IVDU
-prosthetic valve

A

-native valve: pen G + gent
-IVDU: nafcillin + gent
-prosthetic valve: vanc + gent + rifampin

83
Q

patients who get endocarditis prophylaxis

A

-prosthetic heart valves
-prior endocarditis
-congenital heart disease
-heart transplant

84
Q

procedures that require endocarditis prophylaxis

A

-dental procedures
-respiratory trat procedures
-I&D

85
Q

antibiotic for endocarditis prophylaxis

A

amoxicillin

86
Q

What is the definition of dyslipidemia

A

Defined as elevated levels of LDL-C and triglycerides, as well as low levels of HDL-C

87
Q

what is the clinical presentation of dyslipidemia

A
  • most are asymptomatic
  • eruptive xanthomas (extreme high TG or VLDL)
  • tendinous xanthomas (high LDL)
  • lipemia retinalis (Extreme high TG)
  • Serum changes (milky serum, high TG)
88
Q

What is the screening reccomendation for dyslipidemia

A
  • all adults 20+ Q 5 years
  • children screen 1 time at ages 9-11
  • start screening at 2 if fmhx of early CVD or significant primary hypercholesterolemia

Q 3 yrs if close to warranting treatment

89
Q

what is the screening test for dyslipidemia

A
  • start with total TG and HDL (fasting preferred but not mandatory, if abnormal confirm w fasting)
  • Fasting full lipid panel is needed if TC > 250 or HDL-C is < 40
90
Q

What are indications for statin therapy in hyperlipidemia patients

A
  • Clinical ASCVD (hx of ACS, CVA, PAD, or arterial revascularization)
  • Type 2 DM
  • LDL >/= 190
  • ASCVD risk >/= 7.5%
  • TG >1000
91
Q

what is the MOA of statins

A

enhances LDL catabolism

92
Q

what should be checked prior to starting a statin

A
  • LFTs (hepatotoxic)
  • pregnancy test (CI in preggo or breast feeding)
93
Q

what are SE of statins

A
  • myalgias
  • rhabdomyolysis
  • hyperglycemia?
  • hepatotoxicity/liver failure
94
Q

what are the blood pressure classifications

A

Normal: <120/<80
Elevated: 120-129/<80
Stage 1: 130-139 Or 80-89
Stage 2: >140 Or >90

95
Q

what is the difference between primary and secondary hypertension

A
  • primary = no underlying cause
  • secondary = underlying cause
96
Q

What are the treatment reccomendations based on classifications of HTN

A
  • elevated: non-pharm therapy, re evaluate in 3-6 months
  • stage 1 + ASCVD>10%: pharm + non pharm tx
  • stage 1 w/o ASCVD: non pharm only
  • Stage 2: pharm + non pharm
97
Q

What is the anti-HTN of choice

A

non AA: ACE/ARB, CCB, thiazides
AA: CCB or thiazides

98
Q

hypertensive urgency

A

-no symptoms
-225/125
-no evidence of end organ damage

idk UTD says >180/120 mmHg

99
Q

Hypertensive Emergency

A

(>220/130) WITH end organ damage.

idk UTD says >180/120 mmHg

100
Q

treatment of hypertensive urgency

A

-clonidine
-captopril
-nifedipine

101
Q

goal of therapy for hypertensive emergency

A

reduce bp to 160/100 over the next 2-6 hours

102
Q

Tx Hypertensive emergency

A

BP decreased no more than 25% in first 2 HOURS→ goal BP of 160/100 over next 2-6hrs

BB 1st Line

103
Q

strongest risk factors for PAD

A

-diabetes
-smoking

104
Q

presentation of PAD

A

-claudication
-relieved with rest
-decreased pulses
-cool skin
-distal hair loss
-shiny skin

105
Q

pseudoclaudication

A

painful cramps that are not caused by peripheral artery disease, but rather, by spinal, neurologic, or orthopedic disorders such as spinal stenosis, diabetic neuropathy, or arthritis
-occurs with standing and can last up to 30 minute

106
Q

diagnosis of PAD

A

-ABI < 0.9
-angiography gold standard

107
Q

treatment of PAD

A

-lifestyle modifications
-ASA or plavix
-statins

108
Q

Mcc of embolus occlusion

A

afib

109
Q

S/S of Arterial Occlusion

A

-pain
-pallor
-pulselessness
-paralysis
-poikilothermia
-parasthesias

110
Q

management of arterial occlusion

A

immediate revascularization and IV heparin

111
Q

thromboangiitis obliterans etiology

A

thrombotic processes

MC in male smokers <40

112
Q

s/s of thromboangiitis obliterans

A

-distal ischemic rest pain or ischemic ulcerations

113
Q

management of thromboangiitis obliterans

A

tobacco cessation

Family Medicine EOR (11 decks)

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