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
2
Q
what causes prinzmetal angina
A
vasospasms
3
Q
what is the tx for prinzmetal angina
A
CCB and NTG
mimics STEMI on EKG and MC in middle aged women
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
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)
6
Q
after undergoing a PCI what medications should be initiated
A
ASA + clopidegrol
7
Q
what is the diagnostic study of choice for carotid artery stenosis
A
CT angiography (carotid angiography)
8
Q
what is the treatment for carotid artery stenosis
A
revascularization via stenting or endarterectomy
mostly for patients >50% stenosis and symptomatic
9
Q
what is the diagnostic of choice for ALL valvular heart diseases
A
echo
10
Q
If you wanna learn about valve murmurs and treatments, do the surgery EOR valvular heart dz card set
A
okie dokie
11
Q
what anticoagulation is used for mechanical valves
A
lifelong warfarin
12
Q
what is the goal INR for warfarin
A
2.5-3.5
13
Q
what is the anticoagulation for a tissue valve replacement
A
ASA for 10+ years
14
Q
when you see aschoff body, what should you think of
A
rheumatic heart disease
15
Q
which valve does rheumatic heart disease MC effect
A
mitral
followed by atrial
16
Q
what is the major criteria for rheumatic heart disease
A
2 major OR 1 major and 2 minor
17
Q
what is the treatment of rheumatic heart disease
A
PCN
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
19
Q
What is sinus arrhythmia
A
irregular rate with normal rhythm. P-P wave intervals are present but vary.
20
Q
treatment of sinus bradycardia
A
none if asymptomatic, atropine can increase HR, but pacemaker is definitive
21
Q
sick sinus syndrome
A
recurrent supraventricular arrhythmias and bradycardia
supraventricular = narrow QRS, tachy at 180-220, regular rhythm.
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)
23
Q
treatment of stable vs unstable sick sinus syndrome
A
stable + asymptomatic: observation
stable + symptomatic: pacemaker
Unstable: urgent atropine and cardiac pacing.
24
Q
treatment of sinus tachycardia
A
beta blockers
25
heart blocks
-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)
26
treatment of heart blocks
-first degree and mobitz 1: none
-mobitz 2 and 3rd degree: pacemaker
Also, Atropine? (2nd and 3rd)
27
what is a PAC
premature beat followed by normal QRS, P wave has different morphology
28
treatment of PAC
-beta blockers or CCB
29
what is a PVC
Premature beat with a wide QRS and a compensatory pause afterward
30
What is SVT
Rapid, narrow regular beats caused by irregular electrical impulses in the atria
31
treatment of SVT
-mechanical measures (valsalva)
-adenosine
-cardioversion if the patient is hemodynamically unstable
32
treatment of afib
-rate control (BB, CCB, digoxin)
-rhythm control (flecanide, amiodarone, sotolol)
-anticoagulation (ASA, Xinhibs, warfarin)
33
how to determine who needs anticoagulation with afib?
CHADS2-VASc
-CHF
-HTN
-over 75 (2)
-DM
-prior stroke (2)
-vascular disease
-between 65-74
-female
34
CHADS2-VASc score interpretation
VASc score interpretation
-0: no antithrombotic therapy needed
-1: ASA or oral anticoagulation
-2: full anticoagulation
35
what is the difference between a-fib and a-flutter
36
treatment of atrial flutter
-catheter based radiofrequency ablation
-anticoagulation same as afib
37
etiology of junctional arrhythmias
-digoxin toxicity
-electrolyte abnormalities
## Footnote
junctional = inverted p wave, no p wave, or post QRS p wave
38
treatment of junctional arrhythmias
treat underlying cause
39
sustained vs nonsustained Vtach
-nonsustained: less than 30 seconds
-sustained: greater than 30 seconds
40
what is brugada syndrome
genetic heart disorder that impairs electrical system of the heart via faulty sodium channels. Increases risk of SCA
41
brugada syndrome EKG
incomplete right bundle branch block and ST-segment elevations
42
management of brugada
ICD
43
management of acute sustained VT
-if unstable: cardioversion
-stable: amiodarone
44
Treatment of nonsustained VT
-with heart disease: BB
-without heart disease: BB only if symptoms
45
treatment of vfib
immediate defibrillation
46
s/s of cardiac tamponade
-JVD
-muffled heart sounds
-hypotension
-kussmauls sign
-pulsus paradoxus
47
kussmauls sign
increase in JVD on inspiration
48
pulsus paradoxus
inspiratory systolic fall in arterial pressure
49
EKG of tamponade
electrical alternans
50
chest xray of tamponade
waterbottle heart
51
angina pectoris
used to describe chest discomfort related to ischemia
52
most sensitive cardiac marker
Troponin I
53
most sensitive early marker for MI
myoglobin
54
initial management of all ACS
-chewable ASA
-NTG
-oxygen if needed (
55
if using TPA what anticoagulants and antiplatelets should be used
-plavix
-lovenox
56
if doing PCI what anticoagulants and antiplatelets should be used
-brilinta (ticagrelor)
-UFH
57
timeline for STEMI management
-30 minutes for fibrinolytics
-120 minutes for PCI
58
presentation of heart failure
-DOE
-PND
-orthopnea
-s3 heart sound
-JVD
-peripheral edema
-ascites
59
diagnosis of heart failure
-CXR: cardiomegaly, interstitial edema
-BNP
-echo
60
treatment of heart failure
-lasix
-ace/arb
-BB
-SGLT2
61
treatment of hypertensive heart failure
-NTG
-then lasix
62
treatment of cardiogenic shock
-oxygen
-250-500mL of IV fluids
-vasopressors
63
NYHA classification of heart failure
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
ACC/AHA classification of heart failure
-A: high risk of heart failure
-B: structural heart defect but no symptoms
-C: structural changes and symptoms
-D: advanced disease causing hospitalization
65
management for HFpEF vs HFrEF
-HFpEF: lifestyle modifications and diuretics
-HFrEF: combination of multiple meds
66
s/s of acute decompensated HF
-pulmonary edema
-pink frothy sputum
-diaphoresis and cyanosis
-inspiratory rales
67
management of acute decompensated HF
-stabilize
-IV lasix
-NTG
68
presentation of cardiogenic shock
-cool, clammy skin
-tachycardia
-hypotension
69
what is endocarditis
an infection of the hearts inner lining (endocardium)
70
MC source of bacterial endocarditis
oral procedures
| specifically oral infections like gingivitis
71
MC organism of native valve endocarditis
staph aureus
72
diseases that increase the risk of endocarditis
-rheumatic fever
-congenital heart diseases
-MVP
-degenerative heart disease
73
MC organism for prosthetic valve endocarditis
staph epidermis
74
MC valve affected by IVDU endocarditis
tricuspid
75
s/s of endocarditis
-FROM JANE
-Fever, chills, weakness, SOB
-Roth spots
-Osler nodes
-Murmur (new regurgitant)
-petechiae
-splinter hemorrhages
-janeway lesions
| anemia, nail hemorrhages, emboli
76
what is the diagnostic criteria for endocarditis
2 major OR 1 major + 2 minor OR 5 minor
77
what are the major criteria for endocarditis
* 2 positive blood cultures
* echo showing valve disease
* new regurgitant murmur
78
what are the minor criteria for endocarditis
* predisposing condition
* fever
* vascular/embolic symptoms
* immunologic signs
* 1 positive blood culture
79
janeway lesions
painless patched on palms or soles caused by emboli
80
osler nodes
painful lesions on pads of fingers or toes caused by vasculitis
81
diagnosis of endocarditis
-CBC
-blood cultures
-echo
82
tx of endocarditis
-native valve
-IVDU
-prosthetic valve
-native valve: pen G + gent
-IVDU: nafcillin + gent
-prosthetic valve: vanc + gent + rifampin
83
patients who get endocarditis prophylaxis
-prosthetic heart valves
-prior endocarditis
-congenital heart disease
-heart transplant
84
procedures that require endocarditis prophylaxis
-dental procedures
-respiratory trat procedures
-I&D
85
antibiotic for endocarditis prophylaxis
amoxicillin
86
What is the definition of dyslipidemia
Defined as elevated levels of LDL-C and triglycerides, as well as low levels of HDL-C
87
what is the clinical presentation of dyslipidemia
* 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
What is the screening reccomendation for dyslipidemia
* 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
what is the screening test for dyslipidemia
* 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
What are indications for statin therapy in hyperlipidemia patients
* Clinical ASCVD (hx of ACS, CVA, PAD, or arterial revascularization)
* Type 2 DM
* LDL >/= 190
* ASCVD risk >/= 7.5%
* TG >1000
91
what is the MOA of statins
enhances LDL catabolism
92
what should be checked prior to starting a statin
* LFTs (hepatotoxic)
* pregnancy test (CI in preggo or breast feeding)
93
what are SE of statins
* myalgias
* rhabdomyolysis
* hyperglycemia?
* hepatotoxicity/liver failure
94
what are the blood pressure classifications
Normal: <120/<80
Elevated: 120-129/<80
Stage 1: 130-139 Or 80-89
Stage 2: >140 Or >90
95
what is the difference between primary and secondary hypertension
* primary = no underlying cause
* secondary = underlying cause
96
What are the treatment reccomendations based on classifications of HTN
* 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
What is the anti-HTN of choice
non AA: ACE/ARB, CCB, thiazides
AA: CCB or thiazides
98
hypertensive urgency
-no symptoms
-225/125
-no evidence of end organ damage
idk UTD says >180/120 mmHg
99
Hypertensive Emergency
(>220/130) WITH end organ damage.
idk UTD says >180/120 mmHg
100
treatment of hypertensive urgency
-clonidine
-captopril
-nifedipine
101
goal of therapy for hypertensive emergency
reduce bp to 160/100 over the next 2-6 hours
102
Tx Hypertensive emergency
BP decreased no more than 25% in first 2 HOURS→ goal BP of 160/100 over next 2-6hrs
BB 1st Line
103
strongest risk factors for PAD
-diabetes
-smoking
104
presentation of PAD
-claudication
-relieved with rest
-decreased pulses
-cool skin
-distal hair loss
-shiny skin
105
pseudoclaudication
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
diagnosis of PAD
-ABI < 0.9
-angiography gold standard
107
treatment of PAD
-lifestyle modifications
-ASA or plavix
-statins
108
Mcc of embolus occlusion
afib
109
S/S of Arterial Occlusion
-pain
-pallor
-pulselessness
-paralysis
-poikilothermia
-parasthesias
110
management of arterial occlusion
immediate revascularization and IV heparin
111
thromboangiitis obliterans etiology
thrombotic processes
| MC in male smokers <40
112
s/s of thromboangiitis obliterans
-distal ischemic rest pain or ischemic ulcerations
113
management of thromboangiitis obliterans
tobacco cessation
