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EOR Family Medicine > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

Patients with ________ and _______ are treated to the same values of hypertension

A

Diabetes

Hypertension

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2
Q

Patients > 60 y/o are treated when systolic pressure over _____ or diastolic over _____ unless they have diabetes or CKD

A

150

90

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3
Q

Stage 1 hypertension

A

Systolic 140-159

Diastolic 90-100

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4
Q

Stage 2 hypertension

A

Systolic > 160

Diastolic > 100

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5
Q

Who should undergo evaluation for secondary hypertension?

A
  • Severe or resistant hypertension (not responsive to at least 3 medications, one of which must include a diuretic)
  • Age < 30 who are otherwise healthy
  • Malignant or very rapidly occurring HTN
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6
Q

Abdominal bruit with hypertension

A

Renal artery stenosis

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7
Q

Hypokalemia and hypernatremia. Increased aldosterone:renin ratio and plasma aldosterone over 15 with hypertension

A

Hyperaldosteronism

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8
Q

Hypertension with elevated creatinine

A

Primary kidney disease

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9
Q

Acute episodes of hypertension with headache, palpitations and sweating

A

Pheochromocytoma

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10
Q

Hypertension in a child. BP high in upper extremities vs lower extremities with diminished femoral pulses

A

Coarctation of the aorta

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11
Q

Routine labs ordered with hypertension (6)

A
  1. UA
  2. Urine micro albumin
  3. EKG
  4. CBC
  5. BMP
  6. Lipid panel
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12
Q

First step treatment for hypertension

A

Initiate lifestyle recommendations such as weight loss, DASH diet, smoking cessation, moderate alcohol use, decrease sodium consumption and exercise

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13
Q

Second step treatment for hypertension if first step is unhelpful

A

Diuretic - hydrochlorothiazide, chlorthalidone

ACE/ARB or amlodipine

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14
Q

Treatment of stage 2 hypertension

A

2 medications

One is typically diuretic

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15
Q

Treatment for HTN for pts with diabetes or CKD

A

ACE / ARB

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16
Q

Treatment for HTN for pts with CHF/ischemia/CAD

A

Beta blocker

ACE / ARB

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17
Q

Treatment for HTN for pts with angina

A

Beta blocker

CCB

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18
Q

Treatment for HTN for pts with BPH

A

Alpha blocker

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19
Q

Treatment for HTN for pts with hyperthyroidism

A

Beta blockers

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20
Q

Treatment for HTN for pts raynaud’s syndrome

A

CCB

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21
Q

Treatment for HTN for pts with migraine

A

Beta blocker or CCB

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22
Q

Treatment for HTN for pts with osteoporosis

A

Thiazide diuretics

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23
Q

Resistant hypertension is defined as:

A

Hypertension that is not responsive to at least 3 medications, one of which must include a diuretic

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24
Q

Acute coronary syndrome encompasses:

A

Unstable angina
NSTEMI
STEMI

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25
Q

Chest pain that is new, worsening (occurs sooner, lasts longer, doesn’t respond to medication) or at rest

A

Unstable angina

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26
Q

Coronary artery disease risks factors

A
  1. Diabetes
  2. Hypertension (most common)
  3. Smoking
  4. Hyperlipidemia
  5. Obesity
  6. Age (males > 45, females > 55)
  7. Family history
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27
Q

All pts with ____ present the same: chest pain (squeezing, pressure, substernal), shortness of breath, N/V, diaphoresis

A

ACS

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28
Q

_________ is a very specific predictor of ACS (ST segment elevation)

A

Diaphoresis

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29
Q

Left main coronary artery is divided into:

A
  1. LAD (left anterior descending)

2. Left circumflex artery

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30
Q

_____ supplies the anterior and inferior portion of the left ventricle with oxygen

A

LAD

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31
Q

_______ supplies SA node in 40% of people, the AV node (10%), left atrium, and the lateral/posterior aspects of the left ventricle with oxygen

A

Left circumflex artery

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32
Q

The right main coronary artery is divided into

A
  1. Right marginal artery

2. Posterior descending artery

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33
Q

Supplies right ventricle, right atrium, SA node (60% of people), and AV (90% with people) with oxygen

A

Right marginal artery

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34
Q

Supplies inferior portion of left ventricle, posteromedial papillary muscle, and septum with oxygen

A

Posterior descending artery

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35
Q

Do not want to give nitrates in the event of a:

A

Right sided MI

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36
Q

Right sided MIs occur in about ____% of pts with an inferior MI

A

40%

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37
Q

First test to be ordered for coronary symptoms

A

ECG

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38
Q

Shows on leads II, III, and aVF

A

Inferior MI

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39
Q

Shows on leads V1-V4

A

Anterior MI

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40
Q

Shows on leads I, aVL, and V5-V6

A

Lateral MI

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41
Q

Unstable and NSTEMI will have signs of ischemia on ECG, such as:

A

ST depression

T wave inversion

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42
Q

The EKG should be repeated every __________ if ACS is suspected, as initial EKG may be normal

A

10 minutes

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43
Q

A new left bundle branch block should be treated as an ___________

A

Infarction

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44
Q

Q waves are specific for __________ but are a late change

A

Necrosis

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45
Q

Cardiac enzymes

A

Myoglobin
CK-MB
Troponins (preferred)

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46
Q

Most pts with negative enzymes can have an MI excluded by __________, but for high risk pts, should continue serial labs for _________ hours

A

8 hours

12-24 hours

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47
Q

Reinfarction is diagnosed if troponin increases over _______

A

20%

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48
Q

Unstable angina will not have an elevation in:

A

Cardiac enzymes

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49
Q

Initially, unstable angina and NSTEMI will present identically, as it takes time for:

A

Cardiac enzymes to rise

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50
Q

All pts presenting with ACs should immediately be given:

A 
Morphine
Nitrates
Aspirin (chewed)
Oxygen (only if hypoxic)
All pts should also get a loading dose of a P2Y12 drug (clopidogrel, ticagrelor)
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51
Q

Nitrates in ACS pts should be avoided if pt is on:

A

Phosphodiesterase-5 inhibitors

Will cause hypotension

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52
Q

If pts have inferior MI, avoid ________, as it will causes severe drop in BP. Instead, give these pts ________

A

Nitrates

Fluid

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53
Q

All pts with ACS (after acute attack) should receive:

A

Beta blocker (metoprolol or atenolol)
ACE
Statin (atorvastatin)
Should get these immediately if no CI exists and be discharged with these

54
Q

Everyone with a STEMI, NSTEMI and unstable angina should get:

A

Heparin

55
Q

______ is preferred to thrombolytics. Must be done within 90 minutes of arrival.

A

PCI

If PCI unavailable or unable to get to center in 90 minutes, give thrombolytics

56
Q

TIMI Risk Score

A

Determines whether pt needed revascularization performed within 24-48 hours or whether medical therapy is needed (pt must be asymptomatic)

57
Q

Most common cause of death within first few days after an MI is _________________

A

Ventricular tachycardia/fibrillation

Therefore, continuous rhythm monitoring is required

58
Q

Should PVCs be treated?

A

No

59
Q

Autoimmune mediated pericarditis. Pts present with pericarditis, fever, malaise, and leukocytosis 2-10 weeks post MI. Give aspirin

A

Dressler syndrome

60
Q

Post STEMI/NSTEMI pts should be put on _______________ for one year

A

Dual antiplatelet therapy

P2Y12 receptor blocker and aspirin

61
Q

Presentation is that of angina in the legs (leg pain with exertion and relieved with rest). Lower extremities may show pallor, ulcerations, diminished pulses, and hair loss

A

Peripheral vascular disease

62
Q

Diagnosis of peripheral vascular disease

A

ABI - positive if ratio is < 0.9

63
Q

All pts with peripheral vascular disease should receive, however first step is a:

A

Aspirin

Supervised 12 week exercise regimen

64
Q

Long PR interval > 0.2 seconds. Treatment?

A

First degree heart block

No treatment

65
Q

PR progressively lengthens until it fails to produce a QRS complex. Treatment?

A

Mobitz I / Wenckebach
No tx until pt is symptomatic.
place pacemaker if sx are present. Atropine if unstable

66
Q

Patient will have continuously dropped QRS complex, however, there won’t be lengthening of the PR interval. Treatment?

A

Mobitz II

Pacemaker to prevent progression to 3rd degree

67
Q

Signal from atria does not reach ventricle. P waves are independent from the QRS complex. Treatment?

A

Third degree heart block

Pacemaker - may be fatal

68
Q

Wide QRS, RSR pattern in leads V1/V2/V3, S wave wider than R wave in leads 1 and V6. Treatment?

A

Right Bundle Branch Block
Asymptomatic does not need tx
Symptomatic: pacemaker

69
Q

Wide QRS, notched R wave in leads I/aVL/V5/V6. Treatment?

A

Left Bundle Branch Block

Must be treated as an MI if new

70
Q

Patients will present with abrupt onset of palpitations and the EKG will show complex tachycardia. QRS absorbs p waves. Treatment?

A

Paroxysmal Supraventricular Tachycardia
If hemodynamic instability exists: cardiovert
If stable: vagal maneuvers - valsalva or carotid massage
If this does not work: adenosine - then CCB or BB

71
Q

Congenital disorder that has abnormal cardiac tissue connecting the atria to the ventricles - leads to an accessory pathway, and in turn, leads to preexcitation

A

Wolff-Parkinson-White-Syndrome

72
Q

When pts are in sinus rhythm, EKG will have delta wave, widened QRS, short PR interval

A

Wolff-Parkinson-White-Syndrome

73
Q

Most accurate test for Wolff-Parkinson-White-Syndrome

A

EPS (electrophysiology studies)

However, not necessary for diagnosis

74
Q

Treatment for Wolff-Parkinson-White-Syndrome

A

If asymptomatic, you can observe
If symptomatic - treat with amiodarone or procainamide
Ablation is curative

75
Q

EKG will show alternating bradycardia and tachycardia, sinus arrest without an appropriate escape rhythm, and an inappropriate response to stress. Treatment?

A

Sick sinus syndrome

Pacemaker

76
Q

Treatment for ventricular tachycardia

A

Unstable - cardiovert

Stable - amiodarone, lidocaine, or procainamide

77
Q

Treatment for torsades de pointes

A

Magnesium sulfate

If magnesium doesn’t work, cardiac pacing is offered

78
Q

Treatment for ventricullar fibrillation

A

ACLS: defibrillation, CPR, epinephrine, and amiodarone

79
Q

Infection of the endocardial surface of the heart, which extends to the heart valves

A

Endocarditis

80
Q

Risk factors for endocarditis

A 
Valvular heart disease
Congenital heart disease
Prosthetic heart valves
Immunosuppression
Age > 60 y/o
Injection drug users
81
Q

Most common etiology of endocarditis in native valves

A

Streptococci viridans

82
Q

Most common etiology of endocarditis in those who are injection drug users

A

Staphylococcus aureus

83
Q

Most common etiology of endocarditis in those with prosthetic valve endocarditis

A

Staphylococcus epidermidis

84
Q

Fever, anorexia, weight loss, fatigue, ECG conduction abnormalities

A

Endocarditis

85
Q

Painless erythematous macules on the palms and soles

A

Janeway Lesions

Endocarditis

86
Q

Retinal hemorrhages with pale centers. Petechiae (conjunctiva and palate)

A

Roth spots

Endocarditis

87
Q

Tender nodules on the pads of the digits

A

Osler’s Nodes

Endocarditis

88
Q

Splinter hemorrhages of proximal nail bed, clubbing, hepatosplenomegaly

A

Endocarditis

89
Q

Diagnostic studies for endocarditis

A
  1. Blood cultures - before abx initiation - 3 sets at least 1 hour apart if pt is stable
  2. ECG
  3. Echo
  4. Labs - leukocytosis, anemia, increased ESR, rheumatoid factor
90
Q

Major Duke Criteria

A 
Sustained bacteremia (2 + blood cultures)
Endocardial involvement - on echo
New aortic or mitral regurg
91
Q

Minor Duke Criteria

A 
Predisposing condition 
Fever
Janeay lesions, etc. 
\+ blood culture
\+ echo not meeting major criteria
92
Q

Clinical criteria for infective endocarditis based on criteria

A

2 major or
1 major + 3 minor or
5 minor

93
Q

Indications for surgery with endocarditis

A 
Refractory CHF
Persistent or refractory infxn
Invasive infection
Prosthetic valve
Recurrent systemic emboli
Fungal infxns
94
Q

Management of endocarditis (acute)

A

Nafcillin + Gentamicin OR vanco + gentamicin

95
Q

Management of endocarditis (prosthetic valve)

A

Vancomycin + gentamicin + rifampin

96
Q

Management of endocarditis (fungal)

A

Amphotericin B

97
Q

Screening for hyperlipidemia not high risk

A

Males >35 y/o
Females > 45 y/o
If high risk, screen 10 years earlier

98
Q

Treament for hyperlipidemia

A
  1. Lifestyle modifications

2. Statins

99
Q

Pts with triglyceride levels > 500 should be started on:

A

Niacin, fish oil or a fibrate

100
Q

Myocardial ischemia secondary to exertion (increased oxygen demand)

A

Stable angina

101
Q

Presents with chest discomfort (squeezing/pressure/substernal) with exertion that is relieved by rest and/or nitroglycerin. Does not occur at rest

A

Stable angina

102
Q

_____ will be normal in stable angina

A

ECG

Cardiac enzymes

103
Q

Treatment for stable angina

A

Lifestyle modifications
Control hypertension, diabetes, hyperlipidemia
All pts are treated with statin, aspirin, beta blocker

104
Q

Most common cause of systolic congestive heart failure

A

Coronary artery disease

105
Q

Most common cause of diastolic congestive heart failure

A

HTN

106
Q

In diastolic dysfunction, ejection fraction is: _______. In systolic dysfunction, ejection fraction is: _______

A

Normal

Less than < 50%

107
Q

Fatigue, SOB, orthopnea (SOB upon lying), PnD, chronic cough, pedal edema, JVD, S3 gallop, S4 gallop

A

Congestive heart failure

108
Q

S3 gallop is seen with ______ heart failure

A

Systolic

109
Q

S4 gallop is seen with ________ heart failure

A

Diastolic

110
Q

Crackles, orthopnea and PND are seen more with _________ heart dysfunction

A

Left sided

111
Q

JVD, hepatojugular reflux, pedal edema, ascites are seen more with _______ heart dysfunction

A

Right sided

112
Q

Diagnosis of congestive heart failure

A
  1. Clinical
  2. Echo w/ ejection fraction
  3. ECG
  4. CXR
  5. Stress testing
113
Q

Treatment for diastolic dysfunction

A

Manage sx and treat comorbid conditions. No medications proven

114
Q

Treatment for systolic dysfunction

A

ACE/ARBs

BB

115
Q

Never give _____ during an acute exacerbation of CHF and also be careful with ____

A

BB

CCB

116
Q

Most acute exacerbations of CHF present with:

A

Acute pulmonary edema

117
Q

Treatment of acute exacerbation of CHF

A 
LMNOP
loop diuretic
morphine
nitrates
oxygen
position (head up)
118
Q

Definitive diagnosis for all valvular disease is reached with:

A

Echocardiogram

119
Q

Most symptoms of valvular disease are similar to that of CHF:

A

SOB and chest discomfort

120
Q

Holosystolic murmurs:

A

Mitral regurgitation
Tricuspid regurgitation
VSD

121
Q

Increases sound of all murmurs, except mitral valve prolapse and HOCM (decreases)

A

Squatting
Leg raise
Handgrip

122
Q

Systolic crescendo-decrescendo murmur heart best at the second right intercostal space - radiates to the neck

A

Aortic stenosis

123
Q

Heard best at the left upper sternal border with an ejection click

A

Pulmonic Stenosis

124
Q

Holosystolic murmur heard best over the apex that radiates to the axilla

A

Mitral regurgitation

125
Q

Mid systolic click with a possible late systolic murmur

A

Mitral valve prolapse

126
Q

Holosystolic murmur heard best at the left mid sternal border

A

Tricuspid regurgitation

127
Q

Decrescendo murmur with a blowing quality heard best at the left sternal border

A

Aortic regurgitation

128
Q

Decrescendo murmur

A

Pulmonic regurgitation

129
Q

Low pitch rumble heard best at the apex

A

Mitral stenosis

130
Q

Heard best at the 4th intercostal space at the left lower sternal border

A

Tricuspid stenosis

EOR Family Medicine (14 decks)

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