Cardiovascular Flashcards
1
Q
Patients with ________ and _______ are treated to the same values of hypertension
A
Diabetes
Hypertension
2
Q
Patients > 60 y/o are treated when systolic pressure over _____ or diastolic over _____ unless they have diabetes or CKD
A
150
90
3
Q
Stage 1 hypertension
A
Systolic 140-159
Diastolic 90-100
4
Q
Stage 2 hypertension
A
Systolic > 160
Diastolic > 100
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
6
Q
Abdominal bruit with hypertension
A
Renal artery stenosis
7
Q
Hypokalemia and hypernatremia. Increased aldosterone:renin ratio and plasma aldosterone over 15 with hypertension
A
Hyperaldosteronism
8
Q
Hypertension with elevated creatinine
A
Primary kidney disease
9
Q
Acute episodes of hypertension with headache, palpitations and sweating
A
Pheochromocytoma
10
Q
Hypertension in a child. BP high in upper extremities vs lower extremities with diminished femoral pulses
A
Coarctation of the aorta
11
Q
Routine labs ordered with hypertension (6)
A
- UA
- Urine micro albumin
- EKG
- CBC
- BMP
- Lipid panel
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
13
Q
Second step treatment for hypertension if first step is unhelpful
A
Diuretic - hydrochlorothiazide, chlorthalidone
ACE/ARB or amlodipine
14
Q
Treatment of stage 2 hypertension
A
2 medications
One is typically diuretic
15
Q
Treatment for HTN for pts with diabetes or CKD
A
ACE / ARB
16
Q
Treatment for HTN for pts with CHF/ischemia/CAD
A
Beta blocker
ACE / ARB
17
Q
Treatment for HTN for pts with angina
A
Beta blocker
CCB
18
Q
Treatment for HTN for pts with BPH
A
Alpha blocker
19
Q
Treatment for HTN for pts with hyperthyroidism
A
Beta blockers
20
Q
Treatment for HTN for pts raynaud’s syndrome
A
CCB
21
Q
Treatment for HTN for pts with migraine
A
Beta blocker or CCB
22
Q
Treatment for HTN for pts with osteoporosis
A
Thiazide diuretics
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
24
Q
Acute coronary syndrome encompasses:
A
Unstable angina
NSTEMI
STEMI
25
Chest pain that is new, worsening (occurs sooner, lasts longer, doesn't respond to medication) or at rest
Unstable angina
26
Coronary artery disease risks factors
1. Diabetes
2. Hypertension (most common)
3. Smoking
4. Hyperlipidemia
5. Obesity
6. Age (males > 45, females > 55)
7. Family history
27
All pts with ____ present the same: chest pain (squeezing, pressure, substernal), shortness of breath, N/V, diaphoresis
ACS
28
_________ is a very specific predictor of ACS (ST segment elevation)
Diaphoresis
29
Left main coronary artery is divided into:
1. LAD (left anterior descending)
| 2. Left circumflex artery
30
_____ supplies the anterior and inferior portion of the left ventricle with oxygen
LAD
31
_______ supplies SA node in 40% of people, the AV node (10%), left atrium, and the lateral/posterior aspects of the left ventricle with oxygen
Left circumflex artery
32
The right main coronary artery is divided into
1. Right marginal artery
| 2. Posterior descending artery
33
Supplies right ventricle, right atrium, SA node (60% of people), and AV (90% with people) with oxygen
Right marginal artery
34
Supplies inferior portion of left ventricle, posteromedial papillary muscle, and septum with oxygen
Posterior descending artery
35
Do not want to give nitrates in the event of a:
Right sided MI
36
Right sided MIs occur in about ____% of pts with an inferior MI
40%
37
First test to be ordered for coronary symptoms
ECG
38
Shows on leads II, III, and aVF
Inferior MI
39
Shows on leads V1-V4
Anterior MI
40
Shows on leads I, aVL, and V5-V6
Lateral MI
41
Unstable and NSTEMI will have signs of ischemia on ECG, such as:
ST depression
| T wave inversion
42
The EKG should be repeated every __________ if ACS is suspected, as initial EKG may be normal
10 minutes
43
A new left bundle branch block should be treated as an ___________
Infarction
44
Q waves are specific for __________ but are a late change
Necrosis
45
Cardiac enzymes
Myoglobin
CK-MB
Troponins (preferred)
46
Most pts with negative enzymes can have an MI excluded by __________, but for high risk pts, should continue serial labs for _________ hours
8 hours
| 12-24 hours
47
Reinfarction is diagnosed if troponin increases over _______
20%
48
Unstable angina will not have an elevation in:
Cardiac enzymes
49
Initially, unstable angina and NSTEMI will present identically, as it takes time for:
Cardiac enzymes to rise
50
All pts presenting with ACs should immediately be given:
```
Morphine
Nitrates
Aspirin (chewed)
Oxygen (only if hypoxic)
All pts should also get a loading dose of a P2Y12 drug (clopidogrel, ticagrelor)
```
51
Nitrates in ACS pts should be avoided if pt is on:
Phosphodiesterase-5 inhibitors
| Will cause hypotension
52
If pts have inferior MI, avoid ________, as it will causes severe drop in BP. Instead, give these pts ________
Nitrates
| Fluid
53
All pts with ACS (after acute attack) should receive:
Beta blocker (metoprolol or atenolol)
ACE
Statin (atorvastatin)
Should get these immediately if no CI exists and be discharged with these
54
Everyone with a STEMI, NSTEMI and unstable angina should get:
Heparin
55
______ is preferred to thrombolytics. Must be done within 90 minutes of arrival.
PCI
| If PCI unavailable or unable to get to center in 90 minutes, give thrombolytics
56
TIMI Risk Score
Determines whether pt needed revascularization performed within 24-48 hours or whether medical therapy is needed (pt must be asymptomatic)
57
Most common cause of death within first few days after an MI is _________________
Ventricular tachycardia/fibrillation
| Therefore, continuous rhythm monitoring is required
58
Should PVCs be treated?
No
59
Autoimmune mediated pericarditis. Pts present with pericarditis, fever, malaise, and leukocytosis 2-10 weeks post MI. Give aspirin
Dressler syndrome
60
Post STEMI/NSTEMI pts should be put on _______________ for one year
Dual antiplatelet therapy
| P2Y12 receptor blocker and aspirin
61
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
Peripheral vascular disease
62
Diagnosis of peripheral vascular disease
ABI - positive if ratio is < 0.9
63
All pts with peripheral vascular disease should receive, however first step is a:
Aspirin
| Supervised 12 week exercise regimen
64
Long PR interval > 0.2 seconds. Treatment?
First degree heart block
| No treatment
65
PR progressively lengthens until it fails to produce a QRS complex. Treatment?
Mobitz I / Wenckebach
No tx until pt is symptomatic.
place pacemaker if sx are present. Atropine if unstable
66
Patient will have continuously dropped QRS complex, however, there won't be lengthening of the PR interval. Treatment?
Mobitz II
| Pacemaker to prevent progression to 3rd degree
67
Signal from atria does not reach ventricle. P waves are independent from the QRS complex. Treatment?
Third degree heart block
| Pacemaker - may be fatal
68
Wide QRS, RSR pattern in leads V1/V2/V3, S wave wider than R wave in leads 1 and V6. Treatment?
Right Bundle Branch Block
Asymptomatic does not need tx
Symptomatic: pacemaker
69
Wide QRS, notched R wave in leads I/aVL/V5/V6. Treatment?
Left Bundle Branch Block
| Must be treated as an MI if new
70
Patients will present with abrupt onset of palpitations and the EKG will show complex tachycardia. QRS absorbs p waves. Treatment?
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
Congenital disorder that has abnormal cardiac tissue connecting the atria to the ventricles - leads to an accessory pathway, and in turn, leads to preexcitation
Wolff-Parkinson-White-Syndrome
72
When pts are in sinus rhythm, EKG will have delta wave, widened QRS, short PR interval
Wolff-Parkinson-White-Syndrome
73
Most accurate test for Wolff-Parkinson-White-Syndrome
EPS (electrophysiology studies)
| However, not necessary for diagnosis
74
Treatment for Wolff-Parkinson-White-Syndrome
If asymptomatic, you can observe
If symptomatic - treat with amiodarone or procainamide
Ablation is curative
75
EKG will show alternating bradycardia and tachycardia, sinus arrest without an appropriate escape rhythm, and an inappropriate response to stress. Treatment?
Sick sinus syndrome
| Pacemaker
76
Treatment for ventricular tachycardia
Unstable - cardiovert
| Stable - amiodarone, lidocaine, or procainamide
77
Treatment for torsades de pointes
Magnesium sulfate
| If magnesium doesn't work, cardiac pacing is offered
78
Treatment for ventricullar fibrillation
ACLS: defibrillation, CPR, epinephrine, and amiodarone
79
Infection of the endocardial surface of the heart, which extends to the heart valves
Endocarditis
80
Risk factors for endocarditis
```
Valvular heart disease
Congenital heart disease
Prosthetic heart valves
Immunosuppression
Age > 60 y/o
Injection drug users
```
81
Most common etiology of endocarditis in native valves
Streptococci viridans
82
Most common etiology of endocarditis in those who are injection drug users
Staphylococcus aureus
83
Most common etiology of endocarditis in those with prosthetic valve endocarditis
Staphylococcus epidermidis
84
Fever, anorexia, weight loss, fatigue, ECG conduction abnormalities
Endocarditis
85
Painless erythematous macules on the palms and soles
Janeway Lesions
| Endocarditis
86
Retinal hemorrhages with pale centers. Petechiae (conjunctiva and palate)
Roth spots
| Endocarditis
87
Tender nodules on the pads of the digits
Osler's Nodes
| Endocarditis
88
Splinter hemorrhages of proximal nail bed, clubbing, hepatosplenomegaly
Endocarditis
89
Diagnostic studies for endocarditis
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
Major Duke Criteria
```
Sustained bacteremia (2 + blood cultures)
Endocardial involvement - on echo
New aortic or mitral regurg
```
91
Minor Duke Criteria
```
Predisposing condition
Fever
Janeay lesions, etc.
+ blood culture
+ echo not meeting major criteria
```
92
Clinical criteria for infective endocarditis based on criteria
2 major or
1 major + 3 minor or
5 minor
93
Indications for surgery with endocarditis
```
Refractory CHF
Persistent or refractory infxn
Invasive infection
Prosthetic valve
Recurrent systemic emboli
Fungal infxns
```
94
Management of endocarditis (acute)
Nafcillin + Gentamicin OR vanco + gentamicin
95
Management of endocarditis (prosthetic valve)
Vancomycin + gentamicin + rifampin
96
Management of endocarditis (fungal)
Amphotericin B
97
Screening for hyperlipidemia not high risk
Males >35 y/o
Females > 45 y/o
If high risk, screen 10 years earlier
98
Treament for hyperlipidemia
1. Lifestyle modifications
| 2. Statins
99
Pts with triglyceride levels > 500 should be started on:
Niacin, fish oil or a fibrate
100
Myocardial ischemia secondary to exertion (increased oxygen demand)
Stable angina
101
Presents with chest discomfort (squeezing/pressure/substernal) with exertion that is relieved by rest and/or nitroglycerin. Does not occur at rest
Stable angina
102
_____ will be normal in stable angina
ECG
| Cardiac enzymes
103
Treatment for stable angina
Lifestyle modifications
Control hypertension, diabetes, hyperlipidemia
All pts are treated with statin, aspirin, beta blocker
104
Most common cause of systolic congestive heart failure
Coronary artery disease
105
Most common cause of diastolic congestive heart failure
HTN
106
In diastolic dysfunction, ejection fraction is: _______. In systolic dysfunction, ejection fraction is: _______
Normal
| Less than < 50%
107
Fatigue, SOB, orthopnea (SOB upon lying), PnD, chronic cough, pedal edema, JVD, S3 gallop, S4 gallop
Congestive heart failure
108
S3 gallop is seen with ______ heart failure
Systolic
109
S4 gallop is seen with ________ heart failure
Diastolic
110
Crackles, orthopnea and PND are seen more with _________ heart dysfunction
Left sided
111
JVD, hepatojugular reflux, pedal edema, ascites are seen more with _______ heart dysfunction
Right sided
112
Diagnosis of congestive heart failure
1. Clinical
2. Echo w/ ejection fraction
3. ECG
4. CXR
5. Stress testing
113
Treatment for diastolic dysfunction
Manage sx and treat comorbid conditions. No medications proven
114
Treatment for systolic dysfunction
ACE/ARBs
| BB
115
Never give _____ during an acute exacerbation of CHF and also be careful with ____
BB
| CCB
116
Most acute exacerbations of CHF present with:
Acute pulmonary edema
117
Treatment of acute exacerbation of CHF
```
LMNOP
loop diuretic
morphine
nitrates
oxygen
position (head up)
```
118
Definitive diagnosis for all valvular disease is reached with:
Echocardiogram
119
Most symptoms of valvular disease are similar to that of CHF:
SOB and chest discomfort
120
Holosystolic murmurs:
Mitral regurgitation
Tricuspid regurgitation
VSD
121
Increases sound of all murmurs, except mitral valve prolapse and HOCM (decreases)
Squatting
Leg raise
Handgrip
122
Systolic crescendo-decrescendo murmur heart best at the second right intercostal space - radiates to the neck
Aortic stenosis
123
Heard best at the left upper sternal border with an ejection click
Pulmonic Stenosis
124
Holosystolic murmur heard best over the apex that radiates to the axilla
Mitral regurgitation
125
Mid systolic click with a possible late systolic murmur
Mitral valve prolapse
126
Holosystolic murmur heard best at the left mid sternal border
Tricuspid regurgitation
127
Decrescendo murmur with a blowing quality heard best at the left sternal border
Aortic regurgitation
128
Decrescendo murmur
Pulmonic regurgitation
129
Low pitch rumble heard best at the apex
Mitral stenosis
130
Heard best at the 4th intercostal space at the left lower sternal border
Tricuspid stenosis
