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Boards 2 > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

Guidelines for treating hyperlipidemia

A
  1. LDL > 190
  2. diabetic 40-75y/o.
  3. ASCVD risk >7.5%.
  4. history of ASCVD, AMI, stroke, TIA, peripheral artery disease.
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2
Q

Statins

A
  • Decrease cholesterol, inhibition of HMG-CoA reductase.
  • Best effect on LDL.
  • ADR: myositis, hepatotoxicity. Draw LFT as baseline before starting.
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3
Q

Ezetimibe

A
  • Impairs dietary and biliary cholesterol absorption at brush border of intestine.
  • Lowers LDL.
  • ADR: myalgia, LFT.
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4
Q

Fibrates

A
  • Primary effect on triglycerides and HDL.
  • Reduce hepatic secretion of VLDL.
  • ADR: myositis, LFT.
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5
Q

Bile Acid sequestrants (cholestyramine, colestipol)

A
  • Primary effect on LDL.
  • ADR: GI Upset.
  • Cholestyramine used as adjuvant to bind C.diff toxin.
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6
Q

Niacin

A
  • Primary effect on HDL.
  • ADR - flushing.
    • Prevent w/ NSAID or acetaminophen before use.
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7
Q

Omega - 3 fatty acids (fish oil)

A

Primary effect on triglycerides, Need super high dose.

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8
Q

Anterior wall MI

A

V2, V3, V4, V5. LAD

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9
Q

Septal wall

A

V1, V2, V3. LAD

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10
Q

Inferior wall

A

II, III, aVF. Posterior descending.

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11
Q

Lateral wall

A

I, aVL, V5, V6. LAD or circumflex.

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12
Q

Aspirin

A

Blocks COX-1/-2. Impairs platelet aggregation

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13
Q

Clopidogrel, Ticlopidine, Prasugrel, ticagrelor

A
  • ADP-receptor blockers:
    • prevent platelet aggregation
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14
Q

abciximab, eptifibatide, tirofiban

A
  • GpIIb/IIIa inhibitors:
    • block platelet aggregation
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15
Q

Heparin

A

Activates antithrombin.

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16
Q

LMWH (enoxaparin)

A

activates antithrombin

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17
Q

Warfarin

A
  1. Vit K antagonist.
    1. Blocks PrC, PrS, 10, 9, 7, 2 factors.
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18
Q

alteplase, reteplase, tenecteplase

A

Thrombolytics; increase plasmin. Which breaks down fibrin.

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19
Q

Treatment of Prinzmetal angina

A
  1. Smoking Cessation
  2. CCB (diltiazem)
  3. Nitrates

**Avoid B-blocker and triptans. Lease lead to vasonconstriction and worsen condition**

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20
Q

Benign cardiac sounds, IF patient is asymptomatic.

A
  • Split S2 with inspiration.
  • Split S1.
  • S3 < 40yo
  • early quiet systolic murmur < grade III.
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21
Q

Aortic Stenosis

A
  • Causes:
    • congenital bicuspid valve (Turner syndrome)
    • Elder age (senile calcifications)
  • Presentation
    • dyspnea, angina, syncope.
  • Dx
    • systolic ejection murmur at RUSB, radiates into carotids.
    • Valsalva decreases. Squatting increases.
    • Echo is definitive Diagnostic.
  • Tx
    • aortic valve replacement.
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22
Q

Mitral Regurgitation

A
  • Causes
    • MVP, rheumatic heart disease, infective endocarditis.
  • Pt
    • fatigue, DOE, A-fib
  • Dx:
    • holosystolic murmur at LLSB, with radiation into axilla.
  • Tx
    • vasodilators
    • anticoagulate if (+) A-fib.
    • mitral valve repair
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23
Q

Aortic Regurgitation

A
  • Cause
    • infective endocarditis, tertiary syphilis.
  • Pt
    • dyspnea, heart failure.
    • wide pulse pressure, rhythmic head bobbing.
    • diastolic murmur at RUSB.
  • Tx
    • ACEi, BBlock, spironolactone.
    • Aortic valve replacement.
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24
Q

Mitral Stenosis

A
  • Cause
    • rheumatic heart disease
  • Pt
    • dyspnea, CHF, A-fib
  • Dx:
    • Diastolic at apex, w/ opening snap.
  • Tx
    • balloon valvuloplasty.
      • diuretics for symptom relief.
      • anticoagulate if A-fib(+)
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25
Q

Systolic Heart Failure (HFrEF)

A
  • Chronic HTN
    • high afterload
    • high preload
  • Reduced contractility.
  • High output conditions
    • poor O2 circulation.
    • high metabolic demand.
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26
Q

Diastolic HF (HFpEF)

A
  • LV hypertrophy
  • Hypertrophic cardiomyopathy
  • restrictive cardiomyopathy.
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27
Q

Tx for acute decompensated CHF?

A
  • NOLIP
  • Nitrates, O2, Loop diuretics, Inotropics, Position.
28
Q

Which drugs are proven to reduce mortality in CHF patients?

A
  • ACEi/ARBs
    • reduce afterload/preload, increase cardiac output.
  • B-blocker
    • Carvedilol, bisoprolol. Do not start during an acute event.
  • Aldosterone antagonists
    • spironolactone, eplerenone.
29
Q

Dobutamine

A
  • B1 agonist.
    • increase HR and contractility
  • Use for cardiogenic shock
30
Q

Norepinephrine

A
  • A1, B1 agonist.
  • use for septic shock
31
Q

Epinephrine

A
  • a1, a2, b1,b2 agonist.
    • a1 at high dose.
    • b1 at low dose.
  • Use for anaphylactic shock.
  • 2nd line for septic shock
32
Q

Vasopressin

A
  • weak vasoconstrictor
  • use as 2nd line for septic or anaphylactic shock.
33
Q

Phenylephrine

A
  • a1 agonist.
  • Use 2nd line septic shock
34
Q

Dopamine

A
  • b1 agonist (low dose)
  • a1 agonist (high dose)

2nd line for cardiogenic shock.

35
Q

Treatment of myocarditis.

A
  1. Supportive (majority are viral cause)
  2. If bacterial –> antibiotics.
  3. Stop any offending Rx.
  4. Tx any arrhythmias.
  5. Immunosuppresion if immunocompromised.
36
Q

Diagnosis of acute rheumatic fever.

A
  • Typically occurs 2-4wk s/p strep throat infection. Ab attack heart valves.
  • Requires 2 major or 1 major and 2 minor JONES criteria.
  • Major:
    • polymigratory arthritis.
    • pancarditis.
    • subcutaneous nodules (wrist, elbow, knee)
    • erythema marginatum
    • syndeham chorea.
  • Minor: PEACE
    • previous h/o
    • ECG w/ prolonged PR.
    • Arthralgias
    • CRP/ESR elevated.
    • Elevated temp.
37
Q

Treatment for acute rheumatic fever

A
  • NSAIDs
  • corticosteroids
  • penicillin if strep throat is still ongoing or recurring.
38
Q

Dental procedure ppx.

A
  • Indicated for H/o
    • prosthetic valve.
    • infective endocarditis.
    • congenital heart disease.
    • heart transplant.
  • Rx
    • amoxicillin 2g IV 30-60 min prior.
39
Q

Endocarditis

A
  • Etiology
    • M >60.
    • poor dentition.
    • IV drug use.
  • Pt
    • Janeway lesions, Osler nodes, Splinter hemorrhages, Roth spots.
    • fever, malaise, weight loss, New murmur.
40
Q

DUKE criteria

A

Used to diagnose Endocarditis

Consist of 2 Major, 1 Major + 3 minor, or 5 minor criteria.

  • Major:
    • (+) serial blood Cx.
    • (+) valvular vegetations or abscess.
    • New valve regurgitation
    • (+) Coxeilla burnetii.
  • Minor:
    • IV drug use.
    • Fever >38.0.
    • arterial emboli, conjunctival hemorrhages, janewaylesion.
    • immunologic disease.
41
Q

Treatment of bacterial endocarditis

A
  1. 2-3 blood Cx before therapy to confirm
  2. Empiric Vancomycin 4-6wk. Taper based on Cx.
42
Q

Kussmaul Sign

A

JVD during inspiration

  • Seen with Constrictive pericarditis.
  • restrictive cardiomyopathy
  • RV infarction
  • Tricuspid stenosis
  • Massive PE
  • Rt CHF
43
Q

Treatment for Wenckebach?

A

Adjust current medications.

Pacemaker if bradycardic

44
Q

Treatment for Mobitz type II block

A

Requires pacemaker

45
Q

3rd Degree heart block treatment

A

Pacemaker

46
Q

Causes and treatment for Paroxysmal supraventricular tachycardia

A
  • Causes
    • AV nodal reentry
    • WPW (accessory nerve conduction pathway)
  • Treatment
    1. Carotid massage, Valsalva
    2. IV adenosine
    3. Bblock, CCB, cardioversion.
47
Q

Tx for multifocal atrial tachycardia

A

Non-dihydropyradine CCB (verapamil, diltiazem)

Bblock.

Coorect K>4.0. Mg > 2.0.

48
Q

Management of A-fib

A
  • Acute (<48hr onset)
    • electric cardioversion
  • > 48 hours
    1. TEE
    2. heparin + warfarin
    3. Rhythm control (sotalol, amiodarone)
    4. Rate control (b-block, NDHP-CCB, digoxin)
49
Q

Sodium Channel Blockers

A
  • IA
    • quinidine, procainamide, disopyramide
  • IB
    • lidocaine, mexiletine, tocainide
  • IC
    • flecainide, propafenone
50
Q

Potassium channel blockers

A

Class III

  • sotalol
  • amiodarone
  • ibutilide
51
Q

Tx for V-fib or PEA?

A
  • shock, CPR x 2min (30:2)
  • check rhythm
  • Shock, CPR x 2min, Epinephrine 1mg Q3-5min
  • Check rhythm
  • Shock, CPRx2min, Amiodarone 300mg. 150mg. Repeat check rhythm.
52
Q

What are you doing while you are running through the checklist of ACLS?

A

Checking your H’s and T’s.

  • Hypovolemia, hypoxemia, acidosis, hyperkalemia, hypokalemia, hypoglycemia, hypothermia.
  • Tamponade, tension pneumothorax, thrombosis, trauma, toxin overdose.
53
Q

Casuses of secondary HTN

A
  • ESRD
  • Drugs: OCP’s in females. Especially over 35yo.
  • Hypercortisolism
  • Pheochromocytoma
  • Hypo/Hyperthyroidism
  • Hyperparathyroidism
  • Aortic coarctation
  • OSA
54
Q

HTN urgency and emergency

A
  • HTN Urgency: >180/ 120 without end organ damage
  • HTN emergency: >180/120 WITH end organ damage.
  • Tx
    • Goal BP of 160/100. However only reduce MAP by max of 25% in 2-3 hours.
    • MAP = DBP - 1/3(SBP - DBP)
  • Rx to use
    • nitroprusside
    • Labetalol
    • nicardipine
    • clonidine
    • captopril
    • enalapril
55
Q

Captopril, enalapril, fosinopril

A
  • ACE-I
  • Inhibit angiotensin converting enzyme. less Angiotensin, less aldosterone. Less fluid resorption and less vasoconstriction.
  • Used
    • post-MI, CHF, CKD, diabetes to prevent diabetic renal failure.
  • ADR:
    • dry cough.
    • angioedema
56
Q

Candesartan, Losartan, Valsartan

A
  • ARBs
    • inhibit angiotensin receptors (therefore do not increase bradykinin)
  • Uses
    • post-MI, CHF, CKD.
  • ADR
    • renal insufficiency
    • hyperkalemia.
57
Q

Dihydropyridine CCB

A
  • amlodipine, felodipine, nifedipine.
    • Block Ca channels in smooth muscle.
  • Use
    • prinzmetal angina.
    • esophageal spasm. Migraine prophylaxis.
  • ADR:
    • peripheral edema, HA, constipation, GERD.
58
Q

Diltiazem, Verapamil

A
  • Non-dihydropyridine CCB
    • Block Ca channels in the heart causing reduced cardiac output.
  • Use
    • A-fib, SVT.
    • Migraine prophylaxis.
  • ADR
    • peripheral edema, HA, constipation, GERD, bradycardia.
59
Q

Thiazide diuretics

A
  • Chlorthalidone, HCTZ.
    • reduce intravascular volume and vasodilation. Reduce Ca excretion.
  • Use
    • CHF, CKD
  • ADR
    • hyperkalemia
    • hypercalcemia
    • hyponatremia
    • Sulfa allergy
60
Q

A1 blocker

A
  • Doxazosin, prazosin, terazosin
    • block a1 adrenergic –> vasodilation
  • Use
    • BPH, HTN
  • ADR
    • orthostatic HoTN
    • rebound HTN.
61
Q

Arterial vasodilators for HTN

A
  • Hydralazine, minoxidil
    • relax vascular smooth muscle.
  • Use
    • HTN. male pattern baldness.
  • ADR
    • reflex tachycardia
    • drug-induced lupus (hydralazine)
62
Q

Indications for repair of abdominal aortic aneurysm

A
  • Males >5.5 cm
  • Females > 5.0cm
  • Increase in size >0.5cm in 6months.
  • symptomatic (back pain, tenderness)
63
Q

Peripheral artery disease

A
  • Pt
    • intermittent claudication. Non-healing foot ulcers, erectile dysfunction.
  • Dx:
    • Ankle-Brachial Index.
    • ABI < 0.9 = abnormal. ABI > 0.9 is normal.
    • start w/ US or CTA. Follow up with Arteriogram.
  • Tx
    • Medical: smoking cessation, glucose/BP control. exercise, Cilostazol - improve bloodflow. daily ASA +/- statin.
    • Failure of medical management –> progress to angioplasty, bypass grafting, amputation.

**consider coronary artery disease also**

64
Q

Diagnostic criteria for Kawasaki Disease

A
  • CRASH and Burn
  • Requires a high grade fever for at least 5 days, 4/5 sxms:
    • Conjunctivitis (bilateral, non-exudative, painless)
    • Rash (trunk)
    • Adenopathy (cervical LN)
    • Strawberry tongue and diffuse erythema
    • Hand/feet desquamation

Risk of coronary artery aneurysm within weeks on disease onset.

  • Tx
    • IVIG (1st 10 days of illness)
    • Aspirin (high-dose)
    • F/U echocardiogram 6-8 wk later.
65
Q

Polyarteritis Nodosa

A

Lung sparing. kidney, GI tract.

  • Association w/ HCV, HBV.*
  • (-) ANCA.*
  • angiography shows multiple aneurysms.*
66
Q

Wegener’s Granulomatosis

Granulomatosis with polyangiitis

A
  • Granuloma formation in:
    • upper airway
    • Lungs
    • Kidney
  • (+) c-ANCA.
  • Tissue Bx is required to definitively confirm the diagnosis.
67
Q

Mixed Cryoglobulinemia Syndrome

A
  • Polyclonal IgG and IgM antibodies associated with HCV.
  • Melzer’s Triad:
    • palpable purpura.
    • peirpheral neuropathy
    • arthralgias.

Majority also have renal failure w/ hematuria and proteinuria

Boards 2 (10 decks)

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