Cardiovascular Flashcards
What heart sound might you hear with Mitral valve regurgitation?
Mitral valve regurgitation may cause a wide split of the second heart sound.
Mitral valve regurgitation can be caused by mitral valve prolapse, rheumatic heart disease, ischemic cardiomyopathy, myocarditis or endocarditis. This condition places a pathophysiological volume overload on the heart. Symptoms include fatigue, weakness and exertional dyspnea. Heart failure and pulmonary edema can occur in the acute or chronic setting.
Echocardiography is diagnostic and treatment consists of medical management of secondary conditions (i.e. congestive heart failure, atrial fibrillation, etc.) and surgical repair. Because the deterioration of left ventricular function is progressive and irreversible the latter should be done prior to the onset of symptoms and early operation is indicated in asymptomatic patients with a reduced ejection fraction (less than 60%) and/or left ventricular dilation.
Acute therapy for NSTEMI
Medical treatment for NSTEMI includes: anti-ischemic therapy (oxygen, nitroglycerin, beta blocker), antiplatelet therapy (aspirin, clopidogrel or brilinta, platelet glycoprotein IIb/IIIa inhibitor), and antithrombotic therapy (heparin, low-molecular-weight heparin).
Describe Heart Failure due to diastolic dysfunction
Diastolic dysfunction is an important mechanism of heart failure with a preserved ejection fraction, which causes nearly 50% of cases of heart failure in the United States. It is most commonly seen among women and older patients. Additional risk factors include obesity, hypertension, diabetes mellitus, coronary disease, and tobacco use.
Clinically, this is suspected in patients with typical signs and symptoms of heart failure and a left ventricular ejection fraction that is >50%. It is most often due to left ventricular hypertrophy as a response to chronic systolic hypertension. The ventricle becomes stiff and unable to relax or fill adequately, leading to decreased cardiac output and increased diastolic pressures that put pressure on the pulmonary venous system and resulting in high mean pulmonary capillary wedge pressures.
Palpitations associated with ___________ have increased risk of a cardiac etiology
Patients with a history of cardiovascular disease, palpitations that affect their sleep, or palpitations that occur at work have an increased risk of an underlying cardiac cause (positive likelihood ratio 2.0–2.3)
How is AS followed?
The American Heart Association and the American College of Cardiology recommend that asymptomatic patients with mild aortic stenosis undergo repeat echocardiography every 3–5 years.
most effective drug for treating allergic rhinnitis?
steroid nasal spray
what are the 3 phases of scalp hair follicle rotation
The actively growing anagen-phase hairs give way to the catagen phase, during which the follicle shuts down, followed by the resting telogen phase, during which the hair is shed.
describe telogen effluvium
a nonscarring, shedding hair loss that occurs when a stressful event, such as a severe illness, surgery, or pregnancy, triggers the shift of large numbers of anagen-phase hairs to the telogen phase. Telogen-phase hairs are easily shed. Telogen effluvium occurs about 3 months after a triggering event. The hair loss with telogen effluvium lasts 6 months after the removal of the stressful trigger.
Describe anagen effluvium
diffuse hair loss that occurs when chemotherapeutic medications cause rapid destruction of anagen-phase hair
round patches of hair loss, thought to have an autoimmune etiology.
Alopecia areata
Best medication to prevent osteoporotic hip and back fx
treatment with bisphosphonates to prevent osteoporotic hip and vertebral fractures is the only one supported by consistent patient-oriented, high-quality clinical evidence
foods that have cross reactivity with latex allergy
avocados, bananas, chestnuts, and kiwi
sequence for testing for hepatitis C
Hepatitis C testing should be initiated with an antibody test ( anti‑HCV test). People testing anti‑HCV positive/reactive should have follow-up testing for detection of HCV RNA. If that is positive- confirmed
If negative, it was false positive.
If the third test, quantitative RNA is neg, it is an old infection resolved.
Can hepatitis C resolve on its own
Yes, 15-20%
Features of a benign pulmonary nodule on CXR
Radiographic features of benign nodules include a diameter <5 mm, a smooth border, a solid appearance, concentric calcification, and a doubling time of less than 1 month or more than 1 year.
Two most common causes of hypercalcemia
Malignancy and hyperparathyroidism
What is the recommendation for low dose Aspirin?
Do not recommend routinely for primary prevention.
The ADA guidelines recommend low-dose aspirin for diabetic patients with 10-year CVD risk ≥10%
Recommended to all for secondary prevention
Non modifiable Cardiovascular risk factors
Age, sex, family hx DM/CAD
What is used to reverse heparin (UFH)
Protamine zinc
T or F. Only STEMI patients with stents should be discharged on statins
All MI patients should be discharged on high dose statins.
do STEMi or NSTEMI have better long term outcomes
About the same, NSTEMI slightly worse
what are the 3 more commonly used glycoprotein inhibitors -
abciximab (abcixifiban) (ReoPro)
eptifibatide (Integrilin)
tirofiban (Aggrastat)
when is the special circumstance for use of gycoprotein inhibitors
Patients undergoing stenting
What drug category is clopidogrel and brilinta
Both anti platelet aggregation through binding of ADP/P2Y12 sites
50 yr old male with classic Angina symptoms has what percent chance of it being cardiac
90%
Female 73%
What type of patient is best suited for cardiac stress tesing
those with intermediate pretest probability of cardiac dx
Which is most sensitive and specific regarding stress testing MPI vs Stress echo
MPI is more sensitive
Stress echo more specific
Guidelines for recommending CABG
3 vessel disease with LV dysfunction, LAD >50% occlusion
Problem with coronary stents in diabetics
Much higher rate of re-occlusion. Overall do better with CABG
Drug Eluding stents have more early reocclusions, T or False
True. It takes longer to epithelialize
Drug eluding stents should have what for a year
clopidogrel or ticagrelor (ASA for life)
Bare stents 6 months
For patients with multivessel dx, unstable angina or previous MI, STENT vs CABG
they overall have better outcomes CABG
Drugs for pericarditis
Colchicine, NSAIDS and if fail consider prednisone
pure rt heart failure with JVD, hypotension is preload dependent T or F
True. Needs IV fluids
Pulsus paradoxus occurs with tamponade. Define it
Pulsus paradoxus refers to an exaggerated fall in a patient’s blood pressure during inspiration by greater than 10 mm Hg. On physical examination, one can detect beats on cardiac auscultation during inspiration that cannot be palpated at the radial pulse.
Is RHF synonymous with RV dysfunction
NO. Some patients have asymptomatic RV dysfunction, and not all RHF is caused by RV dysfunction.
CCTA is better at ruling out CAD than ruling it in T/F
True. Negative predictive value is 93% as opposed to PPV of 82% May slow HR with B-blocker to improve images
What is the BP goal of treatment in diabetic patients 30-59y?
<140/90 Tighter control does not have better results.
if >60 yr old make goal <150/90
Holiday heart syndrome
Afib from a binge of Alcohol
Uncontrolled AF can be cardioverted if
Has been present < 48hrs
Or clear of clots by TEE
DOAC vs NOAC
Direct vs New oral anticoagulant
• Apixaban (Eliquis®)
• Dabigatran (Pradaxa®)
• Rivaroxaban (Xarelto®)
How long does it take for the anti-coagulant effect of Apixaban and Rivaraxaban vs Dabigatran
Immediate vs required heparin bridging with pradaxa
Reversal agent for Apixaban and Rivaroxaban (aksi
Andexxa (Andexanet alfa)
What is pulsus alterans
alternating strong and weak pulses seen in decreased Ejection fraction of severe LVHF
Classification of LVHF. Based on activity level
Class I strenuous activity causes sx
Class II moderate activity
Class III mild
Class IV at rest
Treatment that is included for all 4 NY Heart Ass classes
Salt intake < 2g for moderate to severe, otherwise <3g
Fluid intake <2L
ACE/ARB, Betablocker
