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Medicine > Cardiovascular II > Flashcards

Cardiovascular II Flashcards

1
Q

The CHA2DS2-VASc score is useful for assessing thromboembolic risk in patients with […]:

C: Congestive heart failure

H: Hypertension

A2: Age > 75* (2 points)

D: Diabetes mellitus

S2: Stroke/TIA/thromboembolism* (2 points)

V: Vascular disease (prior MI, PAD, or aortic plaque)

A: Age 65-74

Sc: Sex category (female)

A

The CHA2DS2-VASc score is useful for assessing thromboembolic risk in patients with non-valvular atrial fibrillation:

C: Congestive heart failure

H: Hypertension

A2: Age > 75* (2 points)

D: Diabetes mellitus

S2: Stroke/TIA/thromboembolism* (2 points)

V: Vascular disease (prior MI, PAD, or aortic plaque)

A: Age 65-74

Sc: Sex category (female)

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2
Q

The combination of atrial tachycardia with AV block is fairly specific for […] toxicity.

A

The combination of atrial tachycardia with AV block is fairly specific for digitalis toxicity.

digitalis causes both an increased ectopy in the atria or ventricles (atrial tachycardia) and an increased vagal tone (AV block)

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3
Q

The current indications for operative/endovascular repair of an AAA include rapid rate of expansion, presence of symptoms, and aneurysm size > […] cm.

A

The current indications for operative/endovascular repair of an AAA include rapid rate of expansion, presence of symptoms, and aneurysm size > 5.5 cm.

rapid rate of expansion is considered > 0.5 cm in 6 months or > 1 cm per year

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4
Q

The murmur of pulmonic stenosis is characterized by an ejection click followed by a crescendo-decrescendo systolic murmur over the […] space.

A

The murmur of pulmonic stenosis is characterized by an ejection click followed by a crescendo-decrescendo systolic murmur over the left second intercostal space.

versus aortic stenosis, which is typically heard over the right second intercostal space

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5
Q

The presence of a continuous abdominal bruit has a high specificity for the presence of […] hypertension.

A

The presence of a continuous abdominal bruit has a high specificity for the presence of renovascular hypertension.

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6
Q

The strongest predictors of abdominal aortic aneurysm rupture are large aneurysm diameter, rapid rate of expansion, and […].

A

The strongest predictors of abdominal aortic aneurysm rupture are large aneurysm diameter, rapid rate of expansion, and current cigarette smoking.

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7
Q

True ventricular aneurysm is a complication that may occur months after an MI and increases risk for mural […].

A

True ventricular aneurysm is a complication that may occur months after an MI and increases risk for mural thrombus.

echocardiogram typically reveals a thinned and dyskinetic myocardial wall

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8
Q

What abnormal heart sound is associated with a stiff left ventricle (e.g. LV hypertrophy due to prolonged hypertension)?

A

S4

often referred to as “ten-nes-see” a sound, which corresponds to S4-S1-S2

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9
Q

What abnormal heart sound is associated with volume overload (e.g. CHF with LV dysfunction)?

A

S3

often referred to as “ken-tuc-ky” a sound, which corresponds to S1-S2-S3

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10
Q

What abnormal heart sound is often heard during the acute phase of myocardial infarction?

A

S4 (atrial gallop)

due to left ventricular stiffening and dysfunction

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11
Q

What abnormal RBC may be seen in patients with scleroderma renal crisis?

A

Schistocytes

due to microangiopathic hemolytic anemia

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12
Q

What adrenergic receptor is the primary target of dobutamine?

A

Beta-1 receptors (agonist)

also has a weak affinity for beta-2 and alpha-1 receptors

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13
Q

What age range of diabetic patients should be started on statin therapy?

A

40 - 75 years old

high-intensity if 10-year ASCVD risk > 7.5%; moderate intensity if < 7.5%

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14
Q

What analgesics are associated with decreased metabolism of warfarin (i.e. increased bleeding risk)?

A

acetaminophen and NSAIDs

other notable CYP450 inhibitors include amiodarone and some antibiotics/antifungals (e.g. metronidazole)

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15
Q

What anti-hypertensive medication is commonly associated with peripheral edema as an adverse effect?

A

Dihydropyridine Ca2+-channel blockers

due to preferential dilation of precapillary vessels (arteriolar dilation), which increases capillary hydrostatic pressure

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16
Q

What area of the myocardium is likely involved in an MI with ST elevations in leads I and aVL?

A

Lateral (typically LCX obstruction)

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17
Q

What area of the myocardium is likely involved in an MI with ST elevations in leads II, III, and aVF?

A

Inferior (typically RCA obstruction, or less commonly LCX)

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18
Q

What area of the myocardium is likely involved in an MI with ST elevations in leads V1 - V4?

A

Anterior (typically LAD obstruction)

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19
Q

What arrhythmia commonly develops in patients with mitral stenosis?

A

Atrial fibrillation

due to significant left atrial dilatation

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20
Q

What artery is likely obstructed given the ECG below?

A

Right coronary artery

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21
Q

What class of drugs should be administered within 24 hours of an MI to limit ventricular remodeling?

A

ACE inhibitors

except in patients with a contraindication; ventricular remodeling often results in dilatation of the ventricle

22
Q

What classes of medications (3) should be held for 48 hours prior to cardiac stress testing?

A

beta blockers, calcium channel blockers, and nitrates

exception: continue these medications in patients with known CAD undergoing stress testing to assess the efficacy of anti-anginal medication

23
Q

What CXR finding is often found in patients with coarctation of the aorta?

A

Notching of the ribs

also may have a “3” sign due to indentation of the aorta with pre- and post-stenotic dilation

24
Q

What drug classes (2) are used as first-line therapy for chronic stable angina?

A

beta-blockers (preferred) and non-dihydropyridine CCBs

these drugs decrease myocardial O2 demand by reducing myocardial contractility and heart rate

25
Q

What drug classes are useful for reducing Ca2+ channel blocker-induced peripheral edema?

A

ACE inhibitors and ARBs

dihydropridine Ca2+ channel blockers cause edema due to pre-capillary vasodilation; ACE inhibitors relieve edema via post-capillary venodilation

26
Q

What ECG finding is fairly specific for pericardial effusion?

A

Electrical alterans

diagnosis of pericardial effusion can be more definitely made using echocardiogram

27
Q

What electrolyte abnormality may potentiate the effects of digoxin?

A

Hypokalemia

28
Q

What electrolyte abnormality parallels the severity of heart failure and is an independent predictor of adverse clinical outcomes?

A

Hyponatremia

caused by increased levels of renin, norepinephrine, and ADH; treatment involves fluid restriction, ACE inhibitors, and loop diuretics

29
Q

What hypertensive complication is defined as severe hypertension (> 180/120 mmHg) with no symptoms or acute end-organ damage?

A

Hypertensive urgency

30
Q

What hypertensive complication presents as severe hypertension (> 180/120 mmHg) with cerebral edema and non-localized neurologic signs/symptoms (e.g. confusion)?

A

Hypertensive encephalopathy (hypertensive emergency)

31
Q

What hypertensive complication presents as severe hypertension (> 180/120 mmHg) with retinal hemorrhages, exudates, or papilledema?

A

Malignant hypertension (hypertensive emergency)

32
Q

What imaging study is used for the definitive diagnosis of cardiac tamponade?

A

Echocardiography

management includes immediate percutaneous or surgical drainage of pericardial fluid

33
Q

What imaging study should be considered in a patient with acute limb ischemia after an MI?

A

Transthoracic echocardiogram

to screen for LV thrombus and evaluate LV function; patients also require immediate anticoagulation and vascular surgery consult

34
Q

What intervention is most likely to improve cardiovascular and overall long-term mortality in patients with acute STEMI?

A

Restoration of coronary blood flow (e.g. PCI, fibrinolysis)

35
Q

What is preferred treatment to prevent coronary artery disease in a patient with inducible ischemia?

A

Anti-platelet therapy (e.g. aspirin)

a decreased tracer uptake with stress but normal at rest indicates inducible ischemia

36
Q

What is the best initial management for a hemodynamically stable patient with palpitations and the ECG findings below?

A

IV amiodarone

37
Q

What is the first-line therapy for conscious and stable patients with torsades de pointes?

A

IV magnesium

if patient is hemodynamically unstable, immediate defibrillation is indicated

38
Q

What is the imaging modality of choice for diagnosis and follow-up of abdominal aortic aneurysms?

A

Abdominal ultrasound

cheap and does not require contrast (vs. CT and MRI)

39
Q

What is the initial management for a patient with pulmonary hypertension that presents with JVD, peripheral edema, bibasilar crackles, and an ejection fraction of 30%?

A

Loop diuretics and ACE inhibitors (or ARBs)

the pulmonary hypertension is due to LV systolic dysfunction and thus treatment involves addressing the underlying cause; beta-blockers and occasionally aldosterone antagonists may be used for long-term management as well (note: endothelin-1 receptor antagonists and PDE-5 inhibitors are used for idiopathic pulmonary hypertension)

40
Q

What is the initial management for a patient with suspected acute arterial occlusion leading to an immediately-threatened limb (e.g. sensory loss, weakness)?

A

Anticoagulation (e.g. IV heparin)

should be done prior to further evaluation with non-invasive or invasive imaging

41
Q

What is the initial management for a patient with suspected acute limb ischemia?

A

Anticoagulation (e.g. IV heparin)

should be initiated empirically, prior to further evaluation with other imaging studies

42
Q

What is the initial management for hypotension in a patient with a right ventricular MI that has low-normal JVP?

A

IV saline bolus (nitrates should be avoided)

RVMI often creates high sensitivity to intravascular volume depletion; hypotension with low JVP suggests inadequate RV preload

43
Q

What is the initial management of choice (besides pain control) for patients with type B aortic dissection?

A

IV beta blockers (e.g. labetalol, esmolol, propanolol)

results in decreased HR, BP, and LV contractility (less aortic wall stress)

44
Q

What is the initial therapy for patients with atrial fibrillation due to hyperthyroidism?

A

Beta blockers

helps control heart rate and hyperadrenergic symptoms; should be continued until the patient becomes euthyroid with thionamides, radioiodine, and/or surgery

45
Q

What is the initial treatment for a hemodynamically stable patient with atrial fibrillation with rapid ventricular response?

A

Rate control (e.g. beta blockers or CCBs)

rhythm control should be considered in patients unable to achieve adequate HR control or in those with recurrent symptomatic episodes

46
Q

What is the initial treatment for chronic venous insufficiency?

A

Conservation measures (e.g. leg elevation, exercise, compression therapy)

patients who do not respond to conservative measures should have diagnosis of CVI confirmed by identification of venous reflux in the deep venous system on duplex ultrasound

47
Q

What is the initial treatment for symptomatic sinus bradycardia?

A

IV atropine

in patients with inadequate response, further treatment options include IV epinephrine or dopamine, or transcutaneous pacing

48
Q

What is the initial treatment for tachycardia-mediated cardiomyopathy?

A

Rate or rhythm control

presents with progressive dyspnea, decreased exercise tolerance, and LV systolic dysfunction secondary to chronic tachycardia (e.g. chronic A-fib)

49
Q

What is the initial treatment of choice for a patient with atrial fibrillation that develops asystole or pulseless electrical activity (no palpable pulse but electrical activity on ECG)?

A

CPR with vasopressor therapy (e.g. epinephrine)

potentially reversible causes of PEA should also be investigated (see below)

50
Q

What is the initial treatment of choice for a patient with persistent tachyarrhythmia with associated hemodynamic instability?

A

Immediate synchronized cardioversion

energy delivered is synchronized to the QRS complex to minimize the likelihood of the shock occuring during repolarization, which can precipitate ventricular fibrillation; hemodynamically stable patients may be managed with rate control (e.g. beta-blockers, non-dihydropyridine CCBs)

Medicine (33 decks)

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