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Internal Medicine Clerkship > Cardiovascular System > Flashcards

Cardiovascular System Flashcards

1
Q

ST depression indicates

A

subendocardial ischemia

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2
Q

Medicines for pharmacological stress test:

A

Adenosine, dipyridamole, dobutamine

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3
Q

action of dobutamine

A

increases myocardial oxygen demand by increasing heart rate, blood pressure, and contractility

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4
Q

action of adenosine and dipyridamole

A

generalized coronary vasodilation

Since diseased coronary arteries are already maximally dilated, this causes a relative blood flow deficiency in diseased arteries

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5
Q

amount of stenosis necessary to produce angina

A

> 70%

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6
Q

The only medications that lower mortality in stable angina:

A

Aspirin, Beta-blocker

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7
Q

Outcome of revascularization

A

improvement of symptoms

does not reduce incidence of MI

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8
Q

Should CCB be used in CAD?

A

Not routinely, they raise heart rate

Use if still symptomatic despite B-blockers and Nitrates

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9
Q

Treatment of CHF

A

ACEi

Diuretics

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10
Q

Indications for CABG

A

Three-vessel disease >70% stenosis in each vessel
LMA > 50% stenosis
LV dysfunction

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11
Q

Difference between UA and NSTEMI

A

NSTEMI has elevated cardiac enzymes

both UA and NSTEMI lack ST elevations and Q waves

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12
Q

When to do stress testing for UA:

A

UA have higher risk of adverse events during stress testing, stabilize with medical management before stress testing or start with cardiac catheterization

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13
Q

Treatment of UA/NSTEMI

A 
ASA
Clopidogrel 9-12 mo.
Beta-blockers
Heparin/Enoxaparin -> PTT 2-2.5x normal
Nitrates
O2 if hypoxic
Statin
Check K+ and Mg+ and replace PRN

> 90% will improve with medical management in 2 days
If no improvement, cath

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14
Q

Thrombolysis in Myocardial Infarction (TIMI score):

A 
Age > 65
3+ CAD risk factors
Known CAD
2+ episodes of angina in past 24 hours
ASA use in last 7 days
Elevated cardiac enzymes
ST changes
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15
Q

Drug used to induce coronary vasospasm (Prinzemetal angina)

A

Ergonovine

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16
Q

Signs of MI

A

Substernal chest pain
> 30 min
Doesn’t respond to NG

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17
Q

Meaning of ST elevation/depression

A

ST elevation = transmural injury

depression = subendocardial injury

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18
Q

Time course of cardiac enzymes

A

Trop: (better than CK)
increases within 3-5 hours
can be falsely elevated in renal failure

CK:
increases within 4-8 hours
returns to normal in 48-72 hours

19
Q

Difference in medical treatment of MI vs. UA/NSTEMI

A

MI should get ACEi in addition to B-blocker

MI should get IV heparin

20
Q

Treatment of Vtach

A

hemodynamically unstable –> cardioversion

stable –> amiodarone

21
Q

Treatment of AV block:

A

1st and 2nd (type I) - no treatment
2nd (type II) and 3rd:
Anterior MI –> emergent pacemaker
Inferior MI –> IV atropine

22
Q

Treatment of pericarditis

A

ASA

  • NSAIDs and Steroids are contraindicated
23
Q

Dressler’s Syndrome

A

postmyocardial infarction immunologic
fever, malaise, pericarditis, leukocytosis, pleuritis
weeks to months post MI

TX: ASA, Ibuprofen

24
Q

NYHA CHF classification:

A

I: symptoms only with vigorous activity
II: moderate exertion
III: activities of daily living
IV: at rest

25
Q

Treatment of CHF:

A 
Class I:
  Salt restriction
  Loop diuretic  - improves symptoms
  ACEi  - improves mortality
Class II:
  B-blocker  - improves mortality
Class III:
  Digoxin - symptomatic (positive inotrope for EF
26
Q

Contraindicated in CHF:

A

Metformin –> lactic acidosis
Thiazoladinediones –> fluid retention
NSAIDs

27
Q

Treatment of Afib

A

Stable –> rate control with B-blocker, then cardiovert

Unstable –> Cardiovert

Anticoagulate for 3 weeks before and 4 weeks after cardioversion

If

28
Q

Medication that blocks the AV node

A

Adenosine

29
Q

QT prolonging drugs:

A

TCAs, anticholinergics

30
Q

Treatment of Torsades de pointes

A

IV magnesium

31
Q

Difference between second-degree blocks

A

Mobitz I (Wenckebach) - progressive prolongation of PR interval
Site of block is within the AV node
Benign

Mobitz II - Randomly non-conducted QRS waves
Site of block is within the His-Purkinje system
Requires pacemaker

32
Q

Medication causes of dilated cardiomyopathy

A

Doxorubicin

Adriamycin

33
Q

Infectious causes of dilated cardiomyopathy

A

Viral
Chagas’ disease
Lyme disease
HIV

34
Q

Murmur of Hypertrophic Cardiomyopathy

A

Systolic ejection murmur
Decreases with squatting, lying down, or straight leg raise (decreased outflow obstruction)
Increases with Valsalva and standing (Decreased LV size -> increased outflow obstruction)

This pattern is opposite of what is normally observed in all other murmurs except mitral valve prolapse

35
Q

ECG findings of pericarditis

A

diffuse ST elevation and PR depression

PR depression is more specific

36
Q

Epstein’s Anomaly

A

Congenital malformation of tricuspid valve in which there is downward displacement of the valve into the RV

37
Q

Symptoms of Rheumatic fever

A

2 Major or 1 Major + 1 Minor

Major:
  Migratory polyarthritis
  Erythema Marginatum
  Cardiac involvement
  Chorea  
  Subcutaneous Nodules
Minor:
  Fever
  ESR
  Polyarthralgia
  Long PR interval
  Evidence of Strep infection
38
Q

Symptoms of ASD

A

Wide, fixed split S2

May have systolic ejection murmur at pulmonary area due to increased blood flow

39
Q

VSD

A

The most common congenital cardiac malformation
Symptoms:
small shunt -> none
large shunt
-> first, left to right, CHF, growth failure, respiratory infections
-> later, Eisenmenger, SOB on exertion
Blowing holosystolic murmur
Smaller defect -> louder murmur

40
Q

PDA

  • association
  • clinical findings
  • medications
A

congenital rubella syndrome

continuous machine-like murmur (systolic and diastolic)

Indomethacin -> closure
PGE1 -> keep open

41
Q

Medical treatment of PVD claudication

A

Cilostazol (PDE inhibitor)

42
Q

Indications for tPA in PE

A

hemodynamically unstable

right heart failure

43
Q

When superficial thrombophlebitis occurs id different locations in a short period of time, think of…

A

Migratory superficial thrombophlebitis –> occult malignancy, often pancreas

44
Q

Worst risk factor for ischemic heart disease

A

Diabetes Mellitus

Internal Medicine Clerkship (3 decks)

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