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1
Q

CC: Chest pain
PE: Chest wall tenderness

Diagnosis?
Accurate test?

A

Costochondritis

No additional testing

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2
Q

CC: Chest pain w/ radiation to back
PE: Unequal blood pressure between arms

Diagnosis?
Accurate test?

A

Aortic Dissection
CXR: Widened mediastinum
Confirmatory: CT/MRI/TEE

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3
Q

CC: Chest pain in person under 40yo
PE: Replicate pain with lying flat, improve with sitting up

Diagnosis?
Accurate test?

A

Pericarditis

ECG: ST elevations everywhere with PR depressions

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4
Q

CC: Chest pain sudden onset with SOB
PE: tachycardic, hypoxic

Diagnosis?
Accurate test?

A

Pulmonary embolism

Spiral CT or VQ scan

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5
Q

Niacin- effect and adverse effects

A

Excellent at adding to Statin for lipid control, increase HDL

AE: elevation in glucose and uric acid, pruritus

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6
Q

Statin- effect and adverse effects

A

HMG-CoA reductase inhibitor, lowers LDL

Antioxidant effect on endothelial lining

AE: elevations in LFTs (monitor), myositis

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7
Q

Gemfibrozil- effect and adverse effects

A

Fibric acid derivative, lowers TG. No mortality benefit.

AE: Enhances statins myositis

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8
Q

Cholestryamine- effect and adverse effects

A

Bile acid sequester ant

AE: GI discomfort- flatus and cramps
Reduces absorption of other medications from gut

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9
Q

Ezetimibe- effect and adverse effects

A

Lowers LDL, no effect on anything

Essentially useless

Well tolerated

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10
Q

Dihydropyridine CCB (all the ones that end in -dipine)- effect

A

Decrease vascular resistance, negative inotrope

Causes reflex tachycardia- increasing myocardial oxygen demand

**increase mortality in CAD

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11
Q

Non-dihydropyridine CCB (verapamil and diltiazem) - effect

A

Cardiac specific- reduce myocardial oxygen demand and vasospasm.

Used in with CAD when:
Severe asthma limits use of BB
Pinzmetal variant angina 
Cocaine induced chest pain 
Inability to control pain despite max medical management

***Does NOT lower mortality risk

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12
Q

Side effects of CCB

A

Edema
Constipation
Heart block
Increased prolactin (only verapamil)

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13
Q

Extra heart sound right before S1

A

S4- indicated atrium contracting against stiffen ventricle

May be present during infarction or ventricular hypertrophy

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14
Q

Extra heart sound right after S2

A

S3- turbulent flow into ventricles

May be present in diastolic heart failure

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15
Q

> 10mmHg decrease in BP on inhalation

A

Pulsus paradoxus

Associated with cardiac tamponade

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16
Q

Triphasic scratchy sound on auscultation

A

Pericardial friction rub

Associated with pericarditis

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17
Q

Contraindications to thrombolytics

A

Major bleeding: Melena or Any brain bleed
Surgery in last 2 weeks
BP >180/110
Nonhemorrhagic stroke in last 6mo

***If thrombolytics contraindicated- transfer to facility that performs PCI

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18
Q

ACS- Aspirin

A

Every patient prior to revascularization

***Improves mortality

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19
Q

ACS-Clopidigrel

A

If aspirin is not tolerated

Always if patient undergoes stenting or angioplasty

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20
Q

ACS- Beta blockers

A

Every patient- improves mortality

Not time sensitive-just start any time after admission

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21
Q

ACS- ACE/ARB

A

Every patient- improves mortality

Best results if EF<40%, not time sensitive

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22
Q

ACS- Statins

A

Every patient

Best benefit with LDL >100

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23
Q

ACS- Heparin

A

After thrombolytic/PCI to prevent restenosis

Initial therapy with NSTEMI/UA (give immediately after ASA)

24
Q

ACS- Glycoprotein IIb/IIIa inhibitors, abciximab, tirofiban, eptifibitide

A

Redue mortality in those who are going to undergo angioplasty and stenting who have ACS (NOT STEMI)

25
Q

CC: Dyspnea, sudden onset
PE: clear lungs

Diagnosis?

26
Q

CC: Dyspnea, sudden onset
PE: wheezing, increased expiratory phase

Diagnosis?

27
Q

CC: Dyspnea with circumoral numbness, caffeine use, and history of anxiety

Diagnosis?

A

Panic attack

28
Q

CC: Dyspnea

PE: fever, sputum, unilateral rales/rhonci

Diagnosis?

29
Q

CC: Dyspnea, gradual
PE: Pallor

Diagnosis?

30
Q

CC: Dyspnea with palpitations or syncope

Diagnosis?

31
Q

CC: Dyspnea, long history of smoking
PE: Barrel chest
Diagnosis?

32
Q

CC: Dyspnea with recent anesthetic use
Pe: Brown blood, clear lungs, cyanosis

Diagnosis?

A

Methemoglobinemia

33
Q

CC: Dyspnea after fire, wood burning stove exposure, suicidal

A

CO poisoning

34
Q

Which murmurs always increase with inspiration?

A

Right sided lesions

35
Q

Best initial test for heart murmurs?

A

Echo

Transesophageal echo is more specific

36
Q

Most accurate test for murmur?

A

Cardiac cath

37
Q

Most common etiology of mitral stenosis?

A

Rheumatic fever

38
Q

Indications for treatment of MS

A

Symptoms

Valve surface area less than 1cm2

39
Q 
CHF 
Hoarseness 
Dysphagia 
A. fib 
Hemoptysis
A

MS- symptoms from LA dilitation

40
Q

Diastolic murmur

Increased intensity with squatting and leg raise

A

MS- increased venous return to heart causes increase in murmur

41
Q

Treatment for mitral stenosis

A
  1. Diuretics and sodium restriction

2. Balloon valvuloplasty

42
Q

Etiology of AS

A

Congenital bicuspid aortic valve

Calcified aortic valve

43
Q

CHF
Angina
Syncope

44
Q

Systolic crescendo-decrescendo murmur
Radiates to carotids
Improve with valsalva and standing and hand grip

A

AS
Decreased venous return to heart decreases murmur (val and stand)
Decrease after load softens murmur (hand)

45
Q

Treatment for AS

A

Valve replacement

46
Q

Etiology of mitral regurg

A 
HTN 
endocarditis 
MI 
Papillary muscle rupture 
and anything that dilates the heart
47
Q

Holosystolic murmur that radiates to axilla

Worsens with handgrip, squatting, and leg raise

A

MR
Decrease after load worsens murmur
Decreased venous return worsens

48
Q

Treatment for MR

A
  1. Vasodilators (ARB/ACE) decrease progression of regurgatant lesion
  2. Valve replacement is indicated when heart starts to dilate: LVESD >40 and EF drops below 60%
49
Q

Etiology of AR

A 
MI
HTN
Endocarditis 
Marfans/cystic medical necrosis
Inflammatory disorders such as ankylosing spondylitis and Reiter's
Syphyllis 
Congenital bicuspid aortic valve
50
Q 
CHF
Wide pulse pressure 
Water hammer pulses 
Pulsations in finger nail beds 
BP much higher in legs 
Head bobbing
51
Q

Diastolic decrescendo murmur
Improve with valsalva and standing
Worsens with handgrip

A

AR
Decrease venous flow improves murmur
Increased afterload worsens murmur

52
Q

Treat AR

A
  1. ACE/ARB, nifedipine as vasodilators increase forward flow and decrease progression
  2. surgical valve replacement- replace before: EF less than 55% or LVESD
53
Q

MVP etiology

A

Normal physiologic variant

54
Q

Atypical chest pain
Palpitations
Panic Attacks

55
Q

Midsystolic click
valsalva and standing worsen
Handgrip improves murmur

56
Q

MVP Treatment

A
  1. BB with symptoms

2. Valve repair via catheter with clip placement, or open with sutures

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