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1
Q

What is the worst risk factor for CAD?

What is the most common risk factor for CAD?

A

DM

HTN

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2
Q

What is the relationship between family history and CAD?

A

First degree relatives carry a risk

Premature CAD carries a risk (males

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3
Q

What lipid marker is the greatest concern for CAD risk

A

Elevated LDL

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4
Q

What is Tako Tsubo CM?

What is it caused by?

A

Post menopausal women experience a massive catecholamine surge and have LV ballooning
Due to sudden stress

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5
Q

What are 2 characteristics of ischemic pain?

What are 5 characteristics of non-ischemic pain?

A

Dull/sore, squeeze/pressure

Sharp, couple seconds, pleuritic, positional, tender

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6
Q

What is the initial test for chest pain?
What is the next step in an office?
What is the next step in a hospital?

A

EKG
Transfer to ED
CK MB + Tropinin

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7
Q

What is the maximum heart rate?

A

220-age

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8
Q

When should you stress test someone?

A

Etiology of chest pain is uncertain + EKG is nondiagnostic

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9
Q

What are 2 tests for when you cannot read an EKG because of a baseline abnormality?

A

Nuclear isotope uptake (thallium or sestamibi)

Echo detection of wall motion abnormalities

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10
Q

What is a medication for stress testing that should be avoided in asthmatics and why?
What should you use instead?

A

Dipyridamole causes bronchospasm

Dobutamine with an Echo

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11
Q

What is the next step in a patient with a positive stress test for ischemia?
Who gets a stent vs a CABG?

A 
Coronary angiography (most accurate detector of CAD)
Stent for 1-2 vessels, CABG for 3+ or 2 in DM
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12
Q

When do you use Holter monitoring?

A

Rhythm evaluation

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13
Q

What antiplatelet meds should an ACS patient receive immediately upon arrival?

A

ASA + Clopedigrel or Prasugrel or Ticagrelor (P/T if being stented)

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14
Q

What is ticlopidine and who gets it?

A

Platelet inhibitor in patients intolerant of ASA and clopidogrel
Causes neutropenia + TTP

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15
Q

What patients receive ranolazine?

A

Angina patients refractory to other treatments

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16
Q

What has the best mortality benefit to Low EF CHF?

A

ACEi/ARBs

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17
Q

What do you combine with hydralazine and why?

A

Nitrates –> dilate coronary As so blood is not stolen away when after load is decreased

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18
Q

What is the most common adverse affect of statins?

A

Liver dysfunction

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19
Q

What are the adverse effects of Niacin?

Any positives?

A

Increased glucose, increase Uric acid, pruritus

Increased HDL

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20
Q

What are the adverse effects of Fibrates?

Any positives?

A

Myositis risk with statins

Lower TGs

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21
Q

What are the adverse effects of cholestyramine?

A

Significant interactions with other meds, flatus/cramping

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22
Q

What are the adverse effects of Ezetimibe?

A

It is useless (though it does lower LDL)

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23
Q

What is the association of Ca Channel blockers and CAD?

Who are the exceptions and what drugs?

A

May increase mortality (reflex tach)

Verapamil/Dilt –> severe asthma pts who can’t use BBlockers, prinzmetal angina, Cochin induced chest pain

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24
Q

When does CABG lower mortality?

A

3 vessels of >70% stenosis
L Main occlusion
2 vessels + DM
Persistent Sx despite max medical therapy

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25
Q

How long do the 2 types of graft last in a CABG?

A

Mammary A: 10 years

Saphenous V: 5 years

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26
Q

What heart sound is associated with ACS and why?

A

S4 gallop

Ischemia causes LV noncompliance

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27
Q

What is kussmaul sign and what is it associated with?

A

Increased JVD on inhalation

Constrictive pericarditis > restrictive CM

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28
Q

What is a displaced PMI characteristic of?

A

LVH

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29
Q

EKG finding of anterior wall MI

A

ST elevation in V2-V4

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30
Q

EKG finding of the inferior wall

A

ST elevation in II, III, aVF

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31
Q

EKG finding of 1st degree AV block

A

PR >200mSec

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32
Q

EKG findings of posterior wall MI

A

ST depression in V1 and V2

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33
Q

What is the first drug to administer in an acute MI patient because it lowers mortality?
What are the next 3 drugs?

A

ASA

Morphine + O2 + Nitroglycerin

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34
Q

What are 3 drugs given to MI patients that are not time sensitive?

A

Metoprolol
ACEi
Station

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35
Q

What disease can cause a false positive troponin and why?

A

Renal insufficiency

Troponin excreted by the kidney

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36
Q

What are the 2 steps for a patient who has a suspected reinfarction a few days after their MI

A

1) EKG
2) CKMB
* 3) transfer to ICU

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37
Q

How much time should elapse to giving PCI in an MI?

How is restenosis prevented?

A

90 minutes

Drug eluding stent (Paclitaxel, Sirolimus)

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38
Q

When is heparin useful with regards to ACS?

A

ST depression and other NSTEMI events

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39
Q

When are Cannon A waves seen?

What are they?

A

3rd degree AV block

Atrial systole against the tricuspid valve (which is closed)

40
Q

How is symptomatic Brady treated?

A

1) atropine –> pacemaker if necessary

41
Q

What are the findings in RV in fact?
What is most specific?
How do you treat these?
What do you avoid?

A

Tachy
ST elevation in V4
High volume fluid replacement
Nitroglycerin (worsens cardiac filling)

42
Q

What are 3 clues of post MI valve or septal rupture?

A

Step up in O2 SATs from RA to RV
New onset mitral regurg murmur
Pulmonary congestion

43
Q

When is an intraaortic balloon pump used?

A

Bridge to valve replacement for

44
Q

What are 2 diagnoses if there is a sudden loss of pulse with JVD?

A

Tamponade

Wall rupture

45
Q

What are the meds that a post infarct patient goes home with?

A

ASA
Metoprolol
Statin
ACEi

46
Q

What 3 diseases cause >95% of Systolic dysfunction CHF

A

Infarct
CM
Valve disease

47
Q

What heart sound is associated with CHF

A

S3 gallop

48
Q

What is the most important test in CHF (also initial)?

What is the most accurate test for CHF?

A

TTE

MUGA

49
Q

What can you use a Swan Ganz catheter to distinguish?

A

CHF and ARDS

50
Q

What thyroid disorders can cause CHF?

A

Both high and low ;)

51
Q

What is the most common cause of death from CHF?

A

Arrhythmia leading to sudden death

52
Q

What are 5 drugs classes used in low EF CHF and why?

A

ACEi/ARB: all
BBlocker (Metoprolol/Bisprolol/Carvedilol): all
Spironolactone: class 3+ –> Eplerenone if gynecomastia
Diuretics: initial Sx control
Digoxin: controls Sx but NO MORTALITY BENEFIT

53
Q

What are 2 non medicine treatments for CHF with mortality benefit?

A

Defibrillator (ischemic CM + EF 120)

54
Q

What is a good treatment in Preserved EF CHF?

What is bad?

A 
Beta Blockers (diuretics if Sx but no HCM)
Digoxin, Spironolactone
55
Q

Initial therapy for acute pulmonary edema?

2 tests to do afterward?

A

IV Furosemide

EKG + ECHO

56
Q

_____ _____ have basically never had MIs

A

Menstruating women

57
Q

What is the most common valve disease of rheumatic fever?

A

Mitral stenosis

58
Q

What valve disease is associated with aging?

A

Aortic stenosis

59
Q

What side of the heart valvular lesions increase on inhalation? Why?

A

Right side –> increased venous return

60
Q

What side of the heart lesions increase with exhaling? Why?

A

Left –> squeezes blood from the lungs into the heart

61
Q

What is the best initial and accurate tests for valvular heart disease?

A

Initial: ECHO (TEE > TTE)
Accurate: catheterization

62
Q

What do you look for to determine if a valve replacement will be helpful or not?

A

End diastolic volume (too large: will not be helpful)

63
Q

What are 2 clues to mitral stenosis as the diagnosis?

A

Pregnancy (increased plasma V squeezing through stenosed valve)
Immigrant (not immunized)

64
Q

What are 4 unique features of Mitral Stenosis?

A

Dysphagia (LA presses on esophagus)
Hoarseness (LA on laryngeal N)
Afib (+ stroke due to enormous LA)
Hemoptysis

65
Q

What is the heart murmur of mitral stenosis? What changes it?

A

Diastolic right after opening snap

Squatting + leg raise increase intensity (increase V return)

66
Q

What are the steps to treat mitral stenosis?

A

1) diuretics/Na restriction
2) balloon valvuloplasty –> valve replaced if needed
3) Warfarin for afib to 2-3
4) Rate control (dig/BBlock/CCB)

67
Q

What is the most common and 2nd most common presentation of AS?

A

Angina > syncope

68
Q

What is the murmur of AS?

A

Systolic crescendo decrescendo radiating to the carotid
Valsalva, Standing: soften by decreasing V return
Handgrip: soften by decreasing ejection of blood

69
Q

What is the treatment for AS?

A

Valve replacement

70
Q

What can cause mitral regurg?

How does it present?

A

Any reason for heart dilation
Holosystolic radiating to the axilla
Handgrip: Increases (increases afterload)
Squatting, leg raise: increase (increased V return)

71
Q

What are some unique findings of Aortic Regurg?

What is the murmur?

A

Wide pulse P, Water Hammer bounding pulse, Pulsing nail bed, BP in legs 40mg>arm, head bobbing
Diastolic decrescendo in LLSB
Valsalva, Standing: improve
Handgrip: worsens (increases afterload by compressing arm As)

72
Q

What is the most common presentation of MVP?

A

Nothing!

But also atypical chest pain, palpitations, panic attack

73
Q

What is the murmur in MVP?

A

Midsystolic click
Valsalva, Standing: worsen MVP (decrease venous return)
Squatting, handgrip: improve murmur (increase LV size)

74
Q

CM presentation?
Initial test?
Accurate test?
Treatment?

A

Shortness of breath
ECHO
ECHO
Diuretics

75
Q

What 2 murmurs do not increase with expiration?

A

HCM

MVP

76
Q

What valvular finding is classic for HOCM?

A

Systolic anterior motion of the mitral valve

77
Q

What is the treatment of HCM and HOCM?

A

1) BBlock
2) negative ionotropes (Verapamil, Disopyramide)
3) Diuretics for HCM but NOT for HOCM

78
Q

What is the best initial test of RCM?

Accurate?

A

ECHO

Endomyocardial biopsy

79
Q

What is the result of standing suddenly?

A

open venous capacitance vessels in legs

80
Q

What is the result of a valsalva?

A

1) increased intrathoracic P

2) decreased V return to R side of the heart

81
Q

Which are the murmurs that improve with more blood?

A

MVP

HOCM

82
Q

What happens with the handgrip?

A

1) Arm As are compressed

2) increased afterload because heart cannot empty

83
Q

What does Amyl Nitrate do to murmurs?

A

1) direct A vasodilator
2) stimulates the effect of ACEis/ARBs
3) emptier LV

84
Q

What is the treatment for idiopathic pericarditis?

A

NSAIDs + Colchicine (decrease recurrence)

85
Q

What are signs of pericardial tamponade?

A

HypoTN
Tachy
Distended neck Vs
Clear lungs

86
Q

What are 2 classic signs of constrictive pericarditis?

A

Kussmaul sign: increase in JVD on inhalation (should decrease)
Knock: heart fills to its maximum

87
Q

What is the best initial test for constrictive pericarditis?
Accurate?
Additional?

A

CXR
CT/MRI (not needed if CXR done first)
ECHO

88
Q

What is the classic symptom of PAD?

What is different in spinal stenosis?

A

Leg pain in the calves on exertion improving with rest

SS is worse walking down hills because you lean back

89
Q

What is the best initial test for PAD?

Accurate?

A

ABI (

90
Q

What are the treatments of PAD?

A

ASA
Smoking cessation
Cilostazol

91
Q

What 3 things do you control in major vascular disease?

A

BP

LDL

92
Q

What is the initial test for Aortic Dissection?

Accurate?

A

CXR

Angiography

93
Q

What are 2 findings in aortic dissection?

A

Pain between the scapulae

Difference in BP between the arms

94
Q

What are the treatment steps for aortic dissection?

A

1) BBlock
2) Nitroprusside (must BB first to prevent reflex tach)
3) surgery

95
Q

Who is screened for AAA?

A

Men who ever smoked >65

96
Q

What is the most dangerous heart disease in a pregnant woman?

A 
Peripartum CM (reversible LV dysfunction usually but if not may need a heart transplant)
Typically develops after pregnancy!

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