Cards Flashcards
1
Q
GI disorders assc with chest pain
A
- duodenitis
- cholelithiasis
- ulcers
- gastritis
2
Q
Worst risk factor for CAD? Most common?
A
Worst- DM
MC- HTN
3
Q
Age assc with CAD in men vs women?
A
45 men 55 women
this is why lipids at 35 and 45
4
Q
Most dangerous portion of lipid profile
A
high LDL (more impactful than obesity itself)
5
Q
When is fam hx CAD relevant?
A
FIRST DEGREE, EARLY MI (65 woman, 55 male)
6
Q
“Tako Tsubo”/ Broken heart syndrome pathogenesis and key findings
A
catechol surg; ballooning of LV
7
Q
Which lifestyle change has the most immediate effect on CAD risk
A
smoking cessation
8
Q
What pains are abnormal for ACS?
A
sharp/stabbing/ knifelike
9
Q
Chest pain worst when lying flat is ___? How to dx?
A
Pericarditis
EKG (Diffuse STE, PRD)
10
Q
Epigastric pain worst BETTER WITH FOOD
A
duodenal ulcer
11
Q
Chest pain with fever =
A
PE or PNA
12
Q
Max heart rate
A
220- age patient
13
Q
Appearance of CAD on nuclear scan?
A
decreased thallium uptake
14
Q
Reversible ischemia present on stress NBS
A
angiography –> plasty/ surgery
*NOTE YOU CAN DO NOTHING ABOUT FIXED LESIONS!
15
Q
Options for stress tests
A
1) Exercise + EKG
2) Exercise + Thallium or Echo (for abnl EKG)
3) Diypridamole + Thallium or Dobutamine + echo (for intability to exercise)
16
Q
To correct stenosis must be at least ____%
A
70%
17
Q
Medications for stable CAD?
A
BBer * ASA* ACEi Statin NG PRN
*lower mortality
18
Q
ASA should be used in all stable CAD/angina…
When should second antiplatelet agent (ie clopidogrel) be added?
A
- Acute ACS
- Recent Stenting
- In place of ASA if intolerant
19
Q
When should ACEi be used?
A
- Low EF/Systolic Dysfunction
- Valvular Regurg
20
Q
When to use statins?
A
All CAD patients on statins, get LDL at least below 100
Also use for CAD equivalents (Stroke, carotid disease, PAD, DM, aortic disease)
Also use for hyperlidipemia
21
Q
ADRs of statins + which is MC?
A
- # 1: transamintitis
- myositis
- CPK ^
- rhabdo
22
Q
Why is statin therapy superior to others?
A
largest mortality decrease, antioxidant effect on endothelial lining of arteries
23
Q
Niacin ADRs
A
flushing, glucose/uric acid ^^
24
Q
Fibrate ADRs
A
increased risk myositis when added to statins
25
Colestyramine ADRs
- flatulence/bloating
| - can decrease absorption of other meds
26
Ezetimibe ADRs
actually well tolerated but doesn't work worth a shit
27
Effect of CCBs on mortality in CAD?
actually increases due to reflex tachycardia so do not routinely use
28
ADRs of CCBs
edema
constipation
heart block
29
Indications for CABG
- 3 vessel disease
- 2 vessel disease +DM
- Left Main occlusion
- Persistent symptoms despite max therapy
30
Which veins are used for bypass? how long do they last?
IMA- 10 years
| Saphenous- 5 years
31
Why is S4 heard in ACS?
Ischemia --> noncompliant left ventricle
32
MI location with highest mortality rate?
anterior wall (V2-4)
33
Increased JVD on inhalation is _____ sign?
| When is it seen?
Kussmal
| Constrictive pericarditis
34
Triphasic scratchy sound is _____ assc with ____
friction rub, pericarditis
35
A decrease in BP more than 10mg on inspiration is _____ assc with _____.
pulsus paradoxus; tamponade
36
Drug that is most important to give immediately in ACS to lower mortality (while activating cath lab)
ASA
37
Which management should always be "NBS" in ACS?
whatever lowers mortality
38
How long from MI does it take for troponin to rise?
4- 6 hours
39
Appropriate door to balloon time? Door to needle? (thrombolytics)
90 mins; 30 mins
40
What best prevents restenosis following angioplasty?
drug eluting stent
41
Contraindications to thrombolytics?
| What to do if pt has these?
CNS/GI bleed, surg last two weeks, stroke last 6months, BP 180/110
*Transfer for angioplasty even if will be more than 90 mins
42
When are GPIIB/IIIA inhibitors used?
| abciximab, tirofiban, eptifibatide
stenting; NSTEMI not STEMI
43
When is heparin used in ACS?
NSTEMI
44
Drugs given in case of NSTEMI
1-2) ASA, antiplatelet
3) BBer
4) Nitrate, morphine, O2
5-6) Heparin, GPIIBIIIAI
45
Drugs given in case of STEMI
1) ASA, Statin
2) BBer
3) Thrombolytics --> heparin or stenting
4) statin
5) morphine, nitrates, o2
46
Clue to right ventricular infarct?
Inferior MI's (leads II,III,avf)
Clear lungs
STE in RV4
47
Special treatment for RVI
no nitro
| extra fluids
48
How does 3AV block assc with MI present?
cannon A waves
| symptomatic bradycardia
49
Presentation of tamponade/wall rupture post MI
sudden loss of pulse, JVD
| several days after the original MI
50
Presentation of valve or septal rupture post MI?
| How to dx?
new onset murmur
pulm congestion
need echo
51
Purpose of intraaortic balloon pump
bridges to surg in anatomic lesion... 24-48 hours
52
Management of post MI mural thrombus
heparin --> warfarin
53
Testing prior to discharge from hospital for MI patient
stress --> angiography if needed
54
BBer typically used postMI
metoprolol
55
When to use prophylactic antiarrythmics
don't... that's stupid.
56
Causes of ED post MI
anxiety, BBer
57
In which CHF type is ejection fraction preserved?
diastolic
58
3 MCC CHF
MI
cardiomyopathy
valve disease
59
Difference between asthma exacerbation and PE
lungs clear in PE
60
Circumoral numbness and chest pain is assc with?
panic attack
61
S3 sound? S4
S3 Ken-tuc-KY
| S4 TEN-ne-see
62
Why to do CBC in case of CHF
R/O anemia as a cause
63
Meds for systolic heart failure
ACE/ARB
BBer
Diuretics
```
Dig PRN
Spironolactone (class III, IV)
```
64
BBers that are appropriate for CHF
metoprolol (B1)
bisoprolol (B1)
carvedilol (a1, B1)
65
Most common cause of death from CHF
arrhythmia
66
Alternative to ACEi in case of hyperkalemia
hydral + nitrate
67
What drugs have mortality benefit in systolic dysfunction
```
ACEi
BBer
Spironolactone
Defibrillator
hydral, nitrates in AA
```
68
When is an implantable defibrillator appropriate for CHF
ischemic cardiomyopathy
| EF less than 35%
69
When is a biventricular pacer appropriate treatment for CHF
EF under 35%
| QRS more than 120 ms
70
Only two drugs that are clearly beneficial in diastolic heart failure
BBer
| diuretics
71
Drugs that are harmful in diastolic heart failure
Dig
| spiro
72
Heart sound assc with pulmonary edema
S3
73
Metabolic changes assc with CHFE
until very severe, respiratory alkalosis due to severe hyperventilation
74
Management of acute pulm edema
- ->EKG, if arrhythmia (ie afib or flutter)-cardiovert
- -> no arrhythmia, diuretics
all: echo +O2/morphine/nitrates but do above first
75
Why is dig not helpful in acute setting?
takes effect weeks after starting
76
Causes of regurgitant heart disease
ischemic heart disease
| hypertension
77
Which murmurs increase with inhalation
right sided
78
Treatment of stenotic valvular disease
mitral- balloon
| aortic- replace
79
Treatment of regurgitant disease
vasodilators --> if end systolic diameter ^^ need to replace before its too late, also replace if acute
80
Unique features (symptoms) of mitral stenosis
- afib
- hoarseness/dysphagia from big LA
- hemoptysis
81
Mitral stenosis
| murmur and EKG findings
- biphasic P wave in leads V1-2 (m wave)
| - diastolic, opening snap
82
Two causes AS
congenital bicuspid valve
| aging- calcification
83
What decreases the intensity of AS murmur
standing, Valsalva
| worse with handgrip, squatting
84
Acute causes of mitral regurg or aortic regurg
- MI (pap muscle rupture)
| - endocarditis
85
Murmur of MR
holosystolic
86
Appropriate vasodilators for regurgitant valve disease
ACE/ ARBs best
87
Syndromes/ diseases assc with aortic regurg (4)
- marfans
- ank spon
- reiter
- syphilis
88
Unique symptoms of AR murmur
head bob
pulsating finger nails
high pressure in legs
wide pulse pressure
89
Symptoms of MVP
palpitations, panic attack
90
Murmur of MVP
midsytolic click --> MR murmur
91
Most murmurs are ______ with standing. ____ and _____ are _____ with standing.
most- decrease with standing and Valsalva
| MVP and HOCM- WORSE with standing and Valsalva, better with squatting
92
MVP treatment
BBer if symptomatic
93
Dilated and Hypertoropic Cardiomyopathy are treated with _____.
diuretics ... NOT HOCM though!
94
Dilated cardiomyopathy is treated with?
see systolic CHF
| ACE, BBer, Diuretic, +/-spiro/dig
95
In addition to MI/ischemia what are some of the weirdo causes of dilated cardiomyopathy
- alcohol
- virus, Chagas
- rads, doxo
96
Special PE finding assc with Hypertrophic Cardiomyopathy
S4 (stiff ventricle)
97
What is far and away the most common cause of HCM?
HTN
98
What worsens hOcm
ACE/ARB, dig, hydral, stress and high HR
99
Best initial therapy for both HCOM and HCOM
BBer
100
____ are helpful in HCM but harmful in HCOM.
diuretics
101
Treatment for diastolic/hypertrhopic cardiomyopathy
bber, diuretics
102
Treatment for systolic/ dilated heart failure
bber, ace, diuretics +/- spiro and dig
103
Specific therapies for HOCM
implantable defibrillator if syncope
| ablation of septum/ myometctomy
104
EKG findings with HOCM
inferior and lateral Q waves
| and LVH
105
Restrictive cardiomyopathy is ____ + ____
dilated + hypertrophic CM
106
Causes of restrictive cardiomyopathy
- hemochromatosis
- sarcoid
- amyloid
- fibrosis/ scleroderma
107
Common PE finding with restrictive CM
Kussmal (JVD with inspiration)
108
Treatment of restrictive CM
only diuretics may help. no other clear treatment.
109
Maneuvers that decrease MVP and HOCM
squatting
handgrip
leg reaise
110
Maneuvers that increase MVP and HOCM
standing
| Valsalva
111
Standing and Valsalva are = to what medication
diuretics; less blood helps everything except MVP and HOCM
112
What valvular disease follows trends of HOCM/ MVP in case of only handgrip/amyl nitrate
AS
113
What murmurs are increased by amyl nitrate?
MVP, HOCM, AS
| because empties left ventricle
114
Amyl nitrate is equal to
ACE/ ARB (which treat regurgitant lesions by decreasing blood amount!)
115
Handgrip = ____ blood. Amyl nitrate = _____ blood.
hangrip more. amyl less.
less better for regurgitation
more better for MVP, HOCM, AS
116
Three pericardial diseases that are closely linked
pericarditis, tamponade, constrictive pericarditis
117
MC infection causing periocarditis? Most common CT disorder?
virus--coxsackie; lupus
118
EKG finding in pericarditis
diffuse STE and PRD
| *PRD more specific
119
What decreases recurrence of pericarditis?
colchicine, but NSAIDs treat acutely.
| Can give both.
120
Risk assc with pericarditis
tamponade
121
PE finding most likely assc with tamponade?
pulsus paradoxus. BP down 10 with inspiration
| also JVD, low bp, tachy, clear lungs because no blood to lungs
122
Best dx tool for tamponade
echo
123
EKG finding in tampoande
electrical alternans
124
Constrictive pericarditis- best PE clues x2 + dx
"knock" + ^^JVD when INHALING (Kussmal); calcification on xray
125
Treatment of constrictive pericarditis
diuretics --> surgery
126
Clue to spinal stenosis
worse when walking downhill
127
Most effective medication for treating PAD
cilostazol
128
Best test for dissection
| Initial test for dissection
best- angio
| initial- cxr
129
Who to screen for AAA
men who ever smoked above age 65
130
Treatment of aortic dissection:
BBer
Nitroprusside
Surgery
131
Treatment of peripartum cardiomyopathy
same as dilated/systolic therapy
