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1
Q

GI disorders assc with chest pain

A
  • duodenitis
  • cholelithiasis
  • ulcers
  • gastritis
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2
Q

Worst risk factor for CAD? Most common?

A

Worst- DM

MC- HTN

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3
Q

Age assc with CAD in men vs women?

A

45 men 55 women

this is why lipids at 35 and 45

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4
Q

Most dangerous portion of lipid profile

A

high LDL (more impactful than obesity itself)

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5
Q

When is fam hx CAD relevant?

A

FIRST DEGREE, EARLY MI (65 woman, 55 male)

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6
Q

“Tako Tsubo”/ Broken heart syndrome pathogenesis and key findings

A

catechol surg; ballooning of LV

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7
Q

Which lifestyle change has the most immediate effect on CAD risk

A

smoking cessation

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8
Q

What pains are abnormal for ACS?

A

sharp/stabbing/ knifelike

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9
Q

Chest pain worst when lying flat is ___? How to dx?

A

Pericarditis

EKG (Diffuse STE, PRD)

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10
Q

Epigastric pain worst BETTER WITH FOOD

A

duodenal ulcer

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11
Q

Chest pain with fever =

A

PE or PNA

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12
Q

Max heart rate

A

220- age patient

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13
Q

Appearance of CAD on nuclear scan?

A

decreased thallium uptake

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14
Q

Reversible ischemia present on stress NBS

A

angiography –> plasty/ surgery

*NOTE YOU CAN DO NOTHING ABOUT FIXED LESIONS!

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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)

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16
Q

To correct stenosis must be at least ____%

A

70%

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17
Q

Medications for stable CAD?

A 
BBer *
ASA*
ACEi
Statin
NG PRN

*lower mortality

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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
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19
Q

When should ACEi be used?

A
  • Low EF/Systolic Dysfunction

- Valvular Regurg

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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

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21
Q

ADRs of statins + which is MC?

A
  • # 1: transamintitis
  • myositis
  • CPK ^
  • rhabdo
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22
Q

Why is statin therapy superior to others?

A

largest mortality decrease, antioxidant effect on endothelial lining of arteries

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23
Q

Niacin ADRs

A

flushing, glucose/uric acid ^^

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24
Q

Fibrate ADRs

A

increased risk myositis when added to statins

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25
Q

Colestyramine ADRs

A
  • flatulence/bloating

- can decrease absorption of other meds

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26
Q

Ezetimibe ADRs

A

actually well tolerated but doesn’t work worth a shit

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27
Q

Effect of CCBs on mortality in CAD?

A

actually increases due to reflex tachycardia so do not routinely use

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28
Q

ADRs of CCBs

A

edema
constipation
heart block

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29
Q

Indications for CABG

A
  • 3 vessel disease
  • 2 vessel disease +DM
  • Left Main occlusion
  • Persistent symptoms despite max therapy
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30
Q

Which veins are used for bypass? how long do they last?

A

IMA- 10 years

Saphenous- 5 years

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31
Q

Why is S4 heard in ACS?

A

Ischemia –> noncompliant left ventricle

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32
Q

MI location with highest mortality rate?

A

anterior wall (V2-4)

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33
Q

Increased JVD on inhalation is _____ sign?

When is it seen?

A

Kussmal

Constrictive pericarditis

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34
Q

Triphasic scratchy sound is _____ assc with ____

A

friction rub, pericarditis

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35
Q

A decrease in BP more than 10mg on inspiration is _____ assc with _____.

A

pulsus paradoxus; tamponade

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36
Q

Drug that is most important to give immediately in ACS to lower mortality (while activating cath lab)

A

ASA

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37
Q

Which management should always be “NBS” in ACS?

A

whatever lowers mortality

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38
Q

How long from MI does it take for troponin to rise?

A

4- 6 hours

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39
Q

Appropriate door to balloon time? Door to needle? (thrombolytics)

A

90 mins; 30 mins

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40
Q

What best prevents restenosis following angioplasty?

A

drug eluting stent

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41
Q

Contraindications to thrombolytics?

What to do if pt has these?

A

CNS/GI bleed, surg last two weeks, stroke last 6months, BP 180/110

*Transfer for angioplasty even if will be more than 90 mins

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42
Q

When are GPIIB/IIIA inhibitors used?

abciximab, tirofiban, eptifibatide

A

stenting; NSTEMI not STEMI

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43
Q

When is heparin used in ACS?

A

NSTEMI

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44
Q

Drugs given in case of NSTEMI

A

1-2) ASA, antiplatelet
3) BBer
4) Nitrate, morphine, O2
5-6) Heparin, GPIIBIIIAI

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45
Q

Drugs given in case of STEMI

A

1) ASA, Statin
2) BBer
3) Thrombolytics –> heparin or stenting
4) statin
5) morphine, nitrates, o2

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46
Q

Clue to right ventricular infarct?

A

Inferior MI’s (leads II,III,avf)
Clear lungs
STE in RV4

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47
Q

Special treatment for RVI

A

no nitro

extra fluids

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48
Q

How does 3AV block assc with MI present?

A

cannon A waves

symptomatic bradycardia

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49
Q

Presentation of tamponade/wall rupture post MI

A

sudden loss of pulse, JVD

several days after the original MI

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50
Q

Presentation of valve or septal rupture post MI?

How to dx?

A

new onset murmur
pulm congestion

need echo

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51
Q

Purpose of intraaortic balloon pump

A

bridges to surg in anatomic lesion… 24-48 hours

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52
Q

Management of post MI mural thrombus

A

heparin –> warfarin

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53
Q

Testing prior to discharge from hospital for MI patient

A

stress –> angiography if needed

54
Q

BBer typically used postMI

A

metoprolol

55
Q

When to use prophylactic antiarrythmics

A

don’t… that’s stupid.

56
Q

Causes of ED post MI

A

anxiety, BBer

57
Q

In which CHF type is ejection fraction preserved?

A

diastolic

58
Q

3 MCC CHF

A

MI
cardiomyopathy
valve disease

59
Q

Difference between asthma exacerbation and PE

A

lungs clear in PE

60
Q

Circumoral numbness and chest pain is assc with?

A

panic attack

61
Q

S3 sound? S4

A

S3 Ken-tuc-KY

S4 TEN-ne-see

62
Q

Why to do CBC in case of CHF

A

R/O anemia as a cause

63
Q

Meds for systolic heart failure

A

ACE/ARB
BBer
Diuretics

Dig PRN 
Spironolactone (class III, IV)
64
Q

BBers that are appropriate for CHF

A

metoprolol (B1)
bisoprolol (B1)
carvedilol (a1, B1)

65
Q

Most common cause of death from CHF

A

arrhythmia

66
Q

Alternative to ACEi in case of hyperkalemia

A

hydral + nitrate

67
Q

What drugs have mortality benefit in systolic dysfunction

A 
ACEi 
BBer
Spironolactone 
Defibrillator 
hydral, nitrates in AA
68
Q

When is an implantable defibrillator appropriate for CHF

A

ischemic cardiomyopathy

EF less than 35%

69
Q

When is a biventricular pacer appropriate treatment for CHF

A

EF under 35%

QRS more than 120 ms

70
Q

Only two drugs that are clearly beneficial in diastolic heart failure

A

BBer

diuretics

71
Q

Drugs that are harmful in diastolic heart failure

A

Dig

spiro

72
Q

Heart sound assc with pulmonary edema

A

S3

73
Q

Metabolic changes assc with CHFE

A

until very severe, respiratory alkalosis due to severe hyperventilation

74
Q

Management of acute pulm edema

A
  • ->EKG, if arrhythmia (ie afib or flutter)-cardiovert
  • -> no arrhythmia, diuretics
    all: echo +O2/morphine/nitrates but do above first
75
Q

Why is dig not helpful in acute setting?

A

takes effect weeks after starting

76
Q

Causes of regurgitant heart disease

A

ischemic heart disease

hypertension

77
Q

Which murmurs increase with inhalation

A

right sided

78
Q

Treatment of stenotic valvular disease

A

mitral- balloon

aortic- replace

79
Q

Treatment of regurgitant disease

A

vasodilators –> if end systolic diameter ^^ need to replace before its too late, also replace if acute

80
Q

Unique features (symptoms) of mitral stenosis

A
  • afib
  • hoarseness/dysphagia from big LA
  • hemoptysis
81
Q

Mitral stenosis

murmur and EKG findings

A
  • biphasic P wave in leads V1-2 (m wave)

- diastolic, opening snap

82
Q

Two causes AS

A

congenital bicuspid valve

aging- calcification

83
Q

What decreases the intensity of AS murmur

A

standing, Valsalva

worse with handgrip, squatting

84
Q

Acute causes of mitral regurg or aortic regurg

A
  • MI (pap muscle rupture)

- endocarditis

85
Q

Murmur of MR

A

holosystolic

86
Q

Appropriate vasodilators for regurgitant valve disease

A

ACE/ ARBs best

87
Q

Syndromes/ diseases assc with aortic regurg (4)

A
  • marfans
  • ank spon
  • reiter
  • syphilis
88
Q

Unique symptoms of AR murmur

A

head bob
pulsating finger nails
high pressure in legs
wide pulse pressure

89
Q

Symptoms of MVP

A

palpitations, panic attack

90
Q

Murmur of MVP

A

midsytolic click –> MR murmur

91
Q

Most murmurs are ______ with standing. ____ and _____ are _____ with standing.

A

most- decrease with standing and Valsalva

MVP and HOCM- WORSE with standing and Valsalva, better with squatting

92
Q

MVP treatment

A

BBer if symptomatic

93
Q

Dilated and Hypertoropic Cardiomyopathy are treated with _____.

A

diuretics … NOT HOCM though!

94
Q

Dilated cardiomyopathy is treated with?

A

see systolic CHF

ACE, BBer, Diuretic, +/-spiro/dig

95
Q

In addition to MI/ischemia what are some of the weirdo causes of dilated cardiomyopathy

A
  • alcohol
  • virus, Chagas
  • rads, doxo
96
Q

Special PE finding assc with Hypertrophic Cardiomyopathy

A

S4 (stiff ventricle)

97
Q

What is far and away the most common cause of HCM?

A

HTN

98
Q

What worsens hOcm

A

ACE/ARB, dig, hydral, stress and high HR

99
Q

Best initial therapy for both HCOM and HCOM

A

BBer

100
Q

____ are helpful in HCM but harmful in HCOM.

A

diuretics

101
Q

Treatment for diastolic/hypertrhopic cardiomyopathy

A

bber, diuretics

102
Q

Treatment for systolic/ dilated heart failure

A

bber, ace, diuretics +/- spiro and dig

103
Q

Specific therapies for HOCM

A

implantable defibrillator if syncope

ablation of septum/ myometctomy

104
Q

EKG findings with HOCM

A

inferior and lateral Q waves

and LVH

105
Q

Restrictive cardiomyopathy is ____ + ____

A

dilated + hypertrophic CM

106
Q

Causes of restrictive cardiomyopathy

A
  • hemochromatosis
  • sarcoid
  • amyloid
  • fibrosis/ scleroderma
107
Q

Common PE finding with restrictive CM

A

Kussmal (JVD with inspiration)

108
Q

Treatment of restrictive CM

A

only diuretics may help. no other clear treatment.

109
Q

Maneuvers that decrease MVP and HOCM

A

squatting
handgrip
leg reaise

110
Q

Maneuvers that increase MVP and HOCM

A

standing

Valsalva

111
Q

Standing and Valsalva are = to what medication

A

diuretics; less blood helps everything except MVP and HOCM

112
Q

What valvular disease follows trends of HOCM/ MVP in case of only handgrip/amyl nitrate

A

AS

113
Q

What murmurs are increased by amyl nitrate?

A

MVP, HOCM, AS

because empties left ventricle

114
Q

Amyl nitrate is equal to

A

ACE/ ARB (which treat regurgitant lesions by decreasing blood amount!)

115
Q

Handgrip = ____ blood. Amyl nitrate = _____ blood.

A

hangrip more. amyl less.
less better for regurgitation
more better for MVP, HOCM, AS

116
Q

Three pericardial diseases that are closely linked

A

pericarditis, tamponade, constrictive pericarditis

117
Q

MC infection causing periocarditis? Most common CT disorder?

A

virus–coxsackie; lupus

118
Q

EKG finding in pericarditis

A

diffuse STE and PRD

*PRD more specific

119
Q

What decreases recurrence of pericarditis?

A

colchicine, but NSAIDs treat acutely.

Can give both.

120
Q

Risk assc with pericarditis

A

tamponade

121
Q

PE finding most likely assc with tamponade?

A

pulsus paradoxus. BP down 10 with inspiration

also JVD, low bp, tachy, clear lungs because no blood to lungs

122
Q

Best dx tool for tamponade

A

echo

123
Q

EKG finding in tampoande

A

electrical alternans

124
Q

Constrictive pericarditis- best PE clues x2 + dx

A

“knock” + ^^JVD when INHALING (Kussmal); calcification on xray

125
Q

Treatment of constrictive pericarditis

A

diuretics –> surgery

126
Q

Clue to spinal stenosis

A

worse when walking downhill

127
Q

Most effective medication for treating PAD

A

cilostazol

128
Q

Best test for dissection

Initial test for dissection

A

best- angio

initial- cxr

129
Q

Who to screen for AAA

A

men who ever smoked above age 65

130
Q

Treatment of aortic dissection:

A

BBer
Nitroprusside
Surgery

131
Q

Treatment of peripartum cardiomyopathy

A

same as dilated/systolic therapy

Step 2 CK (8 decks)

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