Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Step Up to Medicine - 5th Edition > Ch. 1 - Disease of the Cardiovascular System > Flashcards

Ch. 1 - Disease of the Cardiovascular System Flashcards

1
Q

Normal LV EF?

A

> 50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What 3 medications are typically used for a pharmacologic stress test?

A

IV

  1. adenosine
  2. dipyridamole
  3. dobutamine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the definitive test for CAD?

A

Coronary angiography

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Coronary stenosis >__% may be significant

A

70%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

RIsk factors for CAD?

A
  1. smoking
  2. HTN
  3. Hyperlipidemia
  4. DM
  5. Obesity
  6. lack of exercise
  7. diet high in saturated fat and cholesterol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are 2 drugs administered to patients with stable angina that improve mortality?

A
  1. ASA

2. high intensity statins (or in some cases PCSK9 inhibitor)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are 4 types of drugs that relieve angina?

A

beta blockers
nitrates
calcium channel blockers
ranolazine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are 2 side effects of beta blockers?/

A

Erectile Dysfunction in males

Inability to increase HR in response to exercise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are side effects of Nitrates?

A

headache
orthostatic hypotension
tolerance
syncope

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the treatment for Mild CAD?

normal EF, mild angina, single vessel disease

A

Nitrates + B-blockers (Metoprolol)

+/- CCBs (Verapamil/Diltiazem) if refractory

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the treatment for Moderate CAD?

normal EF, moderate angina, two-vessel disease

A

Nitrates + B-blockers (Metoprolol)
+/- CCBs (Verapamil/Diltiazem) if refractory
AND Consider coronary angiography to assess for need for revascularization (PCI or CABG)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the treatment for Severe CAD?

reduced EF, severe angina, three-vessel disease/left main/LAD disease

A

Coronary angiography to assess for need for CABG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What type of medication MUST be avoided with reduced ejection fractions?

A

CCBs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the indications for CABG?

A

3 vessel disease with >70% stenosis in each vessel

Left main coronary disease with >50% stenosis, left ventricular dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Dual antiplatelet therapy includes ___ and ____

A

ASA 325
and
P2Y12 inhibitor (Clopidogrel, TIcagrelor, or Prasugrel)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How long should DAPT be continued in patients with unstable angina?

A

9-12 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How long should LMWH (Enoxaparin) be continued in patients with unstable angina?

A

at least 48 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

The _____ score can be used to guide the decision on conservative versus more aggressive patients with stable angina.

A

TIMI risk score

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What did the CARE trial demonstrate?

A

Patients with a hx of MI had a 24% reduced risk of death, 31% reduced risk of stroke, and 27% reduced need for CABG or coronary angioplasty if they were started on a statin (regardless of LDL level).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the hallmark of Variant (Prinzmetal) Angina?

Angina classically occurs at ____

A

transient ST-segment elevation (not depression) on ECG during chest pain, which represents transmural ischemia.

night

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the definitive test for Variant (Prinzmetal) Angina?

A

Coronary Angiography

- displays coronary vasospasm when the patient is given IV ergonovine or acetylcholine (to provoke vasoconstriction)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the treatment for Variant (Prinzmetal) Angina?

A

Vasodilators - nitrates and CCBs

and risk factor modification (smoking and lipid lowering)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

MI is associated with a __% mortality rate

A

30%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

MI can be asymptomatic in 1/3 of patients and is more likely in which 4 populations?

A

post-op patients
diabetics
elderly
women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

___ are transmural infarcts

A

STEMI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

___ are subendocardial infarcts (inner 1/3-1/2 of the wall)

A

NSTEMI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Obtain Troponin I or T levels on admission and again every ___ hours for __ to __ hours.

A

every 6 hours

for 18 to 24 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Troponins increase within __ to __ hours and return to normal in __ to __ days

A

3-5 hours

5-14 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

CKMB increases within __ to __ hours and return to normal in __ to __ hours

A

4-8 hours

48-72 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Obtain Troponin I or T levels on admission and again every ___ hours for 24 hours.

A

8

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What 4 agents are the only ones shown to reduce mortality in MI?

A
  1. ASA
  2. Ticagrelor
  3. B-blockers
  4. ACE-inhibitors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is the best statin to start before discharging a STEMI patient?

A

Atorvastatin 80 mg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

The CAPRICORN study showed that ____ reduces the risk of death in patients with post-MI LV dysfunction

A

Carvedilol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is the treatment for a patient with MI?

A
  1. ASA
  2. P2Y12 inhibitor (Clopidogrel, Ticagrelor)
  3. Nitroglycerin
  4. B-blocker (Atenolol or Metoprolol)
  5. ACE-inhibitor
  6. LMWH (Enoxaparin)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

In acute MI, we attempt to get the HR under __ beats per minute with a systolic pressure > __ mm Hg

A

70 BPM

> 90 mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What are absolute contraindications to beta blocker therapy in MI?

A
  • cardiogenic shock
  • active bronchospasm
  • severe bradycardia or heart block greater than 1st degree
  • overt heart failure (including pulmonary edema)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What are absolute contraindications of thrombolytic therapy?

A 
Trauma: recent head trauma or traumatic CPR
Previous stroke
recent invasive procedure or surgery 
dissecting aortic aneurysm
active bleeding or bleeding diathesis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

When is a free wall rupture most likely to occur?

A

90% in first 2 weeks after MI
Most 1-4 days after

(90% mortality rate)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What is the treatment for free wall rupture?

A
  1. hemodynamic stabilization
  2. immediate pericardiocentesis
  3. surgical repair
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

When is a rupture of the interventricular septum most likely to occur?

A

within the first 10 days after MI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What is the treatment for papillary muscle rupture after MI?

A 
emergency surgery for mitral valve replacement
afterload reduction (sodium nitroprusside or intra-aortic balloon pump [IABP])
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What 2 treatments are contraindicated in Acute pericarditis?

A

NSAIDs and corticosteroids

may hinder myocardial scar formation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What is the presentation of Dressler Syndrome, aka postmyocardial infarction syndrome?

A

fever, malaise, pericarditis, leukocytosis, and pleuritis

occurring weeks to months after MI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What is the most effective therapy for Dressler syndrome?

A

ASA

ibuprofen is 2nd best

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What is the initial pharmacological therapy in patient who presents with chest pain?

A

If you suspect cardiac cause of pain, sublingual nitroglycerin is appropriate.
Also give aspirin if the patient does not have a bleeding disorder.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What are the 4 initial steps to managing a patient with chronic stable angina who presents with unstable angina?

A
  1. ECG and cardiac enzymes
  2. ASA
  3. IV Heparin (If not contraindications – active bleeding, recent life threatening bleed)
  4. Admission to hospital for workup (CXR, PE workup etc.)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

In a normal heart, increasing ___ results in greater contractility.

A

preload

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Heart Failure with Reduced Ejection Fraction is defined as an EF of < __%

A

<40%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What are some causes of HFrEF?

A

ischemic heart disease or recent MI
idiopathic
HTN
Myocarditis (postviral, giant cell, autoimmune)
Drugs: alcohol, cocaine, meth, chemo (anthracyclines and trastuzumab)
Infiltrative disease (amyloidosis, sarcoidosis, hemochromatosis, Wilson disease)
Radiation therapy
Thyroid disease
Peripartum cardiomyopathy
Infectious disease (chagas, HIV, endocarditis causing valvular disease)
Valvular heart disease (MR, aortic stenosis or regurg)
High output HF (severe anemia, AV fistulas, pregnancy, severe thiamine deficiency)
Congenital/hereditary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What are some causes of HFdEF?

A

HTN –> myocardial hypertrophy
Valvular heart disease (Mitral stenosis, aortic stenosis or regurg)
Restrictive disease (amyloidosis, sarcoidosis, hemochromatosis in their early phases)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

BNP levels > __ correlate strongly with the presence of decompensated CHF

A

> 100

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

An NT-proBNP < ___ virtually excludes the diagnosis of CHF

A

<300

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

BNP may be falsely __ in obese patients

A

low

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What is a MUGA scan?

A

Multigated Aquisition scan
- radionuclide ventriculography using Technitium-99m
used in assessment of CHF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

What is the usefulness of diuretics in the treatment of CHF?

A

symptomatic relief; no reduction in mortality or improvement in prognosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

What is the #1 treatment for CHF?

A

Lifestyle modifications

  • sodium restriction (<4g/day)
  • fluid restriction (1.5-2L/day)
  • weight loss
  • smoking cessation
  • restrict alcohol use
  • exercise program
  • monitor weight daily to detect fluid accumulation
  • annual influenza and pneumococcal vaccine recommended
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Which diuretics are useful in treatment of CHF symptoms?

A

Loop diuretics: Furosemide (Lasix) – most common
- Bumetanide (Bumex) and torsemide
Thiazide-like diuretics are adjuncts: Metolazone, Chlorthiazide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Which ACE inhibitors for CHF have been proven to improve outcomes?

A

enalapril, lisinopril, captopril

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Which beta blockers for CHF have been proven to improve outcomes?

A

Metoprolol succinate
Carvedilol
Bisoprolol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Which aldosterone antagonists for CHF have been proven to improve outcomes?

A

spironolactone, epleronone
(if EF <35%)
*** spironolactone is contraindicated in renal failure (Cr > 2)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

In CHF patients with an EF less than __%, primary prevention of sudden cardiac death with ICD implantation is recommended

A

35

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

What is a good combination therapy for African American patients with HFrEF?

A

Hydralazine and nitrates (isosorbide dinitrate)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

What medication can be added to a patient’s therapy that is maxed out on ACEi or ARB with an EF of <35%?

A

Sacubatril/valsartan

- angiotensin/neprilysin inhibitor (ARNI)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

What medications are proven to improve mortality in patients with HFpEF?

A

none

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

What is the treatment for Mild CHF (NYHA Classes I to II)?

A
  • restriction of sodium intake and physical activity
  • ACE-inhibitor
  • start loop diuretic if volume overload or pulmonary congestion is present
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

What is the treatment for Moderate CHF (NYHA Classes II to III)?

A
  • ACE-inhibitor
  • loop diuretic
  • add B-blocker if response to above is suboptimal
    (also reduces mortality)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

What is the treatment for Severe CHF (NYHA Classes III to IV)?

A
  • ACE-inhibitor
  • loop diuretic
  • Can add digoxin (for sx relief; takes several weeks to work)
  • Add spironolactone or epleronone if EF <35%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

What is the mechanism of action of ACE-inhibitors?

A

Cause venous and arterial dilation, decreasing preload and afterload and thus blood pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

When starting ACE-inhibitors, what 3 things must you monitor?

A

BP, potassium, and creatinine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

What is the treatment for Afib in a hemodynamically unstable patient?

A

immediate electrical cardioversion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

What is the treatment for Afib in a hemodynamically STABLE patient?

A

rate control with B-blockers (preferred over CCBs)
Then,
If new (<48 hrs), Cardiovert.

If old (>48 hrs), TEE to determine if thrombus in left atrium... 
If no--cardiovert. If yes, anticoagulate for 3 weeks then cardiovert.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

what is the target rate for rate control in hemodynamically stable Afib patient?

A

Rate <110 BPM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

What medications are contraindicated in patients with CHF?

A

Metformin
Thiazolidinediones
NSAIDs
some antiarrhythmic agents with negative ionotropic effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

The overall 5 year mortality in patients with CHF is about __%.

A

50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

What is the difference between cardioversion and defibrillation?

A

Cardioversion: delivery of a shock that is in synchrony with the QRS complex
- shock is timed NOT to hit the T wave

Defibrillation: delivery of a shock that is NOT in synchrony with the QRS complex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

What is the goal of Cardioversion?

A

to terminate certain dysrhythmias such as PSVT or VT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

What are the indications for cardioversion?

A

AFib
Atrial Flutter
VT with a pulse
SVT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

What is the goal of defibrillation?

A

Convert a dysrhythmia to normal sinus rhythm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

What are the indications for defibrillation?

A

Vfib, VT without a pulse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

What are the 3 treatment goals of Afib?

A
  1. rate control (<110)
  2. assess need for anticoagulation
  3. Rhythm control: restore normal sinus rhythm if first presentation or symptomatic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

What is the ideal medication for treating both Afib and HFrEF?

A

Metoprolol succinate

can also consider digoxin or amiodarone, useful for rhythm control

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

What scoring system can be used to assess risk of stroke in patients with Afib or Atrial flutter?

A

CHA2DS2-VASc score

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

When is warfarin indicated in AFib patients with a score >1?

A

mechanical valve
mitral valvular disease
ventricular assist devices
(otherwise DOACs can be used)

84
Q

Which DOACs are approved for Afib?

A

Factor Xa inhibitors - Apixaban, Rivaroxaban, Edoxaban
Direct Thrombin Inhibitors - Dabigatran
- only one with FDA approved reversal agent

85
Q

What is a couplet on EKG?

A

two successive PVCs

86
Q

What is bigeminy on EKG?

A

Sinus beat followed by a PVC

87
Q

What is trigeminy on EKG?

A

Two sinus beats followed by a PVC

88
Q

How can acute warfarin-associated bleeding be reversed?

A

Fresh frozen plasma (FFP)

Prothrombin Complex Concentrate (PCC)

89
Q

Why is it important to anticoagulate a patient with Afib >48 hours 3 weeks before cardioversion and 4 weeks after?

A

risk of embolization during cardioversion = 2-5%

(Can obtain TEE of left atrium to rule out presence of clot to avoid waiting 3 weeks; if no clot present, start IV heparin and cardiovert within 24 hrs)

90
Q

In Afib cardioversion, is electrical or pharmacological cardioversion preferred?

A

Electrical

91
Q

How can pharmacological cardioversion be achieved in Afib patients?

A

Parenteral ibutilide, procainamide, flecainide, sotalol, amiodarone

92
Q

What is the treatment for chronic AFib?

A

Rate control with a B-blocker or CCB

Anticoagulation (unless <65 and without heart disease or underlying risk factors)

93
Q

What is required to make a diagnosis of Multifocal Atrial Tachycardia?

A

At least 3 p wave morphologies

in presence of tachycardia

94
Q

If there are 3 or more p wave morphologies, but rate is between 60 and 100, what is the diagnosis?

A

wandering atrial pacemaker

95
Q

What are possible treatments for multifocal atrial tachycardia with preserved left ventricular function?

A 
CCBs
Beta blockers
digoxine
amiodarone
IV flecainide
IV propafenone
96
Q

What are possible treatments for multifocal atrial tachycardia with decreased left ventricular function?

A

Digoxin
Diltiazem
Amiodarone

97
Q

What is the most common arrhythmia caused by digoxin toxicity?

A

paroxysmal atrial tachycardia with 2:1 block

98
Q

What is the treatment for paroxysmal SVT?

A
  1. Maneuvers
    • Valsalva, Carotid sinus massage, breath holding, head holding in cold water
  2. IV adenosine
    • alternatives: IV diltiazem (CCB), IV metoprolol (b-blocker), or digoxin
  3. If refractory, DC cardioversion
99
Q

Tachycardias with narrow QRS complexes originate _____

A

at or above the level of the AV node

100
Q

Tachycardias with wide QRS complexes originate ____

A

outside of the normal conducting system or there is a supraventricular arrhythmia w/ coexisting abnormality in the His-Purkinje system

101
Q

What are 5 side effects of Adenosine?

A
  1. Headache
  2. Flushing
  3. SOB
  4. Chest pressure
  5. nausea
102
Q

What is the treatment for WPW Syndrome?

A

ablation, procainamide or quinidine

Avoid drugs active on the AV node (beta blockers, CCBs, digoxin, adenosine)

103
Q

What are risk factors for long QT?

A 
hypokalemia
hypomagnesemia
hypocalcemia
drugs --antiemetics, antipsychotics, SSRIs, TCAs, macrolide and fluoroquinolone antibiotics]
congenital long QT syndrome
104
Q

What is the treatment for Torsades de Pointes?

A

IV magnesium or if unstable –> electrical cardioversion
address underlying cause
may require Isoproterenol

105
Q

Unlike ___, VT does NOT respond to vagal maneuvers or adenosine.

A

PSVT

106
Q

What are cannon A waves?

A

clinical feature of VT found in the neck

secondary to AV dissociation, which results in atrial contraction during ventricular contraction

107
Q

What is the treatment for a hemodynamically stable patient with sustained VT?

A

IV amiodarone

108
Q

Always suspect ___ in patients with a wide QRS (>.12 seconds)

A

VT

109
Q

What is the most effective treatment for patient with nonsustained VT with underlying heart disease?

A

placement of implantable defibrillator

110
Q

What is the treatment for VFib?

A

immediate defibrillation and CPR

111
Q

What is sick sinus syndrome?

A

sinus node dysfunction characterized by a persistent spontaneous sinus bradycardia. Patients usually elderly.

112
Q

What is the treatment for First Degree AV block?

A

benign condition that does not require treatment

113
Q

What is the treatment for Second Degree AV block, type 1?

A

benign condition that does not require treatment

114
Q

What is the treatment for Second Degree AV block, type 2?

A

pacemaker placement is necessary; often progresses to 3rd degree AV block

115
Q

What is the treatment for Third Degree AV block?

A

pacemaker placement is necessary

116
Q

What is the initial drug given to symptomatic patients with Hypertrophic Cardiomyopathy?

A

Beta blockers

117
Q

What is the treatment for hemochromatosis?

A

phlebotomy or feroxamine

118
Q

What is the treatment for Sarcoidosis?

A

Glucocorticoids for acute flairs

119
Q

What are causes of myocarditis?

A

viruses –Coxsackie, Parvovirus B19, HHV6
bacteria –group A strep in rheumatic fever, Lyme Disease, Mycoplasma etc
SLE
Medications (eg sulfonamides)
idiopathic

120
Q

What 4 changes are seen on ECG in the case of Acute Pericarditis?

A
  1. DIffuse ST elevation and PR depression, with PR elevation in aVR
  2. ST segment returns to normal–typically around 1 week
  3. T wave may invert
  4. T wave returns to normal
121
Q

What is the treatment for Acute Pericarditis?

A

high dose NSAIDs (ASA, ibuprofen, naproxen, or indomethacin)

adjunctive colchicine

122
Q

How does ventricular filling differ in constrictive pericarditis vs cardiac tamponade?

A

constrictive pericarditis - unimpeded during early diastole, then halts
cardiac tamponade - impeded throughout

123
Q

What is Kussmaul sign and what is it indicative of?

A

JVP (venous pressure) paradoxically increases during inspiration

124
Q

What can be used to distinguish Constrictive Pericarditis and Restrictive Cardiomyopathy?

A

echo or cardiac catheterization

125
Q

What is the imaging modality of choice for diagnosis of pericardial effusion and cardiac tamponade?

A

echocardiogram

126
Q

what is the most important part of cardiac tamponade?

A

the RATE of fluid accumulation (not amount)

127
Q

What are the key findings of Cardiac Tamponade?

A

Becks Triad – Hypotension, muffled heart sounds, elevated JVP
Pulsus paradoxus
narrowed pulse pressure

128
Q

What is the treatment for a nonhemorrhagic cardiac tamponade?

A

If hemodynamically stable – monitor closely

If unstable – pericardiocentesis

129
Q

What is the treatment for a hemorrhagic cardiac tamponade?

A

emergent surgery

pericardiocentesis is only a temporizing measure until surgery

130
Q

Almost all cases of mitral stenosis are due to ___

A

rheumatic heart disease

131
Q

Patients with mitral stenosis are usually asymptomatic until the mitral valve area is reduced to approximately ____ cm^2

A

1.5 cm^2. (normal is 4-5)

132
Q

What is a mitral stenosis murmur?

A

S2 followed by an opening snap, followed by a low-pitched diastolic rumble and presystolic accentuation
loud S1

133
Q

How is the mitral stenosis murmur heard best?

A

left lateral decubitus position with bell of stethoscope

134
Q

For the mitral stenosis murmur, what indicates a worse prognosis?

A

distance between S2 and the opening snap–closer to S2 = worse prognosis

135
Q

In a patient with aortic stenosis, the development of what 3 things indicates a poor prognosis?

A
  1. Angina - 3 yrs
  2. Syncope - 2 yrs
  3. Heart failure - 1.5 yrs
136
Q

What murmur is heard for aortic stenosis?

A

Harsh crescendo-decrescendo murmur (2nd right intercostal space),
radiates to carotid arteries

137
Q

What is the treatment for aortic stenosis?

A

If asymptomatic –> no treatment
If symptomatic –> surgical aortic valve replacement or transcatheter aortic valve replacement (TAVR) depending on patient risk
(medical therapy has limited role)

138
Q

What are acute causes of aortic regurg?

A
  1. infective endocarditis
  2. trauma
  3. aortic dissection
  4. iatrogenic as during a failed replacement therapy
139
Q

What are chronic causes of aortic regurg (primary valvular)?

A 
Rheumatic fever
bicuspid aortic valve
Marfan syndrome
Ehlers-danlos syndrome
ankylosing spondylitis
SLE
140
Q

What are chronic causes of aortic regurg (aortic root disease)?

A 
syphilitic aortitis
osteogenesis imperfecta
aortic dissection
Behcet syndrome
Reiter syndrome
systemic HTN
141
Q

What are physical exam findings in pt with Aortic Regurg?

A
  1. widened pulse pressure
  2. DIastolic decrescendo murmur
  3. Corrigan pulse
  4. Austin Flint murmur
    displaced PMI
    murmur instensity increases with sustained handgrip
142
Q

What is a Corrigan pulse?

A

rapidly increasing pulse that collapses suddenly as arterial pressure decreased rapidly in late systole and diastole; can be palpated at wrist or femoral arteries

143
Q

What is an Austin Flint murmur?

A

low-pitched diastolic rumble due to competing flow anterograde from the LA and retrograde from the aorta. Similar to the murmur appreciated in mitral stenosis

144
Q

What is the treatment for Aortic Regurg in patient that is asymptomatic with normal LV function?

A

no therapy indicated

145
Q

What is the treatment for Aortic Regurg in patient that is asymptomatic with severe AR and LV dysfunction?

A

ACE inhibitor (or ARB) - for afterload reduction

146
Q

What is the treatment for Aortic Regurg in patient that is symptomatic?

A

salt restriction, diuretics, afterload reduction (ACE-i),
HFrEF if heart failure
restriction on strenuous activity

147
Q

What is definitive treatment for AR or for acute AR?

A

surgery – aortic valve replacement

148
Q

What murmur is seen with mitral regurgitation?

A

Holosystolic murmur (starts with S1 and continues on through S2) at the apex, which radiates to the back or clavicular area

149
Q

What is the treatment for Mitral Regurg?

A

Afterload reduction with vasodilators is recommended for symptomatic patients only
If AFib – chronic anticoagulation
Eventually – surgery

150
Q

What murmur is seen with Tricuspid regurg?

A

blowing holosystolic murmur

  • at LLSB
  • intensified with inspiration; reduced during expiration or the Valsalva maneuver
151
Q

What type of murmur is seen with MVP?

A

midsystolic or late systolic click(s)

mid-to-late systolic murmur

152
Q

What maneuvers increase the MVP murmur?

A

standing and the valsalva maneuver

reduce LV chamber size, allowing the click and murmur to occur earlier in systole

153
Q

What maneuvers decrease the MVP murmur?

A

squatting (decreases LV chamber size)

154
Q

What is the treatment for MVP?

A

asymptomatic –> reassurance
for chest pain –> beta blockers maybe useful
benign condition

155
Q

How is the diagnosis of Acute Rheumatic Fever made?

A

2 major criteria OR 1 major criteria, 2 minor criteria

156
Q

What are the major criteria associated with Acute Rheumatic fever?

A

Major criteria:

  • migratory polyarthritis
  • erythema marginatum
  • cardiac involvement (eg pericarditis, CHF, valve disease)
  • Chorea
  • subcutaneous nodules
157
Q

What are the minor criteria associated with Acute Rheumatic fever?

A

Minor criteria:

  • fever
  • elevated ESR
  • polyarthralgias
  • prior hx of rheumatic fever
  • prolonged PR interval
  • evidence of preceding streptococcal infection
158
Q

What is the treatment for streptococcal pharyngitis?

A

Penicillin (penicillin or amoxicillin),
or Cephalosporin,
if penicillin allergy –> Macrolide (Azithromycin or Clarithromycin)

159
Q

What is the treatment for Acute Rheumatic Fever?

A

NSAIDs

160
Q

What is used to monitor treatment of Acute Rheumatic Fever?

A

C-reactive protein

161
Q

Acute endocarditis is most commonly caused by ___

A

Staph aureus (highly virulent)

162
Q

Acute endocarditis most commonly occurs on a ___ (normal/injured) heart valve

A

normal

163
Q

Acute endocarditis is most commonly caused by ___

A

Strep viridans or enterococcus

164
Q

Endocarditis caused by ___ is associated with increased risk of active colonic malignancy.

A

strep bovis

165
Q

Prosthetic valve endocarditis: ____ is the most common cause of early onset endocarditis (<60 days after surgery).
___ is the most common cause of late onset endocarditis (>60 days after surgery).

A

staphylococci

Streptococci

166
Q

How is the diagnosis of endocarditis made?

A

Duke Criteria - 2 major criteria or 1 major and 3 minor criteria

167
Q

What are the major criteria in the Duke criteria?

A

sustained bacteremia - by organism known to cause endocarditis
Endocardial involvement - by echocardiogram or new valve regurg

168
Q

What are the minor criteria in the Duke criteria?

A

predisposing condition (abnormal valve or abnormal risk of bacteremia
fever
vascular phenomena (septic emboli, mycotic aneurysm, intracranial hemorrhage, janeway lesions)
immune phenomena (Glomerulonephritis, Osler nodes, Roth spots, rheumatoid factor)
positive blood cultures
positive echocardiogram

169
Q

What is Marantic Endocarditis?

A

sterile deposits of fibrin and platelets that form long the closure line of cardiac valve leaflets; associated with debilitating illness such as metastatic cancer

170
Q

Characterized by the formation of small warty vegetations on both sides of valve leaflets and may present with regurgitant murmurs

A

Libman-Sacks Endocarditis

assoc with SLE

171
Q

How is atrial septal defect diagnosed?

A

TEE (with bubble study)

172
Q

A late complication of atrial septal defect in which irreversible pulmonary HTN leads to reversal of shunt, heart failure, and cyanosis

A

Eisenmenger disease

173
Q

When does an atrial septal defect need to be surgically repaired?

A

when pulmonary to systemic blood flow ratio is greater than 1.5:1 or 2:1 (or if symptomatic)

174
Q

What is the most common congenital cardiac malformation?

A

ventricular septal defect

175
Q

What type of murmur is associated with ventricular septal defect?

A

harsh, blowing holosystolic murmur with thrill

- at 4th left intercostal space

176
Q

What increases a VSD murmur? decreases?

A

Increased with handgrip

decreased with standing

177
Q

How is a coarctation of the aorta diagnosed?

A

CT angiogram

178
Q

What murmur is associated with PDA?

A

continuous “machinery murmur” at left second intercostal space (both systolic and diastolic components)

179
Q

What is the treatment for PDA?

A

if pulmonary vascular disease is absent –> surgical ligation
if severe pulmonary HTN or right-to-left shunt is present, do NOT correct the PDA – surgery is CONTRAINDICATED

180
Q

What 4 cardiac abnormalities make up tetrology of fallot?

A
  1. ventricular septal defect
  2. RV hypertrophy
  3. pulmonary artery atresia or stenosis
  4. overriding aorta
181
Q

How is hypertensive emergency defined?

A

systolic BP >/= 180 or diastolic BP >/= 120

IN ADDITION TO end-organ damage

182
Q

What is the first step in treating a patient with severe headache and markedly elevated BP?

A

lower BP with antihypertensive agent

then CT scan to rule out intracranial hemorrhage, if negative – then lumbar puncture

183
Q

What is the goal of treatment in pt with hypertensive emergency?

A

reduce mean arterial pressure by 25% in 1-2 hours

184
Q

If hypertensive emergency is severe, with diastolic BP >130, what should be administered?

A

IV agents

esmolol, nitroprusside, labetalol, or nitroglycerin

185
Q

What are the preferred tests in the diagnosis of aortic dissection?

A

CTA and TEE

186
Q

What is the treatment for aortic dissection?

A

IV beta blockers should be initiated immediately
- labetalol, esmolol
Goal systolic BP of 100-120
can add sodium nitroprusside

187
Q

What triad of symptoms are indicative of a RUPTURED AAA?

A

abdominal pain,
hypotension
palpable pulsatile abdominal mass

188
Q

What is the diagnostic test of choice for AAA?

A

Ultrasound

189
Q

At what diameter of an AAA is surgical resection with synthetic graft placement recommended?

A

> 5 cm

190
Q

What is the name for an atheromatous occlusion of distal aorta just above bifurcation causing bilateral claudication, impotence, and absent/diminished femoral pulses?

A

Leriche syndrome

191
Q

What is a normal ankle to brachial index (ABI)?

A

0.9 to 1.3

192
Q

ABI < ___ usually means claudication

A

0.7

193
Q

ABI < ___ usually presents with rest pain

A

0.4

194
Q

ABI > 1.3 is due to ____

A

noncompressible vessels and indicates severe disease

195
Q

What is the gold standard for diagnosing and locating PAD?

A

Arteriography

196
Q

What is the most common site for an acute arterial occlusion?

A

common femoral artery

197
Q

What are the 6 Ps of acute limb ischemia?

A 
Pain
Pallor
Polar 
Paralysis
Paresthesias
Pulselessness
198
Q

Skeletal muscle can tolerate __ hours of ischemia

A

6

199
Q

____ is a
- complication of syphilitic aortitis,
- aneurysm of the aortic arch with retrograde extension backwards to cause aortic regurg and stenosis of aortic branches, most commonly the coronary arteries
usually affecting men in their 4th-5th decade

A

Leutic Heart

200
Q

What is the initial test for DVT and most accurate for DVT of proximal veins–Femoral and Popliteal?

A

Doppler analysis and Duplex ultrasound

201
Q

What is the most accurate test for DVT of calf veins?

A

Vengraphy

202
Q

What is the initial treatment for DVT?

A

anticoagulation with either
injectable LMWH (enoxaparin, dalteparin)
or DOACs (apixaban, rivaroxaban, edoxaban, dabigatran)
or warfarin with heparin bridge

203
Q

When is thrombolytic therapy used as an adjunct to anticoagulation in patient with DVT?

A

if massive PE and hemodynamically unstable and no contraindications

204
Q

What is the treatment for localized thrombophlebitis?

A

a mild analgesic (ASA or NSAIDs). elevation, and hot compresses; continue activity

205
Q

What is the treatment for suppurative thrombophlebitis?

A

remove IV cannula and administer systemic abx

Step Up to Medicine - 5th Edition (1 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions