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MKSAP Internal Medicine > Chap 1 - Cardiovascular > Flashcards

Chap 1 - Cardiovascular Flashcards

1
Q

Treatment for viral pericarditis?

A

NSAID (+3 months colchicine)

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2
Q

Classic findings of pericarditis?

A

Pleuritic chest pain, friction rub, diffuse ST-segment elevations

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3
Q

How to diagnose costochondritis?

A

Insidious onset, lasts hours to days, pain reproducible, worse with turning/twisting/etc.

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4
Q

Treatment for costochondritis?

A

NSAIDs and rest

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5
Q

Characteristics of panic disorder?

A

Chest pain but in a young, low-risk individual lasting 5-60 minutes, often with agoraphobia

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6
Q

Treatment for panic disorder?

A

SSRI

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7
Q

Common history in secondary spontaneous pneumothorax?

A

COPD

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8
Q

Work-up for secondary spontaneous pneumothorax?

A

Upright CXR

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9
Q

Work-up of non-cardiac chest pain?

A

Exclude cardiac causes => empiric PPI therapy 8-10 weeks => endoscopy, manometry, or ambulatory pH monitoring

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10
Q

When to revascularize in chronic angina?

A

If optimal medical therapy does not improve symptoms

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11
Q

Indicated diagnostics in chronic stable angina?

A

Routine ECG, exercise stress testing, and echo are NOT recommended

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12
Q

Indication for exercise stress test?

A

Diagnose CAD in patients with normal ECG at baseline but anginal symptoms. Use ONLY when pre-test probability is intermediate

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13
Q

Gender pitfalls of ECG exercise stress test?

A

Higher false-positive rate in women

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14
Q

How to optimize medical therapy in chronic stable CAD with anginal symptoms?

A

Increase B-blocker until resting HR is 55-60, add nitrates, then add CCB, then ranolazine, then coronary angiography

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15
Q

Manage acute chest pain in ED?

A

If intermediate suspicion of ACS, admit to telemetry unit with serial ECGs and troponins

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16
Q

Treating STEMI?

A

PCI if < 2 hours away

Thrombolytic therapy: ASA, clopidogrel, heparin, intravenous nitrates, thrombolytics

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17
Q

Indication for cardiac catheterization in NSTEMI?

A

Serial troponins => if rising with evolving ECG, then go to catheterization

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18
Q

How long after symptom onset do patients benefit from PCI?

A

Up to 12 hours
90 minutes door-to-balloon time at PCI facility
120 minutes to balloon time from non-PCI facility

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19
Q

New holosystolic murmur at left lower sternal border s/p anterior wall MI?

A

Either acute mitral valve regurgitation (papillary muscle dysfunction) or ventricular septal defect (has palpable thrill)

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20
Q

Anatomic defect associated with inferior wall MI?

A

Aortic dissection

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21
Q

Presentation of left ventricular free wall rupture?

A

Hemopericardium => muffled heart sounds, RHF, no murmur

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22
Q

Medical therapy for unstable angina?

A

ASA, clopidogrel, LMWH, nitrate, B-blocker

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23
Q

Contraindication for treatment with B-blocker?

A

Bronchospastic disease => use CCB instead

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24
Q

Contraindicated CCB in unstable angina?

A

Nifedipine => causes increased HR

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25
Q

Indication for cardiac catheterization in STEMI?

A

Go to PCI if within 90 minutes of presentation and 12 hours of symptoms
DO NOT wait for troponins

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26
Q

Diagnose Sick Sinus Syndrome?

A

Sinus bradycardia correlated with dizziness

Pathologic findings: sinus arrest, sinus exit block, sinus bradycardia

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27
Q

Treatment for asymptomatic complete heart block?

A

Permanent pacemaker

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28
Q

ECG difference between First-/Third-degree heart block and 2nd-degree?

A

2nd-degree does not have consistent R-R intervals

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29
Q

LBBB characteristics on ECG?

A

Absent Q waves and wide, positive R waves in I, aVL, V6, prolongation of QRS > 0.12 sec

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30
Q

Management of new LBBB with anginal symptoms?

A

Consider equivalent to STEMI even though no ST elevations

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31
Q

Consistent and non-consistent characteristic in Mobitz type I?

A

PP interval constant, PR interval increasing

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32
Q

Similarity between atenolol and diltiazem conduction system side effect?

A

Decrease conduction through AV node

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33
Q

Lyme carditis manifestations?

A

Acute onset, high grade AV conduction deficits rapidly leading to 3rd degree AV block. Administer IV ceftriaxone until resolution of symptoms then 21 days oral therapy

34
Q

Management of A-fib?

A

Hemodynamically stable: B-blocker or CCB

Hemodynamically unstable: Cardioversion

35
Q

CHADS2 guidance of treatment?

A

0 => no ASA
1 => ASA, consider anti-coag if other RFs
>=2 => long-term anticoagulation on warfarin

36
Q

A-fib patient with contraindication to warfarin?

A

Use ASA + clopidogrel

37
Q

Indication for A-fib ablation therapy?

A

Failure of at least one antiarrhythmic agent

38
Q

ECG characteristics of WPW syndrome (ventricular preexcitation syndrome)?

A

Short PR interval, prolonged QRS, slurred QRS onset (delta wave).
Paradoxically split S2

39
Q

ECG characteristics of A-flutter?

A

Sawtooth appearance most noticeable in inferior leads, clearly defined p-waves (vs. a-fib), atrial conduction rate approaches 250-300/min

40
Q

ECG characteristics of MAT?

A

3 different p-wave morphologies best seen in II, III, V1 with varying P-P, P-R, and R-R intervals

41
Q

ECG characteristics of AVNRT?

A

Lost P-waves, narrow QRS, Regular rhythm

42
Q

ECG characteristics of AVRT?

A

Short R-P tachycardia with P wave in ST-segment, regular rhythm

43
Q

What are the paroxysmal SVTs?

A

AVNRT, AVRT, ATach

44
Q

Treatment of paroxysmal SVTs?

A

IV adenosine push => slow rate in AVNRT and AVRT, but not in ATach

45
Q

Treatment of asymptomatic HOCM?

A

Implantable defibrillator

If not feasible, use amiodarone

46
Q

Treatment of wide complex tachycardia with history of CAD/cardiomyopathy?

A

Assume it is a ventricular tachycardia

IV amiodarone

47
Q

What are premature ventricular complexes?

A

Spontaneous depolarizations from ventricles

48
Q

Treatment of PVCs?

A

B-blockers => RF ablation if refractory

49
Q

What is long QT syndrome?

A

Familial condition with long QT interval predisposing patients to syncope and cardiac arrest due to TdP, especially during exertion

50
Q

Why does one become unresponsive during STEMI?

A

Ventricular fibrillation arrest => immediate cardioversion

51
Q

Indication for pacemaker placement?

A

SA node dysfunction (sinus brady, intra-nodal block, exit block), symptomatic 2nd or 3rd degree block

52
Q

Indication for ICD placement?

A

If ventricular arrhythmia occurs >48 hours s/p MI, patients with EF < 30%

53
Q

Baseline medications for CHF?

A

ACE inhibitor and B-blocker

54
Q

Additional medication for NYHA III-IV CHF?

A

Spironolactone

55
Q

What makes BNP falsely low in CHF patients?

A

Obesity

56
Q

New onset heart failure with evidence of ischemia?

A

Coronary angiography if high pretest probability of CAD

57
Q

Indications for biventricular pacing?

A

NYHA Class III-IV CHF, EF < 35%, ventricular dyssynchrony (QRS > 120 msec)

58
Q

dCHF medications?

A

Furosemide and ACE inhibitor/ARB
Do not use preload reducing meds: CCB and nitrates
Digoxin good for sCHF, not dCHF

59
Q

Optimal medical therapy for sCHF class III-IV?

A

ACE inhibitor, B-blocker, spironolactone

60
Q

Treatment of concurrent hypertension and sCHF?

A

Loop diuretic, max out doses of B-blocker and ACE inhibitor, then add CCB - new dihydropyridine class (amlodipine)

61
Q

CCB that have negative inotropic effects and can exacerbate sCHF?

A

Nifedipine, verapimil, diltiazem

62
Q

Tricuspid regurg murmur?

A

Early systolic murmur at left lower sternal border that increases with inspiration, does not radiate

63
Q

Progression of heart disease from chronic lung disease?

A

Chronic lung disease => pulmonary hypertension => right ventricular overflow => tricuspid insufficiency => cor pulmonale

64
Q

Most prominent physical exam finding for dysfunctional prosthetic aortic valve?

A

Blowing diastolic murmur at left sternal border = aortic regurgitation

65
Q

Murmur heard in LBBB?

A

Expiratory splitting of S2

66
Q

TTE indications?

A

Diagnosing >=3/6 systolic murmurs, diastolic murmurs, continuous murmurs, holosystolic murmurs, late systolic murmurs, ejection clicks, murmurs radiating to back or neck

67
Q

Physical exam findings of AR?

A

Carotid pulse rapid upstroke and decline (Corrigan pulse), widened pulse pressure, diastolic murmur

68
Q

Cardiac consequences of radiation therapy?

A

Valvular regurgitation, constrictive pericarditis (RVF symptoms), restrictive cardiomyopathy (RVF symptoms)

69
Q

Bicuspid aortic valve associated anatomic difference?

A

50% have aortic root dilation

70
Q

Mitral stenosis murmur characteristics?

A

Opening snap followed by diastolic murmur accentuated by atrial contraction => loud S1

71
Q

Prominent parasternal impulse?

A

Right ventricular hypertrophy

72
Q

Prominent pulmonic component of S2?

A

Pulmonary hypertension

73
Q

Characteristics of MVP murmur?

A

Late systolic murmur with click at apex, Valsalva and sit-to-stand will move click to early systole but not decrease intensity of murmur

74
Q

Effects of preload and afterload on HCM?

A

Decrease preload => intensify murmur

Increase afterload => decrease murmur

75
Q

What is Leriche syndrome?

A

Aortoiliac arterial disease => characterized by erectile dysfunction, hip and buttock pain when walking, diminished femoral, popliteal, and DP pulses

76
Q

Acute AAA management

A

Sudden, severe low back pain associated with syncope
Low BP, infraumbilical and suprapubic tenderness
CT scan and repair emergently

77
Q

Management of renovascular hypertension 2/2 fibromuscular dysplasia?

A

Percutaneous transluminal kidney angioplasty

78
Q

Fibromuscular dysplasia angiogram finding?

A

String of beads

79
Q

Management of anticoagulation in setting of acute venous thromboembolism?

A

5-7 days of LMWH with warfarin with target INR of >2.0 for 24 hours

80
Q

Treatment of DVT in kidney insufficient patients post-operative?

A

IV unfractionated heparin
Unfractionated heparin cleared by reticuloendothelial system
LMWH cleared by kidneys

MKSAP Internal Medicine (4 decks)

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