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Quarter 3 > Clin Med Exam 1 > Flashcards

Clin Med Exam 1 Flashcards

1
Q

EKG

ELECTROcardiography

A

machine detects the electrical activity of the heart

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2
Q

Test for Acute Chest Pain

A

EKG

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3
Q

Telemetry

A

Continuous EKG monitoring in inpatient setting

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4
Q

When to do Telemetry

A

Hospital admission for CP or possible ACS-Acute Coronary Syndrome

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5
Q

Cardiac regulatory protein that controls the calcium-mediated Actin-Myosin interaction

regulates muscle contraction

A

Troponin

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6
Q

CTn-I

A

only in the heart

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7
Q

CTn-T

A

in heart and skeletal muscle

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8
Q

High sensitivity cardiac troponin

A

preferred, cardiac specific

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9
Q

Troponin

A

preferred method of dx and prognosis in Acute MI

more sensitive and specific than CK-MB

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10
Q

Troponin is increased in

A

trauma, surgery, inflammation, and infection

“biomarker of cardiac injury”

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11
Q

CK

A

isoenzyme in a bunch of tissues: heart, brain, and skeletal muscle

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12
Q

CK-MB

A

more specific for cardiac injury than regular CK (not as much as trop)

any form of heart damage can increase CK-MB (ischemia, trauma, surgery, inflammation, infection)

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13
Q

How long does elevated CK last

A

36-48 hours

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14
Q

How long does elevated Troponin last

A

up to 14 days

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15
Q

CK and Trop details

A

Onset 3-12 hrs after injury

Peak 18-24 hrs after injury

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16
Q

ECHOcardiography (movie)

A

US of heart

crystal probe- transmit high frequency sound pulse into tissue

some of sound waves reflect back to probe and are picked up by machine displaying a 2D image on the monitor

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17
Q

TransTHORACIC echo

A

evaluate cardiac Anatomy and Function

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18
Q

Indications for TransTHORACIC echo

A

evaluate Wall Motion

calculate Ejection Fraction/Systolic Fx

Evaluate Valve Structure and Fx

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19
Q

TransESOPHAGEAL echo

A

reveals Posterior cardiac structures

Can detect:
Clots
Valvular pathology (vegetations in endocarditis)

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20
Q

Contraindications of TransESOPHOGeal echo

A

AMS, compromised cardio-resp status, recent or active esoph tear or hemorrhage, coagulopathies, thrombocytopenia, esoph stricture

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21
Q

inadequate oxygen supply

A

hypOperfusion

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22
Q

3 types of stress test

A

EKG stress test
Nuclear stress test
Stress echo

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23
Q

Indications for Cardiac Stress Test

A

Exertional CP
CHD with new/worsening sx
Newly dx heart failure or cardiomyopathy

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24
Q

Contraindications to all forms of stress testing

A 
Acute MI w/in 48 hr
Unstable/uncontrolled angina, cardiac arrhythmia (a-fib)
severe, sx aortic stenosis
uncontrolled heart failure or HTN
severe pulm HTN
acute aortic dissection
acutely ill
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25
Q

Exercise EKG stress test, pt exercises to achieve

A

Target HR
Symptoms
Time limit

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26
Q

During Exercise EKG stress test, clinician looks for

A

EKG changes
Increased HR
Symptom development

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27
Q

Big difference with stress echo

A

more specific and can localize ischemia

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28
Q

Nuclear stress test

A

Radioactive tracer: Technetium-99m agents (or Thallium)

concentrate in areas of myocardium with adequate blood flow and living cells

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29
Q

Nuclear stress test

A

perfusion defect seen in areas of hypoperfusion

Take rest images, then add med and retake images

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30
Q

Vasodilators used in Nuclear Stress Test

A

Adenosine

Dipyridamole

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31
Q

Ionotropes used in Nuclear Stress Test

A

Dobutamine (increases HR and contractility)

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32
Q

Nuclear stress test

A

Gamma-ray detection camera scans at rest and after stress

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33
Q

When to do Nuclear Stress Test?

A

Pt has abnormal resting EKG (rendering it useless)
Assess areas of ischemia
Location and size of injured muscle after MI
Dx Coronary artery stenosis
Evaluate how grafted vessels work after bypass surgery

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34
Q

Stress echo (movie)

A

More focused on development of WALL MOTION abnormality with stress/exercise

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35
Q

Stress echo (movie)

A

Peak stress images obtained once pt reaches 85% predicted HR

Exercise (treadmill) OR
Dobutamine (increase contractility) used to get pt to 85% predicted HR

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36
Q

Indications for stress echo (movie)

remember this is focused more on wall motion

A

Known of suspected CAD
Evaluation of CP, SOB, DOE
Evaluate valvular abnormalities
Pre-op risk assessment

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37
Q

Avoid stress echo (movie) in pts with

A

A-Fib or LBBB

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38
Q

Holter monitor

A

continuous recording, on for the whole duration of 24-48 hr

keep sx diary

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39
Q

Indications for Holter monitor

A 
Evaluation of syncope
PALPITATIONS
Rhythm recording
HR variability
ST segment monitoring
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40
Q

Event monitor

A

NOT continuous, only turns on if an “event” is experienced

worn for 30-60 days

pt must activate device (button) to capture previous 2-5 min and few subsequent min

signal then transmitted to interpreting center for eval

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41
Q

Implantable cardiac monitor

A

SubQ, records up to 3 years

automatically activated to programmed criteria

pt can also prompt device to record

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42
Q

Indications for Implantable cardiac monitor

A 
Infrequent sx (remember this can record up to 3 yr)
Suspected arrhythmia but non-invasive testing has been negative or inconclusive
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43
Q

Fingertrip monitor

A

instant, portable EKG at home without clinician assistance

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44
Q

Indication for Fingertip monitor

A

MONITORING ARRHYTHMIAS such as A-Fib

EKG and HR can be synced to smartphone or computer

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45
Q

CT scan

A

combo of x ray images to produce cross-sectional images “slices” of specific areas

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46
Q

CCTA (coronary CT angiography)

A

Pt given IV CONTRAST and then CT scan of heart to evaluate for coronary artery occlusion

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47
Q

Coronary CT Calcium scan

A

NO contrast

Assess for calcium deposits in the coronary arteries and therefore risk of MI

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48
Q

Cardiac CT useful for

A

Evaluating Thoracic aorta and Pericardium which are less mobile

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49
Q

Major applications for Cardiac CT

A

Detect Aortic dissection (major one)

Detect Coronary Artery calcium

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50
Q

Indications for Cardiac CT

A

Stable angina
Acute Coronary Syndrome
AORTIC DISSECTION (main one)

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51
Q

Contraindications to Cardiac CT

A

Allergic to contrast dye

Severe Renal insufficiency

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52
Q

Cardiac MRI

A

Assess Functional and Tissue properties of heart

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53
Q

Indications

A

used AFTER evaluation with 1st line testing, such as echo

For complicated and advanced dz patients

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54
Q

Cardiac MRI Indications

A

Myocardial, valvular, pericardial dz
cardiac tumor
coronary artery dz
myocardial perfusion (w gadolinium contrast) during adenosine stress

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55
Q

Contraindications for cardiac MRI

A

Metal or electrical implants, devices, or foreign bodies

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56
Q

Cardiac cath/coronary angiography

A

Gold standard for diagnosing CAD

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57
Q

Indications for cardiac cath/coronary angiography

A

Known/suspected CAD***

also,
unstable angina
angina and + stress test
history of MI w/EKG change
Post-resusc from cardiac arrest
atypical CP 
b4 valve surgery
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58
Q

Statins

A

lower LDL
Adverse: Liver toxic, myopathy, drug interactins

If myositis (Rhabdo), discontinue and check CK level

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59
Q

Fibrate

A

lower Triglycerides (main use)

Do NOT use with statin- increased risk of toxicity

60
Q

Niacin

A

lower LDL, raise HDL

Adverse: Flushing
Check LFT, caution use with Statin

61
Q

Bile Acid Sequestrant

A

lower LDL
SAFE in pregnancy
synergistic w Statin
Adverse: Can INCREASE Triglycerides, GI side effects

62
Q

Ezetamibe

A

lower LDL, statin add-on

BUT, dont use with statin in liver dz

63
Q

PCSK9 Inhib

A

lower LDL, statin add on

expensive injections

64
Q

Drugs to use with Statins

A

Bile acid sequestrant
Ezetimibe (as long as no liver dz)
PCSK9 Inhibitor

65
Q

Not recommended to use with Statins

A

Nicotinic Acid
Fibric Acid
(N and F Acid)

Bile Acid is ok to use w/Statin

66
Q

Cholesterol

A

<200 desirable

240 high risk

67
Q

Triglycerides

A

<150 desirable

200-499 high risk

68
Q

HDL

A

60 desirable

<35 high risk

69
Q

LDL

A

60-130 desirable

160-189 high risk

70
Q

Bile Acid Sequestrant aka Resins

A

bind bile acid in intestine, lower LDL, synergistic w/Statin

safe during pregnancy!

Risk of increasing Trig

71
Q

Nicotinic Acid

A

lower LDL and increase HDL

Flushing and pruritus side effect

72
Q

Fibric Acid

A

main use: Lowering Triglycerides

can also increase HDL

73
Q

Drugs that can affect Warfarin use

A

Bile Acid Sequestrant (adverse effect)

Fibric Acid Derivative (relative contraindication)

74
Q

Statin Benefit Group #1 (secondary prevention, preventing recurrence)

A

Individuals with Atherosclerotic Cardiovascular Dz (ASCVD)

  • Acute coronary syndrome
  • Hx MI
  • Symptomatic PAD
  • Stroke or TIA
75
Q

Statin Benefit Group #2

A

those with LDL >/ 190

76
Q

Statin Benefit Group #3

A

those w DM 40-75 YO
WITH
LDL >/ 70

77
Q

Statin Benefit Group #4

A

those w/o ASCVD or DM but with LDL 70-189
AND
estimated 10-yr ASCVD risk >/ 7.5%

78
Q

Tool to estimate ASCVD risk

A

Pooled Cohort Eq’ns

79
Q

1st line med for Acute Angina

A

Nitroglycerin (short acting, decreased preload)

80
Q

1st line med for Chronic Angina

A

Beta blocker (long acting, decreased afterload)

81
Q

Decreasing O2 meds that decrease AFTERload

A

Beta blockers and CCB-calcium channel blocker

82
Q

Decreasing O2 med that decreases PREload

A

Nitrate

83
Q

Use this when pts dont respond to Nitrates or Beta blockers

A

CCB

84
Q

Meds that both decrease oxygen demand AND increase oxygen supply

A

Nitrates

CCBs

85
Q

Dilated Cardiomyopathy-CDM

A

Idiopathic

S3 gallop

86
Q

Gold standard for diagnosing Infectious DCM

A

Endomyocardial biopsy

87
Q

Peripartum DCM Risk Factors

A 
>30
African American
hx precampslia
Maternal cocaine
>4 wks use of Oral Tocolytic
88
Q

Presentation of Peripartum DCM

A

36 wks-5 months postpartum

Dyspnea, PND, pedal edema, cough, hemoptysis

89
Q

Diagnosis of Peripartum DCM

A

Increased BNP

Echo EF <45

90
Q

Alcoholic DCM

A

about 6 drinks per day for 5-10 yrs

91
Q

Tachycardia mediated DCM

A

130-200 bpm sustained rapid ventricular rates

92
Q

Echo of Dilated Cardiomyopathy will show:

A

Dilated ventricle(s), reduced LV systolic function (decreased EF)

93
Q

1st line med for Dilated Cardiomyopathy

A

ACE- Inhibitors

94
Q

What do ACE-I do?

A

Vasodilation- reduce afterload on the heart

Reduce BP

95
Q

Beta blockers

A

decrease oxygen demand from the heart

96
Q

Digoxin

A

(+) ionotrope, use if person fails to respond to other treatment

97
Q

Digoxin

A

used in A-fib, fatigue, dyspnea

98
Q

When to use Anti-coag for Dilated Cardiomyopathy

A

If A-fib present,
Ejection Fraction <30
hx of clot
presence of mural clot

99
Q

Histological hallmark of Hypertrophic Cardiomyopathy

A

myocyte hypertrophy and disarray, interstitial fibrosis

100
Q

Factors that WORSEN LVOT in Hypertrophic Cardiomyopathy

A 
Tachycardia
Hypovolemia
Standing, Vasalva
(+) Ionotrops
Diuretics
Vasodilators
101
Q

S4 gallop found in

A

Hypertrophic Cardiomyopathy

102
Q

How to increase murmur heard with Hypertrophic Cardiomyopathy

A

Vasalva and Standing

103
Q

How to decrease murmur heard with Hypertrophic Cardiomyopathy

A

Squat and Isometric hand grip

104
Q

Echo of Hypertrophic Cardiomyopathy shows:

A

Increased LV thickness: >/15 mm is diagnostic

105
Q

Stress/Exercise Echo for someone with Hypertrophic Cardiomyopathy

A

Risk stratify

Assess LVOT

106
Q

Preferred Meds to treat Hypertrophic Cardiomyopathy

A

Beta blockers
Calcium channel blockers (Nd)

both are (-) ionotropes

107
Q

Surgery for Hypertrophic Cardiomyopathy

A

if someone has sx of LVOT obstruction and isnt responding to Meds

108
Q

3 surgeries for Hypertrophic Cardiomyopathy

A

Surgical septal myectomy
EtOH ablation
Mitral valve surgery

109
Q

Restrictive Cardiomyopathy

A

Non dilated rigid ventricles

Diastolic issue (restrictie filling)

110
Q

Ejection fraction in Restrictive Cardiomyopathy?

A

Preserved!!

111
Q

Restrictive Cardiomyopathy does what to the Atria

A

cause them to Hypertrophy bc they are having to work much harder to pump blood into the ventricles

112
Q

Restrictive cardiomyopathy

A

the least common cardiomyopathy

Amyloidosis is the most common cause

113
Q

Restrictive Cardiomyopathy presentation

A

will have “Right Heart Failure” like sx

114
Q

Restrictive Cardiomyopathy

A

S3 gallop
JVP
Kussmaul’s sign

115
Q

Cardiac Amyloidosis (cause of RCM)

A

Elevated JVP
Hepatomegaly
Ascites
Peri-orbital purpura

116
Q

Echo of Cardiac Amyloidosis

A

Increased ventricular wall thickness with diastolic dysfunction

later Right diastolic dysfx develops

117
Q

Definititive dx of Cardiac Amyloidosis

A

Endomyocardial biopsy

118
Q

Echo of Restrictive Cardiomyopathy will show:

A

Atrial enlargement!!
Normal/small ventricle cavity
(amyloid can cause wall to thicken)
Normal Ejection fraction, BUT abnormal filling

119
Q

Cardiac MRI for RCM

A

chamber size, wall thickness, infilatraion, inflamation, fibrosis

120
Q

The only 2 pathologies that Cardiac MRI is mentioned for

A

Restrictive Cardiomyopathy and Takitbutso Cardiomyopathy

121
Q

TCM Takibutso

A

Left venricular Systolic AND Diastolic dysfx (tansient)

122
Q

EKG of TCM

A

STE and TWI

123
Q

At d/c, what meds do you Rx to someone with Takitsubo?

A

ASA, Beta blocker, ACE-I until LV fully recovers

124
Q

4 criteria to diagnose someone with Tabotsubo

A
  1. transient wall abnormalities of left ventricle
  2. no CAD or plaque rupture
  3. new EKG abn
  4. absence of Pheo or Myocarditis
125
Q

Chylomicrons

A

carry dietary lipids

126
Q

VLDL

A

carry triglycerides

127
Q

LDL

A

carry cholesterol

128
Q

Both inherited types of hypercholesterolemia

A

Familial (one gene)
Polygenic (many, obviously)

Treat with statin

129
Q

Secondary hyperlipid (non lipid etiology)

A

less common than inherited

130
Q

Screen for hyperlipid

A

9-11 YO

again at 17-21 YO

131
Q

Plane xanthomas

A

chol filled soft yellow plaques

can be familial or secondary cause

132
Q

Tuberous xanthomas

A

yellow-orange nodules often over knees and elbows

can also be tendinous

assoc w FAMILIAL

133
Q

Tuberous xanthomas

A

elbows, knees

FAMILIAL

134
Q

Eruptive xanthoma

A

small red-yellow papules
Elevated TRIGLYCERIDES
may indicate Familial

135
Q

Statins

A

inhibit HMG-CoA reductase, rate limiting in cholesterol synthesis

136
Q

Statins

A

Rhabdo, liver toxic

give at bedtime

137
Q

Contra-indications to Statins

A

Acute Liver dz

Pregnancy

138
Q

Caution when using a Statin

A

and other CYP3A4 inhibitors

139
Q

Med to lower triglycerides

A

Fibric Acid

140
Q

Med that has a risk of raising triglycerides

A

Bile Acid

141
Q

Statins

A

Lower LDL

142
Q

Fibrates

A

Decrease triglycerides

143
Q

Niacin

A

Raise HDL, lower LDL

144
Q

Bile acid

A

lower LDL BUT be careful can raise triglycerides.

Safe in pregnancy.
can use with statin

145
Q

Statin add-on

A

Bile acid
Ezetamibe
PCSK9

146
Q

1st line Med for Acute Angina

A

Nitro (a preload reducer)

147
Q

1st line Med for Chronic Angina

A

Beta blocker (an afterload reducer)

Quarter 3 (17 decks)

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