CV Flashcards
1
Q
most common cause of non-ischemic cardiomyopathies
A
chronic alcoholism
2
Q
most common type (95%) of cardiomyopathy
A
dilated
3
Q
MCC of dilated cardiomyopathy
A
ischemia
4
Q
the 6 Ds that cause dilated cardiomyopathy
A
6 Ds: don’t know, Doxorubicin (chemo), drinking (alcohol), drugs (cocaine), deficiency (vit B1), delivery (post-partum)
5
Q
MCC of restrictive cardiomyopathy
A
amyloidosis
6
Q
how to hear HCM murmur bettere
A
stand after squat, valsalva (L sternal border)
7
Q
tx for symptomatic bradycardia
A
atropine
8
Q
for suspected afib, besides HTN/heart dz/valve dz, should ask about hx of: (3)
A
stroke, hyperthyroidism, lung dz (COPD, PNA, PE, CA)
9
Q
preferred anti-coags in Afib
A
DOACs
10
Q
when to use warfarin instead of preferred anti-coags in Afib -3
A
if NOAC is too expensive, in valvular A.Fib, or GFR<30.
11
Q
A fib 1st line for rate control
A
BB and non-diCCBs
12
Q
most common congenital heart problem
A
VSD
13
Q
ASD murmur best heard where
A
L 2nd-3rd ICS
14
Q
VSD murmur best heard where
A
L sternal border
15
Q
what Dx? classic sign: kid with higher blood pressure in the arms than in the legs and pulses that are bounding in the arms but decreased in the legs.
A
coarctation of the aorta
16
Q
what congenital murmur usually disappears on its own w/in a day or so?
A
Patent ductus arteriosus
17
Q
2 CXR findings for coarctation of the aorta
A
CXR: notching of posterior ribs; aortic shadow shows figure of 3 sign due to dilatation of proximal and distal segments surrounding coarctation.
18
Q
4 features of tetrology of fallot
A
4 features (PROVe): 1) pulmonary stenosis, 2)RVH, 3) overriding aorta, 4) ventricular septal defect.
19
Q
CXR finding for tetralogy of fallot
A
boot shaped heart
20
Q
gold standard for dx of CAD
A
coronary angiography
21
Q
Consider ________ test for CV risk assessment in asymptomatic adults >40 at intermediate risk
A
Coronary artery Ca scoring
22
Q
tx for CAD (4)
A
Statin, aspirin, ACE-I/ ARB, BB
23
Q
during MI, troponin onset happens b/w __ and __ hrs
A
4-8 hrs
24
Q
what med is CI if MI from cocaine?
A
BB
25
ST elevation must be >1.5-2.5mm in which leads to count as STEMI (otherwise just >1mm in 2 consecutive)
V2-V3
26
2 tx for * Prinzmetal variant (aka vasospastic) angina
nitro, CCB
27
pt dx in ED is unstable angina. next step?
do Heart/TIMI and if high score (5+), do stress test. If low score (<3), discharge and have pt follow up w/ PCP/cardiology (they will do stress test). If neg stress test, \Give statin, aspirin, or BB based on risk factors.
28
HFrEF has a EF < ____
<40%
40 or less
29
4 pillars of HFrEF tx
ARNi (sacubitril + valsartan) or ACEi or ARB, BB (carvedilol, metoprolol, bisoprolol), Mineralcorticoid receptor antagonist (spironolactone / eplerenone), SGLT-2 inhibitors (dapagliflozin)
30
tell HF pts to avoid _____ (med) and limit intake of _____ (2)
avoid NSAIDs. limit fluid and Na intake
31
treat HTN if >____ and no comorbities
>140/90
32
tx HTN if >130/80 + what conditions (3)
>130/80 w/ hx of CVD/ DM or age 65-75 or ASVCD risk >10%
33
tx HTN in CKD if > _____
120
34
tx for HTN in CKD (in any race)
ACE/ARB
35
tx for black pts w/ HTN
long-acting dihydrophyridine Ca Channel Blocker (amlodipine) or a thiazide-like diuretic (chlorathaladone)
36
tx for non-black DM pts w/ HTN
ACE/ARB
37
tx for HTN in pregnancy
methyldopa, labetalol, procardia
38
what is the FROM JANE of endocarditis?
FROM Jane: Fever, Roth's spots, Osler nodes, Murmer, Janeway lesions, Anemia, Nail bed hemorrhage, Emoboli. Janeway lesions (small erythematous/hemorrhagic nonpainful macules on palms/soles caused by septic emboli); Osler's nodes (painful pink palpable pea-sized nodules in fingers/toes); subungual splinter hemorrhages (linear in middle of nail)
Roth's spots (white areas in retina surrounded by zone of hemorrhage).
39
endocarditis prophylaxis
Amox PO 2g 30-60min prior to procedure
40
pericarditis pain feels better when pt ____
leans forward
41
pulse abnormality poss present in pericarditis
paradoxical pulse (increased drop in SBP during inspiration). Would feel like pulse diminishes or disappears during inspiration
42
most specific finding for pericarditis
3 part fiction rub (highly specific; best heard w/ diapragm over L sternal border w/ pt upright and leaning forward and holding breath after expiration; triphasic; raspy, scratchy, grating, or squeaking
43
EKG finding in pericarditis
ST elevations and PR depressions in all leads; T wave elevation in most leads
44
tx for mild pericarditis
NSAIDs in anti-inflammatory dose + colchicine
45
tx for pericarditis secondary to dressler syndrome
aspirin + cochicine X 3 mo (not ibuprofen)
46
Beck's triad in cardiac tamponade
Beck's triad: JVD, muted heart sounds, hypotension. (in <50%).
47
order __ to dx tamponade
echo
48
what EKG finding is specific for pericardial effusion
electrical alternans (rhythm switching of QRS axis; specific but not sensitive for effusion)
49
MCC of aortic stenosis in <70
bicuspid aortic valve
50
MCC of aortic stenosis in >70
ddegenerative
51
R vs L sided murmurs: which increase w/ inspiration
R sided
52
MCC of S3
CHF
53
tx for aortic stenosis
valve replacement
54
how to make aortic stenosis murmur louder (2)
leaning forward with expiration and squatting
55
MCC of AR
weakening of vlaves due to aging.
56
aortic dissections can cause what murmur?
AR
57
tx for acute AR
early surgery w/in 24 hrs of diagnosis is best prognosis
58
MCC of mitral stenosis
rheumatic heart dz
59
MCC of chronic MR
Most common: MVP, then rheumatic heart dz, ischemia,, infectious endocarditis.
60
MR shows up how long after rheumatic fever
20-40 years
61
rumbling low pitch murmur with palpable S1 at apex and opening snap just after S2
MS
62
blowing holosystolic murmur (ssssh dub) at apex w/ split S2, radiates to L axilla
MR
63
tx for MVP w/ palpitations
BB
64
consider what 3 consequences from MS and MR
CHF, afib / stroke
65
only effective tx for MR
valve repair/replacement
66
if CP + focal neuro deficit, think _____
aortic dissections
67
MC focal neuro deficit in aortic dissections
cerebral ischemia
68
MC location of AAA
below renal arteries
69
who to screen for AAA
Screen all men 65-75 w/ hx of smoking 100+ cigs.
70
what D dimer cutoff to help r/o aortic dissections
<500
71
tx for symptomatic aortic dissections
surgery
72
non-surgery tx for AAA — lifestyle + 3 meds
goal = prevent rupture. Quit smoking. Statin, BB, ACE-I / ARB
73
when to do surgery for AAA
Surgery if acute rupture, rapidly growing, involves branching arteries, or >5.5cm.
74
tx for arterial embolism in leg
Anticoag w/ IV heparin (bolus then constant). If not limb threatening, call vascular surgeon for angioplasty, graft, or endarterectomy. Goal is embolectomy w/in 4-6 hrs.
75
pt c/o sudden onset leg pain. loss of distal pulse, cyanosis. dx?
arterial embolism
76
giant cell arteritis is vasculitis of what size arteries?
medium to large
77
suspect what dx if amaurosis fugax? (brief--only a few min--visual field loss upper and extends downward like a curtain).
temporal arteritis
78
tx for temporal arteritis
high dose corticosteroids and refer for biopsy w/in 1 wk to decrease chance of blindness
79
skin findings in PAD
thin shiny skin, hair loss, poss ulcers/gangrene. pallor on elevation, cool to touch.
80
test for PAD and results
Ankle Brachial Index--ankle will be low in comparison to arm (PAD is <1; normal is 1.0-1.4).
81
look for what other dz if PAD?
CAD
82
what is more common? DVT or superficial thrombophlebitis?
superficial thrombophlebitis
83
tx for superficial thrombophlebitis
warm compresses, compression, LE elevation, normal activities, NSAIDs (8-12 days)
84
6 causes of hypercoagulability
estrogen therapy, pregnancy, inflammation, dehydration, cancer, thrombophilia
85
most common vascular dz after ACS and stroke.
Venous thromboemboism
86
gold standard test for PE
chest angiography
87
SVT Stable, NARROW complex QRS acute treatment
Vagal maneuvers (valsalva, carotid massage). If that doesn't work - fast bolus Adenosine (6mg fast bolus; repeat w/ 12 mg after 1-2 min if not effective; can repeat 12mg once more) , AV nodal blocking agents (BB, CCB--diltiazem)
88
tx for WPW
procainamide. no BB or n-dCCB.
89
PE finding for premature contraction.
Bigeminal pulse (normal beat followed by premature beat)
90
what dx? three or more consecutive “PVCs”. Rates typically 120-250bpm
VT
91
Med tx for Stable, Sustained VT (acute)
Antiarrhythmics via IV such as Procainamide, Amiodarone
92
tx for unstable VT
DCCV (shock)
93
pt w/ V fib will present _____
pulseless, unresponsive
94
MCC of Torsades de pointes
hypoMg
95
tx for TdP
IV Mg 1-2g IV over 15 min. defib, discontinue QT prolonging drugs.
96
bradycardia w/ pauses >3 sec
SSS
97
SSS tx
pacemaker
98
Constant, prolonged PR interval >200ms (one square on EKG) that stays same length. dx?
1st degree heart block
99
Progressive PR interval lengthening leading to dropped QRS. dx?
Second Degree AV block Type I (Wenckeback/Mobtiz I)
100
Constant, prolonged PR interval with dropped QRS (some P waves don't conduct
Second Degree AV block Type II (Mobtiz II)
101
tx for 2nd degree heart block type 1
atropine
102
tx for 2nd degree heart block type 2
beta adrenergic agent (dopamine, dobutamine). AVOID Atropine. Temporary pacing.
103
regular P-P intervals unrelated to R-R intervals
3rd degree heart block aka complete
104
5 Hs of H and Ts that cause cardiac arrest
Hypoxia - MC
Hypovolemia - 2nd MC
Hydrogen ion /acidosis
Hypo/hyperK
Hypothermia
105
5 Ts of H and Ts that can cause cardiac arrest
Tension PTX
Tamponade
Toxins
Thrombosis, pulm
Thrombosis, coronary
106
multifocal atrial tachycardia is ASW what comorbitity
COPD
107
Which of the following antiarrhythmic drugs can be associated with hyper- or hypothyroidism following long-term use?
Quinidine
Amiodarone
Digoxin
Verapamil
Amiodarone is structurally related to thyroxine and contains iodine, which can induce a hyper- or hypothyroid state.
108
Contraindications to beta blockade following an acute myocardial infarction include which of the following?
Third degree A-V block
Sinus tachycardia
Hypertension
Rapid ventricular response to Atrial fibrillation/flutter
Beta blockade is contraindicated in second and third heart block.
109
A 74 year-old male is diagnosed with pneumonia. The physician assistant should ensure the patient is not on which of the following before starting therapy with clarithromycin (Biaxin)?
Dipyridamole (Persantine)
simvastatin
Lasix
lisinopril
Statins are known to interact with the macrolides as they may cause prolonged QT interval, myopathy and rhabdomyolysis.
110
In congestive heart failure the mechanism responsible for the production of an S3 gallop is
contraction of atria in late diastole against a stiffened ventricle.
rapid ventricular filling during early diastole.
vibration of a partially closed mitral valve during mid to late diastole.
secondary to closure of the mitral valve leaflets during systole.
Rapid ventricular filling during early diastole is the mechanism responsible for the S3.
111
During an inferior wall myocardial infarction the signs and symptoms of nausea and vomiting, weakness and sinus bradycardia are a result of what mechanism?
Increased sympathetic tone
Increased vagal tone
Activation of the renin-angiotensin system
Activation of the inflammatory and complement cascade system
Increased vagal tone is common in inferior wall MI; if the SA node is involved, bradycardia may develop.
112
Of the following, which is the most common cause of secondary hypertension?
Hyperthyroidism
Hypothyroidism
Obstructive sleep apnea
Aortic coarctation
OSA. Although the vast majority of patients have primary or essential hypertension, secondary hypertension is identified in approximately 10% of adult patients. Common causes of secondary hypertension include the following:
Renovascular disease
Obstructive sleep apnea
Renal parenchymal disease
Primary aldosteronism
Drug- or alcohol-induced
113
holosystolic murmur is caused by what 3 valvular / septal conditions?
A holosystolic murmur is caused by Mitral Regurgitation, Tricuspid Regurgitation, or a Ventricular Septal Defect.
114
Which of the following physical exam findings is consistent with Aortic Stenosis?
A: Narrow pulse pressure
B: Systolic murmur best heard at the apex
C: Diastolic murmur heard best at the right 2nd intercostal space
D: Systolic murmur and a sternal heave
E: The murmur gets louder during inspiration
A: Narrow pulse pressure (systolic minus diastolic blood pressure < 30 mmHg).
115
Which one of the following cardiac dysrhythmias is associated with antipsychotic use?
A Atrial fibrillation
B Third degree heart block
C Torsades de pointes
D Wolff-Parkinson-White syndrome
TdP
116
According to guidelines from the Eighth Report of the Joint National Committee (JNC 8), patients older than age 60 years with hypertension and no other medical history should be treated to which of the following blood pressure goals?
A < 120/80 mm Hg
B < 130/85 mm Hg
C < 140/85 mm Hg
D < 150/90 mm Hg
D < 150/90 mm Hg
117
Which of the following medications has the greatest impact on reducing mortality in patients presenting with acute coronary syndrome?
A Aspirin
B Metoprolol
C Morphine
D Nitroglycerin
ASA
118
Which of the following is commonly the first reported symptom of aortic stenosis?
A Chest pain
B Dyspnea
C Syncope
D Vomiting
dyspnea
119
What is the most common cause of tricuspid valve stenosis?
A Bacterial endocarditis
B Dilation and dissection of the aortic root
C Marfan syndrome
D Rheumatic heart disease
D Rheumatic heart disease
120
What is the recommended anticoagulant for a pregnant patient diagnosed with a deep vein thrombosis?
Low-molecular-weight heparin.
121
for PAD tx, rx ASA/plavix + statin + ______ (class)
cilostazol or pentoxifylline (phosphodiasterase inhibitor),
122
EKG shows inferior ST elevation. next step?
ECG findings suggestive of this include ST segment elevation in leads II, III, and aVF with the elevation in lead III greater than that of lead II or associated elevation in lead V1. Any ST segment elevation in the inferior leads should prompt a right-sided electrocardiogram. ST segment elevation in leads V4R, V5R and V6R is diagnostic of a right ventricular infarct
123
Which of the following laboratory studies should be ordered in a patient being evaluated for hypertriglyceridemia?
A Antinuclear antibody
B Complete blood count
C Thyroid-stimulating hormone
D Troponin I
TSH. can be caused by hypothyroidism
124
Which of the following best describes the physiologic process responsible for the fourth heart sound heard in patients with advanced aortic stenosis?
AAtrial contraction against a noncompliant left ventricle
BBlood striking a dilated left ventricle during diastole
CDelayed closure of the aortic valve in relation to the pulmonic valve
DTurbulent blood flow across a calcified aortic valve
AAtrial contraction against a noncompliant left ventricle
125
long term rx for incident of sustained monomorphic VT
BB
126
ABCDE of causes of 1st degree AV block
adenosine
BB
n-hCCB
digoxin
exercisers
127
BLOCK of causes of 2nd degree AV block type 1
BB
lyme
ordinary (normal variant)
CCB
K - hyperK
128
MC chronic arrhythmia
afib
129
tx for stable WIDE complex SVT
IV procainamide or amiodarone
130
definitive tx for SVT
radiofreqency catheter ablation
131
tx for symptomatic PVCs
BB (alt non-dCCB)
132
worst RF for angina/CAD
DM
133
4 meds that pt with CAD/angina should be on
statin
ASA
BB
nitro
134
most effective med class to improve mortality in HFrEF
ACe inhiitors
135
MCC (virus) of myocarditis
coxsackie B
136
2 most important orders to put in for suspected infective endocarditis
blood cultures and echo
137
is AS ASW S3 or S4
S4
138
if pt develops myalgias on a statin, switch to one of which 2 statins?
pravastatin or fluvastatin
139
3 AE of statins that require lab monitoring
liver dysfunction
kidney disfunction
hyperglycemia
140
bile acid sequestrants (cholestyramine) are used to lower LDLs, but can increase ________
triglycerides
141
aortic dissection SBP goal is ______ - _____ after _____ minutes
100-120
20 min
142
nonatherosclerotic inflammatory small and medium vessel vasculitis, leading to vaso-occlusive phenomena
Pt will be young smoker with claudication or ischemic ulcers on LE
thromboangiitis obliterans aka Buerger's dz
143
is an innocent murmur systolic or diastolic?
systolic
144
Which of the following is the mechanism of action of Class III antiarrhythmic drugs?
Na+ channel blocker
K+ channel blocker
Beta adrenoreceptor blocker
Ca++ channel blocker
K+ channel blocker
think 3k
145
MC arrhythmia in MS
afib
146
A 46 year-old male with no past medical history presents complaining of chest pain for four hours. The patient admits to feeling very poorly over the past two weeks with fever and upper respiratory symptoms. The patient denies shortness of breath or diaphoresis. On examination the patient appears fatigued. Vital signs reveal a BP of 130/80, HR 90 and regular, RR 14. The patient is afebrile. Labs reveal a Troponin I of 10.33 ug/L (0-0.4ug/L). Cardiac catheterization shows normal coronary arteries and an ejection fraction of 40% with global hypokinesis. Which of the following is the most likely diagnosis?
myocarditis
pericarditis
hypertrophic cardiomyopathy
coronary artery disease
myocarditis
147
A hospitalized patient is found with confirmed pulseless ventricular tachycardia. IV access is obtained following the second shock given. Which medication is to be administered immediately?
epi
148
The drug of choice for treating hypertensive encephalopathy in the nonpregnant patient is
sodium nitroprusside
labetalol
esmolol
IV nitroglycerin
hydralazine
sodium nitroprusside
Most of the medications listed are a good option for hypertensive emergencies . Sodium nitroprusside is the most widely used/ available, is a rapidly acting arterial and venous dilator, and is the drug of choice for most hypertensive emergences unless there is severe kidney disease.
149
ST segment elevation that is present beyond 4-8 weeks after the acute infarct and a scar that bulges paradoxically during systole on echocardiogram. dx?
ventricular aneurysm
150
Which of the following medication classes is the recommended treatment for patients who have an anterior wall myocardial infarction with poor left ventricular function?
Beta blockers
Calcium channel blockers
Potassium sparing diuretics
ACE inhibitors
ACE inhibitors. ACE inhibitors have been proven to be effective in the therapy of heart failure, especially in the setting of left ventricular dysfunction. They are considered first-line therapy in patients with symptomatic left ventricular systolic function
Beta blockers need to be used with caution in a patient with severe left ventricular dysfunction as they will worsen left ventricular contractility and may make this dysfunction worse. They are used, however, in the early stages of chronic heart failure.
151
Which of the following is the most common complication that occurs in the setting of acute pericarditis?
Pericardial effusion
Left ventricular failure
Superior vena cava syndrome
Subclavian steal syndrome
Pericardial effusion. Accumulation of transudate, exudate or blood in the pericardial sac can occur due to pericardial inflammation.
152
A patient presents to the office following a syncopal episode. The patient claims that the syncope occurs when he changes position such as rolling over in bed or when he bends over to tie his shoes. Which of the following is the most likely explanation for this presentation?
Carotid sinus hypersensitivity
Vasovagal episode
Subclavian steal syndrome
Atrial myxoma
Atrial myxoma most commonly presents with sudden onset of symptoms that are typically positional in nature due to the effect that gravity has on the tumor. Myxomas are the most common type of primary cardiac tumor in all age groups and are most commonly found in the atria.
