CV Flashcards
1
Q
MI in mensturating woman
A
VIRTUALLY NEVER
2
Q
MI in mensturating woman
A
VIRTUALLY NEVER
3
Q
chest pain– must find out if they have
A
RISK FACTORS FOR CAD
4
Q
most likely to benefit cardiac outcome
A
REGULAR EXERCISE
5
Q
tai chi and yoga with CV effects
A
NOT PROVEN yet, difficult in measuring relaxation
6
Q
who dies from heart disease
A
WOMEN die more from heart disease than men
7
Q
nb fam hx for cv risk factor
A
must be hx of PREMATURE cad
and FIRST DEGREE RELATIVE
8
Q
worst risk factor for CAD
A
DM
9
Q
most common risk factor for CAD
A
HTN
10
Q
premature age of CAD men
A
11
Q
premature age of CAD women
A
12
Q
most dangerous lipid profile for a patient
A
elevated LDL
13
Q
tx TAKO-TSUBO
A
ACE inhibs
Beta blockers
NO REVASC— since no problem with coronary vessels
14
Q
tx TAKO-TSUBO
A
ACE inhibs
Beta blockers
NO REVASC— since no problem with coronary vessels
15
Q
chest pain– must find out if they have
A
RISK FACTORS FOR CAD
16
Q
most likely to benefit cardiac outcome
A
REGULAR EXERCISE
17
Q
tai chi and yoga with CV effects
A
NOT PROVEN yet, difficult in measuring relaxation
18
Q
who dies from heart disease
A
WOMEN die more from heart disease than men
19
Q
nb fam hx for cv risk factor
A
must be hx of PREMATURE cad
and FIRST DEGREE RELATIVE
20
Q
worst risk factor for CAD
A
DM
21
Q
most common risk factor for CAD
A
HTN
22
Q
premature age of CAD men
A
23
Q
premature age of CAD women
A
24
Q
most dangerous lipid profile for a patient
A
elevated LDL
25
PC: postmenopausal woman
son died in war
ballooning of LV and LV dyskinesia
chest pain
TAKO-TSUBO cardiomyopathy:
| massive catecholamine discharge from stressful event (divorce, financial issues, earthquake, lightning, hypoglycaemia)
26
tx TAKO-TSUBO
ACE inhibs
Beta blockers
NO REVASC--- since no problem with coronary vessels
27
elevated homocysteine as rf for CAD
FALSE
28
elevated CRP as rf for CAD
FALSE
29
infection with chlamydia as rf for CAD
FALSE
30
immediate benefit if remove which CAD rf
STOP SMOKING
31
description for cardiac/ischemic chest pain
DULL or SORE
| SQUEEZING or pressure like
32
UNLIKELY description of ischaemic pain
sharp (knifelike) or pointlike
lasts for a few seconds
NOT
- tender
- positional
- pleuritic
33
chest wall tenderness
costochondritis
34
costochondritis most accurate test
physical exam
35
chest pain radiating to back, unequal bp between arms
AD
36
AD most accurate test
```
CXR with widened mediastinum
confirmation of AD, chest:
- CT
- MRI
- TEE
```
37
chest pain worse with lying flat, better when sitting up, young person (
pericarditis
38
2 factors nb for ETT
1. cannot read EKG, ie. its not diagnostic
| 2. patient can exercise: get heart rate above 85% of maximum
39
chest pain + bad taste, cough, hoarseness
GERD
40
best test for GERD
response to PPI's
aluminum and magnesium hdroxide
viscous lidocaine
41
chest pain
cough
sputum
haemoptysis
PNEUMONIA
42
SUDDEN SOB and chest pain
tachycardia
hypoxia
PE
43
chest pain thats sharp
pleuritic pain
tracheal deviation
pneumothorax
44
best test pneumothorax
CXR
45
NONspecific symptoms seen in MANY causes of chest pain
```
nausea
fever
SOB
sweating
anxiety
```
46
BEST INTIAL TEST for all forms of chest pain
EKG
47
office based ambulatory setting EKG
likely to be normal, but CANNOT go on to other forms of testing until EKG is done
48
acute chest pain in office/ clinic setting, next best answer
TRANSFER TO EMERGENCY DEPARTMENT
49
acute chest pain in emergency department, next best step
ENZYMES
50
when to do exercise tolerance testing
UNCLEAR cause of chest pain
51
2 factors nb for ETT
1. you can read EKG
| 2. patient can exercise: get heart rate above 85% of maximum
52
maximum heart rate
220 MINUS patients age
53
determining ischaemic when cannot read the EKG/ baseline EKG abnormalities
1. Thallium or sestamibi scan
| 2. ECHO-- wall motion abormalities
54
baseline EKG abnormalities causes
1. LBBB
2. LVH
3. pacemaker use
4. effect of digoxin
55
normal myocardium with Thallium
INCREASED UPTAKE of thallium
56
abnormal myocardium with Thallium
DECREASED UPTAKE of thallium
57
ECHO for baseline EKG abnormaltiies
decreased wall motion
| dyskinesia/akinesia/hypokinesia
58
ischaemia reversible or irreversible
REVERSIBLE
59
infarction reversible or irreversible
IRREVERSIBLE
60
alternatives to exercise in stress testing
| NOTE they are of equal sensitivity and specificity
1. persantine= dipyridamole or adenosine in combo with thallium or sestamibi
2. dobutamine + ECHO
61
avoid with agent for stress testing in asthmatic patients
DIPYRIDAMOLE
62
exercise thallium same as
exercise ECHO
63
dipyridamole thallium same as
dobutamine ECHO
64
PC: man with atypical chest pain has normal nuclear uptake in his myocardium at rest. with exercise, decreased uptake in inferior wall. two hours after exercise, nuclear isotope returns to normal. NEXT BEST STEP
CORONARY ANGIOGRAPHY-- because already know this patient has reversible ischaemic, it's 100% specific for coronary disease
NOT dobutamine ECHO because only done when NOT SURE of the cause
65
coronary angiography determines...
bypass SURGERY vs. bypass ANGIOPLASTY
66
most accurate method of detecting CAD
angiography
67
stenosis
INSIGNIFICANT
68
surgically correctable disease % stenosis
70% stenosis
69
goal of LDL
1. PAD
2. Carotid disease (NOT stroke)
3. Aortic vessel disease
4. stroke
5. DM
70
do you do ETT in ACS patients currently having pain?
NO because the diagnosis is already clear
[remember don't put the patients on the treadmill to exercise/ stress heart-- if they are CURRENTLY having chest pain]
71
meds that lower chronic angina mortality (not ACS)
"BAN"
beta blockers
aspirin
nitroglycerin
best= B + A
72
propanolol use in cardiology
NO-- B/C NON-specific
73
acute coronary syndrome tx
ASPIRIN + 1 other anti platelet
- clopidogrel
- prasugrel
- ticagreolar
74
NB use of clopidogrel
aspirin intolerance
75
NB use of prasugrel
antiplatelet in those undergoing
ANGIOPLASTY and STENTING
dangerous in patients>775 since risk of hemorrhagic stroke
76
what drug if intolerant to aspirin and clopidogrel
| truly intolerant, not because bleeding
TICLOPIDINE
77
side effects of ticlodipine
neutropenia and ttp
78
CAD use of ACE/ARBs
```
LOW EF (systolic dysfunction)-- BEST MORTALITY BENEFIT
REGURGITANT valvular disease
```
79
BIG 3 SE's of CCBs
1. edema
2. constipation
3. heart block (rarely)
80
what drugs if systolic dysfunction CAD
ACEinhibitors or
hydralazine
(both directly decrease mortality)
81
goal level for LDL in CAD
82
goal of LDL
1. PAD
2. Carotid disease (NOT stroke)
3. Aortic vessel disease
4. stroke
5. DM
83
ACS associated with point of maximal impulse
NOOOOOO--- because no specific physical findings in ACS
PMI:
- LVH
- DCM
84
NB monitoring for patients on statins
AST, ALT even without symptoms
| DON'T DO CPK ROUTINELY (only done if have symptoms)
85
give to all CAD patients regardless of lipid levels
STATINS
86
NB effect of statins on endothelial lining
ANTIOXIDANT effect on endothelial lining
87
if full lipid control is not achieved with statins alone, add....
NIACIN
88
gemfibrozil + statins
increase myositis risk
89
ezetimibe
no better than placebo in terms of clinical endpoints
but yes definitely lowers LDL, but of no clinical benefit
well tolerated and nearly useless!
90
which drug increases mortality in patients with CAD
CCB's-- since raise heart rates-- reflex tachycardia with nifedipine
DO NOT USE CCBs in CAD
91
only times when can use CCBs in CAD
1. SEVERE asthmatic
2. prinzmetal
3. cocaine
4. failed aspirin and beta blocker medical tx
92
BIG 3 SE's of CCBs
1. edema
2. constipation
3. heart block (rarely)
93
few circumstances, in which CABG lowers mortality
```
VERY SEVERE DISEASE
1. THREE vessels at least 70% stenosis
2. L MAIN coronary artery occlusion
[3. 2 vessels in DM patient
[4. persistent symptoms despite maximal medical tx
```
94
duration of graft length before occlusion
internal mammary= 10 years
| saphenous vein= 5 years
95
BEST TX FOR ACS
PCI = angioplasty
96
ACS associated with point of maximal impulse
NOOOOOO--- because no specific physical findings in ACS
PMI:
- LVH
- DCM
97
ST elevation in leads II, III, aVF
acute MI inferior wall
98
mortality with IWMI
99
DOOR TO BALLOON TIME
90 minutes
100
PR interval >200 milliseconds
first degree AV block-- little pathologic potential
101
ST elevation in leads V2-V4
Anterior Wall MI
102
premature ventricular contractions
aw later development of more severe arrhythmias
| no additional tx if NORMAL K, Mg
103
ST depression in leads V1 and V2
posterior wall mI; low mortality
104
RBBB vs LBBB
```
RBBB= benign
LBBB= pathologic
```
105
treatment of PVCs
DO NOT TREAT
TX WORSENS OUTCOME
106
FIRST MGMT OF ACS
ASPIRIN-- since it lowers mortality (more important than morphine, oxygen and nitroglycerin-- however these are all administered)
107
NB rules in mgmt of ACS
START TX ASAP and do testing
| BEFORE move to ICU
108
on step 2 CK should you ever consult with another dr?
NO-- DO IT YOURSELF
109
ONLY 2 things that decrease mortality in ACS-- and must be prioritized first
1. ASPIRIN
| 2. PCI/angioplasty
110
mgmt of reinfarction
1. EKG-- check new ST abnormality
2. check CK-MB
CK-MB BETTER at detecting reinfarction
111
ACS angioplasty or thrombolytics?
ANGIOPLASTY-- better with survival/mortality, less bleeding, less complications of MI develop
112
DOOR TO BALLOON TIME
90 minutes
113
complications of PCI
- RUPTURE coronary artery when inflate the balloon
- RESTENOSIS (thrombosis) of vessel after angioplasty
- HAEMATOMA- at entry site into artery
114
most NB in decreasing risk of restenosis of coronary artery after PIC?
placement of drug-eluting stent-- paclitaxel, sirolimus
115
4 ABSOLUTE contraindications to thrombolytics
1. major bleed in bowel (BLACK-MELENA, not brown), and brain (ANY type of bleed)
2. recent surgery (in last 2 weeks)
3. severe HTN (above 180/110)
4. non-haemorragic stroke in last 6 months
116
Door to needle time
30 minutes
117
who should get beta blockers in ACS
EVERYONE,
| BUT NOT dependent on time
118
first line treatment for NSTEMI (stable)
LMWH, clopidogrel or enoxaparin
obviously because want to prevent the clot from growing and FULLY occluding the coronary arteries
119
GP2b/3a inhibitors
abciximab
tirofiban
eptifibatide
120
use of GP2b/3a inhibitors
ANGIOPLASTY and STENTING and NONSTEMI
121
only use for thrombolytics in MI
STEMI not for nstemi
122
SPECIFICALLY which type of heparin is best for NSTEMI
LMWH
not unfractionated heparin in terms of mortality benefit
123
NSTEMI that is not getting better with LMWH tx
- persistent pain
- S3 gallop or CHF developing
- worse EKG changes or sustained ventricular tachycardia
- rising troponin levels
124
post-MI stress test
```
done for EVERYONE prior to discharge
UNLESS SYMPTOMATIC (since immediately need angiography)
```
deciding whether need angiography or not
125
intra-aortic balloon pump
BRIDGE to surgery for valve replacement or transplant for 24-48hrs after rupture of valve or septum post-MI
126
dipyridamole in coronary artery disease
NEVER NEVER NEVER NEVER NEVER
127
ACE inhibitors are best for which type of wall infarct
ANTERIOR wall infract, since most likely to develop systolic dysfunction
128
bradycardia and canon A waves post-MI
third degree AV block
129
bradycardia and NO canon A waves post-MI
sinus bradycardia
130
clear chest and new inferior wall MI
RV infarct
131
don't give what if RV infarct
Nitroglycerates-- since cause hypotension
132
SUDDEN loss of pulse with jugulovenous distension
tamponade
133
DIAGNOSIS V.FIB
EKG
134
tx v/tach
electric cardioversion/ defib
| PCI ASAP
135
new murmur post-MI in LLSB
septal rupture
136
oxygen sats in RA = 72% and 85% in RV
septal rupture
137
prophylactic antiarrhythmics post-MI
```
DON'T DO IT!!!!!!!!!!!!!!!!! even if have frequent PVC's and ectopy
don't use:
- amiodarone
- flecainide
- any rhythm controller
```
138
sexual issues post-infarction
1. NO nitrates and sildenafil
2. erectile dysfunction most commonly from ANXIETY, however if med associated--most commonly= beta blockers
3. do NOT need to wait to have sex (or normal exercise, given that post-MI stress test was normal)
139
most common cause of admission to the hospital in the US
Congestive heart failure
140
SOB brown blood and cyanosis, not improved with oxygen and clear lungs
methhaemoglobinaemia
141
burning wood stove in winter
carbon monixde poisoning
142
MOST important test in chf
ECHO
143
TEE or transthoracic ECHO best for CHF
transthoracic best, but TEE MOST accurate test (but often not needed)
144
MOST accurate test in CHF
MUGA= nuclear ventriculography
multiple gated acquisition scan
most accurate because evaluates WALL MOTION abnormalities
145
when to use MUGA ....
patient receiving doxorubicin
146
ACE inhibitors and ARBs in tx of systolic dysfunction CHF
ALL PATIENTS,
| benefits seen with ANY drug in combo
147
when to answer ARBs >ACE inhibitors CHF
when the patient has cough from ACE inhibitor
148
which beta blockers to use for CHF (Recall don't use acutely)
- metoprolol and bisoprolol= beta 1
| - carvedilol= non-specific
149
MCC death from CHF
ischaemia--> arhythmia--> sudden death
150
decrease mortality in CHF drugs
1. spironolactone and eplrenone
[anti-androgenic, and NOT anti-androgenic]
2. hydralazine + nitrates (systolic dysfunction)
3. ACEinhibitors/ ARBS
4. beta blockers
151
loops and spironolactone not given at diuretic effect in ACUTE MGMT CHF
do NOT lower mortality
152
NO benefit in mortality CHF systolic dysfunction
1. loops (and spironolactone at non-diuretic levels)
| 2. digoxin/ positive inotropes
153
BENEFIT mortality in CHF systolic dysfunction
1. spironolactone/ eplerenone
2. implantable defbrillator
3. biventricular pacemaker
4. hydralazine + nitrates (systolic dysfunction)
5. ACE inhibitors/ ARBs
6. beta blockers
154
when to give implantable defibrillator
- ischaemic cardiomyopathy
| - EF
155
when to give biventricular pacemaker
- dilated cardiomyopathy
| - EF 120ms
156
should you give warfarin if there is no clot in the heart?
NOOOOO
157
CCB's in heart failure
NO clear benefit in systolic dysfunction
| some can actually RAISE MORTALITY
158
clearly beneficial diastolic dysfunction CHF
beta blockers
| diuretics
159
clearly NOT beneficial diastolic dysfunction CHF
spironolactone
| digoxine
160
uncertain beneficial diastolic dysfunction CHF
ACE inhibitors
ARBs
hydralazine
161
tx of acute pulmonary oedema from arrhythmia
CARDIOVERSION ASAP!!!!
162
nesiritide on mortality
NO PROVEN BENEFIT and
| NOT PROVEN BETTER than standard agents for acute pulmonary edema
163
dobutamine in acute pulmonary edema
if failed LMNOP
164
digoxin in acute pulmonary edema
NOOOOO
165
treatment of acute pulmonary oedema with heparin but NO CLOT
NOOOOOOO NEVER
166
INITIAL diagnostic test for valvular heart disease
TEE: transesophageal ECHO
167
most accurate test for vaulter heart disease
catheterization
168
surgery with MS
dilated with a balloon
169
treatment of regurgitant lesions
VASODILATORS:
- ACE inhibitors, ARBs
- nifedipine
- hydralazine
170
with valvular heart disease and heart dilates XS from regurgitant----
CANNOT correct the decrease in systolic function
| thus will end up needing to replace the valve
171
assessment of ventricular size
based on end-SYSTOLIC diameter and EF
172
prophylaxis antibiotics in valvular disease
ONLY IF....
1. prosthetic valve
2. hx of endocarditis
173
Mitral stenosis clues
PREGNANCY
IMMIGRANT
and YOUNG ADULTS
174
what 4 big things a/w MS
1. haemoptysis
2. dysphagia
3. hoarseness
4. A. FIB************ VERY COMMON
175
tx of MS
1. diuretics and sodium restriction
2. balloon valvuloplasty
3. valve replacement
4. warfarin for a fib, INR 2-3
5. rate control: digoxin, beta blockers, diltiazem, verapamil
176
balloon valvuloplasty for AS
NOT routinely done, since the calcification= the problem, and putting in the balloon doesn't help this problem
ONLY really done when can't do surgery because patient is unstable or fragile
177
PC:
- atypical chest pain
- palpitations
- panic attack
3P's of MVP
| pain/palpitations/panic attack
178
need for catheterization in MVP
NOOOOOOOO, because don't need to know if exact pressure gradient
179
NB ECHO finding in HOCM
SAM
180
HOCM vs. HCM
HCM-- high bp, Y- ACEi, Y-diuretics
| HOCM-- genetic, N- ACEi, N- diuretics
181
don't use which two drugs in hypertrophic cardiomyopathy
spironolactone and digoxin
182
EKG in HCM
non-specific ST and T wave changes
septal Q waves in inferior and lateral leads (NOT MI)
183
standing and valsalva = same effect as...
DIURETICS
184
amyl nitrate
direct arteriolar vasodilator
SIMULATES the effect of ACE inhibitors/ ARBs on the heart
185
ventricle size with handgrip and amyl nitrate
handgrip= FULLER left ventricle
| amyl nitrate= ACE inhibitors= EMPTIER left ventricle
186
ACE inhibitor effect on MS
NO EFFECT,
thus amyl nitrate and handgrip, also no effect
187
inspiration effect on murmurs
INCREASES all heart sounds
188
valsalva and standing effect on murmurs
decreases most
INCREASES HOCM
EARLIER MVP
189
hand gripping effect on murmurs
INCREASES MR.AR.VSD
decreases HOCM
later MVP
190
squatting effect on murmurs
INCREASES AS
decreases HOCM
later MVP
191
NOTE-- decreasing murmur intensity = same as
IMPROVING murmur
192
what drug to decrease recurrence of pericarditis?
COLCHICINE
193
what is the best pain relief in pericarditis?
NSAID and COLCHICINE
| together
194
most APPROPRIATE diagnostic test in cardiac tamponade
ECHO
195
what MUST you do before catheterization in cardiac tamponade
ECHO
196
ECHO in cardiac tamponade:
COLLAPSE of RA + RV
197
Right heart catheterization in cardiac tamponade
EQUALIZATION of pressures in diastole
198
best initial test in constrictive pericarditis
CHEST X-RAY-- shows calcification and fibrosis
199
initial treatment of constrictive pericarditis
DIURETICS (Decompresses the filling of the heart), later on can do surgery
200
pain worse in calves when walking DOWN hill
spinal stenosis (since leaning back)
201
single most effective medication in PAD
CILOSTAZOL
202
which drug does NOT HELP PAD
Calcium Channel Blockers
203
best initial diagnosis of aortic dissection
CXR-- simple, and shows widening of mediastinum
204
MOST ACCURATE diagnosis of aortic dissection
CT angio= GOLD STANDARD
205
screening AAA
men
>65yo
smokers
206
surgical correction AAA
>5cm
207
peripartum cardiomyopathy
occurs AFTER delivery
autoantibodies to myocardium
LV dysfunction often reversible
if worsening of LV function--> TRANSPLANT
208
tx OK with ACEi in peripartum cardiomyopathy
YES because occurs AFTER delivery
209
what happens when woman with hx of peripartum cardiomyopathy gets PREGNANT AGAIN
BIGGER surge of antibodies and
| WORSENING of cardiac function
210
what cardiac functions worsen in pregnancy
peripartum cardiomyopathy
eisenmenger syndrome
[above 2 worsen more than MS]
211
syncope-- suddenly, have heart disease, frequent ectopic beats, thiazides
arrhythmia
212
syncope-- before get dizzy/weak/nauseous; EMOTIONAL trigger
vasovagal
