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Master the Boards > CV > Flashcards

CV Flashcards

1
Q

MI in mensturating woman

A

VIRTUALLY NEVER

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2
Q

MI in mensturating woman

A

VIRTUALLY NEVER

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3
Q

chest pain– must find out if they have

A

RISK FACTORS FOR CAD

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4
Q

most likely to benefit cardiac outcome

A

REGULAR EXERCISE

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5
Q

tai chi and yoga with CV effects

A

NOT PROVEN yet, difficult in measuring relaxation

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6
Q

who dies from heart disease

A

WOMEN die more from heart disease than men

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7
Q

nb fam hx for cv risk factor

A

must be hx of PREMATURE cad

and FIRST DEGREE RELATIVE

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8
Q

worst risk factor for CAD

A

DM

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9
Q

most common risk factor for CAD

A

HTN

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10
Q

premature age of CAD men

A
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11
Q

premature age of CAD women

A
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12
Q

most dangerous lipid profile for a patient

A

elevated LDL

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13
Q

tx TAKO-TSUBO

A

ACE inhibs
Beta blockers

NO REVASC— since no problem with coronary vessels

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14
Q

tx TAKO-TSUBO

A

ACE inhibs
Beta blockers

NO REVASC— since no problem with coronary vessels

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15
Q

chest pain– must find out if they have

A

RISK FACTORS FOR CAD

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16
Q

most likely to benefit cardiac outcome

A

REGULAR EXERCISE

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17
Q

tai chi and yoga with CV effects

A

NOT PROVEN yet, difficult in measuring relaxation

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18
Q

who dies from heart disease

A

WOMEN die more from heart disease than men

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19
Q

nb fam hx for cv risk factor

A

must be hx of PREMATURE cad

and FIRST DEGREE RELATIVE

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20
Q

worst risk factor for CAD

A

DM

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21
Q

most common risk factor for CAD

A

HTN

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22
Q

premature age of CAD men

A
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23
Q

premature age of CAD women

A
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24
Q

most dangerous lipid profile for a patient

A

elevated LDL

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25
Q

PC: postmenopausal woman
son died in war
ballooning of LV and LV dyskinesia
chest pain

A

TAKO-TSUBO cardiomyopathy:

massive catecholamine discharge from stressful event (divorce, financial issues, earthquake, lightning, hypoglycaemia)

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26
Q

tx TAKO-TSUBO

A

ACE inhibs
Beta blockers

NO REVASC— since no problem with coronary vessels

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27
Q

elevated homocysteine as rf for CAD

A

FALSE

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28
Q

elevated CRP as rf for CAD

A

FALSE

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29
Q

infection with chlamydia as rf for CAD

A

FALSE

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30
Q

immediate benefit if remove which CAD rf

A

STOP SMOKING

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31
Q

description for cardiac/ischemic chest pain

A

DULL or SORE

SQUEEZING or pressure like

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32
Q

UNLIKELY description of ischaemic pain

A

sharp (knifelike) or pointlike
lasts for a few seconds

NOT

  • tender
  • positional
  • pleuritic
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33
Q

chest wall tenderness

A

costochondritis

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34
Q

costochondritis most accurate test

A

physical exam

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35
Q

chest pain radiating to back, unequal bp between arms

A

AD

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36
Q

AD most accurate test

A 
CXR with widened mediastinum
confirmation of AD, chest:
- CT
- MRI
- TEE
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37
Q

chest pain worse with lying flat, better when sitting up, young person (

A

pericarditis

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38
Q

2 factors nb for ETT

A
  1. cannot read EKG, ie. its not diagnostic

2. patient can exercise: get heart rate above 85% of maximum

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39
Q

chest pain + bad taste, cough, hoarseness

A

GERD

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40
Q

best test for GERD

A

response to PPI’s

aluminum and magnesium hdroxide

viscous lidocaine

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41
Q

chest pain
cough
sputum
haemoptysis

A

PNEUMONIA

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42
Q

SUDDEN SOB and chest pain
tachycardia
hypoxia

A

PE

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43
Q

chest pain thats sharp
pleuritic pain
tracheal deviation

A

pneumothorax

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44
Q

best test pneumothorax

A

CXR

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45
Q

NONspecific symptoms seen in MANY causes of chest pain

A 
nausea
fever
SOB 
sweating
anxiety
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46
Q

BEST INTIAL TEST for all forms of chest pain

A

EKG

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47
Q

office based ambulatory setting EKG

A

likely to be normal, but CANNOT go on to other forms of testing until EKG is done

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48
Q

acute chest pain in office/ clinic setting, next best answer

A

TRANSFER TO EMERGENCY DEPARTMENT

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49
Q

acute chest pain in emergency department, next best step

A

ENZYMES

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50
Q

when to do exercise tolerance testing

A

UNCLEAR cause of chest pain

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51
Q

2 factors nb for ETT

A
  1. you can read EKG

2. patient can exercise: get heart rate above 85% of maximum

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52
Q

maximum heart rate

A

220 MINUS patients age

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53
Q

determining ischaemic when cannot read the EKG/ baseline EKG abnormalities

A
  1. Thallium or sestamibi scan

2. ECHO– wall motion abormalities

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54
Q

baseline EKG abnormalities causes

A
  1. LBBB
  2. LVH
  3. pacemaker use
  4. effect of digoxin
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55
Q

normal myocardium with Thallium

A

INCREASED UPTAKE of thallium

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56
Q

abnormal myocardium with Thallium

A

DECREASED UPTAKE of thallium

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57
Q

ECHO for baseline EKG abnormaltiies

A

decreased wall motion

dyskinesia/akinesia/hypokinesia

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58
Q

ischaemia reversible or irreversible

A

REVERSIBLE

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59
Q

infarction reversible or irreversible

A

IRREVERSIBLE

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60
Q

alternatives to exercise in stress testing

NOTE they are of equal sensitivity and specificity

A
  1. persantine= dipyridamole or adenosine in combo with thallium or sestamibi
  2. dobutamine + ECHO
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61
Q

avoid with agent for stress testing in asthmatic patients

A

DIPYRIDAMOLE

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62
Q

exercise thallium same as

A

exercise ECHO

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63
Q

dipyridamole thallium same as

A

dobutamine ECHO

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64
Q

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

A

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

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65
Q

coronary angiography determines…

A

bypass SURGERY vs. bypass ANGIOPLASTY

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66
Q

most accurate method of detecting CAD

A

angiography

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67
Q

stenosis

A

INSIGNIFICANT

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68
Q

surgically correctable disease % stenosis

A

70% stenosis

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69
Q

goal of LDL

A
  1. PAD
  2. Carotid disease (NOT stroke)
  3. Aortic vessel disease
  4. stroke
  5. DM
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70
Q

do you do ETT in ACS patients currently having pain?

A

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]

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71
Q

meds that lower chronic angina mortality (not ACS)

A

“BAN”
beta blockers
aspirin
nitroglycerin

best= B + A

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72
Q

propanolol use in cardiology

A

NO– B/C NON-specific

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73
Q

acute coronary syndrome tx

A

ASPIRIN + 1 other anti platelet

  • clopidogrel
  • prasugrel
  • ticagreolar
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74
Q

NB use of clopidogrel

A

aspirin intolerance

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75
Q

NB use of prasugrel

A

antiplatelet in those undergoing
ANGIOPLASTY and STENTING

dangerous in patients>775 since risk of hemorrhagic stroke

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76
Q

what drug if intolerant to aspirin and clopidogrel

truly intolerant, not because bleeding

A

TICLOPIDINE

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77
Q

side effects of ticlodipine

A

neutropenia and ttp

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78
Q

CAD use of ACE/ARBs

A 
LOW EF (systolic dysfunction)-- BEST MORTALITY BENEFIT
REGURGITANT valvular disease
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79
Q

BIG 3 SE’s of CCBs

A
  1. edema
  2. constipation
  3. heart block (rarely)
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80
Q

what drugs if systolic dysfunction CAD

A

ACEinhibitors or
hydralazine

(both directly decrease mortality)

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81
Q

goal level for LDL in CAD

A
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82
Q

goal of LDL

A
  1. PAD
  2. Carotid disease (NOT stroke)
  3. Aortic vessel disease
  4. stroke
  5. DM
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83
Q

ACS associated with point of maximal impulse

A

NOOOOOO— because no specific physical findings in ACS

PMI:

  • LVH
  • DCM
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84
Q

NB monitoring for patients on statins

A

AST, ALT even without symptoms

DON’T DO CPK ROUTINELY (only done if have symptoms)

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85
Q

give to all CAD patients regardless of lipid levels

A

STATINS

86
Q

NB effect of statins on endothelial lining

A

ANTIOXIDANT effect on endothelial lining

87
Q

if full lipid control is not achieved with statins alone, add….

A

NIACIN

88
Q

gemfibrozil + statins

A

increase myositis risk

89
Q

ezetimibe

A

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
Q

which drug increases mortality in patients with CAD

A

CCB’s– since raise heart rates– reflex tachycardia with nifedipine

DO NOT USE CCBs in CAD

91
Q

only times when can use CCBs in CAD

A
  1. SEVERE asthmatic
  2. prinzmetal
  3. cocaine
  4. failed aspirin and beta blocker medical tx
92
Q

BIG 3 SE’s of CCBs

A
  1. edema
  2. constipation
  3. heart block (rarely)
93
Q

few circumstances, in which CABG lowers mortality

A 
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
Q

duration of graft length before occlusion

A

internal mammary= 10 years

saphenous vein= 5 years

95
Q

BEST TX FOR ACS

A

PCI = angioplasty

96
Q

ACS associated with point of maximal impulse

A

NOOOOOO— because no specific physical findings in ACS

PMI:

  • LVH
  • DCM
97
Q

ST elevation in leads II, III, aVF

A

acute MI inferior wall

98
Q

mortality with IWMI

A
99
Q

DOOR TO BALLOON TIME

A

90 minutes

100
Q

PR interval >200 milliseconds

A

first degree AV block– little pathologic potential

101
Q

ST elevation in leads V2-V4

A

Anterior Wall MI

102
Q

premature ventricular contractions

A

aw later development of more severe arrhythmias

no additional tx if NORMAL K, Mg

103
Q

ST depression in leads V1 and V2

A

posterior wall mI; low mortality

104
Q

RBBB vs LBBB

A 
RBBB= benign
LBBB= pathologic
105
Q

treatment of PVCs

A

DO NOT TREAT

TX WORSENS OUTCOME

106
Q

FIRST MGMT OF ACS

A

ASPIRIN– since it lowers mortality (more important than morphine, oxygen and nitroglycerin– however these are all administered)

107
Q

NB rules in mgmt of ACS

A

START TX ASAP and do testing

BEFORE move to ICU

108
Q

on step 2 CK should you ever consult with another dr?

A

NO– DO IT YOURSELF

109
Q

ONLY 2 things that decrease mortality in ACS– and must be prioritized first

A
  1. ASPIRIN

2. PCI/angioplasty

110
Q

mgmt of reinfarction

A
  1. EKG– check new ST abnormality
  2. check CK-MB

CK-MB BETTER at detecting reinfarction

111
Q

ACS angioplasty or thrombolytics?

A

ANGIOPLASTY– better with survival/mortality, less bleeding, less complications of MI develop

112
Q

DOOR TO BALLOON TIME

A

90 minutes

113
Q

complications of PCI

A
  • RUPTURE coronary artery when inflate the balloon
  • RESTENOSIS (thrombosis) of vessel after angioplasty
  • HAEMATOMA- at entry site into artery
114
Q

most NB in decreasing risk of restenosis of coronary artery after PIC?

A

placement of drug-eluting stent– paclitaxel, sirolimus

115
Q

4 ABSOLUTE contraindications to thrombolytics

A
  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
Q

Door to needle time

A

30 minutes

117
Q

who should get beta blockers in ACS

A

EVERYONE,

BUT NOT dependent on time

118
Q

first line treatment for NSTEMI (stable)

A

LMWH, clopidogrel or enoxaparin

obviously because want to prevent the clot from growing and FULLY occluding the coronary arteries

119
Q

GP2b/3a inhibitors

A

abciximab
tirofiban
eptifibatide

120
Q

use of GP2b/3a inhibitors

A

ANGIOPLASTY and STENTING and NONSTEMI

121
Q

only use for thrombolytics in MI

A

STEMI not for nstemi

122
Q

SPECIFICALLY which type of heparin is best for NSTEMI

A

LMWH

not unfractionated heparin in terms of mortality benefit

123
Q

NSTEMI that is not getting better with LMWH tx

A
  • persistent pain
  • S3 gallop or CHF developing
  • worse EKG changes or sustained ventricular tachycardia
  • rising troponin levels
124
Q

post-MI stress test

A 
done for EVERYONE prior to discharge
UNLESS SYMPTOMATIC (since immediately need angiography)

deciding whether need angiography or not

125
Q

intra-aortic balloon pump

A

BRIDGE to surgery for valve replacement or transplant for 24-48hrs after rupture of valve or septum post-MI

126
Q

dipyridamole in coronary artery disease

A

NEVER NEVER NEVER NEVER NEVER

127
Q

ACE inhibitors are best for which type of wall infarct

A

ANTERIOR wall infract, since most likely to develop systolic dysfunction

128
Q

bradycardia and canon A waves post-MI

A

third degree AV block

129
Q

bradycardia and NO canon A waves post-MI

A

sinus bradycardia

130
Q

clear chest and new inferior wall MI

A

RV infarct

131
Q

don’t give what if RV infarct

A

Nitroglycerates– since cause hypotension

132
Q

SUDDEN loss of pulse with jugulovenous distension

A

tamponade

133
Q

DIAGNOSIS V.FIB

A

EKG

134
Q

tx v/tach

A

electric cardioversion/ defib

PCI ASAP

135
Q

new murmur post-MI in LLSB

A

septal rupture

136
Q

oxygen sats in RA = 72% and 85% in RV

A

septal rupture

137
Q

prophylactic antiarrhythmics post-MI

A 
DON'T DO IT!!!!!!!!!!!!!!!!! even if have frequent PVC's and ectopy
don't use:
- amiodarone
- flecainide
- any rhythm controller
138
Q

sexual issues post-infarction

A
  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
Q

most common cause of admission to the hospital in the US

A

Congestive heart failure

140
Q

SOB brown blood and cyanosis, not improved with oxygen and clear lungs

A

methhaemoglobinaemia

141
Q

burning wood stove in winter

A

carbon monixde poisoning

142
Q

MOST important test in chf

A

ECHO

143
Q

TEE or transthoracic ECHO best for CHF

A

transthoracic best, but TEE MOST accurate test (but often not needed)

144
Q

MOST accurate test in CHF

A

MUGA= nuclear ventriculography
multiple gated acquisition scan

most accurate because evaluates WALL MOTION abnormalities

145
Q

when to use MUGA ….

A

patient receiving doxorubicin

146
Q

ACE inhibitors and ARBs in tx of systolic dysfunction CHF

A

ALL PATIENTS,

benefits seen with ANY drug in combo

147
Q

when to answer ARBs >ACE inhibitors CHF

A

when the patient has cough from ACE inhibitor

148
Q

which beta blockers to use for CHF (Recall don’t use acutely)

A
  • metoprolol and bisoprolol= beta 1

- carvedilol= non-specific

149
Q

MCC death from CHF

A

ischaemia–> arhythmia–> sudden death

150
Q

decrease mortality in CHF drugs

A
  1. spironolactone and eplrenone
    [anti-androgenic, and NOT anti-androgenic]
  2. hydralazine + nitrates (systolic dysfunction)
  3. ACEinhibitors/ ARBS
  4. beta blockers
151
Q

loops and spironolactone not given at diuretic effect in ACUTE MGMT CHF

A

do NOT lower mortality

152
Q

NO benefit in mortality CHF systolic dysfunction

A
  1. loops (and spironolactone at non-diuretic levels)

2. digoxin/ positive inotropes

153
Q

BENEFIT mortality in CHF systolic dysfunction

A
  1. spironolactone/ eplerenone
  2. implantable defbrillator
  3. biventricular pacemaker
  4. hydralazine + nitrates (systolic dysfunction)
  5. ACE inhibitors/ ARBs
  6. beta blockers
154
Q

when to give implantable defibrillator

A
  • ischaemic cardiomyopathy

- EF

155
Q

when to give biventricular pacemaker

A
  • dilated cardiomyopathy

- EF 120ms

156
Q

should you give warfarin if there is no clot in the heart?

A

NOOOOO

157
Q

CCB’s in heart failure

A

NO clear benefit in systolic dysfunction

some can actually RAISE MORTALITY

158
Q

clearly beneficial diastolic dysfunction CHF

A

beta blockers

diuretics

159
Q

clearly NOT beneficial diastolic dysfunction CHF

A

spironolactone

digoxine

160
Q

uncertain beneficial diastolic dysfunction CHF

A

ACE inhibitors
ARBs
hydralazine

161
Q

tx of acute pulmonary oedema from arrhythmia

A

CARDIOVERSION ASAP!!!!

162
Q

nesiritide on mortality

A

NO PROVEN BENEFIT and

NOT PROVEN BETTER than standard agents for acute pulmonary edema

163
Q

dobutamine in acute pulmonary edema

A

if failed LMNOP

164
Q

digoxin in acute pulmonary edema

A

NOOOOO

165
Q

treatment of acute pulmonary oedema with heparin but NO CLOT

A

NOOOOOOO NEVER

166
Q

INITIAL diagnostic test for valvular heart disease

A

TEE: transesophageal ECHO

167
Q

most accurate test for vaulter heart disease

A

catheterization

168
Q

surgery with MS

A

dilated with a balloon

169
Q

treatment of regurgitant lesions

A

VASODILATORS:

  • ACE inhibitors, ARBs
  • nifedipine
  • hydralazine
170
Q

with valvular heart disease and heart dilates XS from regurgitant—-

A

CANNOT correct the decrease in systolic function

thus will end up needing to replace the valve

171
Q

assessment of ventricular size

A

based on end-SYSTOLIC diameter and EF

172
Q

prophylaxis antibiotics in valvular disease

A

ONLY IF….

  1. prosthetic valve
  2. hx of endocarditis
173
Q

Mitral stenosis clues

A

PREGNANCY
IMMIGRANT

and YOUNG ADULTS

174
Q

what 4 big things a/w MS

A
  1. haemoptysis
  2. dysphagia
  3. hoarseness
  4. A. FIB**** VERY COMMON
175
Q

tx of MS

A
  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
Q

balloon valvuloplasty for AS

A

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
Q

PC:

  • atypical chest pain
  • palpitations
  • panic attack
A

3P’s of MVP

pain/palpitations/panic attack

178
Q

need for catheterization in MVP

A

NOOOOOOOO, because don’t need to know if exact pressure gradient

179
Q

NB ECHO finding in HOCM

A

SAM

180
Q

HOCM vs. HCM

A

HCM– high bp, Y- ACEi, Y-diuretics

HOCM– genetic, N- ACEi, N- diuretics

181
Q

don’t use which two drugs in hypertrophic cardiomyopathy

A

spironolactone and digoxin

182
Q

EKG in HCM

A

non-specific ST and T wave changes

septal Q waves in inferior and lateral leads (NOT MI)

183
Q

standing and valsalva = same effect as…

A

DIURETICS

184
Q

amyl nitrate

A

direct arteriolar vasodilator

SIMULATES the effect of ACE inhibitors/ ARBs on the heart

185
Q

ventricle size with handgrip and amyl nitrate

A

handgrip= FULLER left ventricle

amyl nitrate= ACE inhibitors= EMPTIER left ventricle

186
Q

ACE inhibitor effect on MS

A

NO EFFECT,

thus amyl nitrate and handgrip, also no effect

187
Q

inspiration effect on murmurs

A

INCREASES all heart sounds

188
Q

valsalva and standing effect on murmurs

A

decreases most
INCREASES HOCM
EARLIER MVP

189
Q

hand gripping effect on murmurs

A

INCREASES MR.AR.VSD
decreases HOCM
later MVP

190
Q

squatting effect on murmurs

A

INCREASES AS
decreases HOCM
later MVP

191
Q

NOTE– decreasing murmur intensity = same as

A

IMPROVING murmur

192
Q

what drug to decrease recurrence of pericarditis?

A

COLCHICINE

193
Q

what is the best pain relief in pericarditis?

A

NSAID and COLCHICINE

together

194
Q

most APPROPRIATE diagnostic test in cardiac tamponade

A

ECHO

195
Q

what MUST you do before catheterization in cardiac tamponade

A

ECHO

196
Q

ECHO in cardiac tamponade:

A

COLLAPSE of RA + RV

197
Q

Right heart catheterization in cardiac tamponade

A

EQUALIZATION of pressures in diastole

198
Q

best initial test in constrictive pericarditis

A

CHEST X-RAY– shows calcification and fibrosis

199
Q

initial treatment of constrictive pericarditis

A

DIURETICS (Decompresses the filling of the heart), later on can do surgery

200
Q

pain worse in calves when walking DOWN hill

A

spinal stenosis (since leaning back)

201
Q

single most effective medication in PAD

A

CILOSTAZOL

202
Q

which drug does NOT HELP PAD

A

Calcium Channel Blockers

203
Q

best initial diagnosis of aortic dissection

A

CXR– simple, and shows widening of mediastinum

204
Q

MOST ACCURATE diagnosis of aortic dissection

A

CT angio= GOLD STANDARD

205
Q

screening AAA

A

men
>65yo
smokers

206
Q

surgical correction AAA

A

> 5cm

207
Q

peripartum cardiomyopathy

A

occurs AFTER delivery
autoantibodies to myocardium
LV dysfunction often reversible
if worsening of LV function–> TRANSPLANT

208
Q

tx OK with ACEi in peripartum cardiomyopathy

A

YES because occurs AFTER delivery

209
Q

what happens when woman with hx of peripartum cardiomyopathy gets PREGNANT AGAIN

A

BIGGER surge of antibodies and

WORSENING of cardiac function

210
Q

what cardiac functions worsen in pregnancy

A

peripartum cardiomyopathy
eisenmenger syndrome
[above 2 worsen more than MS]

211
Q

syncope– suddenly, have heart disease, frequent ectopic beats, thiazides

A

arrhythmia

212
Q

syncope– before get dizzy/weak/nauseous; EMOTIONAL trigger

A

vasovagal

Master the Boards (20 decks)

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