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1, Cardiology > Fast Cardio Questions > Flashcards

Fast Cardio Questions Flashcards

1
Q

the stretching of the left ventricle from the left atrium contracting enabling the left ventricle to contract stronger and force more blood out of the heart

A

-Preload

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2
Q

atrial fib does what to cardiac preload?

A

-there is no preload when the heart is in atrial fib

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3
Q

the pressure behind the aortic valve in the heart

A
  • afterload

- it is the diastolic blood pressure

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4
Q

the strength of the left ventricular muscle

A

-contractility

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5
Q

a medication that increases cardiac contractility

A

-digoxin

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6
Q

medication that decreases cardiac contractility

A

-verapamil

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7
Q

term for when the blood leaves the left ventricle for the body

A

-systole

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8
Q

passive phase of diastole

A
  • gravity pulling blood into the left ventricle

- S3 sound if dilated/CHF

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9
Q

active phase of diastole

A
  • artium squeezes blood into the ventricle

- S4 if LVH

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10
Q

an atypical symptom of heart attack in the elderly

A

-syncope

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11
Q

atypical symptom of heart attack in diabetics

A
  • silent heart attack, no chest pain

- they have SOB or even heart failure

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12
Q

atypical symptom of women with a heart attack

A

-abdominal pain

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13
Q

Acute Coronary Syndrome (ACS) includes what 3 possibilities?

A
  • angina
  • NSTEMI
  • STEMI
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14
Q

% of blood ejected out of the ventricle and into the body

A

-ejection fraction

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15
Q

Normal Systole (normal ejection fraction)

A

55-60%

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16
Q

Non Modifiable cardiac risk factors

A
  • age
  • sex
  • genetics
  • ethnicity
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17
Q

Modifiable cardiac risk factors

A
  • increased cholesterol
  • HTN
  • diabetes
  • smoking
  • obesity
  • physical inactivity
  • alcohol consumption
  • stress
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18
Q

Guy comes to ER, what 3 things make you think he is having a heart attack?

A
  • chest pain, with good story
  • EKG changes consistent with ischemia, ST or flipped T
  • elevated cardiac enzymes
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19
Q

AMI with STEMI

A

-Chest pain (CP) + ST elevations on EKG

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20
Q

AMI NSTEMI

A

-CP + cardiac enzymes (low), but neg EKG changes

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21
Q

Guy comes in with CP with negative cardiac enzymes and negative EKG has what?

A

-Angina

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22
Q

patient with predictable pattern of chest pain, walks a block relieved by rest, walks a block relieved with rest (exertion chest pain)…

A

-Stable angina

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23
Q

patient walks a block has chest pain takes 2 nitroglycerin tabs pains goes away, walks a block has chest pain takes 2 nitroglycerin tab pain goes away (exertion chest pain)…

A

-stable angina

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24
Q

guy has new chest pain due to partial occlusion of a coronary artery lasting less than 30 minutes with good cardiac story and risk factors (ACS acute coronary syndrome) …

A

-unstable angina

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25
Q

guy with hx of stable angina and his chest pain does not go away with three nitroglycerine tabs

A

-unstable angina

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26
Q

what is the work up for stable angina

A

-stress test (nuclear medicine exam)

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27
Q

test that looks for coronary artery blockages

A

-nuclear medicine exam, done by walking or medication to speed up the heart

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28
Q

If a nuclear medicine exam is positive what do you do with the patient?

A

-he needs a cardiac catherization

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29
Q

What is the tx for stable angina?

A
  • ACE inhibitors
  • b blockers
  • asa
  • nitroglycerine, sublingual
  • statin
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30
Q

45 y.o. female presents with chest pain which wakes her at night, she has ST elevation during this pain. She can walk all day with no symptoms. Dx?

A

-Prinzmetal varient

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31
Q

CPK cardiac enzyme

A

-comes from general muscle

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32
Q

CKMB cardiac enzyme

A
  • peaks first

- CKMB is the cardiac marker

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33
Q

Troponin cardiac enzyme

A
  • most sensitive and specific cardiac enzyme

- can be detected for 3 days

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34
Q

Tx for guy with Non ST Elevation, Chest pain, and low positive troponins? (this guy has a NSTEMI)

A
  • MONA B CASHPAD

- elective cardiac cath (planned)

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35
Q

Tx for a guy with CP, ST elevations, and increased troponin?

this guy has a STEMI

A
  • MONA B CASHPAD

- urgent cardiac cath within 90 min door to balloon

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36
Q

M
O
N
A

A
  • morphine, vasodilator and reduce anxiety
  • O2, NC > NRB > CPAP > intubate
  • Nitro, SL > Paste or IV drip
  • aspirin, ALWAYS 325mg
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37
Q

B

A

Bblockers

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38
Q

Metaoprolol

A

-short acting and long acting versions

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39
Q

Which beta blocker do you use with an ejection fraction over 40%

A

-metaprolol

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40
Q

Which Bblocker do you give when the guy has an ejection fraction less than 40%

A

-give Carveditol

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41
Q

Which Bblocker do you give for rate control ?

A

-Esmolol

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42
Q

Which Bblocker do you give for HTN with ACS?

A

-labetalol

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43
Q 
C
A
S
H
P
A
D
A
  • CCB, (use Cardizem for fib rate control only)
  • ACE inhibitor, prevents remodeling
  • Statin, short term antiinflammatory/platelet
  • Heparin, for STEMI or Lovenox NTEMI/Angina
  • Plavix, load 300mg then 75mg daily
  • Amiodarone for VT/VF or any arryhthmia
  • Dopamine/Dobutamine/diuretics
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44
Q

inflammation of the pericardial sac surrounding the heart

A

-Pericarditis

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45
Q

patient has chest pain, increased by inspiration and recumbency, relieved by leaning forward. There are ST segment elevations in most leads. What’s he got?

A

-pericarditis

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46
Q

young female has chest pain, increased by inspiration and recumbency. What might she have?

A

-think SLE

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47
Q

three causes of pericarditis

A
  • viral
  • post AMI think Dressler’s syndrome
  • SLE in young females
  • radiation
  • bacterial infections
  • rheumatic fever
  • injury
  • neoplasms
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48
Q

What is the tx for pericarditis?

A
  • NSAIDs, steroids

- watch for pericardial effusion

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49
Q

Drug that can cause pericarditis

A

-hydralazine

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50
Q

this large vessel problem involves only one layer the intima

A

-aortic dissection

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51
Q

who gets an aortic dissection

A

-males 2 x greater, 40-80 yrs old

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52
Q

risk factors for aortic dissection

A
  • pregnancy
  • cocaine abuse
  • HTN (chronic, present 70-90% of cases)
  • Marfan’s
  • Ehlers-Danlos Syndrome
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53
Q

what anatomical area do most aortic dissections occur

A

-Type A (60-65%), ascending aorta

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54
Q

What is the 2nd most common area for aortic dissections occur?

A

-Type B (30-35%), descending aorta (after the origin of the subclavian artery)

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55
Q

What is the gold standard for Dx of aortic dissections?

A

-Aortic Angiography (most are seen in the ER and tx and get a CT and then the angiography is obtained)

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56
Q

Meds to lower blood pressure in aortic dissections?

A
  • nicardipine
  • Esmolol
  • Labetalol
  • Nitropursside–may cause cyanide toxicity leading to AMS and high anion gap acidosis
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57
Q

What is the tx for aortic dissections?

A

-lower the blood pressure

  • for Type A–surgical management
  • for Type B–medical management initially, surgery if needed
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58
Q

patient has tearing sensation, and pain radiating to the his back, the pain in not quite as bad as it was when it first started. whats he got?

A

-aortic dissection

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59
Q

This aneurysm peaks in incidence over 60 yrs of age and accounts for 75% of all aneurysms

A

-Aortic aneurysms

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60
Q

what part of the vessel is involved in aortic aneurysms

A

-all three layers

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61
Q

what anatomical area are most aortic aneurysm seen?

A

infra-renal

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62
Q

60 y.o. presents with back pain, pulsatile mass and hypotension, what’s he got?

A

-Aortic aneurysm, this is a classic presentation

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63
Q

Other symptoms of AAA include?

A
  • 75 are asymptomatic

- others have abrupt onset sever pain unrelieved by change of position

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64
Q

Best study for suspected aortic aneurysm?

A

-Ultrasound, then CT angiogram for prep evaluation

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65
Q

When do you do surgery on an aortic aneurysm?

A
  • if > than 5.4 cm

- if it changes >0.5 cm in 6 months or > 1 cm in 1 year

66
Q

severe pain radiating to the back, hypotension, pulsatile mass and decreased femoral pulses ?

A

-aortic rupture

67
Q

Risk factors for aortic aneurysm?

A
  • tabacco abuse
  • atherosclerosis
  • HTN
  • COPD
68
Q

what is the cause of aortic aneurysms?

A
  • caused by elastin and collagen degradation the aortic wall
  • involves all three layers
  • most common infra-renal
69
Q

AA

A
  • no further testing
  • repeat US yearly
  • repeat US q 6 months, refer
  • repeat US Q 3 months
70
Q

collapse of the right ventricle, because there is so much pressure on the heart

A

-Pericardial tamponade

71
Q

Beck’s triad, 3 D’s of pericardial tamponade

A
  • distant heart sounds
  • distended jugular veins
  • decreased arterial pressure
72
Q

Rise in jugular venous pressure on inspiration (Kussmaul)

and paradoxical pulse (exaggerated fall in systolic blood pressure with inspiration, usually more than 10mm)

A

-suspect percardial tamponade

73
Q

Dx findings of pericardial tamponade?

A
  • EKG with electrical alterans, CXR shows huge globular heart (old hot water bottle shape)
  • Echo is the Gold Standard for Dx
74
Q

What is the tx for paricardial tamponade?

A
  • pericardial window, send fluid for source

- 3 sided cut like a flap and drains to the lung

75
Q

How do you know that blood you drew came from the pericardial sac?

A

-pericardial centesis blood does not clot

76
Q

What does the echocardiogram show in pericardial tamponade?

A

-echo will show collapse of the right ventricle

77
Q

Endocarditis involves what part of the heart?

A

-the endocardium which includes the heart valves

78
Q

What causes acute endocarditis?

A

-Staph aureus

79
Q

What is the significance of acute endocarditis?

A
  • the Staph Aureus causes high fever and rapid valve destruction
  • tricuspid valve infection leads to septic emboli and lung abscess, esp in the IV drug abuser
80
Q

Clinically describe Subacute endocarditis?

A

-caused by Strep viridian’s/enterocooci,
-you see low grade fever, arthralgia, embolism/brain
“Stroke + Fever = Endocarditis”

81
Q

Duke major criteria for Dx of endocarditis, (need 2) ?

A

+ blood culture and/or + echo for vegetation

82
Q

Duke minor criteria for Dx of Endocarditis (need 5) ?

A 
Petechiae
splinter hemorrhages (finger nail beds)
Jane's lesions (plainness on the hands)
Osler's nodes (painful lesions on the hands)
-Roth spots (retinal lesions)
83
Q

This is the most common skin finding in endocarditis but not specific for endocarditis?

A

-petichiae

84
Q

What is the tx for endocarditis?

A

1st line is amoxicillin, clindamycin if allergic

  • cephalosporins or azithromycin as alternatives
  • ofter required valve surgery
85
Q

you find tricuspid endocarditis …

A

consider IV drug use and Staph infection and septic emboli which leads to lung abscess

86
Q

Aschoff bodies are pathognomonic for ?

A

-Acute Rheumatic Fever

87
Q

This disorder is thought to be a cardiac muscle disposition to the antibodies during a strep infection?

A

-Acute Rheumatic Fever

88
Q

You need 2 Major criteria to Dx Acute Rheumatic fever. List the 5 major criteria.

A

J Joints (migratory polyarthritis) O Carditis
N Nodules, subcutaneous (Aschoff bodies)
E Erythema marginatum (pink rings on trunk and flexor surf)
S Sydenham’s chorea

89
Q

You can use 1 Major and 2 Minor criteria for Dx of Acute Rheumatic fever. List the minor criteria.

A
  • arthralgia
  • fever
  • lab: elevated ESR/CRP
  • EKG: prolonged PR interval
90
Q

What is the tx for Acute Rheumatic Fever?

A
  • Penicillin or macrolides for pen allergic

- tx with prophylaxis with penicillin until age 20 or at least 5 years after last carditis episode

91
Q

describe the S3 heart sound

A

rapid blood splashing into the ventricle

-think systolic heart problem right away

92
Q

describe the S4 heart sound

A

-means a stiff ventricle, hypertrophic, enlarged (LVH, hypterophic cardiomyopathy,

93
Q

Rubs

94
Q

Gallops

A

S1 + S2 plus a S3 or S4 or both

95
Q

Gallop with S1 + S2 plus S3

A

-think systolic CHF

96
Q

Gallop with S1 + S2 plus S4

A

-think diastolic CHF or ischemia (MI)

97
Q

Inspiration make which murmurs get louder?

A

-pulmonic and tricuspid murmurs–increases venous return

98
Q

Exhalation causes which murmurs to get louder?

A

-Aortic and Mitral

99
Q

ASD, atrial septal defect

A
  • pulmonic ejection murmer you hear Fixed S2 splitting
  • dilated pulmonary arteries are seen/noted
100
Q
  • blood pressure is high but equal in both arms
  • blood pressure is lower in the legs
  • radial femoral pulse lag
A

-coarctation of the aorta

101
Q

-this heart condition includes a bicuspid aortic valve which causes cerebral aneurysms

A

-coarctation of the aorta

102
Q

-continous machine like murmur, and here you may see failure to thrive-

A

-PDA and is treated with indomethacin

103
Q

Pansystolic (holosystolic) murmer

-heard best at mid sternal boarder

A
  • VSD, ventricular septal defect

- most common murmur

104
Q

Patients/kids will often squat if they have this heart problem. They run, get tired, then squat and “pink up” and feel better (“Tet spells”).

A

-tetralogy of fallot

105
Q

4 elements of tetralogy of fallot

A
  • pulmonary valve stenosis
  • VSD (ventricular septal defect)
  • overriding aorta
  • right ventricular hypertrophy
106
Q

Name this syndrome in which a congenital heart condition causes Col Pulmonale.

A

Eisenmenger Syndrome, and it’s too late to do surgery if it gets this far

107
Q

Patient presents with fixed S2 splitting? What chest x-ray findings would expect to see.

A

-dilated pulmomary arteries

108
Q

-What murmer/heart problem includes dilated pulmonary arteries?

109
Q

12 y.o. boy presents with calf cramping and leg pain with running (claudication symptoms), what condition do you suspect?

A

-coarctation of the aorta

110
Q

what medication do you give to a baby with a continuos machine like murmur?

A

-indomethacin

111
Q

most common cardiac defect

112
Q

Cor Pulmonale caused by a VSD is called what?

A

-Eisenmenger’s syndrome

113
Q

You note a holosystolic murmur at the mid sternal boarder of child. What is the murmur?

114
Q

Why does squatting help with exertion in a kid with Tetralogy of Fallout?

A

-Tetralogy of Fallout is a central cyanotic condition. Squatting helps to temporarily reverse the shunting of the VSD.

115
Q

Transposition of the great vessels of an infant is common to mothers with what condition?

116
Q

Indomethacin is used to close PDA in babies–true or false

117
Q

true or false

Squatting makes Tetralogy of Fallott worsen oxygen delivery.

118
Q

ASD is associated with increased pulmonary vascularity.

true or false

A

-true, thus you see increased great theart vessel size on X-ray

119
Q

transposition of great vessels is seen in young mothers

true or false

A

false, transposition is seen in diabetic mothers

120
Q

if a patient has DM, an MI or CHF what blood pressure medication should they be on

121
Q

What BP medication causes angioedema, cough, and hyperkalemia for side effects?

122
Q

You place your DM patient or patient that has had an MI on an ACEI, one week later you should order this lab?

A

-basic metabolic panel to see if they have hyperkalemia

123
Q

Which BP med causes a cough?

124
Q

Which BP med causes angioedema

125
Q

A pregnant female should never get this blood pressure medication?

A
  • ACEI

- also don’t give Angiotensin II inhibitor

126
Q

A guy with Renal Artery Stenosis should never get this HTN medication?

127
Q

This HTN medication is not given first line very often. It is given for cirrhosis of the liver and in CHF?

A

-Aldosterone inhibitors–spironolactone

128
Q

These 3 HTN meds cause hyperkalemia?

A
  • ACEI
  • Angiotension II inhibiors
  • Aldosterone inhibitors–spironolactone
129
Q

This BP med is rarely used alone. It is indicated for MI, CHF, CAD, and DM.

130
Q

You would not give this BPmedication to a young person, and Why not?

A

Bblocer

  • sexual dysfunction (causes inpedence)
  • causes lack energy
131
Q

Don’t give this BP medication to an asthmatic or to someone that is bradycardia. Why not?

A

Bblocker -it causes asthma symptoms
-it further slows HR

132
Q

All diabetics should be placed on this type of BP medication. Why? What med do you place them on if they are allergic to ACEI or cannot tolerate ACEI?

A
  • ACEI
  • to protect the kidneys
  • place on a CC blocker
133
Q

Drug of choice for tx of HTN in pregnancy?

A

-methyl dopa

134
Q

Do not give these BP meds during pregnancy?

A
  • ACEI

- angiotension II inhibitors

135
Q

This would be a good choice for an athlete or active person with HTN?

136
Q

Two BP meds in this class control heart rate?

A
  • Verapamil (phenylakylamine)
  • Cardizem (benzothiazepine)

both are calcium channel blockers

137
Q

For a person with atrial fibrillation and hypertension these two drugs would be great for treatment.

A
  • Verapamil
  • Cardizem

-calcium channel blockers that control rate and treat hypertension

138
Q

A big side effect for calcium channel blockers is what?

A

-leg edema

139
Q

This is a calcium channel blocker that vasodilates?

A

-Amlodipine, Nifedipine, (dihydropyridine)

140
Q

If you can’t place a DM or hypertrophic cardiomyopathy patient on a ACEI or Angiotension II med what is the next choice to help protect the kidneys?

A

-Calcium channel blocker

141
Q

Side effects of thiazide diuretics

A
  • hypokalemia
  • increase uric acid

so they make gout worse and make calcium stones better

142
Q

Don’t give thiazide diuretics to what patients

A
  • DM
  • Gout
  • Pregnant
143
Q

This HTN medication can cause Lupus syndrome and also can cause pericarditis

A

-hydralazine

144
Q

Central acting HTN meds (clonidine) and also alpha blockers (terazosin, doxosazin) have what common side effect?

A
  • postural hypotension

- so give at nightt

145
Q

This HTN medication is a potent vasodilator and can help grow hair.

A

-minoxidil

146
Q

BP > 180/120 with end organ dysfunction

A

Hypertension emergency

147
Q

BP > 180/120 without end organ dysfunction

A

Hypertension urgency

148
Q

What is your goal in Tx hypertension emergency or urgency?

A

-decrease BP no more than 25% over the first 1-2 hours, then keep lowering until you get it to a more normal range

149
Q

What can happen if you lower

BP too fast in hypertension emergency or urgency?

A
  • they can pass out

- can decrease cerebral blood flow

150
Q

Who gets orthostatic hypotension?

A
  • diarrhea, vomiting, dehydrated, walking around in the desert
  • or DM, or age (autonomic)
  • Bleeding
  • Med: Bblockers, vasodilators, diuretics, clonidine
151
Q

A guy is treated for BPH and now has orthostatic hypotension, why?

A

-you placed him on an alpha blocker, terososin, and you caused the orthostatic hypotension

152
Q

Med of choice for HTN in diabetics

153
Q

med of choice for Tx of HTN in a patient without comorbidities

A

-hydrochlorthiazide (thyazide diuretic)

154
Q

use this med to tx HTN and BPH

A

-alpha blocker

155
Q

pre hypertension range

A

120/80 to 139/90

156
Q

retinal exam findings for chronic uncontrolled HTN

A

-cotton wool spots, AV nicking

157
Q

What 2 agents cause angioedema?

A

-ACEI and angiotension II receptor blockers

158
Q

this BP med causes impotence in men

159
Q

this HTN med is causing edema in my legs

A

calcium channel blocker

160
Q

Why are ACEI always used to tx angina?

A

-ACEI interfere with the formation of Angiotensin II, this hormone constricts blood vessels. We want the vessels to relax, so ACEI are given to increase blood flow in vessels by reducing constriction caused by Angiotensin II.

161
Q

If you can’t give a patient with angina an ACEI a Beta Blocker is usually used. How do beta blockers help angina?

A

-Beta blockers work by blocking the effects of epinephrine/adrenaline. As a result the heart beats more slowly and with less force reducing cardiac work load and using less O2. Beta blockers also relax blood vessels and open up for more blood flow, reducing or preventing angina.

1, Cardiology (11 decks)

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