IM-Cardio Flashcards
1
Q
-Asymptomatic proteinuria or nephrotic syndrome
- Hepatomegaly, macroglossia
-cardiomyopathy (restrictive)
-Peripheral/autonomic neuropathy
- Waxy skin thickening, easy brusing
Dx?
A
Amylodosis
2
Q
Fatigue, exertional dyspnea, and LE swelling in the absence of pulmonary edema, Dx? manifestation of?
A
R-sided heart failure ( predominant manifestation of restrictive cardiomyopathy)
3
Q
what therapy is the preferred treatment to prevent coronary artery disease in a patient with who have inducible ischemia when a reversible defect is noted
A
antiplatelet therapy
4
Q
What is the guideline for statin therapy for an atherosclerotic cardiovascular disease age < or =75
A
High-intensity statin
5
Q
What is the guideline for statin therapy for an atherosclerotic cardiovascular disease (ASCVD) age >75
A
Moderate-Intensity statin
6
Q
What is the guideline for statin therapy for LDL > or = 190 mg/dL?
A
High-intensity statin
7
Q
What is the guideline for statin therapy for Age 40-75 with diabetes?
A
10-years ASCVD risk > or= 7.5%
High-intensity statin
if the risk is < 7.5% moderate-intensity statin
8
Q
What is the guideline for statin therapy for an estimated 10-year ASCVD risk > or = 7.5% is
A
Moderate to high intensity statin
9
Q
Signs of venous overload (3)
A
- JVD, ascites, pedal edema
10
Q
defined as lack of the typical inspiratory decline in central venous pressure, and presence of a pericardial knock
A
Kussmaul’s sign
11
Q
Pericardial knock is
A
early heart sound after S2 (MIddiastolic sound)
12
Q
3 main causes of constrictive pericarditis
A
- idiopathic or viral pericarditis
- Cardiac surgery or radiation therapy
- Tuberculous pericarditis (in endemic areas)
13
Q
- Fatigue & dyspnea on exertion
- peripheral edema and ascites
- JVD
- Pericardial knock
- Pulsus paradoxus
- Kussmaul’s sign
A
Constrictive pericarditis
14
Q
Diagnostic findings for constrictive pericarditis (3)
A
- ECG show A-fib or low-voltage QRS complex
- Imaging shows pericardial thickening & calcification
- Jugular venous pulse tracing shows prominent x & Y descents
15
Q
The most common cause in developing countries and endemic areas such as Africa, India and China like constrictive pericarditis
A
Tuberculosis
16
Q
Common cause of dilated cardiomyopathy in young adults
A
Viral myocarditis
17
Q
Causes of acute limb ischemia (3)
A
- Cardiac/arterial embolus
- Arterial thrombosis
- Iatrogenic/blunt trauma
18
Q
3 risks for aortic dissection?
A
- Hypertension
- Marfan syndrome
- Cocaine use
19
Q
Severe, sharp, tearing chest or back pain
A
aortic dissection
20
Q
> 20mm Hg variation in systolic blood pressure between arms
A
Aortic dissection
21
Q
It is responsible for almost 50% of the aortic dissections seen in patients age <40
A
Marfan syndrome
22
Q
Pt with worsening fatigue and irregular heart rate is
A
atrial fibrillation
23
Q
__ score is recommended for assessment of stroke risk inpatient with nonvalvular atrial fibrillation
A
CHAzDS2-VASc score
24
Q
Diagnosis and follow up for a patient with fibromuscular dysplasia
A
- Noninvasive preferred (CT, Duplex US)
- Catheter-based digital subtraction arteriography for a patient with inconclusive noninvasive testing
- Medically tx pt, follow up BP & Cr q 3-4 months and Renal US q 6-12 months
25
The most common lower extremity edema cause
Chronic venous insufficiency
26
Initial tx for chronic venous insufficiency
Leg elevation
exercise
compression therapy
27
In hypertrophic cardiomyopathy (HOCM); During Valsalva (Strain phase) what happens physiologically to preload, LV blood volume, and murmur intensity
Preload- decreases
LV blood volume- decreases
Murmur intensity- increases
28
In hypertrophic cardiomyopathy (HOCM); During abrupt standing what happens physiologically to preload, LV blood volume, and murmur intensity
Preload- decreases
LV blood volume- decreases
Murmur intensity- increases
29
In hypertrophic cardiomyopathy (HOCM); During nitroglycerin administration what happens physiologically to preload, LV blood volume, and murmur intensity
Preload- decreases
LV blood volume- decreases
Murmur intensity- increases
30
In hypertrophic cardiomyopathy (HOCM); During sustained handgrip what happens physiologically to afterload, LV blood volume, and murmur intensity
Afterload- Increases
LV blood volume- Increases
Murmur intensity- decreases
31
In hypertrophic cardiomyopathy (HOCM); During squatting what happens physiologically to afterload & preload, LV blood volume, and murmur intensity
Afterload & preload- Increases
LV blood volume- Increases
Murmur intensity- decreases
32
In hypertrophic cardiomyopathy (HOCM); During passive leg raise what happens physiologically to preload, LV blood volume, and murmur intensity
Preload- Increases
LV blood volume- Increases
Murmur intensity- decreases
33
The only time you can do a physiological maneuver to increase both preload and afterload is by
squatting
34
EKG with diffused ST elevation and PR depression
Pericarditis
35
Diastolic decrescendo murmur
Aortic regurgitation
36
Sudden SOB and chest pain, elevated left atrial and ventricular filling pressures & acute pulmonary edema. Dx? possible cause?
Acute mitral regurgitation due to papillary muscle displacement in MI
37
Ascending aortic aneurysms are most often due to _____ or ______
Cystic medial necrosis
| Connective tissue disorder
38
On Chest x-ray, are mediastinal silhouette (widened), increased aortic knob, and tracheal deviation
Thoracic aortic aneurysm
39
The addition of a fibrate to a statin is rarely indicated because
- increased SE, myopathy
| - lack of proven CV benefit
40
In a pt with hypertriglyceridemia (150-500), the first line of pharmacologic therapy is
High-intensity statins
41
Pt placed on Statin and have known CV disease or high risk what other therapy is recommended?
- Lifestyle modifications (Wt loss, moderate alcohol intake, increased exercise)
42
What happens to
1. CI
2. PCWP
3. RV preload
in Tension pneumothorax & Cardiogenic shock (MI)
Tension pneumothorax
1. CI- LOW
2. PCWP- LOW
3. RV preload- LOW
Cardiogenic shock (MI)
1. CI- Very LOW
2. PCWP- HIGH
3. RV preload-HIGH
43
an IV drug user with bacterial endocarditis will have what kind of valvular issue and what is the murmur?
- Tricuspid regurgitation
| - Holosystolic murmur with inspiration
44
Pt treated for the hypertensive emergency with nitroprusside got confused, high lactate, sz and coma?
Cyanide toxicity
| SE of nitroprusside
45
Microangiopathic hemolytic anemia on peripheral blood smear of a pt with scleroderma renal crisis with acute renal failure will show
- fragmented RBC (Schistocytes) and Thrombocytopenia
46
What is the amount of alcohol intake that puts pat at risk for hypertension
> 2drinks a day or binge drinking (> 5 drinks in a row)
47
Lab findings in poor prognostic factors in systolic heart failure (3)
- Hyponatremia
- Elevated pro-BNP levels
- Renal insufficiency
48
ECG findings in poor prognostic factors in systolic heart failure (2)
- QRS duration > 120msec
| - LBBB block pattern
49
Echocardiography findings in poor prognostic factors in systolic heart failure (4)
- Severe LV dysfunction
- Concomitant diastolic dysfunction
- Reduced right ventricular function
- Pulmonary hypertension
50
Associated conditions in poor prognostic factors in systolic heart failure (3)
- Anemia
- A fib
- Diabetes mellitus
51
Arrthymias that is most specific for digitalis (digoxin) toxicity
Atrial tachycardia with AV block
52
```
Exertional dyspnea
Fatigue
A-fib
signs of heart failure
What valvular problem can that be?
```
Mitral regurgitation
53
Holosystolic murmur heard best at the apex with radiation to the axilla
Mitral regurgitation
54
Mitral facies -pinkish-purple patches on cheeks
Mitral stenosis
55
Loud S1, loud P2 if pulmonary hypertension
Mitral stenosis
56
Opening snap-high-frequency early diastolic sound
Mitral stenosis
57
Mid-diastolic rumble-best heard at the cardiac apex
Mitral stenosis
58
CXR- Pulmonary blood flow the to upper lobes, dilated pulmonary vessels, left atrial enlargement, flattened left heart border
Mitral stenosis
59
ECG: P mitrale (broad and notched P waves), atrial tachyarrhythmias, RVH (Right ventricular hypertrophy)- tall R waves in V1 & V2
Mitral stenosis
60
TTE - MV thickening/calcification/decreased mobility, coexisting MR
Mitral stenosis
61
Name the 3 clinical features of Mitral stenosis
- Dyspnea, orthopnea, PND, Hemoptysis
- A-fib, systemic thromboembolism
- Voice hoarseness from recurrent laryngeal nerve compression due to LAE (Ortner syndrome)
62
Hypertension (headaches, epistaxis), Claudication of extremities,
Brachial-femoral pulse delay,
Upper & lower extremity bp differences,
Left interscapular systolic or continuous murmur
Coarctation of the aorta
63
on Chest X-ray
- Inferior notching of the 3rd and 8th ribs
- "3" sign due to aortic indentation
Coarctation of the aorta
64
Tx for coarctation of the aorta
- Ballon angioplasty +/- stent placement
| - Surgery
65
Stress testing that examines myocardial contractility that leads to an increase in myocardial oxygen demand due to increased HR includes the use of
- Exercise &
| - Dobutamine (Beta-1 receptor agonist)
66
Stress testing that examines by causing vasodilation and increased blood flow in normal coronary arteries and a relatively small increase in blood flow in stenotic coronary arteries use
Adenosine
- The difference in blood flow allows for diagnosis of obstructive coronary artery disease due to reduced uptake of radioactive isotope in ischemic myocardium
67
Pt with SOB when laying flat and bibasilar crackles after noted to have an aortic dissection
Aortic valve insufficiency
68
What is the tx for acute pulmonary edema (flash pulmonary edema) due to MI?
Diuretics (lasix)
69
What medication should you avoid in patients with decompensated CHF or bradycardia?
Beta Blockers
70
Physical examination findings that suggestive of severe aortic stenosis (3)
- Pulsus parvus and tardus
- Single and soft second heart sound (S2)
- Mid-to late-peaking systolic murmur , radiating to the carotids
71
Delayed (slow rising) and diminished (weak) carotid pulse is called
Pulsus parvus and tardus
72
Sudden-onset cardiogenic shock with hypotension, biventricular failure, and new harsh holosystolic murmur with a palpable thrill at the left sternal border 3-5 days after MI
Rupture of interventricular septum
73
After MI, Right ventricular failure involves
- Time course?
- what coronary artery?
- Clinical findings? (3)
- EKG findings?
- Acute
- RCA
- Hypotension, clear lungs, Kussmaul sign
- Hypokinetic RV
74
After MI, Papillary muscle rupture involves
- Time course?
- what coronary artery?
- Clinical findings? (3)
- EKG findings?
- Acute or 3-5 days
- RCA
- Severe pulmonary edema & new holosystolic murmur
- Severe mitral regurgitation with a flail leaflet
75
After MI, interventricular septum rupture involves
- Time course?
- what coronary artery?
- Clinical findings? (3)
- Echo findings?
- Acute or 3-5days
- LAD or RCA
- Chest pain, new holosystolic murmur, biventricular failure, shock
- Left-to-right ventricular shunt & increase in 02 level from RA to RV
76
After MI, Free wall rupture involves
- Time course?
- what coronary artery?
- Clinical findings? (3)
- EKG findings?
- within 5 days- 2 weeks
- LAD
- Chest pain, shock, distant heart sound
- Pericardial effusion with tamponade
77
After MI, left ventricular aneurysm involves
- Time course?
- what coronary artery?
- Clinical findings? (3)
- EKG findings?
- Up to several months
- LAD
- Subacute heart failure & stable angina
- Thin & dyskinetic myocardial wall
78
A secondary cause of hypertension with elevated serum creatinine and abnormal urinalysis (proteinuria, RBC casts)
Renal parenchymal disease
79
A secondary cause of hypertension with severe HTN after age 55, recurrent flash pulmonary edema or resistant HF, a rise in serum cr, abd bruit
Renovascular disease
80
A secondary cause of hypertension with early provoked hypokalemia, slight hypernatremia, HTN with adrenal incidentaloma
Primary aldosteronism
81
A secondary cause of hypertension with paroxysmal elevated bp with tachycardia, pounding headaches, palpitations, diaphoresis, HTN with an adrenal incidentaloma
Pheochromocytoma
82
A secondary cause of hypertension with central obesity, facial plethora, proximal muscle weakness, abd striae, ecchymosis,, amenorrhea/erectile dysfunction, HTN with adrenal incidentaloma
Cushing syndrome
83
A secondary cause of hypertension with fatigue, dry skin, cold intolerance, constipation, wt gain, bradycardia
Hypothyroidism
84
A secondary cause of hypertension with hypercalemia (polyuria, polydipsia), kidney stones, neuropsychiatric presentation
Primary hyperparathyroidism
85
A secondary cause of hypertension with differential hypertension with brachial-femoral pulse delay
Coarctation of the aorta
86
Syncope triggered by prolonged standing or emotional distress, painful stimuli, prodromal symptoms (Nausea, warmth, diaphoresis)
Vasovagal or neurally mediated syncope
87
Syncope triggered by cough, micturition or defecation
situational syncope
88
Syncope triggered by postural changes in HR/BP after standing suddenly
Orthostatic syncope
89
Syncope triggered by exertion or during exercises (3)
Aortic stenosis
Hypertrophic cardiomyopathy (HCM)
Anomalous coronary arteries
90
Syncope with a prior history of CAD, MI, cardiomyopathy, or decreased EF
ventricular arrhythmias
91
Syncope with sinus pauses, increased PR or QRS duration (3)
Sick sinus syndrome
bradyarrhythmias
AV block
92
Syncope triggered by hypokalemia, hypomagnesemia, medications causing increased QT interval
Torsades de pointes (acquired long QT syndrome)
93
Syncope with family hx of sudden death, increased QT interval, syncope with triggers (exercises, startle, sleeping)
Congenital long QT syndrome
94
The most common cause of mitral regurgitation in developed countries is
mitral valve prolapse
95
Tx for vasospastic angina (Prinzmetal angina) is
CCB ( Diltiazem, amlodipine)
96
HTN, hematuria, protenuria, palpable renal masses, progressive renal insufficiency
Polycystic kidney disease
97
Flank pain with nephrolithiasis, infection, cyst rupture, hemorrhage, hematuria
polycystic kidney disease
98
Drug causing GI SE of Anorexia, N/V abd pain
Digoxin toxicity
99
Drug causing cardiac SE of life-threatening arrhythmias
Digoxin toxicity
100
Drug causing neurological SE of fatigue, confusion, weakness, color vision alterations
Digoxin toxicity
101
Adding Amiodarone with other drugs can cause
serum levels of the other drug to increased because it is CYP 450 inhibitor
102
What is the USPSTF recommendation for AAA screening?
- Male active or former smokers aged 65-75
| ONE abdominal ultrasound
103
Electrical alternans with sinus tachycardia is a highly specific sign for
large pericardial effusion
104
what is electrical alternans?
Swinging motion of the heart in the pericardial cavity causing a beat-to-beat variation in QRS axis and amplitude
105
Main SE of dihydropyridine calcium channel antagonists like Amilodipine
Peripheral edema
106
Major SE of amiodarone in cardiac
- Sinus brady, Heart block
| - Proarrhtymias- QT prolongation and torsades de pointes
107
Major SE of amiodarone in Pulmonary
- Chronic interstitial pneumonities (Caugh, fever, dyspnea, pulmonary infiltrates)
108
Major SE of amiodarone in endocrine
- Hypo and hyperthyroidism
109
Major SE of amiodarone in GI/Hepatic
-Elevated transaminases, hepatitis
110
Major SE of amiodarone in ocular
- corneal microdeposites
| - Optic neuropathy
111
Major SE of amiodarone in dermatologic
- Blue-grey skin discoloration
112
Major SE of amiodarone in neurologic
- peripheral neuropathy
113
Persistent ST-segment elevation with deep Q waves
Ventricular aneurysm
| - progressive left ventricular enlargement and dyskinetic wall motion leading to heart failure
114
It is very helpful in improving CHF symptoms like dyspnea and fatigue but not shown to improve survival in patient with CHF
Digoxin
115
The primary anti-ischemia and abtianginal effects of nitrates are due to
systemic vasodilation rather than coronary vasodilation
116
Increased incidence of orthostatic hypotension in the elderly is due to progressively decreasing
baroreceptor sensitivity and defects in the myocardial response
117
the most common side effect of dihydropyridine CCBs is and what types of drugs can reduce this symptom
Peripheral edema
| Angiotensin system antagonist (ACE or ARB)
118
Dobutamine (potent inotropic agent with a strong affinity for beta-1 and weak for beta 2 & alpha-1 increased myocardial contractility to improve EF by _____ & _____
- Reduced left ventricular end-systolic volume
| - Symptomatic improvement of decompensated heart failure
119
ECG changes in Acute aortic dissection
Normal or nonspecific ST & T-wave changes
120
Chest X-ray changes in Acute aortic dissection
Mediastinal widening
121
What is the definitive diagnosis for Acute Aortic dissection? (2)
- CT angiography
| - TEE for definitive diagnosis
122
The 4 treatments needed for Acute Aortic dissection
- Pain control (Morphin)
- IV BB (Esmolol, Labetalol)
- Sodium nitroprusside (if SBP >120)
- Urgent surgical repair for ascending dissection
123
Two drugs that can be used in treatment for a-fib in patients with structurally normal hearts
Flecainide & Propafenone (class 1c)
124
Up to 70% of pt with Mitral stenosis will develop a-fib because of the significant
left atrial dilatation
125
Patient with symptomatic bradycardia should be treated initially with IV _____ and if no response use IV ___ or ____ or transcutaneous pacing
atropine;
| epinephrine or dopamine
126
What is the dose of atropine in pt with bradycardia
IV 0.5mg bolus, repeat every 3-5 minutes up to 3.0 mg maximum
127
What diagnostic is used for definitive diagnosis and management of cardiac tamponade?
Echocardiography
128
What do you expect to see on Echo for cardiac tamponade?
- Right atrial and Ventricular collapse, plethora of the IVC
129
How do you define IVC plethora?
a decreased in the proximal venal caval diameter by <50% during deep inspiration
130
ECG changes on Leads V1-V6, Blocked vessels? Involved myocardium?
LAD
| Anterior MI
131
ST elevation in Leads II, III & aVF, Blocked vessels? Involved myocardium?
RCA or LCX
| Inferior MI
132
ST depression in leads V1-V3, Blocked vessels? Involved myocardium?
LCX or RCA
| Posterior MI
133
ST elevation in leads I & aVL , Blocked vessels? Involved myocardium?
LCX
| Posterior MI
134
ST depression in leads I & aVL, Blocked vessels? Involved myocardium?
RCA
| Posterior MI
135
ST elevation in leads I, aVL, V5,V6; Blocked vessels? Involved myocardium?
LCX, diagonal
| Lateral MI
136
ST depression in leads II, III & aVF, Blocked vessels? Involved myocardium?
LCX, diagonal
| Lateral MI
137
ST elevation in leads V4-V6R, Blocked vessels? Involved myocardium?
RCA
| Right Ventricle MI
138
Initiation of statin therapy is recommended for primary prevention in patient with
10 year risk of atherosclerotic cardiovascular disease (ASCVD) >/= 7.5%
139
- Severe: Right sided heart failure in childhood
- Mild: symptoms (like dyspnea) in early adulthood
- Crescendo-decrescendo murmur (increased with inspiration)
- Systolic ejection click & widened split of S2
Pulmonic valve stenosis (congenital defect is common than acquired)
140
Pulmonic valve stenosis treatment (2)
- Percutaneous balloon valvulotomy
| - Surgical repair in some cases
141
The two common reasons to have acquired Pulmonic valve stenosis (not-congenital)
- Rheumatic fever
| - Carcinoid syndrome
142
Ejection click (high pitch sound after S1 best heard during expiration) followed by a crescendo-decrescendo systolic murmur over the Left second intercostal space
pulmonic valve stenosis
143
what is the complication of cardiac catheterization and other vascular procedures that gives pt cutanouse finding (blue toe syndrome, livedo reticularis), cerebral or intestinal ischemia, AKI, and Hollenhorst plaques
Atheroembolism (Cholesterol embolism)
144
How do you treat atheroembolism (Cholesterol embolism)
Supportive and statin therapy for risk factor reduction and prevention
145
Isolated systolic hypertension (SBP >140 and DBP <90) in elderly is caused by
increased stiffness or decreased elasticity of the arterial wall (increase in mortality & morbidity)
146
Brachial-Femoral pulse delay, high blood pressure in both arms compared to lower extremities and continuous machinery murmur over the back
Aortic coarctation
147
continuous abdominal bruit has a high specificity for the presence of
Renovascular hypertension
148
The most common causes of regular, narrow-complex SVT include (4)
- Sinus tachycardia
- Atrial Tachycardia
- A-flutter
- AV nodal reentrant tachycardia
149
which drugs may potentiate the anticoagulant effects of warfarin, leading to variable dose response and increase the risk of bleeding (CYP450 inhibitors) (4)?
Acetaminophen
NSAIDs
Amiodarone
antibiotic
150
Chest pain, ECG with ST-segment elevations in leads II, III & aVF, bp 115/70, but 3 mins after 75/50 with HR 85, diaphoretic and cold extremities, JVD, lungs clear. Next step?
- Normal Saline bolus
| - Inferior MI, affecting right ventricle filling so increases preload by bolus
151
what therapy is important to reduce recurrent MI and cardiovascular death compared with aspirin alone in pt with non-ST elevation MI?
Duel antiplatelet therapy (aspirin and P2y12 receptor blocker)
-Also reduces the risk of stent thrombosis and recommended on all patients for at least 12 months following drug-eluting stent placement
152
Which drugs are considered P2y12 receptor blocker (5)?
antiplatelets like
clopidogrel, ticlopidine, ticagrelor, prasugrel, cangrelor
- adenosine diphosphate (ADP) P2y12 receptors
153
32yo F, hx of recent cold symptoms, fatigue, progressive SOB, feet swelling, bilateral basal crackles, JVD, normal CBC, Echocardiogram will show ? Dx? Cause?
dilated ventricles with diffuse hypokinesia
- Dilated cardiomyopathy due to viral cause or idiopathic myocarditis (cox B, Parovirus B19, Human Herpesvisus 6, adenovirus and enterovirus)
154
The initial diagnostic study for patient with possible Acute Type A aortic dissection/ What will it show?
- Ct angiography
| - Intimal flap separating the true and false lumens in the ascending or descending aorta
155
The most effective intervention in overweight patient for blood pressure control is ________ and other effective measures include (5)
Weight control
- DASH diet
- low sodium intake
- Moderation of alcohol intake
- regular moderate exercise
- Smoking cessation
156
10- 20% of patient with permanent pacemaker implantation have an adverse effect of
Tricuspid Regurgitation
157
Chest pain symptoms r/t CAD (4)
- Substernal
- Radiation to arm, shoulder, and jaw
- Precipitated by exertion
- relieved by rest or nitro
158
Chest pain symptoms r/t Pulmonary/Pleuritic (pericarditis) (3)
- Sharp/Stabbing pain
- Worse with inspiration
- Worse when lying flat
159
Chest pain symptoms r/t Pulmonary/pleuritic (PE, Pneumothorx) (3)
- Sharp/Stabbing pain
- Worse with inspiration
- Respiratory distress, hypoxia
160
Chest pain symptoms r/t Aortic (dissection, intramural hematoma) (4)
- Sudden, severe "tearing" pain
- Radiating to back
- Elderly men
- HTN & risk for atherosclerosis
161
Chest pain symptoms r/t GI/esophageal (5)
- Nonexertional (substernal squeezing)
- Relieved by antacids
- Upper abd and substernal
- Associated with regurgitation, nausea, dysphagia
- Nocturnal pain
162
Chest pain symptoms r/t chest wall/MSK (3)
- Persistent &/or prolonged pain
- Worse with movement or change in position
- Often follows repetitive activity
163
Risk factors for AAA (5)
- >60YO
- smoking
- FMHx
- White race
- Atherosclerosis
164
The peripheral wedge of lung opacity due to pulmonary infarction is called
Hamptons's hump
165
6 drugs that have been shown to improve long-term survival in patients with LV systolic dysfunction are
- ACE inhibitors
- ARBs
- BBs
- Mineralocorticoid receptor antagonists (MRAs- Spironolactone & eplerenone)
- Hydralazine (in AAs')
- Nitrates (in AAs'), combined with HTZ
166
What medication should be started in 24hrs after MI in pt without contraindication?
ACE inhibitor
167
It lessens the chance for ventricular remodeling that happens weeks to months after MI
ACE inhibitor
168
The 3 main medication classes for prevention of stable angina symptoms? which is is 1st line?
BB (1st line)
CCB
long-acting nitrates
169
Pulsus parvus et tardus is mostly seen in
Aortic stenosis
170
Early diastolic murmur is heard in
Aortic regurgitation/ marfan syndrome
171
Opening snap is heard in
Mitral stenosis (not in Mitral valve prolapse)
172
Mid-to-late systolic murmur is heard in
Mitral valve prolapse
173
AV block in pt with infective endocarditis can be caused by
perivalvular abscess
-Aortic valve endocarditis is associated with an increased risk of periannular extension of endocarditis
174
Terminating Atrioventricular nodal reentry tachycardia (AVNRT) using cold water immersion or diving reflex, Valsalva maneuver or eyeball pressure) is due to
altering AV nodal conductivity
175
To reduce the risk of stent thrombosis in pt who had MI and PCI in the last 12 months they need
Dual antiplatelet therapy (aspirin) and platelet P2y12 receptor blocker (clopidogrel, prasugrel, ticagrelor)
176
Tx for vasovagal syncope triggered by (stress, prolonged standing...)(3)
- Reassurance
- Avoidance of triggers
- Counterpressure techniques for recurrent episodes
177
Myxomatous valve degeneration causes _____ and produces what kind of heart sound?
Mitral valve prolapse
| Midsystolic click
178
Atrial Myxomas (intracardiac tumor) causes ______ and produces what kind of heart sound?
embolize and stroke or acute ischemia
| mid-diastolic rumble
179
PAC's that can lead to a-fib can be precipitated by which 4 factors
- Alcohol
- Tobacco
- Caffeine
- Stress
180
What is the most frequent location of the ectopic foci that causes A-fib?
Pulmonary vein
181
what is the most predominant mechanism responsible ventricular arrhytmias in the immediate post IM period?
Reentry ventricular arrhythmias (PVC's, VT, VF & VF )
182
Sharp and pleuritic chest pain
pericardial friction rub
uremia
```
Uremic pericarditis (6-10% of RF pt)
BUN >60
```
183
Drugs for stable wide-complex tachycardia (4)
Amiodarone
procainamide
sotalol
lidocaine
184
5days- 3 months Post MI, with acute ST-segment elevation and deep Q waves
Ventricular aneurysm
185
2-7 days post MI, acute severe MR (hypotension, pulmonary edema, cardiogenic shock) with no persistent ST-segment elevation
Papillary muscle rupture
186
Decreased CO/CI
Increased SVR
Increased LVEDV
CHF due to LV systolic dysfunction
187
Intermittent claudication due to PAD treatment plan (from less invasive to invasive) (3)
- low-dose aspirin and statin therapy
- Supervised exercise program
- Cilostazol and percutanous or surgical revascularization (for persistent symptoms)
188
The 3 effects Direct renin inhibitors (aliskiren) have
- increases natriuresis
- decreases serum Ang II concentration
- decreases aldosterone production
189
Management of Hypertrophic cardiomyopathy (3)
- Avoiding volume depletion
- BBs/CCBs
- Surgery if persistent symptoms
190
WHat murmur is heard for Hypertrophic cardiomyopathy
systolic murmur at the left sternal border
191
All pt with carotid artery stenosis should receive 3 things
- Antiplatelet agent
- Statin
- BP control
192
two meds that can trigger bronchoconstriction in a patient with asthma
- BB
| - Aspirin
193
A response with Exercise or atropine for Morbiz type 1 and 2
Improves Type 1 AV block (Morbiz type 1)
| Worsens type II AV block (Morbiz Type 2)
194
A response with vagal maneuvers (carotid sinus massage) for Morbiz type 1 and 2
for Morbiz type 1 (worsens)
| and Morbiz type 2 (paradoxically impoves)
195
“Water bottle” heart shape with clear lung fields
Cardiac tamponade due to large pericardial effusion
196
Beck’s triad
- hypotension
- JVD
- Muffled heart sound (hard to find the point of maximal apical impulse )
197
Inability to palate the point of maximal apical impulse is indicative of
Large pericardial effusion
198
Define Hypertensive urgency
Server HTN (>/= 180/120) with no symptoms or acute end-organ damage
199
Define Hypertensive emergency
server HTN with acute, life-threatening, end-organ complications
200
Two end-organ complication of hypertensive emergency
- Malignant hypertension
| - Hypertensive encephalopathy
201
Sever hypertension with retinal hemorrhages, exudates, or papilledema
Malignant hypertension
202
Severe hypertension with cerebral edema and non-localizing neurologica symptoms and signs
Hypertensive encephalopathy
203
Exaggerated drop in BP with inspiration
Pulsus paradoxus
204
Why do you see Pulsus paradoxus in Asthma or COPD
- drop in the tinrathoracic pressure (up tp 40mmHg), causing pooling of blood in the pulmonary vasculature decreasing LV preload
- Marked expansion of lung in Asthma/COPD can also impinge upon the outward expansion of the heart
- leading to drop in pressure
205
Pt with initial diagnosis of HTN should also have work up for (4)
- UA for occult hematurina and Urine protien/Cr ratio
- Chemistry panel
- Lipid profile
- Baseline EKG
206
Pounding pulse and “water hammer” pulse
Aortic regurgitation
207
Mitral valve abnormality (leaflet motion)
Hypertrophic cardiomyopathy
208
Treatment for WPW (Wolff-Parkinson-White syndrome) 2
- Cardiversion
| - Antiarrhytmiacs (procainamide)
209
Drugs not to give for WPW (4)
BB
CCB
Digoxin
Adenosisne
210
Recurrent headache
Pulsatile tinnitus
TIA/Stroke
Internal Carotid artery stenosis
211
Young Women with internal carotid artery stenosis and renal artery stenosis & HTN
Fibromuscular dysplasia
212
Secondary hypertension and flank pain
Renal artery stenosis
213
Hyperreactivity of coronary smooth muscle
Vasospastic angina (variant or prinzmetal angina)
214
Chest pain at rest or during sleep, spontaneous resolution = 15 minutes
Vasospastic angina (variant or prinzmetal angina)
215
Bradycardia, AV block, wheezing and hypotension in sucide attempt, Cause? Tx?
Beta blocker
| Tx- IV glucagon
216
Mechanism of action with IV glucagon in BB overdose
Increase levels of cyclic AMP
| Bronchodilator, positive Inotropic/ chronotropic
217
Bradycardia, AV block, and hypotension in sucide attempt, Cause? 3
CCB
Digoxin
Cholinergic agents
218
Risk factors for cholesterol crystal embolism (arthroembolism) 4
HDL
HTN
DM
Cardiac catheeterization or vascular procedure
