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UWORLD-STEP2 (BA) > IM-Cardio > Flashcards

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

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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)

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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

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4
Q

What is the guideline for statin therapy for an atherosclerotic cardiovascular disease age < or =75

A

High-intensity statin

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5
Q

What is the guideline for statin therapy for an atherosclerotic cardiovascular disease (ASCVD) age >75

A

Moderate-Intensity statin

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6
Q

What is the guideline for statin therapy for LDL > or = 190 mg/dL?

A

High-intensity statin

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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

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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

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9
Q

Signs of venous overload (3)

A
  • JVD, ascites, pedal edema
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10
Q

defined as lack of the typical inspiratory decline in central venous pressure, and presence of a pericardial knock

A

Kussmaul’s sign

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11
Q

Pericardial knock is

A

early heart sound after S2 (MIddiastolic sound)

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12
Q

3 main causes of constrictive pericarditis

A
  1. idiopathic or viral pericarditis
  2. Cardiac surgery or radiation therapy
  3. Tuberculous pericarditis (in endemic areas)
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13
Q
  • Fatigue & dyspnea on exertion
  • peripheral edema and ascites
  • JVD
  • Pericardial knock
  • Pulsus paradoxus
  • Kussmaul’s sign
A

Constrictive pericarditis

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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
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15
Q

The most common cause in developing countries and endemic areas such as Africa, India and China like constrictive pericarditis

A

Tuberculosis

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16
Q

Common cause of dilated cardiomyopathy in young adults

A

Viral myocarditis

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17
Q

Causes of acute limb ischemia (3)

A
  • Cardiac/arterial embolus
  • Arterial thrombosis
  • Iatrogenic/blunt trauma
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18
Q

3 risks for aortic dissection?

A
  • Hypertension
  • Marfan syndrome
  • Cocaine use
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19
Q

Severe, sharp, tearing chest or back pain

A

aortic dissection

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20
Q

> 20mm Hg variation in systolic blood pressure between arms

A

Aortic dissection

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21
Q

It is responsible for almost 50% of the aortic dissections seen in patients age <40

A

Marfan syndrome

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22
Q

Pt with worsening fatigue and irregular heart rate is

A

atrial fibrillation

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23
Q

__ score is recommended for assessment of stroke risk inpatient with nonvalvular atrial fibrillation

A

CHAzDS2-VASc score

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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
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25
Q

The most common lower extremity edema cause

A

Chronic venous insufficiency

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26
Q

Initial tx for chronic venous insufficiency

A

Leg elevation
exercise
compression therapy

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27
Q

In hypertrophic cardiomyopathy (HOCM); During Valsalva (Strain phase) what happens physiologically to preload, LV blood volume, and murmur intensity

A

Preload- decreases
LV blood volume- decreases
Murmur intensity- increases

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28
Q

In hypertrophic cardiomyopathy (HOCM); During abrupt standing what happens physiologically to preload, LV blood volume, and murmur intensity

A

Preload- decreases
LV blood volume- decreases
Murmur intensity- increases

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29
Q

In hypertrophic cardiomyopathy (HOCM); During nitroglycerin administration what happens physiologically to preload, LV blood volume, and murmur intensity

A

Preload- decreases
LV blood volume- decreases
Murmur intensity- increases

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30
Q

In hypertrophic cardiomyopathy (HOCM); During sustained handgrip what happens physiologically to afterload, LV blood volume, and murmur intensity

A

Afterload- Increases
LV blood volume- Increases
Murmur intensity- decreases

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31
Q

In hypertrophic cardiomyopathy (HOCM); During squatting what happens physiologically to afterload & preload, LV blood volume, and murmur intensity

A

Afterload & preload- Increases
LV blood volume- Increases
Murmur intensity- decreases

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32
Q

In hypertrophic cardiomyopathy (HOCM); During passive leg raise what happens physiologically to preload, LV blood volume, and murmur intensity

A

Preload- Increases
LV blood volume- Increases
Murmur intensity- decreases

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33
Q

The only time you can do a physiological maneuver to increase both preload and afterload is by

A

squatting

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34
Q

EKG with diffused ST elevation and PR depression

A

Pericarditis

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35
Q

Diastolic decrescendo murmur

A

Aortic regurgitation

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36
Q

Sudden SOB and chest pain, elevated left atrial and ventricular filling pressures & acute pulmonary edema. Dx? possible cause?

A

Acute mitral regurgitation due to papillary muscle displacement in MI

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37
Q

Ascending aortic aneurysms are most often due to _____ or ______

A

Cystic medial necrosis

Connective tissue disorder

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38
Q

On Chest x-ray, are mediastinal silhouette (widened), increased aortic knob, and tracheal deviation

A

Thoracic aortic aneurysm

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39
Q

The addition of a fibrate to a statin is rarely indicated because

A
  • increased SE, myopathy

- lack of proven CV benefit

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40
Q

In a pt with hypertriglyceridemia (150-500), the first line of pharmacologic therapy is

A

High-intensity statins

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41
Q

Pt placed on Statin and have known CV disease or high risk what other therapy is recommended?

A
  • Lifestyle modifications (Wt loss, moderate alcohol intake, increased exercise)
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42
Q

What happens to

  1. CI
  2. PCWP
  3. RV preload

in Tension pneumothorax & Cardiogenic shock (MI)

A

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
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43
Q

an IV drug user with bacterial endocarditis will have what kind of valvular issue and what is the murmur?

A
  • Tricuspid regurgitation

- Holosystolic murmur with inspiration

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44
Q

Pt treated for the hypertensive emergency with nitroprusside got confused, high lactate, sz and coma?

A

Cyanide toxicity

SE of nitroprusside

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45
Q

Microangiopathic hemolytic anemia on peripheral blood smear of a pt with scleroderma renal crisis with acute renal failure will show

A
  • fragmented RBC (Schistocytes) and Thrombocytopenia
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46
Q

What is the amount of alcohol intake that puts pat at risk for hypertension

A

> 2drinks a day or binge drinking (> 5 drinks in a row)

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47
Q

Lab findings in poor prognostic factors in systolic heart failure (3)

A
  • Hyponatremia
  • Elevated pro-BNP levels
  • Renal insufficiency
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48
Q

ECG findings in poor prognostic factors in systolic heart failure (2)

A
  • QRS duration > 120msec

- LBBB block pattern

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49
Q

Echocardiography findings in poor prognostic factors in systolic heart failure (4)

A
  • Severe LV dysfunction
  • Concomitant diastolic dysfunction
  • Reduced right ventricular function
  • Pulmonary hypertension
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50
Q

Associated conditions in poor prognostic factors in systolic heart failure (3)

A
  • Anemia
  • A fib
  • Diabetes mellitus
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51
Q

Arrthymias that is most specific for digitalis (digoxin) toxicity

A

Atrial tachycardia with AV block

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52
Q 
Exertional dyspnea
Fatigue
A-fib
signs of heart failure
What valvular problem can that be?
A

Mitral regurgitation

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53
Q

Holosystolic murmur heard best at the apex with radiation to the axilla

A

Mitral regurgitation

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54
Q

Mitral facies -pinkish-purple patches on cheeks

A

Mitral stenosis

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55
Q

Loud S1, loud P2 if pulmonary hypertension

A

Mitral stenosis

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56
Q

Opening snap-high-frequency early diastolic sound

A

Mitral stenosis

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57
Q

Mid-diastolic rumble-best heard at the cardiac apex

A

Mitral stenosis

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58
Q

CXR- Pulmonary blood flow the to upper lobes, dilated pulmonary vessels, left atrial enlargement, flattened left heart border

A

Mitral stenosis

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59
Q

ECG: P mitrale (broad and notched P waves), atrial tachyarrhythmias, RVH (Right ventricular hypertrophy)- tall R waves in V1 & V2

A

Mitral stenosis

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60
Q

TTE - MV thickening/calcification/decreased mobility, coexisting MR

A

Mitral stenosis

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61
Q

Name the 3 clinical features of Mitral stenosis

A
  • Dyspnea, orthopnea, PND, Hemoptysis
  • A-fib, systemic thromboembolism
  • Voice hoarseness from recurrent laryngeal nerve compression due to LAE (Ortner syndrome)
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62
Q

Hypertension (headaches, epistaxis), Claudication of extremities,
Brachial-femoral pulse delay,
Upper & lower extremity bp differences,
Left interscapular systolic or continuous murmur

A

Coarctation of the aorta

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63
Q

on Chest X-ray

  • Inferior notching of the 3rd and 8th ribs
  • “3” sign due to aortic indentation
A

Coarctation of the aorta

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64
Q

Tx for coarctation of the aorta

A
  • Ballon angioplasty +/- stent placement

- Surgery

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65
Q

Stress testing that examines myocardial contractility that leads to an increase in myocardial oxygen demand due to increased HR includes the use of

A
  • Exercise &

- Dobutamine (Beta-1 receptor agonist)

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66
Q

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

A

Adenosine
- The difference in blood flow allows for diagnosis of obstructive coronary artery disease due to reduced uptake of radioactive isotope in ischemic myocardium

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67
Q

Pt with SOB when laying flat and bibasilar crackles after noted to have an aortic dissection

A

Aortic valve insufficiency

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68
Q

What is the tx for acute pulmonary edema (flash pulmonary edema) due to MI?

A

Diuretics (lasix)

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69
Q

What medication should you avoid in patients with decompensated CHF or bradycardia?

A

Beta Blockers

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70
Q

Physical examination findings that suggestive of severe aortic stenosis (3)

A
  • Pulsus parvus and tardus
  • Single and soft second heart sound (S2)
  • Mid-to late-peaking systolic murmur , radiating to the carotids
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71
Q

Delayed (slow rising) and diminished (weak) carotid pulse is called

A

Pulsus parvus and tardus

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72
Q

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

A

Rupture of interventricular septum

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73
Q

After MI, Right ventricular failure involves

  • Time course?
  • what coronary artery?
  • Clinical findings? (3)
  • EKG findings?
A
  • Acute
  • RCA
  • Hypotension, clear lungs, Kussmaul sign
  • Hypokinetic RV
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74
Q

After MI, Papillary muscle rupture involves

  • Time course?
  • what coronary artery?
  • Clinical findings? (3)
  • EKG findings?
A
  • Acute or 3-5 days
  • RCA
  • Severe pulmonary edema & new holosystolic murmur
  • Severe mitral regurgitation with a flail leaflet
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75
Q

After MI, interventricular septum rupture involves

  • Time course?
  • what coronary artery?
  • Clinical findings? (3)
  • Echo findings?
A
  • 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
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76
Q

After MI, Free wall rupture involves

  • Time course?
  • what coronary artery?
  • Clinical findings? (3)
  • EKG findings?
A
  • within 5 days- 2 weeks
  • LAD
  • Chest pain, shock, distant heart sound
  • Pericardial effusion with tamponade
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77
Q

After MI, left ventricular aneurysm involves

  • Time course?
  • what coronary artery?
  • Clinical findings? (3)
  • EKG findings?
A
  • Up to several months
  • LAD
  • Subacute heart failure & stable angina
  • Thin & dyskinetic myocardial wall
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78
Q

A secondary cause of hypertension with elevated serum creatinine and abnormal urinalysis (proteinuria, RBC casts)

A

Renal parenchymal disease

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79
Q

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

A

Renovascular disease

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80
Q

A secondary cause of hypertension with early provoked hypokalemia, slight hypernatremia, HTN with adrenal incidentaloma

A

Primary aldosteronism

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81
Q

A secondary cause of hypertension with paroxysmal elevated bp with tachycardia, pounding headaches, palpitations, diaphoresis, HTN with an adrenal incidentaloma

A

Pheochromocytoma

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82
Q

A secondary cause of hypertension with central obesity, facial plethora, proximal muscle weakness, abd striae, ecchymosis,, amenorrhea/erectile dysfunction, HTN with adrenal incidentaloma

A

Cushing syndrome

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83
Q

A secondary cause of hypertension with fatigue, dry skin, cold intolerance, constipation, wt gain, bradycardia

A

Hypothyroidism

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84
Q

A secondary cause of hypertension with hypercalemia (polyuria, polydipsia), kidney stones, neuropsychiatric presentation

A

Primary hyperparathyroidism

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85
Q

A secondary cause of hypertension with differential hypertension with brachial-femoral pulse delay

A

Coarctation of the aorta

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86
Q

Syncope triggered by prolonged standing or emotional distress, painful stimuli, prodromal symptoms (Nausea, warmth, diaphoresis)

A

Vasovagal or neurally mediated syncope

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87
Q

Syncope triggered by cough, micturition or defecation

A

situational syncope

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88
Q

Syncope triggered by postural changes in HR/BP after standing suddenly

A

Orthostatic syncope

89
Q

Syncope triggered by exertion or during exercises (3)

A

Aortic stenosis
Hypertrophic cardiomyopathy (HCM)
Anomalous coronary arteries

90
Q

Syncope with a prior history of CAD, MI, cardiomyopathy, or decreased EF

A

ventricular arrhythmias

91
Q

Syncope with sinus pauses, increased PR or QRS duration (3)

A

Sick sinus syndrome
bradyarrhythmias
AV block

92
Q

Syncope triggered by hypokalemia, hypomagnesemia, medications causing increased QT interval

A

Torsades de pointes (acquired long QT syndrome)

93
Q

Syncope with family hx of sudden death, increased QT interval, syncope with triggers (exercises, startle, sleeping)

A

Congenital long QT syndrome

94
Q

The most common cause of mitral regurgitation in developed countries is

A

mitral valve prolapse

95
Q

Tx for vasospastic angina (Prinzmetal angina) is

A

CCB ( Diltiazem, amlodipine)

96
Q

HTN, hematuria, protenuria, palpable renal masses, progressive renal insufficiency

A

Polycystic kidney disease

97
Q

Flank pain with nephrolithiasis, infection, cyst rupture, hemorrhage, hematuria

A

polycystic kidney disease

98
Q

Drug causing GI SE of Anorexia, N/V abd pain

A

Digoxin toxicity

99
Q

Drug causing cardiac SE of life-threatening arrhythmias

A

Digoxin toxicity

100
Q

Drug causing neurological SE of fatigue, confusion, weakness, color vision alterations

A

Digoxin toxicity

101
Q

Adding Amiodarone with other drugs can cause

A

serum levels of the other drug to increased because it is CYP 450 inhibitor

102
Q

What is the USPSTF recommendation for AAA screening?

A
  • Male active or former smokers aged 65-75

ONE abdominal ultrasound

103
Q

Electrical alternans with sinus tachycardia is a highly specific sign for

A

large pericardial effusion

104
Q

what is electrical alternans?

A

Swinging motion of the heart in the pericardial cavity causing a beat-to-beat variation in QRS axis and amplitude

105
Q

Main SE of dihydropyridine calcium channel antagonists like Amilodipine

A

Peripheral edema

106
Q

Major SE of amiodarone in cardiac

A
  • Sinus brady, Heart block

- Proarrhtymias- QT prolongation and torsades de pointes

107
Q

Major SE of amiodarone in Pulmonary

A
  • Chronic interstitial pneumonities (Caugh, fever, dyspnea, pulmonary infiltrates)
108
Q

Major SE of amiodarone in endocrine

A
  • Hypo and hyperthyroidism
109
Q

Major SE of amiodarone in GI/Hepatic

A

-Elevated transaminases, hepatitis

110
Q

Major SE of amiodarone in ocular

A
  • corneal microdeposites

- Optic neuropathy

111
Q

Major SE of amiodarone in dermatologic

A
  • Blue-grey skin discoloration
112
Q

Major SE of amiodarone in neurologic

A
  • peripheral neuropathy
113
Q

Persistent ST-segment elevation with deep Q waves

A

Ventricular aneurysm

- progressive left ventricular enlargement and dyskinetic wall motion leading to heart failure

114
Q

It is very helpful in improving CHF symptoms like dyspnea and fatigue but not shown to improve survival in patient with CHF

A

Digoxin

115
Q

The primary anti-ischemia and abtianginal effects of nitrates are due to

A

systemic vasodilation rather than coronary vasodilation

116
Q

Increased incidence of orthostatic hypotension in the elderly is due to progressively decreasing

A

baroreceptor sensitivity and defects in the myocardial response

117
Q

the most common side effect of dihydropyridine CCBs is and what types of drugs can reduce this symptom

A

Peripheral edema

Angiotensin system antagonist (ACE or ARB)

118
Q

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 _____ & _____

A
  • Reduced left ventricular end-systolic volume

- Symptomatic improvement of decompensated heart failure

119
Q

ECG changes in Acute aortic dissection

A

Normal or nonspecific ST & T-wave changes

120
Q

Chest X-ray changes in Acute aortic dissection

A

Mediastinal widening

121
Q

What is the definitive diagnosis for Acute Aortic dissection? (2)

A
  • CT angiography

- TEE for definitive diagnosis

122
Q

The 4 treatments needed for Acute Aortic dissection

A
  • Pain control (Morphin)
  • IV BB (Esmolol, Labetalol)
  • Sodium nitroprusside (if SBP >120)
  • Urgent surgical repair for ascending dissection
123
Q

Two drugs that can be used in treatment for a-fib in patients with structurally normal hearts

A

Flecainide & Propafenone (class 1c)

124
Q

Up to 70% of pt with Mitral stenosis will develop a-fib because of the significant

A

left atrial dilatation

125
Q

Patient with symptomatic bradycardia should be treated initially with IV _____ and if no response use IV ___ or ____ or transcutaneous pacing

A

atropine;

epinephrine or dopamine

126
Q

What is the dose of atropine in pt with bradycardia

A

IV 0.5mg bolus, repeat every 3-5 minutes up to 3.0 mg maximum

127
Q

What diagnostic is used for definitive diagnosis and management of cardiac tamponade?

A

Echocardiography

128
Q

What do you expect to see on Echo for cardiac tamponade?

A
  • Right atrial and Ventricular collapse, plethora of the IVC
129
Q

How do you define IVC plethora?

A

a decreased in the proximal venal caval diameter by <50% during deep inspiration

130
Q

ECG changes on Leads V1-V6, Blocked vessels? Involved myocardium?

A

LAD

Anterior MI

131
Q

ST elevation in Leads II, III & aVF, Blocked vessels? Involved myocardium?

A

RCA or LCX

Inferior MI

132
Q

ST depression in leads V1-V3, Blocked vessels? Involved myocardium?

A

LCX or RCA

Posterior MI

133
Q

ST elevation in leads I & aVL , Blocked vessels? Involved myocardium?

A

LCX

Posterior MI

134
Q

ST depression in leads I & aVL, Blocked vessels? Involved myocardium?

A

RCA

Posterior MI

135
Q

ST elevation in leads I, aVL, V5,V6; Blocked vessels? Involved myocardium?

A

LCX, diagonal

Lateral MI

136
Q

ST depression in leads II, III & aVF, Blocked vessels? Involved myocardium?

A

LCX, diagonal

Lateral MI

137
Q

ST elevation in leads V4-V6R, Blocked vessels? Involved myocardium?

A

RCA

Right Ventricle MI

138
Q

Initiation of statin therapy is recommended for primary prevention in patient with

A

10 year risk of atherosclerotic cardiovascular disease (ASCVD) >/= 7.5%

139
Q
  • 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
A

Pulmonic valve stenosis (congenital defect is common than acquired)

140
Q

Pulmonic valve stenosis treatment (2)

A
  • Percutaneous balloon valvulotomy

- Surgical repair in some cases

141
Q

The two common reasons to have acquired Pulmonic valve stenosis (not-congenital)

A
  • Rheumatic fever

- Carcinoid syndrome

142
Q

Ejection click (high pitch sound after S1 best heard during expiration) followed by a crescendo-decrescendo systolic murmur over the Left second intercostal space

A

pulmonic valve stenosis

143
Q

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

A

Atheroembolism (Cholesterol embolism)

144
Q

How do you treat atheroembolism (Cholesterol embolism)

A

Supportive and statin therapy for risk factor reduction and prevention

145
Q

Isolated systolic hypertension (SBP >140 and DBP <90) in elderly is caused by

A

increased stiffness or decreased elasticity of the arterial wall (increase in mortality & morbidity)

146
Q

Brachial-Femoral pulse delay, high blood pressure in both arms compared to lower extremities and continuous machinery murmur over the back

A

Aortic coarctation

147
Q

continuous abdominal bruit has a high specificity for the presence of

A

Renovascular hypertension

148
Q

The most common causes of regular, narrow-complex SVT include (4)

A
  • Sinus tachycardia
  • Atrial Tachycardia
  • A-flutter
  • AV nodal reentrant tachycardia
149
Q

which drugs may potentiate the anticoagulant effects of warfarin, leading to variable dose response and increase the risk of bleeding (CYP450 inhibitors) (4)?

A

Acetaminophen
NSAIDs
Amiodarone
antibiotic

150
Q

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?

A
  • Normal Saline bolus

- Inferior MI, affecting right ventricle filling so increases preload by bolus

151
Q

what therapy is important to reduce recurrent MI and cardiovascular death compared with aspirin alone in pt with non-ST elevation MI?

A

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
Q

Which drugs are considered P2y12 receptor blocker (5)?

A

antiplatelets like
clopidogrel, ticlopidine, ticagrelor, prasugrel, cangrelor
- adenosine diphosphate (ADP) P2y12 receptors

153
Q

32yo F, hx of recent cold symptoms, fatigue, progressive SOB, feet swelling, bilateral basal crackles, JVD, normal CBC, Echocardiogram will show ? Dx? Cause?

A

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
Q

The initial diagnostic study for patient with possible Acute Type A aortic dissection/ What will it show?

A
  • Ct angiography

- Intimal flap separating the true and false lumens in the ascending or descending aorta

155
Q

The most effective intervention in overweight patient for blood pressure control is ________ and other effective measures include (5)

A

Weight control

  • DASH diet
  • low sodium intake
  • Moderation of alcohol intake
  • regular moderate exercise
  • Smoking cessation
156
Q

10- 20% of patient with permanent pacemaker implantation have an adverse effect of

A

Tricuspid Regurgitation

157
Q

Chest pain symptoms r/t CAD (4)

A
  • Substernal
  • Radiation to arm, shoulder, and jaw
  • Precipitated by exertion
  • relieved by rest or nitro
158
Q

Chest pain symptoms r/t Pulmonary/Pleuritic (pericarditis) (3)

A
  • Sharp/Stabbing pain
  • Worse with inspiration
  • Worse when lying flat
159
Q

Chest pain symptoms r/t Pulmonary/pleuritic (PE, Pneumothorx) (3)

A
  • Sharp/Stabbing pain
  • Worse with inspiration
  • Respiratory distress, hypoxia
160
Q

Chest pain symptoms r/t Aortic (dissection, intramural hematoma) (4)

A
  • Sudden, severe “tearing” pain
  • Radiating to back
  • Elderly men
  • HTN & risk for atherosclerosis
161
Q

Chest pain symptoms r/t GI/esophageal (5)

A
  • Nonexertional (substernal squeezing)
  • Relieved by antacids
  • Upper abd and substernal
  • Associated with regurgitation, nausea, dysphagia
  • Nocturnal pain
162
Q

Chest pain symptoms r/t chest wall/MSK (3)

A
  • Persistent &/or prolonged pain
  • Worse with movement or change in position
  • Often follows repetitive activity
163
Q

Risk factors for AAA (5)

A
  • > 60YO
  • smoking
  • FMHx
  • White race
  • Atherosclerosis
164
Q

The peripheral wedge of lung opacity due to pulmonary infarction is called

A

Hamptons’s hump

165
Q

6 drugs that have been shown to improve long-term survival in patients with LV systolic dysfunction are

A
  • ACE inhibitors
  • ARBs
  • BBs
  • Mineralocorticoid receptor antagonists (MRAs- Spironolactone & eplerenone)
  • Hydralazine (in AAs’)
  • Nitrates (in AAs’), combined with HTZ
166
Q

What medication should be started in 24hrs after MI in pt without contraindication?

A

ACE inhibitor

167
Q

It lessens the chance for ventricular remodeling that happens weeks to months after MI

A

ACE inhibitor

168
Q

The 3 main medication classes for prevention of stable angina symptoms? which is is 1st line?

A

BB (1st line)
CCB
long-acting nitrates

169
Q

Pulsus parvus et tardus is mostly seen in

A

Aortic stenosis

170
Q

Early diastolic murmur is heard in

A

Aortic regurgitation/ marfan syndrome

171
Q

Opening snap is heard in

A

Mitral stenosis (not in Mitral valve prolapse)

172
Q

Mid-to-late systolic murmur is heard in

A

Mitral valve prolapse

173
Q

AV block in pt with infective endocarditis can be caused by

A

perivalvular abscess

-Aortic valve endocarditis is associated with an increased risk of periannular extension of endocarditis

174
Q

Terminating Atrioventricular nodal reentry tachycardia (AVNRT) using cold water immersion or diving reflex, Valsalva maneuver or eyeball pressure) is due to

A

altering AV nodal conductivity

175
Q

To reduce the risk of stent thrombosis in pt who had MI and PCI in the last 12 months they need

A

Dual antiplatelet therapy (aspirin) and platelet P2y12 receptor blocker (clopidogrel, prasugrel, ticagrelor)

176
Q

Tx for vasovagal syncope triggered by (stress, prolonged standing…)(3)

A
  • Reassurance
  • Avoidance of triggers
  • Counterpressure techniques for recurrent episodes
177
Q

Myxomatous valve degeneration causes _____ and produces what kind of heart sound?

A

Mitral valve prolapse

Midsystolic click

178
Q

Atrial Myxomas (intracardiac tumor) causes ______ and produces what kind of heart sound?

A

embolize and stroke or acute ischemia

mid-diastolic rumble

179
Q

PAC’s that can lead to a-fib can be precipitated by which 4 factors

A
  • Alcohol
  • Tobacco
  • Caffeine
  • Stress
180
Q

What is the most frequent location of the ectopic foci that causes A-fib?

A

Pulmonary vein

181
Q

what is the most predominant mechanism responsible ventricular arrhytmias in the immediate post IM period?

A

Reentry ventricular arrhythmias (PVC’s, VT, VF & VF )

182
Q

Sharp and pleuritic chest pain
pericardial friction rub
uremia

A 
Uremic pericarditis (6-10% of RF pt)
BUN >60
183
Q

Drugs for stable wide-complex tachycardia (4)

A

Amiodarone
procainamide
sotalol
lidocaine

184
Q

5days- 3 months Post MI, with acute ST-segment elevation and deep Q waves

A

Ventricular aneurysm

185
Q

2-7 days post MI, acute severe MR (hypotension, pulmonary edema, cardiogenic shock) with no persistent ST-segment elevation

A

Papillary muscle rupture

186
Q

Decreased CO/CI
Increased SVR
Increased LVEDV

A

CHF due to LV systolic dysfunction

187
Q

Intermittent claudication due to PAD treatment plan (from less invasive to invasive) (3)

A
  • low-dose aspirin and statin therapy
  • Supervised exercise program
  • Cilostazol and percutanous or surgical revascularization (for persistent symptoms)
188
Q

The 3 effects Direct renin inhibitors (aliskiren) have

A
  • increases natriuresis
  • decreases serum Ang II concentration
  • decreases aldosterone production
189
Q

Management of Hypertrophic cardiomyopathy (3)

A
  • Avoiding volume depletion
  • BBs/CCBs
  • Surgery if persistent symptoms
190
Q

WHat murmur is heard for Hypertrophic cardiomyopathy

A

systolic murmur at the left sternal border

191
Q

All pt with carotid artery stenosis should receive 3 things

A
  • Antiplatelet agent
  • Statin
  • BP control
192
Q

two meds that can trigger bronchoconstriction in a patient with asthma

A
  • BB

- Aspirin

193
Q

A response with Exercise or atropine for Morbiz type 1 and 2

A

Improves Type 1 AV block (Morbiz type 1)

Worsens type II AV block (Morbiz Type 2)

194
Q

A response with vagal maneuvers (carotid sinus massage) for Morbiz type 1 and 2

A

for Morbiz type 1 (worsens)

and Morbiz type 2 (paradoxically impoves)

195
Q

“Water bottle” heart shape with clear lung fields

A

Cardiac tamponade due to large pericardial effusion

196
Q

Beck’s triad

A
  • hypotension
  • JVD
  • Muffled heart sound (hard to find the point of maximal apical impulse )
197
Q

Inability to palate the point of maximal apical impulse is indicative of

A

Large pericardial effusion

198
Q

Define Hypertensive urgency

A

Server HTN (>/= 180/120) with no symptoms or acute end-organ damage

199
Q

Define Hypertensive emergency

A

server HTN with acute, life-threatening, end-organ complications

200
Q

Two end-organ complication of hypertensive emergency

A
  • Malignant hypertension

- Hypertensive encephalopathy

201
Q

Sever hypertension with retinal hemorrhages, exudates, or papilledema

A

Malignant hypertension

202
Q

Severe hypertension with cerebral edema and non-localizing neurologica symptoms and signs

A

Hypertensive encephalopathy

203
Q

Exaggerated drop in BP with inspiration

A

Pulsus paradoxus

204
Q

Why do you see Pulsus paradoxus in Asthma or COPD

A
  • 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
Q

Pt with initial diagnosis of HTN should also have work up for (4)

A
  • UA for occult hematurina and Urine protien/Cr ratio
  • Chemistry panel
  • Lipid profile
  • Baseline EKG
206
Q

Pounding pulse and “water hammer” pulse

A

Aortic regurgitation

207
Q

Mitral valve abnormality (leaflet motion)

A

Hypertrophic cardiomyopathy

208
Q

Treatment for WPW (Wolff-Parkinson-White syndrome) 2

A
  • Cardiversion

- Antiarrhytmiacs (procainamide)

209
Q

Drugs not to give for WPW (4)

A

BB
CCB
Digoxin
Adenosisne

210
Q

Recurrent headache
Pulsatile tinnitus
TIA/Stroke

A

Internal Carotid artery stenosis

211
Q

Young Women with internal carotid artery stenosis and renal artery stenosis & HTN

A

Fibromuscular dysplasia

212
Q

Secondary hypertension and flank pain

A

Renal artery stenosis

213
Q

Hyperreactivity of coronary smooth muscle

A

Vasospastic angina (variant or prinzmetal angina)

214
Q

Chest pain at rest or during sleep, spontaneous resolution = 15 minutes

A

Vasospastic angina (variant or prinzmetal angina)

215
Q

Bradycardia, AV block, wheezing and hypotension in sucide attempt, Cause? Tx?

A

Beta blocker

Tx- IV glucagon

216
Q

Mechanism of action with IV glucagon in BB overdose

A

Increase levels of cyclic AMP

Bronchodilator, positive Inotropic/ chronotropic

217
Q

Bradycardia, AV block, and hypotension in sucide attempt, Cause? 3

A

CCB
Digoxin
Cholinergic agents

218
Q

Risk factors for cholesterol crystal embolism (arthroembolism) 4

A

HDL
HTN
DM
Cardiac catheeterization or vascular procedure

UWORLD-STEP2 (BA) (19 decks)

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