Med / Cardiovascular

Question 1

Symptoms of typical angina pain?

Answer 1

location (substernal), quality (pressure) chest pain, and duration (>20min)

Question 2

When to screen for AAA?

Answer 2

Men 65-75 who have ever smoked

Question 3

What does squatting do to murmurs and why?

Answer 3

Increases blood in LV

Question 4

What do you do for PEA?

Answer 4

Start CPR stat; IV access, epi q3-5 min, CPR x 2 min, watch for shockable rhythm

Question 5

V fib or pulseless v tach?

Answer 5

Defibrillate!

Question 6

Tx for anaphylaxis?

Answer 6

Epinephrine, supportive cares; maybe add antihistamine or glucocorticoid

Question 7

Signs of pericarditis?

Answer 7

better with sitting up, pleuritic; Diffuse ST elevation and PR depression; pericardial effusion; friction rub/squeak loudest leaning forwards

Question 8

What type of pericarditis will not have ST elevation?

Answer 8

Uremic

Question 9

Beck’s triad of tamponade?

Answer 9

hypotension, JVD, and muffled heart sounds

Question 10

Should you use a beta blocker in a CHF exacerbation?

Answer 10

No! Can worsen; only use after adequate diuresis

Question 11

Does digoxin decrease mortality in CHF exacerbation? Loop diuretic?

Answer 11

No and no

Question 12

Medical tx for aortic dissection? Why?

Answer 12

Beta blocker - reduce HR, SBP and LV contractility (Wall stress)

Question 13

Medical tx of known coronary disease?

Answer 13

• Dual antiplatelet therapy (aspirin + P2y12 inhibitor like clopidogrel/prasugrel/ticagrelor)
• Beta blocker (consider CCB if not sufficient)
• ACE or ARB
• Statin (can cause myopathy)
• Aldosterone antagonist - spironolactone, eplerenone if HFrEF or diabetes

Question 14

Acute MI medical tx?

Answer 14

• O2 if dyspnea or sat <90
• Aspirin 325
• P2Y12 inhibitor (clopidogrel)
• Nitrates
• Beta blocker - unless hypotensive, bradycardic, CHF (don’t give if pulmonary edema - if acute, decompensated CHF), or heart block
• High dose statin
• Anticoagulation
• IF Pulmonary Edema - give IV lasix if not hypovolemic (For Flash pulmonary edema!)

Question 15

How long to use antiplatelet after drug eluting stent for CAD?

Answer 15

12 months of clopidogrel or similar

Question 16

ST elevation II, III, aVF means

Answer 16

Inferior MI: RCA or LCX

Question 17

Complications of RCA MI (inferior)

Answer 17

supplies AV node, associated with bradycardia post MI. After 3-5 days, risk of papillary muscle rupture - pulmonary edema, new holosystolic murmur

Question 18

Signs and tx of MI with RV involvement?

Answer 18

chest pain, autonomic signs (diaphoresis, vomiting), JVD, Kussmaul’s sign (JVD increase w/ inspiration). Cause decreased preload, hypotension. May give fluids. AVOID nitrates or diuretics (preload dependent)

Question 19

Complication common after cardiac cath; associated problems

Answer 19

livedo reticularis (lacy, purple/red, blanches), ulcers, blue toe syndrome; AKI, retinal involvement (Hollenhorst plaques); GI mesenteric ischemia, pancreatitis, stroke, etc. See eosinophilia, eosinophilia, low complement

Question 20

Why is nitroglycerin helpful?

Answer 20

Decreased myocardial o2 demand:
NITRATES - smooth mm relaxation, systemic venodilation (increased capacitance) - primary anti-ischemic effect from systemic vasodilation and decreased cardiac preload - thus lowers end diastolic and end systolic volume = less left ventricular systolic wall stress (reflecting after load) = decreased myocardial oxygen demand (not via coronary vasodilation), raised creatinine, hyperkalemia

Question 21

How to treat cocaine induced vasospasm

Answer 21

IV benzos, avoid b blockers (unopposed alpha activity would worsen vasoconstriction)

Question 22

Treatment for intermittent claudication

Answer 22

cilostazol (PDE inhibitor)

Question 23

When to cardiovert chronic a fib?

Answer 23

After 3 weeks on anticoagulant or after TTE to confirm to thrombus

Question 24

What is WPW?

Answer 24

Accessory tract, see delta waves, short PR, and ST/T changes

Question 25

In WPW, what do you do, what should you NOT give and why?

Answer 25

try catheter ablation or procainamide/quinidine. NO AV nodal blockers (b blocker, adenosine, digoxin, verapamil) since these would promote conduction through the accessory pathway.

Question 26

Electrolytes causing Torsades

Answer 26

Hypokalemia, hypomagnesemia; see long QT

Question 27

How does adenosine work, and when should you NOT give it?

Answer 27

- Adenosine inhibits L type calcium channels, decrease conduction velocity at AV node; do not give in 2nd/3rd AV block

Question 28

What are the 4 types of AV block?

Answer 28

* 1st degree: PR prolongation * 2nd degree, type 1: “random” missed QRS * 2nd degree, type 2: progressively prolongs, then drops * 3rd degree: complete disassociation

Question 29

Main SE of amiodarone?

Answer 29

- Amiodarone: class III; toxicity = interstitial pneumonitis, diffuse reticular/ground-glass opacities on CXR, dyspnea, non-productive cough

Question 30

Symptoms of rheumatic fever?

Answer 30

* Mitral most common; can affect any valve | * Migratory polyarthritis, pancarditis, Syndeham’s chorea, erythema marginatum, subcutaneous nodules

Question 31

Describe the murmur of HOCM

Answer 31

• harsh cres-decres murmur at apex; quieter with squatting, loud with standing or valsalva (decreases preload)

Question 32

Murmur of ASD

Answer 32

• wide fixed split of S2; blood flow to right heart, pulmonic systolic ejection murmur ULSB

Question 33

Murmur and associations with TR?

Answer 33

• holosystolic, increases with inspiration; infective endocarditis, RVfailure, pulsatile liver

Question 34

How to treat idiopathic pHTN?

Answer 34

endothelin receptor antag (bosentan) or PDE5 inhibitor (sildenafil) or prostanoid (epoprostenol)

Question 35

Main SE of CCBs? Which drugs have this worse?

Answer 35

Tox: peripheral edema, preferential dilation of precapillary/arterioles. Worse with dihydropiridines (nifedipine, amlodipine) • Less edema if combined with ACEi

Question 36

Which cardiac med has a severe SE of angioedema?

Answer 36

ACE inhibitors, lisinopril

Question 37

SE of norepinephrine

Answer 37

• Norepi-induced vasospasm (alpha 1 agonist properties cause vasoconstriction while trying to increase BP during hypotension/sepsis) – can result in ischemia or necrosis of distal fingers and toes (or mesenteric ischemia or AKI) – cool, dusky