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Step 2 CK z > Med / Cardiovascular > Flashcards

Med / Cardiovascular Flashcards

1
Q

Symptoms of typical angina pain?

A

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

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2
Q

When to screen for AAA?

A

Men 65-75 who have ever smoked

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3
Q

What does squatting do to murmurs and why?

A

Increases blood in LV

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4
Q

What do you do for PEA?

A

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

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5
Q

V fib or pulseless v tach?

A

Defibrillate!

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6
Q

Tx for anaphylaxis?

A

Epinephrine, supportive cares; maybe add antihistamine or glucocorticoid

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7
Q

Signs of pericarditis?

A

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

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8
Q

What type of pericarditis will not have ST elevation?

A

Uremic

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9
Q

Beck’s triad of tamponade?

A

hypotension, JVD, and muffled heart sounds

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10
Q

Should you use a beta blocker in a CHF exacerbation?

A

No! Can worsen; only use after adequate diuresis

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11
Q

Does digoxin decrease mortality in CHF exacerbation? Loop diuretic?

A

No and no

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12
Q

Medical tx for aortic dissection? Why?

A

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

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13
Q

Medical tx of known coronary disease?

A
  • 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
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14
Q

Acute MI medical tx?

A
  • 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!)
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15
Q

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

A

12 months of clopidogrel or similar

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16
Q

ST elevation II, III, aVF means

A

Inferior MI: RCA or LCX

17
Q

Complications of RCA MI (inferior)

A

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

18
Q

Signs and tx of MI with RV involvement?

A

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)

19
Q

Complication common after cardiac cath; associated problems

A

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

20
Q

Why is nitroglycerin helpful?

A

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

21
Q

How to treat cocaine induced vasospasm

A

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

22
Q

Treatment for intermittent claudication

A

cilostazol (PDE inhibitor)

23
Q

When to cardiovert chronic a fib?

A

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

24
Q

What is WPW?

A

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

25
Q

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

A

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

26
Q

Electrolytes causing Torsades

A

Hypokalemia, hypomagnesemia; see long QT

27
Q

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

A
  • Adenosine inhibits L type calcium channels, decrease conduction velocity at AV node; do not give in 2nd/3rd AV block
28
Q

What are the 4 types of AV block?

A
  • 1st degree: PR prolongation
  • 2nd degree, type 1: “random” missed QRS
  • 2nd degree, type 2: progressively prolongs, then drops
  • 3rd degree: complete disassociation
29
Q

Main SE of amiodarone?

A
  • Amiodarone: class III; toxicity = interstitial pneumonitis, diffuse reticular/ground-glass opacities on CXR, dyspnea, non-productive cough
30
Q

Symptoms of rheumatic fever?

A
  • Mitral most common; can affect any valve

* Migratory polyarthritis, pancarditis, Syndeham’s chorea, erythema marginatum, subcutaneous nodules

31
Q

Describe the murmur of HOCM

A

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

32
Q

Murmur of ASD

A

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

33
Q

Murmur and associations with TR?

A

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

34
Q

How to treat idiopathic pHTN?

A

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

35
Q

Main SE of CCBs? Which drugs have this worse?

A

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

36
Q

Which cardiac med has a severe SE of angioedema?

A

ACE inhibitors, lisinopril

37
Q

SE of norepinephrine

A

• 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

Step 2 CK z (5 decks)

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