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Cardio > MTB > Flashcards

MTB Flashcards

1
Q

What is the worst risk factor for CAD

A

Diabetes mellitus

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2
Q

What is the most common risk factor for CAD

A

HTN

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3
Q

Risk factors for CAD

A 
Diabetes mellitus
Tobacco smoking
HTN
Hyperlipidemia
FHX - Premature CAD in first degree (M  45, Females >55
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4
Q

Correcting which risk factor has greatest immediate improvement

A

Stoping smoking

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5
Q

Most dangerous component of lipid profile for CAD

A

Elevated LDL

Low HDL = poor long-term prognosis

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6
Q

Presentation of Tako-Tsubo Cardiomyopathy

A 
Acute myocardial damage
Postmenopausal women
Follows stressful event
Ballooning and LV dyskinesis
Massive catecholamine discharge
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7
Q

TX for Tako-Tsubo Cardiomyopathy

A

Beta blockers

ACE-I

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8
Q

Unreliable risk factors for CAD

Wrong answers

A

Elevated homocysteine, CRP

Chlamydia Infxn

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9
Q

Presentation of Inferior Wall ischemia

A 
Vagal reflexes
Bradycardia
HypoTN
Dizziness
Fainting
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10
Q

Presentation of ischemic pain

A 
Dull/sore
Squeezing/pressure-like
Substernal
Lasts 20-30 mins
Can radiate to neck/arm
Sometimes w exertion
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11
Q

Chest pain that is NOT ischemic presentation

A 
Sharp/Pointlike
Lasts a few seconds
Right or left sided
Pleuritic 
Positional 
Tender
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12
Q

Chest pain w chest wall tenderness

Most accurate next test?

A

Costochondritis

PE

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13
Q

Chest pain radiating to back + unequal BP in arms

Most accurate next test?

A

Aortic Dissection
- Can also present as tearing, sharp pain, radiating to in b/t scapula
CXR shows widened mediastinum
CT, MRI, TEE = confirm

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14
Q

Chest pain worse w lying flat, better sitting up

Most accurate next test?

A

Pericarditis

EKG shows ST elevation all leads, PR depression

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15
Q

Chest pain worse w inspiration?

A

Costochondritis

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16
Q

Epigastric discomfort + pain relieved with eating

Test?

A

Duodenal Ulcer Dz

Endoscopy

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17
Q

Bad taste, cough, hoarseness

Test?

A

GERD

Response to PPI’s, Al OH, Mg OH

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18
Q

Cough, sputum, hemoptysis

Test?

A

Pneumonia

CXR

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19
Q

Sudden onset SOB, tachycardia, hypoxia

Test?

A

PE
Spiral CT
V/Q scan for pregnant women

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20
Q

Sharp, pleuritic pain, tracheal deviation

Test?

A

Pneumothorax

CXR

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21
Q

How does aortic stenosis present?

Worst prognosis

A

Angina
Syncope
CHF = worst prognosis

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22
Q

Causes of Pleuritic pain

A 
PE
Pneumonia
Pericarditis
Pneumothorax (PTX) 
Pleuritis
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23
Q

CKMB

Begin? Peak? Normalizes?

A

Begins @ 4 hours
Peaks @ 12 hours
Normalizes 3-4 days

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24
Q

Best cardiac enzyme reinfarction

A

CKMB

25
Q

Troponin
Accumulates in what pts?
Normalizes?

A

Pts with renal failure and seizures

2 weeks to normalize

26
Q

What factors must be present to do a stress test?

A
  1. Can read the EKG

2. Pt can exercise = HR > 80% of maximum

27
Q

Which drugs impact validity of stress test

A

Beta blockers

Digoxin

28
Q

High False Positive rates seen in who with stress tests

A

Asymptomatic young females

29
Q

High False Negative rates seen in who with stress tests

A

Pts with known CAD

30
Q

Workup if positive stress test

A

Angiogram

  • If 3 Vessel DZ or Left Main -> CABG
  • If 1 or 2 Vessel dz -> Angioplasty
31
Q

How to differentiate ischemia v. infarction

A

Reperfusion images at rest

- Ischemia detected by reversal of decrease in thallium uptake or wall motion returning to normal after rest

32
Q

Testing for pt that cannot exercise in CAD

A

Persantine (dipyridamole) OR adenosine with nuclear isotopes (thallium, sestamibi)
Dobutamine Echo

33
Q

When do we do angiography

What is done

A

Detect location of CAD

Radiopaque contrast dye injected into blood vessels - imaging w X-ray

34
Q

Most accurate method to detect CAD

A

Angiography

35
Q

When do we use Holter

A

Rhythm disorders

A fib, A flutter, ectopy - PVCs, V tach

36
Q

Drugs that lower mortality in chronic Angina

A

ASA
Beta blockers
Nitroglycerin

37
Q

Which drugs lower mortality in CAD

A 
ASA
Beta blockers
Angioplasty
TPA
Clopidogrel
Statins IF LDL > 100
ACE-Inhibitors IF decreased EF
38
Q

Route of admin of nitroglycerin in chronic Angina

A

Oral

Transdermal patch

39
Q

Route of admin of nitroglycerin in acute coronary syndromes

A

Sublingual
Paste
IV

40
Q

When is Clopidogrel used

A

ASA intolerance

Recent angioplasty w stenting

41
Q

AEs of Prasugrel

A

Hemorrhagic stroke

42
Q

AEs of Ticlopidine

A

Neutropenia

43
Q

When to use Ticlopidine

A

Pt allergic to ASA and Clopidogrel

44
Q

Do ACE I or ARBs cause hyperkalemia

A

Both b/c they inhibit Aldosterone, which excretes K+ from distal tubule

45
Q

MOA of Hydralazine
Impact on afterload/preload
Mortality benefit?

A

Direct acting arterial vasodilator
Decreases Afterload
Mortality benefit in Systolic dysfunction
Used w nitrates to dilate coronary arteries

46
Q

What is goal LDL in CAD pts?

A

Less than 100 mg/dL

47
Q

Which lipid do lifestyle modifications improve the most

A

HDL

48
Q

Impact of weight loss on BP

A

For every kg lost = 1 mmHg Reduction

49
Q

What are CAD equivalents

A

PAD
Aortic disease
Diabetes mellitus
Carotid dz

50
Q

MC AE of statins

A

Liver Dysfunction
- Test all pts AST and ALT
Rhabdomyolysis = much less common

51
Q

Statins MOA - 2

A
  1. Inhibit HMG-Co A Reductase (RLE in cholesterol synthesis)

2. Antioxidant effect on endothelial ling of coronary arteries

52
Q

Niacin ass’d with

A

Glucose intolerance
Elevation of uric acid
Histamine release = itching

53
Q

Gemfibrozil, Fibric Acid Derivatives

AE

A

Lower TGs

Myositis

54
Q

Cholestyramine

AE

A

GI AE’s

55
Q

Which drug is NOT used in CAD

A

DHP CCB’s (Nifedipine, Amlodipine)

  • Raise HR = increase myocardial O2 demand
  • Reflex tachycardia
56
Q

When are NDHP CCB’s used in CAD?

Which ones are they?

A

Severe Asthma
Prinzmetal Angina
Cocaine-induced chest pain
Verapamil, Diltiazem

57
Q

AE’s of CCBs

A

Edema
Constipation
Heart block

58
Q

Indications for CABG

A
  1. Three vessel disease
  2. Left main Coronary occlusion
  3. Two vessel disease + Diabetes
  4. Persistent Sx’s despite maximal medical management
59
Q

Best therapy in acute coronary syndrome

A

PCI/Angioplasty

Cardio (6 decks)

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