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MTB STEP 3 (J) > MTB 3 - Cardio > Flashcards

MTB 3 - Cardio Flashcards

1
Q

Worst risk factor for CAD

A

DM

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2
Q

Most common risk factor for CAD

A

HTN

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3
Q

Risk Factors for CAD

A

DM, tobacco, HTN, hyperlipidemia, 1st degree family member with premature CAD, Men >45 & Women > 55

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4
Q

Correcting which risk factor shows greatest improvement with CAD?

A

smoking cessation

50% 1 year, 90% 2 years after smoking

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5
Q

Ischemic Pain

A

dull or sore

squeezing or pressure-like

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6
Q

Non-ischemic pain

A

Sharp or point-like
lasts for a few seconds
Changes with respiratoin (pleuritic), position, touch/tenderness

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7
Q

Chest Wall Tenderness

A

Costochondritis

Do PE

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8
Q

Radiation to back, unequal BP in arms

A

Aortic Dissection
chest x-ray-widened mediastinum
chest CT, MRI, or TEE confirms Dx

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9
Q

Pain worsens with lying flat, better when sitting up

A

Pericarditis

EKG with ST-elevation everywhere, PR depression

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10
Q

Epigastric discomfort, pain better when eating

A

Duodenal ulcer disease

Endoscopy

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11
Q

Bad taste, cough, hoarseness

A

GERD

Response to PPIs; Alumium hydroxide and Mg hydroxide, viscous lidocaine

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12
Q

Cough, sputum, hemoptysis

A

Pneumonia

CXR

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13
Q

Sudden-onset SOB, tachy, hypoxia

A

PE (can have fever)

Spiral CT*, V/Q scan

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14
Q

Sharp, pleuritic pain, tracheal deviation

A

Pneumothorax

CXR

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15
Q

Best initial test for chest pain

A

EKG

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16
Q

EKG not diagnostic and etiology of chest pain unclear-next step

A

stress test

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17
Q

Mortality lowering drugs with chronic angina

A

1) Aspirin-(clopidogrel used in apsirin intolerant pts or new stented pts)
2) Beta blockers-B1 spec. metoprolol
3) Nitroglycerin

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18
Q

Statin AE

A 
Elevated transaminases (AST/ALT) do liver fxn tests
Myositis
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19
Q

Niacin AE

A

Pruritis (+histamine)

elevation glucose and uric acid level

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20
Q

Fibric Acid derivatives (gemfibrozil) AE

A

increase risk myositis with statins

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21
Q

Cholestyramine AE

A

flatus, abd cramping

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22
Q

Ezetimibe AE

A

well tolerated, add to statins, not very useful

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23
Q

ACS confirmed on EKG, next step

A

Aspirin-shown to decrease mortality

clopidogrel is aspirin intolerant or if pt has stent already

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24
Q

ACS confirmed, aspirin given, next step

A

Angioplasty (90 min door time)>thrombolytics
Thrombolytics only used if angioplasty not available, in STEMIs, or new LBBB
NSTEMI-use heparin instead

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25
contraindications to thrombolytics
1) hx major bleeding to brain/bowel 2) recent surgery-2 wks 3) severe HTN-180/110 4) nonhemorrhagic stroke in last 6 months
26
Indication for tPA (thrombolytics) in MI
only beneficial with STEMI
27
Indication for heparin in MI
best for NSTEMI (LMWH)
28
Indication for GP IIb/IIIa inhibitors in MI
best for NSTEMI and undergoing PCI and stenting
29
Post MI routine meds on d/c
1) Aspirin 2) Beta blockers (metoprolol) 3) Statins 4) ACEi
30
CHF Systolic vs Diastolic
Systolic- low EF, dilation of heart, or diastolic dysfxn. can't get blood out Diastolic- inability of heart to relax and receive blood EF is preserved, can be increased
31
Top causes of systolic CHF
HTN #1, MI, cardiomyopathy, valve disease-(95%) | -all can lead to dilated cardiomyopathy
32
Other causes of systolic CHF
alcohol, postviral idiopathic myocarditis, radiation, doxorubicin, Chagas (other infxns), Hemochromatosis (restrictive too), Thyroid dx, Peripartum cardiomyopathy, Thiamine deficiency
33
Sxs CHF
``` #1- SOB/dyspnea upon exertion orthopnea, peripheral edema, rales, JVD, paroxysmal nocturnal dyspnea, S3 gallop (fluid overload) ```
34
Dyspnea, sudden onset, clear lungs
PE
35
Dyspnea, sudden onset, wheezing, increased expiratory phase
asthma
36
Dyspnea, slower, fever, sputum, unilateral rales/rhonchi
Pneumonia
37
Dyspnea, decreased breath sounds unilaterally, tracheal deviation
Pneumothorax
38
Dyspnea, circumoral numbness, caffeine use, hx anxiety
panic attack
39
Dyspnea, pallor, gradual over days to weeks
anemia
40
Dyspean, pulsus paradoxus, decreased heart sounds, JVD
tamponade
41
Dyspnea, palitation, syncope
arrhythmia of any kind
42
Dyspnea, dullness to percussion at bases
pleural effusion
43
Dyspnea, long smoking history, barrel chest
COPD
44
Dyspnea, recent anesthetic use, brown blood no improved with O2, clear lungs, cyanosis
methemoglinemia | tx: methylene blue
45
Dyspnea, burning building or car, wood-burning stove, suicide attempt
carbon monoxide poisoning | tx: 100% O2 hyperbaric chamber
46
Tx Systolic CHF
ACEi/ARB, Beta blockers (decrease mortality), Spironolactone (blocks aldosterone), Diuretics (tx sxs), Digoxin (tx sxs)
47
Mortality benefitting Rxs in CHF
ACEi/ARBs, Beta blockers, Spironolactone, Hydralazine/Nitrates, implantable defib (
48
Tx diastolic CHF
Beta blockers*, Diuretics | Uncertain-ACEi, ARBs, and hydralazine
49
Don't use in diastolic CHF
Digoxin and spironolactone
50
Rheumatic fever MC a/w
mitral stenosis
51
valvular lesions that increase/worsen with inhalation
right side-tricuspid and pulmonic
52
valvular lesions that increase/worsen with exhalation
left side-mitral and aortic
53
Mitral Stenosis Sxs
Diastolic murmur with opening snap - squatting and leg raise (+VR) increase murmur - CHF and SOB - Dysphagia- LA pressing on esophagus - Hoarseness-LA pressing on laryngeal nerve - AFib and stroke - Hemoptysis
54
Mitral Stenosis- CXR
straightening of left heart border elevation of left main-stem bronchus second bubble behind heart
55
Tx Mitral Stenosis
1) Balloon valvuloplasty 2) diuretics and sodium restriction with fluid in lungs 3) valve replacement if needed 4) warfarin for afib 5) rate control-dig, beta block, verap/dilt
56
Aortic Stenosis Sxs
``` systolic crescendo-decrescendo murmur Valsalva and Standing decrease murmur Handgrip also decrease murmur -Angina-#1 -Syncope -CHF ```
57
Aortic Stenosis-CXR
LVH >50% of transthoracic diameter
58
Mitral Stenosis- EKG
EKG-biphasic P-wave in V1, V2
59
Aortic Stenosis-EKG
S wave in V1, R wave in V5 > 35mm
60
Tx Aortic Stenosis
Valve replacement | Diuretics, but not always well tolerated
61
Mitral Regurgitation Sxs
pansystolic murmur, radiates to axilla | CHF, dyspnea
62
Mitral Regurg- hand grip, squatting, leg raise
all increase murmur
63
Tx Mitral Regurgitation
1) Vasodilators*-ACE or ARBs. decrease progresion 2) Dig and diuretics tx sxs 3) Valve replacement when heart starts to dilate
64
Aortic Regurg Sxs
``` diastolic decrescendo murmur Wide pule pressure Water-hammer pulse Quincke pulse (pulsations in nail bed) Hill sign (leg BP>>arm BP) Head bobbing (de Musset sign) ```
65
Aortic Regurg- Valsalva/standing, hand grip/squatting
Valsalva and standing- decrease murmur | Hand grip/squatting- increase murmur
66
Tx-Aortic Regurg
ACEi/ARBs or nifedipine-vasodilators to increase forward flow, decrease progression Dig and diuretics little benefit Surgery before dilates
67
Mitral Vale Prolapse Sxs
``` Different from other lesions-considered normal if aSxs midsystolic click Atypical chest pain Palpitations Panic attack ```
68
MVP- Valsalva/standing, Hand grip/Squatting
Valsalva/Standing- increase murmur (decrease VR) | Hand grip/Squatting- decrease murmur (increase afterload)
69
Tx- MVP
Beta blockers if symptomsatic Valve repair/stitches Endocarditis pxs not needed
70
Murmurs do not increase with expiration in?
HOCM and MVP
71
Cardiomyopathy Sxs
SOB, worse on exertion Edema Rales JVD
72
Best test Cardiomyopathy
Echo-best and most accurate | CXR and EKG can also be done
73
Causes of dilated cardiomyopathy
1) MI/Ischemia 2) Alcohol 3) postviral myocarditis 4) Radiation 5) Toxins-doxorubicin 6) Chagas dx
74
Rxs lower mortality in dilated cardiomyopathy
1) ACEi/ARBs 2) metoprolol, carvedilol 3) Spironolactone | diuretics and dig for sxs
75
Tx in dilated cardiomyopathy wide widened QRS (>120ms)
biventricular pacemaker
76
HCM vs HOCM
HOCM sxs- 1) chest pain 2) syncope, dizzy 3) worse w/increase in HR (exercise, dehydration, diuretics) 4) sudden death in healthy athletes-rare
77
Initial Tx HCM and HOCM
Beta blockers | verapamil and disopyramide too, neg inotropes
78
Used in HCM, but not in HOCM
diuretics and ACEi
79
Causes of restrictive cardiomyopathy
1) Sacroidosis 2) Amyloidosis 3) Hemochromatosis 4) Endomyocardial fibrosis 5) Scleroderma
80
Sxs Restrictive Cardiomyopathy
Kussmaul sign-increase in JVD pressure (unique) | dyspnea with RH failure- ascites, edema, JVD, liver/spleen enlargement
81
Pericarditis EKG
ST segment elevation in all leads and *PR segment depression*
82
Hypotension, tachycardia, distended neck veins, clear lungs, pulsus paradoxus
Pericardial Tamponade
83
Electrical alternans (different height of QRS between beats)
Pericardial Tamponade
84
Tx Pericardial Tamponade
1) Pericardiocentesis, 2) IV fluids 3) pericardial window placed for recurrent cases
85
Contraindicated drug in pericardial tamponade
diuretics- will decrease the cardiac filling pressure and further collapse heart
86
Constrictive Pericarditis a/w
TB-MCC | calcification and fibrosis
87
Best test for peripheral artery disease
ankle-brachial index (ABI) | if difference in pressure is >10% then present
88
Initial Tx PAD
1) Aspirin, stop smoking, Cilostazol (single most effective) 2) Bypass surgery if Rxs not effective
89
Calcium Channel Blocker indications
``` Verapamil/Diltiazem 1) severe asthma (can't use beta-block) 2) Prinzmetal variant angina 3) cocaine-induced chest pain (beta-block CA) Rarely used in CAD ```
90
Adverse effects of CCBs
Edema, constipation (relax smooth muscle), Heart Block (rare)
91
maneuvers that increase preload
1) handgrip, 2) squat, 3) leg elevation, 4) lying down, 5)venoconstrictors
92
maneuvers that decrease preload
1) Valsalva 2) standing, 3) nitrates/venodilators

MTB STEP 3 (J) (3 decks)

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