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Cardiovascular FA > MTB and important from FA 4 > Flashcards

MTB and important from FA 4 Flashcards

1
Q

mcc of CHF

A

hypertension

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2
Q

All diagnosis of dyspnea except CHF will lack

A

orthopnea/ paroxysmal nocturnal dyspnea

S3 gallop

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3
Q

the best initial and the most accurate test for Ejection fraction

A

best initial: Transthoracic echo

most accurate: Multiple-gated acquisition scan (MUGA) (nuclear ventriculography) –> doxorubicin

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4
Q

Transesophangeal as a test (TEE) - accurate at / role in CHF

A

the most accurate in evaluating heart valve function and diameter
not necessary for evaluating CHF

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5
Q

test used to determine etiology of CHF - endomycoardial biopsy - etiology of CHF

A
  • rarely done
  • exclude infiltrative disease such as sarcoid or amyloid when other sites for biopsy inconclusive
  • most accurate test for some infections
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6
Q

systolic dysfunction - medication

A
  1. ACEi (or receptor blockers)
  2. Beta blockers
  3. Spironolactone
  4. Diuretics
  5. Digoxin
  6. Nitrates
  7. Hydralazine
  8. Implantable defibralator
  9. Transplantation
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7
Q

systolic dysfunction - ACEi (or receptor blockers)

A

ALL patients with systolic dysfunction at any stage of the disease
beneficial effects with ANY drug in the class

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8
Q

systolic dysfunction - beta blockers - which drugs exactly

A
  1. Metoprolol (β1)
  2. Bisoprolol (β2)
  3. Carvedilol (non-specific beta blocker with also α1 receptor blocking activity)
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9
Q

systolic dysfunction - spironolactone efective?

A

in NYHA 3 + 4

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10
Q

Devices for CHF treatment

A

2 other treatments taht are associated with mortality benefit in CHF:

  1. Implantable defibrillator
  2. Biventricular pacemaker
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11
Q

CHF - Implantable defibrillator

A

for those with ischemic cardiomyopathy and EF below 35

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12
Q

CHF - Biventricular pacemaker

A
  • dialted cardiomyopathy and EF less than 35 and a wide QRS above 120 mls who have persistent symptoms
  • resychronizes the heart when there is a conduction defect
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13
Q

systolic HF - transplantation

A

when maximal medical therapy and possible the biventricular pacemaker fail to control symptoms of CHF, then the only alternative is this

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14
Q

systolic CHF - CCB

A

nor benefits. some can actually raise mortality

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15
Q

Diastolic dysfunction - treatment

A
  • the management here is not as clear as in the systolic
  • b-blockers have clear benefits
  • digoxin and spironolactone has no benefit and should not used
  • diuretics to control symptoms
  • unclear benefit for ACEi and ARBs and hydralazine
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16
Q

pulm edema - treatment (preload reduction)

A
  1. O2
  2. Loop diuretics (such as furosemide or bumetanide)
  3. Morphine
  4. Nitrates
    - Nesiritide can be used as a part of therapy, but it is not clear that it works better than standard agents (and no proven mortality benefit)
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17
Q

pulm edema - treatment (positive inotropic agents)

A
  • Dobutamine when they don’t respond to therapy acutely with preload reduction
  • amrinone and milrinone (phosphodiesterase inhibitors) that preform the same role
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18
Q

pulm edema - afterload reduction medication

A

in acute setting: nitropruside or IV hydralazine

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19
Q

regurgitant disease is most commonly caused by …

A
  1. hypertension
  2. ischemic heart disease
    LEADS TO DILATION
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20
Q

valvular heart disease - best initial test (explain)

A
  • best initial: ECHO

- Transesophageal echo is both more sensitive and more specific than transthoracic echo

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21
Q

valvular heart disease - catheterization

A

most precise measurement of valvular diameter, as well as the exact pressure gradient across the valve

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22
Q

stenotic valvular heart disease - treatment

A
  • diuretics

- mitral stenosis is dilated with a balloon, aortic needs surgical removal

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23
Q

regurgitant valvular heart disease - treatment

A
  • diuretics
  • vasodilator therapy with (ACEi, nifedipine, hydralazine)
  • surgical replacement before heart dilates
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24
Q

assessment of ventricular size is based on

A
  1. the end systolic diameter

2. EF

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25
Q

MS - critical narrowing?

A

less than 1 cm2

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26
Q

MS - main indication for treatment

A

presence of symptoms

no much point on asymptomatic

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27
Q

MS - pregnancy

A
  • pregnancy is associated with 50% increase in plasma volume which must traverse a narrow valve
  • during delivery, contraction of the uterus can squeeze as much as 500 ml extra of blood into the central circulation (inducing pregnancy related cardiomyopathy
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28
Q

MS - presentation (beside dyspnea and CHF which is in every valvular disease)

A
  1. Dysphagia (LA presses esophagaus)
  2. hoarseness (LA presses laryngeal nerve
  3. AF
  4. hemoptysis
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29
Q

MS - EKG

A
  1. atrial rhythm disturbances (AF is very common)

2. LA hypertrophy (biphasic P wave in V1 and V1)

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30
Q

MS - chest x-ray

A

LA hypertrophy:

  1. straightening of the left heart border
  2. elevation of the left main-stem bronchus
  3. second bubble behind the heart
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31
Q

MS - treatment

A
  1. diuretics and sodium restriction when fluid overload is present in the lungs
  2. ballon valvuloplasty done with catheter
  3. valve replacement only when a catheter procdure cannot be done
  4. Warfarin for AF (target INR:2-3)
  5. Rate control of aAF (digoxin, β-blockers, diltiazem/verapamil)
32
Q

aortic stenosis - presentation

A
  1. angina (mc presentation)
  2. syncope
  3. CHF (poorest prognosis with 2 year average survival)
33
Q

aortic stenosis - EKG

A

LV hypertrophy : S in V1 + R in V5 greater than 35 millimeters

34
Q

aortic stenosis - treatment

A
  • valve replacement is the only truly effective therapy for AS
  • diuretics can be used to decrease CHF, but patients do not tolerate volume depletion very well
  • ballon valvuloplasty is not routinely done for AS
35
Q

MR - treatment

A
  1. vasodilators
  2. Digoxin and diuretics
  3. valve replacement
36
Q

MR - valve replacement

A

When LVESD is above 40 mm or EF drops below 60%

–> surgical valve repair or replacement

37
Q

AR - physical findings (not the murmur)

A
  1. wide pulse pressure
  2. water-hammer (wide,dounding) pulse
  3. Quincke pulse (puslations in the nail)
  4. Hill sign (BP in legs as much as 50 above arm)
  5. head bobbing (de Musset sign)
38
Q

AR - treatment

A
  1. vasodilators
  2. digoxin and diuretics (little benefit)
  3. Valve replacement or repair
39
Q

AR - valve replacement

A
  • EF less than 55 or LVESD greater than 55

- Repairing the valve means tightening the ends of the valve with sutures

40
Q

cardiomyopathy - best initial

A

Echo

41
Q

Dilated cardiomyopathy - treatment

A
  • Dilated cardiomyopathy has the greatest number of medications to lower mortality (ACEi, β-blockers, spironolactone)
  • diuretics and digoxin to control symptoms
  • if QRS is wide (more than 120), a biventricular pacemaker (improve symptoms + survival)
  • Automated implantable cardioverter/defibrillator has moratlity benefit in some patients
42
Q

differences between Hypertrophic cardiomyopathy and other forms of cardiomyopathy

A
  1. S4 gallop

2. Fewer signs of Right HF

43
Q

hypertrophic obstructive cardiomyopathy - diagnostic test

A
  1. Echo is the best initial (septum is 1.5 times the thickness of the posterior wall)
  2. Catheterization is the most accurate test to determine precise gradients of pressure across the chamber
44
Q

HOCM - specific therapy

A

implantable defibrillators should be used in any HCOM patient with syncope
ablation of the septum should frist be tried with a catheter placing absolute alcohol in the muscle causing small infractions. If symptoms persist, sugical mymectomy removing part of the septum is the ultimate therapy.

45
Q

HOCM - EKG

A

septal Q waves in the inferior and lateral leads are common (they are not in MI)

46
Q

Restrictive cardiomyopathy - definition

A

it combines the worst aspects of both dilated and hypertrophic cardiomyopathy. The heart neither contracts nor relaxes normally because it is infiltrated with substances creating immobility (esp DIASTOLIC DYSFUNCTION, systolic later)

47
Q

restrictive cardiomyopathy - treatment

A

treat the underlying cause
diuretics may relieve some of the pulm hypertension the the RHF symptoms
there is no clear therapy

48
Q

mitral stenosis - (1) handgrip vs (2) amyl nitrate effects

A

no effects

amyl nitrate is a vasodilator –> decreases afterload

49
Q

pericarditis - treatment

A
  • treat the underling cause

- Colchicine decreases recurrences

50
Q

pericardial tamponate - diangosis

A

EGG: electrical alterans (different heights of QRS)
Chest x-ray: enlarged shadow expands in both directions (globular heart)
Echo: RA and RV collapse
R heart catheterization: equalization of pressures in diastole

51
Q

constrictive pericarditis - diagnostic tests

A
  • the best initial test is chest x-ray that shows calcification and fibrosis
  • CT and MRI are both accurate, but would not done if a chest x-ray were not done first
  • Echo is often necessary to exlude RV hypertrophy or cardiomyopathy (in constrictive pericarditis the myocardium moves normally)
52
Q

constrictive pericarditis - treatment

A
  1. diuretics: used 1st to decompress the filling of the heart and relieve edema and organomegaly
    2, surgical removal of the pericardium
53
Q

Routine screening for PAD

A

No since there is no mortality benefit to obtain

54
Q

peripheral artery disease (PAD) - presentation

A
  • leg pain in the calves on exertion, relieved by rest
  • it can occurs when walking up or down hills
  • if severe: loss of hair follicels, sweat and sebaceous glands
  • the skin becomes smooth and skiny
55
Q

peripheral artery disease (PAD) - treatment

A
  • best initial treatment: aspirin, stop smoking, cilostazol (cilostazol is the single most effective medication)
  • surgery is done to bypass if medical therapies fail.
56
Q

aortic dissection - treatment

A

the most important is to control the blood pressure:
1. beta blockers
2. nitroprusside
3. surgical correction
beta blockers will decrease the shearing forces that are worsening the dissection –> must be started before nitroprusside to protect against reflex tachycardia (which will worsen shearing forces)

57
Q

who must be checked (screening) aortic aneurysm and when and how (and management)

A

men who ever smoked above 65 with US

58
Q

the worst form of heart disease in pregnancy is …

A

peripartum cardiomyopathy with persistent ventricular dysfunction –> if becomes pregnant again she has VERY HIGH change of markedly worsening of her cardiac function

59
Q

peripartum cardiomyopathy - mechanism

A

it is unknown why there are antibodies made against the myocardium in some pregant women. The LV dysfunction is often reversible and short term
If the LV does not improve, then the person must undergo cardiac transplantation

60
Q

peripartum cardiomyopathy - treatment

A

the medical therapy is the same as dilated cardiomyopathy :

  1. ACEi (because is after delivery)
  2. beta-blockers
  3. spironolactone
  4. diuretics
  5. digoxin
61
Q

HF with preserved EF - spironolactone

A
  • not decreased mortality
  • reduced hospitalisation rate
  • indication in peripheral edema and lung congestion
62
Q

diagnosis of hypercholesteremia requires

A

total cholesterol of > 200 mg/dL on two occasions.

63
Q

Systemic glucocorticoid for pericarditis

A

pericarditis associated with connective tissue diseases and in patients with recurrent pericarditis refractory to treatment with NSAIDs.

64
Q

The first ECG sign of an ST-segment elevation MI can be

A

hyperacute T waves

65
Q

BP with increasing age

A
  • systolic blood pressure increases
  • diastolic blood pressure decreases
  • pulse pressure increases.
66
Q

…… are recommended in patients with newly diagnosed hypertension before initiating therapy.

A

Measurements of blood glucose, potassium, calcium, creatinine, hematocrit; urinalysis; and lipoprotein profile

67
Q

statin in young people

A

A patient 21 years of age or older that presents with an LDL-C of 190mg/dL or higher should be started on statin therapy.

68
Q

after starting lisinopril

A

lab test –> no acute rise in creatinine or the development of hyperkalemia

69
Q

contraindications of PCI include

A
  1. intracranial hemorrhage
  2. ischemic strokes within preceeding 3 months
  3. signs and symptoms of aortic dissection.
70
Q

hypertensive emergency - initial management

A
  • target diastolic blood pressure of 100-105 mm Hg within 2-6 hours
  • initial fall in the mean arterial pressure should not exceed 25% of the presenting value.
71
Q

MI criteria

A
  1. at least 1 mm segment elevation in at least 2 contiguous limb leads
  2. 2mmm elevation in 2 continguous precordial limbs
  3. New LBBB
72
Q

drug that is contraindicated in patients with dilated cardiomyopathy and why

A

NSAID

worsen afterload by inhibiting prostagladin synthesis and by counteracting the benefits of ACEi

73
Q

traumatic thoracic aortic injury - The gold standards for diagnosis

A

CT angiography (in stable patients) and TEE (preferred for hemodynamically unstable patients).

74
Q

renal Fibromuscular dysplasia - Treatment of choice is

A

percutaneous transluminal angioplasty.

75
Q

….. are appropriate methods of treating pericarditis in a patient refractory to oral medications.

A

Balloon pericardiotomy, prolonged pericardial catheter drainage, surgical pericardiectomy, and intrapericardial sclerosing therapy

Cardiovascular FA (8 decks)

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