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Pgs 1 - 24 Flashcards

Cardiovascular Medicine

1
Q

Typical Angina includes:

A

Substernal chest pain with exertion and relief with rest or nitroglycerin

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2
Q

Atypical Symptoms:

A

Exertional dyspnea, fatigue, nausea and vomiting

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3
Q

Signs of cardiac ischemia include:

A

New MR murmur and S3 and S4 gallops

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4
Q

ST-elevation equivalents

A

New LBBB or Posterior MI (tall R waves and ST depressions in V1 - V3

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5
Q

In patients with unstable angina/NSTEMI, immediate angiography is indicated if any of the following are present:

A 
Hemodynamic instabillity
Heart Failure
Recurrent rest angina despite therapy
New or worsening MR murmur
Sustained VT
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6
Q

TIMI Risk score 0 - 2

A

Low Risk

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7
Q

TIMI Risk Score 3 - 7

A

Intermediate to high risk

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8
Q

TIMI low risk management

A

Begin Aspirin, B-blocker, nitrates, heparin, statin, clopidogrel.

Predischarge stress test and angiography if testing reveals significant myocardial ischemia

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9
Q

TIMI intermediate to high risk management

A

Begin Aspirin, B-blocker, nitrates, heparin, statin, clopidogrel, and early angiography

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10
Q

Cardiac catheterization is indicated for patients with the following post-MI stress test results:

A

Exercise-induced ST-segment depression or elevation

Inability to achieve 5 METs during testing

Inability to increase SBP by 10 - 30 mm Hg

Inability to exercise (arthritis)

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11
Q

Other causes of ST-segment elevation:

A 
Acute pericarditis
LV aneurysm
Takotsubo (stress) cardiomyopathy
Coronary vasospasm (prinzmetal angina)
Acute Stroke
Normal variant
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12
Q

Relative contraindication to thrombolytic agents?

A

BP > 180/110 mm Hg on presentation

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13
Q

CABG is indicated acutely for STEMI in the presence of?

A

Thrombolytic PCI failure or mechanical complications (papillary muscle rupture, VSD, free wall rupture).

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14
Q

Patients with right ventricular/posterior infarction may present with?

A

Hypotension or may develop hypotension following administration of nitroglycerin or morphine.

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15
Q

Signs and symptoms of right ventricular/posterior infarction?

A

JVD with clear lungs, hypotension, tachycardia

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16
Q

Most predictive ECG finding in right ventricular/posterior infarction?

A

St-segment elevation on right-sided ECG lead V4R

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17
Q

Initial management of patients with right ventricular/posterior infarction?

A

IV fluids

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18
Q

Patients with papillary muscle rupture and VSD should be stabilized with an?

A

Intra-aortic balloon pump, afterload reduction with sodium nitroprusside, and diuretics followed by emergency surgical intervention.

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19
Q

ICDs are also indicated in post-MI patients meeting all of the following criteria:

A

> 40 days since MI

LVEF < or = to 35% and NYHA functional class II or III or LVEF < or = to 30% and NYHA functional class I

> 3 months since PCI or CABG

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20
Q

ACEI or ARB is indicated post MI at time of discharge in patients with?

A

LV systolic dysfunction, hypertension, diabetes, or kidney disease

21
Q

Stable angina pectoris is defined as

A

Stable anginal symptoms of at least 2 months duration precipitated by exertion or stress and relieved by rest

22
Q

In patients with chronic stable angina, stress testing is most useful in patients with?

A

An intermediate pretest probability of CAD (>10% or <90%)

23
Q

Pretest probability is based on?

A

Patients age, sex, and symptoms; risk factors for CAD; and ECG findings

24
Q

Indications for Exercise ECG with myocardial perfusion imaging or exercise ECHO?

A 
Patients who can Exercise
Pre-excitation (WPW) Pattern
> 1 mm ST depression
Previous CABG or PCI
LBBB
LV hypertrophy
Digoxin use
25
Q

Select coronary angiography for patients with high pretest probability of disease or:

A

LV dysfunction
Class III or IV angina despite therapy
Highly positive stress or imaging test
High pretest probability of left main or three-vessel CAD (a Duke treadmill score < or = to - 11)
Uncertain diagnosis after noninvasive testing
History of surviving sudden cardiac death
Suspected coronary spasm

26
Q

CCB use in patients with chronic stable angina

A

Are first line therapy for patients with absolute contraindications to B-blockers.

In the setting of continued angina despite optimal doses of B-blockers and nitrates, CCBs can be added.

Avoid short acting CCB

27
Q

Are Nitrates as effective as CCBs and BBs in reducing Angina?

A

Yes

28
Q

Prevent nitrate tachyphylaxis by:

A

Establishing a nitrate-free period of 8 - 12 hrs per day (typically overnight), during which nitrates are not used.

29
Q

When should Ranolazine be considered in patients with chronic stable angina?

A

Patients who remain symptomatic despite optimal doses of BB, CCB, and nitrates

30
Q

ACEI is a cardioprotective drug that:

A

reduces cardiovascular and all-cause mortality in patients with diabetes, hypertension, CKD, LVEF < or = to 40%, HF, or a history of MI.

31
Q

NHYA Class I

A

Structural disease but no symptoms

32
Q

NYHA Class II

A

Symptomatic; slight limitation of physical activity

33
Q

NYHA Class III

A

Symptomatic; marked limitation of physical activity

34
Q

NYHA Class IV

A

Inability to perfom any physical activity without symptoms

35
Q

Summarize the BNP level

A

BNP > 400 is compatible with HF

BNP < 100 effectively excludes HF as a cause of acute dyspnea

36
Q

Endomyocardial biopsy in testing for HF is rarely indicated but can assist in the diagnosis of

A

Giant cell myocarditis, amyloidosis, Hemochromatosis

37
Q

What may falsely elevate the BNP?

A

Kidney failure, older age, female sex

38
Q

What reduces the BNP?

A

Obesity

39
Q

When is Hydralazine plus nitrates used in treatment of HFrEF?

A

Given in addition to standard therapy for NYHA class III-IV and EF < 40% in black and select nonblack patients (low output syndrome, hypertension) to reduce mortality.

For patients who cannot tolerate ACEI or ARBS

40
Q

When are aldosterone antagonists used in treatment of HFrEF?

A

NYHA class III - IV HF to reduce mortality

41
Q

When is digitalis used in treatment of HFrEF?

A

Predominantly in patients who continue to experience symptoms despite guideline-directed medical therapy

42
Q

When is Ivabradine used in treatment of HFrEF?

A

EF < or = to 35% who are in sinus rhythme with a HR > or = to 70/min

43
Q

When is Valsartan-sacubitril used in treatment of HFrEF?

A

Substitute for an ACEI or ARB in HFrEF (NYHA class II or III) in patients who have tolerated ACEI or ARB therapy

44
Q

When is ICD placement used in treatment of HFrEF?

A

For ischemic and nonischemic cardiomyopathy in patients with and EF < 35% and NYHA functional class II - III or with an EF < 30% and NYHA functional class I

For NYHA class II - III symptoms

45
Q

Cardiac resynchronization therapy used in treatment of HFrEF?

A

For NYHA class II - IV, LVEF < 35%, and LBBB with QRS duration > 150 ms

46
Q

Dilated cardiomyopathy is characterized by?

A

Dilation and reduced function of one or both ventricles manifesting as HF, arrhythmias and sudden death.

47
Q

Most common cause of dilated cardiomyopathy?

A

Idiopathic dilated cardiomyopathy (50%)

48
Q

Treatment for dilated cardiomyopathy?

A

Reversal of the underlying cause (alcohol, drug, tachycardia-mediated cardiomyopathies)

Standard medical therapy for HF

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