PreTest Medicine: Cardiology Flashcards
A man on beta-blockers, ACEi, nitrates, ASA, and statins comes in with worsening angina–three episodes in the last three days – and has negative EKG and troponin. What should you do?
Admit him for Lovenox and clopidogrel
This is acute coronary syndrome (ACS), specifically unstable angina. You need to admit him to tweak his medicines before sending him home.
True or false: HCTZ can cause QT prolongation.
True!
Although the drug doesn’t directly do so, it can cause hypokalemia and hypomagnesemia which can.
An elderly woman has episodes of tachycardia followed by bradycardia. What should you do?
Some elderly people have this syndrome, and it’s called simply tachycardia-bradycardia syndrome. If they are symptomatic, as evidenced by syncope or presyncope, then you ought to pace them.
Give a rundown on peripartum cardiomyopathy.
- Most often occurs within the first month after delivery but can occur before or after
- More common in multiparous AA women
- 50% recover fully
- Recurrence with future pregnancies is common
True or false: a widened pulse pressure is seen in those with aortic stenosis.
False
A narrowed pulse pressure is seen in those with AS. Those with aortic insufficiency often have a widened pulse pressure.
A diastolic rumbling murmur heard over the apex is consistent with _________________.
mitral stenosis
When should you use apixaban instead of warfarin?
In those with alcohol abuse or other liver abnormalities
Warfarin is hepatically metabolized and may be difficult to dose in those with liver disease.
List the indications for surgery in endocarditis.
- New-onset heart failure
- Persistent bacteremia despite maximum medical therapy
- Presence of embolization
- Vegetation greater than 1.5 cm
The first-line therapies for hypertensive emergency are ________________.
continuous infusion nicardipine or iV labetalol (contraindicated in asthma)
What conditions lead to high-output heart failure?
- Paget disease
- Hyperthyroidism
- AV fistula
Look for tachycardia, a widened pulse pressure, and a hyperdynamic precordium.
A woman comes in with a right-sided MI, bradycardia, and hypotension. What treatment should you give?
Atropine and fluids
Right-sided MIs are preload dependent and thus need fluids to maintain cardiac output. Atropine can treat the bradycardia that results from knocking out the sinus node.
What are the important differences in implanted heart valves?
Bioprosthetic valves do not require anticoagulation, but they do not last as long as mechanical valves.
Heart failure in a person with sickle cell should make you think?
Iron overload leading to hemochromatosis
What is the exception to the “recommend diet and exercise for initial control of HTN” rule?
Diabetes
PreTest says you should jump to an ACEi in diabetics.
