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Step 2 > Step Up- CVD > Flashcards

Step Up- CVD Flashcards

1
Q

Features of stable angina

A

Brought on by exertion

lessened by rest

does not change with position

lasts less than 15 min

pressure, heaviness, squeezing

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2
Q

Exertional angina with clean cath. Dx? What will nuclear stress test show?

A

Syndrome x

Nuclear stress test will show ischemia

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3
Q

How does adenosine work in a cardiac stress test?

A

Because diseased vessels are already maximally dilated, dilation of other vessels caruses shunting of bloodflow away from diseased vessel.

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4
Q

Main indications for CABG?

A

3 vessel disease with >70% stenosis in each

Left main disease with >50% stenosis

LV dysfunction

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5
Q

Characteristics of unstable angina

A

angina at rest

chronic angina with increasing frequency, duration or intensity

New onset angina that is worsening

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6
Q

How to differentiate unstable angina and NSTEMI

A

Cardiac enzymes

(beacuase both lack ECG changes)

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7
Q

Tx of Unstable angina/NSTEMI

A
  • Aspirin (clopidegrel shown to be superior in CURE trial)
  • B Blocker
  • LMWH for at least 2 days (enoxaparin is best)
  • Nitrates
  • O2 if hypoxic
  • Morphine
  • Replace electrolytes
  • Schedule cardiac cath
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8
Q

Classic time for prinzmetal angina to occur?

A

-At night

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9
Q

How does a RV infarct present?

A
  • Inferior ECG changes
  • Hypotension
  • Elevated jugular venous pressure
  • hepatomegaly
  • CLEAR lungs
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10
Q

Earliest ECG change in MI?

A

Peaking T waves

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11
Q

Which cardiac enzymes are the first to rise? Last to return to normal?

A
  • Troponin I and T increase within 3-5hr and peak at 24-48
  • CK-MB peaks first at about 24
  • Trp I and T stay longer– 7-10 days
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12
Q

Which Tx for MI has been shown to reduce mortality?

A
  • Aspirin (or eq. antiplatelet)
  • B Blocker
  • ACE inhibitor
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13
Q

Antiplatelet therapy for ppl who receieve a stent (bare metal and drug eluting)?

A
  • at least 6mo with bare metal
  • at least 12mo with drug eluting

Dual antiplatelet with aspirin and clopidogrel

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14
Q

Pt with complete heart block, likely locations of MI? Which is worse?

A

Anterior or inferior

Anterior has worse prognosis

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15
Q

A re-elevation in this enzyme is more specific for re-infarction dur to its rapid return to basseline…

A

CK-Mb

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16
Q

Ventricular free wall rupture generally occurs within this time frame following MI…

A

First 14 days

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17
Q

Septal rupture occurs within this time frame…

A

10 days

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18
Q

Treatment of acute pericarditis following MI?

A

Aspirin (should already be on)

NSAIDs and corticosteroids are contraindicated! (prevents myocardial scar formation)

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19
Q

Patient 3 months post MI with fever, malaise, pericarditis, pleuritis, and leukocytosis…Dx?

A

Dressler syndrome–autoimmune phenomenon following MI

Tx- aspirin or ibuprofen

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20
Q

Causes of high output cardiac failure

A
  • Think: anything that causes the heart to have to work harder to meet the oxygen and metabolic needs
  • chronic anemia, pregnancy, hyperthyroidism, AV fistula, wet beriberi, paget disease of bone, mitral regurg, aortic insuffciency
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21
Q

A patient with stable angina presents with new onset chest pain that will not relieve with rest. What are the first steps to management of this patient?

A
  • ECG and cardiac enzymes
  • give aspirin
  • begin IV heparin or LMWH
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22
Q

Causes of systolic heart failure

A
  • Ischemic heart disease
  • cardiomyopathy (hypertensive)
  • myocarditis
  • Less common things like radiation, hemochromatosis, thyroid dz)
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23
Q

Casues of diastolic dysfunction

A
  • HTN leading to LVH (most common)
  • valvular disease
  • Restrictive cardiomyopathy (sarcoid, amyloid, hemochomatosis)
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24
Q

Cause of S3 gallop

A

rapid filling into a noncomplaint LV

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25
Q

Cause of S4

A

atrial systole ejected into a non-compliant, stiff LV

-TEN-nes-see

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26
Q

Do diuretics reduce mortality in CHF?

A

NO

Symtomatic relief

-Spironolactone is shown to prolong survival in select patients

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27
Q

Initial combination treatment of choice in CHF…

A

ACEi with a diuretic and beta blocker

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28
Q

What drug is shown to reduce mortality and prolong survival in CHF?

A

ACEi

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29
Q

Digitalis is indicated in which patients with CHF?

A

Those with EF <40% and who are symtomatic

30
Q

Patient with CHF presents with nausea, vomiting, AV block and disorientation…

A

Dig tox

31
Q

Which patient population is at highest risk for developing multifocal atrial tach?

A

Those with severe pulmonary disease

32
Q

What is the difference between MAT and wandering atrial pacemaker?

A

MAT has rate >100

33
Q

Most common arrythmia associated with dig toxicity?

A

paroxysmal atrial tachycardia with 2:1 block

34
Q

Should NSVT be evaluated? Why?

A

Yes becuase it can indicate LV dysfunction and or Ischemia

35
Q

PR interval >0.20s with QRS following each P

A

First degree AV block

36
Q

Progressive lengthening of the PR interval until a P wave fails to conduct

A

Mobitz Type 1

Second degree type 1 block

Wenckebach

37
Q

P randomly does not conduct and sometimes occurs in patterns

A

Second degree type II

Mobitz II

BAD– can degenerate into complete block

38
Q

Clinical features of dilated cardiomyopathy

A

S3, S4

mitral or tricuspid insufficiency

Cardiomegaly

Arrythmias

39
Q

Clinical signs of HOCOM with: valsalva, hand grip, squat, lying down, leg raise, standing…

A

Valsalva, standing, decreased venous return, arterial dilators and BP drugs- worsens

Lying down, hand grip, squatting- gets better

Anything that decrease EDLVP will increase the dynamic obstruction

40
Q

Carotid pulse in a person with HOCOM

A

Bisferious

41
Q

Fist line drug in Tx and prevention of progression of HOCOM

A

B-blocker

42
Q

Low voltages on ECG with speckled appearence on echo

A

amyloidosis

43
Q

Young male with elevated ESR, trending cardiac markers, and previous URI

A

myocarditis– tx is supportive

44
Q

What are the common viral causes of acute pericarditis?

A

Coxsackievirus

Echovirus

adenovirus

EBV

Influensza

45
Q

What is a cause of pericarditis associated with kidney disease?

A

Uremia

46
Q

Pain of pericarditis is relieved by…

A

Sitting forward

47
Q

Mainstay of treatment of acute pericarditis?

A

NSAIDs

Cholchicine

48
Q

What is kussmaul sign? How does it relate to constrictive percarditis?

A

Occurs when JVD fails to decrease during inspiration.

Caused by resitriced filling of the heart during diastole.

49
Q

What is pulsus paradoxus?

A

Exagerated decreased of pulse strength during inspiration.

>10mmHg

Cardiac tamponade

50
Q

Opening snap followed by a low pitch diastolic rumble

A

Mitral stenosis

51
Q

Tx of acute mitral regurg?

A

Afterload reduction with vasodilators

52
Q

What happens to MVP murmur when standing of valsalva?

How about squatting?

A

Standing and valsalva– increases due to LV reduction in size

Squatting– decreases due to increase in LV size

53
Q

Criteria for rhematic heart disease (major)?

A

J- joints: migratory polyarthritis

O- Heart (shape)

N- Subcutaneous nodules

E- Erythema marginatum

S- Sydenham corea

54
Q

Organism most commonly causing infection to native valve

A

S. viridans

and HACEK group

55
Q

Most common cause of prosthetic valve endocarditis

A

S. epidermidis more commonly that S. aureus (except IVDA)

56
Q

Duke criteria for endocarditis

A

Major: Sustained bacteremia, New regurgitant valve

Minor: Predisposition, fever, vascular phenomenon, immune phenomena, + blood culture, +echo

57
Q

Aortic valve with small warty vegitations on them in patient with SLE

A

Libeman-sacks enodcarditis

58
Q

Large pulmonary arteries and + bubble study

A

ASD

59
Q

Most common cardiac defect?

A

VSD

60
Q

Harsh, blowing systolic mumur heard at 4th intercostal decreasing with valsalva and handgrip…

A

VSD

61
Q

Congenital disease associated with coarctation of aorta?

A

Turner syndrome

62
Q

This maintains a ductus areteriosus

A

Prostaglandin and low O2 tension

63
Q

Drug that closes PDA? Drug that keeps open? Why keep open?

A

Close: Indomethacin

Open: Misoprostol (Transposition of great vessels)

64
Q

PRES Syndrome

A

Posterior reversible encephalopathy syndrome

  • Hypertensive patient with cerebral edema
  • Due to loss of autoregulation of cerebral vascularture
65
Q

How much to lower BP in HTN emergency in first 1-2hr?

A

no more than 25%

66
Q

Type A v type B aortic dissection…

A

Type A- Proximal

Type B- Distal to subclavian A.

67
Q

Goal in Tx of aortic dissection?

A

Lower BP and give B-blocker

68
Q

Bilateral leg pain, impotence, and absent lower extremity pulses…

A

Leriche’s syndrome

occlusion of the distal aorta just above iliac bifurcation

69
Q

PDE inhibitor used in PAD to reduce claudication

A

Cilostazol

70
Q

phlegmasia cerula dolens

A

post DVT, severe leg edema and vascular compromise occurs

71
Q

Appropriate PTT and aPTT for DVT on heparin

A

PTT 1.5 to 2x the aPTT

72
Q

Non-cyanotic congenital heart lesions

A

ASD

PDA

VSD

“The 3 D’s”

Step 2 (14 decks)

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