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Internal Medicine > Step Up To Medicine - Cardio > Flashcards

Step Up To Medicine - Cardio Flashcards

1
Q

CAD have have what clinical presentation?

A 
Asymptomatic
Stable angina pectoris
USA pectoris
MI (NSTEMI, STEMI)
Sudden cardiac death
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2
Q

LDL goal in pts w CAD?

A

<100

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3
Q

Describe typical anginal chest pain?

A

Substernal
Worse w exertion
Better w rest/nitro

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4
Q

Best test for chest pain

A

ECG

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5
Q

When should you use a stress test (stable angina)

A

Confirm dx of angina
Eval response of therapy
ID high risk pts

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6
Q

When is a stress test considered positive?

A

ST depression
Chest pain
HOTN
Arrhythmias

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7
Q

Standard of care for stable angina?

A

ASA
B-blocker
Nitrates (chest pain)

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8
Q

SE of nitrates?

A

HA
Orthostatic HOTN
Tolerance
Syncope

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9
Q

COURAGE trial?

A

No difference between PCI (bare metal) or max medical management for stable angina

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10
Q

PCI sciency name

A

Angioplasty

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11
Q

What is acute coronary syndrome?

A

Clnical manafestation of athersclerotic plaque rupture and coronary occlusion

Usually refers to USA, NSTEMI, STEMI

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12
Q

What does stress test identify?

  • hint this is a limitation
A

Flow limiting high-grade lesions

- thus can miss an MI (its an acute rupture of plaque)

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13
Q

How to differentiate USA and MI?

A

Presentation is the same, you must look at cardiac markers and EKG findings

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14
Q

Essence trial?

A

Found that enoxaparin was greater than heparin for

  • risk of death
  • recurrent angina
  • less need for PCI
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15
Q

When is fibrinolysis useful?

A

Only in STEMI when you cant get to PCI

- not used for USA

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16
Q

CARE trial?

A

Pt w hx of MI who took statin

  • death reduced 24%
  • stroke reduced 31%
  • CABAGE reduced 27%
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17
Q

Suspect MI if combination of?

A

Substernal chest pain >30 min and Diaphoresis strongly suggest MI

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18
Q

Who doesnt get Nitro?

A

Right ventricular infarct

  • inferior ECG changes
  • HOTN
  • elevated JVP
  • hepatomegaly
  • clear lungs

Its preload dependent - they will experience cardiovascular collapse

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19
Q

Which is worse STEMI or NSTEMI?

A 
STEMI = infact 75% of time
NSTEMI = infarct 25% of time
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20
Q

How are troponins monitored?

A

Q 8 hrs x 3 samples

  • higher peak and longer enzymes are high more sever the myocardial injury is
  • worse prognosis
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21
Q

Only agents shown to reduce mortality in MI pts?

A

ASA
B-blocker
ACEI

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22
Q

CAPRICORN trial?

A

The b-blocker carvediol reduces risk of death in post MI LV dysfunction

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23
Q

Meds indicated for MI?

A 
O2
Nitro
B-blocker
ASA
Morphine
ACEI 
IV heparin
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24
Q

Best test if pt developes recurrent chest pain while in the hospital (for their MI)

A

CK-MB is the most helpful

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25
Q

Heparin is for STEMI and NSTEMI, when do you not use it?

A

Stable angina

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26
Q

If pt is treated conservatively for UA/NSTEMI, then need what before discharge?

A

stress test to see if they need angiography (cath)

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27
Q

MI pts have elevated risk for?

A

Stroke (during the next 5 yrs)

- the lower the EF and older thept - Higher risk of stroke

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28
Q

MCC of death following MI?

A

Ventricular arrhythmia

  • Vtach
  • VFib
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29
Q

Post MI all pts need to go home with?

A

ASA
B-blocker
statin
ACEI

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30
Q

If you suspect cardiac pain you should give?

A

Nytro and asa

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31
Q

MCC of noncardiac chest pain?

A

GI d/o

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32
Q

Non cardiac pain that may respond to nitro?

A

Esophagela spasm

- still unlikely

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33
Q

If pain changes w respiration rate (pleuritic), body position, or TTP to chest wall?

A

cardiac cause is highly unlikely

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34
Q

Pt has chronic stable angina and presents w symptoms of USA you should?

A

ECG and troponin
Give ASA
IV heparin

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35
Q

Which presents first, systolic or diastolic dysfunction?

A

Usually its simultaneous

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36
Q

Tests to order for new CHF?

A 
cxr 
ECG 
Troponin - r/o MI
CBC - anemia
Echo - r/o pericardial effusion
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37
Q

Common treatable cause of CHF?

A

HTN - goal is to reduce preload and afterload

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38
Q

RALES trial?

A 
Showed spironolactone reduces morbidity and mortality in pts w class III, IV HF
- CI in renal failure
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39
Q

Things to monitor in CHF pt?

A 
Weight (water gain)
Exercise tolerance
Lab values: 
- electrolytes
- potassium
- BUN
- creatinine
- serum digoxin
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40
Q

Standard tx for CHF?

A

Loop diuretic
ACEI
B-blocker

Maybes:

  • digoxin
  • hydralazine/nitrate
  • spironolactone
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41
Q

MCC of death in CHF?

A

Sudden death from ventricular arrhythmias

- ischemia provokes ventricular arrhythmias

42
Q

COMET trial?

A

Carvediol best B-blocker for CHF

43
Q

Meds that do and do not lower mortality in systolic HF’?

A

Do reduce mortality

  • ACEI/ARB
  • B-blocker
  • Spironolactone (aldosterone agonists)
  • Hydralazine+nitrate

do not (symptoms only)q

  • loop diuretics
  • digoxin
44
Q

Signs of digoxin toxicity?

A

GI: N/V, anorexia
Cardiac: ectropic (ventricular) beats, AV block, AFib
CNS: visual disturbances, disorientation

45
Q

What drug plays no role in CHF?

A

CCB - may rause mortality

However i f you need more control of other shit (HTN) you can use

  • amlodipine
  • felodipine
46
Q

5 yr mortality for CHF pts?

A

50%

47
Q

CAST I and CAST II trial?

A

Antiarrhythmic drugs to suppress PVCs after MI increase death

48
Q

Types of PVC’s?

A

couplet - 2 in a row
Bigeminy - sinus beat followed by PVC
Trigeminy - 2 sinus beats followed by PVC

49
Q

Pts in Afib w underlying heart disease have?

A

High risk of embolization and hemodynamic compromise (death)

50
Q

Treatment of Afib and Aflutter?

A

Control ventricular rate
Restore NSR
Assess need for anticoagulation

51
Q

AFFIRM trial?

A

Rate control is superior to rhythm control in treatment of Afib

52
Q

differentiating source of arrhythmias by QRS?A

A

Narrow QRS: above level of AV node

Wide QRS: outside normal conduction system

  • Supraventricular
  • HIS-purkinge systems
53
Q

S/e of adenosine?

A
  • HA
  • Flushing
  • SOB
  • Chest pressure
  • Nausea
54
Q

What causes 75% of cardiac arrest?

A

Vtac

VFib

55
Q

Torsades de points?

A

Rapid polymorphic VT

Causes - prolonged QT interval

  • congenital QT
  • TCA
  • anticholinergics
  • electrolytes
  • ischemia

Tx: iv magnesium and fix prob

56
Q

When is PVC and VT especially worrisome?

A

Pt w underlying heart disease
- LV dysfunction

Risk of Sudden Death

57
Q

If a pt has wide QRS tachycardia you should suspect?

A

VT

58
Q

Best treatment for pt w underlying heart disease and non sustained VT?

A

Implantable defibrillator

59
Q

Difference between cardiac arrest and SCD?

A

Cardiac arrest

  • sudden loss of cardiac output,
  • potentially reversible

Sudden cardiac death
- unexpected death w/in 1 hr of symptom onset

60
Q

Can drugs convert VFib?

A

Not alone

- need defib, CPR and epi

61
Q

Does defib work for asystole?

A

Nope they need CPR and Epi

62
Q

What is PEA?

A

Pulseless electrical activity

- monitor shows stuff but no pulse found

63
Q

Which heart blocks requrie pacemaker?

A

Second degree mobitz type II

Third degree

64
Q

Standing, valsalva and leg raise diminish all murmurs except?

A 
MVP
Hypertrophic cardiomyopathy (HCM)
65
Q

Cardinal manifestations of acute pericarditis?

A 
Chest pain
Pericardial friction rub
ECG changes 
- ST elevation
- PR depression
Pericardial effusion
66
Q

Constrictive pericarditis causes what diastolic dysfunction?

A

Early diastole - rapid filling

Late diastole - halted filling

67
Q

If a pt has signs of cirrhosis- ascities, hepatomegaly and distended neck veins you should r/o what?

A

Constrictive pericarditis

68
Q

Untreated pericarditis progresses to?

A

Worsening Co and hepatic and/or renal failure

They need surgery

69
Q

TOC for pericardial effusion and cardiac tamponade?

A

Echo

70
Q

Rapid pericardial effusion can lead to?

A

Cardiac tamponade

71
Q

What does cardiac tamponade do to cardiac pressures?

A

All 4 chambers pressure equalize during diastole

72
Q

Beck triad is a sign of?

A

Cardiac tamponad

73
Q

What is beck triad?

A

HOTN
Muffled heart sounds
JVD

74
Q

Symptomatic AS pts need?

A

Valve replacement

- 1/4 die in 3 yrs w/o surgery

75
Q

Management of AS?

A

Asymptomatic - nothing

Symptomatic - surgery

76
Q

Physical findings of aortic insufficiency? (Weird ones)

A

De Musset sign: head bobbing
Muller sign: uvula bobs
Duroziez sign: Pistol shot sound heard over femoral arteries

77
Q

Key signs of mitral valve prolapse?

A

Systolic click
Mid systolic rumbling murmur - increase w standing and valsalva
- decreases w squatting

78
Q

Always suspect endocarditis in pts w?

A

New heart murmur and Unexplained fever/bacteriema

79
Q

Best test for diagnosis of endocarditis?

A

TEE - better than trans thoracic

80
Q

Prognosis for infective endocarditis?

A

Almost always fatal

81
Q

Coarctation of the aorta in women is often associated w?

A

Turner syndrome

82
Q

Leading cause of death in adults w PDA?

A

Heart failure

Infective endocarditis

83
Q

Pulmonary pressures in adults w PDA?

A

Usually normal

84
Q

Short active BP lowering med?

A

Hydralazine

85
Q

Types of meds for Hypertensive emergency vs urgency?

A

Emergency - IV drugs

Urgency - PO drugs

86
Q

Types of aortic dissection and treatments

A

Type A - involves the ascending - surgery

Type B - descending only - medical

87
Q

Why is it important to r/o aortic dissection in suspected MI pts?

A

Because thrombolytics used to treat MI are often fatal for aortic dissection pts

88
Q

Preferred tests for acute aortic dissection?

A

TEE - unstable pts

CT - stable pts

89
Q

What is leriche syndrome?

A

Atheromatous occlusion of distal aorta just above the bifurcation - Bilateral claudication, impotence and absent/diminished femoral pulses

90
Q

How to differentate location of peripheral vascular disease?

A

Femoral or popliteal - calf claudication

Aortic - buttock and hip claudication

91
Q

When are ABI not accurate?

A

DM pts - often have calcified incompressible vessels

92
Q

Why do only 1/2 of DVT pts have classic findings?

A

Superficial venous system is patent the classic findings (erythema, pain, cords) dont occur b/c the blood drains from those patent veins

93
Q

Of those pts w classic DVT findings how many have DVT?

A

50%

94
Q

Preferred heparin?

A

LMWH

  • longer 1/2 life
  • given outpatient
  • no need for PTT levels
  • more $$$
95
Q

many pts w DVT develop what?

A

CVI - 80%

96
Q

If you see superficial thrombophlebitis in different locations over a short time you need to worry about?

A

Migratory superficial thrombophlebitis

- trousseau syndrome

97
Q

S/s common in all forms of shock?

A

HOTN
Oliguria
Tachycardia
AMS

98
Q

Only shock with elevated jugular venous pulse?

A

Cardiogenic shock

99
Q

W hypovolemic shock, when do the compensatory measures start to fail?

A

20-25% blood loss

100
Q

Best method for monitor shock treatment?

A

Urine output

101
Q

Skin finding w septic shock and hypovolemic shock?

A

septic: Severe peripheral vasodilation (flushing, warm skin)
Hypovolemic: peripheral vasoconstriction (cool, clammy skin)

102
Q

MCC of death in ICU?

A

Septic shock

Internal Medicine (5 decks)

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