TBL 2: Cardio Objectives

Question 1

CHADS2 criteria?

Answer 1

-Past stroke/TIA = 2 pt
-Age > 75 = 1 pt
-HTN = 1 pt
-DM = 1pt
-HF = 1pt
0 = low –> ASA or nothing
1 = moderate –> ASA or Warfarin
2+ = hihgh –> Warfarin –> INR 2-3 (if prostetic valved 2.5-3.5)

Question 2

What anti-arrhythmic drug do you give to patients w/o coronary heart disease or advanced LV dysfunction?

Answer 2

flecanide

propafenone

Question 3

What anti-arrhythmic drug do you give to patients w/ advanced structural heart dysfunction?

Answer 3

Amiodarone

Question 4

Systolic HF

Answer 4

heart is dilated

EF less than 50%

Question 5

NYHA Class 1

Answer 5

asymptomatic LV dysfunction –> Beta-blocker

Question 6

NYHA Class 2

Answer 6

symptoms with normal physical activity –> Beta-blocker

Question 7

NYHA Class 3

Answer 7

symptoms with minimal activity –> Beta-blocker + spironolactone

Question 8

NYHA Class 4

Answer 8

symptoms at rest –> Beta-blocker + spironolactone

Question 9

AHA/ACC Class A-D

Answer 9

A) At risk for HF (CAD, HTN, DM)
B) Asymptomatic damage
C) Symptomatic damage
D) Heart Failure

Question 10

When do you use ACE-I?

Answer 10

ALL pts with LV dysfunction (except if intolerant or CI)

Question 11

when do you use ARB?

Answer 11

Pts w/ intolerable S/E from ACE-I (cough). If on max ACE-I and Beta-blocker dosing and still have HTN –> (if white –> add in ACE-I) OR (if black –> hydralazine + nitrate)

Question 12

when do you use Hydralazine and Nitrates?

Answer 12

patients’s can’t tolerate ACE-I or AARB

Question 13

when do you use Beta-blockers?

Answer 13

ALL NYHA Classes of HF if patient is stable on ACE-I/other and is not volume overloaded

Question 14

when do you use aldosterone antagonist?

Answer 14

NYHA Class 3/4 have symptoms still even with ACE-I and BB. Spironolactone = MC –> gynecomastia in men.

Question 15

What combo of drugs should be avoided bc of significant risk of hyperkalemia?

Answer 15

ACE-I
ARB
Spironolactone

Question 16

when do you use diuretics?

Answer 16

NYHA Class 2-4 HF

if resistant to loop diuretics –> use thiazide

Question 17

when do you use digoxin?

Answer 17

• Symptomatic NYHA Class 2-4 HF
• A-fib patients –> provides only rate control
• ACC/AHA –> use beta blocker with digoxin for rate control of A-Fib

Question 18

ACE-I S/E

Answer 18

cough
worsening renal insufficicnecy 
hyperkalemia 
azotemia
hypotension

Question 19

ARB S/E

Answer 19

hypotension
azotemia
hyperkalemia

Question 20

Beta Blocker S/E

Answer 20

Bradycardia
heart block
symptomatic hypotension
**Don’t use in pts w/ asthma

Question 21

Aldosterone Antagonists S/E

Answer 21

Severe hyperkalemia
gynecomastia
**Don’t use if creatinine > 2.5

Question 22

Diuretics S/E

Answer 22

electrolyte and volume depletion

azotemia

Question 23

digoxin S/E

Answer 23

N/V
vision changes
arrhythmias