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Cardiovascular FA > UW > Flashcards

UW Flashcards

1
Q

acute coronary syndrome induced by cocaine - management

A

benzodiazepines (for anxiety and BP), aspiri, nitroglyc and CCB, no fibrinolytics (risk for intracranial hemorr), immediate cardiac catheterization with reperdusion when indicated(ST elevation or persistent)

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2
Q

indications for endarterctomy

A
  1. sympromatic with stenosis more than 70%
  2. asymptomatic more than 80%
    (symptomatic means TIA or stroke in the distribution)
    all treated medically with statin and antiplatelet
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3
Q

when to check for 2ry hypertension

A

refractory hypertension after use of 3 different drugs (of different classes), and in non-obese, nonblack patients under 30

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4
Q

causes of high outputHF

A
  1. severe asthma
  2. beriberi
  3. paget
  4. hyperthyroidism
  5. AV fistulas
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5
Q

AF is most commonly caused by ectopic focin within the (vs the atrial flatter)

A

pulmonary veins (and atrial flutter around Tricuspid annulus)

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6
Q

drugs that can cause bronchocostriction in patients with asthma

A
  1. b-blockers

2. aspirin

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7
Q

Cardiac index

A

cardiac output / body surface

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8
Q

initial management of GERD

A
  • fewer than 2 episodes of symptoms per week: lifestyle changes and antihistamines as needed
  • patients with more frequent or severe symptoms, evidence of erosive esophagitis, or laryngopharyngeal involvement should be managed with an 8-week course of a PPI
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9
Q

survivors of Hodgkin lympho,a are at increased risk for cardiac disease, which can preesnt …. (when) due to

A
  • after 10-20 years or more

- due to mediastinal irradiation or anthracyclines

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10
Q

β-blockers intoxication - treatment

A
  • IV fluids and atropine are the first line options

- if profound or refractory hypotension –> glucagon

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11
Q

Most suggestive test to diagnose myxoma

A

TEE (but TTE is usually adequate)

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12
Q

atheroembolism (cholesterol embolism) is a complications of cardiac catheterization and other vascular procedures - manifestations / treatment

A
  1. cutaneous findings: blue toe syndrome, livedo reticularis
  2. cerebral or intestinal ischemia
  3. acute kidney injury
  4. Hollenhorst plaques (retinal findings)
    IT CAN BE IMMEDIATE OR DELAYED (30days or more)
    treatment: statin
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13
Q

exertional syncope - DDX

A
  1. ventricular arrhythmias

2. outflow obstruction (AS, HOCM) `

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14
Q

developing AV block in a patient with endocarditis should raise the suspicion of

A

perivalvular abscess extending into the conduction tissue

increased risk with aortic valve endocarditis and IV drugs

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15
Q

persistent ST elevation post MI –>

A

ventricular aneurysm

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16
Q

MCC of sudden cardiac arrest in the immediate post-infraction period in patients with acute MI

A

Reentrant ventricular arrhythmias (eg. ventricular fibrillation)

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17
Q

hypertensive emergencies - target (if fast decreasing?)

A

target: lowering 10-20% in the first hour and by another 5-15% in the next 23 hours
excessive drop can cause cerebral iscemia (mental status + seizures)

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18
Q

cyanide toxicity - manifestations

A

mental status + seizures + lactic acid

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19
Q

HOCM - ECG

A

LV hypertrofy: tall R in aVL + Depp S in V3 (Cornell criteria)
2. Repolarization changes in anterolateral leads (I, aVL, V4, V5, V6)

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20
Q

difference between uremic pericarditis vs other type of pericarditisi

A

uremic doesn’t have diffused ST elevation because inflammation does not affect the myocardium

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21
Q

describe a benign murmur

A

midsystolic in otherwise young, asyymptomatic adults –> no further evaluation

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22
Q

Diastolic and continious murmurs detected in a routine examination –>

A

usually due to underlying pathologic case –> TTE

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23
Q

cardiac cathetirization in tamponade

A

elevated and equilibrium diastolic pressures

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24
Q

puslus paradoxus - definition / ddx

A

fall in SBP more than 10 during inspiration
frequent in cardiac tamponade but can also occur in conditions without pericardial effusion such as severe asthma or COPD

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25
Q

fibromuscular dysplasia?

A

systemic noninflammatory syndrome that affects renal + internal carotid arteries–> arterial stenosis, aneurysms, dissections

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26
Q

post-infraction pericarditis - treatment

A

supportive
avoid anti-inflammatory (NSAID, steroids) due t impairment of collagen deposition and possible increased risk of serious post-MI complications

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27
Q

a clinical differences in a post-MI papillary rapture vs VSD

A

VSD has a palpable thrill

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28
Q

tension pneumothorax - mechanism of shoch

A

obstruction of vena cava –> decreased venous return

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29
Q

patients with WPW should be treated with

A

cardioversion (if unstable) or antiarrhythymics (if stable) such as procainamide

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30
Q

after the diagnosis of hypertension - tests?

A
  1. urinaysis for occult hematuria + urine protein/creatinine ratio
  2. chemistry panel
  3. lipid profile
  4. baseline electrocardiogram
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31
Q

the strongest predictor of AAA expansion and rupture are

A
  1. large aneurysm diameter
  2. rapid rate of expansion
  3. current cigarette smoking
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32
Q

AAA - current indications for endovascular repair include

A
  1. aneurysm size more than 5.5
  2. more than 0.5 cm in 6 moths or 1 cm per year expansion
  3. symptoms
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33
Q

all patients with new AF should have

A

thyroid function test

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34
Q

constrictive pericarditis manifestations

A

RHF

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35
Q

initial treatment of Pulmonary hypertension due to problem in LV

A

loop diuretics and ACEi

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36
Q

torsades de points - treatment

A

stable: magnesium sulfate
unstable: defibrillation

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37
Q

Sick sinus syndrome

A

due to degeneration and/or fibrosis of the SA node and surrounding atrial myocardium

  • fatigue, lightheartedness, palpitations, presencope, syncope
    ecg: sinus pauses, /arrest, bradycardia, SA exit block, alternating bradycardia and atrial tachyarrhythmias
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38
Q

inferior wall MI - when put temporary pacemaker

A

transient bradyxardia or AV block

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39
Q

Tachycardia-mediated cardiomyopathy

A
  • AF, atrial flatter, ventricular tachycardia, etc

- chronic tachycardia can cause structural changes like LV dilation and Myocardial dysfunction

40
Q

isolated systolic hypertension in elederly patients

A

by increased stiffness or decreased elasticity of the arterial wall
(similar management to that of 1ry hypertension)

41
Q

the major cause of morbidity and mortality in people with PAD

A

MI

42
Q

clinical mainifestation of SEVERE aortic stenosis

A
  1. soft and single S2
  2. pulsus purvus et turdus
  3. mid-to-late peaking systolic murmur (if early: not severe)
43
Q

PAD - when cilostazol

A

patients with symptoms despite antiplatelets and adequate supervised exercise programs

44
Q

the strongest predictor of stent thrombosis after intracoronary stent implantation

A

premature discontinuation of antiplatelet therapy

45
Q

AAA - screening

A

active or former smokers 65-75 with 1 time U/S

46
Q

acute limp arterial occlusion - next step

A

heparin

47
Q

treatment of hypertension in patients with PKD

A

ACEi

48
Q

which arrhythia is most specific for Digitalis toxicity

A

Atrial tachycardia with AV block

49
Q

current guidelines for PCI using

A

within 90 mins in the hospital or 120 if must transferred to other hospital

50
Q

heart failure - hyponatremia

A

indication of severe HF

51
Q

acute AF due to hyperthyroidism - best initial therapy

A

b-blockers

52
Q

a unique symptom of coartraction

A

epistaxis

53
Q

initial treatment of chronic venous insufficiency

A

conservative measures with leg elevation, exercise and compression therapy

54
Q

special characteristic of the murmur due to congenital AS

A
  • right but in the first intercostal (higher than normal)
  • palpable thrill
  • differential BP in the upper extremities
  • unequal carotid pulses
  • may be carotid artery stenosis as associated anomaly
  • angina during exercise
55
Q

indications for using sychronised cardioversion (direct current cardioversion)

A

all patients WITH a pulse who have persistent tachyarrhythmia (narrow or wide complex) causing clinical or hemodytnamic instability)

56
Q

most important predisposing factor for thoracic dissection

A

HTN (not the atherosclerosis)

57
Q

manifestation of sarcoidosis in heart

A
  1. complete AV block (MC)
  2. restrictive cardiomyopathy (early)
    dilated cardiomyopathy (late)
  3. valvular dysfunction
  4. HF
  5. sudden cardiac death due to AV block or ventricular arrhythmia
58
Q

treatment of symptomatic sinus bradycardia

A

initially with IV atropine (0.5 mg every 3-5 mins, max: 3mg) –> if inadequate response –> iv epinephrine or dopamine or transcuteneous pacing –> expert consultation or transvenous pacing

59
Q

the most effective non-pharmacologic way to decrease BP in overweight people

A

Weight loss (better than exercise, smoking, alcohol etc)

60
Q

increased incidence of orthostatic hypertension in elderly

A

progressively decreasing baroreeptor sensitivity and defects in the myocardial response to this reflex
(other: arterial stiffness, decreeased norepinephrine content of sympathetic nerve endigs, reduced sensitivity to of the mocardium to sympathetic stimulation)

61
Q

complete AV block how are the QRS - wide or narrow

A

they can be either wide or narrow

62
Q

what to suspect in patients presenting with RHF following implantable pacemaker or cardioverter defibrillator placement

A

transvenous lead placement through the tricuspid valve can cause severe TR due to direct valve leaflet damage or inadequate leaflet coaptation

63
Q

situational syncope is a form of reflex or neurally mediated syncope associated with specific triggers (eg. cough, micturation. These triggers cause n alternation in the autonomic response and can precipitate a predominant

A

cardioihnibitory, vasodepressor or mixed response

64
Q

squatting - effects on afterload and preload

A

increases both

65
Q

cocaine complications

A
  1. MI 2. aortic dissection 3. intracranial hemorrhage
66
Q

aortic stenosis heart failure -EF

A

normal

67
Q

cor pulmonale - diagnostic tests

A

ECG: partial or complete RBBB, right axis
echo: pulm hypertension, dilated RV, TR
Right heart catheterization: gold standarrd

68
Q

viral myocarditis - echo / biopsy / mri / ecg

A

echo: 4 chamber dilation
ecg: non-specific
biopsy: lymphocytic infiltration
mri: late enchancement of the epicardium

69
Q

viral myocarditis - treatment

A
  1. medication (diuretics, ACEi, b blockers
  2. temporary ventricular assist device if needed
  3. heart transplant if no recovery
70
Q

Alcohol withdrawal syndrome - manifestations and time

A

6-24 h: anxiety insomniia, tremor, palpitations, GI
12-48: single or multiple generalized tonic-clonic
12-48: hallucinations (visual, auditorym tactile)
48-96: confusion, tachycarda, hypertension, fever

71
Q

diagnostic approach of aortic dissection

A

chest x-ray or ECG
- suggests something other –> evaluate + treat
- suggests dissection –> normal serum creatinine + no contrast allergy?
no –> TEE (and in instability)
yes: TEE or chest CT with contrast, MRI (if non-emergency) (has to be stable)

72
Q

neurological symptoms of amiodarone

A
  1. peripheral neuropathy

2. optic neuropathy

73
Q

maniodarone cardiac SE

A

sinus bradycardia, heart block

risk of proarrhythmias, QT prolongation

74
Q

VSD, vs free wall rupture vs aneurysm vs papillary muscle rupture - regarding time + artery

A

papillary muscle: acute or 3-5d (RCA)
VSD: acute or 3-5D (RCA or LAD)
free wall: 5-14d (LAD)
aneyrysm: up to several months (LAD)

75
Q

normal MvO2 and variations in shocks

A

normal: 60-80%
hypovolemic: decreased
cardiogenic: decreased
septic: INCREASED

76
Q

CO variations in shoocks

A

ypovolemic: decreased
cardiogenic: highly decreaesd
septic: increased

77
Q

conditions associated with AF

A

cardiac: hypertensive heart disease (MC), CAD etc
pulmonary: pulm embolsim, COPD etc
other: obesity, endocrine, alcohol, drugs

78
Q

MC cardiac cause for AF

A

hypertensive heart disease

79
Q

S4 - normal in

A

healthy older adults

80
Q

Mobitz 1 vs 2 - vagal maneuvers

A

worsen type 1

improves type 2

81
Q

Mobitz 1 vs 2 - exersise or atropine

A

Improves type 1

Worsens type 2

82
Q

types of amyloidosis

A

AL: clonal plasma cells
AA: chronic inflammation
ATTR: age or familial related
AB2M: hemodialysis

83
Q

amiodarone vs digoxin

A

amidarone can increase serum levels of digoxin –> toxicity

decrease digoxin dose 25-50% when start amiodarone

84
Q

digoxin SE are divided to

A

acute: GI
chronic: neurologic and visual (less GI)

85
Q

combination of nitrates hydralazine in patients with LV systolic dysfunction - survival

A

increases survival in african american

86
Q

MCC of isolated aortic regurgitation in young adults in developed countries

A

bicuspid valve
early decrescendo diastolic murmur, best heard with the diaphragm of the stethoscope along the left sternal border at the the 3rd and 4th intercostal spaces while the patient is sitting u, leaning forward, and holding breath

87
Q

prinzmental angina - treatment (preventive and abortive)

A

preventive: CCBs
abortive: sublingual nitroglycerin
B blockers can worsen it

88
Q

AAA - study of choice for (a) diagnosis and (b) follow up

A

U/S

89
Q

pulsus bisferines (or biphasic pulse)?

A

2 strong systolic peaks of the aortic pulse from LV ejection sepetated by midsystolic click
palpable in patients with significant AR, HOCM, large PDA

90
Q

antiarrhythmis that causes long QT

A

III

I (esp IC in fast HR)

91
Q

Pulmonic valve stenosis? / treatment

A
  • congenital defect, asymptomatic until adulthood, crescendo-decresento murmur
  • Percutaneous balloon valvulotoy (preferred)
    surgical repair in some cases
92
Q

exercise ECG - best for / not for

A

best for patients able to reach HR

Not for LBBB, pacemaker, unable to reach HR

93
Q

Pharmacologic stress test with …. (medication and mechanism of action)

A

adenosine or dipyridamole:

nonselective adenosine agonist / dilates coronary arteries without altering HR or BP

94
Q

Pharmacologic stress test - best for / not for

A

best for LBBB, pacemaker, unable to reach HR

not for reactive airway disease, patients on dipyrodamole or theophylline

95
Q

stress echo - mechanism of action of drug

A

dobutamine: b1 agonist –> increase HR +/- bp

96
Q

stress echo - best for / not for

A

best for reactive airway disease, unable to reach HR

not for tachyarrhythmias

97
Q

LV aneurysm - artery?

A

LAD

Cardiovascular FA (8 decks)

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