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Step 2 > Cardiac and Vascular > Flashcards

Cardiac and Vascular Flashcards

1
Q

Na channel blockers

Class 1

A

ICN AP

DIsopyramide
Quinidine - cinconism - Exacerbates Digoxin tox
procainamide - Tx wpw. Drug induced SLE

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2
Q

Na channel blcoekres

Class 2

A

DEC AP

Used in Post MI. Tx Digitalis tox

Lidocaine - tx Digit. Tx Vtach, Varrhythamia. DONT use for ppx (asystole)
Tocainide
mexilitine
Phenytoin

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3
Q

Class 3

A

AP
Avoid in structural, post - MI. INC RR, QRS during exercise!

Flecanide, Propafenone

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4
Q

Tx for HOCM?

A

B blocker, (2nd line CCB)

also Long QT

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5
Q

When to be cautious of amiodarone use?

A

Thoes w/ preexisting lung conditions .

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6
Q

CCB - 2 groups? Side effects.

A

DHP -
Verapamil, Dilt - INC HF GINGIVLAL HYPERPLASIA

Non-DPH - Amlodipine, Nifedipine -Peripheral edema.

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7
Q

WPW tx?

A

Procainamide, Amiodarone

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8
Q

Digoxin Presentation?

tox tx algorithm?

A

Atrial Tachy w/ AV block

Tx Lidocaine, Mg,

Normalize K! Then antidigoxin fab and pacemaker if needed.

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9
Q

Torsades tx?

A

Mg

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10
Q

Coronary steal?

A

Dipyridamole, adenosone

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11
Q

2 cardiac primar yutmors?

A

Myxoma - ball valve, 90% atrium

Rhabdomyoma - Children. Tuberous Sclerosis

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12
Q

When to give clopidogrel? Fpor hol ong?

A

Post MI - with aspirin for 12 months.
give aspirin indefinitely.

Metal stents - 1 month

DES - 1 year

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13
Q

What sound is heard during acute MI?

A

S4, ventricular stiffending and dysfunction

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14
Q

Dissection diagnosis?

A

Emergent TEE, CT angio if stable

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15
Q

Infective endocarditis =- which valve? What tx?

A

Mitral prolapse w/ mitral regurg MOST COMMON

Must tx w/ IV meds (IV penicillin, IV ceftriaxone)

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16
Q

MI

Anterior
LAteral
Posterior Inferior

A

Anterior - LAD - V5-6

Lateral - LCX - 1,L, V5,6

Posterior - RCA - V1-3

Inferior RCA - 23F

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17
Q

PAC PVC tx?

A

Asx - No tx

Sx - B blocker

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18
Q

SVT tx?

A

Adenosine, CCB

if unstable - Synch cardiovert

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19
Q

Afib w RVR - tx?

A

Rate control - BB, CCB.

Cardiovert if iunstable. Check TSH if concern

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20
Q

Vtach. Tx?

A

Amiodarone.

If unstable - sync cardiovert

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21
Q

Sinus brady tx?

A

Sx - Atropine, TransQ pacing

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22
Q

Types of AV block?

A

1st - Prolonged
2nd T1 - Prolonged then drop
2nd T2 - Just drop

3 - dissociation

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23
Q

Electrical alternans - when do you see?

What else can you see int his condition

A

Pericardial effusion

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24
Q

Post MI structural damage timeline?

A

3-5 d - papillary muscle rupture (RCA)
d -2w - Free wall rupture -(LAD)
5d - 3mo - LV aneurysm

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25
Q

Diffuse ST elevatiosn seen in ?

A

Pericarditis

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26
Q

Granulomatous Vascular

A

Temporal - INC ESR. PMR. High dose steroids if suspicion.

Takayasu - Aortic, Pulseless. INC ESR

Gran w/ Poly - C anca - Nonhealing ULCERS. Tx cyclophosamide

Churg Straus - P anca - Asthma, Eos, IgE, Foot/wrist drop

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27
Q

Nongranulomatous Vascular

A

Micro Poly - P anca - no nasopharynx, no granulomas

Poly No - Hep B - no lungs, no granulomas, no ANCA. *Transumral inflam /w fibrinoid necrosis

bueger ?(thromboaangitis obliterans - segmetnal thrombosis

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28
Q

Ankle brachial index - normal?

A

Normal .9 to 1.3

If dec, sign of DEC perfusion.

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29
Q

Raynauds tx?

A

CCB

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30
Q

2 types of arteriolosclerosis -

A

Hyaline - DM, essential HTN

Hyperplastic - Severe HTN, Onion skinning

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31
Q

Blood presure medications effect?

Hydralazie
Nitroprusside
nitroglycerine

Milrione

A

Hyralazine - a>v
Nitroprsuddie av - CONCERN FOR CYANIDE TOX
Nitroglycerin v>a
Milrinone - blocks PDE.

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32
Q 
Bil resins
Ezetemide
fibrates
Niacin
Statin
A

Bile resin - block bile reab - Chol gallstones, bad taste, HYPERTG

Ezetimide - Blcok chol abs - Diarrhea

Fibrates - INC LPL (DEC TG) - DOC TG - Tox chol stones, hepatotox, myositis (w/ statins)

Niacin - DEC VLDL synth - Flushing, acanthosis, hyperglycemia, GOUT

Statin - Block HMG CoA - hepatotox w/ fibrates.

33
Q

DOC LDL

DOC TG

A

LDL : Statin -> Ezetemide

TG: Fibrates -> Nitrates

34
Q

Those with mitral valve prolapse – tx before high risk dental procedure?

A

No abx. Unless mechanical valve.

35
Q

Mitral stenosis, prognosis based off of sound

A

Diastolic murmur – closer to start of diastole the worse. Holodiastolic is SEVERE MS.

36
Q

Sotolol concerns?

A

Good for controlling rate/afib, but INC change of Vfib/TOrsades.

37
Q

QTC normal length

A

.44 in men and .46 in women.

38
Q

Worse risk factor for CAD
Most immediate benefit?

Worse risk factor for CKD?

A

Worse risk CAD - DM
Immediate benefit: Smoking cessation

Worse risk CKD - HTN

39
Q

In CAD, goal for LDL?

A

LESS THAN 100! May give statins!

40
Q

Worse type/location of MI? (mortality wise)

A

Antero/LAD much worse than inferior/RCA in terms of mortality

41
Q

What has the greatest effect on decreasing rates of restenosis after 6 mo of PCI?

A

Drug eluting stents are least likely to close
10%

Bare metal 15-30%

No stenting 30-40%

42
Q

In terms of MI, when can thrombolytics be administered?

A

Within 12 hours of STEMI

NOT NSTEMI (tx w/ heparin only)

43
Q

What should be given to patients with STEMI?

Algorithm

Difference between NSTEMI and STEMI

A

STEMI:
Aspirin + Clopidogrel
Thrombolytics within 30 min (and 12 hr onset)
PCI within 90.

NSTEMI

Aspiring + Clopidogrel
Heparin!

STEMI gets tpa, NSTEMI gets heparin.

44
Q

In NSTEMI, what is the best type of heparin to give?

A

Give LMWH (Enoxaparin)

greater than regular ole unfractionated heparin.

45
Q

When ti give IABP?

A

Bridge to surgery, valve replacement OR TRANSPLANT

within 24 to 48 hr.

46
Q

If patient has ACS, what must be done before they leave the hospital?

A

Must stress test to determine if angiography is needed.

DO NOT stress test ppl who are sx. They clearly already need angiography.

47
Q

Should you ever use ppx antiarrhyhtmics in prevention of Ventricular tachy/fib POST MI

A

No. They increase mortality.

48
Q

When can pt resume sexual activity post MI?

A

Immediately if sx free.

49
Q

DIgoxin affect on CHF

A

DEC sx. NEVER proven to DEC mortality.

50
Q

Most common cause of death in CHF?

A

Arrhythmia and sudden death

51
Q

Mortality benefit in systolic CHF? THESE ARE IT

KNOW THESE.

A

ACE/ARB
B blocker
Spironolactone (eplerenone for those w/ gynecomastia)
Hyralazine/nitrates
Implantable defibrillators for those w/ ischemic CM or EJ below 35%.

CCB INC mortality
DIgoxin unclear.

52
Q

Mortality benefit in diastolic CHF?

What about dilated CM?

A

B blockers
DIuretics

Digoxin and spironolactone NOT benfifical
A
CEI, ARB, hydralazine unclear benefit

Dil CM - ACE, ARB, BB, Spironolactone all lower mortality.

53
Q

What DEC reaccurance of pericarditis?

A

Colchiine.

Tx NSAID and colchicine.

54
Q

Kussmaul sign vs Pulsus paradoxues

A

Kussmal - JVP w/ inspiration (restrictive)

Pulsus paradoxues (DEC in BP w/ inhalation (tamponade)

May see both in each case.

55
Q

PAD - routinely screen?

Best test?

Best initial therapies?
Single most effective

A

PAD - do not screen as it does not DEC mortality

Test - ABI

Initial therapies - Aspiring, Stopping smoking, cilostazol.
MOST EFFECTIVE IS CILOSTAZOL (phosphodiesterasee inbhitor) . Also give statin.

56
Q

Aortic dissection, rupure

Best initial test

Most accurate test

A

Best - Xray

most accurate - ANtiogram (would never do though…)
Otherwise . CT ANGIO = TEE = MRA.

57
Q

“Worst cardiac diasease in pregnant women?

A

Peripartum cardiomyopathy (Tx ACEI ARB BB, Spironolactone, direuteic)

Peripartum CM> Eisenmenger > Everything else ..

58
Q

Cardiac –

Asx Diastolic murmur in young people vs systolic

A

Diastolic – need owrkup w/ echo. Misystolic sof murmur in ax – no need.

59
Q

Lone Afib that disappears/reverses w/ CHADs2VASC of 0 =

A

no therapy. No anticoag or antiplatelet.

60
Q

Pericardial effusion physical findings

A

– Diminished heart sounds (duh) but also PMI may be difficutl to palpate. No S4

61
Q

Tetraology heart sounds –

A

harsh systolic ejection murm ur in LUSB and SINGLE S2 because stenotic pulmonary valve does not snap shut).

62
Q

Cocaine vasospasm - tx and algorithm,

A

BENZOS, aspirin, nitroglycerin, CCB. NO BB, NO BB no TPA (INC ICH). BUT, cardiac cath if indicated (do all medical first(

63
Q

AV block T 1, asx with normal QR

A

– No tx. If Prolonged QRS then should have electrophysiology testing

64
Q

Infective endocarditis -> splenic abascess presentation

A

fever, leuk, LUQ pain, L pleuritic chest pain, left PLEURAL EFFUSION, Splenomegaly.

65
Q

Afib in WPW – how to tx

A

Must tx with Procainamide (tx WPW) – CCB, BB, etc make it worse!

66
Q

Single loud S2 can refer to

A

Tetralogy, Transposition, Tricuspid, Truncus (almost all of the early cyanotic)

67
Q

Most common cyanotic condition PRESENTING in NEONATAL PERIOD (first few hours)

A

Transposition.

68
Q

Harsh Holosystolic murmur in infant what to do? What if soft and not holosystolic

A

soft likely VSD.harsh holosystolic likelly VSD. ECHO to rule out other defects and look at size. 75% of small VSD close by 2 y.o.

Along these lines, if soft and not holosytolic do not necessarily have to echo, follow up.

69
Q

Aortic stenosis, echo or exercise test?

A

Echo first, then can exercise if appropriate.

70
Q

Infective endocarditis tx algorithm –

A

Must get 3 blood cultures BEFORE empiric antibiotics. If acute, over one hour, if stable over severeal hours with delayed treatment. Mitral REGURG NOT STENOSIS often seen.

71
Q

Mech/reason for vagal maneuvers correcting SVT

A

SVT are usu from accessary pathways through AV node – vagal maneuvers DEC SA automatisim as well as slow AV node conductivity, the LATTER which is more important in SVT.

72
Q

Vasovagal syncope dx?

A

Upright tilt table test if unclear clinically. Carotid massage if for CAROTID HYPERSENSITIVTIY SYNDROME (tight collars etc)

73
Q

Mitral valve prolapse

A

INC venous return/preload SHORTENS/softens murmur

74
Q

Ventricular aneurysm heart sounds?

A

Ventricular aneurysm can cause murmurs by dilating and eventually causing mitral regurg.

75
Q

Which type of shock INCreases mixed venous oxygen saturation?

A

Septic shock Inability to oxygenate tissues and inadequate extraction -> causes INC lactate levels etc.

76
Q

Reversible restrictive CM?

A

Hemochromatois. Amyoid as well as Sarcoid and scleroderma (bot latter tx steroids) cannot be reversed!

77
Q

Kid with holosystolic murmur at LLSB AND Apical diastolic rumble?

A

Large VSD, with shunting leads to pulmonary overcirculation and thus mitral valve flow murmur.

78
Q

Subclavian steal syndrome

A

neuro sx with exercise. Dx angiography, tx bypass. Don’t confuse with thoracic outlet syndrome, which has NO neuro signs.

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