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Cardio > Test Two > Flashcards

Test Two Flashcards

1
Q

Does ST Depression localize ischemia?

A

no

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2
Q

ECG within how many minutes for an MI?

A

10

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3
Q

All should get what during an Acute MI?

A

Aspirin

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4
Q

Oxygen for an MI?

A

lowest flow to keep saturation at 90%

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5
Q

Ask about what drug before nitrates?

A

Viagra

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6
Q

What does an AV block in the setting of an Acute MI mean?

A

extensive underlying ischemia/infarction

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7
Q

Bezold-Jarisch Reflex occurs with what type of MI?

A

INferior

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8
Q

Is an NSTEMI caused by a complete or incomplete occluded vessel?

A

incompletely

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9
Q

Beta-blocker of choice for post-MI care with EF less than 40%?

A

carvedilol

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10
Q

Does an NSTEMI involve a red clot or a white clot?

A

red

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11
Q

Do fibrinolytics help a white clot?

A

no

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12
Q

How long do patients take ASA after an MI?

A

for life

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13
Q

How long do patients take P2Y12 inhibitor after an MI?

A

one year

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14
Q

Keep potassium above what to prevent a PVC?

A

4

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15
Q

Keep magnesium above what to prevent a PVC?

A

2

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16
Q

According to Clark, where does the pace come from during AIVR?

A

Purkinje

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17
Q

According to Clark, what causes a polymorphic Vtach?

A

ischemia

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18
Q

According to Clark, what causes a monomorphic Vtach?

A

scar

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19
Q

According to Clark, what two drugs should be avoided during early pericarditis?

A

NSAIDs and steroids

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20
Q

What two drugs are used to treat Dressler Syndrome?

A

colchicine and ASA

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21
Q

Rupture of what papillary muscle is most likely to cause an MVP?

A

postero-medial

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22
Q

Which papillary muscle has a dual blood supply?

A

Anterolateral

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23
Q

What is a pseudoaneurysm?

A

pericardium holds aneurysm in

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24
Q

What is the cardiac index for cardiogenic shock?

A

less than 1.8 L/min/m2

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25
Q

What is the PAWP for cardiogenic shock?

A

greater than 18 mm Hg

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26
Q

What heart defects are present during Noonan Syndrome?

A

pulmonary stenosis and ASD

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27
Q

What heart defects are present during Williams Syndrome?

A

supravalvular aortic stensosis

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28
Q

A thrill gives what grade to a murmur?

A

grade four

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29
Q

What ventricle is dominant in infants?

A

RV

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30
Q

Where is a perimembranous VSD located?

A

just below aortic valve

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31
Q

Which VSDs have an excellent chance of closing?

A

muscular

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32
Q

What type of infections can a person with a VSD get?

A

pulmonary

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33
Q

What is a synonym for an Atrioventricular Septal Defect?

A

endocardial cushion effect

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34
Q

Most common cause of an AVSD?

A

Downs syndrome

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35
Q

What is done during a Ross Procedure?

A

pulmonary valve to aortic

replace pulmonary valve

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36
Q

What does acidosis do to cardiac contractility?

A

decrease contractility

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37
Q

Does the aorta arise anteriorly or posteriorly off the RV during transposition?

A

anteriorly

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38
Q

What is the purpose of the rashkind procedure? Used to treat?

A

open a hole in the atria

Transposition

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39
Q

Does TOF result in a right-to-left or a left-to-right shunt?

A

right to left

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40
Q

LAD is almost diagnostic for what childhood condition?

A

tricuspid atresia

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41
Q

A fontan procedure is used to fix what Congenital heart defect? What is performed?

A

tricuspid atresia

venous return directly into pulmonary vessels

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42
Q

Would more blood get shunted to the lungs or systemic circulation during Truncus Arteriosus?

A

lungs

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43
Q

What is a sign of decompensation during shock in a child?

A

hypotension

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44
Q

What does critical mean in terms of congenital heart defects?

A

PDA maintains systemic circulation

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45
Q

Why is oxygen not used during a LV Obstruction?

A

can vasodilate lungs and decrease systemic circulation

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46
Q

What can cause heart block in children?

A

maternal Lupus

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47
Q

What is the Gold Standard for DVT?

A

Ascending Contrast Venography

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48
Q

What is the chief complaint of Mitral Regurgitation?

A

Dyspnea

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49
Q

Which valve closes first in mitral regurgitation, A or P?

A

aortic

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50
Q

How is Mitral Regurgitation treated?

A

any drug to decrease afterload

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51
Q

What has lower mortality rate, mitral valve replacement or repair?

A

repair

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52
Q

Which endocrine disorder can cause atrial fibrillation?

A

hyperthyroidism

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53
Q

What is paroxysmal Afib?

A

Afib that lasts 1-7 days

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54
Q

What is Persistent Afib?

A

Afib that lasts longer than 7 days

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55
Q

What two situations are antithrombotics not indicated for Afib?

A

Lone afib

under 60

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56
Q

Where should INR be kept during Afib?

A

2-3

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57
Q

What does myocardial failure mean?

A

defective myocardial contraction

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58
Q

What is the prevalence of heart failure world wide?

A

23 million

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59
Q

What is the prevalence of HF in the US?

A

4.7 million

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60
Q

What are the two main risk factors for a AAA?

A

smoking and atherosclerosis

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61
Q

How big does a AAA need to be in surgically operated on in males?

A

> 5 cm

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62
Q

How big does a AAA need to be in surgically operated on in females?

A

> 5.5 cm

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63
Q

What is the expansion criteria for a AAA to be surgically operated on?

A

creater than 0.5 cm in

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64
Q

What is the screening recommendation for AAA?

A

men age 60-75 who have ever smoked

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65
Q

What part of the aorta is most commonly affected by a thoracic aortic aneurysm?

A

ascending

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66
Q

Where is the worst location for a thoracic aneurysm?

A

ascending

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67
Q

What is the best marker for ruling out an aortic dissection?

A

D-dimer

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68
Q

When should a patient undergo screening of an aortic aneurysm after hospital discharge?

A

1, 3, 6 and 12 months

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69
Q

What is the most specific stress test?

A

stess echo

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70
Q

What drug is used for a stress test in pt’s with COPD?

A

dobutamine

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71
Q

What drug is used for a stress test in pt’s with arrhythmias?

A

Vasodilator

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72
Q

Which atom is used for myocardial perfusion scanning?

A

technitium99

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73
Q

Which stress test is used in patients with known CAD?

A

myocardial perfusion scan

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74
Q

What is the antidote for adenosine?

A

aminophylline

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75
Q

What two situations is adenosine contraindicated for stress test? Relative for?

A

asthma or COPD

regadenoson

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76
Q

Which exercise stress test is most specific?

A

Echo

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77
Q

What is the equation for target HR?

A

(220-age)(0.85)

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78
Q

What is the gold standard stress test?

A

exercise ECG

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79
Q

Which two classes of HF must patients be in to receive beta-blockers for HF?

A

class 2 or class 3

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80
Q

Which two beta-blockers are tolerated by HF patients?

A

metoprolol and carvedilol

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81
Q

Are ARBs FDA approved for HF?

A

No

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82
Q

Agent of choice for HF?

A

ACE Inhibitors

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83
Q

What three drugs did Hoff say can inhibit the neurohormonal model?

A

ACEIs/ARBs/beta-blockers

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84
Q

If a HF patient is hyponatremic, what is the Tx?

A

take away water

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85
Q

What is Stage D HF?

A

Decompensated

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86
Q

What is Stage C HF?

A

structural and symptomatic

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87
Q

What is Stage B HF?

A

strucutral defects but no symptoms

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88
Q

What is Stage A HF?

A

no structural heart disease or symptoms

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89
Q

Does pregnancy worsen or improve HF?

A

Worsen

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90
Q

Would beta-blockers improve or worsen HF?

A

Worsen

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91
Q

Would sotalol improve or worsen HF?

A

Worsen

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92
Q

Would NSAIDs improve or worsen HF?

A

Worsen

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93
Q

Would verapamil and diltiazem improve or worsen HF?

A

Worsen

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94
Q

What is distributive shock?

A

profound peripheral vasodilation

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95
Q

What is the most common cause of distributive shock?

A

sepsis

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96
Q

Can acidemia or alkalemia impair cardiac output?

A

acidemia

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97
Q

Will a narrow or too loose of a cuff under-estimate or over-estimate bp?

A

overestimate

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98
Q

Above what diastolic pressure would be considered a hypertensive emergency?

A

120

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99
Q

What is grade 1 HTN retinopathy?

A

arteriolar narrowing

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100
Q

What is grade 2 HTN retinopathy?

A

AV nicking

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101
Q

What is grade 3 HTN retinopathy?

A

hemorrhages and exudate

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102
Q

What is grade 4 HTN retinopathy?

A

papilledema

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103
Q

What is the leading cause of end stage renal disease?

A

systemic arterial hypertension

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104
Q

What is the most common cause of target organ damage during HTN?

A

ischemic heart disease

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105
Q

What would the GFR be lower than to classify renal damage?

A

less than 60

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106
Q

What type of abnormality on ECG would necessitate an echo?

A

BBB

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107
Q

What are the best diuretics?

A

thiazide

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108
Q

At what systolic and diastolic pressure should anti-HTN meds be started for older than 60 years?

A

systolic = 150

diastolic = 90

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109
Q

At what systolic and diastolic pressure should anti-HTN meds be started for younger than 60 years?

A

systolic = 140

diastolic = 90

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110
Q

Which four anti-HTN drugs should be started in non-black population?

A

ACEI/CCB/ARB/thiazide

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111
Q

Which two ant-HTN meds should be used in blacks?

A

thiazide or CCB

112
Q

anti-HTN to use in patients with kidney disease?

A

ACEI or ARB

113
Q

What is the most common symptom of peripheral vascular disease?

A

intermittent claudication

114
Q

Which two vessels are most commonly effected during fibromuscular dysplasia?

A

renal and carotids

115
Q

According to Hilgerson, what is the gold standard for DVT?

A

ascending contrast venography

116
Q

What does hypoxia due to chemoreceptors?

A

increases their discharge to raise bp

117
Q

Which papillary muscle is most commonly ruptured during a posterior MI?

A

posterior

118
Q

Where is the apical impulse located during mitral regurgitation?

A

down and lateral

119
Q

Would an S3 or S4 more likely occur during mitral regurgitation?

A

S3

120
Q

Is ECG specific for mitral regurgitation?

A

no

121
Q

Drug used to treat acute MR? What drug in addition if hypotensive?

A

nitroprusside

dobutamine

122
Q

What may be the first symptom of mitral stenosis?

A

embolization

123
Q

In what heart disease could the apical impulse be diminished?

A

mitral stenosis

124
Q

What receptor does Hoff say can activate α1 in the periphery can do?

A

inotropy of heart

125
Q

According to Hoff, which system is activated earlier adrenergic or RAAS?

A

adrenergic

126
Q

Does pressure overload result in concentric or eccentric hypertrophy?

A

concentric

127
Q

Does volume overload result in concentric or eccentric hypertrophy?

A

eccentric

128
Q

Do action potentials decrease or increase in length during HF?

A

increase

129
Q

Would LVEDV increase or decrease during HF?

A

increase

130
Q

What does backward HF result in?

A

pulmonary edema

131
Q

What does forward HF result in?

A

inadequate delivery of oxygen into arterial system

132
Q

What is the most common cause of right HF?

A

left HF

133
Q

Is left or right heart failure true congestive heart failure?

A

left

134
Q

Does left or right HF result in systemic congestion?

A

right

135
Q

Why can HF result in nocturia?

A

kidneys are better perfused lying down

136
Q

What is Class Two heart failure?

A

ordinary activities cause symptoms

137
Q

What is Class Three heart failure?

A

marked limitation

138
Q

What is Class Four heart failure?

A

symptoms at rest

139
Q

What is Kussmauls sign?

A

elevated JVP on inspiration

140
Q

When is Kussmauls sign seen?

A

right heart failure

141
Q

What is the hepatojugular reflex?

A

push on liver and JVP rises

142
Q

Where would the apical impulse be in heart failure?

A

down and left

143
Q

Is S4 rare or common in HF?

A

rare

144
Q

Why does pulsus alterans happen in HF?

A

myocytes relax every other beat

145
Q

Congestion of what leads to Kerley B lines?

A

pulmonary lymphatics

146
Q

Is ECG diagnostic of HF?

A

no

147
Q

What types causes of death are caused by HF?

A

tachyarrhythmia or pump failure

148
Q

Would anemia result in low output or high output heart failure?

A

high

149
Q

Would AV fistula result in low output or high output heart failure?

A

high

150
Q

Would hyperthyroidism result in low output or high output heart failure?

A

high

151
Q

Would BeriBeri result in low output or high output heart failure?

A

high

152
Q

Would Pagets Disease of bone result in low output or high output heart failure?

A

high

153
Q

What are the two mechanisms of cardiac remodeling?

A

adrenergic and RAAS

154
Q

What is the agent of choice for HF?

A

ACE Inhibitors

155
Q

How many points is substernal chest pain?

A

one

156
Q

How many points is chest pain with exertion?

A

two

157
Q

How many points is chest pain relieved by NTG?

A

three

158
Q

What is three elements?

A

typical chest pain

159
Q

What is two elements?

A

atypical chest pain

160
Q

What is one element?

A

noncardiac chest pain

161
Q

Is an exercise stress ECG more or less sensitive in women?

A

less

162
Q

Does ST depression correlate to location?

A

no

163
Q

Does ejection fraction increase or decrease during exercise?

A

increase

164
Q

Is dobutamine contraindicated in HTN or hypotension?

A

hypotension

165
Q

Which pharmalogical stressor is contraindicated in dyspnea?

A

dobutamine

166
Q

Which pharmalogical stressor is contraindicated in dyspnea?

A

adenosine

167
Q

Pharmacological stressor used in pts with COPD?

A

dobutamine

168
Q

What is the function of myocardial perfusion scan?

A

to increase specificity in patients with known CAD

169
Q

According to Clark, do mot plaque ruptures result in clinical events?

A

no

170
Q

What is the Bezold-Jarisch reflex?

A

bradycardia and hypotension

171
Q

Isolated AST makes you think what?

A

acute MI

172
Q

How long does TnI stay high?

A

5-10 days

173
Q

How long does TnT stay high?

A

10-14 days

174
Q

What causes an NSTEMI?

A

incomplete obstruction

175
Q

What are the four reasons for coronary catheterization?

A

enzymes

ST changes

recurrent symptoms

low ejection fraction

176
Q

Post MI, how long does a patient go on aspirin?

A

life

177
Q

Post MI, how long does a person stay on a P2Y12 inhibitor ?

A

one year

178
Q

Post-MI patient gets what kind of statin therapy?

A

high intensity

179
Q

What kind of MI does a red thrombus produce? What cells make up the clot?

A

STEMI

fibrin

180
Q

What kind of MI does a white thrombus produce? What cells make up the clot?

A

NSTEMI

platelets

181
Q

Do thrombolytics work in an NSTEMI?

A

no

182
Q

What does the EF have to be less than to begin ACE Inhibitors post-MI?

A

less than 40%

183
Q

What does the EF have to be less than to begin spironolactone Inhibitors post-MI? With or without HF?

A

less than 40%

with HF

184
Q

What is the most common cause of death post-MI? Best indicator for this?

A

VT/VF > 48 hours

EF

185
Q

Can a VSD lie flat?

A

yes

186
Q

Can MR lie flat?

A

no

187
Q

Where does a papillary muscle rupture indicate the MI occured?

A

IWMI

188
Q

What two specific pathologies can Marfan Syndrome cause?

A

aortic dissection or aortic regurg.

189
Q

Which is usually higher, leg BP or arm BP?

A

leg

190
Q

Would PV have a louder of softer murmur?

A

softer

191
Q

Is a PDA a L to R or a R to L shunt?

A

L to R

192
Q

What is seen on an ECG of an AVSD?

A

left axis

193
Q

What does the RV pressure have to be to do a balloon valvoplasty due to pulmonary stenosis?

A

over 50 mmHg

194
Q

Which ventricle hypertrophies in young children with coarctation of the aorta?

A

RVH

195
Q

Which ventricle hypertrophies in older children with coarctation of the aorta?

A

LVH

196
Q

What organ can be permanently impaired in children with coarctation of the aorta?

A

kidneys

197
Q

Does ToF result in a right-to-left or a left-to-right shunt?

A

right to left

198
Q

What causes the murmur in ToF?

A

RV outflow obstruction

199
Q

What vessel does a BT Shunt replace? Used to treat?

A

PDA

ToF

200
Q

What is TAPVR?

A

pulmonary veins drain into right atria

201
Q

Why is O2 not good in a patient with a left sided obstruction?

A

O2 causes pulmonary vasodilation and traps blood in lungs impairing it from going to systemic circulation

202
Q

Which type of plaque has inflammatory cells?

A

unstable

203
Q

Which type of plaque has a thick fibrous cap?

A

stable

204
Q

Does moving around make the pain of ACS better?

A

no

205
Q

What is the leading cause of death in women?

A

heart disease

206
Q

How long does it take for CK-MB to return to normal levels?

A

2-3 days

207
Q

Is morphine associated with higher mortality?

A

yes

208
Q

Post-MI wait on β-blocker until?

A

compensated

209
Q

A cardioembolism is associated with what type of MI?

A

anterior wall

210
Q

Oxygenated blood in the RV post-MI can be indicative of what?

A

VSD

211
Q

Is a thrill more common in a VSD or mitral regurgitation?

A

VSD

212
Q

An infarction in what part of the heart most often produces mitral regurgitation?

A

IWMI

213
Q

Where is the most common location of an ASD?

A

foramen ovale

214
Q

Which ventricle is more compliant in infants, RV or LV?

A

RV

215
Q

What axis would an ASD have?

A

right

216
Q

What is the most common type of CHD in kids?

A

VSD

217
Q

What is the most common type of VSD?

A

perimembranous

218
Q

By what age do large VSDs need to be fixed? Why?

A

6-12 months

avoid irreversible pulm. HTN

219
Q

What increases the risk of a PDA?

A

prematurity

220
Q

Would a PDA have elevated systolic or diastolic pressure? Elevated Pulse Pressure? Elevated or decreased diastolic pressure?

A

systolic

yes

decreased diastolic

221
Q

Is Indomethacin used to close a PDA in premature or term infants?

A

premature

222
Q

What is missing during an AVSD?

A

lower portion of atrial septum and inlet portion of ventricular septum

223
Q

Are blue hands and feet normal in an infant?

A

yes

224
Q

What is the Jatene Procedure?

A

switch pulmonary and aorta vessels

225
Q

What would ECG show during ToF?

A

RVH

226
Q

What procedure is used to treat ToF?

A

BT shunt

227
Q

What defect is also present in most cases of Tricuspid Atresia?

A

ASD

228
Q

What does TAPVR create?

A

pulmonary HTN

229
Q

What does inhaled nitrous oxide do?

A

dilate pulmonary bed

230
Q

According to Mooradian, in what two situations can a chylothorax form?

A

Lymphoma

Noonan syndrome

231
Q

Is a BT Shunt bloackage an emergency?

A

yes

232
Q

According to Hoff, what systolic blood pressure can signify shock?

A

less than 60 mm Hg

233
Q

Which type of shock has the highest degree of mortality?

A

cardiogenic

234
Q

What is the mortality of hypovolemic shock related to?

A

how quickly fluids are administered

235
Q

Which grades of HTN retinopathy are considered malignant HTN?

A

grades three and four

236
Q

What is hypertensive encephalopathy?

A

cerebral edema

237
Q

What does JNC 8 recommend for systolic pressure?

A

less than 140

238
Q

What did the sprint study find? Systolic less than? In what group of patients?

A

intensive BP reduction is better

120

239
Q

Non-drug therapies are recommended for who?

A

anyone with HTN

240
Q

ABI less than what value marks severe ischemia?

A
241
Q

Can cardiomyopathy cause MR?

A

yes

242
Q

Does the LV go into diastolic or systolic overlod during MR?

A

diastolic

243
Q

Sharp carotid artery pulses are indicative of what cardiac pathology?

A

MR

244
Q

What is the most common etiology of mitral stenosis?

A

rheumatic fever

245
Q

What is the valve area during mild MS?

A

2 cm2

246
Q

What is the valve area during critical MS?

A

1 cm2

247
Q

What valvular disorder would produce a loud S1?

A

mitral stenosis

248
Q

Avoid strenuous activities in what type of MS?

A

severe

249
Q

Before cardioversion, what drug does Hoff say use to anticoagulate?

A

Heparin

250
Q

Is prevalence of Afib higher in men or women?

A

men

251
Q

What hemodynamic compensatory mechanism can happen due to loss of atrial kick?

A

tachycardia

252
Q

Which is preferred, rhythm control with drugs or DC Cardioversion?

A

DC Cardioversion

253
Q

What is preferred for Afib, rhythm control or rate control?

A

rate control

254
Q

Why would one choose a stress echo in addition to an exercise ECG?

A

uninterpretable ECG not due to LBBB or ventricular pacing

255
Q

What is the function of the myocardial perfusion scan?

A

increase specificity and sensitivity

256
Q

What is the triad for a AAA rupture?

A

pain

hypotension

pulsatile abdominal mass

257
Q

What drug is used in the management of thoracic aortic aneurysms?

A

beta-blockers

258
Q

Which ventricle will be volume overloaded during a VSD?

A

left

259
Q

What drug is used in coarctation?

A

PGE1

260
Q

Do rhythm or rate control confer survivability for Afib?

A

no

261
Q

Which patiets are hospitalized more, rhythm or rate control?

A

rhythm

262
Q

What is the only beta-blocker approved for chronic HF?

A

carvedilol

263
Q

What is the only beta-blocker approved for chronic HF in EUROPE?

A

bisoprolol

264
Q

A stress echo is necessary is a resting ECG shows abnormalities except for which two?

A

LBBB

ventricular pacing

265
Q

In what regions can mitral stenosis progress faster?

A

subtropics/trocips/alaska/polynesia

266
Q

What fluid does Hoff say to use during shock?

A

isotonic saline

267
Q

How far apart should BP readings be?

A

one week

268
Q

What is the difference between primary and secondary HTN?

A

no cause found in primary

can find a reason in secondary

269
Q

What occurs first in cardiac remodeling, hypertrophy or dilation?

A

hypertrophy and then dilation

270
Q

Never omit what exam on a HTN patient?

A

fundoscopic

271
Q

Hoff says an Echo is necessary if the diastolic bp is between what two numbers?

A

90-94

272
Q

JNC 8 recommeds a sBP below what for hypertensive patients?

A

140

273
Q

Supracristal VSDs are common in what population?

A

Asians

274
Q

Which cyanotic lesions has ‘happy’ babies?

A

Transposition

275
Q

What causes the murmur of ToF?

A

pulmonary obstruction

276
Q

At what age do systolic and diastolic pressure begin to separate?

A

50

Cardio (3 decks)

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