5080 - Heart Failure, Arrhythmias & Angina

Question 1

HTN in children is define as __ percentile for child’s age, height and gender on at least __ occasions. What is main indicator:

Answer 1

95th, 3, obesity

Question 2

Percentage of children with hypertension:

Answer 2

3.9-4.5%

Question 3

Percentage of children with hypertension that are not diagnosed:

Answer 3

75%

Question 4

Stable angina is __ induced and is relieved by __ & __:

Answer 4

Exercise/exertionally induced; rest; nitroglycerin

Question 5

With angina it’s important to note:

Answer 5

Quality of pain; region and radiation of pain; severity of pain; time/duration of pain

Question 6

Stable angina is described as:

Answer 6

Squeezing pressure with radiation to arms, jaw, back or neck and is about 5-7/10 pain which lasts 20 minutes

Question 7

Stable angina has a __ EKG and is caused by:

Answer 7

Normal; atherosclerotic plaques blocking 70%

Question 8

Treatment for stable angina:

Answer 8

75-162mg of ASA daily and pain control. ACE or AERB is typically first-line

Question 9

Unstable angina/NSTEMI/STEMI symptoms:

Answer 9

Pain at rest without provocation; not relieved with rest or nitro; described as crushing chest tightness with substernal pain with radiation; abnormal EKG; 50-60% of vessel is occluded but can rupture easily

Question 10

Unstable angina/NSTEMI/STEMI pain:

Answer 10

Severity of pain is 8-10/10 and lasts more than 20 minutes.

Question 11

Immediate therapy for unstable angina/NSTEMI/STEMI:

Answer 11

MONA B: Morphine, oxygen, SL nitro, Aspirin 325mg, beta blocker

Question 12

Long-term therapy for unstable angina/NSTEMI/STEMI:

Answer 12

Aspirin 81mg, ACE/ARB, Statins, Oral nitrate, bowel regimen to prevent straining

Question 13

2 Antiplatelet therapy agents:

Answer 13

Aspiring & Clopidrogel

Question 14

Aspirin as an anti platelet therapy:

Answer 14

Inhibits thrombaxine, can cause GI upset, bleeding and tinnitus

Question 15

Clopidrogel as an anti platelet therapy:

Answer 15

P2Y 12 inhibitors which reduce platelet aggregation, prevents ADP-mediated activation of the GPIIb/IIIa receptor; adverse reaction is bleeding

Question 16

Anticoagulants include:

Answer 16

Heparin, Lovenox, Arixtra, direct thrombin inhibitor: Bivalirudin

Question 17

How do nitrates work:

Answer 17

increase nitric oxide which causes vasodilation; creates improved exercise tolerance and time til angina onset; may cause tachycardia - needs beta blocker at the same time to prevent

Question 18

Adverse effects of nitrates:

Answer 18

Tachycardia, headache, flushing, hypotension

Question 19

Patient education for nitrates:

Answer 19

SL tab for acute angina only; call 911 is no relief in five minutes; replace supply every 6 months

Question 20

How do first-line treatment beta blockers help angina/NSTEMI/STEMI:

Answer 20

Decrease heart rate and contractility

Question 21

What is second-line treatment needed for unstable angina/NSTEMI/STEMI:

Answer 21

Calcium channel blockers which decrease heart rate and contractility

Question 22

What does Ranolazine do and what is it used for:

Answer 22

Decreases oxygen demand of the heart without reducing HR or BP through reduction of ventricular tension; adjunct only for post-MI

Question 23

Of Clopidrogel, Prasugrel and Ticagrelor antiplatelet therapies, which has reversible inhibition of P2Y12:

Answer 23

Ticagrelor

Question 24

What is a side-effect of Ticagrelor that is not with other anti-platelets:

Answer 24

dyspnea

Question 25

What is the classification of: Abciximab, Tirofiban, Eptifibatide:

Answer 25

Glycoprotein IIb/IIIa inhibitors - anti-platelet agents IV

Question 26

What do beta blockers do in angina and ischemic heart disease:

Answer 26

Decrease myocardial oxygen demand by reducing heart rate and contractility

Question 27

Which beta blocker agents are preferred in angina and ischemic heart disease, and are first-line for stable angina:

Answer 27

Beta-1 agents: Metoprolol, Atenolol, Nebivolol, Bisoprolol

Question 28

Side-effects of beta blocker agents Metoprolol, Atenolol, Nebivolol and Bisoprolol:

Answer 28

Bradycardia, sexual dysfunction, masked hypoglycemia, fluid retention, depression, bronchospasm, patients may initially feel worse so need a slow titration

Question 29

What are the adverse side-effects of Ranolazine:

Answer 29

Dizziness, nausea, palpitations, QTc prolongation

Question 30

Ischemic stroke is:

Answer 30

Abrupt onset focal neurological deficit >24 hrs; occlusion of an artery

Question 31

TIA is:

Answer 31

abrupt onset neurological deficit that lasts <24 hours - usually <30 minutes

Question 32

Treatment for ischemic stroke:

Answer 32

Early repercussion therapy - thrombolytic therapy; tissue plasminogen activator - Alteplase

Question 33

Alteplase helpfulness outweighs risk of hemorrhage only in the first:

Answer 33

4.5 hours

Question 34

Secondary prophylaxis in ischemic stroke:

Answer 34

Antiplatelet therapy; initiate no sooner than 24 hours but no later than 48 hours after Alteplase (tPA therapy): Aspirin, Clopidogrel, Aggrenox; Blood pressure control to initiate 2-7 days after stroke: usually ACE inhibitor; Statin therapy to initiate in all patients post-stroke: Atorvastatin

Question 35

Heart rhythm: Phase 0 =

Answer 35

Rapid depolarization

Question 36

Heart rhythm: Phase 1 =

Answer 36

Brief period of repolarization

Question 37

Heart rhythm: Phase 2 =

Answer 37

Plateau phase, slow depolarization

Question 38

Heart rhythm: Phase 3 =

Answer 38

cellular repolarization

Question 39

Heart rhythm: Phase 4 =

Answer 39

Gradual repolarization

Question 40

Heart rhythm phase 0-3 is called:

Answer 40

The refractory period

Question 41

Line of impulses through the heart:

Answer 41

SA node > Atrial conducting system > AV node > Bundle of His > Purkinje Fibers

Question 42

Supraventricular type of arrhythmia:

Answer 42

PSVT, SVNRT, Atrial fib

Question 43

Ventricular type of arrhythmia:

Answer 43

Ventricular tachycardia/fib, torsades de pointe

Question 44

Antiarrhythmic medications - Class 1:

Answer 44

Sodium channel blockers; 1a - intermediate; 1b - fast-acting; 1c - slow-acting. Do not use in heart failure!

Question 45

Antiarrhythmic medications - Class 2:

Answer 45

Sympathetic nervous system blockers - beta blockers

Question 46

Antiarrhythmic medications - Class 3:

Answer 46

Primary potassium channel blockers

Question 47

Antiarrhythmic medications - Class 4:

Answer 47

Calcium channel blockers