Cardiovascular

Question 1

What is medical management of hypertrophic cardiomyopathy?

Answer 1

Negative inotropic agents (e.g. beta blockers, verapamil)

Question 2

What is the treatment for sustained ventricular tachycardia in a stable patient?

Answer 2

Antiarrhythmic drugs - usually IV amiodarone

Question 3

What is alcoholic cardiomyopathy?

Answer 3

Diagnosis of exclusion: LV dysfunction (dilated) in pt with hx of alcohol abuse in whom no other potential causes of cardiomyopathy (e.g. coronary artery disease, valvular heart disease) are identified. Cessation of EtOH use can improve or even normalize LV function over time

Question 4

What are symptoms of an ateriovenous fistula?

Answer 4

Widened pulse pressure, strong peripheral arterial pulsation (e.g. brisk carotid upstroke), systolic flow murmur, tachycardia, and often flushed extremities if fistula involves the extremity. PMI will be displaced to the left and ECG will show left ventricular hypertrophy

Question 5

What kind of bundle branch block can severe right heart strain cause (e.g. massive PE)?

Answer 5

RBBB

Question 6

What is Beck’s triad?

Answer 6

Hypotension, elevated JVP, and muffled heart sounds - signs of cardiac tamponade

Question 7

What happens to the PMI in pts with large pericardial effusions?

Answer 7

Becomes nonpalpable

Question 8

What is Dressler syndrome?

Answer 8

A secondary form of pericarditis that occurs in the setting of injury to the heart or the pericardium (e.g. following MI). It consists of fever, pleuritic pain, pericarditis and/or a pericardial effusion. Treated with NSAIDS

Question 9

What is/are the most common location(s) for the ectopic foci that cause A-fib?

Answer 9

The pulmonary veins

Question 10

What medication is preferred to manage aortic dissection?

Answer 10

IV beta blocker (e.g. labetalol, proranolol, esmolol) - reduces HR, SBP, and LV contractility putting less stress on the dissection

Question 11

What EKG findings are associated with LVH?

Answer 11

High voltage QRS complexes, lateral ST segment depression, and lateral T wave inversion

Question 12

What valvular disease may result from carcinoid syndrome?

Answer 12

Tricuspid regurgitation

Question 13

What are features of a supravalvular aortic stenosis?

Answer 13

Systolic murmur similar to AS except is best heard at the first right intercostal space, unequal carotid pulses, differential blood pressure in upper extremities (high-pressure jet in ascending aorta), and a palpable thrill in the suprasternal notch

Question 14

Why does left ventricular hypertrophy lead to increased myocardial oxygen demand with exertion?

Answer 14

Patients end up with coronary artery stenosis as an associated anomaly.

Question 15

What is LV wall stress a measure of?

Answer 15

Preload

Question 16

How does morphine reduce myocardial oxygen demand in ACS?

Answer 16

Morphine sulfate reduces sympathetic tone through a centrally mediated anxiolytic affect. Morphine also reduces myocardial oxygen demand by reducing pre-load and by a vagally mediated reduction in heart rate

Question 17

What does a new onset holosystolic murmur 2-7 days after MI indicate (although could be sooner)?

Answer 17

MR due to papillary muscle rupture

Question 18

How does the cardiac index change in hypovolemic shock?

Answer 18

Decreases

Question 19

What pressure measurements represent preload?

Answer 19

RA pressure and PCWP

Question 20

How does preload (RA pressure and PCWP) change in cardiogenic shock?

Answer 20

Increases

Question 21

What is the first line intervention for a conscious and stable patient with torsades de pointes?

Answer 21

IV magnesium

Question 22

What is atropine used for?

Answer 22

Symptomatic sinus bradycardia or atrioventricular nodal block

Question 23

What precipitating factors should be avoided in patients with premature atrial complexes, even if they are asymptomatic?

Answer 23

Tobacco, alcohol, caffeine, and stress

Question 24

What heart sound correlates with an elevated BNP?

Answer 24

S3 - indicates high LV pressure

Question 25

What are symptoms of a RV infarction?

Answer 25

Hypotension, tachycardia, clear lungs, JVD, and NO pulsus paradoxus. DON’T give nitro. Tx w/ vigorous fluid resuscitation (need more preload)

Question 26

What cardiac marker is the best test to get if you are concerned about a repeat MI within a short period of time?

Answer 26

Myoglobin - rises quickly and peaks in 2 hrs. Out of system by 24 hrs (troponin and CKMB will be in the system already from the previous MI because stick around for several days)

Question 27

If cardiac enzymes are normal in a patient you suspect of NSTEMI, what should you do?

Answer 27

Get cardiac enzymes Q8hrs x 3 to make sure

Question 28

In a patient with an MI, what meds should you give?

Answer 28

Morphine, oxygen, nitrates, beta-blocker, aspirin/clopidogrel

Question 29

When would you do a CABG over PCI in a pt with an MI?

Answer 29

Three vessel disease (or 2 vessel in DM), left main disease, or post intervention angina

Question 30

In a patient with unstable angina and has a LBBB or is on digoxin therapy, what kind of stress test is preferred?

Answer 30

ECHO stress test - very difficult to interpret the EKG

Question 31

What are markers of a positive stress test?

Answer 31

CP is reproduced, ST depression, hypotension

Question 32

What should you be thinking in a patient with persistent ST segment elevation and a MR murmur ~1 mo post MI?

Answer 32

Ventricular wall aneurysm

Question 33

What are “Cannon A-waves” a sign of?

Answer 33

AV dissociation (e.g. 3rd degree block or V-fib)

Question 34

In a patient with stable V-tach, how is it treated?

Answer 34

Amiodarone or lidocaine

Question 35

What does the valsalva maneuver do to hemodynamics?

Answer 35

Decreases preload

Question 36

What cardiac defect is associated with a wide, fixed S2?

Answer 36

ASD

Question 37

What type of heart failure dose hemachromatosis cause?

Answer 37

Diastolic HF - reversible with phlebotomy