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Cardiac and Vascular Flashcards

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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
Diffuse ST elevatiosn seen in ?
Pericarditis
26
Granulomatous Vascular
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
27
Nongranulomatous Vascular
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
28
Ankle brachial index - normal?
Normal .9 to 1.3 If dec, sign of DEC perfusion.
29
Raynauds tx?
CCB
30
2 types of arteriolosclerosis -
Hyaline - DM, essential HTN Hyperplastic - Severe HTN, Onion skinning
31
Blood presure medications effect? Hydralazie Nitroprusside nitroglycerine Milrione
Hyralazine - a>v Nitroprsuddie av - CONCERN FOR CYANIDE TOX Nitroglycerin v>a Milrinone - blocks PDE.
32
``` Bil resins Ezetemide fibrates Niacin Statin ```
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
DOC LDL DOC TG
LDL : Statin -> Ezetemide TG: Fibrates -> Nitrates
34
Those with mitral valve prolapse – tx before high risk dental procedure?
No abx. Unless mechanical valve.
35
Mitral stenosis, prognosis based off of sound
Diastolic murmur – closer to start of diastole the worse. Holodiastolic is SEVERE MS.
36
Sotolol concerns?
Good for controlling rate/afib, but INC change of Vfib/TOrsades.
37
QTC normal length
.44 in men and .46 in women.
38
Worse risk factor for CAD Most immediate benefit? Worse risk factor for CKD?
Worse risk CAD - DM Immediate benefit: Smoking cessation Worse risk CKD - HTN
39
In CAD, goal for LDL?
LESS THAN 100! May give statins!
40
Worse type/location of MI? (mortality wise)
Antero/LAD much worse than inferior/RCA in terms of mortality
41
What has the greatest effect on decreasing rates of restenosis after 6 mo of PCI?
Drug eluting stents are least likely to close 10% Bare metal 15-30% No stenting 30-40%
42
In terms of MI, when can thrombolytics be administered?
Within 12 hours of STEMI NOT NSTEMI (tx w/ heparin only)
43
What should be given to patients with STEMI? Algorithm Difference between NSTEMI and STEMI
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
In NSTEMI, what is the best type of heparin to give?
Give LMWH (Enoxaparin) greater than regular ole unfractionated heparin.
45
When ti give IABP?
Bridge to surgery, valve replacement OR TRANSPLANT within 24 to 48 hr.
46
If patient has ACS, what must be done before they leave the hospital?
Must stress test to determine if angiography is needed. DO NOT stress test ppl who are sx. They clearly already need angiography.
47
Should you ever use ppx antiarrhyhtmics in prevention of Ventricular tachy/fib POST MI
No. They increase mortality.
48
When can pt resume sexual activity post MI?
Immediately if sx free.
49
DIgoxin affect on CHF
DEC sx. NEVER proven to DEC mortality.
50
Most common cause of death in CHF?
Arrhythmia and sudden death
51
Mortality benefit in systolic CHF? THESE ARE IT KNOW THESE.
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
Mortality benefit in diastolic CHF? What about dilated CM?
B blockers DIuretics Digoxin and spironolactone NOT benfifical A CEI, ARB, hydralazine unclear benefit Dil CM - ACE, ARB, BB, Spironolactone all lower mortality.
53
What DEC reaccurance of pericarditis?
Colchiine. Tx NSAID and colchicine.
54
Kussmaul sign vs Pulsus paradoxues
Kussmal - JVP w/ inspiration (restrictive) Pulsus paradoxues (DEC in BP w/ inhalation (tamponade) May see both in each case.
55
PAD - routinely screen? Best test? Best initial therapies? Single most effective
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
Aortic dissection, rupure Best initial test Most accurate test
Best - Xray most accurate - ANtiogram (would never do though...) Otherwise . CT ANGIO = TEE = MRA.
57
"Worst cardiac diasease in pregnant women?
Peripartum cardiomyopathy (Tx ACEI ARB BB, Spironolactone, direuteic) Peripartum CM> Eisenmenger > Everything else ..
58
Cardiac – | Asx Diastolic murmur in young people vs systolic
Diastolic – need owrkup w/ echo. Misystolic sof murmur in ax – no need.
59
Lone Afib that disappears/reverses w/ CHADs2VASC of 0 =
no therapy. No anticoag or antiplatelet.
60
Pericardial effusion physical findings
– Diminished heart sounds (duh) but also PMI may be difficutl to palpate. No S4
61
Tetraology heart sounds –
harsh systolic ejection murm ur in LUSB and SINGLE S2 because stenotic pulmonary valve does not snap shut).
62
Cocaine vasospasm - tx and algorithm,
BENZOS, aspirin, nitroglycerin, CCB. NO BB, NO BB no TPA (INC ICH). BUT, cardiac cath if indicated (do all medical first(
63
AV block T 1, asx with normal QR
– No tx. If Prolonged QRS then should have electrophysiology testing
64
Infective endocarditis -> splenic abascess presentation
fever, leuk, LUQ pain, L pleuritic chest pain, left PLEURAL EFFUSION, Splenomegaly.
65
Afib in WPW – how to tx
Must tx with Procainamide (tx WPW) – CCB, BB, etc make it worse!
66
Single loud S2 can refer to
Tetralogy, Transposition, Tricuspid, Truncus (almost all of the early cyanotic)
67
Most common cyanotic condition PRESENTING in NEONATAL PERIOD (first few hours)
Transposition.
68
Harsh Holosystolic murmur in infant what to do? What if soft and not holosystolic
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
Aortic stenosis, echo or exercise test?
Echo first, then can exercise if appropriate.
70
Infective endocarditis tx algorithm –
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
Mech/reason for vagal maneuvers correcting SVT
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
Vasovagal syncope dx?
Upright tilt table test if unclear clinically. Carotid massage if for CAROTID HYPERSENSITIVTIY SYNDROME (tight collars etc)
73
Mitral valve prolapse
INC venous return/preload SHORTENS/softens murmur
74
Ventricular aneurysm heart sounds?
Ventricular aneurysm can cause murmurs by dilating and eventually causing mitral regurg.
75
Which type of shock INCreases mixed venous oxygen saturation?
Septic shock Inability to oxygenate tissues and inadequate extraction -> causes INC lactate levels etc.
76
Reversible restrictive CM?
Hemochromatois. Amyoid as well as Sarcoid and scleroderma (bot latter tx steroids) cannot be reversed!
77
Kid with holosystolic murmur at LLSB AND Apical diastolic rumble?
Large VSD, with shunting leads to pulmonary overcirculation and thus mitral valve flow murmur.
78
Subclavian steal syndrome
neuro sx with exercise. Dx angiography, tx bypass. Don’t confuse with thoracic outlet syndrome, which has NO neuro signs.

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