Cardiac for dummies

Question 1

If a patient doesn’t tolerate an ace inhibitor, you can next try them on an_______. This class of medication should NEVER be given in combination with an ACE inhibitor.

Answer 1

ARBs

-sartans (losartan)

for people who don’t tolerate ACE inhibitors

Question 2

First line agents for HTN are:

Answer 2

thiazide diuretics

Question 3

SBP >180 or DBP>110 is hypertensive____

and is treated with ______

Answer 3

urgency

oral antiHTN

Question 4

swelling of the optic disc with blurred margins

Answer 4

papilledema

emergency, requires IV antiHTN and BP monitoring

Question 5

What EKG changes are seen with classic anginal pain?

Answer 5

ST depression

Question 6

stable/exertional angina

Answer 6

chest pain with exertion

goes away with NTG/rest

typically ST depression

tightness pain of chest

Question 7

Printzmetals angina is caused by:

Answer 7

vasospasm

(NOT BY CAD, these people have a clean angio)

treated with calcium channel blockers

typically ST elevation on EKG

Question 8

Levine’s sign is more than 90% diagnostic of angina.

Levine’s sign is when:

Answer 8

the patient has their hand clenched over their chest

Question 9

What is normal total cholesterol?

Answer 9

<200

Question 10

What is normal triglycerides?

Answer 10

<150

Question 11

What is optimal LDL?

Answer 11

<100

Question 12

When is HDL high?

Answer 12

>60

this is good bc it cancels the preHTN risk

Question 13

Patients with angina should modify their diet by decreasing:

Answer 13

saturated and unsaturated fats

Question 14

30% of patients with MI have no initial _____ changes

Answer 14

12-lead EKG

Question 15

Which troponin is 100% cardio selective?

Answer 15

troponin I

Question 16

Per Barkley, the treatment for acute MI IN ORDER is:

Answer 16

1st ASA

2nd nitro

(unblock the vessel before trying to get O2 to it)

3rd oxygen

Question 17

What is the timeframe for cardiac fibrinolytics?

Answer 17

30 minutes of chest pain, within 6 hours of onset

Question 18

Why do patients with claudication need to exercise?

Answer 18

To develop collateral circulation

Question 19

What is first line therapy for dermatitis?

Answer 19

wet compress and hydrocortisone

(NOT antibiotics)

Question 20

What is the leading cause of heart failure in America?

Answer 20

HTN

Question 21

What heart sound is heard suring systole and is the closing of the AV valves?

Answer 21

S1

Question 22

What heart sound is head during diastole and is the closing of the pulmonic and aortic valves?

Answer 22

S2

Question 23

Name three causes of S3?

Answer 23

pregnancy (normal)

CHF

fluid overload

Question 24

Name three causes of S4?

Answer 24

HTN

stiff ventricular wall

MI

Question 25

Which heart sound sounds like Kentucky?

Answer 25

S3

Question 26

Which heart sound sounds like Tennessee?

Answer 26

S4

Question 27

What is the grading system for cariac murmurs 0-6/6?

Answer 27

1/6 very faint 2/6 faint 3/6 AUDIBLE 4/6 AUDIBLE + THRILL you can feel 5/6 part of stethascope off 6/6 from the door

Question 28

If you hear a low-pitched **d**iaslotic murmur at the APEX, apical crescendo, what is it? \*remember APEX is the bottom = mitral \*MS AR**D**

Answer 28

mitral stenosis

Question 29

A systolic cardiac murmur at the 5th ICS MCL (apex), *radiates to left axilla*, blowing, musical. \*MR ASS \*radiates to left axilla

Answer 29

mitral regurg

Question 30

systolic murmur, *right* 2nd ICS, *radiates to the neck* \*MR ASS

Answer 30

aortic stenosis

Question 31

diastolic murmur at 2nd left ICS (base) MS AR**D**

Answer 31

aortic regurg

Question 32

MS ARD MR ASS

Answer 32

Mitral stenosis Aortic regurg Diastolic mitral regurg aortic stenosis systolic

Question 33

According to Dr. Barkley, standard pharmacologic treatment for heart failure includes:

Answer 33

ace-inhibitors and thiazide diuretics

Question 34

Beta blockers can cause what pulmonary side effect?

Answer 34

wheezing

Question 35

Name 3 Secondary causes of HTN

Answer 35

Renal failure renal artery stenosis pheochromocytoma hyperthyroidism

Question 36

NYHA functional classifications of heart failure

Answer 36

I: no limitations of physical activity II: slight limitations of physical activity but comfortable at rest III: marked limitations of funcitonal activity but comfortable at rest IV: severe; inability to carry out any physical activity without discomfort, signs and symptoms while at rest

Question 37

A patient with what NYHA classification will need pillows for orthopnea at night?

Answer 37

Class 4 because they have signs and symptoms while at rest

Question 38

What differentiates NYHA HF class II from Class III?

Answer 38

both are comfortable at rest, but class II has SLIGHT limitations of physical activity and class III has MARKED limitation of physical activity

Question 39

Name three signs/symptoms of HTN

Answer 39

S4 (r/t ventricular hypertrophy and stiff ventricular wall) suboccopital pulsing HA epistaxis \*often silent killer without any signs and symptoms

Question 40

How does the use of NSAIDS exacerbate HTN?

Answer 40

bc they effect prostaglandins and the kidneys

Question 41

A chest x-ray of a patient with HF may show what three things?

Answer 41

pulmonary edema Kerley B lines effusions

Question 42

According to JNC 8 recommendations, pharmacologic treatment for HTN in African-Americans includes which two drugs first?

Answer 42

1st thiazide diuretics 2nd calcium channel blockers

Question 43

According to JNC 8, goal BP for a patient 60 or **older** is:

Answer 43

**SBP\<150** DBP\<90

Question 44

According to JNC 8, goal DBP for any adult regardless of age is:

Answer 44

DBP\<90

Question 45

According to JNC 8, goal BP for patients *less than 60 is*

Answer 45

SBP\<140 DBP\<90

Question 46

According to JNC 8, the goal BP for any adult with CKD or DM

Answer 46

SBP\<140 DPB\<90

Question 47

According to JNC 8, what is the drug class of choice for the treatment of HTN for adults with CKD *regardless of race or other medical conditions?*

Answer 47

ACE inhibitor ARB if they don't tolerate ACE \*never ACE-I and ARB together

Question 48

According to JNC 8, when do you refer a patient to a HTN specialist?

Answer 48

if 3 or more drugs are needed

Question 49

How do Thiazide diuretics work to reduce morbidity and mortality and patients with HTN and what are their side effects?

Answer 49

Thiazide diuretics increase the exrection of sodium AND water they may cause *hyponatremia*, *hypokalemia,* hypomangesemia, HYPERcalcemia and Hyperglycemia

Question 50

ACE inhibitors (or ARBs if ACE not tolerated) are recommended 1st line for the treatment of HTN in patients with CKD despite age or ethnicity. What female condition and what electrolyte imbalance is an ACE-I/ARB contraindicated in?

Answer 50

ACE inhibitors are contraindicated in pregnancy Do not initiate ACE-I if K\>5.5

Question 51

What anti-HTN drug class should be avoided in patients with asthma/COPD?

Answer 51

beta blockers because beta 2 stimulates bronchoconstriction and can cause wheezing

Question 52

What antiHTN class is used for Printzmetal's angina and migraines?

Answer 52

calcium channel blockers

Question 53

What central alpha-2 agonist is the drug of choice in pregnancy and can also be used in Parkinsons?

Answer 53

methyldopa (aldomet)

Question 54

If you see a patient with BP \>180/120 and fondoscopic changes which include flame-shaped retinal hemorrhages, soft exudates, and papilledema (swelling of the optic disk with blurred margins), what is the diagnosis and how long do you have to correct the BP?

Answer 54

hypertensive emergency/malignant HTN within 1-2 hours redue BP by 25%

Question 55

Satins are contraindicated in patients with

Answer 55

liver disease

Question 56

If you diagnose a patient with angina, what medication would you prescribe *daily*

Answer 56

ASA 81mg PO daily

Question 57

When treating a patient with statin therapy, which level are you targeting?

Answer 57

the goal of statin therapy is to reduce the LDL by at least 50%

Question 58

If you have a patient with liver problems who can't take statins, what is a cheap pharmacologic treatment option that decreases LDL and increases HDL?

Answer 58

niacin

Question 59

HMG-CoA reductase inhibitors are:

Answer 59

statins

Question 60

Exam findings/signs of MI

Answer 60

S4 low grade fever 48 hours Troponin I elevate within 4-6 hours leukocystosis 10-20 on the second day due to inflamation/damage of the necrotic tissue