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Flashcards in Cardio Deck (312):
1

Interchangeable terms with CAD

Atherosclerotic heart disease
Ischemic heart disease

2

MCC of CP when source is clearly not cardiac

GI

3

Best initial test for CP

EKG (regardless of cause)

4

Why are men more at risk for MI under 50

Protective effect of Estrogen
This wears off at menopause and the risk becomes equal to males

5

Useful Hx in Ischemia

Duration
Quality
Location
Radiation
Frequency
Alleviating
Precipitating

6

Worst RF for CAD

DM

7

MC RF for CAD

HTN

8

Unmodifiable RFs for CAD

Age
Sex
Heredity

9

Clear RFs for CAD

DM
Smoking - Risk x2
HTN - goal 140/90, 130/80 in DM
Hyperlipidemia
FHx of premature CAD
Age > 45 men, 55 women

10

What is premature CAD

Males less than 55
Females less than 65

11

When is FHx of CAD relevant

First degree relative
Premature in family

12

Goal for LDL to prevent CAD

Less than 100
Less than 70 in DM

13

MCC of death in DM

Cardiovascular

14

Weight loss effect on BP

1 Kg decreased = 1 mmHg decreased

15

Best way to decrease BP

Weight loss

16

Best way to increase HDL

Exercise

17

Etiology of Takatsubo cardiomyopathy

Massive catecholamine discharge from emotional stress

18

These are NOT RFs for CAD

Chlamydia
Elevated CRP
Elevated homocysteine

19

Greatest improvement in risk for CAD

Stop smoking

20

Features of non-ischemic CP

Pleuritic
Positional
Tender
Knife-like
Lasts a few seconds

21

Why are men more at risk for MI under 50

Protective effect of Estrogen
This wears off at menopause and the risk becomes equal to males

22

Useful Hx in Ischemia

Duration
Quality
Location
Radiation
Frequency
Alleviating
Precipitating

23

When is FHx of CAD relevant

First degree relative
Premature

24

MCC of death in DM

Cardiovascular

25

Weight loss effect on BP

1 Kg decreased = 1 mmHg decreased

26

Best initial test for all forms of CP

EKG

27

Presentation of ischemic pain

Dull/sore
Squeezing

28

Features of inferior wall ischemia

Brady
Hypotension
+/- Dizziness

29

Nitrate effect on CP

↑ in GERD
↓ in Angina

30

Auscultation findings in MI

Wide split S2
LBBB
New S4
S3
New AR - Aortic dissection
New MR - Papillary muscle dysfunction

31

What causes wide split S2

RBBB
Pulm HTN
Pulmonic stenosis
RVH

32

What causes paradoxic S2

LBBB
HTN
AS
LVH

33

What causes fixed split S2

ASD

34

What causes S4 gallop

LVH (atrial systole)
Long standing HTN

35

What causes S3 gallop

Underlying CHF

36

Causes of pleuritic CP

PN
PE
Pericarditis - PR depression
PTX
Pleuritis

37

CP w/ chest wall tenderness:
Most accurate test:

Costochondritis
Physical exam

38

CP w/ radiation to back, unequal BP b/w arms:
Most accurate test:

Aortic dissection
CXR w/ widened mediastinum
CT, MRI or TEE confirms

39

CP w/ pain worse lying flat, age

Pericarditis
EKG w/ ST elevation everywhere, PR depression

40

CP w/ epigastric discomfort, pain better w/ eating:
Most accurate test:

Duodenal ulcer
Endoscopy

41

CP w/ bad taste, cough, hoarseness:
Most accurate test:

GERD
Resonse to PPIs, AlOH, Mg(OH)2, viscous lidocaine

42

CP w/ cough, sputum, hemoptysis:
Most accurate test:

PN
CXR

43

CP w/ sudden onset SOB, tachy, hypoxia:
Most accurate test:

PE
Spiral CT, V/Q in pregnancy

44

CP w/ sharp pleuritic pain, tracheal deviation:
Most accurate test:

PTX
CXR

45

Worst prognostic combination with CP

SOB

46

Best initial test for all forms of CP

EKG

47

When do CKMB and Troponins begin to rise

4hrs

48

When do CKMB and Troponins peak

12-24hrs

49

How long before CKMB resolves

3-4 days - Makes it good to test for re-infarction

50

When to do exercise stress test in setting of CP

Etiology not clear
EKG not diastolic

51

When to use Prasugrel in ischemic heart disease

Pts undergoing angioplasty and stenting
NOT in >75 due to risk of hemorrhage and stroke

52

Calculate a pts max HR

220-Age

53

What indicates ischemia on EKG

ST depression

54

What can cause baseline EKG abnormalities

LBBB
LVH
Digoxin - Downsloping ST
Pacer

55

2 ways of evaluating ischemia w/o EKG

Thallium uptake
Echo - wall motion abnormalities

56

Contraindications to ETT

Cardiac instability - Current CP
Pt can't exercise

57

MCC ischemic heart disease

Atherosclerosis

58

Calculate O2 delivery

CO x Hb/HCT x O2 sat

59

Why does normal myocardium pick up thallium

Looks like K

60

Differentiate infarct and ischemia on thallium uptake

Ischemia uptake returns to normal at rest

61

Increase myocardium O2 consumption w/o exercise

Dipyridamole or adenosine with Thallium
Dobutamine with ECHO

62

When to avoid dipyridamole

Asthmatics - Can cause bronchospasm

63

The lower the pretest likelihood of disease

The higher the rate of false positives

64

Why do we do angiography in ischemic heart disease

Determine bypass surgery vs angioplasty

65

Most accurate method of detecting CAD

Angiography

66

When does CABG decrease mortality

3 vessel disease or Left main
2 vessel disease in DM
2-3 vessel with Low EF
LV dysfunction

67

What lowers mortality in CAD

Aspirin
BBs
tPA
Angioplasty
Clopidogrel
ACEIs if ↓ EF
Statins if LDL > 100

68

What is the purpose of Holter

Rhythm monitoring (A-fib , flutter, premature beats, V-tach)

69

What lowers mortality in ischemic heart disease

Aspirin
BBs
Statins if LDL > 100

70

Best mortality benefit in chronic angina

Aspirin
BBs

71

When to use clopidogrel in ischemic heart disease

Aspirin intolerance
Recent angioplasty w/ stenting

72

AE Ticlopidine

Neutropenia
TTP

73

What do ACEIs/ARBs do in CAD

Decrease EF

74

When to give ACEIs/ARBs in CAD

Regurgitant valvular disease (Decreased LVEF)

75

What to do in hyperkalemia with ACEIs/ARBs

Switch to hydralazine and nitrates

76

What are CAD equivalents (LDL goal

PAD
Carotid disease
Aortic disease
DM

77

MC AE statins

Liver dysfunction (elevated transaminases)

78

Which lipid lowering drugs lower mortality the most in CAD

Statins

79

AE statins

Elevated transaminases
Myositis

80

AE niacin

Elevated glucose and uric acid
Pruritis

81

AE fibrate derivatives

Increase risk of myositis when combined w/ statins

82

AE Cholestyramine

Flatus, ABD cramping

83

AE ezetimibe

Nearly useless but well tolerated

84

Effect of CCBs on CAD

May increase mortality

85

ONLY time to use CCBs in CAD

Severe asthma
Prinzmetal
Cocain-induced CP
Max meds don't control pain

86

AE CCBs

Edema
Constipation (verapamil)
Heart block

87

What lowers mortality in CAD

Aspirin
BBs
tPA
Angioplasty
Clopidogrel
ACEIs if ↓ EF
Statins if LDL > 100

88

Best therapy in acute coronary syndrome

PCI esp w/ ST elevation

89

MCC death in USA

Acute coronary syndrome

90

Only way to determine etiology in acute coronary syndromes

EKG and Enzymes

91

Features of unstable angina

New pain
Worse pain
Rest pain

92

What is the sequelae of unstable angina

NSTEMI

93

Risk factors for unstable angina to progress to NSTEMI

Repetitive/Prolongued Pain
Persistent EKG changes
Hypotension
Elevated cardiac markers
Sustained V-tach
Syncope
EF

94

Heart sound in ACS

S4

95

What is associated with constrictive pericarditis

Kussmaul sign
(Increased JVP on inhalation)

96

Rx Dressler

NSAIDS and Aspirin +/- steroids

97

Displaced PMI is characteristic of

LVH
Dilated cardiomyopathy

98

Leads affected in Anterior wall

V2-4

99

Leads affected in Inferior wall

II, III, aVF

100

PR > 200ms associated with

1st degree AV block

101

Leads affected in posterior wall

ST depression in V1-2

102

Most important next step in ACS

Aspirin then Angioplasty then ICU

103

Greatest mortality benefit in ACS

Angioplasty

104

MCC death first several days after MI

Ventricular arrhythmia

105

How is PCI superior to thrombolytics

Survival and Mortality benefit
Fewer hemorrhage complications
Less MI complications

106

When to DEFINITELY do PCI (ie. thrombolytics are contraindicated)

Recent surgery
Melena
BP > 180/110
Aortic dissection
Stroke

107

When does PCI need to be performed

Within 90min of pt arrival

108

PCI complications

Rupture
Restenosis
Hematoma

109

Most important method of preventing restenosis after PCI

Drug-eluting stent (paclitaxel, sirolimus)

110

When can thrombolytics be administered

Within 12hrs

111

Door to needle time

30min

112

When to do CABG in late presentation MI (>12hrs)

Good anatomy
Cardiogenic shock
Mechanical repair

113

When to do emergency CABG

Failed PCI
Persistent/Recurrent ischemia refractory to meds

114

ACS, who gets Aspirin

Everyone
BIT

115

ACS, who gets clopidogrel

Aspirin not tolerated
Pt undergoing angioplasty and stenting

116

ACS, who gets BBs

Everyone

117

ACS, who gets ACEi/ARBs

Everyone
Best for EF

118

ACS, who gets statins

Everyone
Best for LDL>100

119

ACS, who gets O2, nitrates

Everyone
No mortality benefit

120

ACS, who gets Heparin

After thrombolytics/PCI to prevent restenosis
Initial therapy w/ ST depression and other NSTE events

121

ACS, who gets CCBs

Can't use BBs
Cocaine
Prinzmetal or vasospastic variant

122

When can you give glycoprotein IIb/IIIa inhibitors

ACS w/ angioplasty and stenting
ST depression
NSTEMI

123

Best for NSTEMI

Heparin
Glycoprotein IIb/IIIa inhibitors

124

What does "not better" mean in STE ACS

Persistent pain
S3 gallop or CHF
Worse EKG changes or SVT
Rising troponins

125

Next step for pts in STE ACS and are not getting better

Angiography and possible angioplasty

126

Where do you see cannon A waves

3rd degree AV block

127

Rx Symptomatic 3rd degree AV block

Atropine
Then Pacemaker

128

Most specific finding in Right ventricular infarction

STE in RV4

129

What does the right coronary supply

RV
AV node
Inferior wall

130

Rx RV infarctions

High volume fluid replacement

131

MC complications of MI

V-tach
V-fib

132

When to look for tamponade/free wall rupture after mI

Sudden loss of pulse

133

Rx v-tach/v-fib

Cardioversion/defibrillation
Then give BBs

134

Presentation of valve or septal rupture after MI

New onset murmur and pulm congestion

135

Most accurate test for valve or septal rupture

Echo

136

What to look for in septal rupture

Step-up in O2 sat from RA to RV
(ie. sharp increase in O2 sat)

137

Rx stable v-tach

Amiodarone
Procainamide
Lidocaine

138

When to use intraaortic balloon pump

Acute pump failure from anatomical problem fixed in OR

139

What to look for in reinfarction/infarction extension after MI

Recurrence of pain
New Rales
New bump in CKMB
Sudden onset pulm edema

140

Management of reinfarction/infarction extension after MI

EKG
Angioplasty
Aspirin, BBs, Nitrates, ACE, statins

141

Detection of aneurysms/mural thrombus post MI

Echo

142

Rx mural thrombus post MI

Heparin, then warfarin

143

Why do stress test before d/c after MI

Evaluate need for angiography (residual ischemia)
Only if patient is asymptomatic
Done at 5-7 days

144

Postinfarction meds

Aspirin
BBs
Statins
ACEIs (stop at 6wks if EF is NL)

145

Alternate drugs in postinfarction

Clopidogrel - Aspirin intolerance
ARBs - Cough w/ ACEI
Ticlopidine - Aspirin and Clopidogrel intolerance

146

MCC erectile dysfunction post-MI

Anxiety

147

Essential feature of CHF

Dyspnea

148

Difference between systolic and diastolic dysfunction

EF preserved in diastolic dysfunction
Can really only tell with Echo

149

MCC CHF

HTN causing cardiomyopathy
Myocardial muscle abnormality

150

Other causes of CHF

Valvular heart disease
MI

151

Rare causes of CHF

Alcohol
Postviral
Radiation
Adriamycin
Chagas
Hemochromatosis
Thyroid disease
Peripartum
Thiamine def

152

How to Dx CHF

Clinical Dx
Dyspnea
Orthopnea
Rales
JVD
PND
S3

153

Sudden onset dyspnea w/ clear lungs

PE

154

Sudden onset dyspnea w/ wheezing, increased expiratory phase

Asthma

155

Slow dyspnea w/ fever, sputum, unilateral rales/rhonchi

PN

156

Dyspnea w/ decreased breath sounds unilaterally, tracheal deviation

PTX

157

Dyspnea w/ circumoral numbness, caffein use, hx anxiety

Panic attack

158

Dyspnea w/ pallor gradual over days to weeks

Anemia

159

Dyspnea w/ pulsus paradoxus, decreased heart sounds, JVD

Tamponade

160

Dyspnea w/ palpitations, syncope

Arrhythmia (any)

161

Dyspnea w/ dullness to percussion at bases

Pleural effusion

162

Dyspnea w/ long smoking hx, barrel chest

COPD

163

Dyspnea w/ recent anesthetic use, brown blood not improved w/ O2, clear lungs, cyanosis

Methemoglobinemia

164

Dyspnea w/ burning building/car, wood burning stove in winter, suicide attempt

CO poisoning

165

Most important test in CHF

Echo

166

Best initial test for CHF

TTE

167

Most accurate test for CHF

MUGA

168

When would you use MUGA for CHF

Test for AE of doxorubicin for lymphoma Rx

169

When would you check BNP in CHF

Acute SOB w/ unclear etiology and cannot wait for echo
Normal BNP excludes CHF

170

Test if CHF etiology is from MI or heart block

EKG

171

Test if CHF etiology is from dilated cardiomyopathy

CXR

172

Test if CHF etiology is from paroxysmal arrhythmias

Holter

173

Test if CHF etiology is from valve/septal defects

Cath

174

Test if CHF etiology is from Anemia

CBC

175

Test if CHF etiology is from thyroid

T4/TSH

176

Test if CHF etiology is from infiltrative disease

Endomyocardial bx

177

Differentiate between CHF and ARDS

Swan-Ganz (not routine)

178

Decrease mortality in systolic dysfunction

ACEIs/ARBs
BBs
Spironolactone

179

Decrease sx in systolic dysfunction

Diuretics
Digoxin

180

Only BBs used in systolic dysfunction

Metoprolol
Bisoprolol
Carvedilol

181

How do BBs help in systolic dysfunction

Anti-ischemic
Decrease HR therefore decrease O2 consumption
Antiarrhythmic

182

MCC death from CHF

Arrhythmia

183

AE spironolactone

Gynecomastia - switch to eplerenone
Hyperkalemia

184

When to give diuretics in CHF

Initial therapy w/ low EF along with ACEI/ARB

185

What to do w/ hyperkalemia in CHF treatment

Switch ACEI to hydralazine and nitroglycerin

186

Sx digoxin tox

GI (MC)
CNS
Visual
Hyperkalemia

187

When to give implantable defibrillator in CHF

Ischemic cardiomyopathy w/ EF

188

When to give biventricular pacemaker

DIlated cardiomyopathy w/ EF 120ms

189

Mortality benefit in systolic dysfunction

ACEIs/ARBs
BBs
Spironolactone/Eplerenone
Hydralazine/Nitrates
Implantable defibrillator

190

Clear mortality benefit in diastolic dysfunction

BBs
Diuretics

191

Worst form of CHF

Pulmonary edema

192

Presentation of Pulm edema

Acute SOB
Pink frothy productive cough
Rales, JVD, S3
Orthopnea
Edema

193

What are Kerley B lines on CXR

Fluid in septum

194

When to use BNP in pulm edema

SOB etiology is unclear
NL rules it out

195

CXR in pulm edema

Vascular congestion
LVH (chronic)

196

ABG results in pulmonary edema

Hypoxia

197

Most important test to do acutely in pulm edema

EKG

198

Fastest way to fix acute pulm edema from arrhythmia

Cardioversion

199

Contribution of atrial systole to CO

10-20%

200

Contribution of atrial systole to CO in the setting of dilated cardiomyopathy, decreased EF, valvular disease

40-50%

201

Best initial therapy of pulmonary edema

Diuretics to remove large fluid volumes

202

Preload reduction in pulm edema

Loops
O2
Morphine
Nitrates

203

When to use positive inotropes in pulm edema

Pt in ICU and not responding to diuretics
Dobutamine, Amrinone, Milrinone

204

When to give digoxin in pulm edema

Chronically to increase contractility esp w/ A-fib

205

Acute afterload reduction in pulm edema

Nitroprusside
IV hydralazine

206

Chronic afterload reduction in pulm edema

ACEIs/ ARBs

207

Main causes of regurgitant diseases

HTN
Ischemic heart disease

208

Best initial test for any valvular disease

Echo

209

Most accurate test for any valvular disease

Catheterization

210

Endocarditis PPx in valvular disease

Not indicated unless there has been replacement or previous endocarditis

211

MCC of MS

Rheumatic fever

212

Associations w/ MS

Pregnancy
Immigrants

213

Unique presenting features of MS

Dysphagia
Hoarseness
A-fib and stroke from enlarged LA → systemic emboli
Hemoptysis

214

Murmur in MS

Opening snap in diastole (after S2)
Loud S1

215

Common EKG findings in MS

A-fib

216

CXR in MS

Straightening of left heart border
Elevation of left main-stem bronchus
Second bubble behind heart

217

Rx MS

Diuretics, Na restriction - preload reduction
Balloon valvuloplasty - refractory/pregnant
Valve replacement - balloon contraindicated or fails
Warfarin for A-fib
Rate control for A-fib - digoxin, BBs, diltiazem/verapamil

218

Is pulm HTN a contraindication for surgery for MS

No

219

MCC AS

Congenital bicuspid
Calcification from aging

220

Presentation of AS

Angina (MC)
Syncope
CHF - poorest prognosis, 2yr survival

221

Murmur in AS

Systolic crescendo-decrescendo

222

Echo results in AS

Thick aortic leaflets
Decreased excursion
LVH

223

CXR and EKG findings in AS

LVH

224

Only true effective therapy in AS

Valve replacement when area

225

When to do balloon valvuloplasty in AS

Surgery contraindicated due to instability or fragility of pt

226

Cause of MR

Dilation of the heart
- HTN
- Endocarditis
- MI
- Papillary muscle rupture

227

Only unique physical finding in MR

Pan(holo)systolic murmur
Rest looks like CHF

228

Radiation of MR murmur

Axilla

229

Rx MR

Vasodilators - ACEIs/ARBs
Digoxin/diuretics
Valve replacement - LVSED >45 or EF

230

MCC AR

HTN

231

Causes of AR

Dilation of heart or aorta
- HTN
- MI
- Endocarditis
- Marfan, cystic medial necrosis
- Aortic dissection
- Ankylosing spondylitis/Reiter
- Syphilis

232

Unique PE findings in AR

Wide pulse pressure
Watter hammer pulse
Pulsating nail beds
BP in legs > BP in arms
Head bobbing

233

Murmur in AR

Diastolic decrescendo best heard at left lower sternal border

234

EKG/CXR findings in AR

LVH

235

Rx AR

Vasodilators - ACEIs/ARBs
Valve replacement - LVESD > 55, EF

236

Causes of MVP

Normal variant W>M
Marfan, Ehlers-Danlos

237

MC presentation of MVP

Atypical CP
Palpitations
Panic attack
Syncope

238

Murmur in MVP

Midsystolic click

239

Rx MVP

BBs if symptomatic
Valve repair

240

Endocarditis PPx in MVP

Not indicated

241

Murmurs increased w/ more blood to heart (Leg raise, squat)

MS, AS
MR, AR

242

Murmurs increased w/ less blood to heart (valsalva, standing)

MS, AS
MR, AR

243

Murmurs decreased w/ more blood to heart (Leg raise, squat)

HOCM
MVP

244

Murmurs decreased w/ less blood to heart (valsalva, standing)

HOCM
MVP

245

Murmurs that do NOT increase with expiration

HOCM
MVP

246

Rx for all types of cardiomyopathies

Diuretics

247

MCC dilated cardiomyopathy

Previous MI and ischemia

248

Other causes of dilated cardiomyopathy

Alcohol - 2nd MCC
Postviral myocarditis
Radiation
Toxins
Chagas
Peripartum

249

Dx dilated cardiomyopathy

Echo then EKG, CXR
Shows decreased EF

250

Rx dilated cardiomyopathy

ACEIs/ARBs, BBs, spironolactone
Diuretics, digoxin
Biventricular pacemaker if QRS > 120ms

251

MCC hypertrophic cardiomyopathy

HTN

252

What is HOCM

Genetic disorder w/ abnormal shape of heart septum

253

Features specific to HCM

S4
Fewer RHF signs

254

MCC presentation of HOCM

Dyspnea

255

Other sx in HOCM

CP
Syncope
Sudden death

256

What worsens sx in HOCM

Anything increasing HR
Anything decreasing LV size
- ACEIs/ARBs
- Digoxin
- Hydralazine
- Valsalva
- Standing suddenly

257

Best initial test for HCM

Echo

258

Best initial therapy for HCM and HOCM

BBs

259

Most accurate test for HCM

Cath

260

Common EKG changes in HOCM

Septal Q waves

261

What to give in HOCM w/ syncope

Implantable defibrillator

262

Ultimate therapy in HOCM

Surgical myomectomy
Only after septal ablation is tried and meds fail

263

Hand grip increases

AR, MR

264

Hand grip decreases

AS
MVP
HOCM

265

Problem in restrictive cardiomyopathy

Heart doesn't contract or relax normally

266

Causes of restrictive cardiomyopathy

Sarcoidosis
Amyloid
Hemochromatosis
Endomyocardial fibrosis
Scleroderma
Cancer

267

MC complaint in restrictive cardiomyopathy

Dyspnea w/ RHF signs

268

Where do you see kussmaul's sign

Restrictive cardiomyopathy
Constrictive pericarditis

269

Best initial test for restrictive cardiomyopathy

Echo

270

Most accurate test for restrictive cardiomyopathy

Endomyocardial Bx

271

Rx restrictive cardiomyopathy

Treat underlying cause
Diuretics may help

272

Which valvular diseases do diuretics help

MS, AS
MR, AR

273

MC infection causing pericarditis

Viral

274

MC connective tissue disease causing pericarditis

SLE

275

Presentation of pericarditis

Sharp CP changing in intensity w/ respiration and body position
Worse lying down

276

EKG in pericarditis

PR depression
ST elevation in all leads

277

Rx pericarditis

Treat underlying cause

278

Rx pericarditis if idiopathic cause

Presumed to be coxsackie B
NSAIDS - Steroids if they don't work
Colchicine reduces recurrence

279

Any cause of pericarditis can cause

Pericardial tamponade

280

Common features of pericarditis

Hypotension
Tachy
Distended neck veins (not in PE)
Clear lungs

281

Physical finding in tamponade

Pulsus paradoxus

282

What is pulsus paradoxus

>10mmHg decrease in BP on inspiration

283

Why should echo be done over EKG in tamponade

EKG commonly only shows tachy

284

EKG feature in tamponade

Electrical alternans

285

CXR feature in tamponade

Water bottle heart

286

Echo feature in tamponade

RA and RV diastolic collapse

287

Rx tamponade

Pericardiocentesis
IVF
Subxyphoid window in pericardium for recurrence

288

What is constrictive pericarditis

Any cause of pericarditis leading to calcification and fibrosis (can be from TB)

289

Sx indicating constrictive pericarditis

Signs of RHF
- Edema
- Ascites
- Hepatosplenomegaly
- JVD

290

Physical findings in constrictive pericarditis

Kussmaul sign - Increased JVD on inhalation
Knock - extra heart sound in diastole

291

Best initial test for constrictive pericarditis

CXR showing calcification and fibrosis

292

Rx Constrictive pericarditis

Diuretics FIRST
Surgical removal of pericardium

293

Causitive factors for PAD

DM
Hyperlipidemia
HTN
Smoking

294

Key sx in PAD

Leg pain in calves on exertion (intermittent claudication)
Pain walking up and down hills

295

Differentiate PAD from spinal stenosis in Hx

Stenosis is pain waling down hills only

296

Severe PAD is associated with loss of

Hair follicles
Sweat glands
Sebaceous glands

Skin looks smooth and shiny

297

Best initial test for PAD

ABI

298

Most accurate test for PAD

Angiogram

299

Best initial therapy for PAD

Aspirin
Stop smoking
Cilostazol

300

Single most effective medication for PAD

Cilostazol

301

Sx description in aortic dissection

Severe, Sharp, Tearing
Radiating through to back

302

Key points of aortic dissection

Loss of pulses +/- aortic insufficiency
BP difference b/w arms
Pain between scapulae

303

CXR feature in aortic dissection

Widened mediastinum

304

Most accurate test for aortic dissection

Angiography
However MRA = CTA = TEE

305

Best initial test for aortic dissection

CXR

306

Rx aortic dissection

Control BP
- BBs
- Nitroprusside
- Surgical correction

307

Most appropriate screening for aortic aneurysm

Surgical/Catheter repair when AAA > 5cm

308

Who doesn't get screened for AAAs

Non-smokers
Women

309

Worst form of heart disease in pregnancy

Peripartum cardiomyopathy
- Abs against myocardium in pregnancy

If this isn't a choice then Eisenmenger

310

Rx if LV dysfunction doesn't improve

Cardiac transplant

311

Medical therapy of peripartum cardiomyopathy

ACEIs/ARBs
BBs
Spironolactone
Diuretics
Digoxin

312

Eisenmenger syndrome

R to L shunt from pulm HTN in people w/ VSD