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1
Q

Dx stable angina?

A
  1. EKG
  2. Stress test
  3. Angiography
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2
Q

When to measure cardiac enzymes in angina?

A

Acute chest pain > 1 HR

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3
Q

Drug contraindicated with quinidine?

A

Amiodrone

Decrease quinidine clearance by kidney resulting in fatal arrhythmia

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4
Q

Nitrate formulas and their rout of administration

A
  1. Isosorbide mononitrate = oral no 1st bypass metabolism (Tab)
  2. Isosorbide dinitrate = max effect in 6 min (sublingual)
  3. Glyceryl trinitrate = max effect in 4 min (sublingual)
  4. Erythrityl tetranitrate = mixed w/ lactose (sublingual)
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5
Q

MC SE of CCB? (Amlodipine)

A

Peripheral edema
Low BP
Cough
Lung edema

Due to vasodilation

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6
Q

Drugs improve mortality in MI?

A

BB
ACEI/ARB
Aspirin (time dependent)
Statins

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7
Q

Drug contraindicated in anaphylaxis?

A

Atropine if tachycardia

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8
Q

Lab monitoring with amiodrone

A

LFT
Thyroid (hypo > hyper)
Every 6 months

No need for CXR or slit lamp

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9
Q

SE of amiodrone

A

Liver + thyroid toxicity

Lung toxicity: cough and dyspnea + interstitial filtrates on CXR

ARDS

Corneal deposits don’t effect vision.

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10
Q

Drugs contraindicated with BB? Why?

A

CCB
Verapamil + diltiazem

Cause bradycardia and effect AV conduction.

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11
Q

MCC of drug induced angioedema?

A

ACEI = increase levels of bradykinin

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12
Q

ECG in inferior MI

A

ST elevation in II, III, aVF

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13
Q

What artery causes inferior MI

A

Rt coronary artery

Left circumflex artery

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14
Q

ECG findings of left circumflex artery MI?

A
  1. ST elevation in II = III and ST-depression in V1-3 or ST-elevation in I + aVF
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15
Q

ECG of Rt coronary artery MI

A

ST elevation in III > II

ST-Depression in I and aVF

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16
Q

ECG of left anterior descendant coronary artery?

A

ST elevation or Q wave in any leads V1-V6 + I and aVF

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17
Q

Drug worsen CHF? Why?

A

Vasopressin

Vasoconstricts arteries and veins causing fluid retention and worsen low Na

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18
Q

Mechanism of action of nitroglycerin

A

Dilates veins, arteries, and arterioles.

Reduce LV preload + after load

Reduce oxygen demand

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19
Q

What’s angina decubitus

A

Angina when lying down without cause.

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20
Q

Cause of angina decubitus

A

Gravity redistributes fluids and make the heart work harder.

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21
Q

Dose of aspirin given in acute MI?

A

162-325 mg uncoated aspirin. (Not enteric asa which has delayed effect).

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22
Q

What determines cardiac oxygen demand

A 
Tension 
Preload
After load 
Contractility
HR
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23
Q

DM drugs contraindicated in CHF? Why?

A

Thiazolidinediones (pio/rosiglitazone)

Cause fluid retention

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24
Q

MVP murmur

A

Midsystilic click

Late systolic murmur

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25
Effect of standing + valsalva on valvular disease
1. MVP: Increased | 2. AS: increased
26
AS murmur? Best heard?
Systolic crescendo-decrescendo ejection murmur Rt 2nd ICS w/ patient leaning forward
27
Cardiac SE of sumatriptan
It's a 5HT1D + 1B agonist | Causes vasoconstriction = angina.
28
What's cilostazol?
Phosphodiestrase inhibitor for intermittent claudication
29
Contraindication to cilostazol
CHF | Bcz increases HR
30
Beneficial effects of cilostazol
Increases HDL Rx 3rd degree block.
31
Gold standard for aortic dissection
MRI
32
What's aortic dissection
Tear in aortic intima with separation of intima and media creating false lumen and hemorrhage within media
33
What other than ST elevation indicate MI in ECG?
New onset Lt BBB Left anterior descending artery
34
IE prophylaxis in VHD
Prosthetic valve Underwent repair Hx IE Cyanotic congenital disease even with repair (tetralogy of fallout, Transposition of great vessels) Not patent foramen ovale Give oral amoxicillin 1 HR before procedure If allergic to penicillin: Clindamycin Azithromycin
35
Effect of digitalis on heart
Reduce filling pressure Increase contraction force Increase CO Decrease HR
36
How to measure the effects of warfarin, heparin, ASA
``` Warfarin = PT Heparin = PTT ASA = BT ```
37
Contraindication to ACEI
Angioedema
38
Rx of HTN
``` 1. Age > 60 Start thiazide < 60 Start CCB ``` 2. No benefit combine: Thiazide + CCB + BB + ACE/ARBs 3. Add: - Central a-agonists: a-methyl dopa Clonidine - Peripheral a-antagonists: Prazosin Terazosin Doxazosin - vasodilator: Minoxidil Hydralazine
39
When to start combination HTN meds?
If > 160/100
40
HTN + co-morbidities Rx (6 conditions)
1. Asthma / depression: No BB 2. Black: CCB or thiazide 3. DM: ARBs/ ACEI 4. CAD: BB, ACEI/ARBs 5. Hyperthyroid: BB 6. Osteoporosis: thiazide
41
Benefit of ACEI/ARBs in CHF (systolic)
Improve mortality with low EF
42
Anti-HTN not used in sulfa allergy
Thiazides
43
BP control post stroke
Gradual reduction in SBP 10-20% it it's > 220.
44
Anti-HTN contraindicated in gout?
Thiazide | Increase uric acid
45
Anti-HTN contraindicated in diabetic nephropathy
Alpha blockers
46
Dx VHD?
1st: Echo Dx: catheterization
47
Triad of AS
Syncope Exertional angina CHF
48
AS murmur
Ejection systolic murmur at 2nd ICS Rt to sternum Radiates to clavicle
49
Anti-HTN contraindicated in DM
Thiazide | Increases glucose
50
Hypertrophic obstructive cardiomyopathy classic
Young 20-40 Healthy PMO displaced laterally Mid-systolic harsh murmur at left Lowe sternal Reduced by squatting Enhanced by standing
51
SE of ASA
Tinnitus / ringing in ears
52
Rx of Raynaud's phenomenon
CCB
53
Contraindicated in Raynaud's phenomenon
BB Ergotamine Methysergide
54
Appropriate BP cuff size
Cuff width: 40% of limbs circumference Cuff length: bladder at 80% limbs circumference
55
Placement of BP cuff
3 cm above elbow Bladder on brachial artery At heart level
56
How to measure pressure manually
1. Place cuff 3 cm above elbow 2. Bladder on brachial artery 3. Patient rest seated for 5 min 4. Arm bare and at heart level 5. Inc pressure to 30 mmHg rapidly above level radial pulse is extinguished. 6. Place bell/diaphragm on brachial artery 7. Open valve at deflation rate 2 mmHg/HR 8. Read systolic at 1st tap 9. Read diastolic at point sound disappear.
57
How to avoid venous congestion with manual pressure reading
Allow >1 min between readings
58
Clinical signs of AR
Wide pulse pressure Quinckes pulse Musset sign
59
When is bifid pulse found
Hypertrophic cardiomyopathy
60
When is low amplitude pulse found
Peripheral arteriosclerosis
61
When is pulsus alternans found
CHF
62
When is pulsus paradoxus found
Constrictive or restrictive cardiomyopathy
63
What's 5-HIAA when is it found
Break down of serotonin in urine GI tumor in carcinoid tumors
64
Define resistant HTN
> 140/90 if no DM or CDK > 130/80 if DM/CKD While adherent to 3 Rx including diuretics
65
Diuretic of choice of GFR <30 ml/Min?
Loop > thiazide
66
Drugs contraindicated in cocaine-induced chest pain
BB
67
When is BB contraindicated in chest pain/STEMI?
In Cocaine, amphetamine or stimulant overdose
68
Why BB contraindicated in cocaine overdose
BB = block B2 vasodilator receptor And cocaine activates a-1 and cause vasoconstriction So worsening of MI
69
Rx of cocaine induced chest pain
CCB Hydralazine ASA
70
Common drug interacts with ACEI?
NSAID's 1. NSAIDs lead to Na retention 2. Decrease PG which have a vasodilatory effect on kidney
71
What decreases mortality in hypertrophic cardiomyopathy?
Defibrillator
72
Effect of BB / CCB in hypertrophic cardiomyopathy
Sx control
73
Hypocalcemia ass arrhythmia
QT prolongation
74
Rx of STEMI (time dependent)
ASA + P2Y12 receptor blacker (clopidogrel, prasugrel, ticarogrelor)
75
NSAIDs in STEMI?
Contraindicated | Weaken muscle = rupture.
76
Sx of subaortic stenosis
Young Systolic murmur at Rt sternal Increased with valsalva Decreased with hand grip
77
What valvaular disease in endocarditis from IV drug use?
Tricuspid regurge Systolic murmur Increase with inspiration = inc heart filling
78
Guide lines for HTN in stroke?
Keep SBP < 220 | DBP < 120
79
Why maintain BP at < 220/120 in stroke
Protective mechanism to increase cerebral profusion
80
Replacement of ACE/ARBs in HTN of CHF?
Nitrates/ hydralazine
81
HTN drug causes rebound if stopped?
Alpha-blockers: - Clonidine - Guanfacin
82
T/F: BNP differentiates systolic from diastolic CHF
F
83
When to replace in aortic stenosis?
Aortic area < 1 cm
84
What worsen prognosis of AS?
If asymptomatic survival is same as normal If symptomatic: Angina 50% 5Yr survival Syncope 50% 3Yr survival CHF 50% 2Yr survival
85
T/F: digoxin improve mortality in CHF
F
86
T/F: Digoxin decreases hospital admission from CHF
T
87
What's diastolic HF?
Stiff ventricle = increased EDLV pressure
88
MCC of diastolic HF?
HTN
89
T/F: optima Rx of systolic HF necessary for diastolic HF
F | Worsen diastolic HF
90
T/F: CCB reduce mortality in diastolic HF
F
91
T/F: BB improve mortality in diastolic HF
T Control rate allow for enough filling
92
When to admit DVT?
1. Massive DVT (iliofemoral) 2. PE 3. Risk of bleeding on anticoagulant 4. Co-morbid conditions
93
Outpatient Rx of DVT
LMWH + warfarin | Compression stockings for 1 years
94
HTN + LV hypertrophy Rx
ACEI
95
Pathophysiology of cocaine-chest pain
Dopamine-depleted state = vasospasm
96
Receptors mediate cocaine induced chest pain
Alpha receptor | Thus BB worsen Sx
97
Rx of superventricular tachy
Adenosine
98
Amiodrone is used in what arrhythmia
Sustained VT regardless of hemodynamic stability AFib ONLY in symptomatic w/ LV heart failure
99
Facts about digoxin
1. Not used in AV block unless Rx with pacemaker. 2. Loading dose not necessary 3. Serum levels are not necessary
100
Period of anticoagulation after drug-eluting stent in MI?
12 months of ASA 162-325 Clopidogrel 75 or prasugrel 10 mg
101
DOC for SVT?
Adenosine Other non-pharm: carotid massage
102
Pain Drugs contraindicated in CHF
NSAIDs
103
Effect of high-dose ASA in CHF?
Decrease mortality benefit by ACEI! Use low-dose if must
104
Benefit of exercise in peripheral vascular disease?
As beneficial as bypass or angioplasty! | Needs to be rigorous training!
105
LDL level in any artery disease | MI, PVD or else?
< 100 or < 2.6 If diabetic < 70
106
How to describe SVT?
Narrow QRS
107
SVT resistant to adenosine? Narrow QRS + No P
Verapamil Or BB
108
Ventricular tachycardia | Rx
Epi + amiodrone No improvement = lidocaine

CanQB (16 decks)

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