Flashcards in Cardio Deck (108):
Dx stable angina?
2. Stress test
When to measure cardiac enzymes in angina?
Acute chest pain > 1 HR
Drug contraindicated with quinidine?
Decrease quinidine clearance by kidney resulting in fatal arrhythmia
Nitrate formulas and their rout of administration
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)
MC SE of CCB? (Amlodipine)
Due to vasodilation
Drugs improve mortality in MI?
Aspirin (time dependent)
Drug contraindicated in anaphylaxis?
Atropine if tachycardia
Lab monitoring with amiodrone
Thyroid (hypo > hyper)
Every 6 months
No need for CXR or slit lamp
SE of amiodrone
Liver + thyroid toxicity
Lung toxicity: cough and dyspnea + interstitial filtrates on CXR
Corneal deposits don't effect vision.
Drugs contraindicated with BB? Why?
Verapamil + diltiazem
Cause bradycardia and effect AV conduction.
MCC of drug induced angioedema?
ACEI = increase levels of bradykinin
ECG in inferior MI
ST elevation in II, III, aVF
What artery causes inferior MI
Rt coronary artery
Left circumflex artery
ECG findings of left circumflex artery MI?
1. ST elevation in II = III and ST-depression in V1-3 or ST-elevation in I + aVF
ECG of Rt coronary artery MI
ST elevation in III > II
ST-Depression in I and aVF
ECG of left anterior descendant coronary artery?
ST elevation or Q wave in any leads V1-V6 + I and aVF
Drug worsen CHF? Why?
Vasoconstricts arteries and veins causing fluid retention and worsen low Na
Mechanism of action of nitroglycerin
Dilates veins, arteries, and arterioles.
Reduce LV preload + after load
Reduce oxygen demand
What's angina decubitus
Angina when lying down without cause.
Cause of angina decubitus
Gravity redistributes fluids and make the heart work harder.
Dose of aspirin given in acute MI?
162-325 mg uncoated aspirin. (Not enteric asa which has delayed effect).
What determines cardiac oxygen demand
DM drugs contraindicated in CHF? Why?
Cause fluid retention
Late systolic murmur
Effect of standing + valsalva on valvular disease
1. MVP: Increased
2. AS: increased
AS murmur? Best heard?
Systolic crescendo-decrescendo ejection murmur
Rt 2nd ICS w/ patient leaning forward
Cardiac SE of sumatriptan
It's a 5HT1D + 1B agonist
Causes vasoconstriction = angina.
Phosphodiestrase inhibitor for intermittent claudication
Contraindication to cilostazol
Bcz increases HR
Beneficial effects of cilostazol
Rx 3rd degree block.
Gold standard for aortic dissection
What's aortic dissection
Tear in aortic intima with separation of intima and media creating false lumen and hemorrhage within media
What other than ST elevation indicate MI in ECG?
New onset Lt BBB
Left anterior descending artery
IE prophylaxis in VHD
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:
Effect of digitalis on heart
Reduce filling pressure
Increase contraction force
How to measure the effects of warfarin, heparin, ASA
Warfarin = PT
Heparin = PTT
ASA = BT
Contraindication to ACEI
Rx of HTN
2. No benefit combine:
Thiazide + CCB + BB + ACE/ARBs
- Central a-agonists:
- Peripheral a-antagonists:
When to start combination HTN meds?
If > 160/100
HTN + co-morbidities Rx (6 conditions)
1. Asthma / depression:
2. Black: CCB or thiazide
3. DM: ARBs/ ACEI
4. CAD: BB, ACEI/ARBs
5. Hyperthyroid: BB
6. Osteoporosis: thiazide
Benefit of ACEI/ARBs in CHF (systolic)
Improve mortality with low EF
Anti-HTN not used in sulfa allergy
BP control post stroke
Gradual reduction in SBP 10-20% it it's > 220.
Anti-HTN contraindicated in gout?
Increase uric acid
Anti-HTN contraindicated in diabetic nephropathy
Triad of AS
Ejection systolic murmur at 2nd ICS
Rt to sternum
Radiates to clavicle
Anti-HTN contraindicated in DM
Hypertrophic obstructive cardiomyopathy classic
PMO displaced laterally
Mid-systolic harsh murmur at left Lowe sternal
Reduced by squatting
Enhanced by standing
SE of ASA
Tinnitus / ringing in ears
Rx of Raynaud's phenomenon
Contraindicated in Raynaud's phenomenon
Appropriate BP cuff size
Cuff width: 40% of limbs circumference
Cuff length: bladder at 80% limbs circumference
Placement of BP cuff
3 cm above elbow
Bladder on brachial artery
At heart level
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.
How to avoid venous congestion with manual pressure reading
Allow >1 min between readings
Clinical signs of AR
Wide pulse pressure
When is bifid pulse found
When is low amplitude pulse found
When is pulsus alternans found
When is pulsus paradoxus found
Constrictive or restrictive cardiomyopathy
What's 5-HIAA when is it found
Break down of serotonin in urine
GI tumor in carcinoid tumors
Define resistant HTN
> 140/90 if no DM or CDK
> 130/80 if DM/CKD
While adherent to 3 Rx including diuretics
Diuretic of choice of GFR <30 ml/Min?
Loop > thiazide
Drugs contraindicated in cocaine-induced chest pain
When is BB contraindicated in chest pain/STEMI?
In Cocaine, amphetamine or stimulant overdose
Why BB contraindicated in cocaine overdose
BB = block B2 vasodilator receptor
And cocaine activates a-1 and cause vasoconstriction
So worsening of MI
Rx of cocaine induced chest pain
Common drug interacts with ACEI?
1. NSAIDs lead to Na retention
2. Decrease PG which have a vasodilatory effect on kidney
What decreases mortality in hypertrophic cardiomyopathy?
Effect of BB / CCB in hypertrophic cardiomyopathy
Hypocalcemia ass arrhythmia
Rx of STEMI (time dependent)
ASA + P2Y12 receptor blacker (clopidogrel, prasugrel, ticarogrelor)
NSAIDs in STEMI?
Weaken muscle = rupture.
Sx of subaortic stenosis
Systolic murmur at Rt sternal
Increased with valsalva
Decreased with hand grip
What valvaular disease in endocarditis from IV drug use?
Increase with inspiration = inc heart filling
Guide lines for HTN in stroke?
Keep SBP < 220
DBP < 120
Why maintain BP at < 220/120 in stroke
Protective mechanism to increase cerebral profusion
Replacement of ACE/ARBs in HTN of CHF?
HTN drug causes rebound if stopped?
T/F: BNP differentiates systolic from diastolic CHF
When to replace in aortic stenosis?
Aortic area < 1 cm
What worsen prognosis of AS?
If asymptomatic survival is same as normal
Angina 50% 5Yr survival
Syncope 50% 3Yr survival
CHF 50% 2Yr survival
T/F: digoxin improve mortality in CHF
T/F: Digoxin decreases hospital admission from CHF
What's diastolic HF?
Stiff ventricle = increased EDLV pressure
MCC of diastolic HF?
T/F: optima Rx of systolic HF necessary for diastolic HF
Worsen diastolic HF
T/F: CCB reduce mortality in diastolic HF
T/F: BB improve mortality in diastolic HF
Control rate allow for enough filling
When to admit DVT?
1. Massive DVT (iliofemoral)
3. Risk of bleeding on anticoagulant
4. Co-morbid conditions
Outpatient Rx of DVT
LMWH + warfarin
Compression stockings for 1 years
HTN + LV hypertrophy Rx
Pathophysiology of cocaine-chest pain
Dopamine-depleted state = vasospasm
Receptors mediate cocaine induced chest pain
Thus BB worsen Sx
Rx of superventricular tachy
Amiodrone is used in what arrhythmia
Sustained VT regardless of hemodynamic stability
AFib ONLY in symptomatic w/ LV heart failure
Facts about digoxin
1. Not used in AV block unless Rx with pacemaker.
2. Loading dose not necessary
3. Serum levels are not necessary
Period of anticoagulation after drug-eluting stent in MI?
12 months of
Clopidogrel 75 or prasugrel 10 mg
DOC for SVT?
Other non-pharm: carotid massage
Pain Drugs contraindicated in CHF
Effect of high-dose ASA in CHF?
Decrease mortality benefit by ACEI!
Use low-dose if must
Benefit of exercise in peripheral vascular disease?
As beneficial as bypass or angioplasty!
Needs to be rigorous training!
LDL level in any artery disease
MI, PVD or else?
< 100 or < 2.6
If diabetic < 70
How to describe SVT?
SVT resistant to adenosine?
Narrow QRS + No P