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Flashcards in Cardio Deck (108):
1

Dx stable angina?

1. EKG
2. Stress test
3. Angiography

2

When to measure cardiac enzymes in angina?

Acute chest pain > 1 HR

3

Drug contraindicated with quinidine?

Amiodrone
Decrease quinidine clearance by kidney resulting in fatal arrhythmia

4

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)

5

MC SE of CCB? (Amlodipine)

Peripheral edema
Low BP
Cough
Lung edema

Due to vasodilation

6

Drugs improve mortality in MI?

BB
ACEI/ARB
Aspirin (time dependent)
Statins

7

Drug contraindicated in anaphylaxis?

Atropine if tachycardia

8

Lab monitoring with amiodrone

LFT
Thyroid (hypo > hyper)
Every 6 months

No need for CXR or slit lamp

9

SE of amiodrone

Liver + thyroid toxicity

Lung toxicity: cough and dyspnea + interstitial filtrates on CXR

ARDS

Corneal deposits don't effect vision.

10

Drugs contraindicated with BB? Why?

CCB
Verapamil + diltiazem

Cause bradycardia and effect AV conduction.

11

MCC of drug induced angioedema?

ACEI = increase levels of bradykinin

12

ECG in inferior MI

ST elevation in II, III, aVF

13

What artery causes inferior MI

Rt coronary artery
Left circumflex artery

14

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

15

ECG of Rt coronary artery MI

ST elevation in III > II

ST-Depression in I and aVF

16

ECG of left anterior descendant coronary artery?

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

17

Drug worsen CHF? Why?

Vasopressin
Vasoconstricts arteries and veins causing fluid retention and worsen low Na

18

Mechanism of action of nitroglycerin

Dilates veins, arteries, and arterioles.

Reduce LV preload + after load

Reduce oxygen demand

19

What's angina decubitus

Angina when lying down without cause.

20

Cause of angina decubitus

Gravity redistributes fluids and make the heart work harder.

21

Dose of aspirin given in acute MI?

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

22

What determines cardiac oxygen demand

Tension
Preload
After load
Contractility
HR

23

DM drugs contraindicated in CHF? Why?

Thiazolidinediones (pio/rosiglitazone)

Cause fluid retention

24

MVP murmur

Midsystilic click
Late systolic murmur

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