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IM MTB > Cardio > Flashcards

Cardio Flashcards

1
Q

Pain characteristics that make ischemia less likely

A

Sharp, knife like, last for a few seconds

Changes with respiration, position, touch of the chest wall (tenderness)

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2
Q

How to calculate maximum heart rate

A

220 minus age, so for me it’s 194

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3
Q

Alternatives to exercise stress test

A

Persantine (dipyridamole, avoid in asthmatics) or adenosine in combo with nuclear isotopes such as Thallium or sestamibi
Or Dobutamine with echo

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4
Q

Nitro and ministration in chronic versus acute angina

A

Chronic: oral or transdermal patch
Acute: sublingual, paste, IV

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5
Q

Antiplatelet agents that should be given in ACS

A

Aspirin plus clopidogrl, prasugrel, or ticagrelor (P2Y12 Receptor inhibitors)
Clopidogrel commonly used if aspirin allergy
Prasugrel Best if undergoing angioplasty and stenting but increases risk of hemorrhagic stroke in patients over 75

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6
Q

Best mortality benefit in chronic angina

A

Aspirin and beta blockers

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7
Q

Target LDL in coronary artery disease (or PAD, carotid disease, aortic disease, stroke, diabetes)

A

Less than 100 mg/dL

If diabetes, less than 70 mg/dL

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8
Q

Most common side effect of statins

A

Liver dysfunction, myositis/rhabdo is rare

Measure LFTs not CPK

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9
Q

Why are statins so great for Improving mortality

A

They have an antioxidant effect on the endothelial lining of the coronary arteries in addition to lowering the LDL

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10
Q

Use fibrates with caution why?
Why is cholestyramine not used as much?
Side effects of Niacin?

A

Fibrates: If used in combo with statins have increased risk of myositis
cholestyramine: blocks absorption of other medications and has G.I. side effects
Niacin: elevation in glucose in uric acid level, pruritis

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11
Q

Why not to use Dihydropyridine CCB’s in CAD?

A

They raise the heart rate, reflex tachycardia
Especially Nifedipine
Can use verapamil and diltiazem, which do not increase the heart rate, when beta blockers are contraindicated: severe asthma, Prinzmetal angina, cocaine induced chest pain

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12
Q

When to do CABG instead of standing in CAD

A

If at least three vessels are involved, or the left main is involved, or two vessels in diabetic

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13
Q

Mortality is highest with what type of STEMI

A

Anterior wall, ST elevation in leads V2-V4

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14
Q

Order of therapy and STEMI patient

A

Aspirin first, then angioplasty
Cardiac markers will be normal in the first four hours
Morphine, oxygen, nitrates should be given immediately but do not clearly lower mortality
Beta blockers, statins, ACE inhibitors do lower mortality but are not dependent on time, should be given before discharge

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15
Q

Cardiac marker timeline

A

Myoglobin: shows up at 1 to 4 hours, stays elevated 1 to 2 days
CK – MB: 4-6 hours; 1 to 2 days
Troponin: 4 to 6 hours; 10 to 14 days
Renal insufficiency he can result in false positive troponins

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16
Q

Best for decreasing the risk of restenosis in coronary arteries after PCI

A

Placement of drug eluting stents
Warfarin is not used here, useful in DVT/PE
Heparin is used during the procedure but not long-term

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17
Q

Absolute contraindications to thrombolytics

A

Major bleeding: G.I. or brain
Recent surgery in the last two weeks
Severe hypertension above 180/110
Non-hemorrhagic stroke within the last six months

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18
Q

ACE inhibitors have the most benefit in what patients?

A

In those with systolic dysfunction, ejection fraction below 40%

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19
Q

When to give heparin in MI

A

If ST depression but no ST elevation or in unstable angina
Heparin will prevent a clot from forming
If there is no ST elevation, there is no benefit of TPA

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20
Q

Meds useful when undergoing angioplasty and Stenting or if non-ST elevation MI

A

Glycoprotein IIb/IIIa inhibitors: abciximab, tirofiban, eptifibatide

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21
Q

TPA is only good for?

A

ST – elevation MI

If PC I not available, use within 12 hours of start of chest pain

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22
Q

Which is better in terms of mortality: LMWH or unfractionated heparin?

A

LMWH

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23
Q

3rd° AV block will have what waves?

A

Cannon A waves

Produced by atrial systole against a closed tricuspid valve

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24
Q

How to find the right ventricular infarct

How to treat?

A

Flip the EKG leads to the right side, will have ST elevation in RV4
Treat with high-volume fluid replacement, avoid nitro

25
Q

Diagnosis/treatment of tamponade/free wall rupture

A

Emergency echo, emergency pericardiocentesis on the way to the OR
Elevated JVD but lungs are clear, sudden loss of pulse

26
Q

Post MI complications that present with new onset murmur and pulmonary congestion

A

Both valve rupture and septal rupture, echocardiogram is the best test
Septal rupture will also present with a step up in oxygen saturation as oxygen blood from the LV mixes with blood in the RV

27
Q

How to treat acute pump failure

A

IABP: intra-erotic balloon pump helps push blood forward, serves as a bridge to surgery for valve replacement or transplant for 1 to 2 days

28
Q

Signs of a second infarct

A

Recurrence of pain, new rails on exam, bump in CKMB, sudden onset of pulmonary edema

29
Q

All postinfarction patients should go home on?

A

BASA
Aspirin, beta blockers – metoprolol, statins, ACE inhibitors ace: best for anterior wall infarctions because of high likelihood of developing systolic dysfunction

30
Q

How myocardial infarction leads to CHF

Other causes of CHF (systolic dysfunction) besides infarction

A

Infarction leads to dilation which leads to regurgitation leading to CHF
Others: cardiomyopathy and valve disease

31
Q

Recent anesthetic use, brown blood not improved with oxygen, clear lungs on auscultation, cyanosis, think?

A

Methemoglobinemia

32
Q

Most important test in CHF

A

Echo, best way to distinguish systolic from diastolic dysfunction, determine EF
Best initial test: TTE
Most accurate: MUGA or nuclear ventriculography
TEE is best at evaluating heart valve function and diameter, but is not necessary for evaluating CHF

33
Q

How to treat systolic dysfunction CHF

A

Ace inhibitors, beta blockers, spironolactone, diuretics, digoxin
Best beta blockers: metoprolol, bisoprolol, carvedilol; antiischemis, decrease O2 demand, and antiarrhythmic

34
Q

What does digoxin do for CHF?

A

Control symptoms of dyspnea and decreases the frequency of hospitalizations but does not decrease mortality

35
Q

What treatments have a mortality benefit in stock dysfunction CHF

A

Ace inhibitors/ARB us, beta blockers, spironolactone, hydralazine/nitrates, ICD (ischemic), pacemaker (dilated with wide QRS)

36
Q

Treatment for diastolic dysfunction, a.k.a. CHF with preserved ejection fraction

A

Beta blockers and diuretics
Not beneficial: digoxin, Spironolactone
On the fence: ACEI, ARBs, hydralazine

37
Q

CHF on CXR

A

Vascular congestion with blood vessels filling towards the head
If chronic: heart enlargement and pleural effusions

38
Q

ABG an early pulmonary edema

A

Respiratory alkalosis due to hyperventilation

39
Q

Pulmonary edema treatment

A

Pre-load reduction: LMNO
Loops, morphine, nitrate, oxygen
Positive inotropic agents: Dobutamine, Amrinone and milrinone (phosphodiesterase inhibitors)
Afterload reduction: ace/ARB, nitroprusside and IV hydralazine in acute Setting

40
Q

What murmurs increase with inhalation and why

A

Right-sided murmurs: tricuspid and Pulmonic, as inhalation increases venous return to the right side of the heart
Opposite for left heart murmurs, as they increase with exhalation when blood is squeezed out of the lungs into the left side of the heart (except for MVP and HOCM)

41
Q

Treatment of valvular heart disease

A

Diuretics
Mitral stenosis: balloon dilation
Aortic stenosis: surgical removal
Regurgitated valves: basal dilator therapy: ACE/ARBs, nifedipine, hydralazine, surgery before heart dilates too much

42
Q

When do you think mitral stenosis caused by rheumatic fever

A

Immigrant or pregnancy: which increases plasma volume that has to go through a narrow valve

43
Q

Features unique to mitral stenosis

A

Dysphasia from LA pressing on the esophagus, hoarseness from it pressing on laryngeal nerve, a fib and stroke from enlarged LA, hemoptysis, LA pushing up the left main stem bronchus

44
Q

Diagnostic tests for valve disordes

A

Initial: TTE, TEE is more accurate
Best: catheterization

45
Q

EKG in mitral stenosis may show?

A

A fib, left atrial hypertrophy seen with biphasic P-wave in leads V1 and V2

46
Q

Treatment for mitral stenosis

A

Diuretics, sodium restriction, balloon valvuloplasty, may need valve replacement
Afib: warfarin an INR of 2 to 3, rate control with digoxin, beta blockers for diltiazem/verapamil

47
Q

Treatment for mitral/ aortic regurgitation

A

Vasodilators: ace inhibitors or ARBs, digoxin then diuretics for CHF symptoms,
valve replacement:
mitral regurgitation when LV ESD gets above 40 mm and EF drops below 60%
Aortic regurgitation when LVESD gets above 55 mm and EF drops below 55%

48
Q

MVP is seen in? What is unique about its presentation?

A

In Marfan and Ehlers Danlos
Symptoms of CHF are typically absent, will have atypical chest pain, palpitations, panic attack
Murmur increases with less blood in the heart, as in Valsalva and standing
Murmur decreases with increasing left ventricular chamber size as in squatting or handgrip

49
Q

Commonalities in all forms of cardiomyopathy

A

All present with shortness of breath, typically worsened by exertion, and will have edema, rales, and JVD
Diagnosed with echo, treat with diuretics

50
Q

Differences between HCM and other forms of cardiomyopathy

A

HCM may have an S4 gallop and fewer signs of right heart failure searches ascites and enlargement of the liver and spleen

51
Q

Treatment for HCM and HOCM

A

Beta blockers
verapamil and disopyramide – negative inotropes
Diuretics may help and HCM but a contraindicated in HOCM
NO spironolactone or digoxin
HOCM: ICD if syncope, ablation of septum, surgical myomectomy is ultimate therapy

52
Q

Increase in JVP on inhalation in seen in? And called?

A

Restrictive cardiomyopathy, Kussmaul sign

53
Q

Types of cardio myopathy

A

Dilated: systolic dysfunction
Hypertrophic: diastolic dysfunction, preserved ejection fraction
Restrictive: combo,EF may be normal or elevated

54
Q

What will you see an echo and right heart cath in tamponade?

A

Right atrial and ventricular diastolic collapse on echo

Equalization of pressures and diastole on RH cath

55
Q

Best initial test in constrictive pericarditis

A

CXR: shows calcification in fibrosis

Echo next to exclude RV hypertrophy or cardio myopathy

56
Q

Diuretics in Tamponade or constrictive pericarditis?

A

Not for Tamponade, will decrease feeling pressure in may worsen the collapse of the right heart
Yes for constrictive pericarditis, used to decompress the filling of the heart and relieved edema and organomegaly

57
Q

Best first and then most accurate test for aortic dissection

A

First: CXR, Will see widened mediastinum
Most accurate: angiography
MRA = CTA = TEE

58
Q

Most dangerous heart disease in pregnant woman

A

Peripartum cardiomyopathy: antibodies against the myocardium, LV dysfunction, repeat pregnancies are at risk

IM MTB (7 decks)

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