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PANCE 2024 > Cardiology > Flashcards

Cardiology Flashcards

1
Q

How does digoxin work and when is it indicated

A

NA+K+Pump inhibition

Rate control through slowed AV node conduction

2nd line treatment for AFIB and CHF

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2
Q

Peri infarction pericarditis occurs when

A

Less than 4 days from procedure

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3
Q

Mechanism of action of fibrates

A

Inhibit bile acid synthesis ; best for hypertriglyceridemia .

PPARA goes in and actives MORE LPL —> decreased availability of fatty acids ==> VLDL can’t activate.[decrease in triglycerides]

This PROMOTES gallstones, avoid in gallbladder disease patients

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4
Q

MOA of fish oil in hypertry.

A

Fish oil increases bile acid synthesis ; decreasing cholesterol saturation

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5
Q

MOA of ezetimibe

A

Block cholesterol absorption decreasing liver liver cholesterol stores and reducing biliary cholesterol content

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6
Q

2 side effects of statin therapy

A

Myopathy

And

Hepatic dysfunction

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7
Q

What is the drug of choice for hemodynamically good ; Vtach?

A

Amiodarone

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8
Q

Adverse affects of Amiodarone

A

Bradycardia

QT prolongation

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9
Q

When do you give fibrates

A

If severe triglyceridemia over 500

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10
Q

What is the peripheral resistance in hypovolemic patients

A

High due to stress, fluids decreases this.

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11
Q

1st line medical management of AFIB

A

Beta blocker

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12
Q

If an arrythmia originates below the average node think what type of QRS complex

A

Wide

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13
Q

Hemodynamics of :

Cardiac

Hypovolemic

Distributive

Obstructive

A

Cardiac = high preload,, low cardiac output, high vascular resistance

Hypovolemic = low preload, low cardiac output, high vascular resistance

Distributive = high right sided preload, low left sided ventricular output, high cardiac ouptut, low vascular resistance

Obstructive = low preload, high cardiac output, low vascular resistance

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14
Q

Explain the murmur of mitral stenosis

A

Best heard at the cardiac APEx = OPENING SNAP

Mid diastolic murmur

MC due to RHDz

Echo = Increased left atrial size with normal LV ejection fraction

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15
Q

Most important risk factor for aortic dissection

A

Hypertension

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16
Q

Describe the physiologic murmur of pregnancy

A

Increased blood production @ 6 weeks leads to ventricular dilation and increased CO

-Pulmonic flow murmur = increased w/ inspiration @ the left upper/mid sternal boarder

-S3 = increased FILL of an enlarged LV

-Venous Hum = continuous brisk blood flow through JVD

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17
Q

Atrial thrombi associated with AFIB are most commonly associated with what anatomic part

A

The left atrial appendage

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18
Q

Best way to determine SVT vs V tach

A

SVT = narrow complex tach

VT = WIDE complex tach!

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19
Q

AFIB mechanical intervention

A

Synchronized CARDIOVERSION

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20
Q

Vfib and Vtach can get what mechanical intervention

A

DEFIBRILLATOR!

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21
Q

MOA of ezetimibe

A

Decreases intestinal choleserol absorption leading to decreased liver cholesterol, requiring the liver to to increase LDL receptor expression = pulling cholesterol from the bodies circulation

STOMACH

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22
Q

MOA of PCK9 inhibitor

A

Increases LDL receptors on the liver hepatocyte increasing removal from circulation

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23
Q

Aortic rupture causes what findings

A

Immediate DEATH

Flat neck veins and mediastinal widening

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24
Q

Cardiac Tamponade causes

A

Becks triad : HYPOTN / Venous Distention / Dimensioned Heart Sounds

Distended neck veins and slightly enlarged cardiac contour

Narrow pulse pressure

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25
Q

Indomethacin vs PGE1 for PDA.

A

PDA = closes around day 3 of birth, patient would present with EARLY PULM DECLINE

Indomethacin = CLOSES ; inhibits prostaglandins synthesis which would close the PDA.. HELPS PDA

PGE1= OPENS ; vasodilator that prevents PDA closure= so blood can still bypass the lungs! In Tetrology of Fallot

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26
Q

Calcium scoring is only good when

A

No symptoms [ZERO]

But suspicious risk

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27
Q

Levels of triglycerides elevated but less than 500 get what

A

Statin therapy!

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28
Q

Normal ejection fraction is around what?

A

Usually greater than 60%

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29
Q

What does the heart look like in HFreF vs HFpeF

A

HFreF = thin non compliant weak ventricles

HFpeF = dialted and stiff ventricles

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30
Q

Classifications of heart failure based on ventricle structure

A

HFReF = thin non compliant weak ventricle = S3 SOUNDS

HFPeF = dilated large stiff ventricles = S4 SOUNDS!

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31
Q

HFReF stage A treatment

A

Lifestyle changes

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32
Q

HFrEF stage B treatment is likely

A

ACEI or ARB

B Beta Blocker

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33
Q

HFrEF stage C think what meds

A

Diuretics for sxs

ACE/ARB/ARNI/SGLT2
*ARNI =1st line

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34
Q

HFrEF stage D think what treatment

A

Inotropes

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35
Q

Loop diuretics 4 main points

A

Sxs control ONLY

Decrease total body water; removing heart fluid; relieving sxs

Decreases NA and Chloride absorption in loop of henle

Hypovolemic; increase in sCr; Ototoxic

CONTRA = Sulfa Allergy

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36
Q

What kind of diuretic can you use in sulfa allergy

A

Ethacrynic acid

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37
Q

ARNI FOUR MAIN POINTS

A

Sacubitril and Valsartan

Prevents the breakdown of BNP

Promotes diueresis, natiruesis, and vasodilation

Could cause hypotension, sCr increase, hyperK+, if angioedema/36hr of ACE rxn/use

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38
Q

ACEI four main points

A

Blocks production of AT2 ; which increases bradykinin

Decreases ventricular remodeling and fibrosis

Prevents progression of heart failure

Increased sCr, hyperK, dont use in prior angioedema

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39
Q

Beta blockers 4 main points

A

Inhibits beta adrenergic receptors and decreases catacholamines

Decreases heart rate and constriction

Can correct abnormal arrythmias ; heart selectives - BMAE ; best in asthmatics

Contra if bad lung disease

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40
Q

Aldosterone antagonists [4]

A

Blocks aldosterone in the kidney heart and vasculature

CrCl greater than 30mL/min
K less than 5 in order to use

Class 2-4 HF mainstay

Epileronone > Spironolactone for gynecomastia

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41
Q

SLGT2 four main points

A

Diuretic and hemodynamic effects to decrease mortailty

Mainstay effect with good kidney, glucose function

GFR greater than 20-30 to use

Causes UTIs cause you pee the sugar

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42
Q

Bidil four main points

A

Vasodilates arterial and venous vasodilation

HF benefit only in AA

Can cause HA ; Drug induced Lupus

Dont use with sildenfil = hypotension

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43
Q

Ivabradine four main points

A

Inhibits NA + channels in SA node reducing heart rate

NO MORTALITY BENEFIT

Must also be on a B blocker, HR above 70, and normal sinus rhythm,

Can cause AFIB = discontinue the agent ; hypertension can occur
Not used in ADHF

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44
Q

Digoxin four main points

A

Inhibits Na+ and K+ pump increases heart contractility

Improves exercise tolerance not mortality

Causes bradycardia, heart blocks, N/V, anorexia

Less than 0.5-2 levels in the serum for HF, monitor electrolytes and renal function

Anything over 2 can be considered toxicity

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45
Q

HFpEF treatment algorithm

A

Diuretics as needed

SGLT2

ARNI

MRA

ARB

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46
Q

ADHF stages 1-4

A

1 = normal ; warm and normal

2 = fluid overload over 18 PWP ; pulmonary congestion ; warm and wet

3 = hypoperfusion ; warm and dry

4 = pulm congestion and hypoperfusion; cold and dry

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47
Q

3 step treatment steps for ADHF

A

1.Diuretics

2.Inotropes

3.Inotropes and Diuretics

_Vasodilators prn.

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48
Q

Half life of dobutamine

A

2 mins

*It’s. A beta 1 agonist

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49
Q

Cardiac conduction cycle

A

SA —> AV —> Bundle of His —> Purkinje Fibers

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50
Q

Two main types of cells in cardiac conduction

A

NA + = atria; ventricular ; purkinje cells

CA 2+ = SA and AV node

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51
Q

Pacemaker cell phases

A

4 to 0 to 3

Na + Ca 2+ + decrease in K+

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52
Q

2 main goals of antarrythmics

A

Decrease automaticity

Prolong refractory signals

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53
Q

1234 agents for antiarrythmics

A

Class 1 = NA+ blockers;

Class 2 = K+ channel blockers

Class 3

Class 4 = CCBs

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54
Q

Class 1 anti arrhythmic agents pnuemonic

A

Double Quarter Pounder = Vtach ; WPW = procainamide IV
Lettuce mayo = Vtach ; lidocaine = IV, causes seizures ; crosses the BLOOD BRAIN BARRIER
Fries please = SVTs ; contra in HF ; visual taste disturbance

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55
Q

Amiodarone affects where

A

B blocker, Na+ , K+ blockers
Good in HF
Half life of 60 days

Loading dose required

Need annual labs, eye exams, LFTs

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56
Q

Dronerdarone is contraindicated in

A

HF and AFIB

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57
Q

K+ antiarrythmics have what warning

A

QT prolongation

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58
Q

Initiation of what two drugs requires hospitalization

A

Sotalol

Dofetilide

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59
Q

What med can pharmacologically get a patient out of AFIB

A

Ibutilide

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60
Q

What type of CCBs are used in arrythmias

A

Non dihydrperidine

Verapimil and Dilitiezem

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61
Q

What type of CCBs are used in HTN

A

Dihydrpuridine
-Amlopidine
-Nicardipine

Works mostly in the periphery to vasodilate; decease SVR and BP
Corarny artery vasodilation

Side effects = gingival hyperplasia ; peripheral edema ; flushing

62
Q

Alpha 2 agonists do what

A

Stimulate alpha 2 in the brain
Reduces sympathetic outflow
Decreased SVR/HR/BP

If stop fast = reflex tachycardia !

63
Q

Do not use statins in

A

Liver disease

Muscle damage in the past = measure CPK

64
Q

Dont use eztemibe in what patients

A

Pregnant breast feeding; liver disease

65
Q

Fibrates can do what to LDL if tri’s are high

A

Increase LDL ; can exacerbate gallbladder disease

66
Q

‘PCSK9 is given how?

A

Injection ; prevents breakdown of the LDL receptors to bind body LDL

67
Q

2 unusual signs for thoracic aortic anuerysm

A

Hoarse + Stridor

[Ripping tearing pain is common]

68
Q

What size TAA is a high risk for rupture

A

Greater 5 cm

69
Q

What artery is accessed in repair of TAA

A

Femoral artery

70
Q

2 diseases high risk for TAA

A

Marfans

GCA

71
Q

What is the screening protocol for AAA

A

If they ever smoked = screening abdominal U/S age 65 x 1

Size 3.5-4.4 = annual U/S

Size 4.4 - 5.4 = U/S every 6-12 months

72
Q

Positive Periumbilical mass with pain radiating to the back think what

A

AAA

73
Q

What structural complication can lead to aortic dissection

A

Aortic Regurgitation

-Also, cardiac Tamponade

74
Q

Mc risk factor for AD

A

Hypertension

75
Q

What out he goal and treatment for AD

A

Decrease Bp to less than 120 in the first hour

With BB and CCBs

76
Q

PADz improves with what; treatment should include what two thing

A

Limbs in the dependent position

-often has absent distal pulses

1) Statin

2) ASA

77
Q

Vasculitis effects what joints and where is this ; what is a defining feature

A

Proximal joints

[shoulders ; pelvic girdle]

NO MUSCLE WEAKNESS

78
Q

Worst complication associated with progressive vasculitis

A

Blindness

79
Q

What it’s he treatment of thrombophlebitis

A

Heat pack and NSAIDS

80
Q

What group of pulm hypertension does DVT fall in

A

Group 4

81
Q

Proximal DVT treatment

A

LMWH , heparin , factor 10a inhibitors

82
Q

AC Treatment after DVT in provoked vs. unprovoked VTE

A

Provoked = 3 months ; after major surgery/ pregnancy/ COCs /active malignancy

Unprovoked = lifelong ; unexplained

83
Q

Venous insufficiency is worse when? Presents how?

A

When dependent ; usually presents unilaterally

84
Q

If someone is moderate risk for CAD what can you consider

A

Stress test

85
Q

3 features of stable angina

A

Lasts less than 10 mins
Gets better with rest or nitro
ST Depression on ECG

86
Q

What three drugs can improve survival in stable angina, based on what?

A

ASA
BB
Statins

ASCVD risk greater 10%

87
Q

Printzmetals usually effects what artery?

A

RCA

Rule out cocaine use

88
Q

Mainstay treatment for Unstable Angina and NSTEMI

A

Dual AP therapy : ASA + Clopidogrel
UFH/LMWH

PCI could be indicated if TIMI greater 3

89
Q

4 common findings in STEMI physical exam

A

Positive JVD
Mitral regurgitation
Pulm Edema
S3 sound +

90
Q

Location of STEMI vs. artery effected

A

Inferior = RCA

Lateral = LCx 1, AVL

Anterior Septal = LAD

91
Q

2 common complications post inferior MI

A

Sinus bradycardia

AV blocks

92
Q

Papillary muscle rupture often leads to what

A

Mitral regurgitation

-Holosystolic murmur radiating the the axilla

93
Q

How long should post MI patients be on DAPT

A

At least 1 year

94
Q

What two drugs can reduce cardiac remodeling post MI

A

BB

ACE/ARB

95
Q

Free wall rupture often results in quick what?

A

Death

96
Q

MC etiology of pulmonary stenosis

A

Tetralogy of Fallot

97
Q

Location and sound of Pulmonary stenosis

A

2-3rd Left ICS
Decreases with inspiration*
Ejection click with parasternal lift

Starts asxs then progressive dyspnea —> syncope

98
Q

Pulmonic regurgitation location and sound

A

3rd Left ICS

Early Diastolic heart murmur

Soft high pitched; DECRESCCENDO

Increases with inspiration [RINSPIRATION]

99
Q

Atrial septal defect is association with what etiology

A

Down syndrome

100
Q

ASD is a what shunt

A

Left to Right

101
Q

ASD is assoc with what physical exam findings

A

Positive JVD with increased RA volume

Flow murmur heard best at the 2nd ICS

Fixed split S2 ; doesn’t change with inspire/expire

102
Q

ASD can progress to what?

A

Eisnemrhens syndrome

Right to left shunt

103
Q

What allows fetal blood flow to bypass the lungs

A

Foremen ovale

104
Q

In individuals less than 55 y/o what is the MC reason for stroke

A

PFO

105
Q

When is cyanosis worse in PFO

A

If you as the person to stand = increased RA pressure = increased Right to Left Shunt

106
Q

Talk about treatment for PFO

A

ASA could be taken to prevent blood clots
Anticoagulants if PFO is large

PFO does not usually change with age and will require surgery if causing adverse sxs.

107
Q

4 compartments of tetralogy of fallot

A

Pulmonic Stenosis

VSD

RVH

Overriding Aortic Arch

108
Q

What type of VSD is known to spontaneously close

A

Muscular VSD

Membranous requires surgery*

109
Q

VSD is what location and sound

A

Heard best at the LLSB

Holosytolic murmur // Harsh-Soft //

Handgrip increases the sound = increase in afterload

Left to right shunt

110
Q

MVP sound and location and associated with what diseases

A

Floppy mitral valve

Systolic click

That is louder with standing and valsalva = decrease in preload on the right side of the heart

111
Q

Tricuspid stenosis sis common when

A

Right heart disease

IV drug users

112
Q

Tricuspid stenosis murmur ; TXM?

A

Mid Diastolic Rumble Left LSB

Venous return increases during inspiration = louder with inspire!

TXM = diuretics to decrease congestion

113
Q

Tricuspid regurgitation think what? [4]

A

Holosystolic murmur increases with inspiration

Best heard with the bell

Louder sitting upright or standing or with inspiration = carvollos sign

TXM = diuretics

114
Q

Mitral regurgitation think what? [4]

A

Blowing systolic murmur heard at the APEX radiate to the axilla

Increases with collagen deposits ; #1 MVP ; Post MI

Retrograde flow from LV to LA

TXM = surgery or nitrates/diuretics if shock : vasopressors

115
Q

Aortic regurgitation? [4]

A

Diastolic crescendo decrescendo

Softer with inspiration ; causes LVH

Quincke, corrigan sign = art Bp incr, dec ; musset sign = head bobble

TXM = vasodilators or Inotropes

116
Q

Mitral stenosis [4]

A

Opening snap ; diastolic murmur

MC : rheumatic heart; MVP in the US; r/o outflow obstructions like myxoma

Can lead to AFIB

TXM = nitrates or diuretics to decrease dyspnea

117
Q

A P T M for locations of murmurs

A

A = aortic murmurs [ 2nd Right ICS ]

P = pulmonic murmurs [ 2nd Left ICS ]

T = tricuspid murmurs [LLSB]

M = mitral murmurs [ APEX of the heart ]

118
Q

What grade murmurs have palpable thrill s

A

Grade 3 and above

119
Q

Aortic stenosis [4]

A

1 Cause : CA2+ deposits ; SAD = syncope ; angina ; DOE

Left ventricular heave noted systolic ; HARSH crescendo decrescendo 2nd ICS ; radiates to carotid

Positive narrow pulse pressure

TXM = balloon surgery; TAVR replacement

120
Q

Pericarditis in the following settings = what?

Painless

No fever

Post MI

Positive TOXIC APPEARING

A

Painless = neoplastic

No fever = uremic

Post MI = Dresslers ; ESRs/CRPs elevated

Positive TOXIC APPEARING = BACTERIAL

121
Q

1 side effect of colchicine and dont use with what med class?

A

Diarrhea

NOT w/ Macrolides

122
Q

Constrictive pericarditis think what 3 findings in addition and what TXM

A

-Purulent infections effusions

-Kussmauls breathing

-Edema

TXM = diuresis I ; DX = catheterization

123
Q

Cardiac Tamponade is assoc with what 4 findings

A

Pulsus pardoxous

Low systolic BP = narrow pulse pressure

+PEA Shock

Water Bottle Heart on CXR

124
Q

What three pops get HIS right away

A

LDL over 190

DM with ASCVD risk over 7.5 %

DM with LDL over 70

125
Q

What defect often causes familial hypercholesterolemia

A

LDL receptor gene defects

BEST DIET = Mediterranean

126
Q

Greater than what tri’s = risk of pancreatitis

A

1000

127
Q

Secondary causes of increased lipids [4]

A

Hypothyroidism = gut increases cholesterol absorption and decreases clearance. HIGH LDL.

Metabolic syndrome

Liver Dz

EXOG. Estrogen / Progesterone

128
Q

Native valves with IE are commonly what bacteria

A

Staph A

129
Q

Prosthetic valves in IE are commonly what bacteria

A

Strep viridans

130
Q

GBS infective endocarditis usually infects what 2 populations

A

Cirrhosis

DM2

131
Q

HACEK infective endocarditis organisms infect what population

Hameophilus

Aggregatibacter

Cardiobacterium

Eikenella

Kingella

A

HIV

132
Q

Osler nodes vs. Janeway lesions

A

Osler nodes = painful ; [fingers and toes] nodes [red tender bumps with pale centre]

Janeway = painless ; septic thromboemboli [palms and soles]

133
Q

MC Valve Dz affected in IE

A

MVP

134
Q

Best study to eval for valve vegetations in IE

A

TEE

135
Q

Prophylactic DOC for IE and in what 3 cases

A

Amoxicillin

“Break Skin”

-Dental

-Respiratory

-Skin structural procedures

136
Q

Duke criteria requires what

A

2 majors

1 major + 1 minor

Or 3 minors

137
Q

Minor criteria for IE

A

Fever over 100.4
JONES
Predisposition to IE

138
Q

Major criteria IE

A

+blood current

+vegetation on TEE/Echo

139
Q

Immunologic phenomena of IE [4]

A

Osler nodes

Roth spots

Elevated RF

Glomerulonephritis

140
Q

Diastolic dysfunction think // systolic think

A

Diastolic = S4 sounds

Systolic = S3 sounds

141
Q

1st line treatment in HF think

A

ACEI / ARB

142
Q

Digoxin optimal serum level in HF treatment

A

0.5 -2

143
Q

Dilated cardiomyopathy often leads to what

A

Tricuspid regurgitation

144
Q

Hyperaldosteronism labs = [4]

A

Low K+

High Bp

High aldosterone

Low renin

145
Q

Talk about RAAS system

A

Baroreceptors sense low blood pressure/low blood volume

Release of renin in the kidney

Activates AT to AT1 [AT released by the liver]

Lungs release ACE [Activates AT1–> AT2] [AT2 activation = blood vessel constriction]

AT2 causes adrenal gland to release ALDOSTERONE

ALDOSTERONE tells the kidneys to reabsorb NaCl and H20 follows = increase blood volume/pressure

146
Q

What drugs can cause trigger a PHEO [4]

A

TCAs

Metoclopramide

Naloxone

Antidopinergic agents

147
Q

Coaractation of the aorta [4]

A

Rib notching and figure 3 sign

Delated weak femoral pulses

Systolic murmur in the infraclavicular area under the left scapula

TXM = surgical

148
Q

5 meds/drugs that can cause HTN

A

EPO

NSAIDS

OCPs

CC

Cocaine and Cold meds

149
Q

Labs in Cushings are often ; txm for HTN induced?

A

Increased glucose ; low K+

HTN TXM = Spironolactone

150
Q

History of what is often present in renal artery stenosis [4]

A

Atherosclerosis

Women lesser than 50 yrs with an ABD Bruit and increased creatinine

DX = renal arteriography

TXM = stent ; DO NOT USE ACEI

PANCE 2024 (15 decks)

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