Cardiology 16% Flashcards
1
Q
Inotropes
Ex:
MOA:
A
Ex: dobutamine, dopamine, epinephrine, digoxin
MOA: increase CO by increasing contractility
2
Q
Chronotropes
Ex:
MOA:
A
Positive: adrenaline
Negative: digoxin
MOA: alter heart rate
3
Q
Pressors
Ex:
MOA:
A
Ex: Dopamine, phenylephrine
MOA: improve pressure by increasing vascular tone
4
Q
Postural hypotension =
A
> 20 mmHg drop in SBP OR >10 mmHg drop in DBP b/w supine and sitting and/or standing
5
Q
Metabolic syndrome =
A
3 or more of the following:
- Truncal obesity
- HDL < 40 (men) or <50 (women)
- Hypertriglyceridemia: >150
- Fasting glucose >110
- HTN
6
Q
Blood pressure for: Normal = PreHTN = HTN stage 1 = HTN stage 2 =
A
Normal = <120/<80
PreHTN = 120-139/80-90
HTN stage 1 = 140-159/90-99
HTN stage 2 = >160/>100
7
Q
Hypertensive urgency =
Hypertensive emergency =
A
Increased BP w/ NO apparent acute end-organ damage
> 220 mmHg SBP or >125 mmHg DBP w/ acute target end-organ damage
8
Q
ECG of HTN may reveal ____
A
left ventricular hypertrophy = deep S waves in V1 + V2, tall R waves in V5 + V6
9
Q
Goal blood pressure in HTN
A
140/90
10
Q
Goal blood pressure in diabetes or CKD
A
130/80
11
Q
HCTZ, Chlorthalidone =
MOA:
SE:
A
Diuretic
MOA: prevent kidney Na/water reabsorption at DISTAL DILUTING TUBULE
SE: HypoNa, HypoK
hyperuricemia, hyperglycemia –> caution in pts w/ DM and gout
12
Q
HTN medication that should be used w/ caution in pts w/ DM and gout
A
HCTZ, Chlorthalidone
13
Q
Furosemide, bumetanide =
MOA:
SE:
A
Loop diuretics
MOA: inhibit water transport across Loop of Henle –> increased extretion of water, Na, Cl, K
SE: HypoK/Na/Cl, Hypochloremic metabolic alkalosis, hyperglycemia
14
Q
HTN medication CI in pts w/ sulfa allergies.
A
Loop diuretics: Furosemide, bumetanide
15
Q
Spironolactone, Amiloride, Eplerenone =
MOA:
SE:
A
K+ sparing diuretics
MOA: inhibit aldosterone-mediated Na/H2O absorption
SE: HyperK, gynecomastia
16
Q
HTN medication that causes gynecomastia
A
K+ sparing diuretics: Spironolactone, Amiloride, Eplerenone
17
Q
Nifedipine, amlodipine =
MOA:
Indication:
A
Dihydropyridines CCB
MOA: potent vasodilators (no effect on cardiac contractility/conduction)
Ind: HTN, Angina, Raynaud’s
18
Q
Verapamil, Diltiazem =
MOA:
Indication:
A
Non-dihydropyridines CCB
MOA: cardiac contractility and conduction, potent vasodilators, reduce vascular permeability
Ind: HTN w/ A fib, Angina, Raynaud’s
19
Q
HTN medication that causes constipation
A
verapamil
20
Q
Cardioselective beta blockers: (3)
Non-cardioselective beta blockers: (1)
A
Cardioselective beta blockers (beta-1) : Atenolol, metoprolol, esmolol
Non-cardioselective beta blockers (beta-1 & beta-2): Propranolol
21
Q
T/F: Beta blockers are used as 1st line monotherapy in HTN.
A
False. Thiazide diuretics (HTCZ) are tx of choice as initial therapy in uncomplicated HTN.
22
Q
CI of beta blockers:
A
2nd/3rd heart block, decompensated heart failure
Nonselective beta blockers CI in asthma/COPD –> may worsen peripheral vascular disease/Raynaud’s phenomenon
23
Q
CI of CCB:
A
pts taking beta blockers, CHF, 2nd/3rd heart block
24
Q
Drug of choice for pts w/ HTN and BPH
Indications:
SE:
A
alpha-1 blockers: Prazosin, Terazosin, Doxazosin
Increased HDL, decrease LDL, improves insulin sensitivity
SE: 1st dose syncope, NOT 1st line
25
Tx of hypertensive urgencies/emergencies:
| If MI also present:
Preferred: sodium nitroprusside
If MI present: nitroglycerin or beta-blocker
Others: nicardipine, enalaprilat, diazoxide, trimethaphan, loop diuretics
26
Tx of aortic dissection:
Nitroprusside + beta-blocker (labetalol, esmolol) + urgent surgery
27
Tx of hypertensive urgencies w/ acute renal failure:
Fenoldopam (dopamine-1 receptor agonist)
28
___-sided HF is most commonly caused by ___ -sided HF.
RIGHT-sided HF is most commonly caused by LEFT -sided HF.
29
S4 gallop heard in ___ heart failure
diastolic heart failure
30
Indication of Implantable Cardioverter-defibrillator in CHF
Ejection fraction <35
31
Effect of ACE inhibitors in CHF
decreased left ventricular wall stress
| slow myocardial remodeling and fibrosis
32
Effect of beta-blockers in CHF
improve ejection fraction
reduce left ventricular dilation
reduce incidence of dysrhythmia
33
3 patterns of unstable angina:
1. angina at rest
2. new onset of angina symptoms
3. increasing pattern of pain in previously stable patients
34
Levine sign =
Clenched fist over sternum and clenched teeth when describing chest pain
Seen in pt w/ ischemia
35
Definitive diagnosis of ischemic heart disease
Coronary angiography
36
Most useful diagnosis of ischemic heart disease
Exercise stress testing --> ST segment depression of 1 mm = +
37
1st line therapy for chronic angina
beta-blockers
38
Primary treatment for acute anginal attacks
Sublingual NTG tab/spray
| Sublingual isosorbide dinitrate
39
Dressler syndrome =
1-2 weeks post-MI
| Pericarditis, fever, leukocytosis, pericardial/pleural effusion
40
Type of murmur that might be heard in Acute Coronary Syndrome
Mitral regurgitation
| S4 gallop
41
ST elevatation >1mm in 2 contiguous leads =
STEMI
42
How to differentiate b/w UA and NSTEMI
Cardiac biomarkers become elevated during evaluation = NSTEMI
Both have ST-segment depression
43
Transient ST-segment changes of >0.5 mm =
acute ischemia and Coronary Artery DIsease
44
_____ on ECG is high suggestive of new MI.
New left BBB
45
Progression of ECG changes in STEMI
peaked T waves --> ST seg elevation --> Q waves--> T wave inversion
46
Inferior MI in which leads?
| Artery involved?
II, III, aVF
| Right coronary artery
47
Posterior MI in which leads?
| Artery involved?
V1, V2 ST depressions
| Right coronary artery, Circumflex
48
Anteroseptal MI in which leads?
| Artery involved?
V1, V2
| Proximal Left Anterior Descending
49
Anterior MI in which leads?
| Artery involved?
V1, V2, V3
| Left Anterior Descending
50
Anterolateral MI in which leads?
| Artery involved?
V4, V5, V6
| Circumflex
51
```
Myoglobin
Initial elevation time:
Peak elevation:
Return to normal:
When to draw:
```
Initial elevation time: 1-4 hrs
Peak elevation: 6-7 hrs
Return to normal: 24 hrs
When to draw: 1-2 hrs after onset of chest pain
52
```
Cardiac troponin I
Initial elevation time:
Peak elevation:
Return to normal:
When to draw:
```
Initial elevation time: 3-12 hrs
Peak elevation: 24 hrs
Return to normal: 5-10 DAYS
When to draw: 12 hrs after onset of chest pain, repeat in 8-12 hrs
53
```
Cardiac troponin T
Initial elevation time:
Peak elevation:
Return to normal:
When to draw:
```
Initial elevation time: 3-12 hrs
Peak elevation: 12-48 hrs
Return to normal: 5-14 DAYS
When to draw: 12 hrs after onset of chest pain
54
```
CK-MB
Initial elevation time:
Peak elevation:
Return to normal:
When to draw:
```
Initial elevation time: 3-12 hrs
Peak elevation: 24 hrs
Return to normal: 48-72 hrs
When to draw: At presentation, repeat in 8-12 hrs
Evaluating possible reinfarction: sample baseline when symptoms begin, repeat 6-12 hrs later
55
Most specific cardiac biomarkers for myocardial damage
Troponin T and I
56
Most sensitive test to quantify extent of MI
MRI w/ gadolinium contrast
57
Absolute contraindications of thrombolytic therapy in STEMI (5)
1. Previous hemorrhagic stroke
2. Any stroke within past 1 year
3. Known intracranial neoplasm
4. Active internal bleeding
5. Suspected aortic dissection
58
```
Which of the following is NOT a cyanotic anomaly?
A. Tetralogy of Fallot
B. Pulmonary atresia
C. Transposition of great vessels
D. Hypoplastic left heart syndrome
E. Atrial septal defect
```
E. ASD is non-cyanotic (Left to Right shunt). All others are cyanotic (Right to Left shunt)
59
Tetralogy of Fallot =
1. RV outflow obstruction (pulmonary artery stenosis)
2. RV hypertrophy
3. VSD
4. Overriding aorta
60
MC type of atrial septal defect
Ostium secundum
| Non-cyanotic
61
What type of congenital anomaly?
| Crescendo-decrescendo holosystolic at LSB, radiating to back
Tetralogy of Fallot
| Cyanotic
62
What type of congenital anomaly?
| Systolic ejection murmur at 2nd left intercostal space. Early to middle systolic rumble
ASD
| Non-cyanotic
63
What type of congenital anomaly?
| Systolic murmur at LLSB
VSD
| Non-cyanotic
64
What type of congenital anomaly?
| Continuous machinery murmur
PDA
| Non-cyanotic
65
What type of congenital anomaly?
| Systolic, LUSB and left inter-scapular area
Coarctation of aorta
| Non-cyanotic
66
What type of congenital anomaly?
| Common in Down syndrome
Atrioventricular canal defect
67
Electrical alternans is pathognomonic for ___
Pericaridal effusion
68
IVDU w/ infective endocarditis MC pathogen ____
| ___ valve frequently involved.
Staph aureus
| Tricuspid valve
69
what is an indication for cilostazol therapy?
Peripheral arterial disease
70
Do venous ulcers or arterial ulcers appear on the medial aspect of the ankle?
venous.
| Arterial are more common on the lateral side
71
where is the most common site for an aortic aneurysm?
Infrarenal Aorta
72
Endocarditis prophylaxis of choice:
Amoxicillin
| Clindamycin if PCN allergy
73
When is surgery indicated for abdominal aneurysm?
>5cm aneurysm
| must be > 3 cm to be called an aneurysm
74
Treatment for acutely ill pts w/ HF pending blood cultures w/ Infective endocarditis
Gentamicin, vancomycin + cefepime (4th gen ceph)
75
MC involved valve in rheumatic heart disease
mitral
76
Criteria for Rheumatic fever:
___ major OR ___ major + ___ minor
Major (5)
Minor (5)
Jones criteria: 2 major OR 1 major + 2 minor
Major: carditis, erythema marginatum, subcutaneous nodues, chorea, polyarthritis
Minor: fever, polyarthralgias, reversible prolong PRI, increased ESR, increase C-reactive protein
77
Abx tx of Rheumatic Fever
Penicillin G
| Erythromycin if PCN allergy
78
Leriche syndrome
Erectile dysfunction w/ iliac artery disease in peripheral arterial disease
79
Endocarditis prophylaxis of choice:
Amoxicillin
| Clindamycin if PCN allergy
80
patient with bilateral conjunctivitis, edema and erythema of palms and soles, cracked lips, strawberry tongue. What complication can occur with this disease?
Coronary artery aneurysm (Kawasaki Disease)
81
Elevated ____ has strong association w/ incidence and progression of PAD
homocysteine
82
Brodie-Trendelenburg test
Differentiates saphenofemoral valve incompetence from perforator vein incompetence in Varicose Veins
83
Sensitive/specific test for peripheral arterial disease
Ankle-brachial index <0.9
84
Gold standard for dx of Peripheral Arterial Disease
Angiography
85
```
All of the following are features of Giant Cell Arteritis EXCEPT:
A. Polymyalgia rheumatica
B. Diplopia
C. Normochromic microcytic anemia
D. Thrombocytopenia
E. Elevated ESR and CRP
```
C, D: Normochromic normocytic anemia, thrombocytosis
Polymyalgia rheumatica = pain and stiffness of shoulder and pelvic girdle; present in 50% of pts w/ GCA
86
Management of AAA based on size
3-4 cm: US Q yearly
4-4.5 cm: US Q 6 months
>4.5 cm: Vascular surgeon referral
>5.5 cm or >0.5 cm expansion in 6 months: Immediate surgical repair
87
Dx of choice for:
AAA:
Thoracic aneurysm:
AAA: Abdominal US
| Thoracic aneurysm: CT scan
88
Nonartherosclerotic, inflammatory vascular disease most associated with young (less than 40 y/o) smokers
Thromboangiitis obliterans
| Small-medium vessels
89
U waves
Hypokalemia
90
J waves
Hypothermia
| Aka Osborn waves
91
Regimen that improves morbidity and mortality in Acute Coronary Syndrome
Aspirin, beta blocker, enoxaparin (Lovenox)
92
Tx of variant (Prinzmetal) angina
CCB
93
What electrolyte abnormalities increase risk of digoxin toxicity
HYPOmagnesemia
HYPOkalemia
HYPERcalcemia
94
```
Define:
Dromotropy =
Chronotropy =
Inotropy =
Lusitropy =
```
```
Dromotropy = conduction velocity of AV node
Chronotropy = heart rate
Inotropy = cardiac contractility
Lusitropy = relaxation
```
95
EKG of ASD shows ___
RBBB
96
EKG of ventriculoseptal defect shows ___
LVH
97
EKG of Tetralogy of Fallot shows ___
RVH and right axis deviation
98
CCB recommended for rate control for A fib in what kind of patient?
COPD
| BB can cause severe respiratory distress
99
Rib notching
Coarctation of aorta
100
Cardiac tamponade pulse
Paradoxical pulse (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
101
Tx of DVT in:
1. idiopathic, 1st episode
2. recurrent idiopathic OR continuing risk factors
3. 1st epsiode w/ reversible/time-limiting risk factor (immobilization, trauma, post-sx)
```
Initiation of heparin w/ warfarin in all 3 senarios
1. Warfarin for 6-12 months
2. Warfarin for 12 months
3. Warfarin for 3-6 months
Target INR: 2-3
```
102
Tx of atrial fibrillation
CCB (verapamil) or BB
103
Venous insufficiency: (lateral/medial) malleolus
medial
104
1st line tx for stable angina
BB
105
1st line tx for cardiogenic shock
Dobutamine
106
pulsus paradoxus found in ____
pericardial effusion
107
Abx that should be avoided in Long QT syndrome
macrolides
| fluoroquinolones
108
Wide QRS complex w/ broad slurred R wave in V5 and V6 w/ deep S wave in V1
LBBB
109
M shaped P wave in lead II, biphasic P wave in lead V1
Left atrial enlargement
110
R wave larger than S wave in V1 w/ R wave measuring >7mm
Right ventricular hypertrophy
111
Deep S wave in lead I, isolated Q wave in lead III, inverted T wave in lead III
Right heart strain
| S1Q3T3 --> PE
112
Wide QRS complexes w/ RsR' pattern in leads V1 and V2. Wide S wave in V6.
Right bundle branch block
113
Antidote for Heparin
Protamine sulfate
114
Medications that cause acute pericarditis (5)
```
Isoniazid
Procainamide
Phenoytoin
Hydralazine
Penicillins
```
115
Orthostatic hypotension seen in hypovolemia etiology (Chronic adrenal insufficiency, blood loss) is associated (with/without) compensatory increase in heart rate.
WITH
116
Orthostatic hypotension seen in autonomic etiology (Diabetic autonomic insufficiency) is associated (with/without) compensatory increase in heart rate.
WITHOUT
117
C-reactive protein is a potent predictor of ____
future coronary events (Unstable angina, acute MI) and ischemic stroke
118
What HTN medication may increase serum lithium levels?
Thiazide diuretics
| NOT loop diuretics
119
Best at lowering LDL
HMGcoA Reductase Inhibitors (statins)
120
Best at raising HDL
Niacin (Vit B3)
121
Best at decreasing Triglycerides
Fibrates (Gemfibrozil, fenofibrates)
122
Only lipid lowering agent thats safe in pregnancy
Bile Acid Sequestrates (Cholestryamine, Colestipol, Colesevelam)
123
Marfan's Syndrome is caused by genetic deletion of ___
Fibrillin-1 (FBN-1)
124
Polyarteritis Nodosa is highly associated with ___.
| MOA
Hepatitis B
Antigen-antibody complexes
125
Churg-Strauss syndrome is a ____ (small/medium/large) vessel vasculitis that is characterized by ___ (3)
ANCA-associated (p-ANCA)
small
eosinophilia, asthma, and vasculitis
126
Pericardial effusions present with ____
exertional dyspnea
pulmonary edema
JVD
