Cardiology 16% Flashcards Preview

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Flashcards in Cardiology 16% Deck (126):
1

Inotropes
Ex:
MOA:

Ex: dobutamine, dopamine, epinephrine, digoxin
MOA: increase CO by increasing contractility

2

Chronotropes
Ex:
MOA:

Positive: adrenaline
Negative: digoxin
MOA: alter heart rate

3

Pressors
Ex:
MOA:

Ex: Dopamine, phenylephrine
MOA: improve pressure by increasing vascular tone

4

Postural hypotension =

>20 mmHg drop in SBP OR >10 mmHg drop in DBP b/w supine and sitting and/or standing

5

Metabolic syndrome =

3 or more of the following:
1. Truncal obesity
2. HDL < 40 (men) or <50 (women)
3. Hypertriglyceridemia: >150
4. Fasting glucose >110
5. HTN

6

Blood pressure for:
Normal =
PreHTN =
HTN stage 1 =
HTN stage 2 =

Normal = <120/<80
PreHTN = 120-139/80-90
HTN stage 1 = 140-159/90-99
HTN stage 2 = >160/>100

7

Hypertensive urgency =

Hypertensive emergency =

Increased BP w/ NO apparent acute end-organ damage

>220 mmHg SBP or >125 mmHg DBP w/ acute target end-organ damage

8

ECG of HTN may reveal ____

left ventricular hypertrophy = deep S waves in V1 + V2, tall R waves in V5 + V6

9

Goal blood pressure in HTN

140/90

10

Goal blood pressure in diabetes or CKD

130/80

11

HCTZ, Chlorthalidone =
MOA:
SE:

Diuretic
MOA: prevent kidney Na/water reabsorption at DISTAL DILUTING TUBULE
SE: HypoNa, HypoK
hyperuricemia, hyperglycemia --> caution in pts w/ DM and gout

12

HTN medication that should be used w/ caution in pts w/ DM and gout

HCTZ, Chlorthalidone

13

Furosemide, bumetanide =
MOA:
SE:

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

HTN medication CI in pts w/ sulfa allergies.

Loop diuretics: Furosemide, bumetanide

15

Spironolactone, Amiloride, Eplerenone =
MOA:
SE:

K+ sparing diuretics
MOA: inhibit aldosterone-mediated Na/H2O absorption
SE: HyperK, gynecomastia

16

HTN medication that causes gynecomastia

K+ sparing diuretics: Spironolactone, Amiloride, Eplerenone

17

Nifedipine, amlodipine =
MOA:
Indication:

Dihydropyridines CCB
MOA: potent vasodilators (no effect on cardiac contractility/conduction)
Ind: HTN, Angina, Raynaud's

18

Verapamil, Diltiazem =
MOA:
Indication:

Non-dihydropyridines CCB
MOA: cardiac contractility and conduction, potent vasodilators, reduce vascular permeability
Ind: HTN w/ A fib, Angina, Raynaud's

19

HTN medication that causes constipation

verapamil

20

Cardioselective beta blockers: (3)
Non-cardioselective beta blockers: (1)

Cardioselective beta blockers (beta-1) : Atenolol, metoprolol, esmolol
Non-cardioselective beta blockers (beta-1 & beta-2): Propranolol

21

T/F: Beta blockers are used as 1st line monotherapy in HTN.

False. Thiazide diuretics (HTCZ) are tx of choice as initial therapy in uncomplicated HTN.

22

CI of beta blockers:

2nd/3rd heart block, decompensated heart failure

Nonselective beta blockers CI in asthma/COPD --> may worsen peripheral vascular disease/Raynaud's phenomenon

23

CI of CCB:

pts taking beta blockers, CHF, 2nd/3rd heart block

24

Drug of choice for pts w/ HTN and BPH
Indications:
SE:

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