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Cardiology Flashcards

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1
Q

What are the clinical signs of cardiac tamponade?

A

Beck triad: hypotension, JVD, decreased heart sound
Pulsus paradoxus: >10 mm Hg drop in SBP during inspiration
lungs will be clear to oscillation

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2
Q

What is pulsus paradoxus and how might this present in a in a question?

A

Pulsus paradoxus: >10 mm Hg drop in SBP during inspiration
described as “distal pulses become undetectable to palpation during inspiration”

inspiration = increased venous return = increased right heart volumes, normally this results in expansion of the right ventricle into the pericardial space. With with impaired pericardial space (fluid) the interventricular septum deviates to left ventricle affecting end-diastolic volume & forward stroke volume

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3
Q

When should males be screened for abdominal aortic aneurysm?

A

Age 65-75, with any smoking history via a one-time abdominal ultrasound.

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4
Q

Acute pericarditis etiology

A

viral (adenovirus, coxsackievirus, influenza virus)
autoimmune disease
Uremia
Post myocardial infraction

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5
Q

treatment for hypertriglyceridemia

A
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6
Q

Fibrates drugs names and indication

A

Fibrate (gemfibrozil, fenofibrate)
Effective for decreasing triglyceride levels; indicated for severe hypertriglyceridemia (500-1000)

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7
Q

Mechanical complications of acute MI

A

hemodynamic compromise 1st fe days after an MI = mechanical complications for MI. The infarcted myocardium is the softest and most prone to rupture.
-> Mitral regurgitation due to papillary muscle rupture
Left ventricle free wall rupture
Interventricular septum rupture

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8
Q

Lisit the pharmacological therapy used to prevent recurrent coronary events?

A

Dual antiplatelet therapy: Aspirin & P2y12 receptor blocker (clopidogrel)
Beta blcokers
ACEi/ARBs
HMG-CoA reductase Inhibitors (statins)
Aldosterone antagonist (spironolactone, eplerenone) ->in patients w left ventricular ejection fraction <40% who have heart failure sxs or DM

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9
Q

Lipid guideline for starting statin therapy. HINT 5 indications

A

1) <19y/o w a familial hypercholesterolemia
2) LDL >190 = high intensity statin
3) DM + 40-75 y/o = high intensity statin
4) 40-75 y/o w/o DM + LDL > 70 & <190 get 10 year risk ASCVD
——–> >20% = high intensity statin w goal to reduce LDL by >50%
———> >7.5% - <20% = moderate statin w goals to reduce LDL by 30-49%
———> 5-7.5% suggest statin
———> <5% = lifestyle changes
5) any form of CVD

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10
Q

Lipid normal reference range

A

Total cholesterol <200 mg/dl
Triglyceride <150
HDL >60
LDL<130

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11
Q

Which HMG COA reductase inhibitors are the most potent?

A

Rosuvastatin (high intensity at 20-40 mg) is the most potent followed by atorvastatin (40-80mg)

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12
Q

What is the MOA of HMG-COA reductase inhibitor (statins)?

A

Block the effects of hydoxymethylglutaryl- CoA (HMG-COA) reductase, a rate-limiting step of the hepatic production of cholesterol.

Thereby encouraging the use to LDL receptor = reducing LDL in the blood

Cardio-protective by stabilizing atherosclerotic plaques.

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13
Q

What are the side effects of HMG-CoA reductase inhibitor?

A

Hepatoxicity (increase LFTs)

Myopathy (myalgia, rhabdo-> increased CK). Worse when combined with Niacin and Fibrates.

Contraindication in pregnancy and persistently elevated LFTs

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14
Q

Which two lipid lowering drugs are known to decrease cardiovascular risk?

A

HMG-COA reductase inhibitor
PCSK9 inhibitors

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15
Q

Alirocumab & Evolocumab belongs to which lipid lowering drug?

A

PCSK9 inhibitors

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16
Q

Names of PCSK9 inhibitor drugs

A

Alirocumab & Evolocumab

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17
Q

What are the names of bile acid sequestrants drugs?

A

Cholestyramine
Colestipol
Colesevelam

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18
Q

What is the MOA of bile acid sequestrants?

A

Disrupts the enterohepatic recycling of bile acid via blocking bile intestinal absorption.

Decreased bile absorption
↑ bile fecal removal
↑ LDL receptor upregulation on hepatocytes
decrease serum LDL
Increase hepatic synthesis of bile.

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19
Q

Which bile acid sequestrants are often used to treat biliary obstruction related pruritis?

A

Cholestyramine

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20
Q

What is a side effect of bile acid sequestrants?

A

GI upset
Decreased fat-soluble vitamins (DEKA)
–> Prolonged PT/INR due to decreased vitamin K affecting the production of vitamin-dependent clotting factors

Contraindicated in severe hypertriglyceridemia.

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21
Q

What is the MOA of Ezetimibe?

A

It blocks intestinal absorption of cholesterol

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22
Q

What is a known side effect of ezetimibe

A

increased liver enzymes

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23
Q

What are fibrates drugs?

A

Gemfibrozil, Fenifibrate

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24
Q

What is the side effects of fibrates?

A

Increased risk of cholesterol gallstones
Worsen myopathy when combined with statins

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25
What is are the side effects of niacin (vitamin B3)?
Skin flushing and burning sensation of the face, generalized itching, paresthesias, headache after use 20-30 mins peptic ulcer disease Hyperuricemia worsen myopathy when combined with a statin.
26
In treating A fib in a patient with a mechanical valve, which anti-cogaulation should be used?
Warfarin
27
What steps should be taken if considering a electrical rhythm control for a patient with A Fib?
1)Transesophageal Echo to r/o Left atria thrombus 2) positive signs of a thrombus = anti-coag x3 weeks then cardiovert 3)continue Anti-coag x4 weeks after cardioversion.
28
Which anti-arrhythmic drug should not be used in a patient with structural or coronary heart disease?
Flecainide amiodarone can be used.
29
What does CHA2DS2-VAS score stand for, how is it used?
Congestive heart failure HTN Age >75 ----> 2 points Diabetes Stroke ---> 2 points Vascular disease Age 65-74 Sex: female men >2 or women >3 = anticoagulation
30
multifocal atrial tacycardia is associated with?
COPD
31
what is the difference between Wandering atrial pacemaker and multifocal atrial tachycardia?
Both MAT and WAP have >3 distinct P wave morphologies originating from atrial foci however, MAT has a rate >100 WAP has a rate <100
32
what is ventricular tachycardia?
>3 consective premature ventricular contraction
33
What are the painless lesions on the hands which occur with endocarditis?
Janeway lesion
34
What are the painful lesions on the hands which occur with endocarditis?
osler's nodes
35
what is the rise in jugular pressure that occurs with inspiration in a patient with pericardial tamponade called?
Kussmal sign
36
what are side effects of amiodarone?
pulmonary fibrosis, hepatoxicity, thyroid dysfunction (hyper or hypo thyroidism)
37
what is the treatment for angina in a patient who is allergic to nitrates?
CCB
38
What is the treatment for prinzmental angina?
CCB
39
What does a severe elvation of BP (180/120) w/o endorgan dysfunction define?
Hypertensive urgency
40
Which class of antihypertensive medication can cuaes hypokalemia?
thiazide diuretics
41
Which class of antihypertensive medication can cause hyperkalemia?
ACE, ARB, Aldosterone antagonists
42
AAA screening
1 time screening via abdomina U/S in men 65-75 y/o
43
what is abdominal aortic aneurysm?
localized dilation of the aorta due to weakening of the vessel wall. A diameter >3cm is considered an aneurysm
44
What is the most common site for a AAA?
infrarenal
45
AAA is commonly associated with which modifiable risk factor?
Smoking
46
What is aortic dissection ?
a tear in the intimal layer of the aorta, allowing blood to flow between the intima and the media layers, creating a false lumen
47
What is the most common risk factor for aortic dissection?
HTN
48
Explain how the stanford type a classification differs from standford type B classification for aortic dissection?
Stanford type A involved the ascending aorta. which Stanford type B involves the descending aorta
49
How is stanford type A aortic dissection treated?
surgically with preoperative BP control
50
How is stanford type B aortic dissection treated?
Medically with beta blockers (labetalol)
51
What is homan's sign
calf pain on passive foot dorsiflexion (unreliable for the presence of DVT)
52
what is the diagnostic work up for DVT?
DVT unlikely = dimer to r/o DVT. If >500 then compression U/S w doppler. DVT likely = compression U/S w doppler. Pos if non-compression of imaged vein w pressure. Neg if full compressibility.
53
when should IVC be considered in a patient with DVT?
1) crcl <30 2) bleeding that makes anticoag contraindicated
54
what is rheumatic fever?
an autoimmune inflammatory disease involving the joints, heart, skin, nervous system after an episode of untreated group a street pharyngitis
55
what are the two streptococcal antibody titers
anti-deoxynucleoside B or antistreptolysin O
56
How is rheumatic fever diagnosed?
2 major OR 1 major and 2 minor Major: JONES Joints (migratory polyarthritis) Oh my heart (active carditis) Nodules (subcutaneous) Erythema marginatum (macular red no itchy rash Sydenham chorea (involuntary jerky movements) Minor fever >101 arthralgia prolonged PR interval Evelated ESR, CRP
57
management for rheumatic fever
1st line: abx: penicillin G -> pen allergy: erythromycin Anti-inflammatory: aspirin +/- steroids
58
what is the most common valve affected by rheumatic fever?
mitral -> regurgitation that later develops into stenosis.
59
what is the treatment for rheumatic heart disease?
Penicillin 1) 5yr or until 21 ->no evidence of carditis 2)10 yrs or until 21 -> evidence of carditis but no valvular abnormalities 3) 10 yrs or until 40 -> evidence of carditis + valvular abnormalities whichever time frame is longer
60
what is the treatment for rheumatic heart disease if there is no evidence of carditis?
Penicillin for 5yr or until 21 which ever is longer
61
what is the treatment for rheumatic heart disease if there is evidence of carditis but no valvular
penicillin for 10 yrs or until 21, which ever is longer.
62
what is the treatment for rheumatic heart disease if evidence of carditis + valvular abnormalities?
penicillin for 10 yr or until 40 yr old whichever time frame is longer
63
prinzmetal angia
episodic nocturnal chest pain that wakes the patient up at night. Last 10-15 mins
64
What 1 warning to know about beta blockers?
can mask hypoglycemia symptoms
65
What are some end-organ damage (5) finding associated with HTN emergency?
BP >180/120 + end organ damage 1) intracerebral hemorrhage (speech/vision changes) 2) Ischemic stroke Hypertensive encephalopathy (confusion, HA) Hypertensive Nephropathy (increased SCr) 3)Acute heart failure (cough, pink-tinged sputum) 4) acute coronary syndrome 5) Aortic Dissection
66
what is the treatment for HTN urgency?
Clonidine
67
What is the treatmennt for HTN emergency?
Nitroprusside
68
What is the most common cause of myocarditis?
viral MC (enteroviruses, Coxsackievirus)
69
myocarditis presentation ?
Prodrome viral sxs then sxs of dilated cardiomyopathy
70
treatment for myocarditis
supportive: ACEi, diuretics, BBs
71
what are the causes of pericarditis?
1) viral (coxsackievirus) 2) Dressler syndrome (post MI pericarditis + fever + pleural effusion)
72
What is dressler syndrome?
inflammation of the pericardial sac after an MI with fever and pleural effusion
73
What are EKG findings for pericarditis?
1) Diffuse concave ST elevation in all precordial leads 2) PR depression
74
what is the treatment of pericarditis?
NSAIDs or ASA
75
what is pulsus paradoxus?
>10mmHg decreased in systolic pressure w inspiration associated cardiac tamponade
76
what is constrictive pericarditis?
loss of pericardial elasticity (restriction of ventricular diastolic filling)
77
pericardial knock
high-pitched, knocking-like sound resulting from the abrupt cessation of ventricular filling due to a rigid, non-compliant pericardium, as seen in constrictive pericarditis.
78
recommended regimen for endocarditid prophlaxis when undergoing dental procedures?
2g (2000mg) of amoxicillin before procedure 2g of cephalexin if pen allergy
79
Cilostazol what does it do and how is it used?
Cilostazol -> suppress platelet aggregation & vasodilate arterial-> increase claudication free walking distance. Contraindicated in HF-> specific for PAD
80
Lateral malleolus ulcers are associated with?
Peripheral arterial disease "L-A-teral Ulcers"
81
The 6 Ps of Acute arterial occlusion include?
1) Paresthesias 2) pain 3) pallor 4) pulselessness 5) poikilothermia 6) paralysis
82
superficial thrombophlebitis is commonly caused by?
IV catheterization, pregnancy, varicose veins
83
migratory thrombophlebitis vs localized superficial thrombophlebitis?
Trosseau sign: migratory thrombophlebitis = malignancy Isolated palpable cord, red, painful edema along the vein = superficial thrombophlebitis
84

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