Flashcards in Cardiology Deck (122)
What are the main five risk factors for coronary artery disease?
Gender/age: male greater than 45, female greater than 55.
Family history of first myocardial infarction in the mail at less than 45 or a female at less than 55
HDL less than 40
What are the risk equivalents for coronary artery disease?
history of significant carotid disease/endarterectomy,
history of peripheral arterial disease, history of abdominal aortic aneurysm.
What are the LDL goals with coronary artery disease risk factors and coronary artery disease equivalents?
If there are 0 to 1 risk factors the LDL should be less than 160.
If there are greater than or equal to two risk factors the LDL should be less than 130.
For risk equivalents, the goal should be less than 100 – optimally less than 70.
If the patient has already had a cardiovascular event, the goal is less than 70 or the previous LDL decreased by 50%.
Cardiac findings in graves disease
Tachycardia and wide pulse pressure
What effects does alcohol have on the cardiovascular system?
Increased blood pressure, increased heart rate, increased cardiac output at rest, increased myocardial oxygen consumption, and increased risk for myocardial infarction. Dyslipidemia can be precipitated or aggravated. Muscle weakness and sudden-death, possibly due to hypoglycemia, are also associated.
What cardiac abnormality in the baby is associated with use of lithium in pregnancy?
Most commonly, Ebstein's anomaly of the Tricuspid valve
What is Dressler's syndrome?
Pericarditis that occurs 1 to 2 weeks after myocardial infarction.
How common is primary hyperaldosteronism?
What are its symptoms?
How is it diagnosed?
It is present in as many as 20% of patients referred to specialists for poorly controlled hypertension. It is more common in women. It's it is often asymptomatic. Many patients will not be hypokalemic. Screening can be done with a morning plasma aldosterone/Reanon ratio. If the ratio is 20 or more and the aldosterone level is greater than 15 ng/dL, then primary hyperaldosteronism is likely and referral for confirmatory testing should be considered.
What murmur increases in intensity with Valsalva?
The Valsalva maneuver decreases venous return to the heart, thereby decreasing cardiac output. this causes most murmurs to decrease in length and intensity. The murmur of hypertrophic obstructive cardiomyopathy however increases in loudness. the murmur of mitral valve prolapse becomes longer and may also become louder.
What drugs should be avoided in tachycardia due to Wolff-Parkinson-White syndrome? What drugs should be used?
Adenosine, digoxin and calcium channel antagonists should be avoided, as they may make the tachycardia rate increase and cause ventriclar fibrillation. Procainamide is usually the treatment of choice, though amiodarone may also be used.
Who should get low-dose ASA for MI or CVA prevention?
Men 45-79 for MI prevention
Women 55-79 for ischemic CVA prevention
What is the drug of choice for mitral valve prolapse?
Propranolol or another beta blocker, but only if the patient is symptomatic.
What effect does diabetes have on the risk for abdominal aortic aneurysm?
It is protective, and decreases the risk by one half.
What drug or drugs should be used to manage hypertension in a patient-who has previously had a stroke?
A combination of a diuretic and an ACE inhibitor. This combination has been clinically shown to reduce the risk of recurrent stroke
What drug used for hypertension has been showed to decrease serum uric acid levels?
What cardiac arrhythmia has been reported with high-dose methadone use?
QT prolongation and torsades de pointes
What is a normal ejection fraction?
55 to 75%
What clinical differences are seen in infants with ventricular septal defect versus hypoplastic left heart syndrome versus TGA versus tetralogy of Fallot versus PDA?
VSD causes overload of both ventricles. The murmur is harsh and holosystolic usually heard best at the left lower sternal border. As the volume of shunting increases cardiac enlargement and increased pulmonary pulmonary vascular markings can be seen on x-ray. The infant is not cyanotic.
Hypoplastic left heart syndrome is manifested by near obliteration of the left ventricle on the EKG and chest radiograph. The infant is cyanotic.
Transposition of the great vessels would cause AV conduction defects and single-sided hypertrophy on the EKG. chest x-ray would show a straight shoulder on the left heart border where the aorta was directed to the right. The infant is not cyanotic.
Tetrology of Fallot causes cyanosis and right ventricular enlargement.
The murmur of PDA is continuous and best heard below the left clavicle the EKG shows left atrial and ventricular enlargement. The infant is not cyanotic.
Amiodarone should not be combined with which drugs?
Lidocaine or digoxin
What are the toxicities of amiodarone?
It can cause fatal interstitial lung disease. It causes increased sinus bradycardia and AV block. It can cause corneal depositions and keratopathy. There is a 1 to 2% incidence of anterior ischemic optic neuropathy. It can cause gynecomastia and epididymitis. It may cause hypo more than hyperthyroidism. It can cause abnormal LFTs.
How long should it take for an ACE related cough to resolve after the drug is stopped?
It usually stops within four weeks, but it may take up to three months.
Describe ACE related cough
It occurs in 5 to 35% of patients. It is a dry cough. It occurs independent of the duration of the prescription. There is an increased incidence in women, non-smokers, and people of Chinese ancestry.
What drugs are combination Alpha and beta blockers?
Labetolol and carvedolol
What are the classifications and treatments for acute decompensated heart failure?
Note: wet equals pulmonary wedge pressure of over 18 and warm equals cardiac index over 2.2.
Warm and dry: treatment is diuretics and vasodilators
What is the goal for rate control of atrial fibrillation?
A resting heart rate of less than 110
What are the recommended treatments for a low, intermediate and high CHADS2 score?
High, or greater than or equal to two: warfarin
Intermediate, or one: warfarin or aspirin 75 to 325 mg per day
Low, or zero: aspirin 75 to 325 mg per day
What drugs should be avoided in congestive heart failure?
Nonselective calcium channel blockers, class I antiarrhythmics, and NSAIDs. Vasoselective calcium channel blockers may be okay.
What murmurs change with a change in position from squat to stand?
Mitral valve prolapse: the click moves toward S2 with squat and toward S1 with stand.
Hypertrophic cardiomyopathy: the murmur is softer with squat and louder withstand.
Describe the murmur of mitral regurgitation.
It is a mid to late systolic murmur best heard over the apex and radiating to the left axilla. it is a blowing murmur, medium to high pitched.