Cardiology Flashcards
(125 cards)
0
Q
Causes of dilated cardiomyopathy
A
Alcohol, adriamycin, radiation, Chagas’ disease
1
Q
Diagnostic test for dilated cardiomyopathy?
A
Echo
Best initial test
MUGA or Nuclear ventriculography
Most accurate
2
Q
Treatment for dilated cardiomyopathy?
A
ACE inhibitors, beta blockers, spirinolactone
3
Q
Diagnostic test for HCM?
A
Echo
Shows normal ejection fraction
4
Q
Treatment for HCM?
A
Beta blockers and diuretics
5
Q
What kind of history do patients present with Restrictive Cardiomyopathy?
A
Sardoidosis, amyloidosis, Hemochromatosis, myocardial fibrosis
6
Q
Diagnostic test for Restrictive cardiomyopathy?
A
Cardiac cath- rapid x and y descent
EKG- low voltage
Echo- mainstay of diagnosis
Biopsy- most accurate
7
Q
Treatment for Restrictive cardiomyopathy?
A
Diuretics
8
Q
Best initial test for Pericarditis?
A
EKG- ST segment elevation
- PR depression is pathognomonic
9
Q
What is the treatment for pericarditis?
A
NSAID-best initial therapy
Oral prednisone- for persistent pain
10
Q
What is pulsus paradoxus?
A
decrease of blood pressure greater than 10 mmHg upon inhalation
11
Q
diagnostic test for pericardial tamponade?
A
Echo- most accurate test
- shows diastolic collapse of RA and RV
EKG- low voltage, electric alternans
12
Q
Treatment for Pericardial tamponade?
A
Pericardiocentesis- best initial
Pericardial window- most effective
13
Q
Unique features of Constrictive Cardiomyopathy?
A
Kussmaul’s sign- increase JVD on inhalation
Pericardial Knock- extra diastolic sound from heart hitting calcified pericardium
14
Q
Diagnostic test for Constrictive cardiomyopathy?
A
CXR- shows calcification
EKG- low voltage
CT and MRI- thickening of pericardium
15
Q
Treatment for constrictive cardiomyopathy?
A
diuretic- best initial
removal of pericardium- most effective
16
Q
Best initial test for Dissecting thoracic aorta?
A
CXR- widened mediastinum
17
Q
Most accurate test for Dissecting thoracic aorta?
A
CT angio
18
Q
Treatment for Dissecting thoracic aorta?
A
1st order beta blocker with EKG and CXR
2nd order nitroprusside to control BP.
3rd ICU, surgery consult, and surgical correction
19
Q
Screening tool for AAA?
A
US men over 65 who are smokers
20
Q
Most accurate test for PAD?
A
Angiography
21
Q
Best initial test for Peripheral Arterial disease?
A
ABI- normal greater than 0.9; if there is >10% difference, there is obstruction
22
Q
Best initial therapy for PAD?
A
Aspirin, ACEi(BP control), Cilostazol, Lipid control
23
Q
Patients having negative EKG for Afib should get?
A
Telemetry- inpatients
Holter monitor- outpatients
24
Other tests to order after Afib is diagnosed?
Echo- look for clots, valve function, L atrial size
Thyroid function- T4 and TSH levels
Electrolytes- K, Mg, Ca
25
Treatment for Afib in UNstable patient?
Unstable patient- SYNchonized cardioversion
| Unstable- Systolic <90, CHF, confusion, chest pain
26
Treatment for Afib in Stable patient?
Control Ventricular rate to <120(Beta blocker, CCB, Digoxin)
| Once rate is controlled- anticoagulate with warfarin for target INR 2-3
27
What is CHADS2 score?
Scoring system indicating need for warfarin or aspirin
C- CHF
H- HTN
A- Age (>75)
D- Diabetes
S- Stroke/TIA (2 points if this is present)
- Score ≥ 2 --> warfarin
- Score 0 or 1 --> aspirin
28
Best diagnostic test for SVT?
Holter or telemetry
29
Best initial management for UNstable patient with SVT?
SYNchronized cardioversion
30
Best initial management for stable patient with SVT?
Vagal maneuver
31
If vagal maneuvers do not work for a patient with SVT, what to try next?
HIGH YIELD
IV adenosine
32
Best long term management for SVT?
Radiofrequency ablation
33
What is Wolf Parkinson White syndrome?
abnormal neuralized cardiac tissue around the AV node, conduction through this tissue is increased
34
What is diagnostic finding with WPW syndrome?
delta wave on EKG
| most accurate test- EP study
35
Best initial therapy for WPW?
Procainamide
36
Best long term therapy for WPW?
Radiofrequency ablation
37
How does VT present?
Palpitations, syncope, chest pain, sudden death
38
Treatment for stable Vtach?
amiodarone, lidocaine, procainamide, Mg
39
Treatment for UNstable Vtach?
SYNchronized cardioversion
40
How does VFib present?
DEATH
41
Treatment for VFib?
UNsynchronized cardioversion
42
Treatment for Torsades de pointes?
Mg
43
What to order after syncope?
EKG, Chemistries(glucose), oximeter, CBC, cardiac enzymes, cardiac and neuro exam
44
On further management if diagnosis of syncope is unclear , what do you order?
Holter, telemetry, repeat CK-MB, Urine-tox
45
Most important thing to do in syncope is...?
exclude cardiac etiology, such as arrythmia
46
What is the single worst/most dangerous risk factor for CAD?
diabetes
47
What is the best initial diagnostic test for ischemic type chest pain?
EKG
48
What is the difference between troponin and CK-MB?
CK-MB stays elevated for 1-2 days while troponin stays elevated for 1-2 weeks. CK-MB best test for re-infarction a few days after initial infarction
49
Which cardiac enzyme will rise first during and ischemic event?
Myoglobin rises 1-4 hours after injury
50
When is dipyridamole or adenosine thallium stress test or dobutamine echo the answer for stress test?
When patients cannot exercise to a target heart rate of >85% of maximum:
COPD, Amputation, deconditioning, weakness/previous stroke, demetia, obesity
51
When is exercise thallium testing or stress echo the answer for stress test?
EKG is unreadable for ischemia:
| LBBB, digoxin use, pacemaker in place, LVH
52
What is the next step after an abnormal stress test showing reversible ischemia?
angiography
53
What is the best cardiac test to evaluate valve function?
echo
54
What is the most accurate method to evaluate ejection fraction?
nuclear ventriculogram
55
What is the best initial therapy for ACS?
aspirin
56
What is the effect of aspirin for ACS?
inhibits platelets
57
Which treatments for ACS always lowers mortality?
```
STAMP-C
Statins
Thrombolytics
Aspirin (best initial therapy)
Metoprolol
Primary angioplasty
Clopidogrel
```
58
What is the treatment for ACS?
```
MONA
Morphine
Oxygen
Nitrates
Aspirin
```
59
Primary angioplasty (PCI) is beneficial in patients with ACS when it is preformed in what time frame?
<90 minutes from arrival to ED
60
What has the single greatest efficacy in lowering mortality for STEMI?
Urgent angioplasty (PCI)
61
If patient can not receive PCI for ACS within 90 minutes of the arrival to the ED, what should they receive?
Thrombolytics
62
When is thrombolytics indicated during ACS?
Patient must have chest pain for less than 12 hours and ST elevation in 2 or more leads.
A new LBBB is also an indication
63
If there is systolic dysfunction or left ventricular dysfunction, what will lower mortality?
ACEi or ARBs
64
What is the test and treatment for MI complication of cardiogenic shock?
echo, swan-ganz; ACEi and revasularization
65
What is the test and treatment for MI complication of valve rupture?
echo; ACEi, nitroprusside, balloon pump bridging to surgery
66
What is the test and treatment for MI complication of septal rupture?
echo; ACEi, nitroprusside, urgent surgery
67
What is the test and treatment for MI complication of myocardial wall rupture?
echo; pericardiocentesis, cardiac repair
68
What is the test and treatment for MI complication of sinus bradycardia?
echo; atropine
69
What should patients be discharged with post-MI?
aspirin, clopidogrel, beta-blocker, statin, ACEi
70
What are the differences in management of non-ST segment elevation?
no thrombolytic use, heparin used routinely(lowers mortality), glycoprotein IIb/IIIa inhibitors also lower mortality
71
What are the two main medications that reduce mortality for chronic angina?
aspirin & metoprolol
72
What test needs to be done before undergoing CABG?
coronary angiography
73
What are the indications for CABG?
3 vessels with >70% stenosis
Left main stenosis >50%
2 vessels in a diabetic
2-3 vessels with low ejection fraction
74
What is the indication for lipid lowering therapy for a patient with ACS?
LDL > 100
75
What is the LDL goal in a patient who has diabetes and ACS?
LDL < 70
76
What is the most common adverse effect of statin medications?
Liver toxicity
77
What is the mainstay therapy for acute pulmonary edema?
O2, furosemide, nitrates, morphine
78
What tests should be ordered when a CHF patient presents?
CXR, EKG, oximeter, echo.
| - order these with the treatments(O2, furosemide, nitrates, morphine)
79
What are the drugs that decrease mortality in CHF patients with systolic dysfunction?
ACEi, metoprolol/carvedilol, spirinolactone
80
In patients who have CHF, who are candidates for implantable cardioverter/defibrillators?
Patients with dilated cardiomyopathy with an EF < 35%
| - Most common cause of death with patient with CHF is sudden death from arrhythmia
81
What are the systolic murmurs?
AS, MR, MVP, HCOM
82
What are the diastolic murmurs?
AR, MS
83
All right sided heart lesions and AS, AR, MS, MR become louder with squatting and leg raising
All right sided heart lesions and AS, AR, MS, MR become louder with squatting and leg raising
84
What two lesions will their murmurs become softer with squatting and leg raising?
MVP, HCOM
| - increased murmur with stand or valsalva
85
What lesions will their murmurs become louder with increased hand grip (increased afterload)?
AR, MR, VSD
87
What lesions will their murmurs become softer with increased hand grip (increased afterload)?
AS, HCOM, MVP
88
Where is aortic stenosis heard the best?
2nd right intercostal space, radiates to carotids
89
Where is aortic regurg, tricuspid murmur, and VSD heard the best?
Left lower sternal border
90
Where is mitral regur murmur heard the best?
Apex and radiates to axilla
91
What is the best initial test for valve lesions?
echo
92
What is the most accurate test for valve lesions?
Left heart catheterization
93
In general if handgrip makes the murmur worse, what therapy should the patient be on?
ACEi, ARB
| afterload reduction
94
How does aortic stenosis present?
chest pain, older patient, HTN
95
What kind of murmur is in AS?
cresendo-decresendo systolic
| heard best at 2nd right intercostal space
96
What is the best inital test for AS?
TTE
97
What is more accurate test for AS?
TEE
98
What is the most accurate test for AS?
left heart catheterization
99
What else should be ordered with a patient with AS?
EKG, CXR(LV hypertrophy)
100
What is the best initial therapy for AS?
diuretics
101
What is the treatment of choice for AS?
valve replacement
- Pig valves last ~10 years, no anticoagulation
- mechanical valves last >10 years, must be anticoagulated (INR 2-3)
102
How does AR present?
SOB, fatigue
103
What is the murmur with AR?
diastolic decresendo heard at L sternal border
104
What is the best inital test for AR?
TTE
105
What is more accurate test for AR?
TEE
106
What is the most accurate test for AR?
L heart cath
107
What is the best initial therapy for AR?
ACEi, ARB, nifedipine
| Add furosemide for CCS case
108
When is surgery for AR the correct answer?
When EF < 55%
| LV diameter > 55mm
109
How does MS present?
Immigrant patient with rheumatic fever, also look for preggers patient
dysphagia
hoarseness
Afib
110
What is the murmur for MS?
diastolic rumble after opening snap
111
What is the best initial test for MS?
What is the more accurate test for MS?
What is the most acurate test for MS?
TTE
TEE
L heart cath
112
What is the best initial therapy for MS?
Diuretics
113
What is the most effective therapy for MS?
balloon valvuloplasty
114
How does MR present?
dyspnea on exertion with history of HTN, ischemic heart disease
115
What is the murmur for MR?
holosystolic heard best at the apex and radiating to axilla
116
What is the best initial test for MR?
TTE
117
What is the more accurate test for MR?
TEE
118
What is the best initial treatment for MR?
ACEi, ARB, nifedipine
119
When is surgery the answer for MR?
When EF < 60%
| LV diameter > 40mm
120
What is the murmur for VSD?
holosystolic heard at L sternal border
121
What is the first diagnostic test for VSD?
echo
122
How can ASD present?
SOB
123
What type of splitting will appear in ASD?
fixed splitting of S2
124
How to diagnose ASD?
echo
125
What is the best therapy for ASD?
percutaneous or catheter devices
