cardiology Flashcards by Shannon Payseur

The best confirmatory test for AMI

Cardiac troponins

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The most important lipid risk factor for CAD

Elevated LDL

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What is the recommended energy in joules for an initial attempt at synchronized cardioversion?

100-200 joules for monophasic waveforms

100 joules for biphasic waveforms

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An elevated pulses paradoxus ~14mmHg is indicative of possible

Cardiac tamponade

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Options to slow AV conduction in narrow complex tachycardia

1) IV adenosine
2) IV B-blocker. ) 3)IV diltiazem
4) vagaries maneuvers

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The ALLHAT study recommends the best one drug to start for hypertension is?

Thiazides diuretic specifically chlorthalidone

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Sinus node disease is caused by?

Right or circumflex coronary artery disease
Intrinsic aging
Hypothyroidism
Superimposed drug effect

Treat symptomatic with pacemaker

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Sinus node disease is most common in what age group?

How does it present?

Episodic sinus arrest
Tachy-Brady syndrome 
Persistent sinus bradycardia 
Persistent sinus tachycardia 
Occurs in persons >60yo

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A hypertrophied ventricle with preserved ejection fraction is associated with?

Diastolic dysfunction

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Cirrhosis is usually associated with a decrease in serum

Cholesterol

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Treatment of Rhabdomyolysis

Rapid large infusions of isotonic saline to prevent and treat acute kidney injury

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Dysrhythmia almost always represents disease of the AV node, sometimes seen in athletes caused by

Inferior wall ischemia

The inferior wall is supplied by the RCA which also supplies the AV NODE

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USPSTF recommends targeted screening in adults 20-45 if

Family history of cardiac disease or high cholesterol
Smoking
Diabetes

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Elevated triglyceride level is most commonly associated with

Diabetics with poor glycemic control. Triglycerides are >250

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When the standard treatment with diuretics, b blockers, and ACE-I is insufficient to control symptoms; this medication combo isparticularly effective in African Americans with NYHA class IIIor IV

Hydralazine plus isosorbide dinitrate

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The basic physiologic mechanism in patients with angina pectoris due to myocardial ischemia

An imbalance between oxygen supply and demand due to narrowing of the coronary arteries

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Prior to discharge after MI standard of care is to test with?

Sub maximal stress test, if positive refer for catheteratization
If borderline refer for radionuclide study

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For pulmonale is the term used for

Right heart failure caused by diseases primarily affecting the lungs and pulmonary vasculature

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What is the keystone of effective heart failure treatment regimen?

Sodium and fluid restrictions

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The JNC 8 panel recommends a blood pressure goal for persons younger than 60yo with no co morbidities?

In the general population younger than 60 years, pharmacologic treatment should be initiated when the systolic pressure is 140 mm Hg or higher, or when the diastolic pressure is 90 mm Hg or higher. The target systolic pressure in this population is less than 140 mm Hg, and the target diastolic pressure is less than 90 mm Hg.

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Which valves are most commonly affected by endocarditis?

Aortic and mitral

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For anticoagulation in AMI, what is the dose of enoxaparin (lovenox) ?

Enoxaparin 1mg/kg SQ EVERY 12 hours

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Which drug class would you use first line in patient with symptomatic BPH

Alpha blocker; doxazosin

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Post MI Survival is improved by which meds

Ace inhibitors
B blockers
Statins
ASA

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2007 ACC/AHA GUIDELINES recommends that patients experiencing - recurrent angina or ischemia at rest or low level activity despite intensive medical treatment - elevated cardiac bio markers (TnT or Tnl) - new or presumably new ST segment depression - signs or symptoms of HF or new or worsening mitral regurgitation - high risk findings from noninvasive testing

Percutaneous coronary intervention

Drug of choice for treatment of isolated hypertriglyceridemia

Gemfibrozil

Decreased HDL is always associated with increased

Triglycerides as a risk factor for CAD

Risk factors for coronary artery disease?

Smoking, elevated LDL, HDL45, female>55, first degree female relative CAD

Following MI what test should be performed

Submaximal stress ECG test and echocardiogram

The JNC 8 panel recommends a goal blood pressure for 60 year old patients and older of?

150/90

Regional wall motion abnormality indicates

Ischemic heart disease

STEMI is distinguished from UA/NSTEMI by the presence of

ST- segment elevation on EKG followed by Q wave

Patients with wolf parkinson white WPW Syndrome decompensate with BB and CCB. WHAT Is drug of choice? Clues for WPW include young age, history of tachycardia, palpitations or syncope

Procainamide

Antihypertensive drugs that can cause prolonged hypotension when used with sildenafil?

Peripheral alpha blockers i.e.; doxasosin,tamsulosin, prazosin

Upright wide QRS on EKG

LBBB

Patient h/o COPD ON THEOPHYLLINE presents with rapid regular pulse DX?

Multifocal atrial tachycardia

First study to confirm peripheral vascular disease

ABI

Where is pain most common in patients with AAA RUPTURE

Abdomen, legs, flank, buttocks, groin/ testicles

Pain often made worse by walking downhill and better when walking uphill or leaning foward ( a kyphotic position opens up foramen) is indicative of?

Spinal stenosis

Complication of ticloplidine

Thrombocytopenia

Systolic dysfunction results ejection fraction

USPSTF RECOMMENDATION FOR AAA SCREENING

One Time Screening by ultrasound in men ages 65-75 who have ever smoked

If INR >20 most appropriate action

Rapid reversal withFFP and vit K

Name drug and dose appropriate for treatment asystole

Epinephrine 1 mg

If INR is 5 or less most appropriate action

Hold next dose

Biomarker of choice in the evaluation of acute coronary syndrome

Troponin can be detected 3-6 hours after onset of ischemic symptoms

An enlarged aorta on physical exam should be further assessed by

Abdominal ultrasound study

Type of heart failure associated with long standing uncontrolled hypertension and stiff ventricle that poorly relaxes to allow good filling during diastole

Diastolic dysfunction

Mobitz type I Second degree AV block (Wenckebach)

PR interval progressively lengthens until a P wave fails to conduct and a beat is dropped

If INR 15-20

Administer 5-10 mg of VIT K po

Although benefits of thrombolytic therapy are greatest within the first 1-3 hours, a 10% mortality benefit can be after the onset of pain

12 hours

For patients with AMI, IF 1) complete heart block develops, 2) 2nd degree lock or new LBBB with 1st degree AV block develops or symptomatic bradycardia unresponsive to atropine the proper response is to?

Insert a temporary pacemaker regardless of heart rate

For patients 18years and older with diabetes or chronic kidney disease the JNC8 recommends a blood pressure of?

• In patients with hypertension and diabetes, pharmacologic treatment should be initiated when blood pressure is 140/90 mm Hg or higher, regardless of age.

Thrombolytic therapy and interventional angioplasty are the cornerstone for treatment of acute ST segment elevated MI. Effective therapy limits

Myocardial necrosis, preserves left ventricular function, reduces mortality

What is the earliest marker of MI

CK-M; myoglobin can be detected as early as 2 hours after cardiac necrosis Sensitive but not specific Better for diagnosing reinfarction

3 Beta blockers to use in CHF

Metoprolol Carvedilol Bisoprolol

EKG findings consistent with LVH Should be confirmed with what test?

Echocardiogram

The distinction between unstable angina and chronic stable angina is made on the basis of

History and progression of ST wave changes

The right ventricle is dependent on filling pressure "preload", nitroglycerin decreases preload thus hypotension after dose NTG may be indicative of?

Right ventricular infarction, which is commonly associated with inferior wall MI

Acute treatment of V-tachycardia

Lidocaine | Amiodarone

Right ventricular hypertrophy with paradoxical bulging of the ventricular septum into the left ventricle , right axis deviation on EKG with RBBB is a typical picture of

Cor pulmonale

Sympathomimetic meds like phenylepherine and pseudoephedrine can be problematic because they

Increase heart rate Increase blood pressure Worsen existing urinary obstruction

Causes of ventricular tachycardia

AV dissociation Electrolyte disturbance Fusion beats

Statins can be continued unless liver enzymes elevate how much?

3xs upper limit of normal

As a class CCB tend to cause

Peripheral edema

Cilostazol (pleats) and pentoxiphyline (T rental) phosphodiesterase inhibitors are contraindicated in patients with?

CHF

Stress testing is best suited for which group of individuals?

Men with an intermediate probability of cardiac disease

4 statin benefit groups

Individuals with clinical ASCVD Primary elevations of LDL-C >190mg/dL 40-75yo diabetics and LDL 70--189 Without ASCVD or diabetes, age 40-75, LDL-C 70-189 and estimated 10 year ASCVD risk of 7.5% or higher

Patient with chronic atrial fibrillation taking dabigatran can no longer afford it what is most appropriate switch to Coumadin?

Start Coumadin now and stop dabigatran in 3 days

If a patient is not a candidate for cardioversion because >48 hours a fib, wait how long after anticoagulation to cardiovert the patient

Wait until the patient anti coagulated X 3 weeks with target INR 2-3

What is the most sensitive test for renal artery stenosis?

MR angiography

Early reocclusion secondary to thrombosis is more common with

Drug eluting stents, prescribe for 1 year with dug eluting stent 3 months for bare metal stent

All post MI patients should be discharged with the following meds

Asa, lipid lowering agent, BB, ACEI , NTG prn

AHA allows how much total cholesterol in daily intake

300 mg

In atrial fibrillation with rapid ventricular rate in a stable patient what should you focus your initial treatment

Rate control | Treat with beta blockers

Medication preferred for CHF due to LV systolic dysfunction because they offer greatest reduction in mortality

ACE- inhibitors

Irregularly irregular narrow complex rhythm with atrial rate >300

Atrial fibrillation

Atrial fibrillation CHADS2 parameters assesses stroke risk to indicate anticoagulation

CHF, HTN, age >75, DM, STROKE IN PAST OR TIA

The national cholesterol education program adult treatment panel III ( NCEP-ATP III) guidelines define high cholesterol as Total cholesterol TC? LDL.

TC 200 | LDL 130

At what size in centimeters do you refer patient with AAA to vascular surgeon for surgical intervention 🤔

5-5.5cm

For STEMI, the recommended FIRST AND ONLY FIRST DOSE OF ENOXAPARIN sq dose for persons

30mg IV enoxaparin should be given WITH the first sq dose

If a patient is on theophylline the least desirable method of chemical stressing would be?

Adenosine | Dipyridamole

MC Cause secondary hypertension further supported by presence of unprovoked hypokalemia although in majority of cases potassium is normal

Hyperaldosteronism | Aldosterone increases secretion of potassium which leads to hypokalemia

BNP is secreted from the ventricles in response to ventricular volume expansion and pressure overload Release is directly proportional to ventricular dysfunction and correlates with end diastolic pressure BNP >400 confers

95% likelihood CHF

Indications for CABG?

3vessel disease, left main CAD

Aortic dissection management

Start with beta blockers Goal is to LOWER BLOOD PRESSURE

Anytime there is negative force in lead II there is neg force presence in III and aVF patient will have

Left anterior fascicular block LAFB

The most common etiology for heart failure associated with of systolic dysfunction?

Ischemic heart disease. Get an angiogram

Best screening test for suspected PVD

ABI

The only adjunctive agent that has been shown unequivocally to reduce mortality alone or in conjunction with thrombolytic agents in patients with AMI

ASA

In atrial fibrillation the most effective long term therapy for rate control at both rest and exercise?

Beta blockers Digitalis more effective rate control at rest May not control rate with exercise

What is the most common cause hyperaldosteronism?

Adrenal adenoma

Reproducible ischemic muscle pain that occurs with exercise relieved by rest? 🤔

Claudication

The drug of choice for mild to moderate LDL Elevation

HMG-CoA reductase inhibitors ie; lovastatin, pravastatin, simvastatin rosuvastatin

Heparin has not not been found to outweigh the harms in patients receiving streptokinase, except in cases of patient

Anterior wall MI | Patients with complications prone thromboembolism such as atrial fibrillation or congestive heart failure

Cause of diastolic dysfunction

Increased ventricular stiffness and decreased ventricular compliance

What is the procedure of choice to diagnose congestive heart failure?

Echocardiogram

What Is the loading dose of clopidigrel

600mg

Am ABI > 1.4 indicates?

Calcified non compressible arteries

Contraindications beta blockers in heart failure

Hemodynamics instability Heart block Bradycardia Severe asthma

The anterior wall is supplied by the

Left coronary artery which supplied the His-purkinje system

Most common cause acute Coronary syndrome

Occlusive thrombus developing on top of a disrupted atherosclerotic plaque

Treatment cocaine induced acute Coronary syndrome

NTG and CCB

Glycoprotein IIb/IIIa receptor blockers

Inhibit platelet aggregation Abciximab Eptifibatide Tirofiban

Sinus bradycardia, 1 st degree AVB are commonly associated with other Derek's of physical conditioning Meds not contraindicated

Ate bblockers nor non dihydropyridines CCBs

According to NCEP LDL is elevated when it is higher than

130

Cardiogenic shock is associated with severe left ventricular dysfunction and occurs with large infarcts that produce damage to more than 40% of left ventricle treatment of choice

Intra aortic balloon pump placement to increase coronary flow and to decrease afterload; coronary reperfusion with Percutaneous transiluminal balloon angioplasty ( the mainstay of treatment

The treatment of choice for hypercholesterolemia

Diet therapy

cardiology Flashcards

(108 cards)