CARDIOLOGY

Question 1

Modifiable Risk Factors of Ischemic Heart Disease

Answer 1

Dyslipidemia 
Smoking (2x the risk)
HTN
Obesity
DM

Question 2

Uncontrollable Risk Factors of Ischemic Heart Disease

Answer 2

Age (W>65, M>55)
Males greater risk than females
Family History

Question 3

MI Clinical Features

Answer 3

Chest pain (retrosternal, may radiate to arm, neck or jaw, crushing, constricting)
Prolonged (>20 mins to hours)
N/V
Weakness, Dizziness, Palpitations
Cold Sweat, impending doom

Question 4

MI Physical Exam

Answer 4

No real findings typically

May have elevated BP, JVD, presence of S4, displaced PMI

Question 5

MI Ddx

Answer 5

Pericarditis, PE, aortic dissection, costochondritis, esophageal rupture

Question 6

MI Diagnostic Factors

Answer 6

Labs: leukocytosis
Echo: wall motion abnormalities

Question 7

Cardiac Markers: CK

Answer 7

appears 3-6 hrs, lasts 2-4 days, peaks at 24 hrs

Question 8

Cardiac Markers: Troponin

Answer 8

appears 2-4 hrs, lasts 5-12 days, peaks at 10-24 hrs

Question 9

Cardiac Markers: Myoglobin

Answer 9

appears 1-2 hrs, lasts

Question 10

MI EKG Findings

Answer 10

ST elevation (transmural) and Q waves, ST depression (subendocardial)

Question 11

Inferior Wall

Answer 11

II, III, aVF - RCA

Question 12

Lateral Wall

Answer 12

I, aVL, V5, V6- Circumflex

Question 13

Anterior Wall

Answer 13

V2-V4, I, aVL-LCA

Question 14

Posterior Wall

Answer 14

V1, V2 (ST dep) - RCA, Circumflex

Question 15

MI Treatment

Answer 15

MONA-Hep-B
Morphine
Oxygen
Nitrates
Aspirin
Heparin
Beta-Blockers

Question 16

MI Treatment: Antiplatelet Tx

Answer 16

Aspirin, Clopidogrel, thienopyridine, abciximab (glycoprotein inhibitors)

Question 17

MI Treatment: ACEi

Answer 17

Cardioprotective, start in all patients with AMI, continue if LVH, or HF develops

Question 18

MI Treatment: Heparin (indications)

Answer 18

Antithrombin Tx: inactivates thrombin and factor X

Indications: those not receiving thrombolytics, those with ST depression, those getting TPA

Question 19

MI Treatment: Recanalization

Answer 19

PCI
PCTA
Fibrinolytics: need within 12 hrs (streptokinase)

Question 20

ABSOLUTE Contraindications for Thrombolysis

Answer 20

active internal bleeding
recent head trauma or known intracranial neoplasm
Hx of hemorrhagic CVA
major surgery/trauma

Question 21

Stable Angina Pectoris

Answer 21

Chest pain (lasts 5-15 mins, builds up rapidly)
worse with activity, relieved by rest
PE: normal or S4
Labs: cardiac enzymes negative
EKG: may show ST depression and T waves during pain
Dx: positive stress test
Tx: anti-platelets, BB, ACEi, revascularization with PTCA, CABG

Question 22

Unstable Angina Pectoris

Answer 22

Chest pain not relieved by rest
S/S: DOE, palpitations, fatigue, SOB, diaphoresis
PE: normal or S4
Labs: cardiac enzymes normal
EKG: non-specific changes
Tx: ASA, BB, ACEi, revascularization

Question 23

Acute Pericarditis

Answer 23

Chest pain (better with leaning forward), pericardial friction rub
Viral pericarditis: Coxsackie B virus is MCC
EKG: diffuse ST elevations with upright T waves
Tx: NSAIDs, ASA for pain, steroids if not better, usually self-limiting

Question 24

Cardiac Tamponade Definition

Answer 24

Fluid builds up in pericardial sac, unable to fill cardiac chambers in diastoles leads to reduction of stroke volume and cardiac output which leads to hypotension which leads to shock and death.

Question 25

Cardiac Tamponade

Answer 25

S/S: DOE, orthopnea, JVD, hypotension, muffled heart sounds, pulsus paradoxus Dx: Echo: RA and ventricular collapse during diastole Tx: drain fluid, tx pericarditis, pericardiotomy or windowplacement possible

Question 26

Pericardial Effusion

Answer 26

Large effusions can show signs of cardiac tamponade, small effusions can by asymptomatic S/S: diminished heart sounds, poss friction rub Dx: CXR, EKG, echo Tx: pericardiocentesis, maintain BP

Question 27

Heart Failure

Answer 27

Inability of heart to pump sufficient blood to meet metabolic demands

Question 28

MC Cause of CHF

Answer 28

CAD

Question 29

R-Sided Heart Failure Causes

Answer 29

L-sided HF (90%), Pulmonary disease | THINK SYSTEMIC SX! JVD, edema, ascites

Question 30

L-Sided Heart Failure Causes

Answer 30

MCC is HTN and CAD | THINK PULMONARY SX! dyspnea, orthopnea, rales

Question 31

S/S of L-Sided HF

Answer 31

THINK PULMONARY SX! dyspnea, orthopnea, rales MC sx is Dyspnea (orthopnea, paroxysmal nocturnal dyspnea) rales, rhonchichronic nonproductive cough w/ pink frothy sputum PE: HTN, cheyne stokes breathing, tachycardia, cool extremities

Question 32

S/S of R-Sided HF

Answer 32

``` THINK SYSTEMIC SX! JVD, edema, ascites Systemic fluid retention peripheral edema JVD GI/hepatic congestion ```

Question 33

Dx of HF

Answer 33

Best test-Echo (decreased EF, systolic-thin wall or diastolic-thick wall dysfunction CXR-Kerley B Lines, cardiomegaliy, pleural effusions BNP >100 means CHF is likely

Question 34

Long Term Management of Heart Failure

Answer 34

Unless CI, all pts should be on an ACEi and Diuretic | Na restriction-

Question 35

Acute Pericarditis

Answer 35

acute inflammation of the pericardium MCC is viral (esp enteroviruses like coxsackie and echovirus) Dresslers syndrome autoimmune, idiopatic, systemic

Question 36

Acute Pericarditis S/S

Answer 36

pleuritic chest pain (sharp & worse with inspiration) Postural CP-relieved by leaning forward and worse lying down Pericardial Friction rub-best heard at end of expiration

Question 37

P's of Pericarditis

Answer 37

Persistent Pleuritic Postural Pericardial Friction Rub

Question 38

Dx of Pericarditis

Answer 38

EKG: diffuse ST elevation in precordial leads, associated PR depressions in those leads Echo: check for effusion or tamponade

Question 39

Tx of Pericarditis

Answer 39

1st Line-Aspirin or NSAIDs x 7-14 days 2nd Line-Colchicine Add corticosteroids if not responding to other management or sx>48 hrs

Question 40

Tx of Dressler's Syndrome

Answer 40

Aspirin or Colchicine

Question 41

Pericardial Effusion (sx,dx,tx)

Answer 41

increased fluid in pericardial space pericarditis is a common cause s/s: distant heart sounds Dx: echo shows increased pericardial fluid CXR: cardiomegaly EKG: low voltage QRS complexes, electric alterans (cyclic beat shift in QRS b/c heart is swinging in fluid) Tx: small effusion-tx underlying cause, pericardiocentesis if tamponade or large effusion

Question 42

Beck's Triad

Answer 42

Muffled Heart Sounds Hypotension Increased JVP

Question 43

Pericardial (cardiac) tamponade

Answer 43

pericardial effusion causes lo of pressure on the heart causing restriction of cardiac ventricular filling which leads to dec. cardiac output -small rapidly evolving effusions are more dangerous than chronic ones

Question 44

Pericardial (cardiac) tamponade (s/s, dx, tx)

Answer 44

``` S/S: becks triad (hypotension, muffled heart sounds, inc. JVP) pulsus paradoxus (a decreases in systolic BP >10mmHg) ``` Dx: echo-effusion and diastolic collapse of cardiac chambers Tx: pericardiocentesis, add pericardial window if recurrent

Question 45

Constrictive Pericarditis

Answer 45

thickened fibrotic calcified pericardium S/S: MC is dyspnea r-sided heart failure sx-JVD, edema, NV Kussmauls Sign- Increased JVD during inspiration Pericardial knock- high pitched 3rd heart sound Dx: echo-pericardial thickening CXR- pericardial calcification Tx: pericardiotomy definitive, diuretics for sx

Question 46

What is Pericardial Knock

Answer 46

high pitched 3rd heart sound because of sudden cessation of ventricular filling in early diastole from thickened inelastic pericardium (mistaken for S3 often)