Cardiology

Question 1

ejection fraction will remain normal in _____ heart failure Decreased ejection fraction usually less than 50% in ____ heart failure

Answer 1

diastolic systolic

Question 2

most common etiology of heart fialure is ____

Answer 2

coronary artery disease.

Question 3

MC presenting sxs of heart failure are ____ and ____

Answer 3

fatigue, SOB

Question 4

dx exams for heart failure

Answer 4

ECG: arrhythmia, Q waves, ischemia, LVH stress test: assess exercise tolerance and risk stratification.

Question 5

When do you order a CXR for a pt with heart failure?

Answer 5

to evaluation of dyspnea & rule out other etiologies of SOB (not to diagnose CHF).

Question 6

what meds lower mortility in pts with HF?

Answer 6

ACE/ARBs (Ivabradine and Sacubitril-valsartan) BBs (carvedilol, bisoprolol, and metoprolol succinate)

Question 7

What medications can you give to reduce sxs in heart failure?

Answer 7

Diuretics: fluid overload Digoxin: SOB

Question 8

___ is used when the ejection fraction is below 35% in a pt with HF, those with sustained VT, and/or those with un-explained syncope to prevent a fatal arrhythmia.

Answer 8

ICD

Question 9

Work up for pt in acute exacerbation of HF

Answer 9

ECHO ECG: arrhythmias, MI. BNP: distinguish btCHF exacerbation and COPD exacerbation as the cause of dyspnea. Cardiac enzymes: rule out MI

Question 10

Treatment for acute exacerbation of CHF

Answer 10

LMNOP Loop diuretics Morphine Nitrates Oxygen Position (head up)/positive pressure

Question 11

____ is a disease of the heart muscle associated with cardiac dysfunction that usually has no etiology

Answer 11

cardiomyopathy

Question 12

what are the 3 types of cardiomyopathy

Answer 12

Dilated Restrictive Hypertrophic

Question 13

what dx test is used to differentiate bt Dilated, Restrictive, Hypertrophic cardiomyopathy

Answer 13

echocardiogram

Question 14

what is the only way to definitively dx restrictive cardiomyopathy?

Answer 14

biopsy

Question 15

what is the tx of dilated cardiomyopathy?

Answer 15

same as CHF

Question 16

what is the tx of hypertrophic cardiomyopathy?

Answer 16

BB, CCB ** no diuretics!

Question 17

This heart defect is described as a systolic ejection murmur with a fixed wide splitting of S2

Answer 17

atrial septal defect

Question 18

What may cause the The ductus arteriosus is kept open?

Answer 18

low oxygen environment prostaglandins.

Question 19

machine like continuous murmur describes what heart defect?

Answer 19

PATENT DUCTUS ARTERIOSUS

Question 20

what are the 4 components of tetralogy of fallot?

Answer 20

Right ventricular hypertrophy VSD Overriding aorta Right ventricular outflow obstruction

Question 21

___ is a heart defect that sounds like a holosystolic murmur is heard that does not increase with respiration.

Answer 21

VSD

Question 22

how do you dx HTN?

Answer 22

elevated BP >140/90 on two separate occasions

Question 23

MC cause of secondary HTN

Answer 23

renal disease

Question 24

what labs should be ordered upon HTN dx

Answer 24

urine analysis urine micro albumin EKG CBC BMP lipid panel

Question 25

What PE findings should you look for in a pt newly dx with HTN?

Answer 25

fundoscopy (hemorrhage or papilledema) thyroid assessment carotid bruit size and rhythm of heart crackles in lungs renal bruit pedal edema confusion or weak-ness

Question 26

HTN tx for a pt w/ DM

Answer 26

ACE/ARB

Question 27

HTN tx for a pt w/ CHF/Ischemia/CAD?

Answer 27

Beta blocker or ACE/ARB

Question 28

HTN tx for a pt w/ Angina

Answer 28

Beta blocker or calcium channel blocker

Question 29

HTN tx for a pt w/ BPH

Answer 29

Alpha blocker

Question 30

HTN tx for a pt w/ Hyperthyroid

Answer 30

Beta blocker

Question 31

HTN tx for a pt w/ CKD?

Answer 31

ACE/ARB

Question 32

HTN tx for a pt w/ Raynaud’s syndrome?

Answer 32

Calcium channel blocker

Question 33

HTN tx for a pt w/ Migraine?

Answer 33

Beta blocker or calcium channel blocker

Question 34

\_\_\_\_ is hypertension that is not responsive to at least three medications, one of which must include a diuretic.

Answer 34

Resistant hypertension

Question 35

Common causes of secondary HTN?

Answer 35

Renal artery stenosis Hyperaldosteronism Primary kidney disease Pheochromocytoma Cushing’s disease Sleep apnea Coarctation of aorta

Question 36

\_\_\_ is Severely elevated HTN is considered to occur when the systolic is over 180 and/or when the diastolic is over 120, patient is asymptomatic and no end organ damage.

Answer 36

HYPERTENSIVE URGENCY

Question 37

as a rule of thumb, how much should you drop BP by in hypertensive urgency?

Answer 37

lower pressure no more than 30% in the first few hours reduce over 1-2 days

Question 38

\_\_ is Severely elevated hypertension usually over 180/120 with end organ damage

Answer 38

HYPERTENSIVE EMERGENCY

Question 39

what are two main consequences of hypertensive emergency?

Answer 39

malignant hypertension hypertensive encephalopathy

Question 40

what are s/s of Malignant hypertension due to hypertensive emergency?

Answer 40

papilledema exudates retinal hemorrhage acute kidney injury (hematuria or proteinuria) and/or focal neurological findings.

Question 41

what are s/s of Encephalopathy due to hypertensive emergency?

Answer 41

cerebral edema: Headache, N/V, confusion, seizure, coma.

Question 42

dx tests of pts w/ hypertensive emergency?

Answer 42

EKG, CXR, UA, serum creatinine, and cardiac enzymes (is MI suspected)

Question 43

\_\_\_\_ is a state characterized by decreased perfusion and decreased oxygenation of tissues.

Answer 43

Shock

Question 44

\_\_\_ shock stems from the heart not being able to pump normally.

Answer 44

Cardiogenic

Question 45

MC cause of Cardiogenic shock?

Answer 45

MI

Question 46

Tx of cardiogenic shock

Answer 46

aggressive fluid resuscitation (careful!) pressors (norepinephrine or dopamine) balloon-tipped pulmonary artery (Swan-Ganz) catheter

Question 47

Common etiology of orthostatic hypothension

Answer 47

Medications hypovolemia anemia heart disease diabetes Parkinson’s disease.

Question 48

how is orthostatic hypothension dx?

Answer 48

The diagnosis is made if the systolic blood pressure falls 20mmHg or if the diastolic falls 10mmHg or more when going from laying to stanging positions

Question 49

tx for orthostatic hypotension

Answer 49

1. Treat the underlying etiology. 2. Arise slowly from supine to seated to standing 3. increase fluid and sodium intake. 4. If no response, give fludrocortisone (mineralo-corticoid) as first line medical therapy.