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CVPR > Cardiology Exam > Flashcards

Cardiology Exam Flashcards

1
Q

total cholesterol high

A

> 240

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2
Q

triglycerides high

A

200-500

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3
Q

HDL low

A

<40

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4
Q

LDL high

A

> 100

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5
Q

triglycerides very high

A

> 500

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6
Q

triglycerides borderline

A

151-199

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7
Q

total cholesterol borderline

A

200-240

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8
Q

total cholesterol normal

A

<200

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9
Q

when to screen healthy adults for cholesterol

A

every 5 years starting at 45 (f) and 35 (m)

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10
Q

when to screen diabetic adults

A

at 20 years if other risk factors

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11
Q

when to use a high intensity statin

A

CAD, LDL>190 or TG>500, diabetes (over 50 or multiple risk factors), >20% CV risk calculator

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12
Q

when to use a moderate intensity statin

A

all diabetes 40-50 without other risk factors, between 7.5 and 20% CV risk calculator

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13
Q

when to consider statins (no firm recommendation)

A

over 75 with CAD or DM, under 40 with diabetes, between 5 and 7.5% CV risk calculator

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14
Q

Contraindications to statin use

A

active liver disease, pregnancy

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15
Q

adverse effects of statins

A

myopathy, rhabdo, increased LFTs, increased A1C, cognition

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16
Q

what about niacin, omega-3, fibrate for hyperlipidemia

A

not recommended

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17
Q

what is ezetimibe

A

inhibits cholesterol absorption at small intestine

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18
Q

when to consider bile acid sequestrants

A

ezetimibe intolerant and TG<300

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19
Q

when to use PCSK9 inhibitors

A

very high-risk patients

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20
Q

lipid lowering effect of high-intensity statins

A

decrease LDL by 50%

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21
Q

lipid lowering effect of moderate intensity statins

A

30-50%

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22
Q

parasympathetic cardiac receptor

A

M2

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23
Q

parasympathetic bronchial smooth muscle receptor

A

M3

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24
Q

sympathetic vasodilation for skeletal muscle receptor

A

B2

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25
Q

sympathetic receptor for renin release

A

B1

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26
Q

toxicities of parasympathomimetics

A

bradycardia, bronchospasm

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27
Q

atropine mechanism of action

A

competitive antagonist of muscarinic receptors

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28
Q

can atropine cross BBB

A

yes

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29
Q

atropine toxicity

A

parasympatholytic effects (dry mouth, tachycardia), sedation, delirium, hyperthermia, flushing

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30
Q

what is PO atropine

A

oxybutinin

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31
Q

what is an alpha 1 and alpha 2 agonist used for hypotension

A

phenylephrine

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32
Q

what is isoproterenol

A

B1 B2 agonist used to stimulate the heart in AV block

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33
Q

what is dobutamine

A

B1 agonist used to increase cardiac output in heart failure

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34
Q

what is the only sympathomimetic used to treat hypertension and why

A

clonidine (alpha 2 agonist)

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35
Q

what cardiac biomarker other than troponin is sometimes used and why would it be used

A

CK-MB: levels return to normal faster than troponin so it is useful for re-infarction

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36
Q

when do troponin levels rise

A

4 hours after infarction

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37
Q

when do troponin levels peak

A

24 hours

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38
Q

when do CK-MB levels rise

A

6-12 hours

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39
Q

how long do troponin levels stay elevated

A

7 days

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40
Q

elements of Virchow’s triad

A

hypercoagulable state, endothelial damage, stasis

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41
Q

class 1 antiarrhythmics

A

1a procainamide, 1b lidocaine, 1c flecainide

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42
Q

class 1 antiarrhythmics mechanism

A

fast sodium channel blockers

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43
Q

class 2 antiarrhythmics mechanism

A

beta blockers

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44
Q

class 3 antiarrhythmics mechanism

A

potassium channel blockers

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45
Q

class 4 antiarrhythmics mechanism

A

calcium channel blockers

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46
Q

nonspecific beta blocker

A

propranolol

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47
Q

cardioselective beta blocker

A

metoprolol/atenolol/esmolol

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48
Q

class 3 antiarrythmic prototype

A

amiodarone

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49
Q

class 4 antiarrhythmic prototype

A

verapamil

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50
Q

labetalol/carvedilol mechanism

A

alpha 1 and nonselective beta blocker

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51
Q

what are non-dihydropyridines used for and what are they called

A

antiarrhythmics, verapamil/diltiazem

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52
Q

what are dihydropyridines used for and what are they called

A

antihypertensives, nifedipine, amlodipine

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53
Q

what types of arrhythmias are calcium channel blockers used for

A

supraventricular

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54
Q

what tissues do class I and class III antiarrhythmics affect

A

atrial and ventricular myocytes

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55
Q

most common cause of aortic stenosis <70 y.o

A

bicuspid valve

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56
Q

most common cause of aortic stenosis >70 y.o

A

degenerative (calcific)

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57
Q

murmur of aortic stenosis

A

systolic ejection murmur (crescendo-decrescendo)

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58
Q

causes of acute aortic regurg

A

infective endocarditis, aortic dissection, trauma, prosthetic valve dysfunction

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59
Q

causes of chronic aortic regurg

A

bicuspid, aortic root dilatation, rheumatic disease, connective tissue disease

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60
Q

blood pressure on aortic regurg

A

wide pulse pressure

61
Q

murmur of aortic regurg

A

diastolic decrescendo

62
Q

most common cause of chronic mitral regurg

A

degenerative changes

63
Q

most common causes of acute mitral regurg

A

myxomatous mitral valve with chordal rupture, papillary rupture 2/2 AMI, infective endocarditis

64
Q

most common etiology of mitral stenosis

A

rheumatic disease

65
Q

4/6 murmur

A

loud with thrills

66
Q

5/6 murmur

A

can hear with steth partly off chest

67
Q

6/6 murmur

A

can hear with steth completely off chest

68
Q

when is auscultation used with pt in left lateral decubitus position

A

S3, S4, mitral stenosis (using bell)

69
Q

S3

A

occurs right after S2

70
Q

S4

A

occurs right before S1, blood hitting a noncompliant ventricle

71
Q

heart sound just before the carotid pulse

A

S1

72
Q

characteristics of restrictive cardiomyopathy

A

normal EF but severe systolic dysfunction and concentric hypertrophy

73
Q

hypertrophic cardiomyopathy murmur

A

dynamic systolic ejection murmur that increases with increased preload and increased afterload

74
Q

what causes concentric hypertrophy

A

chronic pressure overload (HTN, aortic stenosis)

75
Q

what causes eccentric hypertrophy

A

chronic volume overload (aortic regurg, dilated cardiomyopathy)

76
Q

formula for ejection fraction

A

(EDV-ESV)/EDV

77
Q

EF values for HF with mildly reduced EF

A

41-49%

78
Q

EF values for HF with reduced EF

A

<40%

79
Q

HF with reduced EF has what hypertrophy

A

eccentric

80
Q

HF with preserved ejection fraction has what hypertrophy

A

concentric

81
Q

role of SNS activation in HF

A

initially helps to maintain cardiac output but long-term increase in norepi levels leads to increase in afterload, fibrosis, arrhythmias

82
Q

action of ACE inhibitors/ARBs/ARNIs in HF

A

decreases afterload and preload, decreases myocardial fibrosis

83
Q

ARNI prototype

A

Sacubitril-valsartan

84
Q

role of hydralazine-nitrate combination in heart failure

A

vasodilators, use in those that cannot tolerate ACE/ARB/ARNI or in conjunction with them

85
Q

beta blockers for HF

A

metoprolol succinate, carvedilol, bisoprolol

86
Q

most common cause of endocarditis

A

strep viridans (usually in the presence of a damaged valve) - subacute

87
Q

most common cause of acute endocarditis (IV drug abuser)

A

staph aureus (tricuspid valve)

88
Q

cause of libman-sacks endocarditis

A

SLE

89
Q

when is BP medication recommended

A

130/80 and CVD risk 10% or more

90
Q

pulse pressure is proportional to ____ and inversely proportional to _____

A

stroke volume, arterial compliance

91
Q

MABP =

A

cardiac output x total peripheral resistance

92
Q

determinants of vascular resistance

A

diameter, viscosity, arrangement (series vs parallel), type of flow (laminar vs turbulent)

93
Q

turbulence is proportional to ____ and inversely proportional to ____

A

diameter/velocity, viscosity

94
Q

dicrotic notch

A

aortic valve closes and causes a secondary pressure wave

95
Q

T-wave in wiggers diagram

A

during reduced ejection

96
Q

mitral valve closure wiggers diagram

A

beginning of iso. contraction

97
Q

aortic valve closure wiggers

A

beginning of iso. relaxation

98
Q

mitral valve opens wiggers

A

end of iso. relaxation/beginning of rapid filling

99
Q

formula for EF

A

SV/EDV

100
Q

what are the primary determinants of coronary perfusion?

A

aortic pressure and coronary artery compression during ventricular compression

101
Q

what is the cholinergic neuron

A

sympathetic preganglionic

102
Q

what is the adrenergic neuron

A

sympathetic postganglionic

103
Q

preganglionic sympathetic neurotransmitter

A

ach

104
Q

postganglionic sympathetic neurotransmitter

A

norepi

105
Q

the systemic circulation is primarily innervated by ____ neurons

A

sympathetic

106
Q

what do adrenergic receptors bind

A

norepi and epi

107
Q

what do cholinergic receptors bind

A

ach

108
Q

what is the endogenous agonist of alpha receptors

A

norepi

109
Q

B1 receptors on cardiac myocytes are stimulated by

A

norepi/epi

110
Q

B2 receptors in skeletal muscle are stimulated by

A

epi

111
Q

nicotinic receptor function

A

mediate neurotransmission at autonomic ganglia and catecholamine release from medulla

112
Q

sympathoadrenal system is mostly responsible for releasing

A

epinephrine

113
Q

epinephrine has a higher affinity for what type of receptor

A

Beta

114
Q

what receptor activates RAAS

A

B1 on juxtaglomerular cells, this releases renin

115
Q

which SNS neurotransmitter is largely released via neuronal stimulation

A

norepi

116
Q

metabolic dilators

A

hypoxia and adenosine

117
Q

what accounts for decrease in TPR during strenuous exercise

A

local vasodilatory metabolites are overriding SNS

118
Q

phase 0 fast response

A

Na channels open and there is a massive Na influx

119
Q

phase 1 fast response

A

Na channels close and K leaks out of cell

120
Q

phase 2 fast response

A

trigger for contraction: Ca channels open and Ca comes in while K leaks out

121
Q

phase 3 fast response

A

Ca channels close and K continues to leak out

122
Q

phase 4 fast response

A

Na and Ca channels are closed, -85 mv resting maintained by constant leak of K out of the cell

123
Q

phase 4 slow response

A

Na slowly leaks into cell until threshold

124
Q

phase 0 slow response

A

Ca channels open and Ca rushes in

125
Q

phase 3 slow response

A

Ca channels close and K channels open, allowing K to leak out

126
Q

difference in action potential between SA and AV node

A

in AV node, phase 4 is longer

127
Q

SV formula

A

SV = EDV-ESV

128
Q

SBP largely determined by

A

SV

129
Q

DBP largely determined by

A

TPR

130
Q

hypocalcemia ekg

A

prolonged QT

131
Q

hypercalcemia ekg

A

shortened QT

132
Q

brugada syndrome ekg

A

ST elevation in V1-V3 with negative T-wave

133
Q

high-intensity statins

A

atorvastatin, rosuvastatin

134
Q

statin mechanism of action

A

prevent cholesterol synthesis in liver

135
Q

what medications are used to lower triglycerides

A

fibrates

136
Q

EKG changes in LAD occlusion

A

V1-V4

137
Q

EKG changes in circumflex artery occlusion

A

laterals

138
Q

EKG changes in PDA (right-dominant)

A

inferiors

139
Q

EKG changes in PDA (left-dominant)

A

laterals (branch of circumflex)

140
Q

EKG changes in isolated PDA occlusion

A

ST depression in V1-V2

141
Q

early post MI complications

A

arrhythmia, then free wall rupture, papillary rupture, tamponade, septal rupture

142
Q

later post MI complications

A

CVA, aneurysm, Dresslers syndrome

143
Q

goal BP for Pts over 60

A

150/90

144
Q

goal BP for pts under 60 or DM

A

140/90

145
Q

dx of endocarditis requires

A

2 major, 1 major/3 minor, or 5 minor (modified Duke criteria)

146
Q

most common organism in infective endocarditis

A

staph aureus (vanc) strep viridans (PCN)

147
Q

3 criteria for typical angina

A

worsens with exercise, relieved with rest/nitro, substernal chest discomfort

148
Q

what counts as satisfactory workload for stress testing

A

4 mets or 85% of max HR

149
Q

HAS-BLED high risk

A

> 3

CVPR (5 decks)

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