Cardiology part 7 Flashcards
(179 cards)
1
Q
Endocardial Cushion Defect
A
x
2
Q
association
A
x
3
Q
what is the most common disease associated with endocardial cushion defect?
A
down syndrome
4
Q
syx
A
x
5
Q
what are the syx of endocardial cushion defect?
A
SOB, face turns blue during feeding and when crying
6
Q
PE
A
x
7
Q
what are the physical exam findings of endocardial cushion defect?
A
harsh holosystolic murmur heard best over the lower left sternal border
8
Q
what murmur do you hear on auscultation?
A
harsh holosystolic murmur heard best over the lower left sternal border
9
Q
dx
A
x
10
Q
what is the diagnostic test for endocardial cushion defect?
A
Echocardiography
11
Q
what would CXR show ?
A
degree of cardiomegaly and pulmonary marking
12
Q
what test is reserved for cases of endocardial cushion defect in which the size of the shunt is uncertain, lab data and clinical findings are equivocal, or when pulmonary vascular disease is suspected?
A
cardiac catheterization
13
Q
Down Syndrome
A
x
14
Q
complications
A
x
15
Q
what are other malformations of down syndrome?
A
duodenal atresia, hirschsprung’s disease, atlanto-axial instability, and hypothyroidism
16
Q
what are patients with Down Syndrome at increased risk of developing?
A
acute leukemia, alzheimer like dementia, autism, ADHD, depressive disorder, and seizure disorder
17
Q
Benign Prostatic Hyperplasia (BPH)
A
x
18
Q
treatment
A
x
19
Q
which medication can worsent prostate sympotoms and induce bronchoconstriction?
A
metoprolol
20
Q
what are three classes of meds to treat BPH?
A
- alpha adrenergic antagonists (terazosin, tamsulosin);
- 5 alpha reductase inhibitors (finasteride, dutasteride);
- Antimuscarinics (tolterodine)
21
Q
alpha adrenergic antagonists (terazosin, tamsulosin);
A
x
22
Q
MOA
A
x
23
Q
how do these drugs work?
A
-relax smooth muscle in bladder neck, prostate capsule and prostatic urethra
24
Q
what is it’s purpose in regards to BPH?
A
work against dynamic componenet of bladder outlet obstruction, usually within days to weeks
25
side effects
x
26
what are the side effects of alpha adrenergic antagonists?
orthostatic hypotension, dizziness
27
5 alpha reductase inhibitors (eg finasteride, dutasteride)
x
28
MOA
x
29
how do these drugs work?
inhibit conversion of testosterone to DHT in the prostate
30
what is it's purpose in regards to BPH?
reduce the prostate gland size (volume) to improve fixed component of bladder outlet obstruction
symptom improvement can take up to 6-12 months
31
what are the side effects of 5 alpha reductase inhibitors (eg finasteride, dutasteride)?
decreased libido, erectile dysfunction
32
Antimuscarinics (eg tolterodine)
x
33
MOA
x
34
what is it's purpose in treatment?
may be useful in men with overactive bladder, urinary frequency, urgency and incontinence
sometimes combined with one of the therapies listed above
35
trx
x
36
what patient population do antimuscarinics serve?
usually restricted to men with low post void residual volme
37
Pulmonary Embolism (PE)
x
38
trx
x
39
when are IV thrombolytics indicated?
hypotension (SBP<90mm Hg) or shock
40
Ischemic Cardiomyopathy
x
41
syx
x
42
what are syx of cardiomyopathy?
SOB, DOE,
43
dx
x
44
what would echo show?
demonstrates LV systolic (rather than only diastolic) dysfunction
45
what is the test to order for evaluating PE if patient cannot undergo CT pulm Angio due to renal insufficiency?
V/Q perfusion scan
46
trx
x
47
what is the optimal medical therapy for ischemic cardiomyopathy?
ACEi, BBlocker, loop diuretic, and aldosterone antagonist
48
classifications of NYHA heart failure
x
49
what is Class I NYHA heart failure?
No symptomatic limitation of physical activity
50
what is Class II NYHA Heart failure?
slight limitation of physical activity (eg dyspnea with climbing stairs)
ordinary activity causes fatigue, palpitations, or dyspnea
51
what is Class III NYHA Heart failure?
marked limitation of physical activity (eg dyspnea with house chores)
less than ordinary activity causes fatigue, palpitations, or dyspnea
52
what is Class IV NYHA heart failure?
inability to perform physical activity without significant discomfort
can have symptoms at rest
53
managmeent
x
54
in select patients in this group, cardiac resynchronization therapy w biventricular pacing is recommended why?
improve excercise tolerance and NYHA functional class, and reduce the rate of recurrent hospitilzation and overall mortality
55
Management of Heart Failure
x
56
do CCBs (amlodipine, felodipine) have any mortality benefit or syx benefit to CHF patients?
nope
57
in increasing order of therapy for all NYHA class CHF, what is the first class of therapy?
ACEi or ARB
58
in which patients are ACEi and ARBs contraindicated?
those with hypotension, renal failure, or hyperkalemia
59
in increasing order of therapy for all NYHA class CHF, what is the next class of therapy if ACEi or ARB don't work?
Diuretic therapy (occassionally can use metolazone , which is a thiazide diuretic, if inadequate response to loop diuretics)
60
in increasing order of therapy for all NYHA class CHF, what is the next class of therapy if EF <=40% and euvolemic after diuresis?
beta blockers
61
in increasing order of therapy for all NYHA class CHF, what is the next class of therapy if EF < 30% and stable renal function and potassium?
Spironolactone
62
in increasing order of therapy for all NYHA class CHF, what is the next class of therapy if EF <= 30% ?
Defibrillators
63
in increasing order of therapy for NYHA class II and III and IV CHF, what is the next class of therapy after ACEi, diuretics, beta blockers, and spiranolactone......when the patient is African American?
isosorbide dinitrie + hydralazine
64
in increasing order of therapy for NYHA class II and III and IV CHF, what is the next class of therapy after ACEi, diuretics, beta blockers, and spiranolactone......when the patient is symptomatic with spiranolactone?
digoxin
65
in increasing order of therapy for NYHA class II and III and IV CHF, what is the next class of therapy after ACEi, diuretics, beta blockers, and spiranolactone......when the QRS>150ms?
cardiac resynchronization
66
in increasing order of therapy for NYHA class III and IV CHF, what is the last resort for CHF management?
Transplant/Ventricular Assist Device Evaluation
67
Mitral Stenosis (MS)
x
68
cause
x
69
most common cause of Mitral Stenosis?
Rheumatic Heart Disease
70
syx
x
71
what are common symptoms of Mitral Stenosis?
dyspnea (70% of patients), fatigue, atrial fibrillation, and thromboembolism (eg stroke), PND
72
what are rarer symptoms of Mitral Stenosis?
hemoptysis (from pulm edema or pulm apoplexy) and hoarseness (due to compression of recurrent laryngeal nerve by enlarged left atrium-ortner syndrome)
73
complicaitons
x
74
which patient population with mitral stenosis is at risk of afib and pulm edema ?
pregnant women (due to physiologic hypervolemia and increased left atrial and pulmonary venous pressure)
75
PE
x
76
what are physical exam fidnings of mitral stenosis?
- mitral facies (pinkish purple patches on cheeks)
- Loud S1, loud P2 if pulmonary HTN
- opening snap (high frequency early diastolic sound)
- mid-diastolic rumble (best heard at cardiac apex)
77
what is the classic murmur of Mitral Stenosis?
#NAME?
78
where is the best location to hear the murmur?
with the bell of the stethoscope at the cardiac apex
79
what is the best position for position for patients to hear the murmur?
fifth intercostal space (between the 5th and 6th ribs) at the left mid clavicular line. Often helpful if the patients exhales and lies in left lateral decubitus position
80
dx
x
81
what do you see on CxR for mitral stenosis?
pulm blood flow redistribution to upper lobes, elevation of the left mainstem bronchus, dilated pulmonary vessels, left atrial enlargement with a flattening of the left heart border
82
what do you see on EKG for mitral stenosis?
P mitrale: broad and notched P waves, atrial tachyarrhythmias, RVH (tall R waves in V1 and V2)
83
what do you see on transthoracic echocardiogram?
MV thickening/calcification/decreased mobility, coexisiting MR
84
Noonan Syndrome
x
85
PE
x
86
what are the physical exam findings of noonan syndrome?
short stature, facial dysmorphism, spectrum of congenital heart defects
87
epid
x
88
what is the epid of Noonan Syndrome?
autosomal dominant disorder
89
Restrictive Cardiomyopathy
x
90
PE
x
91
what are the physical exam findings of restrictive cardiomyopathy?
JVD, bibasilar crackles, pulmonary vascular congestion, biatrial enlargement, and pulmonary artery HTN
92
Peripartum Cardiomyopathy (PPCM)
x
93
risks
x
94
what are risk factors for cardiomyopathy?
maternal age >30, mulitple gestation, preE or eclampsia
95
dx
x
96
what would echo show?
LVEF< 45%
97
what is important to rule out when dx peripartum cardiomyopathy?
no other cause of heart failure
98
onsest
x
99
what is the onset of peripartum cardiomyopathy?
36 weeks gestation- 5months postpartum
100
management
x
101
what is the best management of peripartum cardiomyopathy?
- deliver based on maternal hemodynamic stability
- standard systolic heart failure regimen
- thromboembolism prophylaxis
102
regardless of of PPCM rsolution, patients are evaluated with serial echocardiograms for how long?
few years
103
after delivery, what happens to those with PPCM?
some patients will have spontaneous resolution of ventricular dysfunction and can discontinue their medication regimen
104
recurrence risk
x
105
what is the recurrence risk of peripartum cardiomyopathy?
if LVEF < 20% at diagnosis or persistent LV Systolic dysfucntion
106
Patent Ducturs Arteriosus (PDA)
x
107
PE
x
108
what does the characteristic murmur sound like for PDA?
continuous murmur that is heard best in the left infraclavicular area
109
pathophys
x
110
what is the pathophys of PDA?
abnormal connection between aorta and pulmonary artery
111
Atrial Fibrillation
x
112
management
x
113
what is the preferred antiarryhtmic in patients with Afib with no CAD or structural heart disease?
flecainide, propafenone
114
what is the preferred antiarryhtmic in patients with Afib with LV hypertrophy?
drondedarone, amiodarone
115
what is the preferred antiarryhtmic in patients with Afib with CAD without heart failure?
sotalol, dronedarone
116
what is the preferred antiarryhtmic in patients with Afib with CHF?
amiodarone, dofetilide
117
what is the preferred antiarryhtmic in patients with Afib with recurrent AF symptoms refractory to medication?
radiofrequency ablation
118
what is the preferred rate control agent in some patients with AF and RVR, especially those with low or borderline blood pressure CHF due to LV systolic dysfunction?
Digoxin
119
what is an option for adjunctive therapy in those who continue to have Afib RVR despite beta blockers and CCB?
Digoxin
120
what are three components of Afib trx?
anticoagulation, rate control, or rhythm control
121
what is a good anticoag?
rivaroxaban
122
what is a good rate control agent?
AV nodal blocker (Beta Blocker, CCB)
123
what is a good rate control goal for beta blocker or CCB?
goal <=110bpm
124
in most cases, rate control is preferred over rhythm control , however what situations are rhythm control better?
- inability to maintain adequate heart rate control with rate control agents
- persistence of symptomatic episodes (eg heart failure exacerbation) on rate control agents
125
if HD unstable patient with Afib require what?
emergency cardioversion
126
if HD stable patient with Afib, what meds can you use?
beta blockers, diltizaem, digoxin
127
prevention of stroke in Afib
x
128
antiocagulation in (non valvular) afib
x
129
what is the scoring we use for anticoagulation therapy in Afib?
CHA2DS2-VASc Score
130
what is the scoring criteria for CHA2DS2VASc?
```
C-congestive heart failure: 1
H-HTN: 1
A2-Age: 2
D-Diabetes Mellitus: 1
S2- Stroke/TIA/Thromboembolism: 2
V-Vascular Disease (prior MI, PAD, or aortic plaque); 1
A-Age 65-74: 1
Sc-Sex Category (ie female): 1
```
Max score : 9
131
if chadsvasc score is 0, what is the stroke risk and what is the anticoag therapy?
low, and no anticoag therapy
132
if chadsvasc score is 1, what is the stroke risk and what is the anticoag therapy?
intermediate, none or oral anticoagulant
133
if chadsvasc score is >=2, what is the stroke risk and what is the anticoag therapy?
high, oral anticoagulant (warfarin, rivaroxaban, dabigatraban, apixaban)
134
syx
x
135
what are the syx of Afib RVR exacerbating systolic heart failure?
dizziness, palpitations, SOB, and LE edema
136
side effects of antiarrythmics
x
137
what are side effects of flecainide?
increased risk of arrythmias and death (so avoid in patients iwth structural or coronary heart disease)
138
Acute Aortic Dissection
x
139
syx
x
140
what are symptoms of acute aortic dissection?
2 hour hx of sharp, stabbing CP under sternum, radiating to upper back and shoulders
141
PE
x
142
what are physical exam fidnings of aortic dissection?
>20mm Hg difference in SBP between arms
143
Dx
x
144
what would an EKG show?
normal or nonspecicif ST and T wave changes (eg T wave inversion in leads V5 and V6)
145
what would CXR show?
mediastinal widening
146
what are definitive diagnostic tests for aortic dissection?
CTA or TEE
147
complications
x
148
what are the complications of ascending aortic dissection?
aortic regurg, ACS (RCA occlusion), cardiac tamponade (hemopericardium), stroke (carotid artery occlusion), horner syndrome (SG compression), vocal cord paralysis (recurrent LN compression)
149
what are the complications of descending aortic dissection?
hemothorax or hemoperitneum, renal injury (renal artery occlusion), mesenteric ischemia (eg SMA occlusion), LE ischemia, LE paraplegia (spinal cord ischemia)
150
Ascending Aortic Dissection
x
151
Trx
x
152
what is the treatment of ascending aortic dissection?
IV beta blockers (labetalol, propanolol, or esmolol) to slow HR<60, lowering blood pressure, reducing left ventricular contractility.
153
in addiitonal to medication therapy, what other intervention is needed for ascending aortic dissection?
emergency surgical repair
154
Guidelines for Statin Therapy
x
155
what are the indications for statin therapy?
clinically significant ASCVD
156
what is meant by clinically significant ASCVD?
Acute Coronary Syndrome, Stable Angina, Arterial revascularizatoin (eg CABG), Stroke, TIA, PAD
157
what is the recommended therapy for clinically significant ASCVD?
age <=75y.o. : High intensity statin
| age >75y.o.: Moderate intesity statin
158
If LDL >=190mg/dL, what do you do?
give high intensity statin
159
if age 40-75 y.o. with DM, what do you do?
assess ASCVD risk
160
if age 40-75 y.o. with DM, and ASCVD risk >= 7.5%, what do you do?
high intensity statin
161
if age 40-75 y.o. with DM, and ASCVD risk >= 7.5%, what do you do?
moderate-intensity statin
162
if 10 year ASCVD risk >=7.5%, what do you give?
mod to high intensity statin
163
Statin Types
x
164
what are the high intensity statins?
atorvastatin 40-80 mg, rosuvastatin 20-40 mg
165
what are the moderate intensity statins?
moderate-intensity statins include atorvastatin 10-20 mg, rosuvastatin 5-10 mg, simvastatin 20-40 mg, pravastatin 40-80 mg, lovastatin 40 mg.
166
Hypertriglyceridemia
x
167
dx
x
168
what is considered high triglycerides?
>500-1000mg/dL
169
trx
x
170
what role does niacin play?
lowers LDL and raises HDL
171
patients with moderate hypertriglyceridemia would benefit from?
statin therapy
172
if >880mg/dL Triglycerides, what is good management?
- fibrate therapy (or fish oil or niacin if fibrates not tolerated) to lower risk of pancreatitis.
- once TG are lowered, add statin therapy
173
what is mild hypertriglyceridemia and do you need to treat?
150-500mg/dL, and no need to treat
174
Fibrates and Niacin have favorable effects on lipids but no found to improve cardiovascular outcomes or mortality in patients with known ASCVD. T or F
TRUE
175
Orlistat
x
176
trx
x
177
what is orlistat used for?
treatment of obesity
178
MOA
x
179
what is the mechanism of orlistat?
intestinal lipase inhibitor
