Flashcards in Cardiology (Step up son) Deck (52):
What is the most common site of coronary occlusion?
Left Anterior Descending artery
What does the Posterior Descending artery branch off of?
Right coronary artery (70%)
Left Circumflex artery (10%)
An anastomosis of the RCA and Circumflex (20%)
What increases stroke volume? (6 things)
Increase intracellular Calcium
Decrease in extracellular Sodium
By remembering how digoxin works, two of the other causes of increased stroke volume can be remembered. How does digoxin work?
Digoxin inhibits Na/K-pump. Leading to increased intracellular sodium (thus decreased extracellular sodium) which causes increased intracellular calcium
What decreases stroke volume?
Heart failure (chicken vs. egg)
What is the Fick Principle? What does it determine
(Rate of O2 use) / ([O2]a – [O2]v)
Cardiac Output...just follow the units
Which increases first to increase CO during exercise, SV or HR?
SV increases first, then HR
What equations can be used to determine Mean Arterial Pressure?
CO x TPR
Diastolic pressure + 1/3 pulse pressure
When is an exercise stress test complete?
85% expected max HR (220-age)
Angina like symptoms
Signs of ischemia on ECG
What can be done if an exercise stress test results are ambiguous?
Nuclear exercise test (inject thallium-201 or tech-99)
Exercise stress test with echo
What is used in pharm stress testing? When is this done?
PET myocardial imaging can be done...
...gives 3D images
What is the gold standard in identifying CAD?
What is the most common cause of hypercholesterolemia?
Most cases are acquired
When they say/show high levels of serum homocysteine, what should you think about?
Atherosclerosis (3x risk of significant amount)
For the bulk of the cholesterol meds, what are the common side effects?
Person has substernal chest pain with activity that is relieved with rest. What do they have? How should they be treated? How should they be diagnosed?
Angina pectoris (Prinzmetal if d/t vasospasm) [until proven otherwise]
GERD, esophageal spasm, etc.
Nitroglycerin and rest
Stress test (exercise vs pharm) or nuclear
Patient previously diagnosed with CAD presents with worsening symptoms--now having symptoms at rest--and decreased response to treatment. What are the likely causes?
Patient previously diagnosed with CAD presents with worsening symptoms--now having symptoms at rest--and decreased response to treatment. What should be done in-patient? What is seen on ECG?
ECG and serial cardiac enzymes
Patient previously diagnosed with CAD presents with worsening symptoms--now having symptoms at rest--and decreased response to treatment. What treatment should be done regardless of whether PCI is planned?
S-Statin (preferably before PCI)
Patient previously diagnosed with CAD presents with worsening symptoms--now having symptoms at rest--and decreased response to treatment. What should be added to MONA BS if PCI is planned?
What are the GPIIb/IIIa inhibitors?
Patient previously diagnosed with CAD presents with worsening symptoms--now having symptoms at rest--and decreased response to treatment. What should be added to MONA BS if PCI is NOT planned?
Clopidogrel or ticagrelor
Patient previously diagnosed with CAD presents with worsening symptoms--now having symptoms at rest--and decreased response to treatment. What electrolytes should be monitored?
Potassium > 4mEq/L
Magnesium > 2mEq/L
What are two examples of PCI?
Percutaneous Transluminal Coronary Angioplasty (PTCA)
Coronary Artery Bypass Graft (CABG)
When is PTCA done?
When patient is unresponsive to medications
When is CABG recommended?
Left main stenosis >50%
History of CAD and DM
Which vessels are commonly used for CABG?
Internal mammary artery
When does CK-MB increase post-MI? When does it peak? when does it decrease?
When does LDH increase post-MI? When does it peak?
When does Trop-I increase post-MI? When does it peak? When does it decrease?
gradually decreases over 7 days
What medications have been proven to decrease mortality post-MI?
ACEI or ARB
When have thrombolytics been proven to decrease mortality?
Within 12hrs of MI
When should amiodarone be used post-MI?
When is the greatest risk of cardiac death post-MI? What are the most common causes?
The first few hours post-MI
A patient has an MI and everything seems to be going well. Then the patient dies 4-8 days later. Why?
Ventricular wall rupture
Mobitz I (Wenckebach) is a second degree heart block. What causes it? When is treatment necessary?
Caused by intranodal* or His bundle conduction defect
Drugs (beta-blockers, digoxin, ccb's)
Increased vagal tone
Tx is necessary with symptomatic bradycardia (pacemaker)
Mobitz II is caused by what? How is it treated? What is the concern?
Infranodal conduction problem (bundle of His or Purkinje fibers)
Progression to 3rd degree block
Patient presents with concern for syncope or similar. What should be considered? How can it be treated?
3rd degree heart block
No AV blocking drugs
Who typically gets paroxysmal supraventricular tachycardia?
Young patients with healthy hearts
How can PSVTs be treated?
In case of hemo instability, cardioversion or CCBs
Catheter ablation for long-term control in symptomatic patients
What is the technical definition of Vtach?
What is the MoA for class I antiarrhythmics?
Sodium channel blockers
There are two drugs in each of the three types of class I antiarrhythmics. How can they be remembered? What are they?
Quarter Pounder with Lettuce and Tomato, Fries Please
Quinidine Procainamide Lidocaine Tocainide Flecainide Propafenone
What can quinidine and procainamide be used to treat?
What can lidocaine and tocainide be used to treat?
What can flecainide and propafenone be used to treat?
What are the class II antiarrhythmics? What can they be used to treat?
Class III antiarrhythmics are potassium channel blockers. What are they? What can they treat?
Vtach (except bretylium)
The class IV antiarrhythmics are CCBs. What are they? What can they treat?
What drugs have been proved to decrease mortality of CHF?