Cardiology (Step up son) Flashcards Preview

Step 2 > Cardiology (Step up son) > Flashcards

Flashcards in Cardiology (Step up son) Deck (52):
1

What is the most common site of coronary occlusion?

Left Anterior Descending artery

2

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%)

3

What increases stroke volume? (6 things)

Catecholamine release
Increase intracellular Calcium
Decrease in extracellular Sodium
Digoxin use
Anxiety
Exercise

4

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

5

What decreases stroke volume?

Beta-blockers
Heart failure (chicken vs. egg)
Acidosis
Hypoxia

6

What is the Fick Principle? What does it determine

(Rate of O2 use) / ([O2]a – [O2]v)
Cardiac Output...just follow the units

7

Which increases first to increase CO during exercise, SV or HR?

SV increases first, then HR

8

What equations can be used to determine Mean Arterial Pressure?

CO x TPR
Diastolic pressure + 1/3 pulse pressure

9

When is an exercise stress test complete?

85% expected max HR (220-age)
Angina like symptoms
Signs of ischemia on ECG

10

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

11

What is used in pharm stress testing? When is this done?

Dobutamine

Comorbidities

12

PET myocardial imaging can be done...

...gives 3D images

13

What is the gold standard in identifying CAD?

Coronary angiography

14

What is the most common cause of hypercholesterolemia?

Most cases are acquired

15

When they say/show high levels of serum homocysteine, what should you think about?

Atherosclerosis (3x risk of significant amount)

16

For the bulk of the cholesterol meds, what are the common side effects?

Muscle damage/pain
Increased LFTs

17

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

18

Patient previously diagnosed with CAD presents with worsening symptoms--now having symptoms at rest--and decreased response to treatment. What are the likely causes?

Plaque rupture*
Hemorrhage
Thrombosis

19

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

ST depression*
T-wave flattening/inversion

20

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?

MONA BS

M-Morphine
O-Oxygen
N-Nitroglycerin
A-Aspirin

B-Beta blocker
S-Statin (preferably before PCI)

21

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?

GPIIb/IIIa inhibitor
Unfractioned heparin

22

What are the GPIIb/IIIa inhibitors?

Abciximab
Tirofiban
Eptifibatide

23

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
LMWH

24

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

25

What are two examples of PCI?

Percutaneous Transluminal Coronary Angioplasty (PTCA)
Coronary Artery Bypass Graft (CABG)

26

When is PTCA done?

When patient is unresponsive to medications

27

When is CABG recommended?

Left main stenosis >50%
Three-vessel disease
History of CAD and DM

28

Which vessels are commonly used for CABG?

Saphenous vein
Internal mammary artery

29

When does CK-MB increase post-MI? When does it peak? when does it decrease?

2-12hrs

12-40hrs

24-72hrs

30

When does LDH increase post-MI? When does it peak?

6-24hrs

3-6 days

...rarely used

31

When does Trop-I increase post-MI? When does it peak? When does it decrease?

2-3hrs

6hrs
gradually decreases over 7 days

32

What medications have been proven to decrease mortality post-MI?

Low-dose ASA
Beta-blocker
ACEI or ARB

33

When have thrombolytics been proven to decrease mortality?

Within 12hrs of MI

34

When should amiodarone be used post-MI?

For Vtach

35

When is the greatest risk of cardiac death post-MI? What are the most common causes?

The first few hours post-MI

Vtach
Vfib
Cardiogenic shock

36

A patient has an MI and everything seems to be going well. Then the patient dies 4-8 days later. Why?

Ventricular wall rupture

37

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)

38

Mobitz II is caused by what? How is it treated? What is the concern?

Infranodal conduction problem (bundle of His or Purkinje fibers)

Ventricular pacemaker

Progression to 3rd degree block

39

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
Ventricular pacemaker

40

Who typically gets paroxysmal supraventricular tachycardia?

Young patients with healthy hearts

41

How can PSVTs be treated?

Carotid massage
Valsalva maneuver
IV adenosine

In case of hemo instability, cardioversion or CCBs

Catheter ablation for long-term control in symptomatic patients

42

What is the technical definition of Vtach?

3+ PVCs

43

What is the MoA for class I antiarrhythmics?

Sodium channel blockers

44

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

45

What can quinidine and procainamide be used to treat?

PSVT
Afib
Aflut
Vtach

46

What can lidocaine and tocainide be used to treat?

Vtach

47

What can flecainide and propafenone be used to treat?

PSVT
Afib
Aflutter

48

What are the class II antiarrhythmics? What can they be used to treat?

Beta-blockers

PVC
PSVT
Afib
Aflutter
Vtach

49

Class III antiarrhythmics are potassium channel blockers. What are they? What can they treat?

Amiodarone
Sotalol
Bretylium

Afib
Aflut
Vtach (except bretylium)

50

The class IV antiarrhythmics are CCBs. What are they? What can they treat?

Verapamil
Diltiazem

PSVT
MAT
Afib
Aflut

51

What drugs have been proved to decrease mortality of CHF?

ACEI
Beta-blockers
Spironolactone

52

What can cause right sided HF?

Left sided HF
COPD --> RVH --> Right sided HF ( cor pulmonale)