Cardiovascular System

Question 1

ST depression indicates

Answer 1

subendocardial ischemia

Question 2

Medicines for pharmacological stress test:

Answer 2

Adenosine, dipyridamole, dobutamine

Question 3

action of dobutamine

Answer 3

increases myocardial oxygen demand by increasing heart rate, blood pressure, and contractility

Question 4

action of adenosine and dipyridamole

Answer 4

generalized coronary vasodilation

Since diseased coronary arteries are already maximally dilated, this causes a relative blood flow deficiency in diseased arteries

Question 5

amount of stenosis necessary to produce angina

Answer 5

> 70%

Question 6

The only medications that lower mortality in stable angina:

Answer 6

Aspirin, Beta-blocker

Question 7

Outcome of revascularization

Answer 7

improvement of symptoms

does not reduce incidence of MI

Question 8

Should CCB be used in CAD?

Answer 8

Not routinely, they raise heart rate

Use if still symptomatic despite B-blockers and Nitrates

Question 9

Treatment of CHF

Answer 9

ACEi

Diuretics

Question 10

Indications for CABG

Answer 10

Three-vessel disease >70% stenosis in each vessel
LMA > 50% stenosis
LV dysfunction

Question 11

Difference between UA and NSTEMI

Answer 11

NSTEMI has elevated cardiac enzymes

both UA and NSTEMI lack ST elevations and Q waves

Question 12

When to do stress testing for UA:

Answer 12

UA have higher risk of adverse events during stress testing, stabilize with medical management before stress testing or start with cardiac catheterization

Question 13

Treatment of UA/NSTEMI

Answer 13

ASA
Clopidogrel 9-12 mo.
Beta-blockers
Heparin/Enoxaparin -> PTT 2-2.5x normal
Nitrates
O2 if hypoxic
Statin
Check K+ and Mg+ and replace PRN

> 90% will improve with medical management in 2 days
If no improvement, cath

Question 14

Thrombolysis in Myocardial Infarction (TIMI score):

Answer 14

Age > 65
3+ CAD risk factors
Known CAD
2+ episodes of angina in past 24 hours
ASA use in last 7 days
Elevated cardiac enzymes
ST changes

Question 15

Drug used to induce coronary vasospasm (Prinzemetal angina)

Answer 15

Ergonovine

Question 16

Signs of MI

Answer 16

Substernal chest pain
> 30 min
Doesn’t respond to NG

Question 17

Meaning of ST elevation/depression

Answer 17

ST elevation = transmural injury

depression = subendocardial injury

Question 18

Time course of cardiac enzymes

Answer 18

Trop: (better than CK)
increases within 3-5 hours
can be falsely elevated in renal failure

CK:
increases within 4-8 hours
returns to normal in 48-72 hours

Question 19

Difference in medical treatment of MI vs. UA/NSTEMI

Answer 19

MI should get ACEi in addition to B-blocker

MI should get IV heparin

Question 20

Treatment of Vtach

Answer 20

hemodynamically unstable –> cardioversion

stable –> amiodarone

Question 21

Treatment of AV block:

Answer 21

1st and 2nd (type I) - no treatment
2nd (type II) and 3rd:
Anterior MI –> emergent pacemaker
Inferior MI –> IV atropine

Question 22

Treatment of pericarditis

Answer 22

ASA

• NSAIDs and Steroids are contraindicated

Question 23

Dressler’s Syndrome

Answer 23

postmyocardial infarction immunologic
fever, malaise, pericarditis, leukocytosis, pleuritis
weeks to months post MI

TX: ASA, Ibuprofen

Question 24

NYHA CHF classification:

Answer 24

I: symptoms only with vigorous activity
II: moderate exertion
III: activities of daily living
IV: at rest

Question 25

Treatment of CHF:

Answer 25

``` Class I: Salt restriction Loop diuretic - improves symptoms ACEi - improves mortality Class II: B-blocker - improves mortality Class III: Digoxin - symptomatic (positive inotrope for EF ```

Question 26

Contraindicated in CHF:

Answer 26

Metformin --> lactic acidosis Thiazoladinediones --> fluid retention NSAIDs

Question 27

Treatment of Afib

Answer 27

Stable --> rate control with B-blocker, then cardiovert Unstable --> Cardiovert Anticoagulate for 3 weeks before and 4 weeks after cardioversion If

Question 28

Medication that blocks the AV node

Answer 28

Adenosine

Question 29

QT prolonging drugs:

Answer 29

TCAs, anticholinergics

Question 30

Treatment of Torsades de pointes

Answer 30

IV magnesium

Question 31

Difference between second-degree blocks

Answer 31

Mobitz I (Wenckebach) - progressive prolongation of PR interval Site of block is within the AV node Benign Mobitz II - Randomly non-conducted QRS waves Site of block is within the His-Purkinje system Requires pacemaker

Question 32

Medication causes of dilated cardiomyopathy

Answer 32

Doxorubicin | Adriamycin

Question 33

Infectious causes of dilated cardiomyopathy

Answer 33

Viral Chagas' disease Lyme disease HIV

Question 34

Murmur of Hypertrophic Cardiomyopathy

Answer 34

Systolic ejection murmur Decreases with squatting, lying down, or straight leg raise (decreased outflow obstruction) Increases with Valsalva and standing (Decreased LV size -> increased outflow obstruction) This pattern is opposite of what is normally observed in all other murmurs except mitral valve prolapse

Question 35

ECG findings of pericarditis

Answer 35

diffuse ST elevation and PR depression PR depression is more specific

Question 36

Epstein's Anomaly

Answer 36

Congenital malformation of tricuspid valve in which there is downward displacement of the valve into the RV

Question 37

Symptoms of Rheumatic fever

Answer 37

2 Major or 1 Major + 1 Minor ``` Major: Migratory polyarthritis Erythema Marginatum Cardiac involvement Chorea Subcutaneous Nodules ``` ``` Minor: Fever ESR Polyarthralgia Long PR interval Evidence of Strep infection ```

Question 38

Symptoms of ASD

Answer 38

Wide, fixed split S2 May have systolic ejection murmur at pulmonary area due to increased blood flow

Question 39

VSD

Answer 39

The most common congenital cardiac malformation Symptoms: small shunt -> none large shunt -> first, left to right, CHF, growth failure, respiratory infections -> later, Eisenmenger, SOB on exertion Blowing holosystolic murmur Smaller defect -> louder murmur

Question 40

PDA - association - clinical findings - medications

Answer 40

congenital rubella syndrome continuous machine-like murmur (systolic and diastolic) Indomethacin -> closure PGE1 -> keep open

Question 41

Medical treatment of PVD claudication

Answer 41

Cilostazol (PDE inhibitor)

Question 42

Indications for tPA in PE

Answer 42

hemodynamically unstable | right heart failure

Question 43

When superficial thrombophlebitis occurs id different locations in a short period of time, think of...

Answer 43

Migratory superficial thrombophlebitis --> occult malignancy, often pancreas

Question 44

Worst risk factor for ischemic heart disease

Answer 44

Diabetes Mellitus