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1
Q

What is the worst risk factor for CAD?

What is the most common risk factor for CAD?

A

DM

HTN

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2
Q

What is the relationship between family history and CAD?

A

First degree relatives carry a risk

Premature CAD carries a risk (males

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3
Q

What lipid marker is the greatest concern for CAD risk

A

Elevated LDL

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4
Q

What is Tako Tsubo CM?

What is it caused by?

A

Post menopausal women experience a massive catecholamine surge and have LV ballooning
Due to sudden stress

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5
Q

What are 2 characteristics of ischemic pain?

What are 5 characteristics of non-ischemic pain?

A

Dull/sore, squeeze/pressure

Sharp, couple seconds, pleuritic, positional, tender

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6
Q

What is the initial test for chest pain?
What is the next step in an office?
What is the next step in a hospital?

A

EKG
Transfer to ED
CK MB + Tropinin

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7
Q

What is the maximum heart rate?

A

220-age

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8
Q

When should you stress test someone?

A

Etiology of chest pain is uncertain + EKG is nondiagnostic

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9
Q

What are 2 tests for when you cannot read an EKG because of a baseline abnormality?

A

Nuclear isotope uptake (thallium or sestamibi)

Echo detection of wall motion abnormalities

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10
Q

What is a medication for stress testing that should be avoided in asthmatics and why?
What should you use instead?

A

Dipyridamole causes bronchospasm

Dobutamine with an Echo

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11
Q

What is the next step in a patient with a positive stress test for ischemia?
Who gets a stent vs a CABG?

A 
Coronary angiography (most accurate detector of CAD)
Stent for 1-2 vessels, CABG for 3+ or 2 in DM
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12
Q

When do you use Holter monitoring?

A

Rhythm evaluation

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13
Q

What antiplatelet meds should an ACS patient receive immediately upon arrival?

A

ASA + Clopedigrel or Prasugrel or Ticagrelor (P/T if being stented)

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14
Q

What is ticlopidine and who gets it?

A

Platelet inhibitor in patients intolerant of ASA and clopidogrel
Causes neutropenia + TTP

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15
Q

What patients receive ranolazine?

A

Angina patients refractory to other treatments

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16
Q

What has the best mortality benefit to Low EF CHF?

A

ACEi/ARBs

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17
Q

What do you combine with hydralazine and why?

A

Nitrates –> dilate coronary As so blood is not stolen away when after load is decreased

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18
Q

What is the most common adverse affect of statins?

A

Liver dysfunction

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19
Q

What are the adverse effects of Niacin?

Any positives?

A

Increased glucose, increase Uric acid, pruritus

Increased HDL

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20
Q

What are the adverse effects of Fibrates?

Any positives?

A

Myositis risk with statins

Lower TGs

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21
Q

What are the adverse effects of cholestyramine?

A

Significant interactions with other meds, flatus/cramping

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22
Q

What are the adverse effects of Ezetimibe?

A

It is useless (though it does lower LDL)

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23
Q

What is the association of Ca Channel blockers and CAD?

Who are the exceptions and what drugs?

A

May increase mortality (reflex tach)

Verapamil/Dilt –> severe asthma pts who can’t use BBlockers, prinzmetal angina, Cochin induced chest pain

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24
Q

When does CABG lower mortality?

A

3 vessels of >70% stenosis
L Main occlusion
2 vessels + DM
Persistent Sx despite max medical therapy

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25
How long do the 2 types of graft last in a CABG?
Mammary A: 10 years | Saphenous V: 5 years
26
What heart sound is associated with ACS and why?
S4 gallop | Ischemia causes LV noncompliance
27
What is kussmaul sign and what is it associated with?
Increased JVD on inhalation | Constrictive pericarditis > restrictive CM
28
What is a displaced PMI characteristic of?
LVH
29
EKG finding of anterior wall MI
ST elevation in V2-V4
30
EKG finding of the inferior wall
ST elevation in II, III, aVF
31
EKG finding of 1st degree AV block
PR >200mSec
32
EKG findings of posterior wall MI
ST depression in V1 and V2
33
What is the first drug to administer in an acute MI patient because it lowers mortality? What are the next 3 drugs?
ASA | Morphine + O2 + Nitroglycerin
34
What are 3 drugs given to MI patients that are not time sensitive?
Metoprolol ACEi Station
35
What disease can cause a false positive troponin and why?
Renal insufficiency | Troponin excreted by the kidney
36
What are the 2 steps for a patient who has a suspected reinfarction a few days after their MI
1) EKG 2) CKMB * 3) transfer to ICU
37
How much time should elapse to giving PCI in an MI? | How is restenosis prevented?
90 minutes | Drug eluding stent (Paclitaxel, Sirolimus)
38
When is heparin useful with regards to ACS?
ST depression and other NSTEMI events
39
When are Cannon A waves seen? | What are they?
3rd degree AV block | Atrial systole against the tricuspid valve (which is closed)
40
How is symptomatic Brady treated?
1) atropine --> pacemaker if necessary
41
What are the findings in RV in fact? What is most specific? How do you treat these? What do you avoid?
Tachy ST elevation in V4 High volume fluid replacement Nitroglycerin (worsens cardiac filling)
42
What are 3 clues of post MI valve or septal rupture?
Step up in O2 SATs from RA to RV New onset mitral regurg murmur Pulmonary congestion
43
When is an intraaortic balloon pump used?
Bridge to valve replacement for
44
What are 2 diagnoses if there is a sudden loss of pulse with JVD?
Tamponade | Wall rupture
45
What are the meds that a post infarct patient goes home with?
ASA Metoprolol Statin ACEi
46
What 3 diseases cause >95% of Systolic dysfunction CHF
Infarct CM Valve disease
47
What heart sound is associated with CHF
S3 gallop
48
What is the most important test in CHF (also initial)? | What is the most accurate test for CHF?
TTE | MUGA
49
What can you use a Swan Ganz catheter to distinguish?
CHF and ARDS
50
What thyroid disorders can cause CHF?
Both high and low ;)
51
What is the most common cause of death from CHF?
Arrhythmia leading to sudden death
52
What are 5 drugs classes used in low EF CHF and why?
ACEi/ARB: all BBlocker (Metoprolol/Bisprolol/Carvedilol): all Spironolactone: class 3+ --> Eplerenone if gynecomastia Diuretics: initial Sx control Digoxin: controls Sx but NO MORTALITY BENEFIT
53
What are 2 non medicine treatments for CHF with mortality benefit?
Defibrillator (ischemic CM + EF 120)
54
What is a good treatment in Preserved EF CHF? | What is bad?
``` Beta Blockers (diuretics if Sx but no HCM) Digoxin, Spironolactone ```
55
Initial therapy for acute pulmonary edema? | 2 tests to do afterward?
IV Furosemide | EKG + ECHO
56
_____ _____ have basically never had MIs
Menstruating women
57
What is the most common valve disease of rheumatic fever?
Mitral stenosis
58
What valve disease is associated with aging?
Aortic stenosis
59
What side of the heart valvular lesions increase on inhalation? Why?
Right side --> increased venous return
60
What side of the heart lesions increase with exhaling? Why?
Left --> squeezes blood from the lungs into the heart
61
What is the best initial and accurate tests for valvular heart disease?
Initial: ECHO (TEE > TTE) Accurate: catheterization
62
What do you look for to determine if a valve replacement will be helpful or not?
End diastolic volume (too large: will not be helpful)
63
What are 2 clues to mitral stenosis as the diagnosis?
Pregnancy (increased plasma V squeezing through stenosed valve) Immigrant (not immunized)
64
What are 4 unique features of Mitral Stenosis?
Dysphagia (LA presses on esophagus) Hoarseness (LA on laryngeal N) Afib (+ stroke due to enormous LA) Hemoptysis
65
What is the heart murmur of mitral stenosis? What changes it?
Diastolic right after opening snap | Squatting + leg raise increase intensity (increase V return)
66
What are the steps to treat mitral stenosis?
1) diuretics/Na restriction 2) balloon valvuloplasty --> valve replaced if needed 3) Warfarin for afib to 2-3 4) Rate control (dig/BBlock/CCB)
67
What is the most common and 2nd most common presentation of AS?
Angina > syncope
68
What is the murmur of AS?
Systolic crescendo decrescendo radiating to the carotid Valsalva, Standing: soften by decreasing V return Handgrip: soften by decreasing ejection of blood
69
What is the treatment for AS?
Valve replacement
70
What can cause mitral regurg? | How does it present?
Any reason for heart dilation Holosystolic radiating to the axilla Handgrip: Increases (increases afterload) Squatting, leg raise: increase (increased V return)
71
What are some unique findings of Aortic Regurg? | What is the murmur?
Wide pulse P, Water Hammer bounding pulse, Pulsing nail bed, BP in legs 40mg>arm, head bobbing Diastolic decrescendo in LLSB Valsalva, Standing: improve Handgrip: worsens (increases afterload by compressing arm As)
72
What is the most common presentation of MVP?
Nothing! | But also atypical chest pain, palpitations, panic attack
73
What is the murmur in MVP?
Midsystolic click Valsalva, Standing: worsen MVP (decrease venous return) Squatting, handgrip: improve murmur (increase LV size)
74
CM presentation? Initial test? Accurate test? Treatment?
Shortness of breath ECHO ECHO Diuretics
75
What 2 murmurs do not increase with expiration?
HCM | MVP
76
What valvular finding is classic for HOCM?
Systolic anterior motion of the mitral valve
77
What is the treatment of HCM and HOCM?
1) BBlock 2) negative ionotropes (Verapamil, Disopyramide) 3) Diuretics for HCM but NOT for HOCM
78
What is the best initial test of RCM? | Accurate?
ECHO | Endomyocardial biopsy
79
What is the result of standing suddenly?
open venous capacitance vessels in legs
80
What is the result of a valsalva?
1) increased intrathoracic P | 2) decreased V return to R side of the heart
81
Which are the murmurs that improve with more blood?
MVP | HOCM
82
What happens with the handgrip?
1) Arm As are compressed | 2) increased afterload because heart cannot empty
83
What does Amyl Nitrate do to murmurs?
1) direct A vasodilator 2) stimulates the effect of ACEis/ARBs 3) emptier LV
84
What is the treatment for idiopathic pericarditis?
NSAIDs + Colchicine (decrease recurrence)
85
What are signs of pericardial tamponade?
HypoTN Tachy Distended neck Vs Clear lungs
86
What are 2 classic signs of constrictive pericarditis?
Kussmaul sign: increase in JVD on inhalation (should decrease) Knock: heart fills to its maximum
87
What is the best initial test for constrictive pericarditis? Accurate? Additional?
CXR CT/MRI (not needed if CXR done first) ECHO
88
What is the classic symptom of PAD? | What is different in spinal stenosis?
Leg pain in the calves on exertion improving with rest | SS is worse walking down hills because you lean back
89
What is the best initial test for PAD? | Accurate?
ABI (
90
What are the treatments of PAD?
ASA Smoking cessation Cilostazol
91
What 3 things do you control in major vascular disease?
BP | LDL
92
What is the initial test for Aortic Dissection? | Accurate?
CXR | Angiography
93
What are 2 findings in aortic dissection?
Pain between the scapulae | Difference in BP between the arms
94
What are the treatment steps for aortic dissection?
1) BBlock 2) Nitroprusside (must BB first to prevent reflex tach) 3) surgery
95
Who is screened for AAA?
Men who ever smoked >65
96
What is the most dangerous heart disease in a pregnant woman?
``` Peripartum CM (reversible LV dysfunction usually but if not may need a heart transplant) Typically develops after pregnancy! ```

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