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Flashcards in CV Deck (212):
1

MI in mensturating woman

VIRTUALLY NEVER

2

MI in mensturating woman

VIRTUALLY NEVER

3

chest pain-- must find out if they have

RISK FACTORS FOR CAD

4

most likely to benefit cardiac outcome

REGULAR EXERCISE

5

tai chi and yoga with CV effects

NOT PROVEN yet, difficult in measuring relaxation

6

who dies from heart disease

WOMEN die more from heart disease than men

7

nb fam hx for cv risk factor

must be hx of PREMATURE cad
and FIRST DEGREE RELATIVE

8

worst risk factor for CAD

DM

9

most common risk factor for CAD

HTN

10

premature age of CAD men

11

premature age of CAD women

12

most dangerous lipid profile for a patient

elevated LDL

13

tx TAKO-TSUBO

ACE inhibs
Beta blockers

NO REVASC--- since no problem with coronary vessels

14

tx TAKO-TSUBO

ACE inhibs
Beta blockers

NO REVASC--- since no problem with coronary vessels

15

chest pain-- must find out if they have

RISK FACTORS FOR CAD

16

most likely to benefit cardiac outcome

REGULAR EXERCISE

17

tai chi and yoga with CV effects

NOT PROVEN yet, difficult in measuring relaxation

18

who dies from heart disease

WOMEN die more from heart disease than men

19

nb fam hx for cv risk factor

must be hx of PREMATURE cad
and FIRST DEGREE RELATIVE

20

worst risk factor for CAD

DM

21

most common risk factor for CAD

HTN

22

premature age of CAD men

23

premature age of CAD women

24

most dangerous lipid profile for a patient

elevated LDL

25

PC: postmenopausal woman
son died in war
ballooning of LV and LV dyskinesia
chest pain

TAKO-TSUBO cardiomyopathy:
massive catecholamine discharge from stressful event (divorce, financial issues, earthquake, lightning, hypoglycaemia)

26

tx TAKO-TSUBO

ACE inhibs
Beta blockers

NO REVASC--- since no problem with coronary vessels

27

elevated homocysteine as rf for CAD

FALSE

28

elevated CRP as rf for CAD

FALSE

29

infection with chlamydia as rf for CAD

FALSE

30

immediate benefit if remove which CAD rf

STOP SMOKING

31

description for cardiac/ischemic chest pain

DULL or SORE
SQUEEZING or pressure like

32

UNLIKELY description of ischaemic pain

sharp (knifelike) or pointlike
lasts for a few seconds

NOT
- tender
- positional
- pleuritic

33

chest wall tenderness

costochondritis

34

costochondritis most accurate test

physical exam

35

chest pain radiating to back, unequal bp between arms

AD

36

AD most accurate test

CXR with widened mediastinum
confirmation of AD, chest:
- CT
- MRI
- TEE

37

chest pain worse with lying flat, better when sitting up, young person (

pericarditis

38

2 factors nb for ETT

1. cannot read EKG, ie. its not diagnostic
2. patient can exercise: get heart rate above 85% of maximum

39

chest pain + bad taste, cough, hoarseness

GERD

40

best test for GERD

response to PPI's

aluminum and magnesium hdroxide

viscous lidocaine

41

chest pain
cough
sputum
haemoptysis

PNEUMONIA

42

SUDDEN SOB and chest pain
tachycardia
hypoxia

PE

43

chest pain thats sharp
pleuritic pain
tracheal deviation

pneumothorax

44

best test pneumothorax

CXR

45

NONspecific symptoms seen in MANY causes of chest pain

nausea
fever
SOB
sweating
anxiety

46

BEST INTIAL TEST for all forms of chest pain

EKG

47

office based ambulatory setting EKG

likely to be normal, but CANNOT go on to other forms of testing until EKG is done

48

acute chest pain in office/ clinic setting, next best answer

TRANSFER TO EMERGENCY DEPARTMENT

49

acute chest pain in emergency department, next best step

ENZYMES

50

when to do exercise tolerance testing

UNCLEAR cause of chest pain

51

2 factors nb for ETT

1. you can read EKG
2. patient can exercise: get heart rate above 85% of maximum

52

maximum heart rate

220 MINUS patients age

53

determining ischaemic when cannot read the EKG/ baseline EKG abnormalities

1. Thallium or sestamibi scan
2. ECHO-- wall motion abormalities

54

baseline EKG abnormalities causes

1. LBBB
2. LVH
3. pacemaker use
4. effect of digoxin

55

normal myocardium with Thallium

INCREASED UPTAKE of thallium

56

abnormal myocardium with Thallium

DECREASED UPTAKE of thallium

57

ECHO for baseline EKG abnormaltiies

decreased wall motion
dyskinesia/akinesia/hypokinesia

58

ischaemia reversible or irreversible

REVERSIBLE

59

infarction reversible or irreversible

IRREVERSIBLE

60

alternatives to exercise in stress testing
(NOTE they are of equal sensitivity and specificity)

1. persantine= dipyridamole or adenosine in combo with thallium or sestamibi
2. dobutamine + ECHO

61

avoid with agent for stress testing in asthmatic patients

DIPYRIDAMOLE

62

exercise thallium same as

exercise ECHO

63

dipyridamole thallium same as

dobutamine ECHO

64

PC: man with atypical chest pain has normal nuclear uptake in his myocardium at rest. with exercise, decreased uptake in inferior wall. two hours after exercise, nuclear isotope returns to normal. NEXT BEST STEP

CORONARY ANGIOGRAPHY-- because already know this patient has reversible ischaemic, it's 100% specific for coronary disease

NOT dobutamine ECHO because only done when NOT SURE of the cause

65

coronary angiography determines...

bypass SURGERY vs. bypass ANGIOPLASTY

66

most accurate method of detecting CAD

angiography

67

stenosis

INSIGNIFICANT

68

surgically correctable disease % stenosis

70% stenosis

69

goal of LDL

1. PAD
2. Carotid disease (NOT stroke)
3. Aortic vessel disease
4. stroke
5. DM

70

do you do ETT in ACS patients currently having pain?

NO because the diagnosis is already clear

[remember don't put the patients on the treadmill to exercise/ stress heart-- if they are CURRENTLY having chest pain]

71

meds that lower chronic angina mortality (not ACS)

"BAN"
beta blockers
aspirin
nitroglycerin

best= B + A

72

propanolol use in cardiology

NO-- B/C NON-specific

73

acute coronary syndrome tx

ASPIRIN + 1 other anti platelet
- clopidogrel
- prasugrel
- ticagreolar

74

NB use of clopidogrel

aspirin intolerance

75

NB use of prasugrel

antiplatelet in those undergoing
ANGIOPLASTY and STENTING

dangerous in patients>775 since risk of hemorrhagic stroke

76

what drug if intolerant to aspirin and clopidogrel
(truly intolerant, not because bleeding)

TICLOPIDINE

77

side effects of ticlodipine

neutropenia and ttp

78

CAD use of ACE/ARBs

LOW EF (systolic dysfunction)-- BEST MORTALITY BENEFIT
REGURGITANT valvular disease

79

BIG 3 SE's of CCBs

1. edema
2. constipation
3. heart block (rarely)

80

what drugs if systolic dysfunction CAD

ACEinhibitors or
hydralazine

(both directly decrease mortality)

81

goal level for LDL in CAD

82

goal of LDL

1. PAD
2. Carotid disease (NOT stroke)
3. Aortic vessel disease
4. stroke
5. DM

83

ACS associated with point of maximal impulse

NOOOOOO--- because no specific physical findings in ACS

PMI:
- LVH
- DCM

84

NB monitoring for patients on statins

AST, ALT even without symptoms
DON'T DO CPK ROUTINELY (only done if have symptoms)

85

give to all CAD patients regardless of lipid levels

STATINS

86

NB effect of statins on endothelial lining

ANTIOXIDANT effect on endothelial lining

87

if full lipid control is not achieved with statins alone, add....

NIACIN

88

gemfibrozil + statins

increase myositis risk

89

ezetimibe

no better than placebo in terms of clinical endpoints

but yes definitely lowers LDL, but of no clinical benefit

well tolerated and nearly useless!

90

which drug increases mortality in patients with CAD

CCB's-- since raise heart rates-- reflex tachycardia with nifedipine

DO NOT USE CCBs in CAD

91

only times when can use CCBs in CAD

1. SEVERE asthmatic
2. prinzmetal
3. cocaine
4. failed aspirin and beta blocker medical tx

92

BIG 3 SE's of CCBs

1. edema
2. constipation
3. heart block (rarely)

93

few circumstances, in which CABG lowers mortality

VERY SEVERE DISEASE
1. THREE vessels at least 70% stenosis
2. L MAIN coronary artery occlusion
[3. 2 vessels in DM patient
[4. persistent symptoms despite maximal medical tx

94

duration of graft length before occlusion

internal mammary= 10 years
saphenous vein= 5 years

95

BEST TX FOR ACS

PCI = angioplasty

96

ACS associated with point of maximal impulse

NOOOOOO--- because no specific physical findings in ACS

PMI:
- LVH
- DCM

97

ST elevation in leads II, III, aVF

acute MI inferior wall

98

mortality with IWMI

99

DOOR TO BALLOON TIME

90 minutes

100

PR interval >200 milliseconds

first degree AV block-- little pathologic potential

101

ST elevation in leads V2-V4

Anterior Wall MI

102

premature ventricular contractions

aw later development of more severe arrhythmias
no additional tx if NORMAL K, Mg

103

ST depression in leads V1 and V2

posterior wall mI; low mortality

104

RBBB vs LBBB

RBBB= benign
LBBB= pathologic

105

treatment of PVCs

DO NOT TREAT

TX WORSENS OUTCOME

106

FIRST MGMT OF ACS

ASPIRIN-- since it lowers mortality (more important than morphine, oxygen and nitroglycerin-- however these are all administered)

107

NB rules in mgmt of ACS

START TX ASAP and do testing
BEFORE move to ICU

108

on step 2 CK should you ever consult with another dr?

NO-- DO IT YOURSELF

109

ONLY 2 things that decrease mortality in ACS-- and must be prioritized first

1. ASPIRIN
2. PCI/angioplasty

110

mgmt of reinfarction

1. EKG-- check new ST abnormality
2. check CK-MB

CK-MB BETTER at detecting reinfarction

111

ACS angioplasty or thrombolytics?

ANGIOPLASTY-- better with survival/mortality, less bleeding, less complications of MI develop

112

DOOR TO BALLOON TIME

90 minutes

113

complications of PCI

- RUPTURE coronary artery when inflate the balloon
- RESTENOSIS (thrombosis) of vessel after angioplasty
- HAEMATOMA- at entry site into artery

114

most NB in decreasing risk of restenosis of coronary artery after PIC?

placement of drug-eluting stent-- paclitaxel, sirolimus

115

4 ABSOLUTE contraindications to thrombolytics

1. major bleed in bowel (BLACK-MELENA, not brown), and brain (ANY type of bleed)
2. recent surgery (in last 2 weeks)
3. severe HTN (above 180/110)
4. non-haemorragic stroke in last 6 months

116

Door to needle time

30 minutes

117

who should get beta blockers in ACS

EVERYONE,
BUT NOT dependent on time

118

first line treatment for NSTEMI (stable)

LMWH, clopidogrel or enoxaparin

obviously because want to prevent the clot from growing and FULLY occluding the coronary arteries

119

GP2b/3a inhibitors

abciximab
tirofiban
eptifibatide

120

use of GP2b/3a inhibitors

ANGIOPLASTY and STENTING and NONSTEMI

121

only use for thrombolytics in MI

STEMI not for nstemi

122

SPECIFICALLY which type of heparin is best for NSTEMI

LMWH

not unfractionated heparin in terms of mortality benefit

123

NSTEMI that is not getting better with LMWH tx

- persistent pain
- S3 gallop or CHF developing
- worse EKG changes or sustained ventricular tachycardia
- rising troponin levels

124

post-MI stress test

done for EVERYONE prior to discharge
UNLESS SYMPTOMATIC (since immediately need angiography)

deciding whether need angiography or not

125

intra-aortic balloon pump

BRIDGE to surgery for valve replacement or transplant for 24-48hrs after rupture of valve or septum post-MI

126

dipyridamole in coronary artery disease

NEVER NEVER NEVER NEVER NEVER

127

ACE inhibitors are best for which type of wall infarct

ANTERIOR wall infract, since most likely to develop systolic dysfunction

128

bradycardia and canon A waves post-MI

third degree AV block

129

bradycardia and NO canon A waves post-MI

sinus bradycardia

130

clear chest and new inferior wall MI

RV infarct

131

don't give what if RV infarct

Nitroglycerates-- since cause hypotension

132

SUDDEN loss of pulse with jugulovenous distension

tamponade

133

DIAGNOSIS V.FIB

EKG

134

tx v/tach

electric cardioversion/ defib
PCI ASAP

135

new murmur post-MI in LLSB

septal rupture

136

oxygen sats in RA = 72% and 85% in RV

septal rupture

137

prophylactic antiarrhythmics post-MI

DON'T DO IT!!!!!!!!!!!!!!!!! even if have frequent PVC's and ectopy
don't use:
- amiodarone
- flecainide
- any rhythm controller

138

sexual issues post-infarction

1. NO nitrates and sildenafil
2. erectile dysfunction most commonly from ANXIETY, however if med associated--most commonly= beta blockers
3. do NOT need to wait to have sex (or normal exercise, given that post-MI stress test was normal)

139

most common cause of admission to the hospital in the US

Congestive heart failure

140

SOB brown blood and cyanosis, not improved with oxygen and clear lungs

methhaemoglobinaemia

141

burning wood stove in winter

carbon monixde poisoning

142

MOST important test in chf

ECHO

143

TEE or transthoracic ECHO best for CHF

transthoracic best, but TEE MOST accurate test (but often not needed)

144

MOST accurate test in CHF

MUGA= nuclear ventriculography
multiple gated acquisition scan

most accurate because evaluates WALL MOTION abnormalities

145

when to use MUGA ....

patient receiving doxorubicin

146

ACE inhibitors and ARBs in tx of systolic dysfunction CHF

ALL PATIENTS,
benefits seen with ANY drug in combo

147

when to answer ARBs >ACE inhibitors CHF

when the patient has cough from ACE inhibitor

148

which beta blockers to use for CHF (Recall don't use acutely)

- metoprolol and bisoprolol= beta 1
- carvedilol= non-specific

149

MCC death from CHF

ischaemia--> arhythmia--> sudden death

150

decrease mortality in CHF drugs

1. spironolactone and eplrenone
[anti-androgenic, and NOT anti-androgenic]

2. hydralazine + nitrates (systolic dysfunction)

3. ACEinhibitors/ ARBS

4. beta blockers

151

loops and spironolactone not given at diuretic effect in ACUTE MGMT CHF

do NOT lower mortality

152

NO benefit in mortality CHF systolic dysfunction

1. loops (and spironolactone at non-diuretic levels)
2. digoxin/ positive inotropes

153

BENEFIT mortality in CHF systolic dysfunction

1. spironolactone/ eplerenone
2. implantable defbrillator
3. biventricular pacemaker
4. hydralazine + nitrates (systolic dysfunction)
5. ACE inhibitors/ ARBs
6. beta blockers

154

when to give implantable defibrillator

- ischaemic cardiomyopathy
- EF

155

when to give biventricular pacemaker

- dilated cardiomyopathy
- EF 120ms

156

should you give warfarin if there is no clot in the heart?

NOOOOO

157

CCB's in heart failure

NO clear benefit in systolic dysfunction
some can actually RAISE MORTALITY

158

clearly beneficial diastolic dysfunction CHF

beta blockers
diuretics

159

clearly NOT beneficial diastolic dysfunction CHF

spironolactone
digoxine

160

uncertain beneficial diastolic dysfunction CHF

ACE inhibitors
ARBs
hydralazine

161

tx of acute pulmonary oedema from arrhythmia

CARDIOVERSION ASAP!!!!

162

nesiritide on mortality

NO PROVEN BENEFIT and
NOT PROVEN BETTER than standard agents for acute pulmonary edema

163

dobutamine in acute pulmonary edema

if failed LMNOP

164

digoxin in acute pulmonary edema

NOOOOO

165

treatment of acute pulmonary oedema with heparin but NO CLOT

NOOOOOOO NEVER

166

INITIAL diagnostic test for valvular heart disease

TEE: transesophageal ECHO

167

most accurate test for vaulter heart disease

catheterization

168

surgery with MS

dilated with a balloon

169

treatment of regurgitant lesions

VASODILATORS:
- ACE inhibitors, ARBs
- nifedipine
- hydralazine

170

with valvular heart disease and heart dilates XS from regurgitant----

CANNOT correct the decrease in systolic function
thus will end up needing to replace the valve

171

assessment of ventricular size

based on end-SYSTOLIC diameter and EF

172

prophylaxis antibiotics in valvular disease

ONLY IF....
1. prosthetic valve
2. hx of endocarditis

173

Mitral stenosis clues

PREGNANCY
IMMIGRANT

and YOUNG ADULTS

174

what 4 big things a/w MS

1. haemoptysis
2. dysphagia
3. hoarseness
4. A. FIB************ VERY COMMON

175

tx of MS

1. diuretics and sodium restriction
2. balloon valvuloplasty
3. valve replacement
4. warfarin for a fib, INR 2-3
5. rate control: digoxin, beta blockers, diltiazem, verapamil

176

balloon valvuloplasty for AS

NOT routinely done, since the calcification= the problem, and putting in the balloon doesn't help this problem

ONLY really done when can't do surgery because patient is unstable or fragile

177

PC:
- atypical chest pain
- palpitations
- panic attack

3P's of MVP
pain/palpitations/panic attack

178

need for catheterization in MVP

NOOOOOOOO, because don't need to know if exact pressure gradient

179

NB ECHO finding in HOCM

SAM

180

HOCM vs. HCM

HCM-- high bp, Y- ACEi, Y-diuretics
HOCM-- genetic, N- ACEi, N- diuretics

181

don't use which two drugs in hypertrophic cardiomyopathy

spironolactone and digoxin

182

EKG in HCM

non-specific ST and T wave changes

septal Q waves in inferior and lateral leads (NOT MI)

183

standing and valsalva = same effect as...

DIURETICS

184

amyl nitrate

direct arteriolar vasodilator

SIMULATES the effect of ACE inhibitors/ ARBs on the heart

185

ventricle size with handgrip and amyl nitrate

handgrip= FULLER left ventricle
amyl nitrate= ACE inhibitors= EMPTIER left ventricle

186

ACE inhibitor effect on MS

NO EFFECT,

thus amyl nitrate and handgrip, also no effect

187

inspiration effect on murmurs

INCREASES all heart sounds

188

valsalva and standing effect on murmurs

decreases most
INCREASES HOCM
EARLIER MVP

189

hand gripping effect on murmurs

INCREASES MR.AR.VSD
decreases HOCM
later MVP

190

squatting effect on murmurs

INCREASES AS
decreases HOCM
later MVP

191

NOTE-- decreasing murmur intensity = same as

IMPROVING murmur

192

what drug to decrease recurrence of pericarditis?

COLCHICINE

193

what is the best pain relief in pericarditis?

NSAID and COLCHICINE
(together)

194

most APPROPRIATE diagnostic test in cardiac tamponade

ECHO

195

what MUST you do before catheterization in cardiac tamponade

ECHO

196

ECHO in cardiac tamponade:

COLLAPSE of RA + RV

197

Right heart catheterization in cardiac tamponade

EQUALIZATION of pressures in diastole

198

best initial test in constrictive pericarditis

CHEST X-RAY-- shows calcification and fibrosis

199

initial treatment of constrictive pericarditis

DIURETICS (Decompresses the filling of the heart), later on can do surgery

200

pain worse in calves when walking DOWN hill

spinal stenosis (since leaning back)

201

single most effective medication in PAD

CILOSTAZOL

202

which drug does NOT HELP PAD

Calcium Channel Blockers

203

best initial diagnosis of aortic dissection

CXR-- simple, and shows widening of mediastinum

204

MOST ACCURATE diagnosis of aortic dissection

CT angio= GOLD STANDARD

205

screening AAA

men
>65yo
smokers

206

surgical correction AAA

>5cm

207

peripartum cardiomyopathy

occurs AFTER delivery
autoantibodies to myocardium
LV dysfunction often reversible
if worsening of LV function--> TRANSPLANT

208

tx OK with ACEi in peripartum cardiomyopathy

YES because occurs AFTER delivery

209

what happens when woman with hx of peripartum cardiomyopathy gets PREGNANT AGAIN

BIGGER surge of antibodies and
WORSENING of cardiac function

210

what cardiac functions worsen in pregnancy

peripartum cardiomyopathy
eisenmenger syndrome
[above 2 worsen more than MS]

211

syncope-- suddenly, have heart disease, frequent ectopic beats, thiazides

arrhythmia

212

syncope-- before get dizzy/weak/nauseous; EMOTIONAL trigger

vasovagal