Fast Cardio Questions Flashcards
(161 cards)
1
Q
the stretching of the left ventricle from the left atrium contracting enabling the left ventricle to contract stronger and force more blood out of the heart
A
-Preload
2
Q
atrial fib does what to cardiac preload?
A
-there is no preload when the heart is in atrial fib
3
Q
the pressure behind the aortic valve in the heart
A
- afterload
- it is the diastolic blood pressure
4
Q
the strength of the left ventricular muscle
A
-contractility
5
Q
a medication that increases cardiac contractility
A
-digoxin
6
Q
medication that decreases cardiac contractility
A
-verapamil
7
Q
term for when the blood leaves the left ventricle for the body
A
-systole
8
Q
passive phase of diastole
A
- gravity pulling blood into the left ventricle
- S3 sound if dilated/CHF
9
Q
active phase of diastole
A
- artium squeezes blood into the ventricle
- S4 if LVH
10
Q
an atypical symptom of heart attack in the elderly
A
-syncope
11
Q
atypical symptom of heart attack in diabetics
A
- silent heart attack, no chest pain
- they have SOB or even heart failure
12
Q
atypical symptom of women with a heart attack
A
-abdominal pain
13
Q
Acute Coronary Syndrome (ACS) includes what 3 possibilities?
A
- angina
- NSTEMI
- STEMI
14
Q
% of blood ejected out of the ventricle and into the body
A
-ejection fraction
15
Q
Normal Systole (normal ejection fraction)
A
55-60%
16
Q
Non Modifiable cardiac risk factors
A
- age
- sex
- genetics
- ethnicity
17
Q
Modifiable cardiac risk factors
A
- increased cholesterol
- HTN
- diabetes
- smoking
- obesity
- physical inactivity
- alcohol consumption
- stress
18
Q
Guy comes to ER, what 3 things make you think he is having a heart attack?
A
- chest pain, with good story
- EKG changes consistent with ischemia, ST or flipped T
- elevated cardiac enzymes
19
Q
AMI with STEMI
A
-Chest pain (CP) + ST elevations on EKG
20
Q
AMI NSTEMI
A
-CP + cardiac enzymes (low), but neg EKG changes
21
Q
Guy comes in with CP with negative cardiac enzymes and negative EKG has what?
A
-Angina
22
Q
patient with predictable pattern of chest pain, walks a block relieved by rest, walks a block relieved with rest (exertion chest pain)…
A
-Stable angina
23
Q
patient walks a block has chest pain takes 2 nitroglycerin tabs pains goes away, walks a block has chest pain takes 2 nitroglycerin tab pain goes away (exertion chest pain)…
A
-stable angina
24
Q
guy has new chest pain due to partial occlusion of a coronary artery lasting less than 30 minutes with good cardiac story and risk factors (ACS acute coronary syndrome) …
A
-unstable angina
25
guy with hx of stable angina and his chest pain does not go away with three nitroglycerine tabs
-unstable angina
26
what is the work up for stable angina
-stress test (nuclear medicine exam)
27
test that looks for coronary artery blockages
-nuclear medicine exam, done by walking or medication to speed up the heart
28
If a nuclear medicine exam is positive what do you do with the patient?
-he needs a cardiac catherization
29
What is the tx for stable angina?
- ACE inhibitors
- b blockers
- asa
- nitroglycerine, sublingual
- statin
30
45 y.o. female presents with chest pain which wakes her at night, she has ST elevation during this pain. She can walk all day with no symptoms. Dx?
-Prinzmetal varient
31
CPK cardiac enzyme
-comes from general muscle
32
CKMB cardiac enzyme
- peaks first
| - CKMB is the cardiac marker
33
Troponin cardiac enzyme
- most sensitive and specific cardiac enzyme
| - can be detected for 3 days
34
Tx for guy with Non ST Elevation, Chest pain, and low positive troponins? (this guy has a NSTEMI)
- MONA B CASHPAD
| - elective cardiac cath (planned)
35
Tx for a guy with CP, ST elevations, and increased troponin?
| this guy has a STEMI
- MONA B CASHPAD
| - urgent cardiac cath within 90 min door to balloon
36
M
O
N
A
- morphine, vasodilator and reduce anxiety
- O2, NC > NRB > CPAP > intubate
- Nitro, SL > Paste or IV drip
- aspirin, ALWAYS 325mg
37
B
Bblockers
38
Metaoprolol
-short acting and long acting versions
39
Which beta blocker do you use with an ejection fraction over 40%
-metaprolol
40
Which Bblocker do you give when the guy has an ejection fraction less than 40%
-give Carveditol
41
Which Bblocker do you give for rate control ?
-Esmolol
42
Which Bblocker do you give for HTN with ACS?
-labetalol
43
```
C
A
S
H
P
A
D
```
- CCB, (use Cardizem for fib rate control only)
- ACE inhibitor, prevents remodeling
- Statin, short term antiinflammatory/platelet
- Heparin, for STEMI or Lovenox NTEMI/Angina
- Plavix, load 300mg then 75mg daily
- Amiodarone for VT/VF or any arryhthmia
- Dopamine/Dobutamine/diuretics
44
inflammation of the pericardial sac surrounding the heart
-Pericarditis
45
patient has chest pain, increased by inspiration and recumbency, relieved by leaning forward. There are ST segment elevations in most leads. What's he got?
-pericarditis
46
young female has chest pain, increased by inspiration and recumbency. What might she have?
-think SLE
47
three causes of pericarditis
- viral
- post AMI think Dressler's syndrome
- SLE in young females
- radiation
- bacterial infections
- rheumatic fever
- injury
- neoplasms
48
What is the tx for pericarditis?
- NSAIDs, steroids
| - watch for pericardial effusion
49
Drug that can cause pericarditis
-hydralazine
50
this large vessel problem involves only one layer the intima
-aortic dissection
51
who gets an aortic dissection
-males 2 x greater, 40-80 yrs old
52
risk factors for aortic dissection
- pregnancy
- cocaine abuse
- HTN (chronic, present 70-90% of cases)
- Marfan's
- Ehlers-Danlos Syndrome
53
what anatomical area do most aortic dissections occur
-Type A (60-65%), ascending aorta
54
What is the 2nd most common area for aortic dissections occur?
-Type B (30-35%), descending aorta (after the origin of the subclavian artery)
55
What is the gold standard for Dx of aortic dissections?
-Aortic Angiography (most are seen in the ER and tx and get a CT and then the angiography is obtained)
56
Meds to lower blood pressure in aortic dissections?
- nicardipine
- Esmolol
- Labetalol
- Nitropursside--may cause cyanide toxicity leading to AMS and high anion gap acidosis
57
What is the tx for aortic dissections?
-lower the blood pressure
- for Type A--surgical management
- for Type B--medical management initially, surgery if needed
58
patient has tearing sensation, and pain radiating to the his back, the pain in not quite as bad as it was when it first started. whats he got?
-aortic dissection
59
This aneurysm peaks in incidence over 60 yrs of age and accounts for 75% of all aneurysms
-Aortic aneurysms
60
what part of the vessel is involved in aortic aneurysms
-all three layers
61
what anatomical area are most aortic aneurysm seen?
infra-renal
62
60 y.o. presents with back pain, pulsatile mass and hypotension, what's he got?
-Aortic aneurysm, this is a classic presentation
63
Other symptoms of AAA include?
- 75 are asymptomatic
| - others have abrupt onset sever pain unrelieved by change of position
64
Best study for suspected aortic aneurysm?
-Ultrasound, then CT angiogram for prep evaluation
65
When do you do surgery on an aortic aneurysm?
- if > than 5.4 cm
| - if it changes >0.5 cm in 6 months or > 1 cm in 1 year
66
severe pain radiating to the back, hypotension, pulsatile mass and decreased femoral pulses ?
-aortic rupture
67
Risk factors for aortic aneurysm?
- tabacco abuse
- atherosclerosis
- HTN
- COPD
68
what is the cause of aortic aneurysms?
- caused by elastin and collagen degradation the aortic wall
- involves all three layers
- most common infra-renal
69
AA
- no further testing
- repeat US yearly
- repeat US q 6 months, refer
- repeat US Q 3 months
70
collapse of the right ventricle, because there is so much pressure on the heart
-Pericardial tamponade
71
Beck's triad, 3 D's of pericardial tamponade
- distant heart sounds
- distended jugular veins
- decreased arterial pressure
72
Rise in jugular venous pressure on inspiration (Kussmaul)
| and paradoxical pulse (exaggerated fall in systolic blood pressure with inspiration, usually more than 10mm)
-suspect percardial tamponade
73
Dx findings of pericardial tamponade?
- EKG with electrical alterans, CXR shows huge globular heart (old hot water bottle shape)
- Echo is the Gold Standard for Dx
74
What is the tx for paricardial tamponade?
- pericardial window, send fluid for source
| - 3 sided cut like a flap and drains to the lung
75
How do you know that blood you drew came from the pericardial sac?
-pericardial centesis blood does not clot
76
What does the echocardiogram show in pericardial tamponade?
-echo will show collapse of the right ventricle
77
Endocarditis involves what part of the heart?
-the endocardium which includes the heart valves
78
What causes acute endocarditis?
-Staph aureus
79
What is the significance of acute endocarditis?
- the Staph Aureus causes high fever and rapid valve destruction
- tricuspid valve infection leads to septic emboli and lung abscess, esp in the IV drug abuser
80
Clinically describe Subacute endocarditis?
-caused by Strep viridian's/enterocooci,
-you see low grade fever, arthralgia, embolism/brain
"Stroke + Fever = Endocarditis"
81
Duke major criteria for Dx of endocarditis, (need 2) ?
+ blood culture and/or + echo for vegetation
82
Duke minor criteria for Dx of Endocarditis (need 5) ?
```
Petechiae
splinter hemorrhages (finger nail beds)
Jane's lesions (plainness on the hands)
Osler's nodes (painful lesions on the hands)
-Roth spots (retinal lesions)
```
83
This is the most common skin finding in endocarditis but not specific for endocarditis?
-petichiae
84
What is the tx for endocarditis?
1st line is amoxicillin, clindamycin if allergic
- cephalosporins or azithromycin as alternatives
- ofter required valve surgery
85
you find tricuspid endocarditis ...
consider IV drug use and Staph infection and septic emboli which leads to lung abscess
86
Aschoff bodies are pathognomonic for ?
-Acute Rheumatic Fever
87
This disorder is thought to be a cardiac muscle disposition to the antibodies during a strep infection?
-Acute Rheumatic Fever
88
You need 2 Major criteria to Dx Acute Rheumatic fever. List the 5 major criteria.
J Joints (migratory polyarthritis) O Carditis
N Nodules, subcutaneous (Aschoff bodies)
E Erythema marginatum (pink rings on trunk and flexor surf)
S Sydenham's chorea
89
You can use 1 Major and 2 Minor criteria for Dx of Acute Rheumatic fever. List the minor criteria.
- arthralgia
- fever
- lab: elevated ESR/CRP
- EKG: prolonged PR interval
90
What is the tx for Acute Rheumatic Fever?
- Penicillin or macrolides for pen allergic
| - tx with prophylaxis with penicillin until age 20 or at least 5 years after last carditis episode
91
describe the S3 heart sound
rapid blood splashing into the ventricle
| -think systolic heart problem right away
92
describe the S4 heart sound
-means a stiff ventricle, hypertrophic, enlarged (LVH, hypterophic cardiomyopathy,
93
Rubs
-carditis
94
Gallops
S1 + S2 plus a S3 or S4 or both
95
Gallop with S1 + S2 plus S3
-think systolic CHF
96
Gallop with S1 + S2 plus S4
-think diastolic CHF or ischemia (MI)
97
Inspiration make which murmurs get louder?
-pulmonic and tricuspid murmurs--increases venous return
98
Exhalation causes which murmurs to get louder?
-Aortic and Mitral
99
ASD, atrial septal defect
- pulmonic ejection murmer ****you hear Fixed S2 splitting****
- dilated pulmonary arteries are seen/noted
100
- blood pressure is high but equal in both arms
- blood pressure is lower in the legs
- radial femoral pulse lag
-coarctation of the aorta
101
-this heart condition includes a bicuspid aortic valve which causes cerebral aneurysms
-coarctation of the aorta
102
-continous machine like murmur, and here you may see failure to thrive-
-PDA and is treated with indomethacin
103
Pansystolic (holosystolic) murmer
| -heard best at mid sternal boarder
- VSD, ventricular septal defect
| - most common murmur
104
Patients/kids will often squat if they have this heart problem. They run, get tired, then squat and "pink up" and feel better ("Tet spells").
-tetralogy of fallot
105
4 elements of tetralogy of fallot
- pulmonary valve stenosis
- VSD (ventricular septal defect)
- overriding aorta
- right ventricular hypertrophy
106
Name this syndrome in which a congenital heart condition causes Col Pulmonale.
Eisenmenger Syndrome, and it's too late to do surgery if it gets this far
107
Patient presents with fixed S2 splitting? What chest x-ray findings would expect to see.
-dilated pulmomary arteries
108
-What murmer/heart problem includes dilated pulmonary arteries?
-ASD
109
12 y.o. boy presents with calf cramping and leg pain with running (claudication symptoms), what condition do you suspect?
-coarctation of the aorta
110
what medication do you give to a baby with a continuos machine like murmur?
-indomethacin
111
most common cardiac defect
-VSD
112
Cor Pulmonale caused by a VSD is called what?
-Eisenmenger's syndrome
113
You note a holosystolic murmur at the mid sternal boarder of child. What is the murmur?
-VSD
114
Why does squatting help with exertion in a kid with Tetralogy of Fallout?
-Tetralogy of Fallout is a central cyanotic condition. Squatting helps to temporarily reverse the shunting of the VSD.
115
Transposition of the great vessels of an infant is common to mothers with what condition?
-diabetes
116
Indomethacin is used to close PDA in babies--true or false
true
117
true or false
Squatting makes Tetralogy of Fallott worsen oxygen delivery.
False
118
ASD is associated with increased pulmonary vascularity.
true or false
-true, thus you see increased great theart vessel size on X-ray
119
transposition of great vessels is seen in young mothers
true or false
false, transposition is seen in diabetic mothers
120
if a patient has DM, an MI or CHF what blood pressure medication should they be on
an ACEI
121
What BP medication causes angioedema, cough, and hyperkalemia for side effects?
ACEI
122
You place your DM patient or patient that has had an MI on an ACEI, one week later you should order this lab?
-basic metabolic panel to see if they have hyperkalemia
123
Which BP med causes a cough?
ACEI
124
Which BP med causes angioedema
ACEI
125
A pregnant female should never get this blood pressure medication?
- ACEI
| - also don't give Angiotensin II inhibitor
126
A guy with Renal Artery Stenosis should never get this HTN medication?
-ACEI
127
This HTN medication is not given first line very often. It is given for cirrhosis of the liver and in CHF?
-Aldosterone inhibitors--spironolactone
128
These 3 HTN meds cause hyperkalemia?
- ACEI
- Angiotension II inhibiors
- Aldosterone inhibitors--spironolactone
129
This BP med is rarely used alone. It is indicated for MI, CHF, CAD, and DM.
Bblocker
130
You would not give this BPmedication to a young person, and Why not?
Bblocer
- sexual dysfunction (causes inpedence)
- causes lack energy
131
Don't give this BP medication to an asthmatic or to someone that is bradycardia. Why not?
Bblocker -it causes asthma symptoms
-it further slows HR
132
All diabetics should be placed on this type of BP medication. Why? What med do you place them on if they are allergic to ACEI or cannot tolerate ACEI?
- ACEI
- to protect the kidneys
- place on a CC blocker
133
Drug of choice for tx of HTN in pregnancy?
-methyl dopa
134
Do not give these BP meds during pregnancy?
- ACEI
| - angiotension II inhibitors
135
This would be a good choice for an athlete or active person with HTN?
ACEI
136
Two BP meds in this class control heart rate?
- Verapamil (phenylakylamine)
- Cardizem (benzothiazepine)
both are calcium channel blockers
137
For a person with atrial fibrillation and hypertension these two drugs would be great for treatment.
- Verapamil
- Cardizem
-calcium channel blockers that control rate and treat hypertension
138
A big side effect for calcium channel blockers is what?
-leg edema
139
This is a calcium channel blocker that vasodilates?
-Amlodipine, Nifedipine, (dihydropyridine)
140
If you can't place a DM or hypertrophic cardiomyopathy patient on a ACEI or Angiotension II med what is the next choice to help protect the kidneys?
-Calcium channel blocker
141
Side effects of thiazide diuretics
- hypokalemia
- increase uric acid
so they make gout worse and make calcium stones better
142
Don't give thiazide diuretics to what patients
- DM
- Gout
- Pregnant
143
This HTN medication can cause Lupus syndrome and also can cause pericarditis
-hydralazine
144
Central acting HTN meds (clonidine) and also alpha blockers (terazosin, doxosazin) have what common side effect?
- postural hypotension
| - so give at nightt
145
This HTN medication is a potent vasodilator and can help grow hair.
-minoxidil
146
BP > 180/120 with end organ dysfunction
Hypertension emergency
147
BP > 180/120 without end organ dysfunction
Hypertension urgency
148
What is your goal in Tx hypertension emergency or urgency?
-decrease BP no more than 25% over the first 1-2 hours, then keep lowering until you get it to a more normal range
149
What can happen if you lower
| BP too fast in hypertension emergency or urgency?
- they can pass out
| - can decrease cerebral blood flow
150
Who gets orthostatic hypotension?
- diarrhea, vomiting, dehydrated, walking around in the desert
- or DM, or age (autonomic)
- Bleeding
- Med: Bblockers, vasodilators, diuretics, clonidine
151
A guy is treated for BPH and now has orthostatic hypotension, why?
-you placed him on an alpha blocker, terososin, and you caused the orthostatic hypotension
152
Med of choice for HTN in diabetics
ACEI
153
med of choice for Tx of HTN in a patient without comorbidities
-hydrochlorthiazide (thyazide diuretic)
154
use this med to tx HTN and BPH
-alpha blocker
155
pre hypertension range
120/80 to 139/90
156
retinal exam findings for chronic uncontrolled HTN
-cotton wool spots, AV nicking
157
What 2 agents cause angioedema?
-ACEI and angiotension II receptor blockers
158
this BP med causes impotence in men
Bblockers
159
this HTN med is causing edema in my legs
calcium channel blocker
160
Why are ACEI always used to tx angina?
-ACEI interfere with the formation of Angiotensin II, this hormone constricts blood vessels. We want the vessels to relax, so ACEI are given to increase blood flow in vessels by reducing constriction caused by Angiotensin II.
161
If you can't give a patient with angina an ACEI a Beta Blocker is usually used. How do beta blockers help angina?
-Beta blockers work by blocking the effects of epinephrine/adrenaline. As a result the heart beats more slowly and with less force reducing cardiac work load and using less O2. Beta blockers also relax blood vessels and open up for more blood flow, reducing or preventing angina.
