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MTB STEP 3 (R) > MTB 3 - Cardio > Flashcards

MTB 3 - Cardio Flashcards

1
Q

Worst risk factor for CAD

A

DM

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2
Q

Most common risk factor for CAD

A

HTN

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3
Q

Risk Factors for CAD

A

DM, tobacco, HTN, hyperlipidemia, 1st degree family member with premature CAD, Men >45 & Women > 55

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4
Q

Correcting which risk factor shows greatest improvement with CAD?

A

smoking cessation

50% 1 year, 90% 2 years after smoking

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5
Q

Ischemic Pain

A

dull or sore

squeezing or pressure-like

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6
Q

Non-ischemic pain

A

Sharp or point-like
lasts for a few seconds
Changes with respiratoin (pleuritic), position, touch/tenderness

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7
Q

Chest Wall Tenderness

A

Costochondritis

Do PE

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8
Q

Radiation to back, unequal BP in arms

A

Aortic Dissection
chest x-ray-widened mediastinum
chest CT, MRI, or TEE confirms Dx

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9
Q

Pain worsens with lying flat, better when sitting up

A

Pericarditis

EKG with ST-elevation everywhere, PR depression

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10
Q

Epigastric discomfort, pain better when eating

A

Duodenal ulcer disease

Endoscopy

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11
Q

Bad taste, cough, hoarseness

A

GERD

Response to PPIs; Alumium hydroxide and Mg hydroxide, viscous lidocaine

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12
Q

Cough, sputum, hemoptysis

A

Pneumonia

CXR

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13
Q

Sudden-onset SOB, tachy, hypoxia

A

PE (can have fever)

Spiral CT*, V/Q scan

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14
Q

Sharp, pleuritic pain, tracheal deviation

A

Pneumothorax

CXR

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15
Q

Best initial test for chest pain

A

EKG

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16
Q

EKG not diagnostic and etiology of chest pain unclear-next step

A

stress test

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17
Q

Mortality lowering drugs with chronic angina

A

1) Aspirin-(clopidogrel used in apsirin intolerant pts or new stented pts)
2) Beta blockers-B1 spec. metoprolol
3) Nitroglycerin

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18
Q

Statin AE

A 
Elevated transaminases (AST/ALT) do liver fxn tests
Myositis
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19
Q

Niacin AE

A

Pruritis (+histamine)

elevation glucose and uric acid level

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20
Q

Fibric Acid derivatives (gemfibrozil) AE

A

increase risk myositis with statins

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21
Q

Cholestyramine AE

A

flatus, abd cramping

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22
Q

Ezetimibe AE

A

well tolerated, add to statins, not very useful

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23
Q

ACS confirmed on EKG, next step

A

Aspirin-shown to decrease mortality

clopidogrel is aspirin intolerant or if pt has stent already

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24
Q

ACS confirmed, aspirin given, next step

A

Angioplasty (90 min door time)>thrombolytics
Thrombolytics only used if angioplasty not available, in STEMIs, or new LBBB
NSTEMI-use heparin instead

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25
Q

contraindications to thrombolytics

A

1) hx major bleeding to brain/bowel
2) recent surgery-2 wks
3) severe HTN-180/110
4) nonhemorrhagic stroke in last 6 months

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26
Q

Indication for tPA (thrombolytics) in MI

A

only beneficial with STEMI

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27
Q

Indication for heparin in MI

A

best for NSTEMI (LMWH)

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28
Q

Indication for GP IIb/IIIa inhibitors in MI

A

best for NSTEMI and undergoing PCI and stenting

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29
Q

Post MI routine meds on d/c

A

1) Aspirin 2) Beta blockers (metoprolol) 3) Statins 4) ACEi

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30
Q

CHF Systolic vs Diastolic

A

Systolic- low EF, dilation of heart, or diastolic dysfxn.
can’t get blood out
Diastolic- inability of heart to relax and receive blood
EF is preserved, can be increased

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31
Q

Top causes of systolic CHF

A

HTN #1, MI, cardiomyopathy, valve disease-(95%)

-all can lead to dilated cardiomyopathy

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32
Q

Other causes of systolic CHF

A

alcohol, postviral idiopathic myocarditis, radiation, doxorubicin, Chagas (other infxns), Hemochromatosis (restrictive too), Thyroid dx, Peripartum cardiomyopathy, Thiamine deficiency

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33
Q

Sxs CHF

A 
#1- SOB/dyspnea upon exertion
orthopnea, peripheral edema, rales, JVD, paroxysmal nocturnal dyspnea, S3 gallop (fluid overload)
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34
Q

Dyspnea, sudden onset, clear lungs

A

PE

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35
Q

Dyspnea, sudden onset, wheezing, increased expiratory phase

A

asthma

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36
Q

Dyspnea, slower, fever, sputum, unilateral rales/rhonchi

A

Pneumonia

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37
Q

Dyspnea, decreased breath sounds unilaterally, tracheal deviation

A

Pneumothorax

38
Q

Dyspnea, circumoral numbness, caffeine use, hx anxiety

A

panic attack

39
Q

Dyspnea, pallor, gradual over days to weeks

A

anemia

40
Q

Dyspean, pulsus paradoxus, decreased heart sounds, JVD

A

tamponade

41
Q

Dyspnea, palitation, syncope

A

arrhythmia of any kind

42
Q

Dyspnea, dullness to percussion at bases

A

pleural effusion

43
Q

Dyspnea, long smoking history, barrel chest

A

COPD

44
Q

Dyspnea, recent anesthetic use, brown blood no improved with O2, clear lungs, cyanosis

A

methemoglinemia

tx: methylene blue

45
Q

Dyspnea, burning building or car, wood-burning stove, suicide attempt

A

carbon monoxide poisoning

tx: 100% O2 hyperbaric chamber

46
Q

Tx Systolic CHF

A

ACEi/ARB, Beta blockers (decrease mortality), Spironolactone (blocks aldosterone), Diuretics (tx sxs), Digoxin (tx sxs)

47
Q

Mortality benefitting Rxs in CHF

A

ACEi/ARBs, Beta blockers, Spironolactone, Hydralazine/Nitrates, implantable defib (

48
Q

Tx diastolic CHF

A

Beta blockers*, Diuretics

Uncertain-ACEi, ARBs, and hydralazine

49
Q

Don’t use in diastolic CHF

A

Digoxin and spironolactone

50
Q

Rheumatic fever MC a/w

A

mitral stenosis

51
Q

valvular lesions that increase/worsen with inhalation

A

right side-tricuspid and pulmonic

52
Q

valvular lesions that increase/worsen with exhalation

A

left side-mitral and aortic

53
Q

Mitral Stenosis Sxs

A

Diastolic murmur with opening snap

  • squatting and leg raise (+VR) increase murmur
  • CHF and SOB
  • Dysphagia- LA pressing on esophagus
  • Hoarseness-LA pressing on laryngeal nerve
  • AFib and stroke
  • Hemoptysis
54
Q

Mitral Stenosis- CXR

A

straightening of left heart border
elevation of left main-stem bronchus
second bubble behind heart

55
Q

Tx Mitral Stenosis

A

1) Balloon valvuloplasty
2) diuretics and sodium restriction with fluid in lungs
3) valve replacement if needed
4) warfarin for afib
5) rate control-dig, beta block, verap/dilt

56
Q

Aortic Stenosis Sxs

A 
systolic crescendo-decrescendo murmur
Valsalva and Standing decrease murmur
Handgrip also decrease murmur
-Angina-#1
-Syncope
-CHF
57
Q

Aortic Stenosis-CXR

A

LVH >50% of transthoracic diameter

58
Q

Mitral Stenosis- EKG

A

EKG-biphasic P-wave in V1, V2

59
Q

Aortic Stenosis-EKG

A

S wave in V1, R wave in V5 > 35mm

60
Q

Tx Aortic Stenosis

A

Valve replacement

Diuretics, but not always well tolerated

61
Q

Mitral Regurgitation Sxs

A

pansystolic murmur, radiates to axilla

CHF, dyspnea

62
Q

Mitral Regurg- hand grip, squatting, leg raise

A

all increase murmur

63
Q

Tx Mitral Regurgitation

A

1) Vasodilators*-ACE or ARBs. decrease progresion
2) Dig and diuretics tx sxs
3) Valve replacement when heart starts to dilate

64
Q

Aortic Regurg Sxs

A 
diastolic decrescendo murmur
Wide pule pressure
Water-hammer pulse
Quincke pulse (pulsations in nail bed)
Hill sign (leg BP>>arm BP)
Head bobbing (de Musset sign)
65
Q

Aortic Regurg- Valsalva/standing, hand grip/squatting

A

Valsalva and standing- decrease murmur

Hand grip/squatting- increase murmur

66
Q

Tx-Aortic Regurg

A

ACEi/ARBs or nifedipine-vasodilators to increase forward flow, decrease progression
Dig and diuretics little benefit
Surgery before dilates

67
Q

Mitral Vale Prolapse Sxs

A 
Different from other lesions-considered normal if aSxs
midsystolic click
Atypical chest pain
Palpitations
Panic attack
68
Q

MVP- Valsalva/standing, Hand grip/Squatting

A

Valsalva/Standing- increase murmur (decrease VR)

Hand grip/Squatting- decrease murmur (increase afterload)

69
Q

Tx- MVP

A

Beta blockers if symptomsatic
Valve repair/stitches
Endocarditis pxs not needed

70
Q

Murmurs do not increase with expiration in?

A

HOCM and MVP

71
Q

Cardiomyopathy Sxs

A

SOB, worse on exertion
Edema
Rales
JVD

72
Q

Best test Cardiomyopathy

A

Echo-best and most accurate

CXR and EKG can also be done

73
Q

Causes of dilated cardiomyopathy

A

1) MI/Ischemia
2) Alcohol
3) postviral myocarditis
4) Radiation
5) Toxins-doxorubicin
6) Chagas dx

74
Q

Rxs lower mortality in dilated cardiomyopathy

A

1) ACEi/ARBs 2) metoprolol, carvedilol 3) Spironolactone

diuretics and dig for sxs

75
Q

Tx in dilated cardiomyopathy wide widened QRS (>120ms)

A

biventricular pacemaker

76
Q

HCM vs HOCM

A

HOCM sxs- 1) chest pain 2) syncope, dizzy 3) worse w/increase in HR (exercise, dehydration, diuretics) 4) sudden death in healthy athletes-rare

77
Q

Initial Tx HCM and HOCM

A

Beta blockers

verapamil and disopyramide too, neg inotropes

78
Q

Used in HCM, but not in HOCM

A

diuretics and ACEi

79
Q

Causes of restrictive cardiomyopathy

A

1) Sacroidosis 2) Amyloidosis 3) Hemochromatosis 4) Endomyocardial fibrosis 5) Scleroderma

80
Q

Sxs Restrictive Cardiomyopathy

A

Kussmaul sign-increase in JVD pressure (unique)

dyspnea with RH failure- ascites, edema, JVD, liver/spleen enlargement

81
Q

Pericarditis EKG

A

ST segment elevation in all leads and PR segment depression

82
Q

Hypotension, tachycardia, distended neck veins, clear lungs, pulsus paradoxus

A

Pericardial Tamponade

83
Q

Electrical alternans (different height of QRS between beats)

A

Pericardial Tamponade

84
Q

Tx Pericardial Tamponade

A

1) Pericardiocentesis, 2) IV fluids 3) pericardial window placed for recurrent cases

85
Q

Contraindicated drug in pericardial tamponade

A

diuretics- will decrease the cardiac filling pressure and further collapse heart

86
Q

Constrictive Pericarditis a/w

A

TB-MCC

calcification and fibrosis

87
Q

Best test for peripheral artery disease

A

ankle-brachial index (ABI)

if difference in pressure is >10% then present

88
Q

Initial Tx PAD

A

1) Aspirin, stop smoking, Cilostazol (single most effective) 2) Bypass surgery if Rxs not effective

89
Q

Calcium Channel Blocker indications

A 
Verapamil/Diltiazem
1) severe asthma (can't use beta-block)
2) Prinzmetal variant angina
3) cocaine-induced chest pain (beta-block CA)
Rarely used in CAD
90
Q

Adverse effects of CCBs

A

Edema, constipation (relax smooth muscle), Heart Block (rare)

91
Q

maneuvers that increase preload

A

1) handgrip, 2) squat, 3) leg elevation, 4) lying down, 5)venoconstrictors

92
Q

maneuvers that decrease preload

A

1) Valsalva 2) standing, 3) nitrates/venodilators

MTB STEP 3 (R) (9 decks)

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