PANCE Cardiology #3 Ischemic heart dz

Question 1

Deficiency of oxygen getting to the heart is a function of 3 things.

Answer 1

Cardiac output
hct, hg
%sat
and carbon monoxide poisoning

Question 2

MCC of ischemic heart dz?

Answer 2

coronary atherosclerotic dz

Question 3

What is a major risk factor for CAD?

Answer 3

HTN

Question 4

Whats most important to lower, systolic or diastolic?

Answer 4

both

Question 5

Typical pain duration with stable angina and important defining factor?

Answer 5

5-15 minutes

relieved by rest.

Question 6

What does ST-segment depression indicate?

What does ST-segments elevation mean?

Answer 6

Ischemia

Infarction

Question 7

Criteria for positive stress test, 2 things.

Answer 7

> 2mm ST-segment depression

hypotension of > mmhg in systolic pressure.

Question 8

When do you use angiogram?

Answer 8

when you suspect CABG

Question 9

What is the criteria for CABG?

Answer 9

3 vessel dz or left main coronary

Question 10

When do you place a stent?

Answer 10

1 or 2 vessel dz

Question 11

70 yo male presents with chest pain and ST elevation. What works best,

Answer 11

MONA and beta blockers.

Question 12

whats proven to decrease mortality with acute MI?

Answer 12

aspirin, bblockers, tpa, angioplasty

Question 13

What if you cant use aspirin?

Answer 13

plavix

Question 14

what 3 things do you se to treat CAD; unstable angina, NSTMI?

Answer 14

ASA, clopidogrel, BBlocker (Metoprolol, Atenolol)

Question 15

What 6 things can you use for acute MI and what whill decrease mortality?

Answer 15

M.O.N.A.
Tpa and BBlockers
(aspirin and betablockers are the only things that decrease motality)

Question 16

What test do yo order to tell the difference between unstable angina and NSTMI?

Answer 16

CK-MB, Troponins

Question 17

What does not decrease mortality with MI tx?

Answer 17

m.o.n

Question 18

Do you need CK-MB/troponins to dx a STEMI?

Answer 18

No, its a STEMI

Question 19

Tell me the leads affected with inferior wall MI?
The leads for lateral MI?
the leads for anterior MI?
The posterior wall MI?

Answer 19

2,3,avf
1, AVL, V4, V5, V6
V2-V4
V1-V2, ST-segment depression

Question 20

difference between RBBB, LBBB.

Answer 20

LBBB assoc with ischemia

RBBB no big deal

Question 21

Post MI care? (a,b,c,d,e)

Answer 21

aspirin, betblockers, cholesterol, DM, exercise

Question 22

MCC of abnormal AV conduction of heart?

Answer 22

ischemia

Question 23

what do you do for symptomatic 3rd degree av block?

what do you give for asymptomatic 3rd degree av block?

Answer 23

atropine (1st)

pacemaker (2nd)

Question 24

whats dressler syn?

Answer 24

post MI the dead heart muscle gives off antigens and an immune response is initiated=pericarditis

Question 25

how do you tell the difference between valve rupture and septal rupture?

Answer 25

septal rupture has an increase in saturation from RA to RV.

Question 26

Inferior wall MI associated with? best initial test? best therapy?

Answer 26

right vent=hypotension right vent chest leads IV fluids

Question 27

most sensitive test for prinzmetal angina

Answer 27

angiogram

Question 28

how do you differentiate prinzmetal from unstable?

Answer 28

stress test, angiogram are normal with prinzmetals

Question 29

Definative dx for prinzmetal? | tx?

Answer 29

ergonovine during angiography | CCB

Question 30

chest pain, SOB, hypotension and confusion?

Answer 30

means yor not getting enough profusion

Question 31

treatment for CHF in order of importance

Answer 31

``` O2 diuretics nitrates morphine lower pre-load ```

Question 32

Whats the test of choice for CHF? | what do you see?

Answer 32

``` chest x-ray prominent pulmonary vessels cardiac silhoulette kerley B-lines effusions ```

Question 33

sx's of pulmonary edema from CHF

Answer 33

``` increased R.R productive cough cyanosis PND rales, rhonchi, wheezing ```

Question 34

which tx is acute | which is chronic

Answer 34

dobutamine | digoxin.

Question 35

how do you tell if the pt is in systolic or diastolic heart failure? whats the difference in management?

Answer 35

echocardiagraphy | systolic gets digoxin, and ace inh

Question 36

what drug lowers mortality in CHF?

Answer 36

BBlocker, ACE, arb, spirolactone (K+sparing diuretic) pacemaker

Question 37

what is the MC symptom of digoxin toxicity?

Answer 37

``` GI upset (n/v) gynecomastia blurred vision, yellow halo arrhythmias (atrial tachycardia most common) HYPERKALEMIA ```

Question 38

what is 1st line therapy for any CHF pt with systolic dysfunction..increases survival!!!

Answer 38

ACE!

Question 39

when do the coronary arteries fill?

Answer 39

in diastolie

Question 40

how do you die from CHF?

Answer 40

ischemia

Question 41

tell me some nitrate drugs?

Answer 41

isosorbide=long term drug for CHF | hydralazine