Test Two Flashcards
(276 cards)
1
Q
Does ST Depression localize ischemia?
A
no
2
Q
ECG within how many minutes for an MI?
A
10
3
Q
All should get what during an Acute MI?
A
Aspirin
4
Q
Oxygen for an MI?
A
lowest flow to keep saturation at 90%
5
Q
Ask about what drug before nitrates?
A
Viagra
6
Q
What does an AV block in the setting of an Acute MI mean?
A
extensive underlying ischemia/infarction
7
Q
Bezold-Jarisch Reflex occurs with what type of MI?
A
INferior
8
Q
Is an NSTEMI caused by a complete or incomplete occluded vessel?
A
incompletely
9
Q
Beta-blocker of choice for post-MI care with EF less than 40%?
A
carvedilol
10
Q
Does an NSTEMI involve a red clot or a white clot?
A
red
11
Q
Do fibrinolytics help a white clot?
A
no
12
Q
How long do patients take ASA after an MI?
A
for life
13
Q
How long do patients take P2Y12 inhibitor after an MI?
A
one year
14
Q
Keep potassium above what to prevent a PVC?
A
4
15
Q
Keep magnesium above what to prevent a PVC?
A
2
16
Q
According to Clark, where does the pace come from during AIVR?
A
Purkinje
17
Q
According to Clark, what causes a polymorphic Vtach?
A
ischemia
18
Q
According to Clark, what causes a monomorphic Vtach?
A
scar
19
Q
According to Clark, what two drugs should be avoided during early pericarditis?
A
NSAIDs and steroids
20
Q
What two drugs are used to treat Dressler Syndrome?
A
colchicine and ASA
21
Q
Rupture of what papillary muscle is most likely to cause an MVP?
A
postero-medial
22
Q
Which papillary muscle has a dual blood supply?
A
Anterolateral
23
Q
What is a pseudoaneurysm?
A
pericardium holds aneurysm in
24
Q
What is the cardiac index for cardiogenic shock?
A
less than 1.8 L/min/m2
25
What is the PAWP for cardiogenic shock?
greater than 18 mm Hg
26
What heart defects are present during Noonan Syndrome?
pulmonary stenosis and ASD
27
What heart defects are present during Williams Syndrome?
supravalvular aortic stensosis
28
A thrill gives what grade to a murmur?
grade four
29
What ventricle is dominant in infants?
RV
30
Where is a perimembranous VSD located?
just below aortic valve
31
Which VSDs have an excellent chance of closing?
muscular
32
What type of infections can a person with a VSD get?
pulmonary
33
What is a synonym for an Atrioventricular Septal Defect?
endocardial cushion effect
34
Most common cause of an AVSD?
Downs syndrome
35
What is done during a Ross Procedure?
pulmonary valve to aortic
replace pulmonary valve
36
What does acidosis do to cardiac contractility?
decrease contractility
37
Does the aorta arise anteriorly or posteriorly off the RV during transposition?
anteriorly
38
What is the purpose of the rashkind procedure? Used to treat?
open a hole in the atria
Transposition
39
Does TOF result in a right-to-left or a left-to-right shunt?
right to left
40
LAD is almost diagnostic for what childhood condition?
tricuspid atresia
41
A fontan procedure is used to fix what Congenital heart defect? What is performed?
tricuspid atresia
venous return directly into pulmonary vessels
42
Would more blood get shunted to the lungs or systemic circulation during Truncus Arteriosus?
lungs
43
What is a sign of decompensation during shock in a child?
hypotension
44
What does critical mean in terms of congenital heart defects?
PDA maintains systemic circulation
45
Why is oxygen not used during a LV Obstruction?
can vasodilate lungs and decrease systemic circulation
46
What can cause heart block in children?
maternal Lupus
47
What is the Gold Standard for DVT?
Ascending Contrast Venography
48
What is the chief complaint of Mitral Regurgitation?
Dyspnea
49
Which valve closes first in mitral regurgitation, A or P?
aortic
50
How is Mitral Regurgitation treated?
any drug to decrease afterload
51
What has lower mortality rate, mitral valve replacement or repair?
repair
52
Which endocrine disorder can cause atrial fibrillation?
hyperthyroidism
53
What is paroxysmal Afib?
Afib that lasts 1-7 days
54
What is Persistent Afib?
Afib that lasts longer than 7 days
55
What two situations are antithrombotics not indicated for Afib?
Lone afib
under 60
56
Where should INR be kept during Afib?
2-3
57
What does myocardial failure mean?
defective myocardial contraction
58
What is the prevalence of heart failure world wide?
23 million
59
What is the prevalence of HF in the US?
4.7 million
60
What are the two main risk factors for a AAA?
smoking and atherosclerosis
61
How big does a AAA need to be in surgically operated on in males?
> 5 cm
62
How big does a AAA need to be in surgically operated on in females?
> 5.5 cm
63
What is the expansion criteria for a AAA to be surgically operated on?
creater than 0.5 cm in
64
What is the screening recommendation for AAA?
men age 60-75 who have ever smoked
65
What part of the aorta is most commonly affected by a thoracic aortic aneurysm?
ascending
66
Where is the worst location for a thoracic aneurysm?
ascending
67
What is the best marker for ruling out an aortic dissection?
D-dimer
68
When should a patient undergo screening of an aortic aneurysm after hospital discharge?
1, 3, 6 and 12 months
69
What is the most specific stress test?
stess echo
70
What drug is used for a stress test in pt's with COPD?
dobutamine
71
What drug is used for a stress test in pt's with arrhythmias?
Vasodilator
72
Which atom is used for myocardial perfusion scanning?
technitium99
73
Which stress test is used in patients with known CAD?
myocardial perfusion scan
74
What is the antidote for adenosine?
aminophylline
75
What two situations is adenosine contraindicated for stress test? Relative for?
asthma or COPD
regadenoson
76
Which exercise stress test is most specific?
Echo
77
What is the equation for target HR?
(220-age)(0.85)
78
What is the gold standard stress test?
exercise ECG
79
Which two classes of HF must patients be in to receive beta-blockers for HF?
class 2 or class 3
80
Which two beta-blockers are tolerated by HF patients?
metoprolol and carvedilol
81
Are ARBs FDA approved for HF?
No
82
Agent of choice for HF?
ACE Inhibitors
83
What three drugs did Hoff say can inhibit the neurohormonal model?
ACEIs/ARBs/beta-blockers
84
If a HF patient is hyponatremic, what is the Tx?
take away water
85
What is Stage D HF?
Decompensated
86
What is Stage C HF?
structural and symptomatic
87
What is Stage B HF?
strucutral defects but no symptoms
88
What is Stage A HF?
no structural heart disease or symptoms
89
Does pregnancy worsen or improve HF?
Worsen
90
Would beta-blockers improve or worsen HF?
Worsen
91
Would sotalol improve or worsen HF?
Worsen
92
Would NSAIDs improve or worsen HF?
Worsen
93
Would verapamil and diltiazem improve or worsen HF?
Worsen
94
What is distributive shock?
profound peripheral vasodilation
95
What is the most common cause of distributive shock?
sepsis
96
Can acidemia or alkalemia impair cardiac output?
acidemia
97
Will a narrow or too loose of a cuff under-estimate or over-estimate bp?
overestimate
98
Above what diastolic pressure would be considered a hypertensive emergency?
120
99
What is grade 1 HTN retinopathy?
arteriolar narrowing
100
What is grade 2 HTN retinopathy?
AV nicking
101
What is grade 3 HTN retinopathy?
hemorrhages and exudate
102
What is grade 4 HTN retinopathy?
papilledema
103
What is the leading cause of end stage renal disease?
systemic arterial hypertension
104
What is the most common cause of target organ damage during HTN?
ischemic heart disease
105
What would the GFR be lower than to classify renal damage?
less than 60
106
What type of abnormality on ECG would necessitate an echo?
BBB
107
What are the best diuretics?
thiazide
108
At what systolic and diastolic pressure should anti-HTN meds be started for older than 60 years?
systolic = 150
diastolic = 90
109
At what systolic and diastolic pressure should anti-HTN meds be started for younger than 60 years?
systolic = 140
diastolic = 90
110
Which four anti-HTN drugs should be started in non-black population?
ACEI/CCB/ARB/thiazide
111
Which two ant-HTN meds should be used in blacks?
thiazide or CCB
112
anti-HTN to use in patients with kidney disease?
ACEI or ARB
113
What is the most common symptom of peripheral vascular disease?
intermittent claudication
114
Which two vessels are most commonly effected during fibromuscular dysplasia?
renal and carotids
115
According to Hilgerson, what is the gold standard for DVT?
ascending contrast venography
116
What does hypoxia due to chemoreceptors?
increases their discharge to raise bp
117
Which papillary muscle is most commonly ruptured during a posterior MI?
posterior
118
Where is the apical impulse located during mitral regurgitation?
down and lateral
119
Would an S3 or S4 more likely occur during mitral regurgitation?
S3
120
Is ECG specific for mitral regurgitation?
no
121
Drug used to treat acute MR? What drug in addition if hypotensive?
nitroprusside
dobutamine
122
What may be the first symptom of mitral stenosis?
embolization
123
In what heart disease could the apical impulse be diminished?
mitral stenosis
124
What receptor does Hoff say can activate α1 in the periphery can do?
inotropy of heart
125
According to Hoff, which system is activated earlier adrenergic or RAAS?
adrenergic
126
Does pressure overload result in concentric or eccentric hypertrophy?
concentric
127
Does volume overload result in concentric or eccentric hypertrophy?
eccentric
128
Do action potentials decrease or increase in length during HF?
increase
129
Would LVEDV increase or decrease during HF?
increase
130
What does backward HF result in?
pulmonary edema
131
What does forward HF result in?
inadequate delivery of oxygen into arterial system
132
What is the most common cause of right HF?
left HF
133
Is left or right heart failure true congestive heart failure?
left
134
Does left or right HF result in systemic congestion?
right
135
Why can HF result in nocturia?
kidneys are better perfused lying down
136
What is Class Two heart failure?
ordinary activities cause symptoms
137
What is Class Three heart failure?
marked limitation
138
What is Class Four heart failure?
symptoms at rest
139
What is Kussmauls sign?
elevated JVP on inspiration
140
When is Kussmauls sign seen?
right heart failure
141
What is the hepatojugular reflex?
push on liver and JVP rises
142
Where would the apical impulse be in heart failure?
down and left
143
Is S4 rare or common in HF?
rare
144
Why does pulsus alterans happen in HF?
myocytes relax every other beat
145
Congestion of what leads to Kerley B lines?
pulmonary lymphatics
146
Is ECG diagnostic of HF?
no
147
What types causes of death are caused by HF?
tachyarrhythmia or pump failure
148
Would anemia result in low output or high output heart failure?
high
149
Would AV fistula result in low output or high output heart failure?
high
150
Would hyperthyroidism result in low output or high output heart failure?
high
151
Would BeriBeri result in low output or high output heart failure?
high
152
Would Pagets Disease of bone result in low output or high output heart failure?
high
153
What are the two mechanisms of cardiac remodeling?
adrenergic and RAAS
154
What is the agent of choice for HF?
ACE Inhibitors
155
How many points is substernal chest pain?
one
156
How many points is chest pain with exertion?
two
157
How many points is chest pain relieved by NTG?
three
158
What is three elements?
typical chest pain
159
What is two elements?
atypical chest pain
160
What is one element?
noncardiac chest pain
161
Is an exercise stress ECG more or less sensitive in women?
less
162
Does ST depression correlate to location?
no
163
Does ejection fraction increase or decrease during exercise?
increase
164
Is dobutamine contraindicated in HTN or hypotension?
hypotension
165
Which pharmalogical stressor is contraindicated in dyspnea?
dobutamine
166
Which pharmalogical stressor is contraindicated in dyspnea?
adenosine
167
Pharmacological stressor used in pts with COPD?
dobutamine
168
What is the function of myocardial perfusion scan?
to increase specificity in patients with known CAD
169
According to Clark, do mot plaque ruptures result in clinical events?
no
170
What is the Bezold-Jarisch reflex?
bradycardia and hypotension
171
Isolated AST makes you think what?
acute MI
172
How long does TnI stay high?
5-10 days
173
How long does TnT stay high?
10-14 days
174
What causes an NSTEMI?
incomplete obstruction
175
What are the four reasons for coronary catheterization?
enzymes
ST changes
recurrent symptoms
low ejection fraction
176
Post MI, how long does a patient go on aspirin?
life
177
Post MI, how long does a person stay on a P2Y12 inhibitor ?
one year
178
Post-MI patient gets what kind of statin therapy?
high intensity
179
What kind of MI does a red thrombus produce? What cells make up the clot?
STEMI
fibrin
180
What kind of MI does a white thrombus produce? What cells make up the clot?
NSTEMI
platelets
181
Do thrombolytics work in an NSTEMI?
no
182
What does the EF have to be less than to begin ACE Inhibitors post-MI?
less than 40%
183
What does the EF have to be less than to begin spironolactone Inhibitors post-MI? With or without HF?
less than 40%
with HF
184
What is the most common cause of death post-MI? Best indicator for this?
VT/VF > 48 hours
EF
185
Can a VSD lie flat?
yes
186
Can MR lie flat?
no
187
Where does a papillary muscle rupture indicate the MI occured?
IWMI
188
What two specific pathologies can Marfan Syndrome cause?
aortic dissection or aortic regurg.
189
Which is usually higher, leg BP or arm BP?
leg
190
Would PV have a louder of softer murmur?
softer
191
Is a PDA a L to R or a R to L shunt?
L to R
192
What is seen on an ECG of an AVSD?
left axis
193
What does the RV pressure have to be to do a balloon valvoplasty due to pulmonary stenosis?
over 50 mmHg
194
Which ventricle hypertrophies in young children with coarctation of the aorta?
RVH
195
Which ventricle hypertrophies in older children with coarctation of the aorta?
LVH
196
What organ can be permanently impaired in children with coarctation of the aorta?
kidneys
197
Does ToF result in a right-to-left or a left-to-right shunt?
right to left
198
What causes the murmur in ToF?
RV outflow obstruction
199
What vessel does a BT Shunt replace? Used to treat?
PDA
ToF
200
What is TAPVR?
pulmonary veins drain into right atria
201
Why is O2 not good in a patient with a left sided obstruction?
O2 causes pulmonary vasodilation and traps blood in lungs impairing it from going to systemic circulation
202
Which type of plaque has inflammatory cells?
unstable
203
Which type of plaque has a thick fibrous cap?
stable
204
Does moving around make the pain of ACS better?
no
205
What is the leading cause of death in women?
heart disease
206
How long does it take for CK-MB to return to normal levels?
2-3 days
207
Is morphine associated with higher mortality?
yes
208
Post-MI wait on β-blocker until?
compensated
209
A cardioembolism is associated with what type of MI?
anterior wall
210
Oxygenated blood in the RV post-MI can be indicative of what?
VSD
211
Is a thrill more common in a VSD or mitral regurgitation?
VSD
212
An infarction in what part of the heart most often produces mitral regurgitation?
IWMI
213
Where is the most common location of an ASD?
foramen ovale
214
Which ventricle is more compliant in infants, RV or LV?
RV
215
What axis would an ASD have?
right
216
What is the most common type of CHD in kids?
VSD
217
What is the most common type of VSD?
perimembranous
218
By what age do large VSDs need to be fixed? Why?
6-12 months
avoid irreversible pulm. HTN
219
What increases the risk of a PDA?
prematurity
220
Would a PDA have elevated systolic or diastolic pressure? Elevated Pulse Pressure? Elevated or decreased diastolic pressure?
systolic
yes
decreased diastolic
221
Is Indomethacin used to close a PDA in premature or term infants?
premature
222
What is missing during an AVSD?
lower portion of atrial septum and inlet portion of ventricular septum
223
Are blue hands and feet normal in an infant?
yes
224
What is the Jatene Procedure?
switch pulmonary and aorta vessels
225
What would ECG show during ToF?
RVH
226
What procedure is used to treat ToF?
BT shunt
227
What defect is also present in most cases of Tricuspid Atresia?
ASD
228
What does TAPVR create?
pulmonary HTN
229
What does inhaled nitrous oxide do?
dilate pulmonary bed
230
According to Mooradian, in what two situations can a chylothorax form?
Lymphoma
Noonan syndrome
231
Is a BT Shunt bloackage an emergency?
yes
232
According to Hoff, what systolic blood pressure can signify shock?
less than 60 mm Hg
233
Which type of shock has the highest degree of mortality?
cardiogenic
234
What is the mortality of hypovolemic shock related to?
how quickly fluids are administered
235
Which grades of HTN retinopathy are considered malignant HTN?
grades three and four
236
What is hypertensive encephalopathy?
cerebral edema
237
What does JNC 8 recommend for systolic pressure?
less than 140
238
What did the sprint study find? Systolic less than? In what group of patients?
intensive BP reduction is better
120
239
Non-drug therapies are recommended for who?
anyone with HTN
240
ABI less than what value marks severe ischemia?
241
Can cardiomyopathy cause MR?
yes
242
Does the LV go into diastolic or systolic overlod during MR?
diastolic
243
Sharp carotid artery pulses are indicative of what cardiac pathology?
MR
244
What is the most common etiology of mitral stenosis?
rheumatic fever
245
What is the valve area during mild MS?
2 cm2
246
What is the valve area during critical MS?
1 cm2
247
What valvular disorder would produce a loud S1?
mitral stenosis
248
Avoid strenuous activities in what type of MS?
severe
249
Before cardioversion, what drug does Hoff say use to anticoagulate?
Heparin
250
Is prevalence of Afib higher in men or women?
men
251
What hemodynamic compensatory mechanism can happen due to loss of atrial kick?
tachycardia
252
Which is preferred, rhythm control with drugs or DC Cardioversion?
DC Cardioversion
253
What is preferred for Afib, rhythm control or rate control?
rate control
254
Why would one choose a stress echo in addition to an exercise ECG?
uninterpretable ECG not due to LBBB or ventricular pacing
255
What is the function of the myocardial perfusion scan?
increase specificity and sensitivity
256
What is the triad for a AAA rupture?
pain
hypotension
pulsatile abdominal mass
257
What drug is used in the management of thoracic aortic aneurysms?
beta-blockers
258
Which ventricle will be volume overloaded during a VSD?
left
259
What drug is used in coarctation?
PGE1
260
Do rhythm or rate control confer survivability for Afib?
no
261
Which patiets are hospitalized more, rhythm or rate control?
rhythm
262
What is the only beta-blocker approved for chronic HF?
carvedilol
263
What is the only beta-blocker approved for chronic HF in EUROPE?
bisoprolol
264
A stress echo is necessary is a resting ECG shows abnormalities except for which two?
LBBB
ventricular pacing
265
In what regions can mitral stenosis progress faster?
subtropics/trocips/alaska/polynesia
266
What fluid does Hoff say to use during shock?
isotonic saline
267
How far apart should BP readings be?
one week
268
What is the difference between primary and secondary HTN?
no cause found in primary
can find a reason in secondary
269
What occurs first in cardiac remodeling, hypertrophy or dilation?
hypertrophy and then dilation
270
Never omit what exam on a HTN patient?
fundoscopic
271
Hoff says an Echo is necessary if the diastolic bp is between what two numbers?
90-94
272
JNC 8 recommeds a sBP below what for hypertensive patients?
140
273
Supracristal VSDs are common in what population?
Asians
274
Which cyanotic lesions has 'happy' babies?
Transposition
275
What causes the murmur of ToF?
pulmonary obstruction
276
At what age do systolic and diastolic pressure begin to separate?
50
