Internal Cardiology

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Internal Cardiology
2013-02-14 17:28:34
Internal Cardiology

Internal Cardiology
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  1. What decreases risk of restenosis after PCI?
    • Sirolimus
    • Paclitaxel
  2. Time from admission to tPA?
    30 min
  3. TIme from admission to PCI?
    90 min
  4. POst mI, a stress test determines what??
    need for angiography
  5. Angiography determines what?
    need for revascularization
  6. Prophylactic antiarrhythmics have what effect on mortality?
    they increase it
  7. St segment depression gets what, tpa or heparin?
  8. St segment elevation MI gets what? tpa or heparin?
  9. ACE inhibitors are best for what type of infarcts?
    anterior wall infarcts
  10. Kussmaul sign?
    increase in jugulovenous pressure due to constrictive pericarditis or restrictive cardiomyopathy
  11. a drop of 10 mm in bp on inhalation is seen in what condition?
    cardiac tamponade
  12. Acute coronary syndromes are associated with what kind of adventitious heart sound?
  13. WHat carries higher mortality, anterior wall or inferior wall infarcts?
    anterior wall infarcts
  14. Depression of st in chest leads v1 and v2 equals what?
    st segment elevation in other leads
  15. Failure of what organ can cause a false positive troponin level?
    renal failure or insufficiency
  16. ABsolute contraindications to thrombolytics?
    • Bleeding into abdomen (melena) or brain
    • hypertension (180/110)
    • recent surgery in 2 weeks
    • non hemorrhagic stroke within last 6 months
  17. WHat causes pulseless electrical activity?
    free wall/cardiac tamponade
  18. Post infarction routine medications?
    • aspirin
    • bb
    • statin
    • aceI
  19. Diastolic or systolic dysfuntion produces a lower EF?
  20. WHat drug is contraindicated in  HCM?
    Diuretics because they produce less volume
  21. What is BNP used for?
    to exclude CHF as a cause of dyspnea
  22. What ionotrope drug is used actutely?
    • dobutamine
    • digoxin
  23. Alternative to using ACEI and ARBs in CHF
    Hydralazine and nitroglycerin
  24. Which interventions decrease mortality in CHF?
    • Defibrillator
    • Ace/ARB
    • BB
    • Spironolactone
    • Hydralazine/nitrates
  25. What electrolyte disturbance causes digoxin toxicity?
  26. digoxin can cause what electrolyte abnormality?
  27. What toxicities can digoxin cause?
    • CNS
    • GI
    • VIsual disturbance
  28. CNS and EKG disturbance is treated with?
  29. When do you replace valves in MR and AR with respect to EF and LVESD?
    •                      MR           AR
    • EF               <60%        <55%
    • LVESD      >45mm      >55mm
  30. What effect do standing or valsalva have on heart murmures? What are teh exceptions?
    • decrease it
    • MVP and HCM
  31. What effect do leg raising and squatting have on heart murmurs? What are teh exceptions?
    • Increase the intensity 
    • Exceptions are MVP and HCM
  32. What meds treat MVP and HCM?
  33. What meds treat AR and MR?
    ACEi and diuretics
  34. Rx for aortic stenosis?
    valve replacement
  35. Rx for MS?
    Balloon valvuloplasty
  36. Rx for bradycardia without symptoms?
  37. Rx for 1st degreee heart block?
  38. Rx for mortbits type 1?
  39. Rx for Morbitz type 2?
  40. Rx for 3 degree heart block?
  41. Adenosine works on what condition only?
  42. The only cancer that can be cured by radiation therapy?
    Stage 1 Hodgkin Lymphoma
  43. most common risk factor for cad?
  44. worst risk factor for cad?
  45. most common finding in mi?
  46. infarct where can produce diarhea, brady cardia bc of irritation of diaphragm and stimulation of vagus nerve?
    inferior wall mi
  47. what happens to ischemia/esophageal spasm when given nitroglycerin?
    • relieves it--ischemia/esophageal spasm
    • worsens it--gerd
  48. 3 examples when response to therapy makes the diagnosis?
    • opiates and naloxone
    • esaphagitis candidiasis and fluconazole
    • cns toxo and tmp/smh
  49. blood pressure difference between two arms means what?
    aortic dissection
  50. wide  split of a2?
    • rbbb
    • p. stenosis
    • rvh
  51. parodixical split of a2?
    • aortic stenosis
    • lbbb
    • lvh
  52. fixed split s2?
  53. how long does it take for ckmb to elevate?
    4 and it peaks at 12
  54. how many mm elevation do you need to see on ekg for it to be significant?
  55. time from door to tpa?
    30 minutes
  56. what elevates troponins?
    renal failure
  57. most common cause of epigastric pain?
    non ulcer dyspepsia
  58. only chest pain that is pleuritic and positional?
  59. pain inbetween the scapula?
    aortic dissection
  60. mvp presents with?
    • panic
    • palpitations
  61. aortic dissection best initial test?
    after that?
    most accurate test?
    x ray

    • tee
    • ct angiography
    • mra
    • arteriography
  62. test of choice for pe in pregnant woman?
    v/q scan
  63. what is the most specific ekg finiding for pericarditis?
    pr segment depression
  64. Rx for pericarditis?
    refractory cases?
    • nsaids
    • steroids
  65. most common cause of mitral stenosis?
    rheumatic fever
  66. Criteria for Bacterial Endocarditis?
    • 2 blood cultures
    • 1 coxiella burnetti
    • consecutive + blood cultures 12 hours apart
    • echocardiography showing endocardium involvement or new regurg
    • Minor...
    • Fever
    • Immunologic phenomena
    • vascular phenomena
    • echocardiography suggestive evidence
    • Predispositon
    • microbiology evidence not meeting the major criteria
  67. criteria for rheumatic fever
    • dx is 2 major or 1 major and 2 minor + evidence of recent GAS infection
    • Joints
    • Carditis
    • Nodules
    • Erythema marginatum
    • Syndenhams chorea
    • pr prolonged
    • Esr
    • Arthralgias
    • Crp
    • Elevated temp
  68. Stenosis or regurg of what valve produces the most afib? systemic arterial emboli leading to ischemia?
    mitral stenosis
  69. opening snap?
    mitral stenosis
  70. left main bronchus being displaced upward occurs in what valvulopathy?
    mitral stenosis
  71. ace inhibitors help ventricular filling or emptying?
  72. preload reduction helps ventricular filling or emptying?
  73. what effect do diuretics have on the fetus?
    growth retardation
  74. Best initial test for Valvular Heart Disease?
    Most accurate test for valvular heart disease?
    • echo
    • catheterization
  75. medical therapy for Mitral Valve stenosis?
    Surgical therapy?
    • decreased preload- diuretics and low Na diet
    • BB
    • surgical-
    • balloon valvuloplasty or replacement
  76. Balloon valvuloplasty is for what patients specifically with mitral valve stenosis?
    pregnant patients
  77. When do you replace the valve in mitral regurg?
    • EF <60%
    • LESVD > 40 mm
  78. Medical therapy for mitral valve regurg?
    • afterload decrease with hydralazine
    • valve replacement if EF<60% or LVESD >40 mm
  79. most common congenital valvular condition?
  80. Most common cause of Mitral Regurg?
  81. When do you prophylax for MVP?
    never even with a murmur
  82. Medical rx for MVP?
  83. most common cause of aortic stenosis?
    • calcification in elderly
    • bicuspid in the young
  84. Which valvular disease produces Hypertrophy and vessel congestion?
    all of the valvular disease
  85. MEdical therapy for aortic stenosis?
    • none really--maybe afterload decrease
    • Replacement
  86. medical therapy for aortic regurg?
    • afterload decrease
    • replacement if EF<55% or LVESD-->55%
  87. What effect does handgrip have on as, ms, mr, ar?
    AMyl nitrate?
    • increases the murmur
    • decreases murmur
    • increases the murmur
    • decreases murmur
  88. best drug for ar, as, ms, mr?

    best drug for HOCM and MVP?
    ace inhibitor or diuretic and amylnitrate

  89. MCC of dilated cardiomyopathy?
    • ischemia
    • 2nd is alcohol
  90. most common symptoms of HOCM?
  91. mcc cause of hypertrophic cardiomyopathy?hypertension
  92. How do you differentiate pericarditis fromMI?
    both have st segment elevation but no reciprical lead changes
  93. Pericardial effusion slow vs fast?
    slow effusion--pericardium accomadates

    fast--cardiac tamponade
  94. Ekg changes on cardiac tamponade?
    electric alternans
  95. D/D for pulsus paradoxus?
    • cardiac tamponade
    • asthma
    • copd
    • pneumothorax
  96. D/D for Kussmaul sign?
    • constrictive pericarditis
    • right ventricle infarction
    • cardiac tamponade
    • pericarditis
    • Tricuspid regurg
  97. most accurate test for constrictive pericarditis
    ct or mri showing calcified pericardiac sac
  98. rx for bradycardia?
    • none unless there is symptoms then 
    • atropine
    • pacemaker
  99. when do you give a pacer in bradycardia outside of a pt being symptomatic?
    in 2nd degree heart block, type 2 or in 3rd degree heart block
  100. Adams stokes attack?
    • brady cardia
    • hypotension
    • loc
  101. Diagnosis of MAT?
    3 different p morphologies secondary to copd or other respiratory conditions
  102. Rx for unstable a flutter?
    synchronized shock
  103. what are the classifications of afib?
    • duration--paroxysmal(self terminating) vs. persistent >7 days and permanent >1 year
    • valvular vs non valvular
    • lone a fib <60 yo with no clinical or echo evidence heart disease
  104. goal of ventricular rate control in a fib?
    <100 bpm
  105. Drug of choice in a fib with
    a) thyrotoxicosis
    d) low blood pressure or chf?
    • bb
    • cb
    • digoxin
  106. Is rhythm conversion or rate control preffered in afib?
    rate control is prefferred
  107. who is anticoagulated in afib?
    • valvular afib with warfarin, or chads2 score of more than 2
    • chads2 score of 1 or 0 ---->aspirin
  108. Long term rx for afib?
    catherer ablation of the firing focus
  109. Long term rx of WPW?
    cathere ablatioin
  110. why are bb, ccb and digoxin avoided in wpw?
    bc they increase the bypass of the electrical current around the av node and increase wpw
  111. rx for PAD?
    • cilostazol
    • aspiring
  112. at what percentage stenosis do you surgically revascularize with a stent or bypass a coronary artery?
    70 percent
  113. what lowers mortality in stable angina?
    • aspirin
    • bb
    • nitroglycerin
  114. how is nitroglycerin used in stable angina?
    • stable angina--oral or patch
    • acs-- sublingual, paste, iv
  115. when is clopidogrel used?
    • aspirin allergy
    • recent stent
  116. when is prasugrel used?
    for angioplasty with stenting
  117. when is ticlopidine used?
    in apiring and clopidogrel allergy
  118. side effect of niacin?
    • hyperglycemia
    • hyperuricemia
    • itchiness due to histamine
  119. MOA of niacin?
    MOA of fibrates?
    MOA of Ezetemibe?
    • reduces VLDL secretion
    • increase LPL--increased TG clearance
    • decreased cholesterol absorption
  120. MI involving what wall of the heart has the highest mortality associated with it?
    anterior wall MI
  121. st segment elevation in leads v2 thru v4, next best step?
    • aspirin
    • PCI
  122. Complications of PCI?
    • restenosis
    • rupture of a coronary
  123.  contraindications to thrombolytics in acs?
    • 1. bleeding into the bowel or cns
    • 2. surgery in the past 2 weeks
    • 3. hypertension 185/110
    • 4. non hemorrhagic stroke
  124. When are Gp IIb inhibitors given?
    in unstable/nstemi and angioplasty and stent
  125. when should a patient with unstable angina/nstemi be transferred to angiography?
    • when medical therapy fails to improve the chest pain, S develops and score of 3 is met on the timi score
    • aspirin in past 7 days, age more than 65, angina 2 in the past 24 hours
    • biomarkers
    • cad risk factors
    • dx of cad
    • Ekg changes
  126. How do you recognize sinus bradycardia from 3 degree heart block producing bradycardia?
    3rd degreee heart block will have canon a waves
  127. which infarctions have the highest likelyhood of developing a systolic dysfunction?
    anterior wall mi
  128. who gets angiography post mi?
    those with a positive stress test
  129. what kind of exercise can one expect to partake in after a normal stress test?
    any form of exercise
  130. when is muga or nuclear ventriculogram used?
    to assess the condition of the heart before giving cardiotoxic drugs
  131. most common cause of death in chf?
    arrhythmia and sudden death
  132. when is an implantable debifrilator indicated in chf?
  133. when is a biventricular pacemaker used?
    EF<35% and QRS is >120msec
  134. what decreases mortality in diastolic heart failure?
    • bb
    • diuretics such as loops
  135. how is acute pulmonary edema managed?
    preload reduction-loops, oxygen, morphine, nitra

    afterload reduction--hydralazine/nitroprosside
  136. Rx for taku tsubo cardiomyopathy?
    • bb
    • ACEi
  137. when should an implantable defibrillator be used in hocm?
    in presence of syncopy
  138. how is HOCM managed?
    • bb or other negative ionotropes
    • implantable defibrillator if syncopy is present
    • ablation of the septum with alcohol or myomectomy
  139. empiric rx for brain abscess?
    • steroids
    • antibiotics
    • needle aspiration
  140. sumatriptans are contraindicated in what 3 populations?
    • pregnancy
    • prinzmetal
    • cad
  141. cause of neuroleptic malignant syndrome?
    • dopamine antagonists?
    • dantrolene
  142. what two drugs can cause malignant hyperthermia?
    • inhalational anesthetics
    • succinylcholine

  143. When is prehypertension of 130/80 treated?
    if present with cad risk factors--dm, htn, hyperlipidemia
  144. anti HTN meds in pregnancy?
    • labetalol
    • methyldopa
    • nifedipine
    • hydralazine
  145. moa of alpha methyl dopa?
    alpha 2 agonist
  146. anti htn not used in depression?
  147. best initial test for renal artery stenosis?
    most accurate
    • mra
    • arteriogram
  148. substitute for ocp causing htn?
    • progestin only
    • depo progesterone
  149. who should be screened for aaa?
    males over 65 who smoked
  150. best initial test for aaa?
    best initial test for aortic dissection?
    • ultrasound
    • xray
  151. best initial rx for aortic dissection?
  152. which aortic dissection need surgery?
    stanford type A
  153. Best initial test for PVD?
    MOst accurate is ?
    • ABI
    • doppler
    • arteriogram
  154. when is a unna boot used?
    for chronic venous insufficiency
  155. everybody on steroids should be on what after 3 months?
    • prophylactic bisphosphonate
    • calcium
    • vitamin d
  156. Rx for kawasaki dz?
    • Aspirin
    • IVIG
  157. Rx for RSV?
  158. ebsteins anomaly is caused by what drug?
  159. leaflets are displaced into the right ventricle
    ebstein anomaly
  160. rx for early cyanotic disease?
    prostoglandin E to keep PDA open
  161. Prophylactic meds for people with prolonged QT interval?
  162. Rx for dvt in a person thats prone to falling?
    IVC filter
  163. When do you give oxygen to COPD pts?
    4 Ps?
    • when the pulse ox is <88%
    • pulmonary htn
    • peripheral edema
    • polycythemia