Card Set Information
What decreases risk of restenosis after PCI?
Time from admission to tPA?
TIme from admission to PCI?
POst mI, a stress test determines what??
need for angiography
Angiography determines what?
need for revascularization
Prophylactic antiarrhythmics have what effect on mortality?
they increase it
St segment depression gets what, tpa or heparin?
St segment elevation MI gets what? tpa or heparin?
ACE inhibitors are best for what type of infarcts?
anterior wall infarcts
increase in jugulovenous pressure due to constrictive pericarditis or restrictive cardiomyopathy
a drop of 10 mm in bp on inhalation is seen in what condition?
Acute coronary syndromes are associated with what kind of adventitious heart sound?
WHat carries higher mortality, anterior wall or inferior wall infarcts?
anterior wall infarcts
Depression of st in chest leads v1 and v2 equals what?
st segment elevation in other leads
Failure of what organ can cause a false positive troponin level?
renal failure or insufficiency
ABsolute contraindications to thrombolytics?
Bleeding into abdomen (melena) or brain
recent surgery in 2 weeks
non hemorrhagic stroke within last 6 months
WHat causes pulseless electrical activity?
free wall/cardiac tamponade
Post infarction routine medications?
Diastolic or systolic dysfuntion produces a lower EF?
WHat drug is contraindicated in HCM?
Diuretics because they produce less volume
What is BNP used for?
to exclude CHF as a cause of dyspnea
What ionotrope drug is used actutely?
Alternative to using ACEI and ARBs in CHF
Hydralazine and nitroglycerin
Which interventions decrease mortality in CHF?
What electrolyte disturbance causes digoxin toxicity?
digoxin can cause what electrolyte abnormality?
What toxicities can digoxin cause?
CNS and EKG disturbance is treated with?
When do you replace valves in MR and AR with respect to EF and LVESD?
EF <60% <55%
LVESD >45mm >55mm
What effect do standing or valsalva have on heart murmures? What are teh exceptions?
MVP and HCM
What effect do leg raising and squatting have on heart murmurs? What are teh exceptions?
Increase the intensity
Exceptions are MVP and HCM
What meds treat MVP and HCM?
What meds treat AR and MR?
ACEi and diuretics
Rx for aortic stenosis?
Rx for MS?
Rx for bradycardia without symptoms?
Rx for 1st degreee heart block?
Rx for mortbits type 1?
Rx for Morbitz type 2?
Rx for 3 degree heart block?
Adenosine works on what condition only?
The only cancer that can be cured by radiation therapy?
Stage 1 Hodgkin Lymphoma
most common risk factor for cad?
worst risk factor for cad?
most common finding in mi?
infarct where can produce diarhea, brady cardia bc of irritation of diaphragm and stimulation of vagus nerve?
inferior wall mi
what happens to ischemia/esophageal spasm when given nitroglycerin?
relieves it--ischemia/esophageal spasm
3 examples when response to therapy makes the diagnosis?
opiates and naloxone
esaphagitis candidiasis and fluconazole
cns toxo and tmp/smh
blood pressure difference between two arms means what?
wide split of a2?
parodixical split of a2?
fixed split s2?
how long does it take for ckmb to elevate?
4 and it peaks at 12
how many mm elevation do you need to see on ekg for it to be significant?
time from door to tpa?
what elevates troponins?
most common cause of epigastric pain?
non ulcer dyspepsia
only chest pain that is pleuritic and positional?
pain inbetween the scapula?
mvp presents with?
aortic dissection best initial test?
most accurate test?
test of choice for pe in pregnant woman?
what is the most specific ekg finiding for pericarditis?
pr segment depression
Rx for pericarditis?
most common cause of mitral stenosis?
Criteria for Bacterial Endocarditis?
2 blood cultures
1 coxiella burnetti
consecutive + blood cultures 12 hours apart
echocardiography showing endocardium involvement or new regurg
echocardiography suggestive evidence
microbiology evidence not meeting the major criteria
criteria for rheumatic fever
dx is 2 major or 1 major and 2 minor + evidence of recent GAS infection
Stenosis or regurg of what valve produces the most afib? systemic arterial emboli leading to ischemia?
left main bronchus being displaced upward occurs in what valvulopathy?
ace inhibitors help ventricular filling or emptying?
preload reduction helps ventricular filling or emptying?
what effect do diuretics have on the fetus?
Best initial test for Valvular Heart Disease?
Most accurate test for valvular heart disease?
medical therapy for Mitral Valve stenosis?
decreased preload- diuretics and low Na diet
balloon valvuloplasty or replacement
Balloon valvuloplasty is for what patients specifically with mitral valve stenosis?
When do you replace the valve in mitral regurg?
LESVD > 40 mm
Medical therapy for mitral valve regurg?
afterload decrease with hydralazine
valve replacement if EF<60% or LVESD >40 mm
most common congenital valvular condition?
Most common cause of Mitral Regurg?
When do you prophylax for MVP?
never even with a murmur
Medical rx for MVP?
most common cause of aortic stenosis?
calcification in elderly
bicuspid in the young
Which valvular disease produces Hypertrophy and vessel congestion?
all of the valvular disease
MEdical therapy for aortic stenosis?
none really--maybe afterload decrease
medical therapy for aortic regurg?
replacement if EF<55% or LVESD-->55%
What effect does handgrip have on as, ms, mr, ar?
increases the murmur
increases the murmur
best drug for ar, as, ms, mr?
best drug for HOCM and MVP?
ace inhibitor or diuretic and amylnitrate
MCC of dilated cardiomyopathy?
2nd is alcohol
most common symptoms of HOCM?
mcc cause of hypertrophic cardiomyopathy?hypertension
How do you differentiate pericarditis fromMI?
both have st segment elevation but no reciprical lead changes
Pericardial effusion slow vs fast?
slow effusion--pericardium accomadates
Ekg changes on cardiac tamponade?
D/D for pulsus paradoxus?
D/D for Kussmaul sign?
right ventricle infarction
most accurate test for constrictive pericarditis
ct or mri showing calcified pericardiac sac
rx for bradycardia?
none unless there is symptoms then
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
Adams stokes attack?
Diagnosis of MAT?
3 different p morphologies secondary to copd or other respiratory conditions
Rx for unstable a flutter?
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
goal of ventricular rate control in a fib?
Drug of choice in a fib with
d) low blood pressure or chf?
Is rhythm conversion or rate control preffered in afib?
rate control is prefferred
who is anticoagulated in afib?
valvular afib with warfarin, or chads2 score of more than 2
chads2 score of 1 or 0 ---->aspirin
Long term rx for afib?
catherer ablation of the firing focus
Long term rx of WPW?
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
rx for PAD?
at what percentage stenosis do you surgically revascularize with a stent or bypass a coronary artery?
what lowers mortality in stable angina?
how is nitroglycerin used in stable angina?
stable angina--oral or patch
acs-- sublingual, paste, iv
when is clopidogrel used?
when is prasugrel used?
for angioplasty with stenting
when is ticlopidine used?
in apiring and clopidogrel allergy
side effect of niacin?
itchiness due to histamine
MOA of niacin?
MOA of fibrates?
MOA of Ezetemibe?
reduces VLDL secretion
increase LPL--increased TG clearance
decreased cholesterol absorption
MI involving what wall of the heart has the highest mortality associated with it?
anterior wall MI
st segment elevation in leads v2 thru v4, next best step?
Complications of PCI?
rupture of a coronary
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
When are Gp IIb inhibitors given?
in unstable/nstemi and angioplasty and stent
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
cad risk factors
dx of cad
How do you recognize sinus bradycardia from 3 degree heart block producing bradycardia?
3rd degreee heart block will have canon a waves
which infarctions have the highest likelyhood of developing a systolic dysfunction?
anterior wall mi
who gets angiography post mi?
those with a positive stress test
what kind of exercise can one expect to partake in after a normal stress test?
any form of exercise
when is muga or nuclear ventriculogram used?
to assess the condition of the heart before giving cardiotoxic drugs
most common cause of death in chf?
arrhythmia and sudden death
when is an implantable debifrilator indicated in chf?
when is a biventricular pacemaker used?
EF<35% and QRS is >120msec
what decreases mortality in diastolic heart failure?
diuretics such as loops
how is acute pulmonary edema managed?
preload reduction-loops, oxygen, morphine, nitra
Rx for taku tsubo cardiomyopathy?
when should an implantable defibrillator be used in hocm?
in presence of syncopy
how is HOCM managed?
bb or other negative ionotropes
implantable defibrillator if syncopy is present
ablation of the septum with alcohol or myomectomy
empiric rx for brain abscess?
sumatriptans are contraindicated in what 3 populations?
cause of neuroleptic malignant syndrome?
what two drugs can cause malignant hyperthermia?
When is prehypertension of 130/80 treated?
if present with cad risk factors--dm, htn, hyperlipidemia
anti HTN meds in pregnancy?
moa of alpha methyl dopa?
alpha 2 agonist
anti htn not used in depression?
best initial test for renal artery stenosis?
substitute for ocp causing htn?
who should be screened for aaa?
males over 65 who smoked
best initial test for aaa?
best initial test for aortic dissection?
best initial rx for aortic dissection?
which aortic dissection need surgery?
stanford type A
Best initial test for PVD?
MOst accurate is ?
when is a unna boot used?
for chronic venous insufficiency
everybody on steroids should be on what after 3 months?
Rx for kawasaki dz?
Rx for RSV?
ebsteins anomaly is caused by what drug?
leaflets are displaced into the right ventricle
rx for early cyanotic disease?
prostoglandin E to keep PDA open
Prophylactic meds for people with prolonged QT interval?
Rx for dvt in a person thats prone to falling?
When do you give oxygen to COPD pts?
when the pulse ox is <88%