-
What decreases risk of restenosis after PCI?
-
Time from admission to tPA?
30 min
-
TIme from admission to PCI?
90 min
-
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?
heparin
-
St segment elevation MI gets what? tpa or heparin?
tpa
-
ACE inhibitors are best for what type of infarcts?
anterior wall infarcts
-
Kussmaul sign?
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?
cardiac tamponade
-
Acute coronary syndromes are associated with what kind of adventitious heart sound?
S4
-
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
- hypertension (180/110)
- 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?
Systolic
-
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?
Chronically?
-
Alternative to using ACEI and ARBs in CHF
?
Hydralazine and nitroglycerin
-
Which interventions decrease mortality in CHF?
- Defibrillator
- Ace/ARB
- BB
- Spironolactone
- Hydralazine/nitrates
-
What electrolyte disturbance causes digoxin toxicity?
hypokalemia
-
digoxin can cause what electrolyte abnormality?
hyperkalemia
-
What toxicities can digoxin cause?
-
CNS and EKG disturbance is treated with?
DIGIbind
-
When do you replace valves in MR and AR with respect to EF and LVESD?
- MR AR
- EF <60% <55%
- LVESD >45mm >55mm
-
What effect do standing or valsalva have on heart murmures? What are teh exceptions?
-
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?
BB
-
What meds treat AR and MR?
ACEi and diuretics
-
Rx for aortic stenosis?
valve replacement
-
Rx for MS?
Balloon valvuloplasty
-
Rx for bradycardia without symptoms?
nothing
-
Rx for 1st degreee heart block?
nothing
-
Rx for mortbits type 1?
nothing
-
Rx for Morbitz type 2?
pacemaker
-
Rx for 3 degree heart block?
pacer
-
Adenosine works on what condition only?
sVT
-
The only cancer that can be cured by radiation therapy?
Stage 1 Hodgkin Lymphoma
-
most common risk factor for cad?
htn
-
worst risk factor for cad?
dm
-
most common finding in mi?
normal
-
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?
gerd?
- relieves it--ischemia/esophageal spasm
- worsens it--gerd
-
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?
aortic dissection
-
-
-
-
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?
1mm
-
time from door to tpa?
30 minutes
-
what elevates troponins?
renal failure
-
most common cause of epigastric pain?
non ulcer dyspepsia
-
only chest pain that is pleuritic and positional?
paricarditis
-
pain inbetween the scapula?
aortic dissection
-
-
aortic dissection best initial test?
after that?
most accurate test?
x ray
- tee
- ct angiography
- mra
- arteriography
-
test of choice for pe in pregnant woman?
v/q scan
-
what is the most specific ekg finiding for pericarditis?
pr segment depression
-
Rx for pericarditis?
refractory cases?
-
most common cause of mitral stenosis?
rheumatic fever
-
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
-
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
-
Stenosis or regurg of what valve produces the most afib? systemic arterial emboli leading to ischemia?
mitral stenosis
-
opening snap?
mitral stenosis
-
left main bronchus being displaced upward occurs in what valvulopathy?
mitral stenosis
-
ace inhibitors help ventricular filling or emptying?
emptying
-
preload reduction helps ventricular filling or emptying?
filling
-
what effect do diuretics have on the fetus?
growth retardation
-
Best initial test for Valvular Heart Disease?
Most accurate test for valvular heart disease?
-
medical therapy for Mitral Valve stenosis?
Surgical therapy?
- decreased preload- diuretics and low Na diet
- BB
- surgical-
- balloon valvuloplasty or replacement
-
Balloon valvuloplasty is for what patients specifically with mitral valve stenosis?
pregnant patients
-
When do you replace the valve in mitral regurg?
-
Medical therapy for mitral valve regurg?
Surgical?
- afterload decrease with hydralazine
- valve replacement if EF<60% or LVESD >40 mm
-
most common congenital valvular condition?
MVP
-
Most common cause of Mitral Regurg?
ischemia
-
When do you prophylax for MVP?
never even with a murmur
-
-
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?
Surgery?
- none really--maybe afterload decrease
- Replacement
-
medical therapy for aortic regurg?
surgical
- afterload decrease
- replacement if EF<55% or LVESD-->55%
-
What effect does handgrip have on as, ms, mr, ar?
AMyl nitrate?
squatting?
valsalva?
- increases the murmur
- decreases murmur
- increases the murmur
- decreases murmur
-
best drug for ar, as, ms, mr?
best drug for HOCM and MVP?
ace inhibitor or diuretic and amylnitrate
bb
-
MCC of dilated cardiomyopathy?
-
most common symptoms of HOCM?
sob
-
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
fast--cardiac tamponade
-
Ekg changes on cardiac tamponade?
electric alternans
-
D/D for pulsus paradoxus?
- cardiac tamponade
- asthma
- copd
- pneumothorax
-
D/D for Kussmaul sign?
- constrictive pericarditis
- right ventricle infarction
- cardiac tamponade
- pericarditis
- Tricuspid regurg
-
most accurate test for constrictive pericarditis
ct or mri showing calcified pericardiac sac
-
rx for bradycardia?
- none unless there is symptoms then
- atropine
- pacemaker
-
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?
- brady cardia
- hypotension
- loc
-
Diagnosis of MAT?
3 different p morphologies secondary to copd or other respiratory conditions
-
Rx for unstable a flutter?
synchronized shock
-
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?
<100 bpm
-
Drug of choice in a fib with
a) thyrotoxicosis
b)copd
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?
cathere ablatioin
-
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
-
-
at what percentage stenosis do you surgically revascularize with a stent or bypass a coronary artery?
70 percent
-
what lowers mortality in stable angina?
-
how is nitroglycerin used in stable angina?
acs?
- stable angina--oral or patch
- acs-- sublingual, paste, iv
-
when is clopidogrel used?
- aspirin allergy
- recent stent
-
when is prasugrel used?
for angioplasty with stenting
-
when is ticlopidine used?
in apiring and clopidogrel allergy
-
side effect of niacin?
- hyperglycemia
- hyperuricemia
- 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?
- restenosis
- 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
- biomarkers
- cad risk factors
- dx of cad
- Ekg changes
-
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?
EF<35%
-
when is a biventricular pacemaker used?
EF<35% and QRS is >120msec
-
what decreases mortality in diastolic heart failure?
- bb
- diuretics such as loops
-
how is acute pulmonary edema managed?
preload reduction-loops, oxygen, morphine, nitra
afterload reduction--hydralazine/nitroprosside
-
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?
- steroids
- antibiotics
- needle aspiration
-
sumatriptans are contraindicated in what 3 populations?
-
cause of neuroleptic malignant syndrome?
rx
- dopamine antagonists?
- dantrolene
-
what two drugs can cause malignant hyperthermia?
rx
- inhalational anesthetics
- succinylcholine
dantrolene
-
When is prehypertension of 130/80 treated?
if present with cad risk factors--dm, htn, hyperlipidemia
-
anti HTN meds in pregnancy?
- labetalol
- methyldopa
- nifedipine
- hydralazine
-
moa of alpha methyl dopa?
alpha 2 agonist
-
anti htn not used in depression?
BB
-
best initial test for renal artery stenosis?
most accurate
-
substitute for ocp causing htn?
- progestin only
- depo progesterone
-
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?
bb
-
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?
- prophylactic bisphosphonate
- calcium
- vitamin d
-
-
-
ebsteins anomaly is caused by what drug?
lithium
-
leaflets are displaced into the right ventricle
ebstein anomaly
-
rx for early cyanotic disease?
prostoglandin E to keep PDA open
-
Prophylactic meds for people with prolonged QT interval?
bb
-
Rx for dvt in a person thats prone to falling?
IVC filter
-
When do you give oxygen to COPD pts?
4 Ps?
- when the pulse ox is <88%
- pulmonary htn
- peripheral edema
- polycythemia
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