step 3 cardio

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pszurnicki
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265667
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step 3 cardio
Updated:
2014-03-30 19:24:08
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step cardio
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step 3 cardio
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  1. when do you do thallium echo or thallium with adenosine?
    • under 5 conditions
    • LBBB
    • ST segment abnormality
    • Digoxin use
    • Pacemaker
    • LVH
  2. When do ACE inhibitors lower mortality in MI?
    • in LV dysfunction
    • decreased EF
    • systolic dysfunction
  3. When do you give prasugrel or clopidogrel?
    if you will do angioplasty and stent
  4. when does the classical treatment for stemi not apply?
    • posterior wall MI
    • MI causing pulmonary edema
    • MI with bradycardia
  5. Sokolow-Lyon criteria for LVH?
    S in V1 + R in V5-V6 > 35mm
  6. When do you give CCB for MI?
    • 3 conditions
    • asthma
    • prinzmetals angina
    • Cocained induced ischemia
  7. Most accurate test for STEMI?
    • Troponin
    • CKMB
  8. What are the first cardiac biomarkers present post MI?
    cardiac myoglobin
  9. in an unequivical case of STEMI, EKG or treatment?
    • Treatment
    • Aspirin
    • BB
    • statin
    • oxygen
    • morphine
    • ace inhibitors
  10. Risk factors for CAD
    • FH of CAD <55 for males <65 for females
    • Age >45 for males > 55 females
    • Smoking 
    • HTN/HDL low
  11. When do you do CABG vs stenting
    • 3 vessel dz
    • 2 vessel dz + DM
    • Left main coronary
  12. TIMI score for UA/NSTEMI
    • Age >65
    • Markers--troponins or ckmb +ve
    • EKG--st changes of 0.5 mm
    • Risk factors for Cad >3
    • Ischemia-2 episodes in 24 hours
    • Cad >50% stenosis
    • Aspirin use in past 7 days
  13. When do you use PM in acute MI management?
    • new LBBB
    • Bifascicular block
    • 3 degree heart block
    • 2 degree type 2 morbitz
    • symptomatic bradycardia
  14. When do you give intra-aortic balloon pump?
    valve rupture
  15. Difference in management of NSTEMi from STEMI?
    • no thrombolytics
    • Heparin
    • G2B inhbitors--abxicimab
  16. How far should you move a clock in the ICU or ED?
    15min-30 mins
  17. What is the initial mngt of Pulmonary Edema
    • Diretics
    • dilators--
    • Oxygen
    • Morphine
  18. what are the + ionotropes used for CHF?
    • dobutamine
    • Amrinone
  19. When do you give an ICD for a pts with CHF?
    EF<35%
  20. When do you use biventricular pacemaker vs ICD?
    • biventricular PM--QRS >120 msec
    • ICD- EF <35%
  21. Bicuspid aortic valve is most commonly seen with what two conditions?
    • turners syndrome
    • coarctation of aorta
  22. which murmurs are best heard at LSB?
    • aortic regurg
    • Tricuspid regurg
    • VSD
  23. best initial test for valvular lesions?
    most accurate
    • echo
    • catherer
  24. How do you treat murmurs  which are decreased by valsalva?
    decrased by amyl nitrate?
    • diuretics
    • ACEI
  25. what tests need to be ordered for valvular disorders?
    • echo
    • ekg
    • cxr
  26. when do you dilate aortic stenosis ?
    if can't do surgery
  27. difference between metallic valves vs bioprostehtic valve like bovine or procine?
    metal require warfarin but last forever

    bioprostethic--- no warfarin , last 10 years
  28. when is sx indicated for aortic stenosis
    • pressure of >40
    • area <1 cm^2
  29. when do you do sx for aortic regurg?
    Mitral regurg sx?
    • ef<55
    • LVED>55

    • ef<60
    • LVED>40
  30. For wall valvular lesions, what tests are ordered initially?
    • ekg
    • echo
    • xray
  31. For valvular lesions, surgical repair/replacement is the best treatement except for what valvular lesion?
    mitral stenosis
  32. ankylosing spondylitis and reiters syndrome can cause what type of valvular lesion?
    aortic regurg
  33. what happens to opening snap with worsening MS?
    moves closer to S2
  34. at what nyha stage, do bb and aceI lower mortality?
    at all stages
  35. when suspecting valvular disease, what exams shoudl be done?
    • chest
    • cvs
    • extremeties
  36. most accurate way to dx restrictive cardiomyopathy
    endomyocardial biopsy
  37. what ekg findings are seen with paricarditis?
    • diffuse st segment elevation
    • pr depression
  38. constrictive pericarditis presents how?
    • like right heart failure
    • -edema
    • -jvd
    • -hepatosplenomegaly
  39. treatment for constrictive pericarditis vs cardiac tamponade?
    • diuretics
    • cardiac tamponade- pericardiocentesis
  40. management of dissection of aorta?
    • bp controle--ekg, chest xray
    • then further bp control + ct angiography or tee or mra
  41. which murmur is not affected by either handgrip or amyl nitrate?
    mitral stenosis
  42. stenotic lesions are best treated how?
    anatomic repair
  43. how are asd repaired?
    percutaneous or catheter
  44. what is the strongest indication for asd repair?
    shunt ratio exceeds 1.5:1
  45. catheterization of heart in cardiac tamponade will show what?
    equalization of pressure in all chambers
  46. most dangerous therapy in cardiac tamponade?
    diuretics
  47. difference in presentation between acute pericarditis and constrictive pericarditis?
    acute pericarditis--- kaussmal sign, sob

    constricitve --chronic heart heart failure--hepatomegaly, edema, jvd
  48. best initial therapy for constrictive pericarditis?
    most effective therapy
    diuretics

    pericardial stripping
  49. best initial therapy for pad?
    • aspirin
    • bp controll
    • cilostazol
    • smoking cessation
    • exercise as tolerate
  50. how do you diagnose afib in the hospital if the initial ekg doesnt show it>
    outpatient setting?
    telemetry monitoring

    holter monitoring
  51. what tests are ordered once afib is found?
    • echo
    • cardiac enzymes
    • electrolytes
    • Thyroid function tests
  52. rx for unstable afib?
    synchronized cardioversion
  53. after how many days do you anticoagulate afib?
    if the questions doesnt state how long afib has been, do you anticoagulate?
    • 2 days
    • yes
  54. when do you give digoxin for afib or a flutter?
    with borderline hypotension
  55. what are the 3 rhythms originating from the atria that can be irregularly irregular?
    • afib
    • a flutter
    • mat
  56. under what circumstances should you order echo?
    in all cases of arrhythmias
  57. when do you give ionotropes for chf exacerbtion?
    if it fails to respond to the initial treatment and you have pulmonary edema
  58. Best SVT treatment
    catheter ablation of aberrant foci
  59. rx for wpw?
    procainamide
  60. best long term rx for wpw
    catherer ablation
  61. what drugs can throw svt into wpw?
    • any drug that delays the av node 
    • ccb
    • bb
    • digoxin
  62. 2 causes for sudden loss of consciesness?
    • cardiac
    • seizures
  63. regaining of consciesness from syncopy?
    sudden--cardiac

    gradual--neurologic
  64. most important to do during a syncopal episode?
    exclude cardiac cause
  65. if after intial work up the cause of syncopy is not clear, next step?
    • urine tox
    • telemetry/holter monitoring
    • tilt table testing
    • EP testing
  66. what do you not order during a syncopal workup
    carotid doppler

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