question

5 causes of acute pericarditis

answer

viral idiopathic autoimmune (SLE) uremia (acute or chronic renal failure) (dialysis resolves symptoms) post-MI (early (peri-infarction pericarditis) or late (dressler synd))

question

.pts w supravalvular AS develop LVH over time + can also have _____ as an associated anomaly

answer

.coronary artery stenosis can have subendocardial ischemia w inc myocardial O2 demand during exercise

question

5 lifestyle modifications to reduce HTN

answer

low salt diet diet rich in fruits, veggies, low-fat dairy regular aerobic exercise lose wt LIMIT ALCOHOL INTAKE

question

definition of resistant HTN

answer

requiring >3 anti-HTN agents from diff classes (including a diuretic)

question

What is preferred for HTN - bb or CCB?

answer

CCB unless compelling indications for BB use - HF, post MI, hyperthyroid, etc)

question

when AR is due to valvular disease - early diastolic murmur best heard: due to aortic root disease - best heard:

answer

LSB RSB

question

development of new conduction abnormality in pts w infective endocarditis should raise suspicion for ____

answer

perivalvular abscess extending into the adjacent cardiac conduction pathways.

question

tricuspid endocarditis murmur

answer

systolic (holosystolic murmur of tricuspid regurg that becomes accentuated w inspiration) (cardiac conduction abnormalities are uncommon in pts w tricuspid valve endocarditis)

question

aortic valve endocarditis + IVDA are assoc w an inc risk of ____

answer

periannular extension of endocarditis

question

3 severe AS PE mild-mod AS murmur

answer

pulsus parvus and tardus (diminished + delayed carotid pulse) mid- to late-peaking systolic murmur soft + single S2 (soft bc thickened/calcification of aortic leaflets leads to reduced mobility) (single bc reduced mobility, A2 is delayed + occurs simultaneously w P2 leading to single S2) early-peaking systolic murmur

question

4 things that cause S3

answer

chronic severe mitral regurg chronic aortic regurg HF high cardiac output states (preg or thyrotoxicosis)

question

loud S1 heard in what

answer

MS

question

primary anti-ischemic + antianginal effects of nitrates

answer

systemic vasodilation (rather than coronary vasodilation) lowering preload + LVEDV -- reducing wall stress + myocardial oxygen demand but nitrates dilate vv, arterioles, + coronary arteries.

question

when to do surgical revasc in PVD/PAD?

answer

if limb-threatening complications (nonhealing ulcers), sig limitation in activities of daily living, or failure to respond to exercise + pharmacologic therapy. supervised graded exercise program = most useful intervention to improve functional capacity + reduce symptomatic claudication in pts w PAD. antiplatelet agents reduce overall CV mortality. statins should also be given to all pts w clinically sig atherosclerotic CVD

question

3 strongest predictors of AAA expansion + rupture

answer

large diameter rapid rate of expansion current cig smoking

question

repair of AAA at what size

answer

5.5cm rate >0.5cm in 6mo or >1cm/yr symptoms (abd, back, flank pain. limb ischemia)

question

malignant HTN definition

answer

severe HTN w retinal hemorrhages, exudates, or papilledema

question

severe HTN 2 diff types

answer

HTN urgency HTN emergency - malignant HTN - retinal hemorrhages, exudates, papilledema -HTN encephalopathy - cerebral edema, non-localizing neuro symptoms + signs.

question

acute pulm edema from acute MI

answer

diuretics -- furosemide (not spironolactone bc not strong enough) BB = standard tx in MI but should be avoided in pts w decompensated CHF or brady.

question

why are DHP CCBs not good for MI or CHF

answer

vasodil can cause reflex tachy + inc myocardial oxygen demand

question

what complication should be suspected in pts presenting w R-sided heart failure following implantable pacemaker or cardioverter-defibrillator placement

answer

tricuspid regurg due to direct valve leaflet damage or inadequate leaflet coaptation

question

digitalis toxicity arrhythmia SUPER SPECIFIC FOR DIGITALIS TOX

answer

atrial tachycardia (ectopy) w AV block (both together = very specific) digitalis toxicity causes inc ectopy + inc vagal tone.

question

use dependence definition in what 2 drug classes what do each of these do w use dependence

answer

enhanced pharmacologic effects of a drug during faster heart rates seen w class I (esp IC) --- flecainide + class IV (CCBs) class IC -- prog dec in impulse conduction w faster HRs leading to inc in QRS complex CCBs w antiarrhythmic properties (verapamil + diltiazem) --inc in CCB w increasing ventricular activation. prolongation of refractory period of AV node - leading to increased PR interval. (no change in QRS)

question

USPSTF recommends screening who for AAA

answer

active or former smokers who are 65-75yo 1 time abd u/s

question

7 things seen in BB overdose how to tx - 2 1st line + another.

answer

bradycardia hypotension hypoglycemia delirium seizures cardiogenic shock 1st-line tx: IVF + atropine. IV glucagon should be administered in pts w profound or refractory hypotension.

question

how to tx hyperTGemia

answer

150-500: inc risk CV events lifestyle mod (wt loss, mod alcohol intake, inc exercise) if known CVD or high risk -- statin >1000: can cause pancreatitis fibrates fish oil alcohol abstinence

question

what are 2ndary causes (5 diseases, 4 med s/e's) of hyperTGemia

answer

diseases: DM obesity hypothyroidism nephrotic syn alcohol abuse med s/e's: tamoxifen BB corticosteroids antiretrovirals

question

how to tx vasospastic angina

answer

CCB (diltiazem, amlodipine) ASA should be AVOIDED in someone w vasospastic angina bc it worsen coronary vasospasm

question

stress test w adenosine, dipyridamole, dobutamine

answer

adenosine + dipyridamole (pharmacologic stress test) - dilates coronary aa w/o inc HR or BP. dobutaine (used in stress echocardiography) - B-1 agonist. inc HP +/- BP.

question

when to initiate statins

answer

for primary prevention in pts w a 10yr risk of atherosclerotic CVD 7.5% or more.

question

tx of vasovagal syncope

answer

reassurance + edu about benign nature of condition avoid triggers USE PHYCIAL COUNTERPRESSURE MANEUVERS during prodromal phase to abort or delay episode of syncope counterpressure maneuvers = leg crossing w tensing of mm, handgrip + tensing of arm mm w clenched fists)

question

on physical exam - heart murmurs syncope what do you do now?

answer

echocardiogram

question

renovascular HTN should be suspected in all pts w ____ + ____, ____, ___, or ____

answer

resistant HTN diffuse atherosclerosis asymmetric kidney size recurrent flash pulm edema elevation in serum creatinine >30% from basline after starting ACEi/ARB (the presence of a continuous abdominal bruit has a high specificity for the presence of renovascular HTN)

question

2 findings specific for CHF due to LVSD

answer

elevated BNP audible 3rd heart sound. not peripheral edema -- bc it is less specific (than S3) + correlates less closely with BNP levels.

question

what 3 arteries are usually involved w fibromuscular dysplasia

answer

renal carotid vertebral

question

fibromuscular dysplasia = a non-___ + non-___ condition

answer

noninflammatory nonatherosclerotid abn cell development in arterial wall. can lead to vessel stenosis, aneurysm, or dissection.

question

dx of fibromuscular dysplasi

answer

CTA of abdomen or duplex u/s

question

SOB S3 symptomatic/ short term tx?

answer

IV diuretics

question

improve survival in LVSD = 4 what 2 in also for AAs

answer

ACEi ARB BB mineralcorticoid R antagonists (MRAs) = spironolactone + eplerenone in AA = hydralazine + nitrates.

question

what do you do unsynchronized cardioversion (defibrillation) for

answer

pulseless cardiac arrest who have a shockable rhthm (vfib, pulsless vtach)

question

isolated systolic HTN definition cause

answer

systolic BP >140 w diastolic BP <90 increased stiffness or decreased elasticity of aortic + arterial walls in elderly.

question

PAC risks what if you don't have any of these risks, what's the next step in PAC tx?

answer

tobacco alcohol caffeine stress ^^avoid these! in the absence of these precipitants - transthoracic echocardiogram is useful to assess for any cardiac/valvular structural +/or functional abnormality.

question

when is holter monitoring used

answer

in outpatient setting to ID intermittent arrhythmias in pts w symptoms (sybcope, palpitations) NOT if the arrhythia has already been captured on ECG

question

hyperthermia confusion multiorgan dysfunction

answer

exertional heat stroke anticholinergic activity can further impair heat dissipation EHS = body temp <104, CNS dysf, + other tissue or organ dysf seizures, ARDS, DIC, + hepatic or renal failure may occur. although anhidrosis is classic, pts can have heavy sweating. tx = immediated rapid cooling, preferably w ice-water immersion, fluid resuscitation, management of metabolic + end-organ complications NOT antipyretic (bc EHS does not involve a change in the hypothalamic set point for temp) (for classic/nonexertional heat stroke -- evaporative cooling, NOT ice-water immersion -- this will inc mortality)

question

besides pain control + sx, initial tx for aortic dissection?

answer

BB - to red SBP, slow HR, dec contractility. goals of tx: pain control reduce systolic BP reduce LV contractility (to reduce aortic wall stress)

question

methamphetamine use is assoc w

answer

cardiomyopathy -- likely occurs due to both ischemic + nonischemic mechanisms

question

most common + likely cause of sudden-onset afib

answer

hyperthyroidism

question

7 major adverse effects of amiodarone

answer

cardiac -- sinus brady, heart block, risk of proarrhthmias pulm - chronic interstitial pneumonitis endocrine - hypo/erthyroidism GI/hepatic - inc transaminases, hepatitis oxular - corneal microdeposits, optic neuropathy derm - blue-gray skin discoloration neuro- periph neuropathy

question

indications for carotid endarterectomy (CEA) men - asymp vs symp women - asymp vs symp

answer

men - asymp = >60% stenosis symp = >50% stenosis women - (both asymp + symp) >70% stenosis

question

HOCM - tx?

answer

BBs/CCBs (nonDHP) (BB = prolong diastole + dec myocardial contractility -> dec LVOT obstruction + improves angina symptoms) + avoidance of volume depletion (bc DHP = vasodil -- which would dec preload) if symptoms (syncope, HF, angina) -- tx w negative inotropic agens -- BB, verapamil, disopyramide

question

most common risk for aortic dissection

answer

HTN

question

scleroderma renal crisis = 3 criteria what's on the peripheral blood smear (2)

answer

abrupt onset mod-severe HTN (inc renin) AKI normal(ish) UA (may see proteinuria) schistocytes thrombocytopenia

question

most common cause of mitral regurg in developed country

answer

mitral valve prolapse (myxomatous degeneration of the mitral valve) mitral annular calcification = way less likely in younger patient. common incidental finding in older adults + usually associated w mild-to-mod MR.

question

vtach -- stable vs unstable tx (NOT including torsades)

answer

stable = IV amiodarone (or procainamide, stoalol, lidocaine) unstable (hypotension, altered mentation, resp distress) = synchronized cardioversion if pulseless = defibrillation/unsynchronized cardioversion

question

SVT - stable vs unstable tx

answer

stable = maneuvers to determine rhythm (carotid massage, rate control) + tx unstable (hypotension, altered mentation, resp distress) = synchronized cardioversion

question

when to do carotid sinus massage

answer

stable SVT to determine rhythm

question

pulsus paradoxus definition seen in what 3 things

answer

exaggerated fall in systemic BP >10 during inspiration freq in cardiac tamponade can also be seen in asthma or COPD (bc greatly exaggerated intrathoracic negative pressure during inspiration -> pooling of blood in pulm vasculature) (also, marked expansion of the lungs in asthma + COPD can also impinge upon the outward expansion of the heart)

question

dx of aortic dissection

answer

renal insufficiency - transesophageal echocardiography hemodynamically unstable - transesophageal echocardiography hemodynamically stable - CT angiography. (MR angiography = more time consuming + reqs the administration of gadolinium-containing contrast agents for contrast enhancement. should be avoided in pts w mod-severe kidney disease due to risk of nephrogenic systemic fibrosis)

question

how do statins cause myalgias

answer

decrease coenzyme Q10 synthesis (which is involved in mm cell E production)

question

pericardial effusions are often secondary to...

answer

viral pericarditis (accompanying pleural effusions may be found as well)

question

how to tx torsades de pointes (TdP)

answer

hemodynamically unstable = defibrillation stable pts w recurrent episodes of TdP = IV magnesium if due to quinidine use = sodium bicarbonate

question

tx SVT/paraoxysmal supraventricular tachycardia

answer

adenosine (not used for vtach)

question

tx cardiotoxicity due to hyperkalemia

answer

calcium gluconate (also, occasionally used for BB +/or CCB overdose)

question

sodium bicarb used for

answer

tx torsades due to quinidine use also beneficial for: cardiac arrest due to : metabolic acidosis hyperkalemia tricyclic antidepressant overdose

question

how to tx AF in pts w WPW

answer

hemo unstable = electrical cardioversion stable = procainamide (or ibutilide) AVN blocking agents like adenosine, BB, CCB, digoxin should NOT be used for AF in pts w WPW -- may promote conduciton across accessory pathway + lead to degeneration of AF into VF.

question

______ can increase the serum levels of digoxin _ cause tox in a pt on a stable digoxin regimen.

answer

amiodarone acute digoxin tox typ presents w GI symptoms chronic - less pronounced GI symptoms but more sig neurologic + visual symptoms (changes in color vision, scotomas, blindness)

question

when to have further workup for 1st degree AV block

answer

if wide QRS -- bc this means the conduction delay is below the AV node. not if normal QRS (bc due to delayed AV nodal conduction)

question

what basic testing should be performed on a pt initially dx w HTN

answer

-urinalysis (for occult hematuria + urine protein/Cr ratio) -chemistry panel -lipid profile (risk stratification for CAD) -baseline ECG (to eval for CAD or LVH)

question

most common form of PSVT how do vagal maneuvers stop them?

answer

atrioventricular nodal reentrant tachycardia (AVNRT) inc parasymp tone in heart + result in slowing of conduction in AV NODE. (not SA) (inc PS tone + result in temp slowing of conduction in AVN + inc in AVN refractory period, leading to term of AVNRT) (although vagal maneuvers dec SAN automaticity + cause slowing of the rate of impulse formation from the sinus node, AVNRT termination is due to effects on reentrant mechanism in the AV node rather than to changes in SAN automaticity)

question

4 potential cardiac sources of emboli

answer

LA thrombus (due to afib) LV thrombus (following ant MI) infective endocarditis (septic emboli) thrombus from prosthetic valves

question

chagas is what kind of bug what 3 things can it cause

answer

protozoan (trypanosoma cruzi) megaesophagus megacolon cardiac dysfunction

question

cardiac index aka

answer

pump function dec in hypovolemic shock really dec in cardiogenic shock inc in septic shock

question

what causes hyperkalemia in CHF

answer

dec Na + water delivery to kidneys leads to reduced K excretion

question

does smoking inc BP?

answer

no causes transient rise in BP, but some studies show that chronic light to mod smokers have lower BP than nonsmokers. butttt smoking cessation may directly lower BP

question

what;s better for BP, dec sodium in diet or DASH diet best nonpharm way to dec BP?

answer

DASH but both together = best best nonpharm way to dec BP = wt loss in overwt people in order: wt loss DASH exercise dietary Na dec alcohol dec

question

CYP inhibitors

answer

acetaminophen NSAIDs abx/antifungals (flagyl) amiodarone cimetidine cranberry juice vit E omeprazole thyroid hormone SSRI

question

CYP inducers

answer

carbamazepine, phytoin ginseng st. john's wort OCPs phenobarbital rifampin

question

intracardiac diastolic Ps w cardiac tamponade

answer

elevation + equalization

question

what is CI in cocaine-induced ACS how to tx cocaine-induced ACS

answer

beta-blocker (bc risk of unopposed cocaine-induced alpha ag activity could worsen vasoconst) use benzos + supplemental oxygen. also can use ASA + CCBs + nitroglycerin cardiac cath if STEMI

question

meds to withhold prior to cardiac stress testing

answer

hold for 48 hrs: BB, CCB, nitrates hold for 48 hrs prior to vasodil stress test -- dipyridamole hold for 12 hrs prior to vasodil stress test -- caffeine-containing food or drinks continue == ACEi, ARB, digoxin, statin, diuretics

question

most AF ectopic foci are where what about aflutter

answer

in pulmonary veins atrial flutter commonly involves a reentrant circuit around the tricuspid annulus.

question

what murmurs gets softer with squatting what do they get softer with?

answer

HCM MVP these get louder w valsalva + standing HCM (+AS) also gets softer w handgrip

question

a few months post-MI, CHF type picture. cause? what will you also see with this?

answer

ventricular aneurysm --- you will also see persistent STE with Q waves in the same leads papillary mm rupture happens from a few days to a couple wks post-MI

question

how can you dec the peripheral edema caused by amlopidine

answer

combine w ARB amlodipine vasodil precap arterioles ARB vasodil post-cap venules

question

what heart sound is heard during the acute phase of ACS

answer

4th / atrial gallop due to LV stiffening/dysf caused by ischemia

question

1st-line therapy for alleviating symptoms + improving exercise tolerance in pts w stable angina

answer

BB

question

cold-water immersion during PSVT works how?

answer

AVN conductivity

question

diff bw arterial thrombosis vs embolism

answer

thrombosis -- will have claudication before... ischemia symptoms less severe bc collateral circ embolism -- sudden, can be after MI

question

ascending aortic aneurysms most often due to ____ descending aortic aneurysms most often due to ___

answer

cystic medial necrosis (usually occurs w aging) CT disorders atherosclerosis (risk factors: smoking, HTN, hypercholesterolemia)

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