Term
| What is the significance of unstable angina? |
|
Definition
| Indicates acute coronary syndrome; concern is for plaque rupture and clot formation with coronary artery |
|
|
Term
| Which diagnostic procedures should be investigate with unstable angina? |
|
Definition
Stress test, EKG, echocardiogram, radionuclide imaging to asses perfursion
cardiac catheterization |
|
|
Term
| What medications should be considered for pts with unstable angina? |
|
Definition
| B-blockers, CCBs, nitro, aspirin or clopidogrel, manage DM, cholesterol, etc. |
|
|
Term
| What findings are likely evident with mitral stenosis upon auscultation? |
|
Definition
| Diastolic mumur, opening snap |
|
|
Term
| True or flase: Endocarditis antibiotic prophylaxis is indicated with mitral valve prolapse. |
|
Definition
|
|
Term
| What type of valvular disease is associated with a harsh systolic murmur which radiates to the common carotids? |
|
Definition
Aortic stenosis
(once sysmptoms present mortality is 50% at 3 years) |
|
|
Term
| Which drug classes should be avoided in a pt with aortic stenosis? |
|
Definition
| Diuretics (in excess), vasodilators (nitrates and ACE inhibitors) |
|
|
Term
| What type of heart murmur is most commonly associated with systolic heart failure? |
|
Definition
|
|
Term
| Which three classes of cardiovascular medications can cause hyperkalemia? |
|
Definition
| ACE-Is, ARBs, spironolactone |
|
|
Term
| What effect does digoxin have on heart failure patients? |
|
Definition
| Reduces incidence of hospitalization but affords no change in clinical outcome. |
|
|
Term
| Which cardiac arrhythmia is associated with decreased ejection fractions? |
|
Definition
|
|
Term
| Which heart murmur is more commonly heard with diastolic heart failure? |
|
Definition
|
|
Term
| How are echocardiograms likely to be different with diastolic heart failure as compared to systolic heart failure? |
|
Definition
| Diastolic heart failure may present with normal ejection fractions |
|
|
Term
| True or false: right-sided valvular lesions do not typically cause heart failure. |
|
Definition
True
more likely to cause profound edema |
|
|
Term
| Which two positions may relieve chest pain due to pericarditis? |
|
Definition
| Sitting up or leaning forward. |
|
|
Term
| What laboratory orders would you consider specifically in cases of pericarditis? |
|
Definition
ANA ? autoimmune disease
PPd
blood cultures (if fever/septic)
renal function |
|
|
Term
| Which medications should be avoided in pericarditis due to recent MI? |
|
Definition
| NSAIDs as they interfere with scar formation. |
|
|
Term
| What are the clinical findings of cardiac tamponade? |
|
Definition
Distant heart sounds
elevated JVP
pulsus paradoxus (more than 10 mmHg drop in systolic BP during inspiration) |
|
|
Term
| What are the three primary contraindications for performing a cardiac stress test? |
|
Definition
Severe aortic stenosis
acute coronary syndrome
decompensated heart failure |
|
|
Term
| What drug is used in chemically induced cardiac stress testing? |
|
Definition
|
|
Term
| When a cardiac stress test is contraindicated what type of evaluation should these patients have? |
|
Definition
| Nuclear imaging with adenosine or dipyridamole (agents cause vasodilation increasing blood flow to unclogged arteries, while arteries with plagues do not demonstrate an increase in blood flow) |
|
|
Term
| What pt group should be observed closely when receiving adenosine or dipyridamole with nuclear imaging for CAD? |
|
Definition
| COPD or asthma as these agents can cause bronchospasm |
|
|
Term
| What two chronic EKG findings invalidate the use of an EKG for cardiac testing/monitoring (principally for acute MI)? |
|
Definition
Baseline ST-segment abnormalities
LBBB |
|
|
Term
| What asculatory finding on cardiac exam signifies LVH? |
|
Definition
| S4 (also displaced point of maximum impulse) |
|
|
Term
|
Definition
| Aldosterone-producing tumor |
|
|
Term
| What blood pressure values fall into pre-HTN? |
|
Definition
Systolic: 120-139
diastolic: 80-89 |
|
|
Term
| How are HTNsive goals different for pts only with HTN and those with concomitant diabetes or renal insufficiency? |
|
Definition
HTN only: less than 140/90
w DM/renal insufficiency: less than 130/80 |
|
|
Term
| When should two anti-HTNsive agents be considered for initial HTN management? |
|
Definition
| When systolic BP is more than 160 |
|
|
Term
| Which two electrolytes/substances tend to be retained when thiazide diuretics are used? |
|
Definition
|
|
Term
| In what type of HTNsive pts are beta blockers optimal? |
|
Definition
| Those with low EF and/or angia |
|
|
Term
| What are the primary side effects of beta blockers? |
|
Definition
| ED, bronchospasm (asthmatics), bradycardia |
|
|
Term
| In what type of HTN pts are ACEis/ARBs of optimal use? |
|
Definition
| Low EF, chronic kidney disease, diabetes w/ microalbuminuria |
|
|
Term
| What are the three major side effects with ACEis use? |
|
Definition
| Cough, angioedema, hyperkalemia |
|
|
Term
| When are calcium channel blockers used in HTN management? |
|
Definition
|
|
Term
| In which three types of pts w/ chest pain should aortic dissection be ruled out? |
|
Definition
Longstanding HTN
cocain use
aortic root disease (Marfan's syndrome or Takayasu's arteritis) |
|
|
Term
| What physical exam finding is key to clinical diagnosis, or at least for suspicious for, a dissecting aorta? |
|
Definition
|
|
Term
| Though CXRs are not highly specific for the detection of aortic dissections, what radiographic findings may be present? |
|
Definition
| Widened mediastinum or hazy aortic knob |
|
|
Term
| What imaging study is diagnostic for a dissecting aorta? |
|
Definition
CT with IV contrast
(transesophageal echocardiography is also highly sensitive/specific) |
|
|
Term
| What are the initial pharmacologic interventions taken for aortic dissection? |
|
Definition
Aggressive heart rate and BP control w/ B-blockers
(nitroprousside may be subsequently added) |
|
|
Term
| What treatment is required for ascending aortic dissections? |
|
Definition
|
|
Term
| What is the characteristic history of an individual with mesenteric ischemia? |
|
Definition
| Postprandial abdominal pain and food avoidance |
|
|
Term
| What are the primary physical findings for lower extremity vascular disease? |
|
Definition
Ulcers, diminished pulses, skin atrophy, loss of hair
(bruits over affected vessels) |
|
|
Term
| How can vascular claudication be differentiated from lower spine stenosis? |
|
Definition
Claudication: improves when standing still
Stenosis: improves when sitting |
|
|
Term
| What two studies are used in the evaluation/diagnosis of peripheral vascular disease? |
|
Definition
Ankle-brachial index (UE vs LE BP)
Doppler ultrasound |
|
|
Term
| What three tests are used in the evaluation/diagnosis of renal artery stenosis? |
|
Definition
| Angiography, MRA, ultrasound w/ Doppler flow |
|
|
Term
| What medication has been demonstrated to improve walking distance in pts with peripheral vascular disease? |
|
Definition
|
|
Term
| Which two cholesterol types can be measured only when a pt is fasting? |
|
Definition
LDL and triglycerides
(total cholesterol and HDL can be calculated following meals) |
|
|
Term
|
Definition
| renal pts commonly have hyperlipidemia |
|
|
Term
| After diet and exercise what medications are indicated as first line agents in the treatment of hypertriglyceridemia? |
|
Definition
Fibrates and nicotinic acid
(both of which also improve HDL) |
|
|
Term
| What types of pts are at increased risk for having infective endocarditis? |
|
Definition
| IV drug users, pts with valvular heart lesions or prosthetic heart valves |
|
|
Term
| What is the major complication with gemfibrozil use? |
|
Definition
| Potentiation of myositis with a statin. |
|
|
Term
| What are the classic constellation of symptoms for a pt with acute endocarditis? |
|
Definition
| Fever, rigors, heart failure, frequently neurologic compromise (secondary to systemic emboli) |
|
|
Term
| How does noninfectious endocarditis most commonly manifest? |
|
Definition
|
|
Term
| What ausculatory finding is concerning for infective endocarditis? |
|
Definition
|
|
Term
| What lesions seen on hands and feet are essentially pathognomonic for pts with infective endocarditis? |
|
Definition
| Osler's nodes (painful) and Janeway lesions (painless skin infarcts) |
|
|
Term
|
Definition
| Retinal hemorrhages with pale or white centers (composed of coagulated fibrin) |
|
|
Term
| What organism is the most common cause of acute infectious endocarditis? |
|
Definition
|
|
Term
| When blood cultures are negative but infective endocarditis is suspect which organisms must still be considered? |
|
Definition
| HACEK: Haemophilus aphrophilus, H. parainfluenzae, Acintobacillus actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, Kingella kingae |
|
|
Term
| Which tests are used in the diagnosis of endocarditis? |
|
Definition
| Blood cultures (usually three sets), EKG, and TEE |
|
|
Term
| Which pts should universally be evaluated for infective endocarditis? |
|
Definition
| Any pt with proven bacteremia with Staphylococcous aureus |
|
|
Term
| What is the duration of treatment for pts with infective endocarditis? |
|
Definition
|
|
Term
| What antibiotics are used in the empiric treatment of endocarditis? |
|
Definition
| Gentamicin plus an antistaphylococcal PCN |
|
|
Term
| What disease is often the underlying cause of verrucous endocarditis? |
|
Definition
|
|
Term
| What are the prophylactic procedures for pts at risk for infective endocarditis? |
|
Definition
| Amoxacillin (or clindamycin/azithromycin for PCN sensitivity) 30-60 minutes before procedure |
|
|
Term
| How should the T wave present in the precordial leads in a pt with RBBB? |
|
Definition
T wave should be opposite in direction of QRS complex; otherwise suspect ischemia
(if QRS is mostly positive, T wave should be inverted) |
|
|
Term
| What mechanism of action do Type I antiarrhytmics have? |
|
Definition
|
|
Term
| What mechanism of action do Type II antiarrhythmics have? |
|
Definition
anti-sympathomimetic activity
(primarily beta-blockers) |
|
|
Term
| Anti-arrhythmics which affect potassium eflux are of what category? |
|
Definition
| Class III antiarrhytmmics |
|
|
Term
| What two mechanisms do antiarhythmics of class IV possess? |
|
Definition
| Affect calcium channels and AV nodal cells |
|
|
Term
| Which two classes of antiarrhythmics are used in Wolff-Parkinson-White syndrome? |
|
Definition
class Ia (procanimide only)
class III (amiodarone the common example) |
|
|
Term
| Which beta-blocker (class II antiarrhythmic) also has activity as a class III antiarrhythmic? (potassium channels) |
|
Definition
|
|
Term
| What is meant by the term "T wave alternans"? |
|
Definition
beat-to-beat variability in T wave amplitude
(increased risk for sudden cardiac death and more likely to require implantable cardiac defibulators) |
|
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