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Flashcards in Cardiology, Harrison Deck (162)
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1
Q

Estimates risk of ischemic stroke in patients with non-rheumatic/non-valvular Afib

A

CHADS2 Score: 1) CHF 2) Htn 3) Age >75 4) DM 5) Previous stroke; Each corresponds to 1 point, except for previous stroke which corresponds to 2 points; A score >2 = oral anticoagulation advised

2
Q

Estimates 10-year risk of coronary disease, cerebrovascular disease, peripheral vascular disease, and heart failure

A

Framingham Cardiovascular Risk: 1) Age 2) SBP 3) Total cholesterol 4) HDL 5) BP treatment 6) Smoking status 7) DM 8) Gender

3
Q

Chest discomfort precipitated by emotion/exertion; rapidly resolves (within 5-10 mins) with resting/nitrates

A

Chronic stable angina

4
Q

MCC of chronic stable angina

A

Atherosclerotic epicardial Hcoronary artery disease

5
Q

Accelerates coronary atherosclerosis in both sexes at all ages

A

Smoking

6
Q

Family history of coronary artery disease, significant ages within genders

A

Male less than 55; Female less than 65 (must be FIRST DEGREE relatives)

7
Q

Chest pain of chronic stable angina lasts for

A

2-10 minutes

8
Q

Atypical chest discomfort of angina is common in

A

1) Elderly >75 2) Women 3) Diabetics; may present with anginal equivalents

9
Q

T/F Pain of chronic stable angina may radiate to the back/interscapular region

A

T

10
Q

Chest pain of chronic stable angina RARELY localises where

A

Below umbilicus or above mandible

11
Q

Angina that occurs at rest is referred to as

A

Unstable angina

12
Q

Angina at night while the patient is recumbent

A

Angina decubitus

13
Q

Symptoms of myocardial schema (MI) other than angina

A

Anginal equivalents: Dyspnea, nausea, fatigue, faintness, epigastric discomfort

14
Q

MI without chest discomfort but detectable by continuous ECG (Holter monitoring) or during stress test

A

Silent ischemia

15
Q

Mitral regurgitation is best appreciated with the patient in ___ position

A

Left lateral decubitus

16
Q

T/F Localization of chest discomfort with a single fingertip on the chest makes angina unlikely

A

T

17
Q

Unstable angina lasts for

A

10-20 minutes

18
Q

Angina of acute MI lasts for

A

> 30 minutes

19
Q

Angina that cannot be relieved by nitroglycerin

A

Acute MI

20
Q

Late-peaking systolic murmur radiating to the carotid arteries

A

Aortic stenosis

21
Q

Condition that can cause chest pain that closely mimics angina

A

Esophageal spasm

22
Q

Simplest test for diagnosis and risk stratification of ischemic heart disease

A

Treadmill ECG (exercise stress test)

23
Q

Used to diagnose ischemic heart disease when resting ECG is abnormal

A

Stress myocardial perfusion imaging: Thallium or sestamini is infused IV during exercise/pharmacologic stress testing; imaged after cessation of exercise and 4 hours later

24
Q

Substances that may be used for pharmacologic stress testing

A

1) Dobutamine 2) Adenosine 3) Dipyridamole

25
Q

Definitive test for assessing severity of CAD

A

Coronary arteriography

26
Q

Target heart rate in exercise stress testing

A

85% of maximal heart rate for age and gender

27
Q

Exercise stress testing is discontinued when

A

1) Chest discomfort 2) Severe shortness of breath 3) Dizziness 4) Severe fatigue 5) ST depression >0.2mV 6) Decrease in SBP by >10mmHg 7) Vtach

28
Q

Baseline (0mV) in ECG

A

PR segment

29
Q

Contraindications to stress testing

A

1) Rest angina within 48 hours 2) Unstable rhythm 3) Severe aortic stenosis 4) Acute myocarditis 5) Uncontrolled heart failure 6) Severe pulmonary htn 7) Active infective endocarditis

30
Q

Vitamins that improve outcomes of patients with IHD

A

Vitamin C and E

31
Q

Indications for coronary artery bypass surgery (CABG)

A

1) Significant left main CAD 2) 3-vessel CAD 3) 2-vessel CAD that includes LAD 4) Require revascularization but vessels unsuitable for PCI 5) Angina refractory to medical therapy 6) Medical therapy not tolerated 7) Diabetic with at least 2-vessel disease

32
Q

Drugs that can be used to increase HDL and decrease TAG

A

1) Niacin (Vitamin B6) 2) Fibrates

33
Q

T/F Unstable angina and NSTEMI have similar mechanisms, clinical presentations, and treatment strategies

A

T

34
Q

Angina that occurs with a crescendo pattern

A

Unstable angina

35
Q

Difference between NSTEMI and Unstable angina

A

NSTEMI: With evidence of myocardial necrosis (elevated cardiac markers

36
Q

Age risk factors per gender

A

Male - 50 or older; Female - 60 or older

37
Q

Clinical hallmark of unstable angina

A

Chest pain

38
Q

Cardiac marker: First to elevate

A

Myoglobin

39
Q

Myoglobin remains elevated up to

A

24 hours

40
Q

CK-MB and Troponin elevate when

A

3-12 hours

41
Q

CK-MB remains elevated until

A

1.5-3 days

42
Q

Cardiac marker: Last to decline

A

Troponin (remains elevated for 1-2 weeks

43
Q

Cardiac marker: Assist with determination of coronary risk

A

1) High sensitivity C-reactive protein (hsCRP) 2) Homocysteine

44
Q

Cardiac marker: Aids in diagnosis, management, prognosis, and monitoring therapy of congestive heart failure (CHF)

A

B-type natriuretic peptide (BNP)

45
Q

A marker of long-term cardiac risk produced by all nucleated cells, unaffected by acute phase reactants, body or muscle mass, and diet

A

Cystatin C

46
Q

When is ambulation permitted in patients with UA and NSTEMI

A

1) No recurrence of schema 2) No elevation of cardiac biomarkers at 12-24 hours

47
Q

Pain reliever used in UA/NSTEMI in patients whose symptoms are not relieved after 3 serial sublingual nitroglycerin tablets

A

Morphine sulfate

48
Q

Antithrombin of choice for UA/NSTEMI; superior to unfractionated heparin in reducing recurrent cardiac events

A

Enoxaparin

49
Q

Drugs shown to have benefit for long-term therapy in UA/NSTEMI patients

A

1) Beta blockers (helps decrease triggers for MI) 2) Statins and ACEIs (long-term plaque stabilisation 3) Antiplatelet (prevents/reduces severity of thrombosis if a plaque ruptures

50
Q

Tearing or ripping knife-like chest pain radiating to the back between the shoulder blades

A

Aortic dissection

51
Q

Grading of heart murmurs

A

1-very faint; 2-faint; 3-moderately loud; 4-loud with thrill; 5-stethoscope lightly pressed on skin; 6-stethoscope slightly above chest wall

52
Q

Posterior calf pain on active dorsiflexion of foot against resistance

A

Homan’s sign

53
Q

Rise or lack of fall of JVP with inspiration

A

Kussmaul’s sign

54
Q

Venous pressure should fall by at least ___ mmHg with inspiration

A

3

55
Q

Abdominojugular reflex

A

Pressure over the RUQ for 10 seconds results in a sustained rise of >3 cm in JVP for at least 15 seconds after release of hand

56
Q

Uncontrolled htn with NO end-organ damage

A

Hypertensive urgency/hypertensive crisis

57
Q

Uncontrolled htn with end-organ damage

A

Hypertensive emergency/malignant hypertension

58
Q

Hypertensive urgency: Treatment

A

Oral drugs first; lower BP within 24 hours

59
Q

Hypertensive emergency: Treatment

A

IV medications; lower BP by not >20-25% within the first hour

60
Q

Drug class that should be avoided in patients with congestive heart failure

A

Beta blockers

61
Q

Criteria for white coat hypertension

A

1) At least 3 clinic measurements >140/90 2) At least 2 non-clinic measurements less than 140/90 3) No target organ damage

62
Q

Orthostatic hypotension is a fall in SBP by ___ mmHg or DBP by ___ mmHg from supine to upright within ___ minutes

A

> 20, >10, 3

63
Q

Leading cause of death and disability in the developed world

A

Atherosclerosis

64
Q

Enzyme inhibited by statins

A

HMG-CoA reductase

65
Q

Characteristic of LDL in diabetic dyslipidemia

A

Levels near average but smaller and denser particles thus more atherogenic

66
Q

Gravest complication of atherosclerosis

A

Acute thrombosis

67
Q

5 A’s of behavioural counselling framework in smoking cessation

A

Ask about tobacco use; Advise to quit; Assess willingness to quit; Assist to quit; Arrange follow-up and support

68
Q

BP goal for patients with diabetes or kidney disease

A

Less than 130/80 (140/90 for all others)

69
Q

Metabolic syndrome describes a constellation of metabolic derrangements that typically includes 3 or more of the following

A

1) Abdominal obesity (>102 cm in men, >88 cm in women) 2) TG 150 mg/dL or greater 3) HDL Less than or equal to 40 mg/dL in males and 50 mg/dL in females 4) BP 130/85 5) Fasting glucose 100 mg/dL or greater

70
Q

Fasting lipid profile should be done for all adults ___ of age; to be repeated every ___ years if values are acceptable

A

> 20, 5

71
Q

Components of lipid profile

A

1) Total cholesterol 2) TAG 3) LDL 4) HDL

72
Q

___ treatment has been shown to reduce risk of first MI in men

A

Low-dose aspirin

73
Q

Risk factors that modify LDL goals

A

1) Smoking 2) Htn 3) Low HDL 4) DM 5) Family history of premature CAD 6) Age >45 in males >55 in females 7) Emerging risk factors (e.g. homocysteine)

74
Q

Metabolic syndrome is aka

A

1) Insulin-resistance syndrome 2) Syndrome X

75
Q

Metabolic syndrome places the individual at increased risk for

A

1) Coronary artery disease 2) Stroke 3) Peripheral vascular disease 4) TIIDM 5) NASH

76
Q

Common key underlying abnormality in metabolic syndrome

A

Insulin resistance

77
Q

Antihypertensive regimen for patients with metabolic syndrome should include

A

ACEI and ARBs

78
Q

ATP III recommends at least ___ minutes of moderate-intensity physical activity on a daily basis for weight reduction

A

30

79
Q

First-line drug for LDL reduction in metabolic syndrome

A

Statin

80
Q

Inability of ventricle to contract normally, with symptoms resulting from inadequate cardiac output; depressed EF

A

Systolic failure (EF less than 40%)

81
Q

Inability of the ventricle to relax and fill normally, with symptoms from elevated filling pressures; preserved EF

A

Diastolic failure (EF >50%)

82
Q

High- vs low-output heart failure: After MI, htn, dilated cardiomyopathy, valvular or pericardial disease

A

Low-output

83
Q

High- vs low-output heart failure: Hyperthyroidism, anemia, pregnancy, AV fistula, beriberi, Paget disease

A

High-output

84
Q

T/F Low-output heart failure is often accompanied by vasoconstriction and cold extremities

A

F, vasodilation and warm extremities

85
Q

Systolic vs diastolic heart failure: More common in women and seen especially in elderly women with hypertension

A

Diastolic

86
Q

Hypertrophy brought about by PRESSURE overload

A

Concentric

87
Q

Hypertrophy brought about by VOLUME overload

A

Eccentric/dilated

88
Q

Ascites is most commonly seen in what etiology of heart failure

A

1) Constrictive pericarditis 2) Tricuspid valve disease

89
Q

Abdominojugular reflex is positive in

A

Congestive hepatomegaly

90
Q

Criteria to establish a clinical diagnosis of CHF

A

Framingham criteria

91
Q

At least ___ major and ___ minor Framingham criteria are required to establish a diagnosis of CHF

A

1 major, 2 minor

92
Q

Major Framingham criteria

A

1) Cardiomegaly 2) S3 gallop 3) Acute pulmonary edema 4) Rales 5) PNDn 6) Neck vein distention 7) (+) hepatojugular reflex 8) Increased venous pressure

93
Q

Minor Framingham criteria

A

1) Extremity edema 2) Night cough 3) Dyspnea on exertion 4) Hepatomegaly 5) Pleural effusion 6) Vital capacity reduced by 1/3 from normal 7) Tachycardia of 120 or greater

94
Q

Major or minor Framingham criterion

A

Weight loss of 4.5 kg or greater over 5 days of treatment

95
Q

Cardiac marker that helps in differentiating between cardiac and pulmonary causes of dyspnea

A

BNP

96
Q

CHF Stage: At high risk of HF but no evident structural heart disease or symptoms of HF

A

A

97
Q

CHF Stage: Structural heart disease without symptoms of HF

A

B

98
Q

CHF Stage: Structural heart disease with prior or current symptoms of HF

A

C

99
Q

CHF Stage: Refractory HF requiring specialized interventions

A

D

100
Q

Sudden death in CHF is most commonly due to

A

Vfib

101
Q

Suspect ___ in middle-aged or elderly who develop asthma for the first time

A

Heart failure (HF)

102
Q

Cornerstone of modern HF treatment

A

ACEI and beta blockers

103
Q

Cor pulmonale is caused by ___ in >50% of cases

A

COPD

104
Q

RV heave is characteristic of

A

Cor pulmonale

105
Q

JVP waves prominent in for pulmonale

A

a and v

106
Q

MC symptom of for pulmonale

A

Dyspnea

107
Q

This is the increased intensity if holosystolic murmur of tricuspid regurgitation with inspiration

A

Carvallo’s sign

108
Q

The main premise in the treatment of for pulmonale is

A

Treat the underlying disorder

109
Q

Hand placed over sternum with a clenched fist to indicate a squeezing, central, substernal discomfort

A

Levine’s sign

110
Q

Form of angina pectoris caused by intermittent focal spasm of a major epicardial coronary artery

A

Prinzmetal/variant angina

111
Q

T/F Prinzmetal angina is more severe than classic angina and occurs typically at rest but usually not increased by exercise

A

T

112
Q

T/F Prinzmetal angina is associated with ST elevation

A

T, transient

113
Q

Substances that places a person at high risk for prinzmetal angina

A

1) Alcohol 2) Cocaine 3) 5-FU 4) Sumatriptan

114
Q

T/F Prinzmetal angina promptly responds to sublingual nitrates

A

T

115
Q

Most common artery involved in prinzmetal angina

A

Right coronary artery

116
Q

Spasm of coronary artery usually occurs within __ cm of luminal obstruction

A

1

117
Q

Cardiac marker: Taken only once, at least 12 hours after chest pain

A

Trop I or T

118
Q

Cardiac marker: Increased sensitivity with serial sampling (q6-8)

A

CK-MB

119
Q

Generally occurs when coronary blood flow decreases abruptly after a thrombotic occlusion of a coronary artery previously affected by atherosclerosis

A

STEMI

120
Q

Prohibited drug implicated in STEMI

A

Cocaine

121
Q

Mc etiology of STEMI

A

Atherosclerotic plaque rupture > formation of a mural thrombus at site of rupture > occlusion

122
Q

Coronary plaques that are prone to rupture

A

Rich lipid core and fibrous cap

123
Q

Circadian variations of STEMI have been reported with clusters seen ___

A

In the morning, within a few hours of awakening

124
Q

MC presenting symptom of STEMI

A

Chest pain

125
Q

~___% of MIs are clinically silent

A

25

126
Q

Anterior vs inferior infarction: Sympathetic hyperactivity (tachycardia or hypertension)

A

Anterior

127
Q

Anterior vs inferior infarction: PSY hyperactivity (bradycardia or hypotension)

A

Inferior

128
Q

Heart disease that may present with radiation of discomfort to trapezius

A

Acute pericarditis

129
Q

When to request for cardiac markers

A

At presentation, 6-9 hours later, 12-24 hours later if diagnosis remains uncertain

130
Q

T/F Echo can distinguish acute STEMI from old myocardial scar

A

F, cannot

131
Q

Sequence of ECG changes in typical STEMI

A

ST elevation > T wave depression > Q wave development

132
Q

T/F Absence of Q wave = no STEMI

A

F, STEMI may be present in the absence of Q waves

133
Q

Initial therapy for STEMI

A

Aspirin, chewed

134
Q

In the absence of ___, fibrinolysis is not helpful and may be harmful in patients with MI

A

ST elevation

135
Q

Preferable symptoms-to-needle (PCI) time

A

Less than 2-3 hours

136
Q

Door-to-needle time for maximum benefit

A

Less than 30 minutes

137
Q

Patients who suffered from MI should be placed on bed rest for how long

A

First 12 hours; ambulate in room by 2nd to 3rd day in the absence of complications

138
Q

Correlates CHF mortality with severity of pump failure

A

Killip class

139
Q

Killip class: No signs of pulmonary or venous congestion

A

I

140
Q

Killip class: Moderate heart failure; R-sided heart failure

A

II

141
Q

Killip class: Severe heart failure; pulmonary edema

A

III

142
Q

Killip class: Shock with systolic pressure less than 90 mmHg

A

IV

143
Q

MCC complication of STEMI developed during hospitalization

A

Cardiogenic shock

144
Q

MC complication associated with transmural STEMI

A

Pericarditis

145
Q

Most out-of-hospital deaths from STEMI are due to

A

Sudden ventricular fibrillation

146
Q

Fibrinolysis is preferred over PCI in STEMI if patient presents ___ from onset

A

Less than 3 hours

147
Q

PCI is preferred over fibrinolysis in STEMI if patient presents ___ from onset

A

> 3 hours

148
Q

Resumption of work and sexual activity in post STEMI patients

A

2 weeks

149
Q

T/F Acute rheumatic fever (ARF) commonly develops in patients after untreated group A streptococcal infection

A

F, only ~3% develop ARF

150
Q

T/F ARF is more common after a GABHS pharyngitis than after a GABHS skin infection

A

T

151
Q

Used to detect GABHS after a throat infection

A

ASO

152
Q

Used to detect GABHS that is more sensitive to streptococcal pyoderma

A

Anti-DNAse-B

153
Q

Peak age of ARF

A

5-15 yo

154
Q

Most initial attacks of ARF in ADULTS occur at

A

End of second and beginning of 3rd decades of life

155
Q

Valve most often affected in ARF

A

Mitral

156
Q

Criteria for diagnosis of rheumatic fever

A

Jones criteria

157
Q

To fulfil the Jones criteria, either ___ OR ___ must be fulfilled

A

2 major; 1 major and 2 minor; + supporting evidence of a recent GABHS infection

158
Q

[USMLE] Order of affectation of heart valves in RF

A

Mitral > aortic&raquo_space; tricuspid

159
Q

Early cardiac lesion of RF

A

MR

160
Q

Late cardiac lesion of RF

A

MS

161
Q

RHD is what type of hypersensitivity reaction

A

II

162
Q

Carditis in RF involves what layer of the wall of the heart

A

All 3 (peri-, myo-, and endocardium); it is a pancarditis