Term
| Which Cardiac Meds prolong survival Post MI? |
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Definition
| Beta-blockers./.Carvedilol./.ACE inhib./.ARBs./.ASA |
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Term
| Which Cardiac Meds Prolong Survival in Heart Failure? |
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Definition
| Beta-blockers...Carvedilol ...ACE inhib ...ARBs Amlodipine...Nitrates... Hydralizine Spironolactone...(Add the ANHS and drop the ASA for Post MI survival Meds) |
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Term
| What effect does Nitrates have on 02 demand? |
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Definition
| Decreases myocardial O2 demand. |
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Term
| List meds that decrease O2 myocardial demand. |
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Definition
| Nitrates...Beta Blockers...Calcium Channel Blockers |
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Term
| True or False.....Ventricular tachycardia or fibrillation within 48 hours of an MI imply a worse prognosis. |
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Definition
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Term
| Conduction disturbances are most common with what type of MI? |
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Definition
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Term
| Which MI is more likely to have a new bundle branch block or high grade AV block? |
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Definition
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Term
| Which MI is more likely to have primary or secondary Type I block (usually temporary) |
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Definition
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Term
| Which MI is known to have LESS myocardium lost? |
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Definition
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Term
| Which cardiac marker is released most rapidly from injured muscle cells? |
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Definition
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Term
| Which Cardiac Marker peaks in the first 12-24 hours |
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Definition
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Term
| Which Cardiac Marker is highly specific for an acute MI |
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Definition
| Troponin I (slightly better than T)... Useful for patients who present more than 24-48 hrs out. |
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Term
| What is the best combo for Cardiac Markers? |
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Definition
| Troponin I (or T) and CKMB1 |
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Term
| When do you NOT give Clopidogrel? |
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Definition
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Term
| Name a Platelet GP IIb/IIIa Antagonist |
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Definition
| eptifibatid_(Integrilin)...tirofiban_(Aggrastat) |
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Term
| In patients for whom PCI is planned what agents should be give? |
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Definition
| Eptifibatide or tirofiban should be given, in addition to ASA and heparin (and perhaps clopidogrel), to patients in whom PCI is planned. These agents should be given, in addition to ASA and haparin, in high-risk patients in whom an invasive strategy is NOT planned. |
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Term
| Fibrinolytics should be given within how many hours after the onset of pain? |
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Definition
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Term
| ABSOLUTE Contraindications for Fibrinolytic Agents? |
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Definition
| Previous hemorrhagic stroke at ANY time or other cerebrovascular events within 1 year...Intracranial neoplasm...Active internal bleeding...Suspected Aortic dissection. |
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Term
| When is fibrinolytic therapy indicated in patients with Unstable angina or NSTEMI? |
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Definition
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Term
| Contraindications to Beta Blocker in MI? |
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Definition
| Bradycardia...2nd or 3rd degree block... Hypotension...h/o bronchospasm...pulmonary congestion... but NOT Diabetes. |
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Term
| When should ACE inhibitors be started post MI? |
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Definition
| In anyone with a large MI or an LVEF <40%. The worse the LV function the better response from ACE inhibitors. They should be continued indefinitely. |
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Term
| Summary of Post MI Medications... |
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Definition
| Beta blockers are continued indefinitely.. ASA is continued indefinitely.. ACE inhibitors are continued indefinitely if there is LV dysfunction.. CLOPIDOGRIL is continued for NINE MONTHS... Lipid lowering drugs should be given to bring LDL below 100mg/dl |
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Term
| When is Left Heart Catheterization not accurate? |
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Definition
| When there is valvular stenosis in low output states or with conconmitant regurgitation; the Left Heart Cardiac Catheterization lacks accuracy. |
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Term
| What are the contraindications for Left Heart Catheterization? |
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Definition
| Contraindications are all relative for Left Heart Cath. |
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Term
| How do you measure the PCWP and what value is normal? |
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Definition
| Do a Right heart cath...normal is <12. |
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
| When is a Stress Test + ? |
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Definition
| A Positive Stress Test is at least 1mm of horizontal or downsloping ST depression 80 msec from the J-point. |
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Term
| What is this? Right Heart Cath Pressures:... RA = 18.... PA = 40/30...PCWP = 30....BP = 70/50 |
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Definition
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Term
| What is this? Right Heart Cath Pressures: ...RA = 18.... PA = 90/32... PCWP = 30... BP = 110/70 |
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Definition
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Term
| What is this? Right Heart Cath Pressures: ...RA = 18... PA = 90/32... PCWP = 10.... BP = 110/70 |
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Definition
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Term
| What is this? Right Heart Cath Pressures: ... RA = 18... PA = 32/18 ... PCWP = 17 ... BP = 70/50 |
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Definition
| Tamponade (note the equaliation of diastolic pressures) also see this with constrictive pericarditis. |
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Term
| What is this? Right Heart Cath Pressures: ...RA = 4 ... PA = 15/5 .... PCWP = 9 ...BP = 110/70 |
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Definition
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Term
| What is Pulsus Parvus et Tardus caused by? |
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Definition
| Aortic Stenosis (AS). May not be present in the elderly in spite of severe AS. |
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Term
| A delay in RV emptying causes what change to the S2? |
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Definition
| Fixed Split (Persistently Split) S2 |
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Term
| A delay in LV emptying causes what change to S2? |
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Definition
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Term
| List four causes of a Fixed or Persistently Split S2. |
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Definition
| PE...PS...RBBB...Extopic LV rhythm |
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Term
| What is this:....Heard in early diastole with rapid passive filling of a stiff ventricle. |
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Definition
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Term
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Definition
| Children and usually in pregnant women. Abnormal over the age of 40. |
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Term
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Definition
| TR...MR...AR...(LV or RV) dysfuction. |
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Term
| CONCENTRIC coronary plaques cause what type of Angina? |
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Definition
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Term
| RUPTURED plaques cause what type of Angina? |
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Definition
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Term
| What percentage of patients with ischemic ST changes have angina? |
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Definition
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Term
| What causes painless ST segment changes on stress testing. |
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Definition
| Silent Myocardial Ischemia and it is caused by inadequate perfusion. |
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Term
| With regard to the prognosis of CAD what is most closely related to Longevity? |
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Definition
| LV function (this is the most powerful risk stratification parameter in all of cardiology)..... Severity of the angina ....Exercise capacity: the duration of exercise on a stress test (measured in METs) is highly predictive of prognosis. Note that none of these parameters requies coronary angiograpy. |
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Term
| When an area of the myocardium has enough perfusion to maintain myocardial viability, but not enough to contract what do you call it? |
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Definition
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Term
| What Test is the GOLD STANDARD for Hibernating Myocardium? |
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Definition
| Positron Emission Tomography (PET) |
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Term
| What is this? Hypotension, clear lung fields, and elevated JVP (Kussmaul's sign) |
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Definition
| RV infarction....avoid nitrates (preload reducing agents) ...give IV fluids and frequently Dobutamine. |
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Term
| How do you treat STABLE VT? |
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Definition
| Lidocaine bolus of 1.0 - 1.5 mg/kg followed by 2 - 4 mg/min infusion....... Amiodrone 150 mg infused over 5 minutes followed by a constant infusion of 1.0 mg/min for 6 hours. |
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Term
| AV High-grade block is usually seen with: |
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Definition
| Anterior MI (usually infraHisian) |
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Term
| How do you treat a High-grade AV block? |
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Definition
| Temporary pacing. Anterior infarcts which produce new AV block have a very high mortality. |
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Term
| When is valve surgery better than no surgery? |
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Definition
| When the patient is symptomatic at rest. |
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Term
| Which is better Valve Replacement or Repair? |
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Definition
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Term
| What is the best test for mitral valve prostheses function? |
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Definition
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Term
| Areas of the heart with poor uptake of thallium both at rest and exercise indicate what? |
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Definition
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Term
| S3 is abnormal in patients greater than what age? |
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Definition
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Term
| What type of coronary artery lesions are associated with UNSTABLE ANGINA? |
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Definition
| Irregular, ulcerated plaques |
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Term
| Which Ca. channel-blocker has the most NEGATIVE INOTROPIC effect? |
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Definition
| Diltiazem/Verapamil (this is why they are not used with beta-blockers). |
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Term
| Which does NOT require Heparin: t-PA or streptokinase? |
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Definition
| Streptokinase does NOT NEED HEPARIN TO MAINTAIN VESSEL PATENCY. |
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Term
| How long should elective surgery be delayed after an MI? |
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Definition
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Term
| What percentage of MI patients develop unstable angina within the 1st week after an MI? |
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Definition
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Term
| What is the best prognostic factor after an MI? |
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Definition
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Term
| List two lifestyle habits and one hormone that INCREASES HDL? |
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Definition
| Exercise...Drinking a little EtOH...and being Female (Estrogen increases HDL) |
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Term
| Does Balloon angioplasty affect survival? |
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Definition
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Term
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Definition
| Type 2 Second degree heart block, also known as Mobitz II heart block is a disease of the distal conduction system. This is also known as Infrahisian block because the level of block is below the bundle of His. Mobitz II heart block is characterized on a surface ECG by a fixed PR interval with a dropped QRS complex after a certain number of P waves. For instance, for every 4 P waves, there are only 3 QRS complexes. |
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Term
| A heart block can be a blockage at any level of the electrical conduction system of the heart. Clinically speaking, most of the important heart blocks are which type? |
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Definition
| Blocks that occur within the sinoatrial node (SA node) are described as SA nodal blocks. Blocks that occur within the atrioventricular node (AV node) are described as AV nodal blocks. Blocks that occur below the AV node are known as infra-Hisian blocks (named after the bundle of His). Clinically speaking, most of the important heart blocks are AV nodal blocks and infrahisian blocks. |
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