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CMN574- Unit 1 Cardiac Exam Questions And
Accurate Answers
OTC analgesics - Answer - Ibuprofen (Pericarditis)
- Naproxen- Acetaminophen
- ASA (Pericarditis, Acute MI) contraindications avoid NSAIDS with HFrEF (Heart Failure Reduced Ejection Fraction) Mineralcorticoid Receptor (MR) agonist - Answer - Sprinolcatone (K+ sparing)
- Eplerenone indications Inhibits aldosterone, symtomatic HFrEF, used as add on to diuretic, ACE, ARB, or ARNIand BB.
contraindicationshyperkalemia. monitor K levels 2-3 days, 1wk, and 4wk.
SE: hyperkalemia, gynecomastia Normal K+ = 3.5-5.0meq Loop Diuretic - Answer - Lasix (severe HF)
contraindications caution w/ dig can cause hypokalemia SE: intravascular volume depletion (IVVD), prerenal azotemia , hypotension,hypokalemia, skin rash, GI, ototoxicity
L=L ACEI - Answer - Lisinopril
- Captopril indications1st line CHF, reduce systemic vascular resistance (SVR), antagonize RAAS, reduce LV remodeling. HTN, CAD, DM, CKD, HFpEF, MI, HFrEF contraindications acute renal failure, hyperkalemia, hx angioedema SE: angioedema, dry cough, renal failure, cough, hyperkalemia ARB - Answer - Valsartan
- Candesartan indications same as ACEI, but do not use both together.
and hospitalization, does of prolong life, use indicated w/ symptomatic HFrEF class II-IVnot responsive to first line tx, SVT.
CCB (NDHP) - Answer - verapamil
- diltiazem indications cause vasodilation/decrease HR contraindications AV block/sinus node depression, bradycardia, increase dig level SE: constipation, pretibial edema, nausea, flushing, dizziness, decrease Left VentricularFailure
HCN channel blocker - Answer - ivabradine (Corlanor) indications inhibits slow NA channel of SA node, selective reduction of HR w/o reducing otherparameters, investigational, stable HF, HR >70 w/max or contraindicated BB use
contraindicationshepatic impairment, BP <90/50, SSS w/o PM, AFB, caution w/ bradycardia, sinus node dz, severe ventricular dysfunction SE: afib, bradycardia, sinus arrest, HB, visual distrubrances Nitrates/Vasodilators - Answer - Hydralazine + isosorbide dinitrate- Nitroglycerin
indicationsperipheral vasodilation, AMI, angina, HF, AA with persistent class III-IV HFrEF despite optimal tx with diuretics, ACE/ARB, BB and MR antagonist contraindicationsSildenafil (Viagra)- Need 8-12 hour break q24hrs.
SE: GI, HA, tachy, hypotension Antiaginal - Answer Ranolazine (Ranexa) indications increase efficiency of oxygen utilization, reduced HR & contractile force PDE 5 inhibitor - Answer - Sildenafil (Viagra): ED, pulmonary arterial HTN
- Tadalafil (Cialis): ED, BPH contraindicationscaution >50yo, CrCl <30, BP <90/50, aortic stenosis, IHSS, CHF/MI/CVA within 6months, nitrate use for HF or angina Thiazolidinedione-type - Answer pioglitazone: DM Factor X inhibitor - Answer - Clopidagrel (Plavix): ACS, or recent MI, CVA, PAD
- Apixaban (Eliquis): DVT/PE tx, CVA/hip/knee prophylaxis, AFIB
moderate intensity statin, high cholesterol, cardiac event prevention, ACD contraindicationspregnancy, myopathy, caution alcohol abuse caution hepatic disease, DM, hypothyroidism SE: myopathy, rhabdo, acute renal failure, SJS, erythema multiforme, DM, URI, HA,constipation, flatulence, CK, elevated, ALT, AST, elevated
aspartate aminotransferase (AST): liver panel alanine aminotransferase (ALT): liver panel*part of the comprehensive metabolic panel (CMP)
Thiazide Diuretic - Answer - Chlorthalidone: indicated for HFrEF, & mild fluid retention ifGFR > 40; not good for impaired kidneys.
Ejection Fraction (EF) - Answer expressed as a % of the total blood volume in the LV thatis ejected with each beat.
Normal= 55-70% Heart Failure with Preserved Ejection Fraction (HFpEF) - Answer also termed diastolicHF. About 1/2 of all HF patients have signs of HF, but have normal to near EF (>40%)
Heart Failure with Reduced Ejection Fraction (HFrEF) - Answer also termed systolic HF.About 1/2 of all HF patients have signs of HR and have a reduced EF (<40%)
HTN - Answer This leads to left ventricular hypertrophy.
CAD - Answer This leads to ischemia, MI, death of cardiac mm with loss of ventricularwall motion
Valvular Disease - Answer This leads to mitral or aortic stenosis or regurgitation Cardiomyopathy - Answer This condition can lead to viral infections, diabetes, and withexcessive alcohol it cause changes in myocardium leading to overall dysfunction of the heart. - disease of the heart mm, making it harder for the heart to pump. Tachyarrhythmias - Answer This can be due to AFIB, and thyroid dysfunction.
- type of arrhythmia Aging ?? - Answer This is not modifiable and leads to myocardial stiffening. Right side HF - Answer symptoms of fluid retention -peripheral edema-r upper quadrant abdominal pain to hepatic congestion -nausea, and anorexia Left side HF - Answer What side HF is this? symptoms of pulmonary congestion -SOB/dyspnea, first on exertion and finally at rest-orthopnea, paroxsmal noctural dyspnea, night time cough
L=L Leading cause of ______ HF is ______ HF - Answer right HF, left HF
- pulmonary arteries
- lungs
- left atrium8) mitral valve
- left ventricle10) aortic valve
- aorta
- the body CT Angio or Cardiac Cath - Answer These test may be used to evaluate patients withevidence of cardiac ischemia and to determine if revascularization would be beneficial
Heart Failure with preserved Ejection Fraction (HFpEF) - Answer There is no actualtherapy treatment for this type of HF. Management is geared toward treatment of comorbid conditions and management of fluid overload with diuretics. AFIB & Coronary Artery Disease (CAD) - Answer These two types of comorbidconditions are identified in up to 2/3 of patients with HFpEF.
BB or CCB - Answer You can rate control AFIB with these two types of agents.Anticoagulation is also used.
Cardiac rehab with dynamic exercise training. - Answer This is the only interventionshow to improve exercise capacity and quality of life in patients with HFpEF.
5-6g of salt/day (2.0-2.5g sodium/day) - Answer Moderate Sodium restriction to - g/of salt/day (____-____g sodium/day) is recommended for treatment of HFpEF
Diuretics (thiazide or loop) & Mineralcorticoid receptor Antagonist (spironalactone) -Answer What type of drugs are used to control symptoms of fluid overload in HFpEF? Be careful with excessive preload reduction resulting in hypotension.
Mineralocorticoid Receptor Antagonist: Spironalactone (Aldactone) - Answer Whatspecific drug is it important to monitor renal function and K+ at baseline, at 2-3 days, 1 week, 4 weeks, 8 weeks and then q3mo? ACE inhibitors "pril" - Answer This category of drugs play an important role in control ofHTN, CAD, DM and chronic kidney disease and help treat the comorbid conditions that contribute to HF. ARBs "sartan" - Answer This category of drugs are used to treat similar conditions asACE inhibitors like HTN, CAD, DM, and chronic kidney disease and also help treat the comorbid conditions that contribute to HF. Beta Blockers "lol" - Answer This category of drugs are potentially beneficial bycontrolling tachycardia, reducing myovardial 02 demands, and lowering BP. They are indicated especially for patients with angina or recent MI. Thiazide Diuretics (HCTZ or chlorthalidone) or Loop Diuretics (Lasix, Bumex, orTorsemide) +ACE inhibitor - Answer What are 1st line, long term medications used to manage HFrEF (LVEF<40%)? Thiazide Diuretics (HCTZ or Chlorthalidone) - Answer This class of drugs are useful formild fluid retention if GFR> 40ml/min
ACE inhibitors "pril" - Answer All _______ can cause INCREASE in K+, so monitorcarefully.
ACE inhibitors "pril" - Answer Azotemia (high levels of nitrogen containing compoundssuch as urea and creatinine) & hypotension are two side effects of ______. Also ANGIOEDEMA.
hospitalization for HF in last 12 months, with systolic BP>100 and GF >30 who havetolerated a high dose ACE or ARB.
20% - Answer ARNIs have a ____% decrease in CV death or hospitalization Angiotensin Receptor-Neprilysin inhibitor (ARNI)- Sacubitril-Valsartan (Entresto) - Answer DO NOT give this drug with an ACE or within 36hr of last ACE dose. HCN channel blocker
- Ivabradine (Corlanor) - Answer used for stable HFrEF patients with HR>70, in sinusrhythm who are on max tolerated dose of BB or have contraindications to BB.
HCN channel blocker - Answer Ivabradine (Corlanor) is what type of drug? HCN channel blocker
- Ivabradine (Corlanor) - Answer This drug decreases HR by inhibiting IF channels insinus node.
Hydralazine + Isosorbide Dinitrate - Answer This is recommended for AA patients withpersistent class III-IV HFrEF despite optimal treatment with diuretics, ACE or ARB, BB, and MR antagonist. *used with any race that can not tolerate ACE or ARB due to INCREASE K+, renalinsufficiency or hypotension.
Digoxin - Answer recommended for patients with HFrEF class II-IV who continue to havesymptoms despite appropriate therapy with diuretic, ACE, BB, and MR antagonist.
Digoxin - Answer This drug is also used in patients with HF and AFIB to controlventricular rate
Digoxin - Answer This drug improves symptoms of fatigue and dyspnea and exerciseintolerance for patients in HFrEF but no benefit in terms of overall mortality. not first line. Non-pharmacologic therapy for HF - Answer - implantable cardioverter/defib
- biventricular pacing
- coronary revascularization- LVAD (implanted in patient waiting heart transplant)
- palliative care Thiazolidinediones (TZDs) - Actos - Answer cause fluid retention and should be avoidedwith HFrEF
Used for Type 2 Diabetics Most CCB (except felodipine or amlodipine) - Answer because they increase HF, thisdrug class should be avoided with HFrEF
*They relax blood vessels and increase the supply of blood and oxygen to the heart,while reducing its workload. They generally should not be used if you have heart failure due to systolic dysfunction. NSAIDS - Answer decrease renal function and impairs response to ACE so these shouldbe avoided in HFrEF
Cox 2 inhibitors (Celebrex) - Answer increase HF exacerbations and should be avoidedin HFrEF
*newer type of NSAID
panic disorder pain - Answer precordial chest pain depression pain - Answer constant or intermittent heaviness unrelated to meals oractivity
screening for psychogenic chest pain - Answer 1) in the past 6 mo did you ever have anattack when all of a sudden you felt anxious, frightened or very uneasy?
- in the past 6 mo did you ever have an attack where for no reason your heart suddenlybegan to race and you felt faint or couldnt catch your breath?
yes to either is positive. no to both is negative. respiratory disorders - Answer this accounts for 5-10% of non cardiac chest painpatients and causes include bronchitis, pneumonia, asthma, COPD, pneyumonitis, pleurisy, and PE. pneumonia pain - Answer dull or no pain- sudden PE or plueritis - Answer sharp, stabbing, usually localized to one side, worse with deepbreath or cough - gradual
Wells score - Answer this predicts risk for PE, used to determine testing. Mitral Valve Prolapse (MVP) - Answer this type of murmur is usually asymptomatic, butmay have non-specific CP, dyspnea and palpitations
Mitral Valve Prolapse (MVP) - Answer found up to 10% of healthy females usually thin,Marfan's or Ehlers-Danlos Syndrome at higher risk.
Mitral Valve Prolapse (MVP) - Answer - pansystolic or holosystolic
- late systole with a single to multi mid-systolic click
- floppy valve look for skeletal changes such as pectus excavatum or scoliosis because collegendisorder
aortic aneurysm/ dissection - Answer - usually presents to the ER due to the severity ofsymptoms.
- abrupt onset of severe, tearing, ripping or knife-like CP radiating to back
- diff in BP between R & L arm.- harsh holosystolic murmur due to aortic insufficiency.
pericarditis - Answer - pleuritic substernal chest pain that may radiate to shoulders,back or epigastrium.
- pain worse when supine.
- fever and dyspnea are common.- pericardial friction rub often heard.
pericarditis - Answer treatment: bedrest, ASA, or NSAIDS, colchicine, steroids 37% - Answer about ____% of patients that experience ANY acute coronary event, eitherangina or MI will die of it in the same year!
Coronary Artery Disease (CAD) - Answer #1 killer in the US and WORLDWIDE risk factors for CAD - Answer - male
- increases with age- fam hx, younger onset
nitroglycerin (NTG) - Answer what medication is a diagnosis of angina if it relieves orshortens attack or if it prophlacticly allows greater exertion or prevents attacks.
history - Answer ___________ is the most useful in diagnosing chronic stable angina. chronic stable angina - Answer - resting ECG may be normal or show signs of old MI,non-specific ST-T wave changes or LVH
- during attack: horizontal or down-sloping ST segment depression that reverses whenischemia resolves. T wave flattening may also occur.
ST segment elevation - Answer ____________ indicates more severe ischemia and is alsoseen with coronary vasospasm
Exercise Stress Test - Answer this test is NOT recommended for asymptomaticindividuals to screen for CAD due to high false pos unless they are at special risks (airline, pilots, etc.) high false pos lead to more invasive testing Coronary Artery Disease (CAD) - Answer refer for coronary angiography if high pre-testprobability for ________.
sublingual nitroglycerin - Answer _____________ is the drug of choice for acute anginaattacks. acts in 1-2 mins.
- available in 0.3, 0.4, and 0.6 mg tabs
- take at onset of pain and repeat 3-5 mins long acting nitrates (Isosobide) - Answer oral, ointment, or transdermal patch
- main SE: headaches
- tolerance develops
- include a 8-10hr/ day period without these. Viagra - Answer this drug is ALWAYS CONTRAINDICATED if the patient is on nitrates.Always ask about this drug.
beta blockers "lol" - Answer - considered first line antianginal agent for most anginapatients
- only drug shown to prolong life (post MI) in patients with CAD beta blockers "lol" - Answer severe broncospastic disease (asthma), bradyarrhythmias,and decompensated heart failure are all contraindications to
Ranolazine (Ranexa) - anti-anginal - Answer give ________ for 1st line for chronic anginaif BB is contraindicated, because it does not have an affect on BP or HR.
Ranolazine (Ranexa) - Answer can be used as monotherapy or in addition to otherantianginals, and safe to use with erectile dysfunction meds
Ranolazine (Ranexa) - Answer contraindicated in patients with prolong QT interval orpatients taking medications that prolong QT such as some anti-arrhythmics or antibiotics (macrolides and fluroquinolones). Ranolazine (Ranexa) - Answer decreases occurrence of AFIB and slightly decreasesHBA1C
CCB - Answer considered 3rd line anti-ischemic drug for post MI patients due toincreased ischemia and increased mortality rates
- also should be avoided in patients with HF with reduced EF.
