Spring 2011 Heart Dz ?adult? Final?

Front 1

What are the

2 MOST-COMMON-CAUSES
of
CHF?

Back 1

MI and HTN

2 MOST-COMMON-CAUSES
of ?

Hint 1

CHF

Front 2

Besides a loss of CO
what else can valve disease cause?

Back 2

CHF

Front 3

what condition is the
most common symptoms:
SOB -->
(especially) DOE --->
ORTHOPNEA --->
PND --->
D@R
?

(dyspnea @ rest)

(P.aroxysmal N.octurnal D.yspnea)

Back 3

Left ventricular heart failure


most common symptoms:
?

Hint 3

SOB -->
(especially DOE) --->
ORTHOPNEA --->
PND --->
D@R
dyspnea @ rest

Front 4

In this condition

-Signs of fluid retention predominate
-Elevated venous pressure
-Hepatomegaly
-Dependent edema.

Back 4

Right ventricular failure

what are the 4ct S/S?

Hint 4

-Signs of fluid retention predominate
-Elevated venous pressure
-Hepatomegaly
-Dependent edema.

Front 5

What causes right ventricular failure most of the time?

Back 5

Left ventricular failure

Front 6

This substance is expressed primarily in the ventricles
is elevated when ventricular filling pressure is high
Measuring it helps differentiate
dyspnea due to heart failure
from
non-cardiac causes.

Back 6

BNP

What is its Rx Name?

Hint 6

Nesiritide

Front 7

CBC
renal function tests
electrolytes
thyroid
iron studies are helpful
for what workup?

Back 7

CHF

Front 8

What test
(and what workup is it part of?)
may indicate (or show) an
underlying
or
secondary arrhythmia
MI
intraventricular conduction defects
LVH
non specific repolarization changes.

Back 8

ECG
in a work-up for
CHF

Front 9

What is the MOST-EFFECTIVE means of providing symptomatic relief for patients with mild to moderate CHF?

Back 9

Diuretics

Front 10

What combination of drugs is recommended for the initial treatment of CHF?

What older drug can be used should that fail?

+h

Back 10

Diuretic and an ACEI

Digitalis

Hint 10

D.A.D.

Front 11

Vasodilators such as

hydralazine
and
isosorbide

are especially useful for CHF (HF) in what group of patients?

Back 11

African Americans

are especially useful for what Rx

Hint 11

Vasodilators such as

hydralazine
and
isosorbide

Front 12

Implantable defibrillators significantly reduce mortality in what disease?

Back 12

Heart failure

Front 13

Biventricular pacing
which ameliorates abnormal conduction
is indicated for heart failure patients with what ejection fraction?

Back 13

>35%

Front 14

Why do case management
for
CHF?

Back 14

30-50% of CHF pts

who are hospitalized will be

readmitted in
3-6 mo.

Front 15

5 year mortality for heart failure is

Back 15

50%

Front 16

What can precipitate

Acute cardiogenic pulmonary edema?

Back 16

An acute

L. Ventricular
Ejection Fraction
Loss

Front 17

This Dz presents as:

-Rales in all lung fields
-Wheezes and Rhonchi
in the setting of
-Heart pathology

could indicate what?
A chest xray might show vascular distribution changes or
a butterfly pattern of alveolar edema

This Dz needs to be in the front of our brain since it is not directly related to HF.

Back 17

CF

This Dz presents as:

Hint 17

-Rales in all lung fields
-Wheezes and Rhonchi
in the setting of
-Heart pathology

Front 18

In acute pulmonary edema
What is the goal for arterial PO2 ?

Back 18

60 mmhg

Front 19

This drug
~used in pulmonary edema
~reduces venous capacity
but
~should not be used in neurogenic pulmonary edema

Back 19

Morphine

Reduces what capacity?
Should not be used in What Condition?

Hint 19

~Reduces Venous Capacity

~Neurogenic Pulmonary Edema

Front 20

This drug class
used in pulmonary edema
offers venousdilatation in addition to their other effects

Back 20

Diuretics

Front 21

Accelerates clinical improvement of pulmonary edema by reducing BP and LV filling pressures
but may precipitate hypotension

Back 21

Nitrates

Front 22

Improves dyspnea more rapidly than IV nitrates
but may precipitate hypotension

Back 22

BNP


&
what is its
Rx
Name?

Hint 22

(nesiritide)

Front 23

Chest pain that is reproducible or
worsened with palpation indicates what?

Back 23

Musculoskeletal cause

Front 24

What is suggestive of nonischemic chest pain?

Back 24

Pointing to the location of the pain

Front 25

what is the 3rd DDx (dz condition) to exclude when diagnosing

-Pericarditis
-Friction Rub
-__________?

How is this done?
what PE manuever?

+h

Back 25

Cardiac Tamponade

by
Looking for pulsus paradoxus and JV pulsations

Hint 25

PP

JVP

Front 26

What could the absence of physical findings with suspected PE mean?

Back 26

Increased likelihood for PE

Front 27

T or F: ECG on its own can rule out a cardiac cause.

Back 27

F

Front 28

What age does a first degree relative have to be during their event to count as a risk factor for CAD?

Back 28

Male 55
female 65.

Front 29

~Myocardial Hypertrophy
~Atherosclerosis
~Arteritis
~Dissection
or
a number of other problems can cause this condition


MAAD

Back 29

Angina pectoris

Nm the 4 conditions that are causes?

Hint 29

These Dz have what in common.....has to do with perfusion

~Myocardial Hypertrophy
~Atherosclerosis
~Arteritis
~Dissection

Front 30

The threshold for
?__what problem__?
can be lowered by

- cold weather
- coronary spasm
- excitement
- sex

Back 30

Angina

The threshold for
Angina
can be lowered by

Hint 30

- cold weather
- coronary spasm
- excitement
- sex

Front 31

Where is the discomfort of angina usually felt?

Back 31

Left and moves centrally

Hint 31

The types of angina are:

Stable angina.
pain is predictable and present only during exertion or extreme emotional distress, disappearing with rest.

Unstable angina.
may signal an impending heart attack.
Angina pain that is different from your regular angina pain
or pain that occurs while at rest.
may occur more frequently,
easily at rest,
feel more severe,
last longer, or
come on with minimal activity.

Although this type of angina can often be relieved with medication, it is unstable and may progress to a heart attack.

Prinzmetal's angina.
angina occurs at rest,
sleeping,
when exposed to cold temperatures.
In these cases, the symptoms are caused by decreased blood flow to the heart's muscle from a spasm of the coronary artery.

The majority of people with this type of angina also have coronary artery disease.
These spasms occur close to the blockage.

Front 32

How long does angina usually last after the patient stops to rest?

What length of attack is suggestive of something else?

Back 32

Usually < 3 minutes

thirty minutes

Front 33

What heart sounds can sometimes be found in CAD?

CAD +info

Back 33

Gallop
or
Apical systolic murmur

due to

Transient
Mitral Regurgitation

What disease process are we discussing.?

Hint 33

Coronary Artery Dz

Front 34

Sharply localized tenderness of intercostal muscles is what syndrome?

Back 34

Anterior chest wall syndrome

Front 35

What causes intercostal neuritis?

Back 35

Herpes Zoster

&/or

DM

What thoracic Dz do these two cause: ?

Hint 35

intercostal neuritis

Front 36

~What test is the definitive diagnostic procedure for angina?

~When is this used?

Back 36

Coronary Angiography

-Activities are Limited....Despite Adequate Rx Regimen
-Concomitant valve disease

many more reasons see H+

Hint 36

Coronary Angiography (C 320)
• The definitive dx procedure for CAD
• Perform in the following circumstances if percutaneous transluminal coronary angioplasty or bypass is a consideration:
1. Limiting stable angina despite an adequate medical regimen
2. Clinical presentation or noninvasive testing suggests high-risk disease
3. Concomitant aortic valve disease and angina pectoris to determine whether the angina is due to accompanying coronary disease
4. Asymptomatic older patients undergoing valve surgery so that concomitant bypass may be done if needed
5. Recurrence of symptoms after coronary revascularization to determine whether bypass grafts or native are occluded
6. Cardiac failure where a surgically correctable lesion is suspected
7. Survivors of sudden death or symptomatic or life-threatening arrhythmias when CAD may be a correctable cause
8. Chest pain or cardiomyopathy of uncertain cause
9. Puke! Enough already

Front 37

What might be done for angina pectoris when there is left main coronary artery stenosis greater than 50% with or
without sx?

Back 37

Revascularization

Front 38

What might be done for patients with three vessel disease
<50% ejection fraction of LV?

Back 38

Revascularization

Front 39

Patients with mitral stenosis are usually presumed to have underlying rheumatic heart disease
though a history of rheumatic fever is usually only in what fraction?

Back 39

1/3

Front 40

Indicated when combined stenosis and regurgitation are present in the mitral valve

Back 40

Valve replacement

Front 41

Surgery is indicated for uncontrolled symptoms
or
when the LV ejection fraction is <60%
what murmur?

Back 41

Mitral valve regurgitation