Mksap 16 Cardio Part 3

Front 1

has the lowest rate of intracerebral hemorrhage among available thrombolytic agents

Back 1

streptokinase

Front 2

the most commonly used criterion to indicate successful reperfusion

Back 2

>50 % Improvement in ST elevation on ECG 1h post tPA

Front 3

initial beta blocker dose in ACS

Back 3

Metoprolol 5mg IV q3-5m x 3 doses; if SBP >90, start metoprolol 25 or 50 mg PO q6h

Front 4

patient with ACS and significant reactive airways disease, which beta blocker to choose?

Back 4

esmolol

Front 5

which should be given early, clopidogrel or glycoprotein 2b3a inhibitors?

Back 5

clopidogrel given at the time of hospital presentation; no benefit of early glycoprotein 2b3a inhibitors ED

Front 6

arrhythmia common with inferior MI

Back 6

bradycardia +/- hypotension; treat with IV fluids, atropine or dopamine

Front 7

arrhythmia common with anterior MI

Back 7

sinus tachycardia

Front 8

implication of complete heart block after MI

Back 8

common after anterior or inferior MI, in inferior infarction, it is usually transient; temporary pacing may be required; in anterior wall MI, it indicates large infarction and poor prognostic sign; permanent pacing required

Front 9

implication of vtach after MI

Back 9

within 24 hours usually self-limited and not assoc with worse outcome; if it occurs later, associated with larger MI and higher mortality risk

Front 10

establishes diagnosis of RV infarction

Back 10

right-sided ECG showing greater than 1 mm of ST-segment elevation in leads V3R and V4R

Front 11

presents 3 to 7 days after the initial MI as hemodynamic compromise with a new holosystolic murmur typically heard along the left sternal border

Back 11

VSD

Front 12

treatment of VSD post MI

Back 12

IABP and vasopressors ffd by surgical repair (mortality >50% but medical treatment alone mortality is 95%)

Front 13

presents several days after infarction with acute pulmonary edema, a loud systolic murmur without a thrill, and rapid progression to cardiogenic shock

Back 13

papillary muscle rupture

Front 14

treatment of papillary muscle rupture after MI

Back 14

IABP, afterload reduction with sodium nitroprusside, diuretics and emergent surgery

Front 15

presents 3 to 7 days after infarction as hemopericardium with pericardial tamponade, electromechanical dissociation, and death

Back 15

rupture of LV free wall

Front 16

risk factors for LV free wall rupture

Back 16

elderly age, female sex, first MI, and anterior location of MI.

Front 17

most common location for a thrombus post anterior MI

Back 17

apex of LV

Front 18

treatment of LV thrombus after MI

Back 18

warfarin x 3-6months

Front 19

NOTE: Current ACC/AHA guidelines allow a great deal of flexibility in choice of PCI or CABG for patients with diabetes,

Back 19

although CABG may be preferred for those with multivessel disease and left ventricular systolic dysfunction.

Front 20

Initial eval of heart failure should focus on assessing

Back 20

functional capacity (NYHA class) and volume status [ by symptoms (shortness of breath, orthopnea, paroxysmal nocturnal dyspnea), physical examination findings, daily body weight monitoring, and diagnostic studies (such as B-type natriuretic peptide [BNP] level)]

Front 21

Standard laboratory evaluation for initial assessment of heart failure

Back 21

CBC, CMP, Ca, Mg, lipid profile, Uric acid, TFTs, urinalysis, (LUTU)

Front 22

utility of BNP

Back 22

differentiating HF vs pulmo disease; <100 pg/mL excludes decompensated HF, but stable heart failure may have "normal ranges" for BP as high as 500 pg/mL

Front 23

indicated for patients with more severe heart failure (NYHA class III-IV)

Back 23

Treatment with spironolactone and hydralazine–isosorbide dinitrate (the latter specifically for black patients) IN ADDITION TO standard therapy with an ACE inhibitor and a β-blocker

Front 24

NOTE: A higher dose versus a lower dose of ACE inhibitor has not been shown to significantly affect survival

Back 24

but may reduce hospitalizations for heart failure.

Front 25

3 B-blockers that have M&M benefit in heart faliure treatment trials

Back 25

metoprolol succinate extended release, carvedilol, and bisoprolol.

Front 26

Digoxin in heart failure - benefits?

Back 26

Digoxin is not associated with a survival benefit but does decrease rates of hospitalization.

Front 27

patient on spironolactone develops gynecomastia, which alternative agent to choose

Back 27

EPLERENONE, selective aldosterone antagonist, more expensive

Front 28

guidelines for starting spironolactone based on evidence (3)

Back 28

NYHA class III-IV symptoms, K <5 and crea <2.5)

Front 29

two situations in which combined hydralazine and isosorbide dinitrate are indicated for treatment of systolic heart failure

Back 29

when ACE inhibitor or ARB therapy contraindicated (kidney disease or hyperK) and black patients with severe systolic HF (NYHA class III-IV) in addition to standard ACE inhibitor and β-blocker therapy.

Front 30

why use ISDN and not ISMN in heart failure?

Back 30

benefits seen with the hydralazine–isosorbide dinitrate combination are related to increased nitric oxide availability, because hydralazine possesses antioxidant properties and isosorbide dinitrate acts as a nitrate donor.