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Cardiovascular Flashcards

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1
Q

What is the most common cause of death for people with diabetes mellitus?

A

C. Cardiovascular disease

Diabetes mellitus is a significant risk factor for cardiovascular disease, which is the most common cause of death among adults with diabetes mellitus.

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2
Q

According to the Virchow triad, which of the following contributes to the development of a venous thromboembolism?

A

B. Venous stasis

The Virchow triad includes alterations in blood flow (e.g., stasis), vascular endothelial injury, and alterations in blood components (e.g., hypercoagulable state).

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3
Q

True or false: Telangiectasias contribute to deep vein or superficial thrombosis.

A

FALSE

Telangiectasias are superficial ‘spider veins’ and do not cause thrombosis.

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4
Q

Which NYHA Functional Class is characterized by no symptoms and no limitation in physical activity?

A

Class I

Class I indicates the absence of symptoms and limitations.

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5
Q

What does Class II in the NYHA Functional Classification indicate?

A

Mild symptoms and slight limitation during ordinary activity

Patients may experience symptoms during physical activities but are comfortable at rest.

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6
Q

In the NYHA Functional Classification, what does Class III signify?

A

Marked limitation in activity due to symptoms but comfort at rest

Patients may experience symptoms even with short distances.

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7
Q

What is the defining characteristic of Class IV in the NYHA Functional Classification?

A

Severe limitations and experiencing symptoms at rest

Patients are unable to carry out any physical activity without discomfort.

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8
Q

A patient with mild symptoms such as fatigue and dyspnea while walking or climbing stairs rapidly would be classified as which NYHA Class?

A

Class II

This classification indicates slight limitations during ordinary activities.

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9
Q

Heart failure with an ejection fraction of 40% or less is categorized as which type?

A

Heart failure with reduced ejection fraction (HFrEF)

HFrEF is also known as systolic heart failure.

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10
Q

An ejection fraction of 41% to 49% is defined as which type of heart failure?

A

Heart failure with mid-range ejection fraction (HFmrEF)

This category falls between HFrEF and HFpEF.

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11
Q

Heart failure with an ejection fraction of 50% or higher is known as what?

A

Heart failure with preserved ejection fraction (HFpEF)

HFpEF is also referred to as diastolic heart failure.

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12
Q

What primarily causes left-sided heart failure?

A
  • Left heart pathologies
  • Left ventricular dysfunction
  • Mitral valve dysfunction
  • Aortic valve dysfunction

These conditions affect the left side of the heart’s ability to pump effectively.

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13
Q

What are the common causes of right-sided heart failure?

A
  • Right heart conditions
  • Pulmonary hypertension
  • Right ventricle dysfunction
  • Pulmonic valve dysfunction
  • Tricuspid dysfunction

Right-sided heart failure is often linked to issues affecting the right side of the heart.

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14
Q

What is the most common microbial cause of infective endocarditis in the United States and most developed countries?

A

Staphylococcus aureus

S. aureus is the most common cause, while worldwide, the three most common causes are staphylococci, streptococci, and enterococci.

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15
Q

Name the three most common causes of infective endocarditis worldwide.

A
  • Staphylococci
  • Streptococci
  • Enterococci

Staphylococci are common in healthcare-associated cases, while streptococci are common in community-acquired cases.

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16
Q

True or false: Staphylococcus aureus is a common cause of community-acquired infective endocarditis.

A

FALSE

Streptococci are more commonly associated with community-acquired infective endocarditis.

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17
Q

Fill in the blank: Staphylococci is a common cause of _______ infective endocarditis.

A

healthcare-associated

This highlights the distinction between types of infective endocarditis based on the source of infection.

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18
Q

When does a cardiac transplant recipient require antibiotic prophylaxis for a tooth extraction?

A

Only if they have developed cardiac valvopathy

This indicates that not all cardiac transplant recipients need prophylaxis for tooth extractions.

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19
Q

Prevention of infective endocarditis

A

Patience with a high risk condition or implanted device are recommended to receive antibiotic prophylaxis prior to invasive, dental or oral procedures 

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20
Q

Which medication is indicated for treatment in patients presenting with Raynaud’s phenomenon?

A

Amlodipine

Amlodipine is a dihydropyridine calcium channel blocker used for initial pharmacologic therapy.

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21
Q

What is the initial approach for treating Raynaud’s phenomenon?

A
  • Avoiding cold exposure
  • Avoiding vasoconstricting drugs
  • Smoking cessation

Nonpharmacologic therapy is often the first step in managing symptoms.

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22
Q

Name an alternative option for pharmacologic therapy in Raynaud’s phenomenon.

A
  • Phosphodiesterase type 5 inhibitors
  • Topical nitrates
  • Losartan
  • Fluoxetine

These alternatives can be used in combination to control symptoms.

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23
Q

Which therapies are not recommended for Raynaud’s phenomenon due to lack of efficacy?

A
  • Angiotensin-converting enzyme (ACE) inhibitors
  • Prazosin
  • Methyldopa

These therapies do not provide sufficient evidence of benefit for Raynaud’s phenomenon.

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24
Q

True or false: Omega-3 fatty acids are recommended as first-line therapy for triglyceride reduction.

A

FALSE

Omega-3 fatty acids may be considered for high ASCVD risk but are not first-line therapy.

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25
What is the primary goal of treatment for patients with **moderate-to-severe hypertriglyceridemia**?
Reduce the risk of pancreatitis ## Footnote This is crucial for managing patients with triglyceride levels above 250 mg/dL.
26
Why is **niacin** not routinely recommended for triglyceride reduction?
Limited benefit and risk of adverse effects ## Footnote Niacin has shown limited effectiveness in managing triglyceride levels.
27
Fill in the blank: The first-line treatment for triglyceride levels of 550 mg/dL is _______.
Fibrate therapy ## Footnote Fibrates are effective in lowering triglyceride levels.
28
What is the **preferred antibiotic** for the prevention of infective endocarditis in patients with a prosthetic heart valve undergoing routine dental cleaning?
Amoxicillin ## Footnote Patients with a prosthetic heart valve should be prescribed an oral antibiotic regimen prior to invasive dental or oral procedures.
29
True or false: Routine dental cleaning is an indication for **antibiotic prophylaxis** in patients with a prosthetic heart valve.
TRUE ## Footnote Patients should receive an oral antibiotic regimen to prevent endocarditis before the procedure.
30
What is an **alternative option** to Amoxicillin for antibiotic prophylaxis if the patient is allergic to penicillin?
Cephalexin ## Footnote Clindamycin is no longer recommended for antibiotic prophylaxis prior to dental procedures.
31
Which antibiotic is **no longer recommended** for antibiotic prophylaxis prior to dental procedures?
Clindamycin ## Footnote The preferred agent for prophylaxis is Amoxicillin.
32
For patients with a prosthetic heart valve, what should be done before **invasive dental or oral procedures**?
Prescribe an oral antibiotic regimen ## Footnote This is to prevent infective endocarditis.
33
What does a **narrow QRS complex** indicate in an EKG?
QRS < 120 milliseconds ## Footnote This is characteristic of **supraventricular tachycardia**.
34
For a hemodynamically stable patient with **supraventricular tachycardia**, what is the initial treatment?
B. Vagal maneuver ## Footnote Vagal maneuvers are a safe and effective first-line treatment according to the 2015 ACC/AHA guidelines.
35
True or false: **Synchronized cardioversion** is the first-line treatment for stable patients with supraventricular tachycardia.
FALSE ## Footnote Synchronized cardioversion is considered if the patient is unstable.
36
If **vagal maneuvers** are ineffective in treating supraventricular tachycardia, what are the second-line treatment options?
* Adenosine * Diltiazem ## Footnote These options are considered if initial vagal maneuvers do not resolve the tachycardia.
37
What is the likely diagnosis for a patient with **hypertension** experiencing severe chest pain lasting 30 minutes?
Unstable angina ## Footnote The patient denies current chest pain and has a negative troponin I test.
38
True or false: **Stable angina** refers to chest discomfort that occurs unpredictably and is not relieved by rest.
FALSE ## Footnote Stable angina occurs predictably at a certain level of exertion and is relieved by rest or nitroglycerin.
39
What distinguishes **unstable angina** from stable angina?
Unstable angina lasts longer than 20 minutes and occurs unpredictably ## Footnote Stable angina is predictable and relieved by rest.
40
What does a **12-lead EKG** reveal in this patient?
Normal sinus rhythm with a rate of 72 beats/min ## Footnote No ST elevation at the J point in two contiguous leads indicates a low likelihood of STEMI.
41
Which diagnosis is unlikely given the **12-lead EKG** findings?
ST-elevation myocardial infarction (STEMI) ## Footnote The EKG does not show ST elevation, which is required for a STEMI diagnosis.
42
Diastolic murmurs
Mitral stenosis and aortic regurgitation
43
Systolic murmur
Mitral, regurgitation and aortic stenosis
44
 Moderate statin therapy
For adults age 40 to 75 years with diabetes mellitus and LDL cholesterol ≥70 mg/dL at a 10-year ASCVD risk of ≥7.5%, start moderate-intensity statin therapy.
45
What is the **LDL cholesterol level** threshold that indicates the start of moderate-intensity statin therapy for adults with diabetes mellitus?
≥70 mg/dL ## Footnote This applies to adults age 40 to 75 years with a 10-year ASCVD risk of ≥7.5%.
46
True or false: **Fibrate therapy** is indicated for patients with low-density lipoprotein (LDL) cholesterol levels.
FALSE ## Footnote Fibrate therapy is indicated for high triglycerides, not for LDL cholesterol management.
47
What may be reasonable for patients on maximally tolerated statin therapy whose **LDL cholesterol levels** remain **≥70 mg/dL**?
Cholesterol-absorption inhibitors (e.g., ezetimibe) ## Footnote These inhibitors can be considered when LDL levels do not reach the target despite statin therapy.
48
What are the dosage ranges for **high-intensity statins**?
* Atorvastatin: 40 to 80 mg * Rosuvastatin: 20 to 40 mg ## Footnote Dosage ranges define the intensity of statins for cholesterol management.
49
Atorvastatin 10 to 20 mg is classified as a **__________** statin.
moderate-intensity ## Footnote This classification helps in determining the appropriate treatment for patients.
50
Pravastatin 10 to 20 mg is classified as a **__________** statin.
low-intensity ## Footnote Understanding statin intensity is crucial for effective cholesterol management.
51
Simvastatin 20 to 40 mg is classified as a **__________** statin.
moderate-intensity ## Footnote This classification is important for prescribing the correct dosage.
52
Point of maximum impulse located
Fifth intercostal space left midclavicular line
53
high-intensity statin therapy
indicated for patients with severe primary hypercholesterolemia LDL > 190
54
True or false: **Niacin and fibrates** are routinely recommended in combination with statin therapy.
FALSE ## Footnote Niacin and fibrates are triglyceride-lowering drugs with mild LDL-lowering action but are not routinely recommended with statins.
55
What LDL-C level indicates the need for **high-intensity statin therapy** in patients with severe primary hypercholesterolemia?
≥190 mg/dL ## Footnote High-intensity statin therapy is indicated for patients with severe primary hypercholesterolemia.
56
If a patient's LDL-C level remains **≥100 mg/dL** after statin plus ezetimibe, what therapy can be considered?
PCSK9 inhibitor ## Footnote This is considered if the patient has multiple factors that increase risk of atherosclerotic cardiovascular disease (ASCVD) events.
57
Fill in the blank: **Ezetimibe** is added if the LDL-C level remains _______ mg/dL.
≥100 ## Footnote Ezetimibe is a reasonable next step for patients whose LDL-C remains elevated despite high-intensity statin therapy.
58
Saw tooth pattern on EKG about 300 bpm
Atrial flutter
59
Which agent is used for **rate control** in atrial flutter?
Diltiazem, verapamil Non-dihydropyridine calcium channel blockers Beta blockers
60
True or false: **Digoxin** is frequently used for rate control in atrial flutter.
FALSE ## Footnote Digoxin is used less frequently due to side effects and toxicity.
61
What is the **drug of choice** for pharmacologic reversion in atrial flutter?
Ibutilide ## Footnote Ibutilide is an alternative option for reverting to normal sinus rhythm.
62
What is a common **definitive treatment** for atrial flutter?
Catheter ablation ## Footnote Cardioversion is also a reasonable option for treatment.
63
In atrial flutter, typical **P waves** are _______.
Absent ## Footnote Atrial activity presents as a sawtooth pattern instead of typical P waves.
64
Which class of drugs is typically used for **rate control** in atrial flutter?
Non-dihydropyridine calcium channel blockers or beta-blockers ## Footnote Examples include verapamil and diltiazem.
65
After initiating **antihypertensive therapy**, a patient's blood pressure should be rechecked after how many months?
1 month ## Footnote The 2017 American College of Cardiology/American Heart Association guidelines recommend follow-up in 1 month after initiating (or titrating) an antihypertensive.
66
When blood pressure is under control, a follow-up visit can occur in __________.
3 months ## Footnote This is part of the recommended follow-up protocol after antihypertensive therapy.
67
List two **risk-enhancing factors** for ASCVD.
* C-reactive protein (CRP) of 2.0 mg/L or greater * Chronic kidney disease ## Footnote Other factors include history of preeclampsia, premature menopause, metabolic syndrome, family history of early ASCVD, ankle-brachial index ≤0.9, and high-risk ethnicity.
68
INR <2
Increase the dose
69
INR 2 to 9
Hold and drop dose
70
INR >10 without bleeding
Give PO vitamin K
71
INR >10 with bleeding
Give IV vitamin K
72
Normal INR
One
73
INR goal
2 to 3
74
True or false: TRIPTANS should be limited to less than 10 days of use per month to avoid medication overuse
TRUE
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