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32 Cards in this Set
- Front
- Back
xtypical innocent-sounding heart murmurs
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1-2/6 short systolic mid-peaking murmurs along left sternal border
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When is coronary angiography indicated? (3)
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CSAP with progressive symptoms despite optimal medical therapy, difficulty tolerating medical therapy; high-risk findings on exercise testing
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How frequently should routine periodic echo be obtained in mild AS, asymptomatic patients?
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not more than every 3-5 years
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treatment of claudication symptoms that is stable
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medical therapy + exercise; NOT percutaneous or revascularization
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screening for AAA - who should be screened, how and how often?
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men 65-75 who smoked, 1-time abd US; do not repeat after a normal study
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leading cause of death in CKD patients
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CV disease
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What is the LAPS trial (Lupus Atherosclerosis Prevention Study)?
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this study failed to show benefit of statins on progression of coronary artery calcification, carotid intima media thickness, or carotid plaque over 2-years in SLE
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preferred diagnostic test in symptomatic patients with intermediate probability of CAD
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cardiac stress testing
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medication change prior to exercise stress testing
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β-Blockers should be withheld for 24 to 48 hours
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what is an "indeterminate" or "submaximal" stress test?
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negative stress test but adequate workload was not achieved
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When to use pharmacologic stressors?
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when patient cannot achieve at least 5 METS
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MOA of dobutamine as pharmacologic stressor
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increases myocardial contractility and oxygen demand
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MOA of adenosine, dipyridamole, regadenoson as a pharmacologic stressor
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induce regional hypoperfusion through coronary vasodilation
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Contraindications to exercise ECG testing (6)
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(MI, arrhythmia, AS, HF, PE, Ao diss) = recent MI (<30 days), uncontrolled arrhythmia, symptomatic severe AS, acute decompensated HF, acute PE, acute aortic dissection
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radioisotopes used in SPECT studies
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thallium and technetium
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medication change prior to adenosine
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caffeine hold x 24 hours before adenosine (caffeine is an adenosine receptor antagonist)
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NOTE: CAC scoring is
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sensitive but not very specific for CAD.
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cholesterol embolism - lab findings?
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urine and peripheral eosinophilia
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groin tenderness, a pulsatile mass, or a femoral bruit is present following coronary angio - Dx? Tx?
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AV fistula or pseudoaneurysm; Tx with US-guided compression, surgical repair if still bleeding, or nerve compression
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post-coronary angio, patient presents with hemodynatmic instability or rapidly decreasing Hct - next step?
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noncontrast abdominal CT
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TEE provides clearer images of these structures
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LA and MV
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TEE appropriate as initial test in these conditions (4)
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detection of LA thrombus, prosthetic valve dysfunction, and aortic dissection, high probability of endocarditis
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indication for PA catheters
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hemodynamically unstable patients, typically those requiring inotropic or vasopressor support
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goals of B blocker therapy in CSAP
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HR 55-60/min and ~75% of the heart rate that produces angina with exertion
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Absolute contraindications to β-blockers (4)
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severe bradycardia, advanced AV block, decompensated HF, severe reactive airways disease. (use calcium channel blockers instead)
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Side effects of calcium channel blockers (4)
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peripheral edema, constipation, dizziness, headache
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when is ranolazine indicated?
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symptomatic CSAP despite B blockers, calcium channel blockers and nitrates
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MOA of ranolazine
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selective inhibition of the late sodium channel
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S/E of ranolazine
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prolonged QT, caution with kidney or liver disease
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2 indications for combination therapy with ASA and clopidogrel
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recent MI or stent placement
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MOA of ezetimibe
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inhibits cholesterol absorption
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NOTE: Although studies have found dramatic reductions in LDL cholesterol levels,
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ezetimibe has not been shown to reduce the progression of atherosclerosis or future cardiovascular events.
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