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Basic Flashcards

1
Q

Q waves in V1-V2 related to lead position? Too high or low?

A

Move leads down and see if R wave appears

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2
Q

BBB re-entry VT is common with?

A

Abnormal slow conduction in the His-Purkinje system.

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3
Q

Transesophageal ECG help for which SVT?

A

Most (AF, AT, AVRT, AVNRT)

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4
Q

Pre-excited AFib use which drugs?

A

Procainamide, Amio & DCCV 1st choic
Disopyramide and Ibutilide OK
Digoxin is contraindicated

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5
Q

Congenital HD associated with WPW?

A

Ebstein’s

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6
Q

Why is incessant VT not an indication for ICD?

A

Actually a contra-indication for ICD, seek to find reversible causes (Ischemia, electrolytes, scar) and treatment 1st including medications prior to device.

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7
Q

Intracardiac ECG pattern for AVN re-entry tachycardia?

A

Simultaneous activation of the atrium and ventricle. With earliest at the HBE tracing.

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8
Q

Intermittent WPW and asymptomatic.

A

No further investigation (by guidelines).

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9
Q

r prime in V1 in narrow tachycardia?

A

AVNRT

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10
Q

Intracardiac ECG pattern for Left sided accessary pathway re-entry tachycardia?

A

earliest atrial activation at distal CS 1-2 with an eccentric activation pattern

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11
Q

Carotid sinus syndrome?

A

Bradycardia and hypotension d/t stimulation of the carotid sinus baro and vagal reflexes.

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12
Q

Carotid sinus syndrome treatment?

A

Pacemaker may help some patients

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13
Q

Only arrhythmia that shows drop in rate of tachycardia with development of BBB?

A

AV reentry tachycardia (accessory bypass tract ipsilateral to the BBB) shows BBB with drop in rate.

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14
Q

Tilt table POTS criteria?

A

30 bpm increase over baseline or over 120bpm in first 10 minutes of HUT.

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15
Q

Prominent can R waves in v1 includes a differential of?

A

WPW
RVH
Posterior MI
Normal variant

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16
Q

Berry Aneurysms are associated with? (2)

A

Coarctation of the aorta

Polycystic kidney disease.

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17
Q

Albuminuria is a CHD risk factor for diabetics or everyone?

A

Everyone based on the HOPE trial

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18
Q

Enoxaparin antidote?

A

Although protamine incompletely reverses the effect of enoxaparin on factor Xa, it does reverse its effect on thrombin (factor IIa) and as such is indicated for patients with bleeding complications due to enoxaparin.

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19
Q

Fondaparinux and PCI?

A

fondaparinux has been associated with higher rates of catheter thrombus at time of PCI, necessitating the use of unfractionated heparin if the PCI is performed > 6 hours from the last dose of fondaparinux.

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20
Q

Tachycardia slows down and BBB develops–only arrhythmia that does this?

A

AV re-rentry with bypass tract ipsilateral to BBB.

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21
Q

Hyperkalemia

A

Patterns are best seen in leads V4-V5

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22
Q

WPW - two common pathways?

A

Left lateral accesory pathway (mimics lateral or posterior MI) Qs in I AND aVL

Posteroseptal accesory pathway (mimics infero-posterior MI) Qs in II AND aVF

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23
Q

Low voltage DDx
Primary
Secondary

A

Primary myocardial causes include multiple or massive infarction(s), infiltrative diseases such as amyloidosis, sarcoidosis, or hemochromatosis, and myxedema

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24
Q

Low voltage DDx

Secondary

A

Pericardial effusion, COPD, pleural effusion, obesity, anasarca and subcutaneous emphysema. When there is COPD, expect to see low voltage in the limb leads, as well as in leads V5 and V6.

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25
Q

in CHF what is a common BB complications?

A

Volume retention is a common complication of beta blocker therapy and should be treated with an increase in diuretic to achieve clinical euvolemia.

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26
Q

Ischemic cascade

A

Perfusion defects, diastolic dysfunction, systolic dysfunction, ECG changes, chest pain.

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27
Q

Seen with constriction

A

disoncordant RV and LV systolic pressures.

Dip-and-plateau (square root sign) in RV tracing.

Kussmaul’s sign.

M or W pattern in RA tracing.

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28
Q

AR due to valve NOT root?

A

Lupus

NOTE: Ankolosising Spondylitis, syphilis, Marfan’s and chronic HTN are all root causes of AR

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29
Q

History of aortic coarchtation leads to risk o f?

A

pregnancy HTN

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30
Q

Echo - end systole and end diastole on ECG?

A

End diastole = end or R wave

End systole = end of T wave

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31
Q

Echo – IVC and RA pressure simplified

50% collapse?
>2.1 and <50% collapse?

A

0-5 (3)

10-20 (15)

32
Q

Echo – when are diastolic fillings pressures using E/e’ are not useful for estimating wedge?

A

MV surgery (repair or replacement)
Severe MAC
Significant MR/MS
Constriction

33
Q

HCM ICD indications?

A 
LV thickness >30 mm
 VT on Holter monitoring
 FH of SCD
 Hypotensive  response to exercise
 syncope or near syncope.
34
Q

BAV imaging recs?

A

initial assessment:
less than 40 mm, every 2 years
> than or equal to 40 mm yearly or more often
+ if clinical change

35
Q

Surgery for subaortic stenosis?

A

CLASS I
50 mm Hg or a mean gradient of 30 mm Hg on echocardiography

Less than a 50-mm Hg peak or less than a 30-mm Hg mean gradient IF:
LV systolic of 50 mm or more
LV ejection fraction less than 55%.

36
Q

Amioardione effects?

A

slows sinus rate,
increases PR and QT
Little or no QRS duration.

37
Q

Left parasternal heave ?

A

RVH

38
Q

Abiximab side effect?

A

actual thrombocytopenia (immune mediated) and pseudothrombocytopenia (due to platelet clumping) can occur with abciximab.

39
Q

Loeys-Dietz imaging?

Treatment?

A

MRA of the aorta and pelvic vessels, as well as the brain looking for aneurysms, and initation of losartan which appears to delay aortic dilation in Loeys-Dietz

40
Q

PET “mismatch” versus “match” patterns?

A

PET “match” pattern, representing predominant infarction.

PET “mismatch” pattern, representing viable

41
Q

ACE inhibitors pre-op?

A

anesthesiologists prefer to hold ACE inhibitors for a few days to reduce the risk of postoperative hypotension due to vasoplegia.

42
Q

Hypo-alpha-liproteinemia?

A

hypo-alpha-lipoproteinemia such as hepatosplenomegaly, retinitis pigmentosa, or have a family history of premature CAD

43
Q

Anabolic steroids?

A

severely low HDLs

44
Q

Rare cause of low HDL and high cholesterol?

A

nephrotic syndrome (will have edema)

45
Q

Right heart cath findings regarding constriction?

A

Prominent x and y descents are seen in pericardial constriction

46
Q

GXT with RBBB? Don’t use which leads?

A

right precordial leads (V1 to V3) should not be interpreted during exercise since repolarization abnormalities in these leads commonly become exaggerated during exercise

47
Q

Phenylepinephrine uses? Emergent? (4)

A

severe hypotension and concomitant aortic stenosis, to correct vagally mediated hypotension during procedures, to correct hypotension due to simultaneous ingestion of sildenafil and nitrates, and to decrease the outflow tract gradients in patients with HOCM.

48
Q

Agent that increase contractility even when taking BB?

A

milrinone, a phosphodiesterase inhibitor, can increase contractility even in the presence of beta-adrenergic blockers.

49
Q

amiodarone vs Class I antiarrhythmics?

A

In contrast to most of the class I antiarrhythmics, amiodarone does not have negative inotropic effects, and can be used in patients with LV dysfunction and heart failure

50
Q

Differential cyanosis is seen with:

A

PDA

51
Q

Development of complete heart block (CHB) in a young adult

A

Congenitally corrected transposition of great arteries (CCTGA) L type

52
Q

risk of pregnancy induced cardiomyopathy?

A

50% for the second pregnancy

53
Q

FFR cutoffs?

A

0.8

54
Q

UA / NSTEMI who rules in but not cath candidate, how long to wait?

A

48-72 hours of medical therapy prior to stress testing is recommended when definite ACS is present

55
Q

RHC findings suggestive of tamponade?

A

equalization of RA and PCW pressures, and low cardiac index indicate that the patient has pericardial tamponade.

56
Q

in addition to aspirin what should be active at the time of PCI

A

ACC/AHA Unstable Angina/Non-STEMI guideline that at least one antiplatelet agent in addition to aspirin should be active at the time of PCI (i.e., either aspirin and a P2Y12 inhibitor or aspirin and a GP IIb/IIIa inhibitor)

57
Q

Ideal waiting time after BMS prior to elective surgery?

A

4-6 weeks after BMS allows the coronary stent to endothelialize

58
Q

When to replace aortic root in BiCuspid AV?

A

bicuspid aortic valve, severe symptomatic AS, as well as a maximal ascending aortic diameter of > 4.5 cm

59
Q

PS Treatment?

A

Balloon valvotomy is young adult patients with pulmonic stenosis who have exertional dyspnea, angina, syncope, or presyncope and an RV–to–pulmonary artery peak-to-peak gradient greater than 30 mm Hg at catheterization. (Level of Evidence: C)
Balloon valvotomy is recommended in asymptomatic adolescent and young adult patients with pulmonic stenosis and RV–to–pulmonary artery peak-to-peak gradient greater than 40 mm Hg at catheterization. (Level of Evidence: C)
CLASS IIb
Balloon valvotomy may be reasonable in asymptomatic adolescent and young adult patients with pulmonic stenosis and an RV–to–pulmonary artery peak-to-peak gradient 30 to 39 mm Hg at catheterization.(Level of Evidence: C)
CLASS III
Balloon valvotomy is not recommended in asymptomatic adolescent and young adult patients with pulmonic stenosis and RV–to–pulmonary artery peak-to-peak gradient less than 30 mm Hg at catheterization. (Level of Evidence: C)

60
Q

Causes of RAD?

A 
RVH
 LPFB
 Dextrocardia 
 Lateral MI (due to Q wave in I)
 VT
 Hyperkalemia 
 Na-channel blocking drugs (TCAs)
 PE 
 Misplaced leads
61
Q

Using v6 and aVR to check lead position?

A

should be opposites

62
Q

Inferior STEMI isolated v2 ST depression – might be ?

A

RV infarct – do right sided leads

63
Q

R in V3 less than 3mm?

A

possibly poor R wave progression, think PE

64
Q

Inferior and anteriorseptal T wave inversions or ischemia?

A

Think PE !!!!! Dr Marriott ECG author

65
Q

Sgarvbossa Criteria

A

Concordant depression, V1-V3
Concordant elevation, any lead
Discordant elevation >5mm any lead

66
Q

Electrically alternans? (2)

A

pericardial effusion

AVRT (SVT)

67
Q

ASA and MVP

A

Aspirin therapy (75 to 325 mg per day) is recommended for symptomatic patients with MVP who experience cerebral transient ischemic attacks. (Level of Evidence: C)
In patients with MVP and atrial fibrillation, warfarin therapy is recommended for patients aged greater than 65 or those with hypertension, MR murmur, or a history of heart failure. (Level of Evidence: C)
Aspirin therapy (75 to 325 mg per day) is recommended for patients with MVP and atrial fibrillation who are less than 65 years old and have no history of MR, hypertension, or heart failure. (Level of Evidence: C)
In patients with MVP and a history of stroke, warfarin therapy is recommended for patients with MR, atrial fibrillation, or left atrial thrombus. (Level of Evidence:

68
Q

Stunned myocardium definition?

A

Revascurized by not yet recovered.

69
Q

Attenuation artifiact?

A

Usually improves from rest to stress and if revealed has NWM.

70
Q

ER stress nuc

A 
Normal rest -- send home
 Abnormal rest (with pain) nut -- cath lab
71
Q

Perfusion study showing 1v disease? Have

A

COURAGE

72
Q

Epleranone differs from sprinolactone in that?

A

epleranone has no gynacomastia (more selective aldosterone blocker)

73
Q

INR levels with statins - just be aware

A

(fluvastatin, Lovastatin, rosuvastatin and simvastatin) and warfarin can increase warfarin concentrations

74
Q

DTS

=/> 5 low

A

Duke score risk categories are low-risk (annual cardiac mortality 3%).

75
Q

Endocarditis – not an indication for surgery?

A

Severe TR is generally not an indication

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