Board Vitals Cardiology Flashcards
Which cardiac valve abnormality causes paradoxical splitting of S2?
Aortic stenosis
What valvular abnormality does repair of tetralogy of Fallot commonly result in?
Pulmonary insufficiency/regurgitation
Systolic murmur heard best at the right upper sternal border.
Diagnosis?
Aortic stenosis
Which valve does rheumatic fever effect the most?
Mitral value is always involved - regurgitation precedes stenosis.
What percentage of rheumatic fever patients have involvement of the aortic valve?
20 - 30%
Does aortic stenosis happen after rheumatic fever in isolation?
Rarely - usually mitral valve is involved.
What can streptococcal pharyngitis as a child cause?
Rheumatic fever
What is the reason for the ACE inhibitor associated cough?
Accumulation of bradykinin
Should you use tricyclic antidepressants for diabetic neuropathy in patients with a recent myocardial infarction?
No (they are contraindicated)
Why are tricyclic antidepressants contraindicated with recent myocardial infarction?
They can cause prolonged QTc interval.
What is the mortality risk of papillary muscle rupture?
10 - 40%
What happens to the pulmonary capillary wedge pressure in cardiogenic shock?
Increases
What happens to the central venous pressure in cardiogenic shock?
Increases
When a patient is getting a pulmonary wedge capillary pressure measurement; what does the pressure beyond the pulmonary wedge occlusion represent?
Left atrial pressure
How long should patients with known atrial fibrillation (> 48 hrs) or unknown duration be anticoagulated for before undergoing direct cardioversion?
3 weeks
Why do patients with known atrial fibrillation (> 48 hrs) or unknown duration need to be anticoagulated before or after undergoing direct cardioversion?
To decrease thromboembolic risk
How long should patients with known atrial fibrillation (> 48 hrs) or unknown duration be anticoagulated for after undergoing direct cardioversion?
4 weeks
A patient with Wolf-Parkinson-White syndrome is treated for atrial fibrillation, and subsequently develops a lupus-like syndrome.
What drug was used?
Procainamide (causes reversible lupus-like syndrome)
When do you see Roth spots in the retina?
Infective endocarditis
What effect does norepinephrine have on the cardiac pacemaker cells?
Reduced time to threshold
What needs to be done before starting a patient on sotalol?
Admission to hospital for Qtc monitoring
Should sotalol be started in an outpatient setting?
No
What needs to be treated prior to repair of large atrial septal defects?
Pulmonary hypertension
Which patients need to begin combination therapy for their hypertension?
Patients with blood pressure more than 20/10 mmHg above their goal.
What 2 conditions is pulsus paradoxus present in?
- Cardiac tamponade
- Constrictive pericarditis
What is the first line drug for SVT?
IV adenosine push
Which class of medications increases the risk of aortic aneurysm rupture?
Fluoroquinolones
Who is at greater risk of aortic aneurysm expansion or rupture - males or females?
Females (4 X compared to males)
Is an increase or decrease in the forced expiratory volume (FEV1) associated with increased risk of aortic aneurysm rupture/dissection?
Decrease in FEV1
Does diabetes mellitus increase or decrease the risk of aortic aneurysm expansion or rupture?
Decrease
Does metformin increase or decrease the risk of aortic aneurysm expansion or rupture?
Decrease
Does smoking increase or decrease the risk of aortic aneurysm expansion or rupture?
Increase
Does family history of AAA rupture increase of aortic aneurysm expansion or rupture?
No
Does hypertension increase or decrease the risk of aortic aneurysm expansion or rupture?
Increase
Do non-selective beta-blockers increase or decrease systemic vascular resistance?
Increase
Which anti-arrhythmic drug causes drug-induced hemolytic anemia?
Quinidine
Which anti-arrhythmic drug causes drug-induced lupus?
Procainamide
Can a transplanted heart increase its rate in response to exercise as rapidly as a native heart?
No
Why can’t a transplanted heart increase its rate in response to exercise as rapidly as a native heart?
Lack of sympathetic innervation
Patients with heart transplant can have a syncopal episode as a result of overly intense exercise regimens.
True or false?
True
What is the mechanism of action of PCSK9 inhibitors?
Prevent LDL receptor degradation
What is the mechanism of action of statins?
HMG-CoA reductase inhibition
What is the mechanism of action of ezetimibe?
- Inhibition of intestinal cholesterol absorption
- Promoting hepatic clearance of cholesterol
What is the mechanism of action of niacin?
Inhibition of hormone sensitive lipase in adipose tissue
Which lipid lowering agents work by stimulation of beta-oxidation pathways?
Fibrates
How long does elective surgery have to be delayed in patients receiving dual antiplatelet therapy (DAPT) because of coronary stenting?
6 months
How long does elective surgery have to be delayed in patients receiving dual antiplatelet therapy (DAPT) because of coronary angioplasty but no coronary stenting?
2 weeks
Which has a greater mortality benefit in patients with diabetes - coronary artery bypass grafting or percutaneous coronary intervention?
Coronary artery bypass grafting
How much fluid is in the pericardial space in a normal healthy person?
15 - 50 mL
How much volume of fluid needs to be in the pericardial space to call it a pericardial effusion?
> 50 mL
Diver develops chest pain during ascent and their is a crunching sound over the mediastinum.
Diagnosis?
Pneumomediastinum
Athlete suffers direct blow to the chest, with resultant arrhythmia and/or unresponsiveness.
Diagnosis?
Commotio cordis
What is polymorphic ventricular tachycardia?
Torsades de pointes
What is the treatment of torsades de pointes (polymorphic ventricular tachycardia)?
IV magnesium
Should you give ondansetron in torsades de pointes (polymorphic ventricular tachycardia)?
No
What does the IV magnesium do in torsades de pointes?
Stabilize the myocardium
Should you cardiovert people who are hemodynamically stable?
No
Do you give oxygen to STEMI patients if their oxygen saturation is normal?
No
What is the predominant cell type in normal pericardial fluid?
Lymphocytes
Is frequent non-sustained ventricular tachycardia an indication for ICD in hypertrophic cardiomyopathy?
No (not anymore)
Is mitral regurgitation an indication for ICD in hypertrophic cardiomyopathy?
No
Is ejection fraction less than 45% an indication for ICD in hypertrophic cardiomyopathy?
Yes
What percentage of cryptogenic strokes occur in patients with patent foramen ovale?
40%
Where does the transducer need to be aimed while doing a transesophageal echocardiogram in order to see the cardiac structures?
Anteriorly
Does furosemide have a negative effect on the fetus?
Yes
Should furosemide be given to a pregnant woman who needs it?
Yes
Corticosteroids used during post-MI pericarditis interfere with the conversion of myocardial infarction to scar tissue, resulting in greater wall thinning and an increased risk of post-MI wall rupture.
True or false?
True
Corticosteroids used during post-MI pericarditis weaken the ascending aortic wall, leading to an increased risk of aortic dissection.
True or false?
False
Should you give a fluid bolus if the pulmonary capillary wedge pressure is high?
No
What is the treatment of cardiogenic shock after a myocardial infarction?
Dobutamine and nitroprusside infusions
How high does the risk need to be on the ACC/AHA calculator before a statin is recommended?
> 7.5%
Which valvular abnormality can be seen in Eisenmenger syndrome?
Tricuspid regurgitation
In a patient with a stent and aspirin exacerbated respiratory disease should you continue the aspirin?
Yes - after aspirin desensitization
Is cardiac output increased or decreased in hypovolemic or hemorrhagic hock?
Decreased
If the patient has hypotension and a pulsatile abdominal mass are they more likely to have an abdominal aortic aneurysm or an aortic dissection?
Abdominal aortic aneurysm
ECG with ST coving in lead V1, ST elevations in leads V1-V3, and incomplete right bundle branch block.
Diagnosis?
Brugada syndrome
What echocardiogram findings are expected in Brugada syndrome?
Normal findings
What is the treatment of Brugada syndrome?
ICD
Does surgery need to be delayed for further testing in case of a left bundle branch block in a patient with no symptoms?
No
Does phenylephrine significantly increase heart rate?
No
Does moderately dosed dopamine (2 - 10 mcg/kg/min) increase heart rate?
Yes
If a mechanical aortic valve develops insufficiency, then what is the patient at risk for at the site of the faulty valve?
Thrombus formation
In patients with hypertriglyceridemia have fibrates demonstrated a benefit in cardiac events when added to statins?
No
In patients with hypertriglyceridemia has icosapent ethyl demonstrated a benefit in cardiac events when added to statins?
Yes
What is the main benefit of fibrates in hypertriglyceridemia?
To prevent pancreatitis
Is antibiotic prophylaxis required for routine colonscopy in patients with prosthetic valves?
No
Is antibiotic prophylaxis required for routine colonoscopy in patients with prosthetic valves?
No
How are pulmonary venous malformations diagnosed on an echocardiogram?
Late bubbles are seen on a bubble study
How is congenital heart disease with right-to-left shunt diagnosed on an echocardiogram?
Immediate bubbles are seen on a bubble study
Patient presents with telangiectasias, skin discoloration, pulmonary arteriovenous malformation, GI bleeding, and hematuria.
Diagnosis?
Hereditary hemorrhagic telangiectasia
Why should patients not have caffeine prior to a cardiac stress MRI?
Caffeine can inhibit adenosine receptors (interferes with the response to adenosine)
Transplanted heart has coronary vessels showing diffuse concentric narrowing with intimal proliferation - what is this called?
Cardiac allograft vasculopathy
Does cardiac allograft vasculopathy involve lipid deposition?
No
Is the coronary narrowing seen in transplanted hearts concentric or eccentric?
Concentric
Is arterial ballooning characteristic of coronary disease in transplanted hearts?
No
Does left ventricular outflow collapse occur as a result of remodeling after myocardial infarction?
No
Does mitral valve annulus widening occur as a result of remodeling after anterior myocardial infarction?
Yes
Does left ventricular dilation occur as a result of remodeling after anterior myocardial infarction?
Yes
Is a patent ductus arteriosus caused by a fetal remnant?
Yes
Is atrioventricular nodal reentrant tachycardia (a supraventricular tachycardia) more common in men or women?
Women
Is atrioventricular nodal reentrant tachycardia (a supraventricular tachycardia) more common in structurally normal or structurally abnormal hearts?
Structurally normal hearts
Is the bundle of His below the node a necessary part on the reentrant circuit in atrioventricular nodal reentrant tachycardia (a supraventricular tachycardia)?
No
Does the pathway which conducts rapidly in atrioventricular nodal reentrant tachycardia (a supraventricular tachycardia) have a relatively long or short refractory period?
Long
Does troponin rise immediately after cardiac insult?
No
Does a negative troponin rule out a STEMI?
No
Can the murmur of mitral regurgitation be holosystolic?
Yes
What is the difference between the holosystolic murmur of acute mitral regurgitation versus that of interventricular septum rupture?
The murmur of interventricular septum rupture is heard all over the precordium; the mitral regurgitation murmur is loudest at the apex
Which medication used for hypertensive crisis causes throat burning and scalp tingling?
Labetalol
Which medication used for hypertensive crisis causes tinnitus?
Nitroprusside
Most cases of Marfan syndrome are because of mutations in which gene?
FBN1
First-degree relatives of patients with a gene mutation associated with aortic aneurysms should undergo genetic testing.
True or false?
True
What is the name for restrictive cardiomyopathy in the setting of parasitic infections?
Loffler endocarditis
What type of ventricular septal defect causes aortic regurgitation?
Perimembranous VSD
What is the only type of VSD that causes a diastolic murmur?
Perimembranous VSD
Does exercise cause an increase or decrease in systemic vascular resistance?
Decrease
Can diltiazem cause torsades de pointes?
No
Can sotolol cause torsades de pointes?
Yes
Which medication is more likely to cause torsades de pointes…
Sotalol or digitalis?
Sotalol
What does a mature coronary plaque consist of?
Fibrous capsule and lipid core
Does a history of Kawasaki disease indicate ischemia or arrhythmia as cause of palpitations?
Ischemia
Can severe aortic insufficiency cause liver failure?
Yes (cardiac cirrhosis)
Can an aberrant focus in a pulmonary vein cause atrial fibrillation?
Yes
What’s the mechanism of action of adenosine?
Blocks conduction through AV node
Which class of medications prevents coronary artery spasm?
Calcium channel blockers
What lifestyle changes are more important of lowering cholesterol…
Dietary changes or exercise?
Dietary changes
A patient undergoes valvular surgery and the histopathology shows Aschoff bodies, Anitschkow cells and valve fibrosis with calcification.
What’s the etiology?
Rheumatic fever
Which test should be used in patients with suspected ischemia who have ECG changes that would make an exercise ECG hard to interpret?
Nuclear myocardial perfusion imaging
In patients with stable angina - does revascularization reduce morbidity and mortality?
It reduces morbidity (symptoms) but not mortality
Which diastolic phase contributes the most to left ventricular filling?
Early rapid left ventricular filling
What is digoxin’s primary mechanism of action in treating supraventricular arrhythmias?
Increased parasympathetic tone
What percentage of patients develop sinus node dysfunction after a heart transplant?
50%
How does sinus node dysfunction typically present in heart transplant patients?
Bradycardia
In left-sided dominant circulation which artery supplies the posteromedial papillary muscle?
Posterior descending artery
What is the most common heart rhythm expected in acute pericarditis?
Sinus tachycardia
Where are pericardial cysts typically located?
Within the pericardial space; usually along the right heart border.
What autoimmune condition develops after myocardial infarction?
Dressler syndrome
Mutations in which genes are implicated in hypertrophic cardiomyopathy?
Sarcomere genes
Does “athelete’s heart” cause left ventricular hypertrophy?
Yes (adaptive mechanism)
Can obstructive sleep apnea cause resistant hypertension?
Yes
Can hypertrophic cardiomyopathy cause resistant hypertension?
No
What is the downward displacement of the tricuspid valve into the right ventricle along with abnormalities of tricuspid leaflets causing regurgitation known as?
Ebstein anomaly
Can amiodarone cause pulmonary fibrosis?
Yes
Which statins are preferred in severe renal impairment?
Atorvastatin
Fluvastatin
Which statins are least likely to cause muscle toxicity?
Pravastatin
Fluvastatin
What happens to the pulmonary capillary wedge pressure in severe mitral regurgitation?
Increases (elevated)
What does the pressure beyond the pulmonary wedge occlusion represent?
Left atrial pressure
Which method offers the most accurate blood pressure reading?
Arterial line
What is the next step in patients presenting with syncope and significant cardiac risk factors?
Hospitalization (and evaluation for arrhythmias)
Should blood cultures be drawn when infective endocarditis is suspected?
Yes
What is the treatment of coronary microvascular disease?
Sublingual nitroglycerin
Risk factor modification
What should you add if there is continued angina despite sublingual nitroglycerin in patients with coronary microvascular disease?
Beta-blocker
What drug can be used to treat malignant hypertension associated with thrombotic microangiopathy?
Labetalol
Physical findings on cardiac exam include: jugular venous distension, ankle edema, left parasternal systolic lift, holosystolic murmur, tricuspid regurgitation murmur, a loud S2, and narrow splitting of S2.
Diagnosis?
Cor pulmonale
What is aortic stenosis at an older age usually due to?
Calcification
What screening should be done in men aged 65 - 75 years with a history of smoking?
Duplex US of the abdominal aorta for AAA
What should be started for patients with gain of function PCSK9 mutation?
High intensity statin (PCSK9 inhibitor is only added on to maximally tolerated statin)
What does procainamide do to the rate of rise of phase 0 of the action potential?
Decreases it
What does procainamide do to the duration of the action potential?
Increases it
Do most patients with congenital absence of pericardium have symptoms?
No (but some patients can have chest pain, shortness of breath and palpitations)
What is the most common arrhythmia after myocardial infarction?
Atrial fibrillation
What is the usual mechanism for atrial fibrillation after myocardial infarction?
Heart failure
What extra heart sounds are heard when there is increased cardiac pressure and volume?
S3 and S4
What is the primary mechanism of action of adenosine?
Potassium channel activation
Should sotalol be used for atrial fibrillation in severe heart failure?
No - increased mortality risk
Should flecainide be used for atrial fibrillation in severe heart failure?
No - increased mortality risk
Which drug is preferred for rhythm control in patients with atrial fibrillation and heart failure?
Amiodarone
What is the most posterior aspect of the heart?
Left atrium
What drug is used to try to convert atrial flutter to normal sinus rhythm pharmacologically?
Ibutilide
What is the pathogenesis of the occluding lesion in case of myocardial infarction?
Plaque rupture with thrombosis
What can happen with sudden discontinuation of clonidine and short-acting beta-blockers?
Rebound hypertension
Why is nitroglycerin not very effective if given orally rather than sublingually or intravenously?
First pass metabolism
What baseline testing must be done before amiodarone is started?
- Thyroid function tests
- Liver function tests
- Pulmonary function tests
What lung disease can amiodarone cause?
Interstitial lung disease
What is the most important intervention in Buerger’s disease (thromboangiitis obliterans)?
Smoking cessation
Patient presents with hands turning blue in cold weather. Lower extremity arteriography demonstrates segmental occlusive lesions with interspersed normal areas, normal proximal arteries with atherosclerosis, and “spider leg collaterals”.
Diagnosis?
Buerger’s disease (thromboangiitis obliterans)
Which medication can be used for rate control in the setting of atrial fibrillation and heart failure?
Digoxin
Does pharmacologic conversion of atrial fibrillation with rapid ventricular rate (RVR) need to be done in case of a hemodynamically stable patient?
No
Injury to pulmonary vascular endothelium can result in pulmonary hypertension.
True or false?
True
Can amyloidosis cause restrictive cardiomyopathy?
Yes
Cardiac tissue shows apple-green birefringence with stained with Congo red dye.
Diagnosis?
Cardiac amyloidosis
What is the most common pathophysiologic mechanism causing stable ischemic heart disease?
Atherosclerotic epicardial coronary artery obstruction
Are ACE inhibitors used in heart failure related to tetalogy of Fallot?
No - can decrease systemic vascular resistance and promote cyanotic spells
What is a complication of pulmonary valvuloplasty to address pulmonary stenosis?
Eventual pulmonary regurgitation with associated right heart failure
Does patent ductus arteriosus increase the risk of infective endocarditis?
Yes
What drug is the optimal choice in case of hypertensive emergency in the setting of chronic kidney disease?
Fenoldopam
What are the most common mutations in familial hypercholesterolemia?
LDL receptor mutations
Should diltiazem be used in NYHA class III and IV heart failure?
No - because of negative inotropic effects
What should you also screen for in patients with coarctation of the aorta?
Berry aneurysm
Should you cardiovert atrial fibrillation with RVR when the atrial fibrillation has been present for more than 48 hours?
No - might dislodge thrombus
Is PR depression on ECG found in Dressler syndrome?
Yes
What is the treatment of isolated systolic hypertension in older people?
Chlorthalidone 12.5 mg p.o. daily
In heart failure there is constant turnover of the extracellular matrix resulting in left ventricular remodeling including dilation or thinning.
True or false?
True
Tertiary syphilis can cause aortic wall calcification, dilation of the aortic valve annulus and aortic root and coronary ostial stenosis.
True or false?
True
What agent reverses apixaban?
Andexanet alfa
What happens to the myocytes in left ventricular hypertrophy?
Lengthen
What does the combination of Tetralogy of Fallot and hypocalcemia suggest?
Di George syndrome
Can anemia cause high output heart failure?
Yes
What is the most common effect of hydrochlorothiazide on potassium levels?
Potassium will decrease
What does coronary angiography show in stress induced (Takotsubo) cardiomyopathy?
Akinesis of left ventricular apex
How is rejection ruled out in a transplanted heart?
Endomyocardial biopsy
How long after cardioversion does the patient need to continue to be anticoagulated?
4 weeks
S4 occurs when the atrium pumps blood into a stiff ventricle.
True or false?
True
Can scleroderma cause pulmonary hypertension?
Yes
What does tadalafil treat?
Pulmonary hypertension
What is the most common ECG change during tricyclic antidepressant toxicity?
Sinus tachycardia
