Cardio

Question 1

Following ECG changes represent:
ST elevation, T wave inversion, Q waves

Answer 1

ischemic changes (Myocardial Infarction)

Question 2

_____ is a common cause of atrial fibrillation resulting from left atrial dilation.

Answer 2

Mitral stenosis

✽ Px with acute dyspnea & Pulm Edema on CXR

Question 3

Distant heart sounds, hypotension, and JVD

Pulsus paradoxus (>10 mm Hg decrease in systemic BP with inspiration).

Diagnosis?

Answer 3

Cardiac Tamponade

Question 4

2 signs of right-heart congestion

Answer 4

pedal edema
hepatomegaly

Question 5

2 signs of left-heart congestion

Answer 5

Crackles (pulmonary edema)
Laterally displaced PMI (LV enlargement)

Question 6

RV infarction
Presents with acute chest pain and hypotension.
Lungs CTAB + Pedal Edema
Ischemic changes on ECG
Diagnosis?

Answer 6

RV infarct

Question 7

↓ CVP (R sided preload)
↓ PCWP (L sided preload)

are expected in ___ shock.

Answer 7

Septic shock

Question 8

↑ CVP (R sided preload)
↑ PCWP (L sided preload)

are expected in ___ shock.

Answer 8

Cardiogenic shock

✽ Acute MI → LV Failure → Cardiogenic Shock

✽ Acute MR s/t MI → Cardiogenic Shock

Question 9

↑ CVP (R sided preload)
↓/– PCWP (L sided preload)

are expected in ___ shock.

Answer 9

Prepulmonary obstructive shock

–Pulmonary Embolism
–TPX
–RV Failure

Question 10

Pt with new-onset JVD and RBBB are indicative of ___ strain, which is commonly seen in association with __

Answer 10

Right heart strain
Pulmonary Embolism

Question 11

Cardiovascular changes in the setting of SEPSIS include:
Hypotension
↓ SVR
_ Cardiac Output
_ PCWP (L sided preload)

Answer 11

↑ Cardiac Output
↓ PCWP (L sided preload)

Question 12

Bradycardia
Hypotension
↑ JVD
Diagnosis?

Answer 12

Complete heart block

Question 13

1. New Right bundle branch block suggests:
2. New Left bundle branch block suggests:

Answer 13

1. Acute massive PE
2. Acute MI

Question 14

Septic embolization of the lungs is usually associated with right-sided ____

Answer 14

endocarditis

(Px: febrile + tricuspid or pulmonic valve diastolic heart murmur)

Question 15

Multifocal Atrial Tachycardia (MAT) is often confused with Atrial Fibrillation.

On ECG, both show irregular RR intervals:
1. MAT demonstrates [P-waves]
2. A-Fib demonstrates [P-waves]

Answer 15

1. distinct P waves with varying morphology (MAT)
2. No P waves (A-Fib)

Question 16

___ is an SVT usually triggered by acute respiratory illness in patients with underlying lung disease like COPD.

Answer 16

Multifocal atrial tachycardia

✽ Tx: correct the inciting disturbance like managing COPD exacerbation to resolve MAT

Question 17

___ is the most common cause of cor pulmonale (RHF w/o LHF)

Answer 17

COPD

➣ Other causes: ILD (idiopathic pulmonary fibrosis), OSA, thromboembolic pulmonary vascular disease,
Restrictive Lung Disease (kyphoscoliosis, Obesity).

Question 18

Mitral stenosis usually occurs s/t rheumatic heart disease and presents with dyspnea, cough, and orthopnea.

Elevation of the left main stem bronchus on CXR indicates [what heart structure change?]

____ is a common CX of MS & can trigger acute decompensated HF

Answer 18

Left Atrail dilation

Atrial fibrillation

Question 19

Congestive heart failure commonly causes bilateral ____ effusions.

Answer 19

Transudative effusions
↳increased hydrostatic pressure or hypoalbuminemia
↳Pleural pH: 7.40–7.55

➣Normal pleural fluid pH: 7.60

Question 20

Diffuse ST-segment elevation is consistent with acute

Answer 20

pericarditis

Question 21

brachial-femoral pulse delay
seen in what vasculature deformity?

Answer 21

Aortic coarctation

↳increased blood flow to the BUE and decreased blood flow to the BLE

Question 22

1. An S3 heard at the apex on end-expiration is consistent with:
2. An S3 heard at the left lower sternal border on end-inspiration is consistent with:

Answer 22

1. Left ventricular failure
2. Right ventricular failure

↳ b/c inspiration increases the volume of blood in the right side of the heart

Question 23

Wide and fixed splitting of S2 occurs in an atrial septal defect (ASD) which can eventually lead to ___ in adults.

Answer 23

Right-sided heart failure

Question 24

List 1º & 2º GDMT for Heart Failure

Answer 24

Diuretics
ACE-I/ ARB/ or ARNI (Sacubitril/Valsartan – Entresto)
& Beta Blocker
——-
Spironolactone (MRA)
Dapagliflozin – Farxiga (SGLT2 Inhibitor)

Question 25

In patients with refractory HF despite optimum pharmacologic GDMT, what is the next step in management?

Answer 25

Device therapy:

Implantable cardioverter-defibrillator (ICD) for 1º or 2º prevention of Sudden Cardiac Death
[in HFrEF or Cardiomyopathy]

Cardiac resynchronization therapy (CRT-D) with Biventricular pacing (aka Biventricular ICD)
[in HFrEF + prolonged QRS]

Question 25

Advanced heart failure therapies for pts with refractory HF despite optimum therapy may include:
1. Palliative care
2. IV vasodilators
3.
4.
or a Heart transplant.

Answer 25

3. IV Inotropes (Milrinone)
4. Mechanical circulatory support
   –Left Ventricular Assist Device (LVAD)
   – Impella Ventricular Support Device

Question 26

Uncontrolled diabetes with history of CKD = ↑ Cr and ↑BUN results in chronic pericardial effusion s/t

Answer 26

uremia

Question 27

hemodynamically unstable pt with Beck triad ( ___), pulsus paradoxus (___ during inspiration), and chest pain, all of which indicate cardiac tamponade.

Answer 27

hypotension, distant heart sounds, & JVD

absent pulse during inspiration

Question 28

Ang II increases GFR by what mechanism?

Answer 28

Constricting Efferent Arteriole

(ACE: Ang II Constricts Efferent)
→ ACE–Inhibitors block this constriction resulting in ↓ GFR

Question 29

Prostaglandin (made from COX/Cholesterol) increase GFR via what mechanism?

Answer 29

Dialating Afferent Arteriole

(PDA: Prostaglandin Dilates Afferent)
→NSAIDs lower prostaglandin resulting in ↓ GFR

Question 30

atrial fibrillation can be triggered by ectopic conduction foci, most frequently from the

Answer 30

pulmonary veins

Question 31

Patients with an accessory atrioventricular bypass tract, as seen in Wolff-Parkinson-White syndrome, may develop a reentrant loop, causing what arrhythmia?

Answer 31

atrioventricular reentrant tachycardia (AVRT)
(Procainamide)

Question 32

What arrhythmia results from a reentrant circuit formed by 2 separate conducting pathways within the atrioventricular node?

ECG shows regular R-R intervals with P waves typically buried within the QRS complexes (ie, retrograde P wave conduction occurs).

Answer 32

Atrioventricular nodal reentry tachycardia (AVNRT)

Question 33

The most common cause of atrial flutter is a reentrant circuit around what structure?

Rapid “sawtooth” flutter waves are seen on ECG, and the rhythm may appear regular or irregular.

Answer 33

tricuspid annulus
(Cavotricuspid Isthmus)

Question 34

Atrial tachycardia + AV block is the most specific arrhythmia for what med toxicity?

Answer 34

digoxin
(from increased automaticity of myocardial conduction and/or increased vagal tone.)