Cardio 3

Question 1

Management of patients with MS and Afib?

Answer 1

Treat all patients with Warfarin regardless of CHADSVASC

Question 2

1. Pt presents with diastolic rumble, opening snap, JVD, edema, and progressive dyspnea. Dx?
2. Rx in Symptomatic?
3. When to treat the Asymptomatic?
4. When is this contraindicated?
5. When is Repair/Replacement Surgery indicated?
6. Pregnant?

Answer 2

1. MS
2. Percutaneous Balloon Mitral commissurotomy
3. Asymptomatic when valve area < 1.5cm2
4. When pt is Concomitant MR or Left Atrial Appendage seen on TEE
5. Only When Balloon Commissurotomy is unavailable or Patient Fails Balloon Method
6. Metoprolol beta-blocker (allow for greater filling time and relief of PH)

Question 3

Name 6 causes of MR?

Answer 3

1. Infection (Endocarditis)
2. Ischemia (Papillary muscle ruption
3. MVP
4. HCM
5. Marfan syndrome (also cases TAA and TR)
6. Ventricular Dilatation

Question 4

Elevated JVD, peripheral edema, holosystolic murmur heard left sternal border Increases during Inspiration due to increase Venous Return. Dx? Test? Rx?

Answer 4

TR

Due TTE to confirm and determine Size and Assess Severity

Surgery when Severe, Symptomatic and NON responsive to Medical Management

Question 5

The rate is 50 bpm> but < 120bpm

Answer 5

Accelerated idoventricular rhythm

Question 6

Name that Rhythm: Associated with SOB and Hypotension

Answer 6

S1Q3T3 PE

Question 7

Name the Rhythm

Answer 7

First Degree AV Block

Question 8

Name that Rhythm

Answer 8

Mobitz Type I Second Degree Heart Block

Question 9

Name that rhytm

Answer 9

AVNRT

Question 10

Name that Rhythm

Answer 10

Right Ventricular Hypertrophy

Shows R ventricular Strain pattern with downward concave ST-T wave abnormality V1-V3

Question 11

Name That Rhythm

Answer 11

Lead Reversal

Opposite deflections in Lead I, II, AVL and AVF

Question 12

Name that Rhythm
What is the treatment?

Answer 12

Long QT Syndrome

Men > 440 Women > 460

Beta Blocker therapy (Propanolol)

ICD for VT or Syncope

Question 13

Name that Rhythm:

Where is this present?

Answer 13

M shaped/Notched P wave in one or more of the mitral leads I, II, AVL

Significant for Mitral Stenosis due to Left atrial Enlargement

Question 14

Name that Rhythm

Answer 14

WPW

Delta Wave Before QRS

Question 15

Name that rhythm, Electrolyte abnormality.

Answer 15

Hypocalcemia, prolongation of QT

Question 16

Name that Rhythm

Answer 16

3rd Degree Heart Block

Question 17

Name that Rhythm

Answer 17

Non acute posterior inferior MI

There are Q waves in lead II, III, AVF

Question 18

Name that Rhythm

Answer 18

Inferior Wall MI

Question 19

Name that Rhythm

Answer 19

Junctional Rhythm

When the P wave is negative in lead II preceding or following the QRS

Question 20

Name That Rhythm

Answer 20

Mobitz II Second Degree Heart Block

Question 21

Name that rhythm:

Answer 21

Hyperkalemia, K+ > 8

Peak T waves

Loss of P wave

Question 22

Next step in management with patient who has Symptomatic Paroxysmal Atrial Fibrillation who failed treatment with at least 1 Class I or Class II anti-arrhythmic.

Answer 22

Catheter Ablation

Question 23

Next step in management for patient who presents with new onset A flutter?

Answer 23

Radiofrequency Ablation

Question 24

Autosomal Dominant disorder presents with Incomplete RBBB, ST elevation in precordial leads and T wave inversions. Pt presents with Syncope or Sudden Cardiac Death?

Answer 24

Brugada Syndrome

Question 25

1. Management of a WPW with Afib?
2. Management of WPW w/o Afib? What to avoid and Why?

Answer 25

1. Ablate
2. Ibulitide or Flecainide. Avoid CCB and BB which will block the AV node and send the impulse down the accessory pathway

Question 26

Management of Aortic Stenosis:

1. Indications for Asymptomatic?
2. Indications for Symptomatic?

How to tell the difference when there is Severe LV Dysfunction (Pseudostenosis) Vs True Aortic Stenosis?

Who gets TAVI?

Rx for Heyde Syndrome?

Answer 26

50%-4.0m/s-40mmg, <1.0cm2

1. AS < 1.0cm2, LVEF < 50% with Velocity > 4.0m/s, Mean graditent > 40mmHg
2. Symptomatic (Angina,Syncope) + AS < 1.0cm2, Velocity > 4.0 m/s, Gradient > 40mmHg

Cardiac Catherization

NON Surgical Candidates

(AS + AVM = GI bleeding) SAVR or TAVI

Question 27

Rhythm?

Answer 27

Electrical Alterans in Cardiac Tamponade