Cardio 5

Question 1

Treatment for Wide Complex Tachycardia associated with Hemodynamic Instability?

Answer 1

Immediate Synchronized Cardioversion

Question 2

Preferred Antiarrhythmics in patients without CAD or Structural Heart Disease?

Answer 2

Flecainide or Propafenone ( favorable in young patients, low side effect profile) , contraindicated in patients with CAD or LVH (structural heart disease)

PF for young

Question 3

Anti-arrhythmics to be used in patients with Afib and LVH?

Answer 3

Amiodarone or Drondarone

Question 4

Anti-arrhythmics to be used in patients with Afib + Heart Failure

Answer 4

Amiodarone or Dofetilide

AFIB= AD

Question 5

Anti-arrhythmics to be used in patients with Afib and CAD without heart failure?

Answer 5

Sotalol or Dronedarone

SoGone

Question 6

What is a common side effect of donepzil?

Answer 6

Syncope and dizziness due to bradycardia or heart blocks.

Question 7

Faint Diastolic Murmur of Aortic Regurgitation, waxing and waning, neurological deficits like Horner Syndrome, Vocal cord Paralysis?

Answer 7

Aortic Dissection

Question 8

1. Prolonged PR interval with all P waves conducted?
2. Progressive Prolong PR interval and non conducted P waves.
3. Fixed prolonged PR interval with non conducted P waves?
4. No Pwaves conducting with QRS complex?
5. What is high-degree AV block?

Answer 8

1. 1st Degree AV Block
   (Second Degree Heart Block- P waves not conducted)
2. 2nd Degree Type 1 -Long (Wakenbach)
3. 2nd Degree Type 2 - Fixed
4. Complete hear block
5. Multiple successive non-conductive P waves

Question 9

When can you not tell the difference in heart block types?

Answer 9

1. When there is a 2:1 block present.

Question 10

Indications for Permanent Pacing in heart block?

Answer 10

1. Symptomatic Without Reversible cause found
2. Asymptomatic with >3 pauses or heart rate <40 bpm
3. Alternating Bundle Branch Block
4. Complete heart block or Mobitz Type 2 (Fixed PR interval, dropped beat has high risk of converting to Complete HEART Block)

Question 11

Management of a patient with hypertensive urgency (180/120 without end organ damage)?

Answer 11

Oral Hypertensive and observe Over a Monitored Setting.

Question 12

1. Initial Therapies for PAD?
2. Which medication to use if the first drug is not tolerable?
3. Which medication to use if patient is still having persistent symptoms ?

Answer 12

1. Aspirin, along with Smoking Cessation and Graded exercise
2. Plavix
3. Cilostazol (usually meet criteria for revascularization at this point)

Question 13

Common complication of cardiac catherization, it presents with hypotension and a drop in hemoglobin?

Answer 13

Retroperitoneal Hemorrhage

Question 14

1. Management of Anticoagulation in a patient with Mechanical Bi-leaflet Aortic Valve undergoing a HIGH Bleeding RISK procedure?
2. Management of Anticoagulation in patient with Mechanical Mitral Valve undergoing a HIGH Bleeding RISK procedure?

Answer 14

1. Stop warfarin 5 days
   Before Procedure until INR < 1.5. No bridging needed.
   Then resume warfarin evening of.
2. Stop Warfarin 5 days Before Procedure and start Heparin when INR < 2.0. Stop Heparin day of procedure and then resume 1-2 after hemostasis is achieved with warfarin.

Question 15

Complications Post-MI: Associated with inferior wall MI.
Occurs 3-5 days presenting with Cardiogenic shock and New Holosytolic Murmur due to Acute MR resulting in Pulmonary Edema, associated with the RCA?

Answer 15

Papillary Muscle Rupture

Question 16

Complications Post-MI:
Occurs within 3-5 days presents with new onset chest pain, Holosytolic Murmmur, shock, Left-to- Right Ventricular Shunt (increase in 02 from RA to RV).

Answer 16

Interventricular Septum Rupture

Question 17

Complications Post-MI:
Occurs within 5 days to 2 weeks associated with LAD. Presents with Chest Pain, Shock, Distant heart sounds, will see Pericardial Effusion with Tamponade .

Answer 17

Free wall rupture

Question 18

Complications Post-MI

Occurs within Several Months, presents with heart failure, stable angina and Dyskinetic Myocardial Wall.

Answer 18

Left Ventricular Aneurysm.

Question 19

Complications Post-MI:

1. Autoimmune phenomenon resulting in fibrinous pericarditis several weeks post MI?
2. Friction Rub heard 1-3 days post MI?

Answer 19

1. Dresslers Syndrome

2. Post-infarction Fibrinous Pericarditis

Question 20

What is the best study to risk stratify patients with WPW? ( This is to determine there possibility of transforming to AFib or AVRT which can lead to VF and Sudden Cardiac Death)

Answer 20

Exercise Testing

Question 21

Difference between athletes heart and HCM?

Answer 21

Athletes heart is usually < 12mm and symmetric thickness. HCM is asymmetric, > 15 mm and associated with Q waves and T wave inversions on EKG.

Question 22

What are the 2 common causes of prolonged QTc?

Answer 22

1. Electrolytes ( Hypomag and Hypokalemia)

2. Drugs (Levofloxacin and antipsychotics)

Question 23

Which 2 medications are contraindicated in patients with NSTEMI/Unstable Angina who have ESRD?

Answer 23

Lovenox and Eptifibatide (Integrillin) ( they are renal cleared and will cause increase bleeding risk)

Question 24

1. Rx for symptomatic bradycardia and hemodynamic distress?

2.Next Rx if that is ineffective?

Answer 24

1. Atropine.
2. Dopamine or Epinephrine infusion until Transcutaneous pacing or Temporary pacing wire can be place.

Question 25

1. Preferred AC in a patient with eGFR > 30ml/min ? | 2. What is the preferred AC when eGFR < 30ml/min?

Answer 25

1. Pradaxa, Eliquis, Xarelto | 2. Warfarin

Question 26

Name the 2 indications for Spironolactone in Heart Failure?

Answer 26

1. Symptomatic HF in Class II, III, IV & LVEF < 35% 2. LVEF < 40% & Symptomatic HF or Diabetes

Question 27

Name the Primary Prevention and Secondary Prevention indications for ICD placement?

Answer 27

Primary Prevention: 1. Prior MI & LVEF < 30%, 2. NYHA Class II or III and LVEF < 30% Secondary Prevention: 1. Prior VF or Unstable VT without Reversible Cause 2. Prior sustained VT with underlying cardiomyopathy

Question 28

Indications for Hydralazine in CHF?

Answer 28

Usually given with nitrates when patients dont tolerate ACE or ARBs.

Question 29

Pt presents with 2 week hx of lightheadedness, feeling wooziness and sense of heaviness in head with squatting. Pt has AICD and had lead revision 1 month ago. Dx? What is the initial test of choice? What is the gold standard? Rx?

Answer 29

Superior Vena Cava Syndrome. CT with Contrast Bilateral Upper Extremity Venography

Question 30

Pt presents with sudden onset of SOB, Chest heaviness, BP 210/100. CXR shows Pulmonary Edema. Pt develops unexplained rise in Cr after starting ACE. Dx?

Answer 30

Bilateral Renal Artery Stenosis

Question 31

Medications given in Unstable Angina/NSTEMI? Which Anticoagulant to give if they have ESRD?

Answer 31

1. Aspirin 2. Plavix 3. BB 4. Heparin Unfractionated Heparin, not LMWH (Enoxaparin) it is Renal cleared and will lead to further bleeding complications.