cardiology 1 Flashcards
What does hypotension and elevated JVP after a cardiac ablation procedure suggest?
Cardiac tamponade
What is the diagnosis for cardiac tamponade?
Echocardiography
What is the treatment for cardiac tamponade?
Pericardiocentesis
What is the intervention for infective endocarditis with persistently positive blood cultures despite a week of antibiotic therapy?
Valve replacement surgery
What is Type IV RTA associated with?
(Hypo-/hyperaldosteronism) and characterized by (hypo-/hyperkalemia) with low plasma renin activity
What is the echocardiographic appearance of catecholamine-induced cardiomyopathy similar to?
Stress-induced cardiomyopathy (apical ballooning syndrome)
What characterizes arrhythmogenic right ventricular cardiomyopathy?
Fibro-fatty replacement of myocardium with ventricular dilation and thinning
What does vasovagal syncope involve?
Increased output of the vagus nerve leading to decreased cardiac output
Is cardiac sarcoidosis often biopsy negative?
Yes (True)
When should apixaban be reduced to 2.5 mg twice daily?
In patients who meet at least 2 of the following criteria: Age > 80 years, Body weight < 60 kg, Serum creatinine > 1.5
What should sudden onset of leg pain with swelling, purple color, and loss of distal pulses raise concern for?
Massive proximal deep vein thrombosis
When should aortic aneurysms be repaired earlier?
At 4.0 to 5.0 cm in patients with genetically mediated causes of aneurysm
What are typical cardiac involvements with sarcoidosis?
AV block, bundle branch block, arrhythmias, heart failure
What often leads to increases in circulating levels of brain natriuretic peptide?
Initiation of sacubitril–valsartan
What should a patient with native-valve endocarditis and aortic valve regurgitation leading to heart failure undergo?
Surgical replacement of the valve
What should all patients with a mechanical heart valve be treated with for anticoagulation?
Warfarin alone
How can catecholamine-induced cardiomyopathy manifest?
As severe diffuse apical wall motion abnormalities with preserved base function
What is the most appropriate initial therapy for a patient with hemodynamically stable monomorphic wide-complex tachycardia?
An antiarrhythmic drug such as amiodarone, procainamide, or lidocaine
What is the most appropriate immediate treatment for a patient with symptomatic complete heart block before a pacemaker is placed?
Transcutaneous or transvenous pacing
What should a patient with CAD be managed with?
Aspirin, a statin, and at least one of the following: a beta-blocker, a CCB, or long-acting nitrate
What is a reasonable next step if TEE is negative in a patient with MRSA bacteremia and ongoing fever?
CT or MRI to find the infection source
What are the ECG findings of left ventricular hypertrophy (LVH)?
Tall R waves, deep S waves, +/- QRS widening, +/- LAD, +/- ST-T changes, +/- LAE
What are typical imaging studies for pulmonary embolism (PE)?
CT angiography, EKG, echocardiography
When is a permanent pacemaker indicated?
For patients with Mobitz type II second-degree heart block even in the absence of symptoms
What is cardiac sarcoidosis often associated with?
Conduction abnormalities such as complete heart block, bundle branch block, and ventricular arrhythmias
What is the risk for orthostatic hypotension highest when taking alpha blockers?
After the first dose
What conditions require antibiotic prophylaxis for bacterial enteritis before dental procedures?
Prosthetic heart valves, valve repair with prosthetic material, heart transplant with valvulopathy, prior infective endocarditis, certain types of congenital heart disease
What should be performed ASAP if infective endocarditis is suspected?
A TEE (transesophageal echocardiogram)
What will rule out acute coronary syndrome (ACS)?
A negative initial high sensitivity cardiac troponin value (<5ng/L) with no significant one-hour increase in value on serial measurement
What typically manifests as a petechial rash after a procedure performed via arterial access?
Cholesterol emboli
What is the initial treatment for Dressler syndrome?
High-dose aspirin, analgesics, and colchicine
What should the initial management of cocaine-associated chest pain consist of?
A benzodiazepine and nitroglycerin
What is the most appropriate management for an asymptomatic patient with structural heart disease and PVCs?
Observation
What is the most appropriate management strategy for paroxysmal atrial fibrillation that is symptomatic despite effective rate control?
Catheter ablation (typically pulmonary vein isolation)
What does a new RBBB or LBBB after an MI depict?
A large MI and a poor prognosis
What is the typical oscillatory description of the pericardial knock?
High-pitched early diastolic heart sound
How long is anticoagulation recommended after cardioversion of A-fib with RVR?
At least 1 month
What is indicated for patients with a 10-year ASCVD risk of 7.5% or higher despite lifestyle modification?
Statin therapy
What is the indication for aortic valve replacement?
For patients with severe aortic stenosis who are undergoing other cardiac surgery or have a left EJ of <50% or symptoms from severe outflow obstruction
What is ibutilide used for?
Cardioversion of suitable patients with A-fib or atrial flutter
What defines a massive pulmonary embolism (PE)?
Systolic BP < 90 mm for 15 minutes, fall in systolic BP by >40 mm for 15 minutes, or requirement for vasopressors
What is the classic triad of RV infarction in the setting of an inferior MI?
Hypotension, distended neck veins, clear lungs
What is the most appropriate initial therapy for hemodynamically stable monomorphic wide-complex tachycardia?
An antiarrhythmic drug such as amiodarone, procainamide, or lidocaine
What are amoxicillin and cephalexin commonly used for?
Secondary prevention of recurrent GAS infection and rheumatic fever complications
What is the most appropriate initial therapy for a patient with hemodynamically stable monomorphic wide-complex tachycardia?
An antiarrhythmic drug such as amiodarone, procainamide, or lidocaine.
True or False: Amoxicillin and cephalexin are commonly used for secondary prevention of recurrent GAS infection and rheumatic fever complications.
False
They have not been well studied at this time.
What is more common for secondary prevention of recurrent GAS infection and rheumatic fever complications as of 2022?
IM Penicillin G Benzathine.
What does a negative initial high sensitivity cardiac troponin value (<5ng/L) with no significant one hour increase rule out?
ACS (Acute Coronary Syndrome) typically.
What is the basis for choosing anticoagulant therapy for patients with nonvalvular atrial fibrillation?
Their absolute annual risk for stroke.
What is the initial management of acute viral pericarditis?
A high-dose NSAID and colchicine.
What should all patients with NSTEMI receive?
DAPT (dual antiplatelet therapy) involving aspirin and a P2Y12 inhibitor.
Where is a pericardial friction rub best heard in acute pericarditis?
At the left sternal border at end expiration while leaning forward.
How should stable atrial fibrillation with preexcitation such as WPW be managed?
With agents that inhibit conduction through the atrioventricular node but not the accessory pathway.
What is the hemodynamic variable most likely to be elevated in a patient with right ventricular infarction?
Central venous pressure.
What is the most common cause of constrictive pericarditis worldwide?
Tuberculosis.
How are patients with recurrent malignant pericardial effusions best treated?
With surgical subxiphoid pericardiotomy.
What is a pericardial window?
Another term for surgical subxiphoid pericardiotomy.
In acute pericarditis, what percentage of patients have an audible pericardial friction rub?
Roughly 85%.
What can high sensitivity troponin assays determine within 1 to 3 hours?
ACS (Acute Coronary Syndrome).
What is the likely diagnosis for a patient with severe retrosternal chest pain radiating to the back and neck, and a diastolic decrescendo murmur?
Aortic dissection.
Why should ACE inhibitors and ARBs not be used together?
Due to concern for renal damage and hyperkalemia.
What are the inferior leads of the heart?
Leads II, III, and aVF.
What cardiac conditions need antibiotic prophylaxis for bacterial enteritis before dental procedures?
Prosthetic heart valves, valve repair with prosthetic material, heart transplant with valvulopathy, prior infective endocarditis, certain types of congenital heart disease.
What is the loading dose of aspirin usually for NSTEMI?
325 mg orally.
What can catecholamine-induced cardiomyopathy manifest as?
Severe diffuse apical wall motion abnormalities with preserved base function.
What should be ruled out in a patient with symptomatic sinus bradycardia?
Medications, sleep apnea, hypothyroidism, myocardial infarction, and electrolyte imbalances.
What is the definitive treatment for symptomatic left atrial myxoma?
Surgical excision.
What is the most appropriate intervention for an older adult with orthostatic hypotension taking an alpha-blocker?
Discontinue the antihypertensive medication.
When is an ICD indicated after an MI?
If the patient has a left ventricular EF of 35% or less at least 40 days after the infarction.
What are the likely symptoms of constrictive pericarditis?
Ascites, lower extremity edema refractory to diuretics, and Kussmaul sign.
Do Type B aortic dissections involve the ascending aorta?
No.
What is the likely diagnosis for a patient with a prominent first heart sound and early low-pitched diastolic heart sound with cardiac and cancer symptoms?
Atrial myxoma.
What does a loud first heart sound indicate in relation to mitral valve closure?
Delayed mitral valve closure resulting from tumor prolapse through the orifice.
What is a ‘tumor plop’?
An early diastolic sound related to contact between the tumor and the endocardial wall when its excursions are halted.
What is the treatment of choice in a hemodynamically stable patient with acute atrial fibrillation and preexcitation?
Intravenous procainamide or ibutilide.
What can a small subset of patients with PE experience?
An exuberant release of epinephrine leading to hypertension.
What is the typical dosing for Apixaban?
5 mg twice daily.
What are the signs of calcium channel blocker overdose?
Hypotension, bradycardia, hyperglycemia, and metabolic acidosis.
What does increased JVP with inspiration describe?
Kussmaul sign.
What are three typical indications for biventricular pacing?
LVEF of less than 35%, sinus rhythm with LBBB morphology, QRS complex duration of greater than 149 ms.
What is the diagnostic criteria for congenital long QT syndrome in women and men?
QTC of >460 msec in women and >440 msec in men.
What is the likely cause of cerebral and peripheral embolic events in a patient with constitutional symptoms and heart failure symptoms?
Atrial myxoma.
What is an atrial myxoma?
Atrial myxoma is a type of tumor found in the heart’s atrium.
What does a 2:1 atrioventricular block in a patient taking digoxin suggest?
It is highly suggestive of digoxin toxicity.
What are nonclassical symptoms of myocardial infarction?
Nonclassical symptoms include jaw, neck, ear, arm, and epigastric pain.
What should primary prevention in patients aged 40 to 75 years with type 2 diabetes include?
It should include at least moderate-intensity statin therapy.
What do SGLT2 inhibitors do for patients with heart failure with reduced ejection fraction (HFrEF)?
They reduce hospitalization and mortality rates.
How can ischemia be diagnosed in patients with left bundle branch blocks or a paced rhythm?
Ischemia can be diagnosed if the ST segment depression is > 1 mm and concordant with the QRS complex.
What is situational syncope?
Situational syncope is similar to vasovagal syncope, except the trigger is a specific action or physiological function.
What is recommended for men aged 65-75 who have ever smoked?
A one-time ultrasound of the abdominal aorta is recommended to evaluate for abdominal aortic aneurysm (AAA).
What EKG findings can be seen in catecholamine-induced cardiomyopathy?
EKG findings can include ST-segment elevation or diffuse T wave inversion throughout the precordial leads.
What is the anticoagulation therapy necessary for a patient with atrial fibrillation?
No anticoagulation therapy is necessary if the patient has no other thromboembolic risk factors.
What are the indications for antibiotic prophylaxis to prevent infective endocarditis?
Indications include patients with prosthetic cardiac valves, prosthetic material used for cardiac valve repair, previous infective endocarditis, unrepaired cyanotic congenital heart disease, and cardiac transplant with valve regurgitation.
What is the shock index in massive pulmonary embolism?
A shock index (HR/SBP) >1 suggests poor hemodynamic reserve and a worse prognosis.
What is the first step in evaluating a patient before noncardiac surgery?
The first step is to exclude active cardiac conditions.
What does Mobitz type 2 heart block describe?
It describes intermittent nonconducted P waves with unchanging PR intervals.
What does ST segment elevation in lead aVR indicate in a patient with acute coronary syndrome?
It indicates diffuse endocardial ischemia.
What is a Bifascicular block?
A Bifascicular block is an RBBB with either a left anterior fascicular block or a left posterior fascicular block.
What preoperative testing is necessary for a patient with coronary artery disease undergoing cataract surgery?
None, if the patient has no active problems and good functional capacity.
What antibiotics are recommended for secondary prevention of rheumatic fever?
Long-acting Penicillin G Benzathine IM every 3 to 4 weeks, daily oral penicillin V, sulfadiazine, or a macrolide.
Why are vasodilators such as nitrates not indicated for right ventricular myocardial infarction?
They may exacerbate hypotension.
What is the most common manifestation of von Willebrand disease?
Nosebleeds and bleeding gums.
What is the next step for a patient with bradycardia following syncope who is currently asymptomatic?
If the patient is stable, a pacemaker is indicated if bradycardia has no reversible causes.
What should patients with PCIS avoid?
They should avoid non-aspirin nonsteroidal anti-inflammatory drugs and glucocorticoids because they impede myocardial healing.
How is hemodynamically stable monomorphic VT typically treated?
It is typically treated with an anti-arrhythmic drug.
What are the signs of heart failure in a critically ill patient?
Signs include volume overload and evidence of low perfusion.
What impedes myocardial healing?
Factors that impede myocardial healing include hemodynamically stable monomorphic VT and volume overload.
What is the typical treatment for hemodynamically stable monomorphic wide-complex tachycardia?
The most appropriate initial therapy is an antiarrhythmic drug such as amiodarone, procainamide, or lidocaine.
What is the preferred first-line agent for pressors in massive PE?
Epinephrine is the preferred first-line agent.
What is the target INR for patients with a mechanical aortic valve?
The typical target INR is 2.0-3.0, increasing to 2.5-3.5 with additional risk factors for thromboembolism.
What imaging studies are typical for PE?
Typical imaging studies include CT angiography, EKG, and echocardiography.
What should be performed if a patient has a hemoglobin level >20 g/dL and hematocrit >65% with symptoms of hyperviscosity?
Phlebotomy should be performed.
What is indicated for patients with symptomatic coronary artery disease?
Along with aspirin and a statin, a beta-blocker is routinely recommended.
What is the next step for a patient with poorly controlled hypertension already on multiple antihypertensives?
The next indicated step would be to add a diuretic.
What is the treatment for hemodynamically unstable patients with A-fib with RVR?
The treatment is synchronized cardioversion.
What is the most appropriate immediate treatment for symptomatic complete heart block?
Transcutaneous or transvenous pacing is the immediate treatment before a pacemaker is placed.
What are indicators of aortic coarctation?
Indicators include diminished and delayed pulses of the femoral arteries relative to the brachial arteries.
What is the equivalent of walking up stairs or hills in metabolic equivalents?
Walking up stairs or hills is equivalent to four metabolic equivalents.
What are the ECG findings of left ventricular hypertrophy (LVH)?
ECG findings include tall R waves, deep S waves, +/- QRS widening, +/- left axis deviation, +/- ST-T changes, and +/- left atrial enlargement.
What is the likely diagnosis for new onset episodic severe hypertension associated with acute cardiomyopathy?
The likely diagnosis is pheochromocytoma.
What antibiotics are recommended for secondary prevention of rheumatic fever?
Long-acting Penicillin G Benzathine IM every 3 to 4 weeks, daily oral penicillin V, sulfadiazine, or a macrolide class of antibiotic.
What class of medications is associated with orthostatic hypotension in older men with hypertension?
Alpha-blockers are associated with orthostatic hypotension.
What are alpha-blockers?
Alpha-blockers are medications used to treat various conditions, especially when the drug is first started or restarted after an interruption in therapy.
What is the next step when a patient recently discharged from the hospital presents with new or worsening symptoms?
The next step is medication reconciliation.
What may patients display in the first week after cholesterol embolization?
Patients may display peripheral eosinophilia and eosinophiluria.
What is indicated if the hematocrit exceeds 65% or hemoglobin exceeds 20 in cyanotic congenital heart disease?
Therapeutic phlebotomy is indicated if there are symptoms of hyperviscosity.
What is the next step for a hemodynamically stable SVT that does not respond to vagal maneuvers?
The next step is IV adenosine.
What is hereditary hemorrhagic telangiectasia?
Hereditary hemorrhagic telangiectasia is an autosomal dominant disorder associated with arteriovenous malformations (AVMs) of the brain, skin, liver, and lungs.
What is an indication for a permanent pacemaker in patients with a 2:1 second-degree heart block?
Symptomatic patients with a 2:1 second-degree heart block are an indication for a permanent pacemaker.
