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ABIM > Cardiology 1 > Flashcards

Cardiology 1 Flashcards

1
Q

When is Surgery indicated for Infective Endocarditis (5)?

A
  1. Symptomatic Heart Failure or Valve
    Dysfunction
  2. Fungal/Highly Resistant Organism
  3. Persistent Bacteremia
  4. Annular or Aortic abscess
  5. Heart block
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2
Q
  1. First Test to Diagnosis Acute Thoracic Aortic Aneurysm?
  2. Initial treatment ?
  3. Rx for type A ?
  4. Rx for type B?
A
  1. CT angiography
  2. Beta blockers (Esmolol) to get pressure < 120 mmg Hg. Add vasodilators (Nitroprusside) if needed medically treat first for patients without shock.
  3. Type A treatment is Surgery
  4. Type B treatment is Medical Therapy Alone, unless complicated.
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3
Q

Rx of patients with Aortic Atheroma?

A

Stains and Plavix to reduce systemic Embolism and Stroke

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4
Q

Indications for Prophylactic TAA (Thoracic Aortic Aneurysm) Surgery (3)?

A
  1. Aortic Diameter > 5.0 cm
  2. Aortic diameter > 4.5 cm and undergoing heart surgery for something else
  3. Rapid Growth >0.5cm in 1 year
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5
Q
  1. Who is screened for AAA?
  2. What is the interval screening time for AAA < 4.0cm? 4.0-5.0 cm?
A
  1. Men age 65 to 75 years who smoked at least 100 cigs in life time or family hx of AAA.
  2. Years. Months.
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6
Q

Measurements to determine Severe AS?

A

Valve area < 1.0cm2 and Mean Gradient > 40 mm Hg

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7
Q

What is the next step in management when there is discrepancy btw Aortic Valve Area on Echo and Symptoms within the patient? (Valve area only 1.5cm and a Mean Gradient of 28 mmhg, (Pt presents with carotid tardus, diminished aortic component of S2, late peaking systolic murmur.)

A

Cardiac Catherization.
The Echo can underestimate the Transvalvular Gradient in patients with Severe LV Dysfunction. (pseudo-steonosis)

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8
Q
  1. Who gets TAVI?
  2. Who gets SAVR?
  3. Whom is TAVI contraindicated?
  4. What to give when patients awaiting surgery/TAVR
A
  1. Intermediate-high risk surgical pts
  2. Low risk surgical pts
  3. Bicuspid Aortic Valve, Significant AR, Mitral valve disease.
  4. Diuretics, ACE, dig
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9
Q

Man that is otherwise healthy has a grade 2/6 Diastolic Decrescendo murmur heard at Right lower sternal border and Echo shows Bicuspid Aortic Valve, Ascending aorta is enlarged with dimension 42mm. Next step in management?

A

CT angio of Aorta. To check for Dissection, Aneurysm, Corarctation.

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10
Q

A re-entrant circuit within the AV node that uses both fast and slow pathways.
Rx?
What helps block recurrent rhythms?

A

AVNRT. Typical (slow-fast) = Short RP interval.
Atypical (Fast-slow) = Long RP interval.
Carotid Massage and Adenosine.

AV nodal blocking agents like CCB and BB can help prevent recurrent.

Catheter Ablation can be considered in patients who do not want long term medical therapy.

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11
Q
  1. Accessory Pathway Mediated Tachycardia which is observed as Pre-excitation. (Short RP interval, Retrograde P wave) ?
  2. When is it called WPW?
A

AVRT

When symptoms are present. WPW syndrome.

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12
Q

Rx for SVT?
How to treat recurrent AVNRT?
What does it mean if there is progression of p wave after adenosine is given?
Definitive Rx?

A

Valsalva, Carotid Massage, cold water immersion, Adenosine.

CCB and Beta blocker prevent recurrent.

Means Afib, Aflutter (continue P waves despite AV block).

Ablation is definitive therapy.

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13
Q

What medications to avoid in AF with WPW? What is the complication.

A

(AV Nodal blocking Agents that cause overuse of the Accessory Pathway) -CCB, Beta blockers, dig. this can convert it to AF, VT, VF

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14
Q

Pt presents with JVD, peripheral edema, hypotension, pulsus paradoxus, enlarged cardiac silhouette on CXR and EKG shows evidence of electrical alterans. Dx?

A

Cardiac Tamponade

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15
Q

When is CABG indicated?

A
  1. Left Main disease
  2. 3 vessel disease
  3. DM
  4. Left ventricular dysfunction
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16
Q

Management of pt with PAD? Management of critical limb ischemia (pt presenting with absent pulses)?

A

Exercise, Asa, Statin (high intensity). Invasive angiography of that leg.

17
Q

What are the forms of ASCVD? Who should be treated with high intensity statin?

A

PAD, ACS, hx of MI, stroke, TIA, PCI, stable and unstable angina.

Patients 75 or younger with one of these ASCVD or calculated risk of 7.5% should be treated with high intensity statin

18
Q

Indications to proceed with TTE for murmurs heard on exam? (4)

A
  1. Systolic Murmur Grade 3 or higher
  2. Late or Holosystolic murmur
  3. Diastolic or Continuous murmur
  4. Murmur with symptoms
19
Q

Name that murmur: Mid-systolic, crescendo-decrescendo, Right upper sternal border radiating to carotid, clavicle, apex. Associated with enlarged non displaced apical impical impulse

A

AS

20
Q

Name that murmur: Diastolic decrescendo murmur at left lower sternal border or right lower sternal border no radiation. Associated with bounding pulses , increased pulse pressure, enlarge displaced apical impulse

A

AR

21
Q

Name that murmur: Diastolic, low pitched decrescendo murmur heard at apex no radiation associated with loud S1, opening snap after S2.

What is the next best step which patients have discrepancy between there symptoms and echo?

A

MS

Exercise Echo

22
Q

Name that murmur:

Systolic, holosystolic or later systolic murmur heard at apex radiates to axilla, Valsalva improves it, hand grip increases intensity

A

MR

23
Q

Name that murmur:

Systolic crescendo- decrescendo murmur heard LEFT upper sternal border radiating to left clavicle associated with Pulmonic Ejection click after S1, diminishes with inspiration.

A

PS

24
Q
  1. Name that murmur: Diastolic decrescendo murmur heard at left lower sternal sternal border associated with loud P2 if pulm HTN present and non radiating.
  2. What if it was associated with bounding pulses and increased pulse pressure and non radiating ?
  3. What if it was associated with elevated CVP and non-radiating?
A

PR
AR
TS

25
Q

Name that murmur: Midsystolic grade 1/6 or 2/6 in intensity heard right upper sternal border associated normal intensity of A2 and normal splitting of S2, no radiation

A

Innocent flow murmur

26
Q

Name that murmur: Systolic crescendo -descrscendo murmur heard at LLSB with enlarged hyperdynamic apical impulse, murmur increases with valsava and moving from squatting to standing position

A

Hypertrophic Obstructive Cardiomyopathy

27
Q

Name that murmur:
Systolic Crescendo-Descrendo heard at Right Upper Sternal Border associated. Fixed Splitting S2, Right ventricle heave.

What if it there was radiation to Right Clavicle and Apex associated with Bicuspid Valve instead?

A

ASD

AS

28
Q

Name that murmur:

Holosystolic, Left lower sternal border, NON-radiating associated with Palpable thrill ?

What if it was radiating and up Left upper sternal border?

A

VSD

TR

29
Q

Anti-Platelet Therapy After Stenting:
1. DES and BMS?
2. Total Duration?
3. Aspirin Management ?

Peri-operative Management:
1. Elective Surgery?
2. Emergent Surgery?
3. Aspirin Management?

A
  1. 6-12 months minimum DAPT, At least 1 month for BMS in select patients
  2. 30 months
  3. Continue Indefinitely
  4. Post-pone until DAPT duration completed (6 months for DES and 1 month for BMS)
  5. Continue DAPT or At least Aspirin Alone during Peri-operative Period.

Hold for Neurosurgery (High Bleeding RISK)

  1. Continue Aspirin unless high risk of surgical bleeding
30
Q
  1. What test should be conducted when a patient has an infrequent arrhythmia that occurs once or twice a week?
  2. What test is done when no cause is found with the least invasive test?
A
  1. External Event Recorder
  2. EP study
31
Q

A. When is Surgical Mitral Valve Repair for MR indicated?

B. Indications for Ballon Valvuloplasty for Mitral
Stenosis?

C. Contraindications for Balloon Valvuloplasty for Mitral Stenosis? (3)

A

A. 1. Acute MR
(Treat with initially with Nitroprusside and
Balloon Pump- decrease Afterload)
2. Asymptomatic LVEF < 60%, LV diameter >
0mm (60,40 Rule)
3. Chronic Symptomatic, PH, Afib
4. When Severe and another surgery is
planned

B. Severe Mitral Stenosis (<1.5cm2) + SOB OR
Pulmonary Artery Pressure (PAP) > 50mm Hg

C. 1. Moderate to Severe Mitral Regurgitation
2. Complex Valve Anatomy
3. Left atrial thrombus

32
Q

Next step in management in a patient with WPW?

Rx 1st line? 2nd line?

A

Stress testing to asses for Ventricular arrhythmia and Sudden Cardiac Death.

Catheter Ablation. Anti-arrhythmic medication

33
Q

Management of Tachyarrthmia with a Pulse:
1. Sinus Tach?
2. Hemodynamic Instability?
3. Hemodynamically stable?
Widened QRS Regular Rhythm ?
Widened QRS Irregular Rhythm ?
Narrow QRS regular?
Narrow QRS Irregular?

A
  1. Airway Management, 02 and Assess Rhythm
  2. Sinus Tach? —-> Treat underlying condition
  3. Hemodynamic Instability Present ? –Cardiovert
  4. Hemodynamically stable? —> Widened QRS complexes (>0.12 sec)? —>regular rhythm? –>Monomorphic VT (Expert Consultation, Pharmacologic cardioversion)

Widened QRS with Irregular Rhythm—> Afib with Abberancy, Pre-excited Afib, PMVT (Expert Consultation)

Narrow QRS? —> Regular Rhythm?—> Non-Afib SVT (AVNRT)
If Narrow QRS and Irregular the Afib/A Flutter

34
Q
  1. Indications for Aortic Valve Replacement? (2)
  2. Management of patients who dont meet criteria?
A
  1. a. Severe Aortic Valve Regurgitation +
    Symptoms
    b. Severe Aortic Valve Stenosis+ EF < 50% or
    Left End Diastolic dimension > 50mm
  2. Echo every 6-12 months.
35
Q

Treatment of Complete Heart Block:

  1. Acutely Symptomatic with Narrow QRS on EKG
  2. Acutely Symptomatic with Wide QRS
  3. Stable Asymptomatic
A

Look for Reversible Causes

  1. Atropine —> Permanent pace maker
  2. Pacing —> Permanent pacemaker
  3. Permanent Pacemaker
36
Q

Who Needs Bacterial Endocarditis PPx? (6)

A
  1. Prosthetic Valve
  2. Repair of Valve using Prosthetic Material
  3. Previous Infection
  4. Unrepaired PDA
  5. Repaired PDA with residual Shunt
  6. Valve Dz in Transplant heart
37
Q

Follow up plan for Aortic Stenosis:
1. Mild
2. Moderate
3. Severe

A
  1. Gradient < 20mmHg follow Every 3-5 Yrs
  2. Gradient 20-39 mmHg follow Every 1-2 Yrs
  3. Gradient > 40mm Hg follow Every 6-12 months
38
Q
  1. Who has an INR recommendation of 2.5-3.5?
  2. Who has an INR recommendation of 2.0-3.0?
A
  1. Mechanical Mitral Valve Or Mechanical Aortic Valve + 1 Risk factor
  2. Modern Bileaflet Mechanical Aortic Valve

ABIM (45 decks)

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