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Internal Medicine > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Routine procedure performed within the first year after cardiac transplantation to diagnose rejection

A

Endomyocardial biopsy

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2
Q

Criteria for mitral valve repair

A

1) chronic severe primary MR in symptomatic patients with LVEF > 30%
2) asymptomatic patients with LVEF < 60% and/or LVESD > 40mm
3) Patients undergoing another cardiac surgical procedure

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3
Q

Monoclonal antibody associated with the development of significant but reversible hypertension

A

Bevacizumab

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4
Q

CAD evaluation in patients with suspected CAD who have baseline ECG abnormalities that preclude the use of ECG stress testing, such as ST-segment depressions >0.5 mm, LBBB, ventricular paced complexes, digitalis effect, and pre-excitation

A

Stress testing with adjunctive imaging

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5
Q

First line therapy for constrictive pericarditis

A

NSAID + colchicine

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6
Q

Test to determine severe ventricular dysfunction with pseudostenosis vs critical aortic stenosis

A

Dobutamine echocardiography

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7
Q

Pharmaceutical agents to consider in cardiogenic shock to improve cardiac function

A

Inotropes, such as dobutamine or milrinone

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8
Q

Most appropriate treatment for patients with symptomatic atrial flutter despite adequate medical therapy and rate control

A

Catheter ablation

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9
Q

Continuous murmur beneath the left clavicle that envelops the S2 but no other cardiovascular features

A

Patent ductus arteriosus

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10
Q

Angina and stress testing abnormalities in the absence of an geographically significant coronary artery disease

A

Cardiac syndrome X

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11
Q

Modifiable risk factor with the highest risk for cardiovascular disease

A

Hyperlipidemia

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12
Q

Small, independently mobile cardiac tumors that are typically attached to the left-sided valvular endocardium by a stock. They may be associated with stroke, TIA, angina, myocardial infarction, and peripheral embolization.

A

Papillary fibroelastomas

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13
Q

Appropriate short term management to improve exercise capacity and quality of life in patients with cyanotic conditions, such as Eisenmenger syndrome

A

Iron therapy

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14
Q

Recommended management for patients with STEMI when symptom onset is within 12 hours and primary PCI is not available within 120 minutes of first medical contact

A

Thrombolytic therapy

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15
Q

Ankle brachial index < 0.90

A

Peripheral Arterial disease

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16
Q

Ankle brachial index > 1.40

A

Presence of calcified, non-compressible arteries in the lower extremities and is considered uninterpretable

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17
Q

Indications for cardiac surgery in patients with infective endocarditis

A

1) persistent infection lasting longer than 5 to 7 days while on appropriate antimicrobial therapy
2) symptomatic heart failure
3) left-sided involvement with staphylococcus aureus, fungal infections, or highly resistant organisms
4) Complications such as heart block, annular or aortic abscess, or destructive penetrating lesions
5) Prosthetic valve infective endocarditis and relapsing infection


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18
Q

Management of uncomplicated type B aortic dissection

A

Medical therapy, including beta blockers, sodium nitroprusside, and opioids

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19
Q

Reversible ventricular systolic dysfunction that is usually precipitated by an acute emotional or physiologic stressor. The hallmark is wall motion abnormalities that extend beyond a single coronary territory, identified by echocardiography or other imaging studies

A

Takotsubo cardiomyopathy

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20
Q

Recommended intervention for patients with symptomatic pulmonary valve stenosis who have appropriate valve morphology, a peak Doppler gradient of >50 mmHg or a mean gradient >30 mmHg, and valve characteristics favorable for percutaneous intervention

A

Balloon valvuloplasty

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21
Q

Hypertension management in pregnancy

A

Labetolol or methyldopa

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22
Q

Recommended frequency for clinical and echocardiographic surveillance in asymptomatic severe MR with preserved left ventricular function who do not have an indication for surgery

A

Every 6 to 12 months

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23
Q

Rare complication of myocardial infarction that produces sudden onset chest pain or syncope with rapid progression to pulseless electrical activity

A

Ventricular free wall rupture

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24
Q

specific type of ASD characterized by Fixed splitting of the S2, AMR murmur, and LAD on ECG.

A

Ostium primum

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25
Q

Recommended minimum duration for DAPT following DES placement for management of stable angina

A

Six months

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26
Q

Treatment for atrial myxoma

A

Surgical excision

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27
Q

Congenital syndrome with pulmonary stenosis, short stature, variable intellectual impairment, unique facial features, neck webbing, hypertelorism, and other cardiac abnormalities including HCM, ASD, VSD

A

Noonan syndrome

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28
Q

Indications for ICD therapy

A

1) NICM with LVEF < 35% + NYHA II or III symptoms

2) NICM + unexplained syncope and significant left ventricular dysfunction

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29
Q

Management for patients with mitral stenosis who have a discrepancy between the clinical findings and the echocardiographic findings

A

Stress ECHO

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30
Q

Frequency of monitoring patients with a bicuspid aortic valve and a thoracic aortic aneurysm if the aortic diameter is >4.5 cm or the rate of enlargement exceeds 0.5 cm/year

A

Every six months

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31
Q

Left ventricular systolic dysfunction with onset toward the end of pregnancy or in the months following delivery in the absence of another Identifiable cause. Patients often present with features of heart failure

A

Peripartum cardiomyopathy

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32
Q

Most effective strategy to preserve tissue viability in patients with critical limb ischemia

A

Invasive angiography with endovascular revascularization

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33
Q

Indications for surgery in patients with severe aortic regurgitation

A

1) presence of attributable symptoms

2) LVEF < 50%
3) significant left ventricular dilatation (>50mm)

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34
Q

Evaluation to establish severity of aortic stenosis in patients with symptoms of aortic stenosis and discrepancies between the physical examination and echocardiographic findings

A

Cardiac catheterization

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35
Q

hypotension, pulses paradoxus, enlarged cardiac silhouette on chest radiograph and electrical alternans on ECG

A

Cardiac Tamponade

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36
Q

Recommended management to improve survival in patients with multivessel coronary artery disease and left ventricular dysfunction in patients with diabetes mellitus and multivessel disease

A

CABG surgery

37
Q

Management for patients with premature ventricular contraction induced cardiomyopathy

A

Catheter ablation

38
Q

Gold standard therapy for patients with end-stage heart failure

A

Cardiac transplantation

If contraindicated, LVAd is appropriate management

39
Q

Contraindications for cardiac

Transplantation

A

1) > 70 y/o

2) Diabetes with end organ complications
3) Malignancies within five years
4) Kidney dysfunction
5) Other chronic illnesses that will decrease survival

40
Q

Most common structural disorder resulting from tetralogy of Fallot repair

A

Pulmonary regurgitation

41
Q

Management for AAAs:

1) < 4.0 cm (5-year risk of 2%)
2) between 4.0 cm and 5.4 cm (5-year risk for rupture of 3% to 12%)
3) > 5.5 cm
4) symptoms or rapid expansion in size (>5.0 cm/year)

A

1) US Every 2 to 3 years
2) US Every 6 to 12 months
3) Repair (surgical or endovascular)
4) Repair (surgical or endovascular)

42
Q

Preferred imaging modality for evaluating patients with a high pretest probability of infective endocarditis or with potential complications of endocarditis, such as abscess

A

TEE

43
Q

Preferred anticoagulation therapy in pregnant patients with a mechanical valve prosthesis

A

Warfarin (If 5 mg daily or less during first trimester)

44
Q

Recommended management for asymptomatic patients with a bicuspid aortic valve and severe aortic regurgitation when the LVESD reaches 50 mm or the LVEF < 50%

A

Valve replacement surgery

45
Q

Elevated resting heart rate, with exaggerated increases in heart rate with light activity and decreases during sleep

A

Inappropriate sinus tachycardia (IST)

46
Q

Preferred diagnostic test for CAD in patients with LBBB

A

Vasodilator stress test (I.e. Adenosine)

47
Q

Right sided heart failure, low or normal BNP level, and the finding of pericardial thickening or calcification on imaging studies

A

Constrictive pericarditis

48
Q

Elevated CVP, fixed splitting of S2, right ventricular heave, RAD and incomplete RBBB on ECG

A

Ostium secundum ASD

49
Q

Recommended management for improvement of limb symptoms in patients with PAD and intermittent claudication

A

Smoking cessation, exercise training, and medical therapy (cilostazol)

50
Q

Black patients > 50 y/o who have left ventricular wall thickening that is not explained by loading conditions (For example, hypertension or aortic stenosis) and present with heart failure or features of diastolic dysfunction

A

Cardiac amyloidosis

51
Q

Criteria for aortic valve replacement/repair of aortic regurgitation

A

1) symptomatic or acute
2) LVEF 50% or less
3) Moderate or severe Aortic regurgitation at time of other cardiac surgery
4) significant LV dilatation (LVESD > 50 mm or indexed ESD > 25 mm/m2)

52
Q

Murmur indications for TTE

A

1) systolic murmur grade 3/6 or higher
2) late or holosystolic murmurs
3) Diastolic or continuous murmurs
4) Murmurs with accompanying symptoms

53
Q

Avoid or reduce dose of ranolazine when used with these medications

A

CYP3A inhibitors

54
Q

Inhibitor of If or “I-funny” Channel of the SA node, resulting in a reduction in HR in patients with HFrEF (LVEF < 35%) and NYHA II to IV, sinus rhythm with HR of > 70 bpm, and on GDMT

A

Ivabradine

55
Q

Indications for device closure of an ostium secundum ASD

A

Right heart enlargement and symptomatic disease

56
Q

Indications for cardiac resynchronization therapy (CRT)

A

1) LVEF < 35%
2) NYHA II to IV despite GDMT
3) Sinus rhythm
4) LBBB with a QRS duration > 150 ms

57
Q

First line therapy for acute pericarditis

A

High-dose aspirin or NSAIDs and adjuvant colchicine therapy

58
Q

Indications for Cardiac catheterization for patients with the following post-MI stress test results (4):

A

1) exercise-induced ST segment depression or elevation
2) Inability to achieve 5 METs during testing
3) inability to increase SBP by 10 to 30 mmHg
4) inability to exercise (arthritis)

59
Q

Recommended management for symptomatic patients Of any age with severe Aortic stenosis and a high or prohibitive surgical risk if predicted post procedure survival is >12 months with an acceptable QOL

A

Transcatheter aortic valve implantation

60
Q

Class 1 recommendations for secondary prevention with implantable cardioverter-defibrillator placement (2)

A

1) Sustained ventricular arrhythmias (>30 sec)

2) Cardiac arrest without reversible cause

61
Q

Rare malignant cardiac tumors typically arise within the RA and are commonly associated with sanguinous pericardial effusion

A

Cardiac angiosarcomas

62
Q

Appropriate management to reduce Cardiovascular risk In patients with PAD

A

Anti-thrombotic therapy with very low-dose rivaroxaban + aspirin

63
Q

Most common form of SVT

A

AVNRT

64
Q

Most appropriate management for asymptomatic PDA in patients with left-sided cardiac chamber enlargement

A

PDA device closure

65
Q

Next step in evaluation in patients with PAD and normal ABI values

A

Exercise ABI testing

66
Q

Appropriate management for recurrent pericarditis initially treated with colchicine and NSAID

A

NSAID, Colchicine, prednisone

67
Q

Most common cause of pregnancy associated MI that occurs most commonly in the first month postpartum

A

Spontaneous coronary artery dissection

68
Q

First line treatment for symptomatic PVC suppression

A

Beta blocker or calcium channel blocker

69
Q

Preserved basal left ventricular function with apical and mid -ventricular hypokinesis

A

Takotsubo cardiomyopathy

70
Q

Effective treatment of cardiac device infection

A

1) Complete extraction of all hardware 2) debridement of the pocket
3) sustained antibiotic therapy
4) reimplantation at a new location after infection has been eradicated

71
Q

Structurally normal heart and right precordial ECG abnormalities, including ST segment coving in leads V1-V3 +/- RBBB

A

Brugada syndrome

72
Q

Appropriate management for atrial myxoma with CNS embolic event

A

Urgent cardiac surgical evaluation and excision

73
Q

Valve area and mean transvalvular gradient in severe AS

A

Valve area: < 1 cm sq

Mean transvalv gradient: > 40 mmHg

74
Q

Most common congenital heart abnormality

A

Bicuspid aortic valve

75
Q

Recommended management for symptomatic AS in patients at low operative risk

A

Surgical AV replacement

76
Q

First line therapy for a stenotic bicuspid aortic valve

A

Surgical AV replacement

77
Q

Indications to surgically repair the aortic root or replace the ascending aorta

A

Aortic root diameter > 5 cm + risk factors for dissection (family hx, rste if progression > 0.5 cm/year) or > 5.5 w/o risk factors

78
Q

ECHO surveillance for ascending aortic diameter

A

Yearly if > 4.5 cm

Every 2 years if < 4.0 cm

79
Q

Most common postoperative sequela of tetralogy of Fallot repair

A

Pulmonary regurgitation

80
Q

Recommend INR range for warfarin therapy in mechanical valves in the mitral position

A

2.5 to 3.5

81
Q

Appropriate management for symptomatic patients with MS and for asymptomatic patients when the valve area is < 1.0 cm sq

A

Percutaneous balloon mitral commissurotomy

82
Q

3 components that classify stable angina pectoralis

A

1) The quality and duration of discomfort (most commonly 2-5 min)
2) provocation by exertional or emotional stress
3) Relief with rest or nitroglycerin

83
Q

Indications for ascending thoracic aneurysms prophylactic surgery

A

1) aortic diameter > 5.0 cm (> 4.5-5.0 cm for Marfan Syndrome)
2) aortic diameter > 4.5 cm and undergoing other heart surgery
3) rapid growth > 0.5 cm/year

84
Q

Next seven evaluation for ABI > 1.4

A

Toe-brachial index

85
Q

Effective therapy for select patients with end-stage restrictive cardiomyopathy

A

Cardiac transplantation

86
Q

Appropriate management for bicuspid AV and aortic sinuses or an ascending aorta > 4 cm in diameter

A

ECHO surveillance

87
Q

 Reason for normal BNP in a patient with symptomatic heart failure

A

High BMI

88
Q

Appropriate management for congenital long QT syndrome

A

Beta blockers (I.e Propanolol, nadolol)

Internal Medicine (12 decks)

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