Cardiology Flashcards
Routine procedure performed within the first year after cardiac transplantation to diagnose rejection
Endomyocardial biopsy
Criteria for mitral valve repair
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
Monoclonal antibody associated with the development of significant but reversible hypertension
Bevacizumab
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
Stress testing with adjunctive imaging
First line therapy for constrictive pericarditis
NSAID + colchicine
Test to determine severe ventricular dysfunction with pseudostenosis vs critical aortic stenosis
Dobutamine echocardiography
Pharmaceutical agents to consider in cardiogenic shock to improve cardiac function
Inotropes, such as dobutamine or milrinone
Most appropriate treatment for patients with symptomatic atrial flutter despite adequate medical therapy and rate control
Catheter ablation
Continuous murmur beneath the left clavicle that envelops the S2 but no other cardiovascular features
Patent ductus arteriosus
Angina and stress testing abnormalities in the absence of an geographically significant coronary artery disease
Cardiac syndrome X
Modifiable risk factor with the highest risk for cardiovascular disease
Hyperlipidemia
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.
Papillary fibroelastomas
Appropriate short term management to improve exercise capacity and quality of life in patients with cyanotic conditions, such as Eisenmenger syndrome
Iron therapy
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
Thrombolytic therapy
Ankle brachial index < 0.90
Peripheral Arterial disease
Ankle brachial index > 1.40
Presence of calcified, non-compressible arteries in the lower extremities and is considered uninterpretable
Indications for cardiac surgery in patients with infective endocarditis
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

Management of uncomplicated type B aortic dissection
Medical therapy, including beta blockers, sodium nitroprusside, and opioids
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
Takotsubo cardiomyopathy
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
Balloon valvuloplasty
Hypertension management in pregnancy
Labetolol or methyldopa
Recommended frequency for clinical and echocardiographic surveillance in asymptomatic severe MR with preserved left ventricular function who do not have an indication for surgery
Every 6 to 12 months
Rare complication of myocardial infarction that produces sudden onset chest pain or syncope with rapid progression to pulseless electrical activity
Ventricular free wall rupture
specific type of ASD characterized by Fixed splitting of the S2, AMR murmur, and LAD on ECG.
Ostium primum
Recommended minimum duration for DAPT following DES placement for management of stable angina
Six months
Treatment for atrial myxoma
Surgical excision
Congenital syndrome with pulmonary stenosis, short stature, variable intellectual impairment, unique facial features, neck webbing, hypertelorism, and other cardiac abnormalities including HCM, ASD, VSD
Noonan syndrome
Indications for ICD therapy
1) NICM with LVEF < 35% + NYHA II or III symptoms
2) NICM + unexplained syncope and significant left ventricular dysfunction
Management for patients with mitral stenosis who have a discrepancy between the clinical findings and the echocardiographic findings
Stress ECHO
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
Every six months
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
Peripartum cardiomyopathy
Most effective strategy to preserve tissue viability in patients with critical limb ischemia
Invasive angiography with endovascular revascularization
Indications for surgery in patients with severe aortic regurgitation
1) presence of attributable symptoms
2) LVEF < 50%
3) significant left ventricular dilatation (>50mm)
Evaluation to establish severity of aortic stenosis in patients with symptoms of aortic stenosis and discrepancies between the physical examination and echocardiographic findings
Cardiac catheterization
hypotension, pulses paradoxus, enlarged cardiac silhouette on chest radiograph and electrical alternans on ECG
Cardiac Tamponade
Recommended management to improve survival in patients with multivessel coronary artery disease and left ventricular dysfunction in patients with diabetes mellitus and multivessel disease
CABG surgery
Management for patients with premature ventricular contraction induced cardiomyopathy
Catheter ablation
Gold standard therapy for patients with end-stage heart failure
Cardiac transplantation

If contraindicated, LVAd is appropriate management
Contraindications for cardiac
Transplantation
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
Most common structural disorder resulting from tetralogy of Fallot repair
Pulmonary regurgitation
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)
1) US Every 2 to 3 years
2) US Every 6 to 12 months
3) Repair (surgical or endovascular)
4) Repair (surgical or endovascular)
Preferred imaging modality for evaluating patients with a high pretest probability of infective endocarditis or with potential complications of endocarditis, such as abscess
TEE
Preferred anticoagulation therapy in pregnant patients with a mechanical valve prosthesis
Warfarin (If 5 mg daily or less during first trimester)
Recommended management for asymptomatic patients with a bicuspid aortic valve and severe aortic regurgitation when the LVESD reaches 50 mm or the LVEF < 50%
Valve replacement surgery
Elevated resting heart rate, with exaggerated increases in heart rate with light activity and decreases during sleep
Inappropriate sinus tachycardia (IST)
Preferred diagnostic test for CAD in patients with LBBB
Vasodilator stress test (I.e. Adenosine)
Right sided heart failure, low or normal BNP level, and the finding of pericardial thickening or calcification on imaging studies
Constrictive pericarditis
Elevated CVP, fixed splitting of S2, right ventricular heave, RAD and incomplete RBBB on ECG
Ostium secundum ASD
Recommended management for improvement of limb symptoms in patients with PAD and intermittent claudication
Smoking cessation, exercise training, and medical therapy (cilostazol)
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
Cardiac amyloidosis
Criteria for aortic valve replacement/repair of aortic regurgitation
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)
Murmur indications for TTE
1) systolic murmur grade 3/6 or higher
2) late or holosystolic murmurs
3) Diastolic or continuous murmurs
4) Murmurs with accompanying symptoms
Avoid or reduce dose of ranolazine when used with these medications
CYP3A inhibitors
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
Ivabradine
Indications for device closure of an ostium secundum ASD
Right heart enlargement and symptomatic disease
Indications for cardiac resynchronization therapy (CRT)
1) LVEF < 35%
2) NYHA II to IV despite GDMT
3) Sinus rhythm
4) LBBB with a QRS duration > 150 ms
First line therapy for acute pericarditis
High-dose aspirin or NSAIDs and adjuvant colchicine therapy
Indications for Cardiac catheterization for patients with the following post-MI stress test results (4):
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)
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
Transcatheter aortic valve implantation
Class 1 recommendations for secondary prevention with implantable cardioverter-defibrillator placement (2)
1) Sustained ventricular arrhythmias (>30 sec)
2) Cardiac arrest without reversible cause
Rare malignant cardiac tumors typically arise within the RA and are commonly associated with sanguinous pericardial effusion
Cardiac angiosarcomas
Appropriate management to reduce Cardiovascular risk In patients with PAD
Anti-thrombotic therapy with very low-dose rivaroxaban + aspirin
Most common form of SVT
AVNRT
Most appropriate management for asymptomatic PDA in patients with left-sided cardiac chamber enlargement
PDA device closure
Next step in evaluation in patients with PAD and normal ABI values
Exercise ABI testing
Appropriate management for recurrent pericarditis initially treated with colchicine and NSAID
NSAID, Colchicine, prednisone
Most common cause of pregnancy associated MI that occurs most commonly in the first month postpartum
Spontaneous coronary artery dissection
First line treatment for symptomatic PVC suppression
Beta blocker or calcium channel blocker
Preserved basal left ventricular function with apical and mid -ventricular hypokinesis
Takotsubo cardiomyopathy
Effective treatment of cardiac device infection
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
Structurally normal heart and right precordial ECG abnormalities, including ST segment coving in leads V1-V3 +/- RBBB
Brugada syndrome
Appropriate management for atrial myxoma with CNS embolic event
Urgent cardiac surgical evaluation and excision
Valve area and mean transvalvular gradient in severe AS
Valve area: < 1 cm sq
Mean transvalv gradient: > 40 mmHg
Most common congenital heart abnormality
Bicuspid aortic valve
Recommended management for symptomatic AS in patients at low operative risk
Surgical AV replacement
First line therapy for a stenotic bicuspid aortic valve
Surgical AV replacement
Indications to surgically repair the aortic root or replace the ascending aorta
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
ECHO surveillance for ascending aortic diameter
Yearly if > 4.5 cm
Every 2 years if < 4.0 cm
Most common postoperative sequela of tetralogy of Fallot repair
Pulmonary regurgitation
Recommend INR range for warfarin therapy in mechanical valves in the mitral position
2.5 to 3.5
Appropriate management for symptomatic patients with MS and for asymptomatic patients when the valve area is < 1.0 cm sq
Percutaneous balloon mitral commissurotomy
3 components that classify stable angina pectoralis
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
Indications for ascending thoracic aneurysms prophylactic surgery
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
Next seven evaluation for ABI > 1.4
Toe-brachial index
Effective therapy for select patients with end-stage restrictive cardiomyopathy
Cardiac transplantation
Appropriate management for bicuspid AV and aortic sinuses or an ascending aorta > 4 cm in diameter
ECHO surveillance
 Reason for normal BNP in a patient with symptomatic heart failure
High BMI
Appropriate management for congenital long QT syndrome
Beta blockers (I.e Propanolol, nadolol)
