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UWorld > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Common symptoms of stable CAD in elderly patients?

A

SOB, lightheadedness, fatigue (without CP) during exertion

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2
Q

Best next test for patients with suspected stable CAD?

A

Non-invasive stress testing … Pharmacologic or Exercise

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3
Q

2 options for pharmacologic stress testing for patients with suspected stable CAD?

A

Dobutamine ECHO, Adenosine myocardial perfusion

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4
Q

Initial evaluation of choice in patients with suspected stable CAD?

A

Non-invasive stress testing

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5
Q

DOC for patients with stable CAD (+) non-invasive stress testing?

A

ASA + statin + b blocker

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6
Q

What is considered a high-risk feature on stress-testing for patient with suspected stable CAD?

A

ST depression

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7
Q

In addition to medical treatment (ASA + statin + b blocker), what is an additional treatment for patients with (+) stress test and high-risk features?

A

Percutaneous coronary angiogram … to assess for stent placement + CABG

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8
Q

72 yo male presents with arrythmia and pulmonary symptoms – diagnosis?

A

MAT … Multifocal Atrial Tachycardia

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9
Q

Appearance of MAT on EKG?

A

Distinct P waves with different morphologies; Irregular rhythm (variable PR and RR segments); Tachycardia

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10
Q

Best treatment for MAT?

A

Treat underlying pulmonary disease

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11
Q

Patient with MAT does not show improvement of arrhythmia on EKG after treatment of underlying pulmonary disease – what is next step in treatment?

A

Check for electrolyte disturbances .. then correct electrolyte disturbances

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12
Q

Patient with MAT does not show improvement of arrhythmia on EKG after treatment of underlying pulmonary disease and electrocyte disturbances – what is next step in treatment?

A

b blockers, CCBs

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13
Q

2 DOC for patients with A-Fib with RVR?

A

b blockers, Non-DHP CCBs

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14
Q

2 examples of Non-DHP CCBs?

A

Diltiazem, Verapamil

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15
Q

Best management of hypertrophic cardiomyopathy (HCM)?

A

Implantable cardioverter-defibrillator (ICD)

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16
Q

Optimal medical therapy for patient with systolic CHF with severe LV dysfunction?

A

b blocker, ACEI, Aldosterone antagonist, Diuretics

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17
Q

Next step of management for patient with systolic CHF + severe LV dysfunction who is unresponsive to b blocker, ACEI, Aldosterone antagonist, Diuretics?

A

Add isosorbide dinitrate + hydralazine

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18
Q

Best pharmacologic management for patients with suspected Acute Coronary Syndrome (ACS)?

A

ASA 325mg + NTG (if experiencing active CP)

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19
Q

Best workup for patients with suspected Acute Coronary Syndrome (ACS)?

A

Troponin I levels … 3 hours apart

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20
Q

Clinical presentation of acute mitral valve prolapse, due to mitral chordae tendinae rupture?

A

Sudden-onset hypotension, pulmonary edema

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21
Q

Cardiac PE finding in setting of acute mitral valve prolapse, due to mitral chordae tendinae rupture?

A

Hyperdynamic precordium

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22
Q

Auscultation PE finding in setting of acute mitral valve prolapse, due to mitral chordae tendinae rupture?

A

Decrescendo holosystolic murmur at cardiac apex

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23
Q

Diagnosis of acute mitral valve prolapse, due to mitral chordae tendinae rupture is confirmed via …

A

Bedside ECHO

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24
Q

Which patients are at increased risk of acute mitral valve prolapse, due to mitral chordae tendinae rupture?

A

Connective tissue disease

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25
Q

ECHO findings for patients with acute mitral valve prolapse, due to mitral chordae tendinae rupture?

A

Rapid equalization of LA and LV pressures

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26
Q

What clinical feature can be used to distinguish Ehlers-Danlos from Marfans?

A

EDS is much more likely to present with skin findings (unhealed scars)

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27
Q

There is a bidirectional link between depression and ___ … Depression is an independent risk factor for increased morbidity/mortality in ___

A

CAD

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28
Q

Best management of patient with Acute Coronary Syndrome (unstable angina, or NSTEMI)?

A

Dual antiplatelet therapy (ASA + clopidogrel), b blockers, NTG, Statin, Heparin

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29
Q

Best management of patient with STEMI?

A

Cardiac catheterization + revascularization within 90 minutes of presentation

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30
Q

Highly specific finding of cardiac tamponade, requiring immediate intervention?

A

Early diastolic collapse of RA/RV on ECHO

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31
Q

Additional specific finding of cardiac tamponade, requiring immediate intervention?

A

JVD plethora, with lack of inspiratory collapse

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32
Q

Best intervention for acute cardiac tamponade?

A

Catheter pericardiocentesis

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33
Q

Consequence of acute cardiac tamponade?

A

Impaired diastolic filling of R heart

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34
Q

Definition of elevated BP?

A

Systolic 120-129

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35
Q

Best management of elevated BP?

A

Lifestyle changes

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36
Q

Definition of Stage 1 HTN?

A

Systolic 130-139, Diastolic 80-89

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37
Q

Best management of Stage 1 HTN?

A

Lifestyle changes + 1 antihypertensive drug

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38
Q

Definition of Stage 2 HTN?

A

Systolic > 140, Diastolic > 90

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39
Q

Best management of Stage 2 HTN?

A

Lifestyle changes + 2 antihypertensive drugs

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40
Q

4 options for monotherapy in Stage 1 HTN?

A

ACEIs, ARBS, CCBs, Thiazide diuretics

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41
Q

Best combination therapy of 2 antihypertensive drugs in management of Stage 2 HTN?

A

ACEI + CCB

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42
Q

Which drug is NOT recommended in initial management of HTN?

A

B blockers

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43
Q

2 conditions in which B blockers would be indicated for initial management of HTN?

A

CAD, CHF

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44
Q

6 additional studies that should be ordered in patient with newly-diagnosed HTN?

A

Fasting lipid profile, BG, UA, serum electrolytes, creatinine, EKG

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45
Q

Best treatment for STEMI?

A

Percutaneous coronary intervention (PCI) within 90 minutes of first medical contact

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46
Q

Alternative best therapy for STEMI in patients who require transfer to PCI facility?

A

PCI within 120 minutes for patients

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47
Q

Best therapy for STEMI in rural setting where PCI is not possible?

A

Fibrolytic therapy

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48
Q

3 EKG findings that are diagnostic for STEMI?

A

New left BBB; > 1 mm ST elevation in all leads except V2 and V3; > 1.5 mm (in women) and > 2 mm (in men) ST elevations and leads V2 and V3

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49
Q

Hallmark of 2nd degree AV block type 2?

A

Intermittent non-conducted P waves

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50
Q

Best treatment of 2nd degree AV block type 2?

A

Pacemaker placement

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51
Q

How long should DVTs due to underlying surgery, pregnancy, trauma, OCP use be treated with anticoagulation therapy?

A

3-6 months

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52
Q

How long should idiopathic DVTs be treated with anticoagulation therapy?

A

> 6 months

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53
Q

Name the murmur … mid-systolic murmur at L upper sternal border; ECHO shows RA and RV dilation?

A

ASD

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54
Q

Additional heart sound heard in setting of ASD?

A

Wide and fixed splitting of S2

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55
Q

ASD is a type of ___ shunt

A

L-to-R

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56
Q

Most common congenital heart defect in adults?

A

Bicuspid aortic valve

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57
Q

2nd most common congenital heart defect in adults?

A

ASD

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58
Q

Clinical presentation of papulopustular rosacea?

A

Erythema in central face, flushing, telangiectasia, pustules

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59
Q

Best management for patients with papulopustular rosacea?

A

Topical metronidazole

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60
Q

Patients with rosacea also experience ___ symptoms

A

Ocular

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61
Q

3 ocular manifestations of rosacea?

A

Foreign body sensation, recurrent chalazion, conjunctivitis

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62
Q

Etiology of chalazion?

A

Inflammation of meibomian gland

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63
Q

Clinical presentation of chalazion?

A

Painless pea-sized nodule within eyelid

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64
Q

What accounts for cocaine-related chest pain?

A

Overstimulation of b1 and alpha1 receptors

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65
Q

MOA of cocaine?

A

Inhibition of presynaptic reuptake of norepinephrine

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66
Q

Initial DOC for management of cocaine-related chest pain?

A

Benzodiazepine

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67
Q

Role of Benzodiazepine in treatment of cocaine-related chest pain?

A

Reduce sympathetic outflow

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68
Q

Medication that is contraindicated in treatment of cocaine-related chest pain?

A

b blockers

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69
Q

Why are b blockers contraindicated in treatment of cocaine-related chest pain?

A

Can lead to excessive alpha-1 receptor vasoconstriction

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70
Q

35 yo female presents with cocaine-related chest pain; 2 hours after presentation, she reports persistent CP with new-onset R-sided weakness – diagnosis?

A

Aortic dissection

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71
Q

What accounts for Aortic dissection in setting of cocaine use?

A

Severe HTN after cocaine ingestion

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72
Q

Diagnostic test for Aortic dissection?

A

CT angiography, MRI, Transesophageal ECHO

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73
Q

Amiodarone is a CYP450 ___

A

Inhibitor … (SICKFACES.COM when I Am drinking GFJ)

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74
Q

How should a patient’s dose of warfarin be altered when Amiodarone is added to their drug regimen?

A

Amiodarone = CYP450 inhibitor … Slows metabolism of warfarin … Reduce warfarin dose by 25-50%

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75
Q

Best strategy for discontinuing amlodipine in a patient with well-controlled HTN, who has recently lost a healthy amount of weight?

A

Amlodipine is a long-acting medication … discontinuation can be achieved by taking the medication every-other-day … OR in lower lose tablets

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76
Q

Best strategy for discontinuing lisinopril in a patient with well-controlled HTN?

A

Lisinopril is a short-acting medication … discontinuation can ONLY be achieved by taking the medication every day in a smaller dose

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77
Q

How can you calculate a CHADS2-VASC score for a patient with newly-diagnosed A-Fib?

A

CHF, HTN, Age > 75 (2 points), DM, Stroke (2 points), Vascular disease, Age 65-74, Sex (female)

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78
Q

What is the role of CHADS2-VASC score in newly-diagnosed A-Fib?

A

Estimate thromboembolic risk

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79
Q

Best treatment for A-Fib patients who are hemodynamically unstable?

A

Emergency cardioversion

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80
Q

Best treatment for A-Fib patients who are hemodynamically stable?

A

Medical therapy

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81
Q

2 DOC for A-Fib rate control?

A

Diltiazem, b blockers

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82
Q

Best additional management for patients with CHADS2-VASC score <2?

A

Periodic follow-up

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83
Q

Best additional management for patients with CHADS2-VASC score >2?

A

Anticoagulation

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84
Q

62 yo male presents with new-onset, RLE pain; Reports CABG performed 3 months ago; Presented to ED 2 nights ago for recurrent CP; Troponin = elevated, angiogram was (+) for coronary artery stenosis; Patient was treated with heparin, anti-platelet agents, b blocker, NTG; Stenting was performed; ECHO was (-); PE shows RLE that is cool to touch, diminished pulses; Labs show thrombocytopenia – diagnosis?

A

Type 2 HIT

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85
Q

3 hallmark clinical findings for Type 2 HIT?

A

Thrombocytopenia, Onset after Heparin administration, Thrombosis

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86
Q

Etiology of Type 2 HIT?

A

Auto-Ig directed against heparin-platelet factor 4 complexes

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87
Q

Difference between Type 1 HIT and Type 2 HIT?

A

Type 1 = non-immune mediated; Type 2 = immune mediated

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88
Q

Diagnostic test for Type 2 HIT?

A

HIT antibody testing

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89
Q

Best management of Type 2 HIT?

A

Discontinue all heparin-containing products; Begin non-heparin anticoagulants … Don’t wait for (+) HIT antibody testing to return

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90
Q

2 types of non-heparin anticoagulants that can be used in setting of Type 2 HIT?

A

Argatroban, Fondaparinux

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91
Q

Approach to future heparin use in a patient diagnosed with Type 2 HIT?

A

Avoid all forms of heparin for life

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92
Q

2 long-term treatment options for patients with A-Fib?

A

Rate control + Anticoagulation; Rhythm control

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93
Q

2 clinical settings in which Rhythm control is the preferred treatment for patients with A-Fib?

A

Inability to maintain HR control with rate-control agents; Persistence of symptomatic CHF episodes while on rate-control agents

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94
Q

2 anti-arrhythmic agents used in treatment of A-Fib for patients with no CAD or structural heart disease?

A

Flecainide, Propafenone

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95
Q

1 anti-arrhythmic agent used in treatment of A-Fib for patients with LV hypertrophy?

A

Amiodarone

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96
Q

1 anti-arrhythmic agent used in treatment of A-Fib for patients with CAD?

A

Sotolol

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97
Q

2 anti-arrhythmic agents used in treatment of A-Fib for patients with CHF?

A

Amiodarone, Dofetilide

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98
Q

3 classes of anti-HTN drugs that affect lithium levels?

A

Thiazide diuretics, ACEIs/ARBs, Spironolactone

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99
Q

1 additional drug that affects lithium levels?

A

NSAIDs

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100
Q

2 classes of anti-HTN drugs that affect do NOT lithium levels?

A

CCBs, Loop diuretics

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101
Q

Lithium is metabolized by which organ?

A

Kidney

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102
Q

In a patient with existing AAA, control of which risk factor is most important for decreasing likelihood of AAA expansion/rupture?

A

Smoking cessation … (not HTN control)

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103
Q

Etiology of early post-MI acute pericarditis?

A

Peri-infarction pericarditis

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104
Q

Typical time-frame of post-MI acute pericarditis?

A

Within 4 days of MI

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105
Q

Etiology of late post-MI acute pericarditis?

A

Dressler Syndrome

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106
Q

EKG findings associated with post-MI acute pericarditis?

A

Diffuse ST segment elevations, PR depression

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107
Q

Cardiac auscultation results for post-MI acute pericarditis?

A

Friction rub

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108
Q

Best treatment for post-MI acute pericarditis?

A

High-dose ASA

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109
Q

Best treatment for acute pericarditis … viral OR idiopathic etiology?

A

NSAIDs + colchicine

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110
Q

Why are NSAIDs + colchicine + corticosteroids NOT recommended as treatment for post-MI acute pericarditis?

A

NSAIDs ma impair cardiac healing, increase risk of septal/free wall rupture

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111
Q

Best test for initial diagnostic evaluation of stable CAD?

A

Exercise EKG … (stress test)

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112
Q

What might account for a holosystolic heart murmur heart in patient with acute decompensated heart failure?

A

Holosystolic murmur = dilated cardiomyopathy causing MR

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113
Q

3 initial tests that should be ordered for patient with acute decompensated heart failure?

A

Pulse Ox, CXR, ECG

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114
Q

Most important initial step in treatment of acute decompensated heart failure?

A

Decrease preload … diuretics (furosemide)

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4
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115
Q

Alternative medication used to decreased preload in patients with acute decompensated heart failure (not furosemide)?

A

Vasodilators (nitroprusside, NTG)

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116
Q

3 characteristic heart sounds heard in aortic stenosis?

A

Single A2, Delayed carotid pulse, Crescendo-Decrescendo systolic murmur

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117
Q

___ refers to Delayed carotid pulse seen in aortic stenosis?

A

Parvus et tardus

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118
Q

What accounts for Single A2 heard in aortic stenosis?

A

Delayed closure of aortic valve

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119
Q

If a patient is preparing to undergo cardiac catheterization, which home medication should be discontinued?

A

Metformin

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120
Q

Why should Metformin be discontinued prior to cardiac catheterization?

A

Increased risk of lactic acidosis … huge amount of iodine contrast exposure

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121
Q

Creatinine level that contraindicates use of metformin?

A

Creatinine > 1.5

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122
Q

Change to RA pressure in setting of hypovolemic shock?

A

Decreased

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123
Q

Change to PCWP in setting of hypovolemic shock?

A

Decreased

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124
Q

Change to cardiac index in setting of hypovolemic shock?

A

Decreased

125
Q

Change to SVR in setting of hypovolemic shock?

A

Increased

126
Q

Change to venous O2 saturation in setting of hypovolemic shock?

A

Decreased

127
Q

Change to RA pressure in setting of cardiogenic shock?

A

Increased

128
Q

Change to PCWP in setting of cardiogenic shock?

A

Increased

129
Q

Change to cardiac index in setting of cardiogenic shock?

A

Decreased

130
Q

Change to SVR in setting of cardiogenic shock?

A

Increased

131
Q

Change to venous O2 saturation in setting of cardiogenic shock?

A

Decreased

132
Q

Change to RA pressure in setting of septic shock?

A

Decreased

133
Q

Change to PCWP in setting of septic shock?

A

Decreased

134
Q

Change to cardiac index in setting of septic shock?

A

Increased

135
Q

Change to SVR in setting of septic shock?

A

Decreased

136
Q

Change to venous O2 saturation in setting of septic shock?

A

Increased

137
Q

Change to RA pressure in setting of cardiac tamponade?

A

Increased

138
Q

Change to RV pressure in setting of cardiac tamponade?

A

Increased

139
Q

Characteristic of RA, RV, PCWP in cardiac tamponade?

A

Equalized

140
Q

Change to RA pressure in PE?

A

Increased

141
Q

Change to RV pressure in PE?

A

Increased

142
Q

Change to PCWP pressure in PE?

A

Increased

143
Q

Best management of NSTEMI or unstable angina in low-risk patients?

A

Exercise stress test

144
Q

Best management of NSTEMI or unstable angina in high-risk patients?

A

Coronary artery angiogram

145
Q

57 yo male presents with new-onset extreme HTN; BP was previously controlled with HCTZ + amlodipine; PE shows R-sided carotid bruit, L-sided diminished popliteal pulses – diagnosis?

A

Renal Artery Stenosis (RAS)

146
Q

3 additional PE findings associated with RAS?

A

Abdominal bruit, Recurrent flash pulmonary edema, Unilateral renal atrophy

147
Q

1 lab value associated with RAS?

A

Elevated creatinine

148
Q

Diagnostic step for RAS?

A

Imaging with MRA, CTA, Doppler US

149
Q

DOC for secondary prevention in patients with known atherosclerotic cardiovascular disease (ASCVD)?

A

High intensity statin (atorvastatin, rosuvastatin)

150
Q

Which patients should receive high-intensity statin therapy as primary prevention for ASCVD?

A

LDL > 190, Age > 40 with DM, 10-year risk of ASCVD > 7.5%

151
Q

EKG finding that might result from interaction of sotalol and azithromycin?

A

QT prolongation

152
Q

EKG complication of QT prolongation?

A

Toursade de Pointes

153
Q

Additional EKG event that might provoke Toursade de Pointes (not hypokalemia)?

A

Bradycardia

154
Q

Best management of Toursade de Pointes?

A

Magnesium … even in patients with NML Mg2+ levels

155
Q

Next step of management for patients with Toursade de Pointes, who do not respond to Mg2+ supplementation?

A

Transvenous pacing

156
Q

Most common cause of dilated cardiomyopathy is idiopathic; What is most common secondary cause?

A

Ischemic cardiomyopathy

157
Q

Screening test that should be performed for all patients with new-onset heart failure?

A

Stress testing, or coronary angiography … to rule out ischemic cardiomyopathy

158
Q

Indication for amiodarone?

A

Ventricular and supraventricular arrhythmia

159
Q

6 AEs of amiodarone?

A

Photosensitivity, skin discoloration, bone marrow suppression, thyroid dysfunction, abnormal LFTs, pulmonary toxicity

160
Q

What is the most common manifestation of amiodarone-induced pulmonary toxicity?

A

Chronic interstitial pneumonitis

161
Q

Appearance of Chronic interstitial pneumonitis on CXR?

A

Diffuse interstitial opacities

162
Q

Best management of amiodarone-induced Chronic interstitial pneumonitis?

A

Discontinue amiodarone

163
Q

Best initial management of patient with suspected Acute Decompensated Heart Failure (ADHF)?

A

Furosemide + O2 supplementation

164
Q

Next management of patient with suspected Acute Decompensated Heart Failure (ADHF), who shows inadequate response to initial diuretic therapy?

A

IV vasodilator (NTG)

165
Q

Beneficial effect of IV vasodilator (NTG) in patients with Acute Decompensated Heart Failure (ADHF)?

A

Decreased cardiac preload; Reduced intracardiac filling pressures, improvement in pulmonary edema

166
Q

Diagnostic test to include in workup for Acute Decompensated Heart Failure (ADHF)?

A

Transthoracic ECHO … to assess LV function, valvular abnormalities

167
Q

Most common cause of acute limb ischemia?

A

Embolism from a cardiac source

168
Q

Best management of acute limb ischemia?

A

Anticoagulation + Emergency surgical intervention

169
Q

Why is emergency surgical intervention required for acute limb ischemia?

A

Increased risk for irreversible myonecrosis

170
Q

Common vasopressor therapy?

A

Norepinephrine

171
Q

3 aspects of initial management for STEMI in the setting of cocaine use?

A

Benzodiazepine, NTG, ASA

172
Q

Role of Benzodiazepine, NTG, ASA in initial management for STEMI in the setting of cocaine use?

A

Reduction in myocardial O2 demand, Improvement in myocardial O2 supply

173
Q

Which medication is contraindicated in the management for STEMI in the setting of cocaine use?

A

b blockers … due to unopposed a activity … HTN

174
Q

Best management of persistent STEMI in patients with recent cocaine use?

A

Coronary angiogram + percutaneous coronary intervention (PCI)

175
Q

Patient undergoes L heart catheterization, which shows “step up” in oxygenation between RA and RV – diagnosis?

A

VSD … L-to-R shunt

176
Q

Description of murmur heard in VSD?

A

Harsh holosystolic murmur over 3rd-4th ICS … with palpable thrill

177
Q

L heart catheterization results for ASD?

A

“step up” in oxygenation between SVC+IVC and RA

178
Q

Best management of patient with stable angina; Coronary angiogram shows stenosis of LAD, LCX, and RCA?

A

CABG … CABG is superior to PCI with drug-eluting stent for patients with multi-vessel disease

179
Q

3 groups of people with stable angina who would benefit from coronary revascularization?

A

Refractory angina, LAD stenosis, multivessel disease

180
Q

Common post-operative complication of cardiac surgery?

A

A-Fib (post-operative A-fib … POAF)

181
Q

Most likely prognosis for POAF?

A

Spontaneous conversion to sinus rhythm within few days of surgery

182
Q

3 complications of POAF?

A

Increased long-term mortality, Embolic CVA, heart failure

183
Q

Describe the murmur - holosystolic murmur at L 4th intercostal space close to sternal border?

A

VSD

184
Q

Description of ASD?

A

Wide, fixed splitting of S2

185
Q

Description of MVP?

A

Late systolic click

186
Q

4 characteristics of Tetralogy of Fallot?

A

RV outflow obstruction, VSD, RV hypertrophy, overriding aorta

187
Q

Description of Triscuspid Stenosis?

A

Mid-diastolic rumble

188
Q

50 yo male presents with substernal CP; BP 84/52, HR 34; PE shows crackles at BL bases; EKG shows ST elevation in II-III-aVF; Best treatment?

A

IV atropine

189
Q

Change in vital signs associated with inferior wall MI?

A

Sinus bradycardia

190
Q

3 EKG changes associated with hyperkalemia?

A

Peaked T waves, PR prolongation, widening of QRS complex

191
Q

Best management of SVT without HD instability?

A

Vagal massage, IV adenosine

192
Q

Best management of SVT with HD instability?

A

Synchronized cardioversion

193
Q

Best management of PEA?

A

CPR

194
Q

What is best diagnostic test for patients with stable angina?

A

Stress testing

195
Q

68 yo male is about to undergo urgent laparotomy for intestinal perforation; Prior to surgery, develops A-Fib with HR 112-118; what is next best step in management?

A

In a HD-stable patient, administer IV B blocker for rate control, proceed with surgery

196
Q

48 yo female presents for chest pain; Was in a MVC yesterday, husband is still hospitalized; HR 102, BMI 31; EKG shows ST segment elevation in leads V3-V6, QTc 509 - what is most likely finding on ECHO?

A

LV wall abnormalities

197
Q

48 yo female presents for chest pain; Was in a MVC yesterday, husband is still hospitalized; HR 102, BMI 31; EKG shows ST segment elevation in leads V3-V6, QTc 509 - diagnosis?

A

Takotsubo cardiomyopathy

198
Q

Typical finding of Takotsubo cardiomyopathy on coronary angiogram?

A

Absence of CAD

199
Q

Etiology of Takotsubo cardiomyopathy?

A

Catecholamine surge

200
Q

Which pathology is associated with RV dilation and hypokinesis?

A

Acute PE

201
Q

55 yo female presents with exertional dyspnea for 3 months; HX of HTN and CKD; Current meds include furosemide, amlodipine, lisinopril; PE shows trace BL pitting edema; Labs show Hgb 10.8, Cr 2.2, GFR 28 - what is next step in workup?

A

Stress ECHO … stable angina

202
Q

66 yo female presents after recent diagnosis of CHF with EF 30%; Reports mild exertional fatigue ; Current medications include sacubitril-valsartan, metoprolol succinate, furosemide; HR 62; PE shows pnsystolic murmur at apex; Labs show no significant e+ abnormalities - what is next step in pharmacotherapy?

A

Add spironolactone

203
Q

Best medication regimen for HF with EF < 40%?

A

ARB, B blocker

204
Q

Best medication regimen for HF with EF < 40% with signs of volume overload?

A

ARB, B blocker + Diuretic

205
Q

Best medication regimen for HF with EF < 35%?

A

ARB, B blocker + Aldosterone antagonist

206
Q

3 EKG changes seen in athletes participating in high-intensity training?

A

Resting sinus bradycardia, 1st degree AV block, LVH

207
Q

Most common cause of SCD in young patients?

A

Structural heart defects

208
Q

Most common terminal event in SCD in young patients?

A

V-tach

209
Q

2 most common Anomalous Aortic Origin of Coronary Artery (AAOCA) responsible for SCD?

A

LCA originating from R aortic sinus, RCA originating from L aortic sinus

210
Q

Typical appearance of resting EKG in SCD?

A

NML

211
Q

Diagnostic study for AAOCA?

A

CT coronary angiogram, MRA

212
Q

What is the most common structural defect that causes SCD?

A

HoCM

213
Q

65 yo male presents for syncope; HX of MI; Current medications include ASA, carvedilol, atorvastatin, ramipril, tansulosin; EKG shows Q waves; ECHO shows apical wall abnormality, EF 40% - etiology of syncope?

A

V-tach

214
Q

Clue that suggests aortic stenosis as cause of syncope?

A

Systolic murmur on PE

215
Q

Clue that suggests V-tach as cause of syncope?

A

Previous MI or cardiomyopathy

216
Q

Clue that suggests Sick Sinus Syndrome as cause of syncope?

A

Sinus pause on EKG

217
Q

Clue that suggests AV block as cause of syncope?

A

Prolonged PR interval, dropped QRS complexes

218
Q

Clue that suggests Toursades as cause of syncope?

A

HypoK, HypoMg, Medications that prolong QT interval

219
Q

34 yo female presents for palpitations; HX of HoCM, hypothyroidism; Currently on metoprolol, levothyroxine; PE shows thyroid gland that is symmetrically enlarged, nontender; EKG shows T wave inversions that are unchanged from 6 months ago; Next best step?

A

Ambulatory EKG monitoring

220
Q

2 heart arrythmias that patients with HoCM are predisposed to?

A

A-Fib, V-tach

221
Q

67 yo male presents with fatigue, LE edema; HX of CABG and MV repair; Recently developed A-Fib, requiring amiodarone and anticoagulation; PE shows JVD, ascites, LE edema; ECHO shows enlarged LA, NML LV wall thickness and RV size, EF 65%; Mild MR; CXR shows nromal heart size, but spotty calcifications along the L heart border - diagnosis?

A

Constrictive pericarditis

222
Q

2 most common etiologies of Constrictive pericarditis?

A

Viral pericarditis, Cardiac surgery

223
Q

EKG finding for Constrictive pericarditis?

A

A-Fib, low-voltage QRS complex

224
Q

Imaging of Constrictive pericarditis?

A

Pericardial thickening and calcification

225
Q

Appearance of Constrictive pericarditis on JVP tracing?

A

Prominent X/Y descent

226
Q

Of the following EKG findings, which warrants further workup – Deep Q waves in V1-V4, 1st degree AV block with PR interval 230 ms, Left BBB with QRS duration 160 ms, QTC interval prolongation of 480 ms?

A

Left BBB

227
Q

3 criteria for pacemaker placement in patient with CHF?

A

EF < 35%, Left BBB with QRS > 150 ms, Symptomatic CHF

228
Q

63 yo male with HTN, HLD presents for wellness exam; PE shows ejection-type systolic murmur at R 2nd ICS; ECHO shows EF 35% - what is best management of patient?

A

ACEI

229
Q

___ is the first-line therapy for patients with asymptomatic ventricular systolic dysfunction

A

ACEI, then b blocker

230
Q

Most common congenital heart abnormality in adults?

A

Bicuspid aorta

231
Q

Risk associated with bicuspid aortic valve?

A

Thoracic aortic aneurysm, Aortic dissection

232
Q

Diagnosis of femoral artery pseudoaneurysm after cardiac catheterization is confirmed by …

A

Ultrasound

233
Q

31 yo male presents for exertional SOB; BP is 147/90, apical impulse is hyperdynamic; ECHO shows increased IV thickness; EF is 75% - diagnosis?

A

Hypertrophic cardiomyopathy

234
Q

Best initial management of Hypertrophic cardiomyopathy?

A

b blocker

235
Q

Change to motion of mitral valve in setting of Hypertrophic cardiomyopathy?

A

Anterior motion of mitral leaflets during systole

236
Q

2 additional medications than can be added to b blocker for patients with Hypertrophic cardiomyopathy?

A

Verapamil, Disopyramide

237
Q

62 yo male presents with CP; Adenosine stress test shows moderate perfusion defect in lateral wall of LV – which coronary vessel is most likely involved?

A

LCX

238
Q

Which coronary vessel supplies the anterior wall of LV?

A

LAD

239
Q

Which coronary vessel supplies the anterolateral wall of LV?

A

LAD’s diagonal branches

240
Q

Which coronary vessel supplies the inferoposterior wall of LV?

A

RCA

241
Q

64 yo male presents with CP; He underwent RCA stenting 2 weeks ago; On presentation today, EKG shows ST elevations in leads II-III-aVF – which additional piece of history is most helpful in diagnosis?

A

Medication non-compliance

242
Q

What is the strongest risk factor for development of stent thrombosis after coronary stent placement?

A

Premature discontinuation of dual antiplatelet therapy

243
Q

What does dual antiplatelet therapy after stent placement include?

A

ASA, P2Y12 receptor blocker (clopidogrel)

244
Q

When is the most common time for stent thrombosis to occur after placement of coronary artery stent?

A

Within 30 days of stent placement

245
Q

68 yo male presents for nausea, anorexia, AMS; Recently admitted for uncontrolled HTN and palpitation; started on new medication; Prior to that, his meds included digoxin, warfarin, simvastatin, HCTZ; HR 50, otherwise VSS - diagnosis?

A

Digoxin toxicity

246
Q

68 yo male presents for nausea, anorexia, AMS; Recently admitted for uncontrolled HTN and palpitation; started on new medication; Prior to that, his meds included digoxin, warfarin, simvastatin, HCTZ; HR 50, otherwise VSS - which medication is contributing?

A

Verapamil

247
Q

How does verapamil induce digoxin toxicity?

A

Inhibits renal tubule secretion of digoxin

248
Q

5 classic findings of digoxin toxicity?

A

AMS, nausea, vomiting, anorexia, visual changes

249
Q

4 medications that can induce digoxin toxicity?

A

Verapamil, amiodarone, spironolactone, quinidine

250
Q

46 yo male presents with PE and RLE DVT; He is started on a heparin drip, but develops bradycardia, without a pulse; CPR and intubation still do not yield a pulse – what is best next step in management?

A

PEA … chest compressions + epinephrine

251
Q

60 yo male presents with fatigue and dyspnea on exertion; HX of HTN and CKD; PE shows cardiac lateral + downward displacement of apical impulse; EKG shows LVH; Labs show Hgb 8.3, MCV 88, ferritin 320 (high) – what is role of treatment with EPO in this patient?

A

Positive impact on LVH

252
Q

Cardiac complication commonly seen in CKD?

A

Mixed concentric + eccentric LVH

253
Q

Major contributor to concentric hypertrophy in CKD?

A

Systemic HTN

254
Q

60 yo male presents with CP, SOB; HX of Hodgkin lymphoma treated with CTX and XRT; PE shows diastolic murmur at L sternal border; ECHO shows enlarged LA, NML LV, EF 60%, moderate diastolic dysfunction; Mitral and aortic valves appear sclerotic, calcified; Aortic root appears normal size but ECHO bright; Moderate AR – diagnosis?

A

XRT cardiotoxicity

255
Q

Hallmark features of XRT cardiotoxicity?

A

Leads to restrictive cardiomyopathy, diastolic dysfunction, preserved EF

256
Q

Hallmark features of anthracycline cardiotoxicity?

A

Leads to dilated cardiomyopathy with decreased EF

257
Q

45 yo male presents for follow-up of HTN; Reports 25 pack-year history; Vitals show BP 140/88, BMI 30; Labs show Total cholesterol 255, TG 340 – what is best next step of workup?

A

Calculate 10-year atherosclerotic CVD risk

258
Q

2 indications for prescription of new statin?

A

LDL > 190, Patients age > 40 yo with DM

259
Q

When should patients with LDL < 190, age > 40 without DM be started on statin?

A

If 10-year CVD risk > 7.5%

260
Q

23 yo male presents for murmur discovered recently at a health fair; PE shows mid-systolic murmur at L sternal border; ECHO shows bicuspid aortic valve – diagnosis?

A

Bicuspid aortic valve

261
Q

Inheritance pattern of bicuspid aortic valve?

A

AD with incomplete penetrance

262
Q

74 yo male presents after MVA with blunt chest trauma; BP 98/65, HR 105; PE shows bruises to anterior chest, otherwise unremarkable exam - next step of workup?

A

Bedside US (FAST exam)

263
Q

Most common manifestation of blunt chest trauma?

A

Cardiac contusion … decreased cardiac contractility, arrhythmia, myocardial rupture

264
Q

70 yo male presents for fatigue; PE reveals crescendo-decrescendo murmur at cardiac base, S2 has inaudible A2 component; ECHO shows LVH, severe aortic valve calcification; Estimated aortic valve diameter is 0.78 cm, transvavlular gradient is 50 mmHg - what is best management for this patient?

A

Aortic valve replacement

265
Q

Indications for aortic valve replacement?

A

Gradient > 40, Valve area < 1cm, aortic jet velocity > 4.0

266
Q

25 yo male presents for sudden-onset L foot pain; Reports fatigue and weight loss over 2 months; Mother developed blood clot in leg after elective surgery; PE shows diastolic murmur over apex, absent pulses in L foot, pale/cool L foot - diagnosis?

A

L atrial myxoma

267
Q

Most common location for atrial myxoma?

A

LA

268
Q

Murmur associated with atrial myxoma?

A

Diastolic murmur over apex

269
Q

Factor V Leiden typically presents as …

A

DVTs

270
Q

62 yo female presents with unstable angina; Stress testing reveals no symptoms during exercise for 8 minutes, no abnormal ST changes on EKG - how should these stress test results be interpreted?

A

Low risk (<1%) for cardiovascular events in the near future (1 year)

271
Q

Wolfe-Parkinson White (WPW) syndrome is a type of …

A

Tahyarrhythmia

272
Q

3 EKG findings associated with WPW syndrome?

A

Short PR interval, Delta wave, Wide QRS

273
Q

What is next best step in suspected WPW syndrome in a patient with (+) EKG findings, recurrent synope?

A

Catheter ablation

274
Q

82 yo female presents with stable angina; BP 152/92; PE shows JVD, diffuse lung crackles, LE edema; EKG shows ST depression in leads I, aVL, V3-V6 - diagnosis?

A

Acute decompensated heart failure

275
Q

82 yo female presents with stable angina; BP 152/92; PE shows JVD, diffuse lung crackles, LE edema; EKG shows ST depression in leads I, aVL, V3-V6 - which medication should be avoided at this time?

A

Metoprolol

276
Q

Why are B-blockers contraindicated in Acute decompensated heart failure?

A

May exacerbate pulmonary edema

277
Q

NTG is contraindicated in which type of heart problem?

A

Inferior MI

278
Q

49 yo male presents for poor sexual performance, inability to have erections at night; HX of DM, HLD, exertional pain in buttocks + thighs; HX of tobacco use; BMI 32 - what is best next step?

A

Measure ABI

279
Q

Role of ABI?

A

Diagnosis of PAD

280
Q

Triad of symptoms seen in Leriche syndrome?

A

LE claudication, absent/diminished pulses, ED

281
Q

Result of ABI that suggests PAD?

A

ABI < 0.9

282
Q

Next step of workup for patient with PAD and atherosclerotic risk factors?

A

Screening for CAD with stress test

283
Q

62-year-old male is hospitalized for CABG; other medical history includes stage III CKD, 50-pack-year smoking history; patient is extubated, but develops drowsiness, lethargy on day 3 of admission, physical exam reveals tachycardia, RR 9, bibasilar lung crackles; EKG shows atrial fibrillation with RVR; what is best next step in management of patient’s altered mental status?

A

Naloxone

284
Q

62-year-old male is hospitalized for CABG; other medical history includes stage III CKD, 50-pack-year smoking history; patient is extubated, but develops drowsiness, lethargy on day 3 of admission, physical exam reveals tachycardia, RR 9, bibasilar lung crackles; EKG shows atrial fibrillation with RVR; diagnosis?

A

Acute opioid intoxication

285
Q

Which opioid is associated with high risk of opioid toxicity in the setting of CKD?

A

Morphine

286
Q

60-year-old male with hypertension and HLD presents for follow-up visit; antihypertensive agent is added to his current medication list; while vacationing in Florida, developed erythematous rash on exposed parts of body - which medication is responsible?

A

HCTZ

287
Q

72-year-old male presents for preoperative evaluation for AAA repair; AAA was initially detected on routine screening 7 years ago; most recent study demonstrated aneurysm with diameter 5.5 cm, increased from 5.1 cm approximately 1 year ago; current medications include aspirin, valsartan, amlodipine, atorvastatin, Metformin, insulin; former smoker, quit 15 years ago; vitals show BP 142/80; BMI 30, PE shows pulsatile mass, trace pitting edema bilaterally; creatinine 1.3, EKG with nonspecific T wave changes; CXR demonstrates tortuous thoracic aorta, otherwise normal -what is most appropriate course of action?

A

Proceed with AAA repair

288
Q

For medications that are indicated in patient with CAD and prior MI?

A

Beta-blocker, statin, antiplatelet therapy, ACE inhibitor

289
Q

53-year-old female presents for hemoptysis, fatigue, shortness of breath, palpations; JVD at 9 cm, BMI 20; loud first heart sound, short apical low pitched diastolic rumbling; bilateral crackles, EKG shows notched P wave in lead II, RAD; CXR shows pulmonary edema, prominent pulmonary arteries, elevation of left mainstem bronchus, left atrial enlargement -diagnosis?

A

Rheumatic heart disease, chronic mitral stenosis

290
Q

What is most common cause of mitral stenosis?

A

Chronic rheumatic heart disease

291
Q

What is typical heart sound heard in setting of mitral stenosis?

A

Loud S1, mid diastolic rumble best heard at the cardiac apex

292
Q

61-year-old female presents with exertional dyspnea; history of current HER-2 positive breast cancer, treated with paclitaxel, carboplatin, trastuzumab; prior to mastectomy, EF was 60%, but now 30% -diagnosis?

A

Trastuzumab associated cardiotoxicity

293
Q

What is best advice for patient regarding Trastuzumab associated cardiotoxicity?

A

Most patients completely recover heart function after discontinuation of trastuzumab

294
Q

What is most typical heart sound heard in the setting of mitral valve prolapse?

A

Nonejection click and systolic murmur that varies in timing depending on body position

295
Q

57-year-old female presents after aortic valve replacement approximately 6 months ago; history also significant for HTN; current medications include aspirin, warfarin, amlodipine, ARB; what is best treatment recommendation for this patient?

A

Continue aspirin and warfarin with goal INR 2-3

296
Q

What is the target INR for mechanical aortic valves with high risk features (A. fib, LVEF < 30%, prior thromboembolism, hypercoagulability)?

A

2.5-3.5

297
Q

72 yo female presents with 4 hours of chest pain; EKG shows ST segment elevation in II-II-avF; while waiting for interventional cardiology, BP 75/45, HR 60; PE shows diaphoresis, cold extremities - what is best next step?

A

Optimize preloaf with IVF … inferior wall MI

298
Q

76 yo male presents with PE findings consistent with varicose veins; PE shows leg heaviness, cramping, worse with prolonged standing - what is best management?

A

Conservative measures with leg elevation and compression stockings

299
Q

28 yo female presents with exertional shortness of breath; From Cambodia, Hx of rheumatic mitral stenosis; 1.5 cm2 area of mitral valve on ECHO 4 months ago - what is next best step in management?

A

Pregnancy test

300
Q

6 yo male presents for annual PE; Reports intermittent pain in legs; BP is 135/88 in UE, HR 110; PE reveals continuous murmur over L interscapular area - diagnosis?

A

Aortic coarctation

301
Q

Additional PE finding associated with Aortic coarctation?

A

Lower extremity hypotension

302
Q

76-year-old male presents with nausea, vomiting, generalized abdominal distention; history of type II DM; diagnostic work-up is consistent with complicated SBO; undergoes exploratory laparotomy, extubated in ICU; several hours later, BP 84/50, HR 32; EKG shows sinus bradycardia with ST elevation in inferior leads; CXR shows increased interstitial markings bilaterally; patient treated with IV fluids and atropine, without significant improvement – what is next best step in management?

A

Temporary cardiac pacing

303
Q

76-year-old male presents with nausea, vomiting, generalized abdominal distention; history of type II DM; diagnostic work-up is consistent with complicated SBO; undergoes exploratory laparotomy, extubated in ICU; several hours later, BP 84/50, HR 32; EKG shows sinus bradycardia with ST elevation in inferior leads; CXR shows increased interstitial markings bilaterally; patient treated with IV fluids and atropine, without significant improvement – diagnosis?

A

Inferior lateral STEMI complicated by sinus bradycardia

304
Q

What accounts for development of bradycardia in the setting of inferior lateral STEMI?

A

AV block

305
Q

Initial treatment for acute inferior wall MI, complicated by sinus bradycardia?

A

IV atropine

306
Q

Prognosis for patients with hypertrophic cardiomyopathy?

A

Will achieve normal life expectancy with appropriate therapy

307
Q

2 factors in hypertrophic cardiomyopathy that indicate favorable prognosis?

A

Lack of symptoms, diagnosis during adulthood

308
Q

1 factor in hypertrophic cardiomyopathy that indicates poor prognosis?

A

LV systolic dysfunction

UWorld (21 decks)

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