Cardiology Flashcards
1
Q
_____ is the leading cardiovascular cause of death in women
A
HTN ,MI death is higher in women, single risk factors are worse for women
2
Q
Lupus/RA increase risk of MI by____
A
60-100%
3
Q
Indication for Stress ECHO
A
baseline bundle branch, fasciular blocks widening QRS, LVH, prior MI T wave depressions, paced rhythm
4
Q
When to avoid dobutamine ECHO (ionotropy)
A
HOCM, severe AS , aneurysm
5
Q
When is dobutamine nuclear perfusion the answer_____
A
ionotropy/vasodilator (adenosine) contraindication
6
Q
`When is PET/CT the answer____
A
Hugely obese patients , gets exact perfusion data. Cardiac MRI when non contraindicated: CKD, pacer
7
Q
When is coronary CT the answer_____
A
Low TIMI score, resolved chest pain, isolate trop elevation. FFR CT (FFR<0.8 = significant)is unique newer modality also assessing for flow dynamics pre/post narrowing. TIMI score assesses probability of UA/NSTEMI
8
Q
Contraindications to TEE
A
esophageal strictures/varices
9
Q
When is electrophysiology study the answer
A
Long term arrhythmia, where there is some plan to ablate : refractory afib/getting ready for maze
10
Q
Stable Angina: Initiate GDMT_____
A
Aspirin/B blocker/nitro PRN/statin +/- imdur and Ca2+ blocker –> Ranolazine—> cath
- Basically max out anti-anginals
- If statin not option (myalgia, transaminases): Fibrate/Ezetimibe/PSC9 (Evolocumab)
11
Q
Medication for refractory anti-anginal pain_____
A
Ranolazine
12
Q
For stable angina, there is a difference in survival for PCI versus GDMT___(T/F)
A
False
13
Q
For multivessel disease, CABG has been shown to improve mortality over PCI (T/F)
A
True
14
Q
NSTEMI vs UA______
A
Troponin elevation
15
Q
hypercalcemia EKG_____
A
Flat T waves, short QT
16
Q
For STEMI, you can use TPA within ____. Cannot use TpA within ____ months of CVA
A
12 hours, 3 months
17
Q
While prasugrel is better than clopidogrel, its worse because of _____
A
Higher bleeding risk , therefore avoid if age>75. Another option is ticagrelor, but may cause dyspnea
18
Q
Indications for aldactone in STEMI____
A
EF<40%
19
Q
Duration of DAPT if no PCI with DES performed after ACS____
A
12 months, never prasugrel (only used per-cath for loading)
20
Q
Indication for Cath in NSTEMI:_______________
A
hemodynamic instability, refractory chest pain, heart failure, or ventricular arrhythmias, high TIMI score (known CAD, high trop, age>65). Should be performed within 24hrs
If TIMI low, use ischemia guided approach: stress test before Cath
21
Q
____ poorly defined condition characterized by anginal chest pain in the presence of angiographically normal coronary arteries or insignificant CAD (<50% stenosis).
A
Cardiac Syndrome X
22
Q
Patients younger than ___ years with STEMI have a nearly 10% risk for probable or definite familial hypercholesterolemia, and screening for familial hypercholesterolemia should be considered in this population.
A
50
23
Q
Diabetics have high rate of stent re-stenosis, ____ (CABG vs PCI) has lowest risk of re-stenosis if applicable
A
CABG
24
Q
In the Breathing Not Properly study of patients who presented to the emergency department with dyspnea, patients with heart failure had a mean BNP level greater than _______
A
600, you need a higher BNP not just a positive BNP for heart failure , BNP is reduced in higher BNP, elevated with age/CKD
25
ACE/ARB strategy in CHF
The ATLAS trial examined the effects of low-dose versus high-dose ACE inhibitor therapy (lisinopril) in patients with systolic heart failure and found no difference in overall mortality; however, high-dose lisinopril was associated with a significant reduction in the composite endpoint of mortality and hospitalizations from heart failure and for any cause.
On the basis of these results, the general consensus is to uptitrate ACE inhibitors to maximal doses or until the onset of symptomatic hypotension.
Many physicians do not recommend increasing the dosage once the creatinine level rises to 2.5 mg/dL (221 μmol/L) or the estimated glomerular filtration rate falls below 30 mL/min/1.73 m2. The estimated glomerular filtration rate should be monitored for decline during uptitration of ACE inhibitor or angiotensin receptor blocker (ARB) therapy and should be rechecked before discontinuation of these drugs, as other conditions or drugs may confound the assessment of kidney function
26
ACE adverse effects
bradykinin cough, angioedema ; avoided with ARB
27
B-blocker strategy in CHF
Uptitrate to goal HR = 60, maximally tolerated
β-Blockers are generally well tolerated in patients with heart failure, but these agents should be initiated only when the patient is euvolemic or nearly euvolemic.
28
When to use digoxin_____
Concomitant afib, b-blocker ACE trialed , caution with CKD
29
Imdur/Hydral for CHF when:
Adjunct therapy for Africam, intolerant to ACE/ARB + B-Blocker combination
30
Indication for Ivabradine______
should be considered for patients who have an elevated heart rate (≥70/min) in sinus rhythm despite maximally tolerated doses of β-blocker therapy.
31
Therapy for HFpEF________
SGLT-2 : Empagaflozin (EMPEROR-Preserved)
Diuresis for euvolemia
No randomized trial proving benefit of spironolactone, meta-analysis has indicated benefit
Diuresis for CHF Exacerbation: Administration of high-dose diuretics (2.5 times the outpatient oral daily dosage) was associated with increased diuresis but also transient worsening of kidney function.
32
Indicator ICD in HFrEF_____________
1)EF<35% NYHA Class II-III, after trialing GDMT over 3 month period
2)NHYA Class IV, with plan for transplant or LVAD
33
Indication for pacemaker in CHF__________
Baseline wide QRS >150, LBBB
EF<35%
*Greatest benefit is patients with LBBB QRS>150
34
Heart Transplant Candidates
age younger than 65 to 70 years,
no medical contraindications (diabetes with end-organ complications,
malignancies within 5 years,
kidney dysfunction,
other chronic illnesses that will decrease survival), and good social support and adherence.
Because most patients with rejection are asymptomatic, regularly scheduled endomyocardial biopsies are often performed to detect rejection for the first few years after transplant.
35
Transplant complications
Short Term______
Long Term______
1)CMV infection
2) CAD, Lymphoma secondary to immunosuppression (Tacro/Cyclosporin)
36
Takutsubo Treatment_____________
GDMT, repeat ECHO 3-6 months
37
Myocarditis CHF treatment
GDMT
38
Giant Cell Myocarditis Treatment__________
Giant cell myocarditis is also associated with an increased incidence of high-grade atrioventricular block and ventricular arrhythmias. Unlike in acute myocarditis, aggressive immunosuppressive therapy has some benefit and should be initiated in these patients
For this reason, patients with acute heart failure unresponsive to usual care or with accompanying arrhythmias should undergo endomyocardial biopsy for diagnosis. Initial biopsy findings may be negative because of the patchy nature of the inflammation.
39
nocturnal bradycardia or conduction disturbances may hint at _____
OSA
40
common medication induced bradycardia____, ______
b blocker, cholinergics (donepezil, neostigmine, pyridostigmine)
41
Indications for pacemaker:
Symptomatic bradycardia without reversible cause
Permanent atrial fibrillation and symptomatic bradycardia
Alternating bundle branch block
Asymptomatic complete heart block, high-degree AV block, or Mobitz type 2 second-degree AV block
Wide QRS>150 CHF
42
_________ a disorder characterized by an elevated resting heart rate, with exaggerated increases in heart rate with light activity. The sinus rate typically decreases during sleep, which can be documented with ambulatory ECG monitoring
Inappropriate sinus tachycardia (IST)
Dx: Of exclusion, ambulatory monitor
Tx: exercise therapy/reversible factors --> b blockers --> ivabradine
43
anti-arrhythmic agent contraindicated with liver disease______
Lidocaine, mexiletine, phenytoin ; also should avoid amiodarone, ranolazine,
44
anti-arrhythmic agent contraindicated with ischemic heart disease, AV block without pacemaker ______
Class 1A (Procainamide, Quinidine), Class 1C (Flecainide, propafenone)
45
_______is an intravenous class III potassium channel blocker that is used for pharmacologic cardioversion of atrial fibrillation.
Ibutilide
46
Preprocedural anticoagulation is reasonable as soon as possible before cardioversion for men with a CHA2DS2-VASc score of 2 or greater and for women with a score of _____ or greater
3
47
In patients in whom the duration of atrial fibrillation is unclear or in whom atrial fibrillation has lasted longer than 48 hours, anticoagulation therapy for ___weeks is required before cardioversion, and ___ weeks post
3, 4
48
DOAC/NOAC acceptable anticoagulation for valvular afib (T/F)
False
As with dabigatran, patients taking rivaroxaban have a higher risk for gastrointestinal bleeding compared with those taking warfarin. Apixaban, another oral factor Xa inhibitor, is superior to warfarin for the prevention of stroke and confers less risk for major bleeding, including intracranial bleeding
-So best to choose apixaban
49
______________ concentrates are recommended for life-threatening bleeding due to rivaroxaban, apixaban, or edoxaban. ______ is a dabigatran-reversal agent available for emergency invasive
Andexanet alfa / 4-factor prothrombin complex
Idarucizumab
50
If someone is on aspirin and develops Afib, add a NOAC for non-valvular Afib (T/F)
False: Discontinue aspirin, can use NOAC alone for CAD/Afib
However patients undergoing PCI:
In patients with atrial fibrillation undergoing percutaneous coronary intervention for acute coronary syndrome, both anticoagulant and antiplatelet therapies are necessary, and these patients with a CHA2DS2-VASc score of 2 or greater can be treated with “double therapy” (clopidogrel or ticagrelor plus warfarin, rivaroxaban, or dabigatran : Plavix/Warfarin , Plavix/Xarelto
51
Patients with infrequent atrial fibrillation who have no structural heart disease or conduction disease (Low risk patient, basically no one) often benefit from a “pill-in-the-pocket” approach. With this strategy, patients take ______ at the onset of an episode of atrial fibrillation.
a class IC drug (flecainide or propafenone)
It is assumed they also have a b-blocker on board however
52
Rhythm control instead of rate control is a preferred strategy for a.flutter ___(T/F)
True
Typical flutter rate: 250-300 (2 boxes) 2:1 flutter
Catheter ablation is the definitive treatment of typical atrial flutter, owing to a very high success rate (>95%) and low complication rate.
53
Aflutter does not terminate with adenosine ____ (T/F)
True
Tachycardias that terminate with adenosine are typically AV node dependent (AVNRT and AVRT), whereas continued atrial activity (P waves) during AV block is consistent with atrial flutter or atrial tachycardia
AVNRT (Most common cause of SVT) is the result of a reentrant circuit within the AV node that uses both the fast and slow pathways. - No p waves, short RP
- Re-entry pathway
-AVNRT may be terminated with vagal maneuvers or adenosine. AV nodal blocking therapy with β-blockers or calcium channel blockers is used to prevent recurrent AVNRT. In patients with recurrent AVNRT and patients who do not tolerate or prefer to avoid long-term medical therapy, catheter ablation should be considered. Catheter ablation of AVNRT has a high success rate, although it is associated with a 1% risk for injury to the AV node necessitating pacemaker implantation.
AVRT : Delta wave (accessory pathway)
54
High PAC burden is associated with increased risk for ______
Afib
55
Wolf Parkinson treated with ______
First-line therapy for patients with Wolff-Parkinson-White syndrome is catheter ablation; antiarrhythmic therapy is reserved for second-line therapy.
56
Among wide complex tachycardias, Vtach most associated with _______
Structural heart disease (95%)
57
First-line treatment for PVC suppression is ______
β-blocker or calcium channel blocker therapy, but only if PVC burden >10% otherwise NTD ---> Catheter ablation if medical therapy fails
Sustained VT episodes require ICD placement, and structural cardiac assessment (ECHO, C-MRI)
58
ICDs are contraindicated in patients with hemodynamically stable idiopathic VT, owing to the benign prognosis and efficacy of other therapies (T/F)
True
59
EKG finding from brugada syndrome _______
Coved ST: https://ecgwaves.com/topic/brugada-syndrome-ecg-treatment-type-1-2-3/
These syndromes: Short QT/Long QT/Brugada all require ICD +/- pacemaker
Long QT syndrome is among the most common inherited arrhythmias, affecting between 1 in 1000 and 1 in 5000 persons.
-Diagnosis requires the presence of a QTc interval greater than 500 ms on repeated 12-lead ECGs accompanied by unexplained syncope or ventricular arrhythmia.
-Autosomal dominant inheritance
60
Diastolic Murmurs
______
_______
______
Aortic Regurgitation / Pulmonic Regurgitation
Mitral Stenosis
Tricuspid Stenosis
61
_____ is characterized by systolic crescendo/decrescendo murmur that increases during valsalva
HOCM
62
Common causes of aortic stenosis_______
Aging, rheumatic heart disease (with mitral valve disease, never alone), prior chest radiation
63
When the valve data from ECHO/clinical symptoms are non-concordant with low EF in suspected aortic stenosis_____
Dobutamine ECHO : Is low flow due to LV dysfunction with pseudostenosis or actual AS
With pseudostenosis, dobutamine increases cardiac output and the opening forces on the aortic valve, causing the valve area to increase out of the severe range. With true aortic stenosis, the calculated valve area remains in the severe range with dobutamine administration, and the aortic valve gradient and velocity increase with increased stroke volume.
Further evaluation with cardiac catheterization, during which the cardiac output and the gradient across the aortic valve can be measured, is required when there are discrepancies between the findings on physical examination and the echocardiographic results in symptomatic patients being considered for surgery.
64
In patients with ______ the characteristic physical findings include a late-peaking systolic murmur, a diminished or absent aortic component of the S2, and a delay in the carotid upstroke (pulsus tardus) that may be accompanied by a decreased pulse amplitude
severe aortic stenosis
65
Severe aortic stenosis is typically defined by a small valve area (≤____ cm2) and either high peak velocity (>___ m/s) or high mean gradient (>___ mm Hg).
1 cm2
4 m/s
40mmHg
Surveillance for asymptomatic is q6month ECHO
66
Indications for AS valve replacement
1)Symptomatic severe stenosis
2)________
EF<50%, some other cardiac procedure (CABG)
67
SAVR vs TAVR is in ___ risk patients
TAVR is currently indicated for symptomatic patients with trileaflet aortic stenosis who are at intermediate or high surgical risk and who do not have concomitant severe aortic regurgitation.
In select cases, balloon valvuloplasty may be used to bridge patients to therapy, ideally cath before surgical correction
68
Criteria for_____ include a jet width that occupies 65% of the LV outflow tract or more, vena contracta greater than 0.6 cm, holodiastolic flow in the descending aorta, regurgitation volume of 60 mL or more, and effective regurgitant orifice area of 0.3 cm2 or greater
Severe aortic regurgitation
0.3, 0.6, 60
69
Surgical treatment of aortic regurgitation is reasonable in cases of significant LV dilatation (end-systolic diameter >___ mm or indexed end-systolic dimension >___ mm/m2)
50
25
Medical Treatment: Nifedipine, ACE/ARB,
70
Risk factors for mitral stenosis______
Female
Rheumatic heart disease
71
Prior to mitral valve replacement, patient requires _____
stress ECHO (helps measure valve dynamics, pulm pressures)
72
findings of ______when the valve is pliable include a tapping LV impulse in the precordium, a loud S1, an increased pulmonic component of S2, a diastolic opening snap, and a diastolic rumble or low-pitched murmur at the apex
mitral stenosis
Rarely ever needs preprocedural cath, in contrast to aortic valve disease
In patients with a discrepancy between the clinical findings and the echocardiographic findings, stress echocardiography with pharmacologic or physical stressors should be pursued to assess the response of the mitral gradient and pulmonary pressures.
73
The procedure of choice for patients with significant rheumatic mitral stenosis and a pliable mitral valve is______
percutaneous balloon mitral commissurotomy (PBMC).
PBMC is indicated for symptomatic patients with severe mitral stenosis and favorable valve morphology. PBMC may be considered in asymptomatic patients with critical mitral stenosis when the valve area is less than 1.0 cm2
In patients with LA thrombus, moderate mitral regurgitation, or a severely calcified valve, PBMC should not be performed.
74
______ should be performed in patients with severe symptoms (New York Heart Association functional class III or IV) and a nonpliable valve or concomitantly in patients undergoing other cardiac surgical procedures.
Surgery for mitral stenosis, also in situations with mod regurg/severe calcification (pliability), LA thrombus
75
Most common arrhythmia with mitral stenosis _______
Afib (ballooning of LA, where conduction system)
Tx: Warfarin INR goal 2-3, after valve replacement = 2.5 - 3.5
NOAC only studied in mild disease, unclear data for mod-severe disease
76
criteria for __________the most common is an effective regurgitant orifice area of 0.4 cm2 or larger, regurgitant volume of 60 mL or more, or vena contracta of 0.7 cm or larger.
severe mitral regurgitation
Unlike AS, you try to correct severe MR if EF>30%. if acute MR with cardiogenic shock/HF also try to do surgical correction: Catheter based if non-surgical candidate
77
______ is nearly always caused by rheumatic disease
Tricuspid stenosis, and 50% of the time for MS
78
Anticoag after mechanical valve placement_____
Warfarin + Aspirin, both ; younger patients <50 should get mechanical valves (last longer, bioprosthetics degrade over time)
Even after bioprosthetic valves, anticoag for 3-6 months
79
_____ is recommended in patients with intermediate or high suspicion for infective endocarditis when TTE is not diagnostic (such as with a prosthetic valve), intracardiac device leads are present, or complications such as abscess have developed or are suspected (conduction abnormalities on electrocardiogram or persistent bacteremia despite antibiotic therapy).
TEE instead of TTE
80
When to go straight to surgery for infective endocarditis
1)_________
2)_________
3)________
4)________
5)________
1)Symptomatic HF with known valvular disease
2)Resistant organisms/Fungi
3)Complications: Heart block, abscess
4) Persistent bacteremia lasting 5-7 days despite antibiotics
5) Large vegetation >1cm , recurrent embolic phenomena (osler nodes)
81
Indications for endocarditis prophylaxis
1)________
2)________
3)________
4)________
5)________
Prior history of endocarditis
Cardiac transplant with valve regurgitation
Prosthetic valve
Prosthetic valve components
Known congenital heart disease , repaired within 6 months
82
HOCM patients require ICD in the following scenarios ____
1) Sudden death family history <50
2) Ventricular thickness >30mm
3) Syncope episode
4) EF<50%
Tx: Volume optimization (avoid low preload) , b blocker, avoid PDE3/5 and nitrates
Invasive treatment of obstruction with open surgical septal myectomy or catheter-based alcohol septal ablation should be considered in patients who have moderate to severe symptoms of obstruction despite maximal medical therapy with a residual resting or provocable LVOT gradient of 50 mm Hg or greater, or in patients with recurrent syncope not related to arrhythmia
Surveillance: TTE is recommended every 1 to 2 years to assess for mitral regurgitation and changes in LV hypertrophy, function, and degree of obstruction.
First-degree relatives of patients with HCM should undergo evaluation with ECG and echocardiography and be offered genetic testing if a sarcomeric mutation is identified in the proband
83
The electrocardiogram paradoxically demonstrates low QRS voltage and a “pseudoinfarct” pattern: Q waves in the anteroseptal leads without regional wall motion abnormalities on echocardiogram is suggestive of _________
Cardiac amyloid
cardiac amyloidosis should be suspected in Black patients older than 50 years 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
84
Restrictive cardiomyopathy versus constrictive pericarditis can be differentiated by: _______
Restrictive cardiomyopathy is distinguished from constrictive pericarditis by an elevated B-type natriuretic peptide level and concordant rise and fall of left and right systolic pressures with respiration.
restrictive physiology: the elevated B-type natriuretic peptide level (often <100 pg/mL [100 ng/L] in constrictive pericarditis), the presence of severe pulmonary hypertension, the absence of pericardial thickening on cardiac magnetic resonance imaging, and the presence of delayed enhancement of myocardium consistent with myocardial fibrosis on cardiac magnetic resonance imaging
Restrictive cardiomyopathy must be differentiated from constrictive pericarditis because surgical pericardiectomy may relieve symptoms and prolong life in patients with constriction.
85
cardiac myxoma most often found____, versus angiosarcoma found in
L atrium
R atrium
Angiosarcomas are highly vascular tumors, and CT or CMR imaging with contrast may help differentiate an angiosarcoma from a right atrial myxoma. - More dangerous, but myxoma can also have embolic phenomena
Papillary fibroelastomas are small, independently mobile cardiac tumors that are typically attached to the left-sided valvular endocardium by a stalk : 8th decade of life, higher embolic phenomena
86
Electrocardiographic changes of ___________ Concave ST-segment elevation is present in most of the leads (arrowheads). The PR segment is depressed in all leads except aVR
Acute pericarditis
Tx: aspirin (750-1000 mg) or NSAIDs (ibuprofen 600 mg) every 8 hours for 1 to 2 weeks. Colchicine (0.5 mg once or twice daily for 3 months) is recommended as adjunctive therapy to shorten the duration of symptoms and reduce the chances of treatment failure or recurrence.
Anything after 3 months = chronic
Glucocorticoid therapy is reserved for patients with recurrent, incessant, or chronic pericarditis despite standard therapy (including patients with uremic pericarditis not responsive to intensive dialysis); patients with contraindications to NSAID therapy; and patients with autoimmune-mediated pericarditis. Prednisone should be initiated at a dosage of 0.25 mg/kg to 0.5 mg/kg and continue for 3 months.
87
The hemodynamic hallmarks of _________ include blunting or loss of the y descent within the right atrial pressure waveform and elevated and equalized diastolic pressures.
Tamponade
88
Current guidelines from the American Academy of Neurology recommend PFO closure for patients younger than___ years with a PFO and embolic stroke of unknown source.
60
For these patients, and for younger patients who do not select PFO closure, antiplatelet therapy or anticoagulation is reasonable
89
______ is characterized by mobile, redundant atrial septal tissue that is often associated with a PFO.
Atrial septal aneurysm
90
Ostium secundum defects, the most common type of ASDs (75% of cases), are located in the mid portion of the atrial septum and are usually isolated anomalies. Located in the lowest portion of the atrial septum, ostium primum defects (15%–20% of ASDs) are a component of endocardial cushion defects.
ASDs may be suspected in patients with unexplained right heart enlargement or atrial arrhythmias. Atrial fibrillation is a common finding in adults with an ASD
Remember ostium primum has associated additional defects: first degree AV block (conduction system), mitral regurgitation, primum has to be surgically closed not percutaneous device
main indications for ASD closure include right-sided cardiac chamber enlargement or symptoms of dyspnea; closure is reasonable for orthodeoxia-platypnea syndrome and also before pacemaker placement because of the increased risk for systemic thromboembolism
91
Percutaneous device closure vs surgical ASD repair
Percutaneous device closure is indicated for patients with an isolated ostium secundum ASD causing functional and hemodynamic consequences and is a reasonable option for asymptomatic patients with shunt-related hemodynamic consequences.
Surgical ASD closure is indicated for nonsecundum ASDs, large secundum ASDs, unfavorable anatomy for device closure, and coexistent cardiovascular disease that requires operative intervention, such as coronary artery disease or tricuspid regurgitation.
92
The typical murmur of a _____ is a continuous “machinery” murmur that envelops the S2, making it inaudible; the murmur is heard beneath the left clavicle
PDA
May also include wide pulse pressure and therefore bounding pulses
93
Contraindication to PDA closure___________
Pulmonary HTN
94
Noonan syndrome (Webbed neck syndrome 2) is associated with _____ congenital valve disease
Pulmonary valve stenosis
Tx: Balloon valvuloplasty
Surgery: Surgical intervention is recommended for pulmonary valve stenosis (PS) associated with a small annulus, more than moderate pulmonary valve regurgitation, severe subvalvar or supravalvar PS, or another cardiac lesion that requires operative intervention.
95
______ is a genetic syndrome associated with aortic co-arctation
Turner
Fifty percent of patients with aortic coarctation have a bicuspid aortic valve (Future risk of aortic stenosis)
96
Features of TOF
1) VSD
2) Over riding Aorta
3)_________
4)_________
R ventricle hypertrophy
Pulmonary stenosis
i.e Pulm regurg is a common complication of TOF repair, ICD if EF<35%
97
Genetic screening is recommended for all patients with ______ who are planning reproduction because the presence of the 22q11.2 chromosome microdeletion (15% of patients) results in congenital heart disease inheritance of approximately 50%.
TOF
98
Bicuspic aortic valve increases risk of ____ and ____
Aortic aneurysm, stenosis
99
Annual surveillance is appropriate in patients with a first-degree relative with a history of familial thoracic aortic aneurysm and aortic dissection (T/F)
True
100
Aortic Aneurysm surveillance
-Routine ECHO >___
- CT Angio ____
5cm
5.5cm
Ehlers Danlos : 4.5cm q6months
Tx: B blocker, ACE/ARB
101
Thoracic endovascular aortic repair (TEVAR) with stent grafting should be used when a descending aortic aneurysm has a diameter greater than _____, has exhibited rapid growth (>0.5 cm/year)
6cm
102
In patients with an ascending aortic diameter exceeding ____, elective aortic repair is warranted to prevent the morbidity and mortality associated with aneurysm rupture; patients with Marfan or Ehlers-Danlos syndrome should undergo aortic repair at _____
5.5cm (6cm no matter what) - Thoracic aortic aneurysm
4.5-5cm
103
Abdominal aortic aneurysm : Task Force recommends one-time screening with duplex ultrasonography in all men_____ who have smoked at least 100 cigarettes in their lifetime
65-75
104
Aortic repair should be performed in patients with an AAA diameter of _____ cm or larger, in those with rapid expansion in AAA size (>0.5 cm/year)
5.5
Surveillance should be started with diameter>4cm
105
Patients with an aortic atheroma should be treated with antiplatelet and statin therapies to reduce cardiovascular risk
106
Acute type ____ aneurysm can actually be managed by medical therapy and not immediate operative boarding
B
107
In patients with an ankle-brachial index greater than 1.40, a ______may be used to diagnose peripheral artery disease.
Toe brachial index ---> CT Angio LE
108
Cilastozol for PAD has black box warning for patients with _____
Heart Failure
109
Cardiotoxic Chemo
1)________
2)Tratszumab
Anthracycline (Doxorubicin)
110
Conditions contra-indicating a pregnancy
1)______
2) HFrEF (EF<40%)
3) Severe plum HTN
Ventricular outflow tract obstruction (aortic stenosis, aortic co-arctation)
If Marfan, diameter = 4.5cm, repair before pregnancy
111
Anticoag in peri-partum cardiomyopathy is indicated for____
EF<35, for atleast 8 weeks
112
Warfarin can be used during pregnancy if dose <____
5mg, specifically during 1st trimester
113
Cardiac drugs to avoid during pregnancy____
ACE/ARB, Spironolactone
114
Eisenmenger optimization_____
In patients with cyanotic conditions, such as Eisenmenger syndrome, iron deficiency is common, and short-term iron therapy will improve exercise capacity and quality of life.
115
_____ scoring helps you decide if NSTEMI gets cath
TIMI 3-7
116
abciximab/eptifibatide is almost never the answer, only if PCI failed with high clot burden
PCI window 90 - 120 minutes
117
CABG during acute STEMI: if initial measures fail, mechanical defects (VSD, free wall/papillary rupture)
118
Stress test for patient with LBBB
Stress ECHO or Lexiscan
119
ICD indication HFrEF : EF<30-35%
CRT-D indication HFrEF: EF<35%, LBBB QRS>150
avoid Ca2+ blockers in heart failure
120
Dilated cardiomyopathy, biventricular failure in young patient____________
Giant cell myocarditis
121
Peripartum cardiomyopathy: avoid ace/arb, spironolactone, anticoag with warfarin if EF<35%
122
HOCM (Auto dominant) treatment = b blocker, ICD if concerning features (Vtach, cardiac arrest, high LV wall thickness)
high amplitude, T wave inversion on EKG
123
Causes of restrictive cardiomyopathy
Sarcoid, amyloid (low voltage QRS, peri-orbital ecchymoses, hepatomegaly ), hemachromatosis
Tx: b blocker, ACE, diuretic as needed
Kussmaul: JVD during inspiration
124
Mobitz ___ and 3rd degree AV block require pacemaker implantation
II
125
Afib with WPW = Different management
Choose procainamade , other agents can cause Vfib/Vtach
Unstable WPW = cardioversion, stabke/symptomatic = ablation
Adenosine is good for SVT (AVNRT/AVRT), does not stop Afib/aflutter but may reveal the rhythm
126
Culprits for QT prolongation
fluoroquinolones, methadone, antifungals
127
Brugada: RBBB with coved ST elevations
128
Drugs associated with pericarditis_______
hydralazine, phenytoin, minoxidil
Troponin may be elevate d
Tx: Colchicine + Aspirin
129
Classic MR murmur radiated to ___________
Axilla
fixed split S2 = ASD
130
Rheumatic Fever: Chorea, polyartheritis, subcuntaneous nodules, carditis, erythema marginatum, caused by GAS
Penicillin/Erythromycin for 10 years or till age 40 + aspirin ; even if GAS throat culture negative
131
When can you not do a TAVR
1) Concomitant mitral disease
2) Significant AR
3) Bicuspid valve as underlying cause of AS
For AS thats symptomatic and severe, u need both ECHO and cath, ECHO can underestimate valve performance
132
When to fix ascending aortic root during dilation (bicuspid valve)_____________
diameter>5.5cm, 0.5cm/year, 5cm with risk factors
133
never use B blocker and balloon pump for acute AR --> surgery/ACE/Ca2+ blocker
Immediate therapy: nitroprusside/dobutamine
134
Mitral stenosis treatment
1) percutaneous commissurotomy , if also MR then surgery
mitral stenosis: diastolic
135
Acute MR
Surgery, with afterload reduction/ionotropy and IABP interim
MR with HFrEF EF<60% LV End diastolic diameter>40mm also warrants surgery
136
Mitral prolapse treated with b blocker, only surgery if MR
137
Most causes of ASD are ostium secundum defect, not associated with other valve pathologies at the same time
ostium secundum can undergo percutaneous closure, ostium primum needs surgical since other valves have associated defects , only close if L to R shunt, not with baseline R to L shunt
138
When to close PFO
Cryptogenic stroke
139
When to repair PDA
Chamber dilation, but after R--> L shunt (Eisenmenger) develops you cant, also cant with pulm htn
140
When is prophylaxis indicated for endocarditis
1)Prosthetic cardiac valve
2) History of endocarditis
3) Unrepaired congenital heart disease
4) Post transplant valve problem
For procedures with
141
Myxomas arise in the L atrium, may embolize,
Due to risk for embolization, myxomas should be resected
142
treatment of eczema _____
Emollients
topical steroids if not on the face
