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PSBIM 2024 recall > Cardiology > Flashcards

Cardiology Flashcards

Recall

1
Q

Indications for permanent pacemaker insertion in sinus node dysfunction (5 items)

A
  • Symptoms that are directly attributable to SND
  • Symptomatic sinus bradycardia because of essential medication therapy for which there is no alternative treatment
  • Tachy-brady syndrome and symptoms attributable to bradycardia
  • Symptomatic chronotropic incompetence
  • In patients with symptoms that are possibly attributable to SND, a trial of oral theophylline may be considered to increase heart rate and determine if permanent pacing may be beneficial
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2
Q

Class IIB recommendation if symptoms are likely/uncertain to correlate with bradycardia in sinus node dysfunction

A

Oral theophylline

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3
Q

Indications for permanent pacemaker implantation in AV block (regardless of symptoms)

A

Aquired Mobitz Type II, high grade AV block, third degree AV block that is not reversible or physiologic

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4
Q

Adjunct pharmacologic treatment for block in the AV node

A

Atropine or Isoproterenol

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5
Q

Indication for pacing in Mobitz I

A

Symptomatic (Class IIA)
Asymptomatic but with with neuromuscular disease associated with progressive conduction tissue disorder (Class I)

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6
Q

Regular atrial tachycardia with defined P wave; may be sustained, nonsustained, paroxysmal, or incessant; frequent sites of origin occur along the valve annuli of left or right atrium, pulmonary veins, coronary sinus musculature, superior vena cava

A

Focal atrial tachycardia (AT)

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7
Q

Commonly seen as sawtooth flutter waves at rates typically faster than 200 beats/min, macroreentry reflected as organized atrial activity on an electrocardiogram (ECG)

A

Atrial flutter and macroreentrant atrial tachycardia

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8
Q

The most common sustained cardiac arrhythmia in older adults; chaotic rapid atrial electrical activity with variable ventricular rate

A

Atrial fibrillation

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9
Q

Multiple discrete P waves often seen in patients with pulmonary disease during acute exacerbations of pulmonary insufficiency

A

Multifocal atrial tachycardia

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10
Q

Regular tachycardia with P waves visible at the end of the QRS complex or not visible at all; the most common paroxysmal sustained tachycardia in healthy young adults; more common in women

A

AV nodal reentry tachycardia (AVNRT)

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11
Q

ECG changes stage 1 in acute pericarditis

A

Widespread elevation of the ST segments, often with upward concavity, involving two or three standard limb leads and V2–V6, with reciprocal depressions only in aVR and occasionally V1

Depression of the PR segment below the TP segment, reflecting atrial involvement, an early change that may occur prior to ST segment elevation

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12
Q

ECG changes stage 2 in acute pericarditis (several days after stage 1)

A

ST segments return to normal

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13
Q

ECG changes stage 3 in acute pericarditis

A

T waves become inverted

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14
Q

ECG changes stage 4 in acute pericarditis

A

ECG returns to normal

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15
Q

Medical treatment for acute percarditis

A

Bed rest and anti inflammatory
Aspirin 2-4 g/day or
Ibuprofen 600-800mg/ TID or
Indomethacin 25-50mg/tab with Omeprazole 20mg/d
(over 1-2 weeks then tapered)

Colchicine 0.5mg qd (<70kg) or 0.5mg BID if >70kg x 3 months

If NSAIDS/colchicine not tolerated- prednisone 1mg/kg/day 2-4 days then tapered

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16
Q

JVP characteristics in cardiac tamponade

A

Prominent x, absent y

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17
Q

Which pericardial pathology presents with Kussmaul’s sign?

A

Constrictive pericarditis (also right ventricular MI, and to a lesser extent restrictive cardiomyopathy)

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18
Q

Pulsus paradoxus definition

A

Greater than 10mmHg inspiratory decline in SYSTOLIC arterial pressure

Present in cardiac tamponade

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19
Q

JVP characteristics in constrictive pericarditis

A

Prominent x AND y descent

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20
Q

Ventricular filling is impeded throughout the diastolic cycle (which percardial pathology)

A

Cardiac tamponade

vs chronic constrictive pericarditis - during early diastole ventricular filling is unimpeded and is reduce abruptly

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21
Q

Only definitive treatment for constrictive pericarditis

A

Pericardial resection

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22
Q

Pattern of congestive symptoms in DCM

A

Left before right, except right prominent in young adults

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23
Q

EF in DCM

A

usually <30%

vs restrictive: 40-50%
hypertrophic: >60%

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24
Q

Best known defective protein associated with DCM

A

Dystrophin

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25
Q

Most commonly recognized genetic cause of DCM

A

Truncating mutation of titin encoded by TTN

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26
Q

Most common toxin implicated in DCM

A

Alcohol

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27
Q

Most common drugs implicated in toxic cardiomyopathy

A

Chemotherapy agents

28
Q

Threshold of serum iron and transferrin saturation to diagnose cardiac siderosis from hemochromatosis DCM

A

Men >60%
Women >45-50%

29
Q

Most common restrictive cardiomyopathy

A

Amyloidosis

30
Q

Proteasome inhibitor used for tx of AL amyloidosis

A

Bortezomib

31
Q

First line agents used in hypertrophic cardiomyopathy

A

B blockers and L type CCB (e.g. verapamil) to slow heart rate, enhance diastolic filling, and decrease contractility

32
Q

Preferred anti arrhythmic agents in hypertrophic cardiomyopathy

A

Disopyramide and amiodarone

Avoid cardiac glycosides (increases contractility and worsens obstruction)

33
Q

Major determinants of myocardial oxygen demand (MVO2)

A

Heart rate, myocardial contractility, myocardial wall tension (stress)

34
Q

Major determinant of coronary resistance

A

R2 prearteriolar vessels and R3 arteriolar and intramyocardial capillary vessels

35
Q

Positive stress test (Ischemic ST segment repsonse)

A

Flat or downsloping depression of the ST segment >0.1 mV below baseline (i.e., the PR segment) and lasting longer than 0.08 s

36
Q

Contraindications to exercise stress testing (7)

A

Rest angina within 48 h
Unstable rhythm
Severe aortic stenosis
Acute myocarditis
Uncontrolled heart failure
Severe pulmonary hypertension
Active infective endocarditis

37
Q

Signs during noninvasive testing indicating HIGH risk for coronary events

A

Inability to exercise for 6 minutes (stage II Bruce protocol)
Strongly positive test at low work loads:
- >/= 1mV ST segment depression before completion of Stage II
- >/= 2mV ST segment depression at ANY stage
- ST segment depression that persists >5mins after cessation of exercise
Decline in systolic pressures >10mmHg during exercise
Development of ventricular tachyarrhythmia

38
Q

Most important signs of LV dysfunction measured during cardiac catheterization

A

elevated LVEDP and ventricular volume and reduced ejection fraction

39
Q

Used for chronic angina; inhibits late inward sodium current

A

Ranolazine

contraindicated in hepatic impairment

40
Q

Choice of anti coagulant in AF patients post PCI (NSTEMI included)

A

Shortened DAPT - stop aspirin 4 weeks post PCI and continue p2Y12 inhibitor plus DOAC for 1 year (unless very high risk for ischemic events)

41
Q

Diagnostic hallmark of Prinzmetal’s variant angina

A

Coronary angiography finding of transient coronary spasm

42
Q

Main therapeutic agent in PVA

A

Nitrates and calcium channel blockers

43
Q

CK rises within ___ hours and generally returns to normal by ___ hours

A

rises within 4-8 hours
normal by 48-72hrs

44
Q

Recommended regimen of tPA (tissue plasminogen activator) for ACS-STE

A

15mg bolus followed by 50mg IV over the first 30 min followed by 35mg over the next 60 minutes

45
Q

Recommended dose of Streptokinase for ACS-STE

A

1.5million units (MU) IV over 1 hour

46
Q

Recommended dose of rPA (reteplase)for ACS-STE

A

Double-bolus regimen consisting of a 10-MU bolus given over 2–3 min, followed by a second 10-MU bolus 30 min later

47
Q

Recommended dose of TNK (tenecteplase) for ACS-STE

A

TNK is given as a single weight-based intravenous bolus of 0.53 mg/ kg over 10 s

48
Q

Clear contraindications for fibrinolytic agents (ACS-STE)

A

History of cerebrovascular hemorrhage at ANY TIME

A nonhemorrhagic stroke or other cerebrovascular event within the PAST YEAR

Marked hypertension (a reliably determined systolic arterial pressure >180 mmHg and/or a diastolic pressure >110 mmHg) at any time during the acute presentation

Suspicion of aortic dissection, Active internal bleeding (excluding menses)

49
Q

Recommended dose of UFH in ACS-STE

A

60U/kg bolus (max 4000U) then infusion 12U/kg per hr (max 1000u/h). Target aPTT 1.5 to 2 x the normal value

50
Q

Risk factors for ASCVD (8)

A

Male
Smoker
Hypertension ≥140/90 mmHg
BMI 25 kg/m2
Family history of premature coronary heart disease
Proteinuria
Left ventricular hypertrophy
Postmenopausal women

51
Q

2 most common autosomal dominant genetic mutations involved in VTE

A

(1) Factor V Leiden, which causes resistance to the endogenous anticoagulant activated protein C (which inactivates clotting factors V and VIII), and

(2) the prothrombin gene mutation, which increases the plasma prothrombin concentration

52
Q

Most common gas exchange abnormalities in PE

A

Arterial hypoxemia
Increased alveolar-arterial O2 tension gradient

53
Q

Pathophysiologic abnormalities in PE (5)

A

Increased pulmonary vascular resistance
Impaired gas exchange
Alveolar hyperventilation
Increased airway resistance
Decreased pulmonary compliance

54
Q

Most common ECG abnormality in PE

A

T wave inversion in leads V1 to V4 (due to RV strain and ischemia)

55
Q

Acute DVT - compression stockings maintained at

A

30-40mmHg or 20-30mmHg
replaced every 3 months

56
Q

UFH dose for DVT/PE

A

Initial bolus of 80U/kg followed by infusion rate of 18U/kg

57
Q

3 strategies for anticoagulation in DVT/PE

A

1) LMWH or fondaparinux bridged to warfarin
2) parenteral x 5 days then NOAC (direct thrombin inhibitor e.g. dabigatran or factor Xa inhibitor e.g. edoxaban)
3) oral rivaroxaban or apixaban with 3 week and 1 week loading dose respectively then maintenance

58
Q

Choice of anticoagulant in patients with suspected/proven HIT

A

Argatroban and bivalirudin (direct thrombin inhibitors)

59
Q

Management of bleeding d/t warfarin

A

Prothrombin complex concentrate (best)

Less serious bleeding: may give fresh frozen plasma or IV vitamin K

60
Q

Management of bleeding d/t heparin or LMWH

A

Protamin sulfate

61
Q

Management of bleeding d/t Dabigatran

A

Idarucizumab

62
Q

Two principal indications for IVC filter insertion

A

(1) active bleeding that precludes anticoagulation and (2) recurrent venous thrombosis despite intensive anticoagulation

63
Q

First line vasopressor and inotropic agents in massive PE

A

NE and dobutamine

64
Q

Claudication characteristically involves the buttocks, thighs, and calves and may be associated with impotence in males

A

Leriche’s syndrome

65
Q

Used to determine whether varicose veins are secondary to deep-venous insufficiency

A

Brodie-Trendelenburg test

As the patient is lying supine, the leg is elevated and the veins allowed to empty. Then, a tourniquet is placed on the proximal part of the thigh and the patient is asked to stand. Filling of the varicose veins within 30 s indicates that the varicose veins are caused by deep-venous insufficienc

PSBIM 2024 recall (9 decks)

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