Cardiology

Question 1

Chest pain on normal coronaries

Answer 1

Microvascular dysfunction

Question 2

Treatment of severe mitral regurgitation

Answer 2

Reduce left ventricular volume:
Ace(arb), beta blocker, aldosterone inhibitors

Question 3

Ascending aorta aneurysm requires repair

Answer 3

5.5 cm

Question 4

SVT terminated by vagal maneuvers

Answer 4

Atrioventricular nodal reentrant tachycardia

Question 5

Cannon a waves

Answer 5

Dissociation of AV conduction

Question 6

Widened QRS due to

Answer 6

1. SVT with aberrancy
2. Pre-excited tachycardia
3. VT

Question 7

Ventricular Tachycardia

Answer 7

1. Positive in aVR
2. QRS morphology concordant (all predominantly positive or negative) in precordial leads
3. Exhibit extreme axis deviation

Question 8

Severe mitral stenosis

Answer 8

Valva area < 1.5 cm2
Mitral gradient > 5-10 mmHg at normal heart rate
PASP > 50 mmHg

Question 9

Beta blockers with mortality effects

Answer 9

Bisoprolol
Carvedilol
Metoprolol succinate

Question 10

Acute limb ischemia

Answer 10

Paresthesia
Pain
Pallor
Pulselessness
Poikilothermia (coolness)
Paralysis

Question 11

HFpEF pathophysiology

Answer 11

1. LV hypertrophy
   2, LV fibrosis
2. Chronotropic incompetence
3. Microvascular dysfunction
4. Inflammation

Question 12

HFpEF

Answer 12

Elevated filling press
Structural abnormalities LVH, LAE
elevated BNP

Question 13

DDX from HFpEF

Answer 13

1. Restrictive CMP
2. Hypertrophic CMP
3. Storage disease
4. Pericardial disease
5. Valvular heart disease
6. Primary RV failure

Question 14

Causes of restrictive heart disease

Answer 14

1. Amyloid
2. Hemochromatosis
3. Sarcoidosis
4. Endomyocardial fibrosis
5. Radiation/chemotherapy

Question 15

Comorbidities in HFpEF

Answer 15

1. Htn
2. Obesity
3. DM/prediabtes
4. Chronic kidney disease
5. Afib
6. Chronotropic incompetence (left ventricular strain)
7. Decrease oxygen uptake

Question 16

Chronotropic incompetence

Answer 16

the inability of the heart to increase its rate commensurate with increased activity or demand

Question 17

Treatment HFpEF

Answer 17

1. Diuretic (1)
2. SGLT2 inhibitors (2a)
3. ARNI (2b)
4. MRA (2b)
5. ARB (2b)

Question 18

Heart Failure
Goal of diuretic

Answer 18

> 100-150 ml/hr

Question 19

CHF
Diuretic combination

Answer 19

Loop diuretic -double dose (2-2.5 x home diuretic divided into twice day(titrate q12-24hrs(max960mg/d)
Metalazone (low K, increamortality)
Acetazolamide (500 mg iv daily)
SGLT2 inhibitors

Question 20

Increase in creatinine and congestion improved

Answer 20

Metra M et al Circ Heart Failure 2012; 5:54

Question 21

Cardiac sarcoidosis

Answer 21

FDG, PET, cMRI, endometrial biopsy

Question 22

Sarcoidosis

Answer 22

Dual isotope pet scanning (N-NH3 defects and matched F-FDG uptake)
Ammonia is perfusion.
FDG activity /metabolism

Question 23

Severe aortic stenosis

Answer 23

Vmax > 4 m/s or mean gradient > 40 mm Hg
Aortic valve area < 1 cm squared

Question 24

Murmur louder with standing

Answer 24

Hypertrophic cardiomyopathy

Question 25

Type B dissection

Answer 25

IV beta blocker
Nitroglycerin iv
Pain control
SBP 120 pulse 60

Question 26

PVC BURDEN OF >10%

Answer 26

PVC induced cardiomyopathy

Question 27

Pharmacologic testing in wheezing must avoid the following:

Answer 27

Adenosine
Dipyridamole
Regadenoson

Question 28

CHF OBJECTIVES diuresis

Answer 28

After six hours 100-150 ml/hr

Question 29

If creatinine goes up and decongestion occurs, ok hold diuretic