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MedicalCNS > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Chest pain on normal coronaries

A

Microvascular dysfunction

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2
Q

Treatment of severe mitral regurgitation

A

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

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3
Q

Ascending aorta aneurysm requires repair

A

5.5 cm

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4
Q

SVT terminated by vagal maneuvers

A

Atrioventricular nodal reentrant tachycardia

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5
Q

Cannon a waves

A

Dissociation of AV conduction

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6
Q

Widened QRS due to

A
  1. SVT with aberrancy
  2. Pre-excited tachycardia
  3. VT
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7
Q

Ventricular Tachycardia

A
  1. Positive in aVR
  2. QRS morphology concordant (all predominantly positive or negative) in precordial leads
  3. Exhibit extreme axis deviation
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8
Q

Severe mitral stenosis

A

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

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9
Q

Beta blockers with mortality effects

A

Bisoprolol
Carvedilol
Metoprolol succinate

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10
Q

Acute limb ischemia

A

Paresthesia
Pain
Pallor
Pulselessness
Poikilothermia (coolness)
Paralysis

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11
Q

HFpEF pathophysiology

A
  1. LV hypertrophy
    2, LV fibrosis
  2. Chronotropic incompetence
  3. Microvascular dysfunction
  4. Inflammation
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12
Q

HFpEF

A

Elevated filling press
Structural abnormalities LVH, LAE
elevated BNP

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13
Q

DDX from HFpEF

A
  1. Restrictive CMP
  2. Hypertrophic CMP
  3. Storage disease
  4. Pericardial disease
  5. Valvular heart disease
  6. Primary RV failure
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14
Q

Causes of restrictive heart disease

A
  1. Amyloid
  2. Hemochromatosis
  3. Sarcoidosis
  4. Endomyocardial fibrosis
  5. Radiation/chemotherapy
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15
Q

Comorbidities in HFpEF

A
  1. Htn
  2. Obesity
  3. DM/prediabtes
  4. Chronic kidney disease
  5. Afib
  6. Chronotropic incompetence (left ventricular strain)
  7. Decrease oxygen uptake
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16
Q

Chronotropic incompetence

A

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

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17
Q

Treatment HFpEF

A
  1. Diuretic (1)
  2. SGLT2 inhibitors (2a)
  3. ARNI (2b)
  4. MRA (2b)
  5. ARB (2b)
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18
Q

Heart Failure
Goal of diuretic

A

> 100-150 ml/hr

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19
Q

CHF
Diuretic combination

A

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

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20
Q

Increase in creatinine and congestion improved

A

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

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21
Q

Cardiac sarcoidosis

A

FDG, PET, cMRI, endometrial biopsy

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22
Q

Sarcoidosis

A

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

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23
Q

Severe aortic stenosis

A

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

24
Q

Murmur louder with standing

A

Hypertrophic cardiomyopathy

25
Q

Type B dissection

A

IV beta blocker
Nitroglycerin iv
Pain control
SBP 120 pulse 60

26
Q

PVC BURDEN OF >10%

A

PVC induced cardiomyopathy

27
Q

Pharmacologic testing in wheezing must avoid the following:

A

Adenosine
Dipyridamole
Regadenoson

28
Q

CHF OBJECTIVES diuresis

A

After six hours 100-150 ml/hr

29
Q

If creatinine goes up and decongestion occurs, ok hold diuretic

30
Q

MINOCA
INOCA
ANOCA

A

Mi w/ non obstructive cad
Ischemia w/ no obstructive cad
Angina w/ non obstructive cad

31
Q

Causes of MINOCA
MI TO NON OBSTRUCTIVE CAD

A

Coronary embolism
Coronary microvascular dysfunction
Coronary spasm
Coronary thrombosis
Myocardial bridging
Plaque rupture
Spontaneous coronary dissection

32
Q

Cardiac MRI HELPS w/ contrast

A

Myocardial edema
Myocardial

33
Q

Non obstructive coronary ischemia

A

Endothelial dysfunction and or VSMC hyperreactivity (autonomic dysfunction)

34
Q

Vasomotor function

A

Important in determining cause for ischemia

35
Q

Testing for cad

A

PET/SPECT structure and function
CMR structure & function
CORONARY CT angiography

36
Q

CTA coronary angiography allows

A

Coronary calcification
% stenosis in epicardial coronaries
Congenital coronaries
Intramyocardial bridging
Bypass grafts

37
Q

CTA angiography also help

A

FRACTIONAL FLOW RESERVE (functional assessment)

38
Q

CTA to assess coronary fractional flow reserve

A

FFR value <0.8 is abnormal

39
Q

PET SCAN HELPS W

A

Myocardial flow reserve

40
Q

PET CT coronaries

A

Myocardial flow reserve
< 2 predicts all cause mortality

41
Q

Afib

A

Cha2ds-vasc equal to or > 2 in men, use anticoagulant
Cha2dsvasc equal to or >3 in women, use doac

42
Q

Pulse field ablation

43
Q

ARNI first line
Decrease in death, increase EF, decrease readmission rates

44
Q

Alternativa to ARNI

A

Hydralazine/isosorbide dinitrate (start 20 mg each)
Hydralazine 100 mg/ isosorbide 40 mg

45
Q

Hold diuretic if you start ARNI

46
Q

Start mineral corticoid antagonist i

A

Men creatinine is <2.5
Women creatinine 2

47
Q

SGLT2 inhibitors
EMPA -Reg outcomes
NEJM
2015:373:2117-28

A

Female patients had more UTI in placebo group
Male same
Except mycotic infection

48
Q

Diuretic adjuncts

A

Acetazolamide 500 mg iv daily
Metolazone 5 mg or chlorothiaxidd 500
Remember to bolud.

49
Q

CVP= J P + 5 cm

A

CVP = JVP + 5 cm

50
Q

ARNI RELATIVE RISK REDUCTION 42%

A

JAMA Cardiology 2021:6(7):743-744

51
Q

Metotolol succinate

52
Q

ARNI GIRST LINE

A

Hydralazinr ISDN 50

53
Q

Stop diuretic when start ARNI

54
Q

After one year after stent, do not add aspirin to pts on DOAC/ac

A

Circulation 2023 Aug29:148(9):e9-e119

55
Q

Mimics of HFpEF
R/o valvular disorder
Congenital heart disease

A

Cardiac amyloid
Cor pulmonale
High output syndrome
Hypertrophic cardiomyopathy
Infiltrative disorder
Ischemic heart disease
Pulmonary HTN
Storage disorder

MedicalCNS (40 decks)

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