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Board Study > Cardiology > Flashcards

Cardiology Flashcards

1
Q

What imaging test is useful to triage low to intermediate risk ACS?

A

Coronary CTA

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2
Q

What disease is indicated by increased LV thickness, decreased EKG voltage, and history of carpal tunnel?

A

Amyloidosis

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3
Q

What does increased LV thickness and decreased voltage on EKG indicate?

A

infiltrative cardiomyopathy

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4
Q

When is AV replacement indicated in severe AS?

A

1) Symptomatic
2) Asymptomatic with EF < 50%
3) Asymptomatic with other cardiac surgical procedure

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5
Q

In Afib, when will early antiarrhythmic or ablative therapy reduce bad clinical outcomes in recent diagnosis of AFib in the last 12 months?

A

According to the EAST-AFNET 4 trial:

-Age >75
- previous TIA/CVA
-Age >65 with 2 comorbidities (CV type or DM or CKD or Female)

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6
Q

A 67 yo patient establishes with PCP for follow up after recent hospitalization where afib was discovered. The patient remains in afib on examination but otherwise feels well on metoprolol and Eliquis. Under what conditions would you refer them for start of antiarrhythmic therapy or ablation?

A

-previous TIA/CVA or if have 2 comorbidities (CV type or DM or CKD or Female)

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7
Q

In an otherwise healthy patient newly diagnosed with afib, what is the age above which the patient would likely reduce risk of bad clinical outcomes if referred for antiarrhythmic or ablative therapy?

A

75

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8
Q

What therapy is next in someone with afib who has been on a DOAC and has suffered significant bleeding or a stroke?

A

LAA occlusion

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9
Q

When is a LAA occlusion a good idea in someone with afib?

A

if they have been on a DOAC and have had a stroke or significant bleeding.

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10
Q

What medicine is good to use if you have an ASA allergy?

A

clopidogrel

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11
Q

what should you expect if mass in the RA associated with a sanguinous pericardial effusion?

A

cardiac angiosarcoma

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12
Q

which atrium is usually affected by Cardiac angiosarcoma?

A

RA

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13
Q

True or False: cardiac angiosarcoma prognosis is good.

A

False. Usually mets when it is found and survival is low even with surgery with or without chemo/radiation.

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14
Q

Which atrium is usually associated with an atrial myxoma?

A

LA

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15
Q

what are the usual symptoms associated with atrial myxoma?

A

weight loss, fatigue, fever, embolic phenomena, symptoms of obstruction

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16
Q

What changes to preload and afterload make an HCM murmur louder or softer?

A

decreased preload = louder, increased afterload = softer (more blood in cavity relieves obstruction)

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17
Q

What do valsalva, squatting, and handgrip do to preload and afterload?

A

valsalva - decreased preload
squatting - increased preload
handgrip - increased afterload

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18
Q

What maneuver(s) would you have someone with HCM do to make the murmur louder?

A

valsalva

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19
Q

Does valsalva do the same thing to murmurs in HCM and AS?

A

No, it makes HCM louder (decreased blood and increased obstruction) and makes AS softer (decreased flow)

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20
Q

What is your differential in a young woman with angina?

A

ACS, coronary vasospasm, SCAD, microvascular dysfunction

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21
Q

How would you describe the RP interval and P waves on an EKG of AVNRT

A

short interval, retrograde P waves best seen in V1

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21
Q

What imaging modality is good to clarify presence of microvascular dysfunction in a young patient with chest pain?

A

cMRI shows perfusion abnormality

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22
Q

Describe the patient perfect for CRT?

A

-sinus rhythm, LVEF 35% or less, NYHA II-IV symptoms, LBBB or QRS >150 any morphology

All of this despite GDMT.

Sometimes can do non LBBB with QRS 120-150 and sometimes Afib can do it.

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23
Q

When is an ICD indicated in HF?

A

EF equal or less to 35% and NYHA II or III on GDMT

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24
Q

What is a normal range for ABIs? What is the value in ischemic rest pain?

A

0.9 to 1.4 is normal, claudication usually has 0.4 to 0.9 and below 0.4 for rest pain

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25
Q

You are evaluating someone with claudication with ABI. Value is 1. what should you do?

A

this value is technically normal, but if you think they have ischemic cause of pain, should do exercise ABI

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26
Q

What meds should someone be on who has symptomatic PAD?

A

ASA or clopidogrel, statin

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27
Q

What is the deal with anticoagulation and PAD with CAD?

A

COMPASS trial said decreased risk major CV and limb adverse events with ASA + low dose Xa inhibitor compared to ASA + placebo

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28
Q

What is recommended therapy for recurrent pericarditis?

A

step up therapy compared to last time, NSAIDs + colchicine +/- prednisone

*exclude TB before using prednisone?

29
Q

If someone is high risk for recurrence after PCI on DAPT and no bleeding risk, how long might you extend therapy?

A

3 years

30
Q

Signs of VT. name 4 and then 2 highly suggestive.

A

1) + in aVR
2) NW axis (-90 to 180) (negative in I,II,avF)
3) concordant QRS morphology in precordial leads (all positive or negative)
4) QRS other than typical LBBB or RBBB

highly suggestive: Fusion or capture beats

*0 is East, -90 is North, 180 is West, +90 is South

     -90 180     .      0
    \+90
31
Q

What is a fusion beat? What is a capture beat?

A

Both are beats which are highly suggestive of VT.

fusion: a hybrid supraventricular and ventricular conducted beat.

capture: a sinus conducted normal QRS in the midst of wide complex tachycardia

32
Q

What is the beat which is highly suggestive of VT which is a hybrid supraventricular and ventricular conducted beat?

A

Fusion beat

33
Q

What is the beat which is highly suggestive of VT which is a sinus conducted normal QRS in the midst of wide complex tachycardia?

A

Capture beat

34
Q

What side effect is more likely to happen with Entresto compared with ACE or ARB?

A

angioedema

35
Q

When might a patient get the best benefit from PFO closure?

A

Age <60 and embolic stroke of undetermined source

(could consider if <65 and few risk factors for stroke but less benefit)

36
Q

A 57 yo M patient is admitted for stroke with full work up identifying it as embolic with unclear source. TTE shows presence of PFO. What should be done for him?

A

PFO closure

37
Q

When should an ASD be closed?

A

dyspnea, right heart enlargement, paradoxical embolization

38
Q

What medications are used first for Hypertrophic cardiomyopathy? If still symptomatic, what medication might you use next?

A

beta blocker or nondihydro CCB. If still symptomatic: disopyramide (negative inotropic antiarrhythmic)

39
Q

What LVOT gradient is the cut off to consider septal reduction therapy?

A

at least 50 resting or provoked

40
Q

What therapy is recommended in HoCM when there is either recurrent syncope or NYHA III or IV with LVOT gradient (resting or provoked) at least 50?

A

septal reduction therapy

41
Q

If you have a patient who has severe symptoms of AS but TTE shows only moderate AS, what should you do?

A

Cardiac cath for more accurate hemodynamic assessment.

*Do NOT do exercise stress test in symptomatic AS due to risk of SCD.

42
Q

When might you do an exercise stress test for clarification of AS?

A

severe AS on echo but no symptoms; this can help confirm there are actually no symptoms yet

43
Q

What percentage of PVCs leads to PVC-induced cardiomyopathy?

A

at least 10-15% of beats

44
Q

If someone has PVCs on in office EKG and symptoms of palpitations, what might be a helpful test?

A

ambulatory EKG to assess percentage and risk of CM/need for therapy

45
Q

Why is a vasodilator single-photon emission CT stress test best in LBBB?

A

HR based stress test such as exercise and dobutamine lead to increased septal motion.

46
Q

What is used for infrequent or highly symptomatic arrhythmias?

A

Implantable loop recorder

47
Q

What might make you want to fix severe MR if asymptomatic? (LVEF and LVESD cut offs)

A

LVEF 60 or less and or LVESD greater than or equal to 40

48
Q

Patient comes in for annual evaluation. Heart murmur auscultated, and TTE shows severe MR with EF 55% with LVESD 38. Does she need mitral valve intervention?

A

Yes by EF not greater than 60.

49
Q

Patient comes in complaining of severe dyspnea and has some new progressive leg swelling. TTE reveals moderate MR with EF 65%. What is next in the work up?

A

cardiac MRI or TEE as TTE can underestimate severity of MR.

50
Q

Patient is asymptomatic with severe MR. TTE shows LVEF 60% and LVESD is 42. Should he undergo evaluation for MV intervention?

A

Yes as LVEF is 60 or less and LVESD is 40 or greater.

51
Q

what are length of DAPT considerations in someone who had PCI for stable angina?

A

If high risk of bleeding, may limit to 3 months at the least. If low bleeding risk, can do 6 months at the least.

52
Q

Patient comes in 4 months after PCI for stable angina requesting to have a Roux en Y bypass performed for weight loss. He has been on DAPT since PCI. Bleeding risk is average. When is he able to transition off of DAPT and have the surgery?

A

Wait 2 months to total 6 months DAPT.

53
Q

Female patient is on warfarin for mechanical valve prosthesis, and she is wanting to get pregnant. What warfarin dose is reasonable?

A

5 mg/d or less although still carries increased risk to fetus.

54
Q

What is the first step in work up of VT?

A

-check for anemia, myocardial ischemia, heart failure, drug effects, electrolyte imbalance

-then identification of reversible causes and structural heart disease and includes echocardiography, cardiac magnetic resonance imaging, and exercise ECG or cath.

55
Q

A patient has new idiopathic VT with no structural heart disease. When might they need an ICD?

A

only in secondary prevention of SCD. not needed otherwise due to usually benign course and response to other therapy.

56
Q

What is pseudosevere AS?

A

looks severe like low gradient AS due to reduced EF <50%

57
Q

what test can be done to distinguish pseudosevere AS from low-flow, low-gradient severe AS?

A

low dose dobutamine echo to see if velocity increases to 4 or greater.

Could also do aortic valve calcium score by CT.

58
Q

Patient is being evaluated for AS with echo. valve area is 0.8 and max velocity at AV is 3.6 m/s. What on echo might suggest this to be pseudosevere AS?

A

EF <50% (increase the EF with dobutamine and it may just normalize AV numbers)

59
Q

what tyrosine kinase inhibitor is known to be associated with afib?

A

Ibrutinib

60
Q

Patient is being treated for stable angina with antianginal therapy including max tolerated daily beta blocker and imdur twice daily. what do you do next?

A

reduce imdur to once daily to give time to prevent tolerance. Then could consider adding ranolazine and then maybe PCI.

61
Q

What drugs should be avoided in treating ibrutinib-induced afib?

A

diltiazem and verapamil (increase levels of ibrutinib)

–use beta blocker

62
Q

Patient has a TIA with negative in hospital work up. Ambulatory ECG also negative for afib. What should be done next?

A

implantable loop recorder reasonable (25% cryptogenic stroke due to afib)

63
Q

What are the side effects associated with ticagrelor?

A

Dyspnea, bradycardia

64
Q

which patients should not get prasugrel? Who should you be cautious about?

A

75 or older, previous TIA or stroke.

–caution if underweight

65
Q

By what age is heart transplant usually done?

A

65

66
Q

instead of triple therapy for afib and PCI for ACS, what is now done?

A

DOAC + P2Y12 (if triple, no more than 30 days)

67
Q

What are the indications for infective endocarditis antibiotic prophylaxis?

A

-hx IE
-heart transplant with regurg due to structurally abnormal valve
-presence of any PROSTHETIC VALVE parts
-other PROSTHETIC material placed in the heart over 6 months
-LVAD
-pulmonary artery valve or conduit placement
-cyanotic congenital heart disease either unrepaired or repaired with residual defect

68
Q

Patient is going to have dental work done. She has severe mitral regurgitation which has not yet been intervened on. Does she need antibiotic prophylaxis for IE?

A

no. this would only be needed if she had had a heart transplant or had any prosthetic material in the valve.

69
Q

Does CABG increase survival in stable angina?

A

Only if >70% stenosis of 2+ major coronary arteries with extensive ischemia, especially if involving prox LAD and or marked LV dysfunction.

70
Q

What does fixed splitting of S2 and either systolic pulmonic murmur or diastolic tricuspid murmur suggest?

A

ASD

71
Q

Which patients should not get vasodilators in stress test?

A

COPD with wheezing (bronchospasm risk)

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