Cardiology Flashcards
The single most important bedside measurement from which to estimate the volume status
JVP
wave that occurs with atrioventricular (AV) dissociation and right atrial contraction against a closed tricuspid valve
cannon a wave
a wave is not present in AF
waves that are present in progressive TR
C-V waves
Abdominojugular reflux is produced with firm and consistent pressure over the upper portion of the abdomen, preferably over the right upper quadrant, for >___ s.
A positive response is defined by a sustained rise of > __ cm in the JVP during the application of firm abdominal pressure
15s
>3 cm
Blood pressure should be measured in both arms, and the difference should be < __mmHg
10
Systolic leg pressures are usually as much as ___ mmHg higher than systolic arm pressures.
20
A weak and delayed pulse (pulsus parvus et tardus) defines what dse ?
severe aortic stenosis (AS)
Abnormal pulse oximetry (a >__% difference between finger and toe oxygen saturation) can be used to detect lower extremity peripheral arterial disease and is comparable in its performance characteristics to the ankle-brachial index.
2
Reversed or paradoxical splitting refers to a pathologic delay in aortic valve closure, such as that which occurs in patients with ______ (5)
left bundle branch block, right ventricular pacing, severe AS, HOCM, and acute myocardial ischemia
With standing, most murmurs diminish, with two exceptions being the murmur of , which becomes louder ___, and that of ___, which lengthens and often is intensified.
HOCM
MVP
Classic triad of findings ECG for pericardial effusion with cardiac tamponade
(1) sinus tachycardia
(2) low QRS voltages
(3) electrical alternans
In CTA, Coronary what calcium scores are considered
moderate ?
severe ?
moderate (100–400)
severe (>400).
considered the most accurate noninvasive technique to evaluate the structure and ejection fraction of the right ventricle
CMR
most common congenital anomaly of the heart
bicuspid aortic valve
An important predictor of outcome in patients with mitral regurgitation of any cause.
Ventricular dilatation
in a patient with significant mitral regurgitation, a large portion of the blood being ejected from the left ventricle with every beat is regurgitant, thus artificially increasing the ejection fraction.
Thus, an ejection fraction of 55% in a patient with severe mitral regurgitation may actually represent substantial reduction in myocardial systolic function
Definition of cardiotoxicity
The accepted standard for clinical diagnosis of cardiotoxicity is defined as a >5% reduction in LVEF to <55% in symptomatic patients or a 10% drop in LVEF to <55% in patients who are asymptomatic.
Most common type of ASD
Secundum
occur most commonly in the region of the fossa ovalis
Warfarin is held starting ___ days prior to the cardiac catheterization to allow the international normalized ratio (INR) to fall to ___ and limit access-site bleeding complications.
2-3
<1.7
What sign is demonstrated by an increase in the left ventricular–aorta pressure gradient with a simultaneous decrease in the aortic pulse pressure following a premature ventricular contraction?
Hypertrophic obstructive cardiomyopathy is confirmed by the Brockenbrough-Braunwald sign
What disease condition/s is/are square root sign seen?
Constrictive pericarditis, restrictive cardiomyopathy
Cardiomyopathy that has amarked increase in right ventricular and pulmonary artery systolic pressures (usually >60 mmHg),
Restrictive
What disease condition has prominent x and y descent?
Constrictive pericarditis
A coronary stenosis of __ % is considered significant
50%
A sinus rate of < ___ beats/min in the awake state in the absence of physical conditioning generally is considered abnormal
40
Treatment options for POTS
Volume expansion with salt supplementation, oral fludrocortisone, compression stockings, and the α-agonist midodrine, often in combination, can be helpful. Exercise training has also been purported to improve symptoms.
Most likely mechanism of MAT
triggered automaticity
The risk of developing VT is greatest in _____ of acute MI.
the first hour
The cardinal symptoms of HF are ____ and ___
fatigue and shortness of breath
Most impt mechanism of dyspnea in HF
The most important mechanism is pulmonary congestion with accumulation of interstitial or intra-alveolar fluid, which activates juxtacapillary J receptors, which in turn stimulate the rapid, shallow breathing characteristic of cardiac dyspnea.
A normal ECG in HF virtually excludes _____
LV systolic dysfunction
For HFreF beta blockers should ideally be restricted to
carvedilol, bisoprolol, and metoprolol succinate
The single most important association of extent of dyssynchrony is ______ on ECG
a widened QRS interval on the surface electrocardiogram, particularly in the presence of a left bundle branch block pattern
Cardiomyopathy that has EF > 60%
Hypertrophic
cardiomyopathy that has LV dimension >60 mm
Dilated
Cardiomyopathy related to valve septum interaction
Hypertrophic
Cardiomyopathy related to endocardial involvement
Restrictive
The most commonly recognized genetic causes of DCM are truncating mutations of the ___
ogiant protein titin, encoded by TTN, which maintains sarcomere structure and acts as a key signaling molecule
Define possible subclinical, probable and definite myocarditis
(1) Possible subclinical acute myocarditis is diagnosed when a typical viral syndrome occurs without cardiac symptoms, but with elevated biomarkers of cardiac injury, ECG suggestive of acute injury, reduced left ventricular ejection fraction or regional wall motion abnormality.
(2) Probable acute myocarditis is diagnosed when the above criteria are met and accompanied by cardiac symptoms, such as shortness of breath or chest pain, which can result from pericarditis or myocarditis.
(3) Definite myocarditis is diagnosed when there is histologic or immunohistologic evidence of inflammation on endomyocardial biopsy and does not require any other laboratory or clinical criteria.
most common infective cause of cardiomyopathy
Chaga’s dse
The most common cause NONinfective inflammation of the heart is
granulomatous myocarditis, including both sarcoidosis and giant cell myocarditis.
most common toxin implicated in chronic DCM
Alcohol
The most common current reason for thyroid abnormalities in the cardiac population is the ______
treatment of tachyarrhythmias with amiodarone, a drug with substantial iodine content
Treatment for HOCM
β-Adrenergic blocking agents and L-type calcium channel blockers slow AV nodal conduction and improve symptoms
cardiac glycosides should be avoided, as they may increase contractility and worsen obstruction
Major risk factors for SCD in HOCM
see table
T-wave changes are more common but are less specific signs of ischemia, unless they are new and deep T-wave inversions ( ____ mV).
≥0.3
Thrombolysis in Myocardial Infarction (TIMI) Trials, which includes seven independent risk factors which include
age ≥ 65 years
3 or more of the traditional risk factors for coronary heart disease
known history of coronary artery disease or coronary stenosis of at least 50%
daily aspirin use in the prior week
more than one anginal episode in the past 24 h
ST segment deviation of at least 0.5 mm
elevated cardiac specific biomarker above the upper limit of normal
The only absolute contraindications to the use of nitrates are _____ and ____
hypotension or the recent use of a phosphodiesterase type 5 (PDE-5) inhibitor, sildenafil or vardenafil (within 24 h), or tadalafil (within 48 h).
Target HR for NSTEMI
50-60
DAPT should continue for at least ____ in patients with NSTEACS, especially those with a drug-eluting stent, to prevent stent thrombosis.
1 year
When is immediate invasive strategy indicated in NSTEMI
see table
Cut off GRACE score to qualify for early invasive strategy in NSTEMI
> 140
Treatment for Prinzmetal angina
Nitrates and calcium channel blockers
Aspirin may actually increase the severity of ischemic episodes, possibly as a result of the sensitivity of coronary tone to modest changes in the synthesis of prostacyclin.
Statin therapy has been shown to reduce the risk of major adverse events, although the precise mechanism is not established
The pain of STEMI may radiate as high as the _____ but not below the ____.
as high as the occipital area but not below the umbilicus.
in STEMI, The nonspecific reaction to myocardial injury is associated with polymorphonuclear leukocytosis, which appears within a few hours after the onset of pain and persists for ___ days; the white blood cell count often reaches levels of 12,000–15,000/μL.
3–7
How do you differentiate Type 1 -5 MI
see table
An idiosyncratic reaction to nitrates, consisting of sudden marked hypotension, sometimes occurs but can be reversed promptly by the rapid administration of intravenous _____
atropine
FMC - device time
<=90 mins
Transfer to PCI capable hospital should be done in ____ mins
120min
Administration of fibrinolytics should be done in ____ mins if transfer to PCI capable hospital would take > 120 mins
30m
Clear contraindications to the use of fibrinolytic agents include
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)
Because of the risk of emesis and aspiration soon after STEMI, patients should receive either nothing or only clear liquids by mouth for the first ___ h.
4–12
patients with STEMI should be kept at bed rest for the first
6–12 h.
patients with STEMI resume an upright posture by dangling their feet over the side of the bed and sitting in a chair within .
the first 24 h
for patients with STEMI, by the _____ day, patients typically are ambulating in their room with increasing duration and frequency, and they may shower or stand at the sink to bathe.
second or third
The typical coronary care unit diet for STEMI px should provide ___ of total calories as fat and have a cholesterol content of ≤300 mg/d. Complex carbohydrates should make up ____ of total calories.
≤30%
50–55%
for patients with STEMI, By day 3 after infarction, patients should be increasing their ambulation progressively to a goal of ___ m at least three times a day.
185 m (600 ft)
primary cause of in-hospital death from STEMI
Pump failure
Most patients who had STEMI will be able to return to work within ___ weeks.
2–4
For STEMI px normal sexual activity may be resumed during this period.
1-2w
How do you define angiographic success in PCI
A successful procedure (angiographic success), defined as a reduction of the stenosis to less than a 20% diameter narrowing, occurs in 95–99% of patients.
most common complication of angioplasty
restenosis
The primary reason for being considered inoperable with CABG is
the presence of severe comorbidities such as advanced age, frailty, severe chronic obstructive pulmonary disease (COPD), poor left ventricular function, or lack of suitable surgical conduits or poor distal targets for bypass
How do you differentiate the different Debakey types of aoric dissection
How do you differentiate the different Stanford types of aoric dissection
What are the contrainidcations to stress testing?
What features during stress testing indicate severe IHD and high risk of future events?
