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Cardiology 2 Flashcards

1
Q

Cardiac monitoring of patient on herceptin

A
  • Baseline TTE

- Repeat TTE a 3,6,9 months after herceptin initiation

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2
Q

RF’s for cardiotoxicity with herceptin

A
  • old age

- previous or concurrent anthracycline use

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3
Q

Management of patient on herceptin with asymptomatic decline in EF of 15% or more

A

Hold herceptin for 4 weeks

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4
Q

Angiosarcomas clinical features

A
  • Right atrium
  • Associated with pericardial effusions, tamponade
  • increased vascularity
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5
Q

Typical origin of cardiac tumors

A

Metastatic

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6
Q

Tumor commonly associated with cardiac mets

A

Melanoma

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7
Q

atrial myxoma clinical features

A
  • typically left atrium
  • have a stalk
  • lack of vascularity
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8
Q

Rhabdomyomas clinical features

A
  • tuberous sclerosis

- kids

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9
Q

Management of patient with AF who has bleed on multiple AC

A

Left atrial appendage (Watchman)

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10
Q

Digoxin toxicity clinical features

A
  • arrhythmia (every rhythm abnormality can be seen with dig toxicity)
  • nausea, anorexia, fatigue, vision changes, AMS
  • often happens with AKI
  • have a low threshold for stopping and checking a level
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11
Q

VTE management in patient with valvular AF (secondary to mitral stenosis)

A

Warfarin (regardless of CHADS-VASc score)

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12
Q

Score indicating need for AC from CHADS-VAs

A
  • Men = 2 or greater

* Women = 3 or greater

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13
Q

Antithrombotic therapy for patient with AF after PCI and stent with elevated bleeding risk

A

Double therapy: Plavix + low-dose rivaroxaban or dose-adjusted warfarin (no aspirin/triple therapy)

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14
Q

Next step after emergent cardio version for new AF

A

Anticoagulation ASAP then continued for at least 4 weeks if CHADSVASC 1 or indefinitely if CHADSVASC 2 or greater (there is high risk of thromboembolism after cardio version)

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15
Q

Primary evidence for clinical benefit from SGLT2 inhibitors or GLP-1 agonists

A
  • primarily in patients with atherosclerotic CV disease

- less benefit in CHF patients

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16
Q

Initial step following diagnosis of symptomatic mild or moderate mitral stenosis

A

IF symptoms are not consistent with valve grade –> Exercise echo (need to ensure symptoms are attributed to mitral stenosis)

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17
Q

management of mild to moderate mitral stenosis in asymptomatic patients

A

annual clinic apt + TTE q5 years

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18
Q

Medical therapy for mitral stenosis

A
  • diuretics
  • long acting nitrates
  • beta-blockers or non-dihydropiridine CCBs (to lower HR and improve LV diastolic filling time)
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19
Q

When do you use medical therapy for mitral stenosis?

A

Only when patient is not a surgical candidate

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20
Q

Antithrombotic therapy in patient with mechanical prosthetic valve

A

Lifelong Aspirin + warfarin (for at least 3 months)

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21
Q

ASD clinical features

A

dyspnea, paroxysmal atrial fibrillation, and features of right heart volume overload with elevation of the central venous pressure and a right ventricular lift (due to left to right shunt)

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22
Q

ostium primum ASD clinical features

A

Fixed splitting of the S2, a mitral regurgitation murmur, and left-axis deviation on electrocardiogram

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23
Q

ostium primum vs. secundum clinical features

A

Secundum = *no mitral regurgitation. *No Left axis deviation.

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24
Q

Papillary fibroelastomas vs. atrial myxoma

A

Left atrial myxoma = Both can embolize. LA myxomas are larger than fibroelastomas, causing obstructive symptoms + typically attach to the fossa ovalis, not the valve (look at where it’s attached).

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25
Q

Left atrial myxoma presentation

A

fatigue, low-grade fever, athralgia

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26
Q

left atrial myxoma vs endocarditis

A

both can cause fever but myxomas often cause obstructive symptoms

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27
Q

Atrial myxoma treatment

A

urgent surgical excision

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28
Q

Nonbacterial thrombotic endocarditis clinical features

A

hypercoagulable state (malignancy, or connective tissue disease), small/irregularly shaped/wart like vegetations

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29
Q

Indication for entresto

A

Include symptomatic hypotension/orthostasis as contraindication

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30
Q

Ivabradine mechanism

A

Inhibits the If or I-funny channel of the SA node, resulting in a reduction in heart rate

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31
Q

Ivabradine indication

A

Sinus rhythm with HR greater than 70 on GDMT, addition to maximal dose betablocker has been shown to reduce CHF hospitalizations

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32
Q

What is GDMT

A

ACE inhibitor, beta-blocker, and aldosterone antagonist

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33
Q

Indication for pacer in CHF

A

EF less than or equal to 35% + NYHA class II to IV CHF despite GDMT + sinus rhythm + left bundle branch block with QRS complex of 150 ms or greater

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34
Q

Management of patient with severe AR who is asymptomatic

A

No echo, or exercise testing if patient has an indication for surgery (treadmill stress echo is used for patients with equivocal symptoms

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35
Q

Recommended echo interval for severe MR surveillance

A

q6-12 months

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36
Q

Indications for surgery with severe primary MR

A
  • 1) symptomatic with LVEF greater thna 30%
  • 2) asymptomatic with LV dysfunction
  • 3) undergoing another cardiac surgery
  • 4) AF or pHTN
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37
Q

Management of CAD + AF

A

Discontinue antiplatelet therapy, and do only oral anticoagulation unless patient has recent active CAD (ACS or revascularization in past 12 months)

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38
Q

Initial step in management of bicuspid aortic valve

A

CT angiography of the aorta (even in asymptomatic patients, aortopathy (aneurysm, dissection, coarctation) is life threatening so these pathologies need to be ruled out)

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39
Q

RBBB on ECG

A
  • widened QRS complex (>120 ms); an RSR′ pattern in lead V1; and a wide negative S wave in leads I, V5, and V6.
  • M and W pattern
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40
Q

LAFB on ECG

A

positive QRS complex in lead I and a negative QRS complex in lead aVF.

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41
Q

Management of asymptomatic bifascicular block

A

No further evaluation

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42
Q

When are pacemakers indicated for symptomatic bradycardia?

A

Always indicated in the *absence of a reversible cause.

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43
Q

Management of patient with a thoracic aortic aneurysm who is requiring CABG

A

IF greater than 4.5 cm –> aneurysm repair at time of surgery (so concomitant surgery)

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44
Q

Management of acute limb ischemia

A

urgent invasive angiography

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45
Q

Indications for device closure with ostium secondum ASD

A
  • Right heart enlargement

- Symptomatic

46
Q

AFib with aberrancy management

A

Beta-blocker + anticoagulation

*standard AF management

47
Q

Indications for cardiac rehab

A

Everyone following hospitalization for ACS and PCI

48
Q

First step in aortic dissection management

A

Differentiate Type A from Type B

49
Q

Management of acute Type A aortic dissection

A

emergent open surgical repair (high mortality rate)

50
Q

Indications for TTE with murmurs

A
  • systolic murmurs grade 3/6 or higher,
  • late or holosystolic murmurs
  • diastolic or continuous murmurs
  • symptomatic
51
Q

Management of suspected peri valvular abscess

A

If high pretest –> proceed directly to TEE

52
Q

Symptoms suggesting severe mitral stenosis

A

Progressive exertional dyspnea

53
Q

Biggest risk factor for cardiovascular disease in nonsmokers or patients who’ve quit smoking more than 10 years ago

A

Hyperlipidemia

54
Q

ABI interpretation

A
  • Less than or equal to 0.90 = PAD
  • Greater than 1.40 = uninterpretable (calcified, non compressible arteries in lower extremities), thus need to calculate toe-brachial index
55
Q

ABI calculation

A

Higher ankle pressure divided by Higher brachial pressure

56
Q

Workup of new heart failure diagnosis

A

CMP, TSH

*Cath only if angina or significant ischemia

57
Q

noonan syndrome clinical features

A

pulmonary stenosis, particularly those with short stature, variable intellectual impairment, unique facial features, neck webbing, hypertelorism, and other cardiac abnormalities, including hypertrophic cardiomyopathy, atrial septal defect, and ventricular septal defect

58
Q

Treatment of effusive constrictive pericarditis

A

NSAIDS + colchicine (pericardiectomy if not responding to medical therapy)

59
Q

Management of severe myxomatous degeneration of mitral valve

A
  • Mitral valve repair

- NOT mitral valve replacement (worse survival compared to valve repair)

60
Q

Indications for surgery with mitral regurg

A

1) Symptomatic with LVEF greater than 30%
2) Asymptomatic with LV dysfunction (EF less than ***60% and or **LV end systolic diameter greater than 40 mm)
3) Patients undergoing another cardiac surgical procedure
4) AF or pHTN

61
Q

Indications for surgery with Severe AR

A
  • symptomatic
  • LVEF less than **50%
  • significant LV dilation
62
Q

Management of severe AR not requiring surgery

A
  • TTE in 6-12 months

- NOT medical management (uncertain benefit, beta-blockers useful when comorbid CHF)

63
Q

BNP levels in heart failure

A
  • Greater than 400 = high likelihood
    Lower than 100 = good NPV for excluding CHF
    *In between is indeterminate.
64
Q

Initial management of symptomatic or frequent PVCs

A

Exercise stress testing (evaluate for ischemia, assess response of PVCs to exercise) + TTE

65
Q

Treatment of symptomatic or frequent PVCs

A

beta-blockers or CCBs

IF persistent, despite medical therapy OR LV dysfunction – catheter ablation

66
Q

Cardiac tamponade clinical features

A
  • hypotension
  • pulsus paradoxus
  • enlarged cardiac silhouette on CXR
  • electrical alternans on EKG
67
Q

Definition of pulsus paradoxus

A

Fall in systolic pressure of 10 mm Hg with inspiration

68
Q

Management of type 1 NSTEMI in patient declining cath

A

Aspirin + ticagrelor for at least 1 year

69
Q

How to titrate beta-blockers in CHF

A

Uptitrate every 2 weeks until patient achieves resting HR of approximately 60

70
Q

Hydralazine + isosorbide dinitrate indication

A

Black + MAXIMAL GDMT + class III-IV CHF

71
Q

First step in management of cryptogenic stroke

A

30 day-event monitor (NOT hotter monitor)

- if inconclusive, loop recorder is reasonable

72
Q

Management of AS with discrepancy between symptoms and TTE

A

Cath to determine severity before valve replacement

73
Q

Initial step in WPW

A

EP study

74
Q

Valve disease management in general

A
  • surgical, rarely ever medical
75
Q

cutoff for severe mitral stenosis

A

Less than 1.0 cm2

76
Q

Other general indication for valve surgery

A

Patient is getting other cardiac surgery

77
Q

Management of MR – repair or replace?

A

Always repair if possible

78
Q

Management of severe MR in patient who isn’t a surgical candidate

A

Mitral clip

79
Q

EF cutoff with MR for repair

A

*60 (higher because ejection fraction looks better but blood is going backward)

80
Q

monitoring frequency of valves

A

Mild - 3 years
moderate - 1 yrs
severe – 6-12 months

81
Q

indications for antibiotic prophylaxis with dental procedures

A
  • prosthetic valve
  • prior endocarditis
  • cardiac transplant with new valve disease (immunosuppressed)
82
Q

Indications for surgery with left sided endocarditis

A
  • CHF
  • highly resistant organism
  • complications (block, abscess)
  • failed abx
83
Q

Indications for surgery with right sided endocarditis

A
  • same indications but you should avoid surgery if possible (more likely to heal)
84
Q

pulmonary stenosis repair vs replacement

A
  • only replace if severely dysplastic valve
85
Q

Indications for valve replacement surgery in asymptomatic patients with bicuspid aortic valve and severe AR

A

LVEDP of 50 mm or LVEF of less than 50%

86
Q

S3 is associated with

A

CHF

87
Q

Management of Type B dissection

A
  • initial medical management, surgery reserved for patients who develop complications of dissection
88
Q

Cause of S4

A

atria contracting forcefully in an effort to overcome an abnormally stiff or hypertrophsic ventricle.

89
Q

indications for pacemakers with second degree heart block

A

Type 1 = Pacer only if symptomatic

Type 2 = Pacer alway

90
Q

Pulsus paradoxes how to measure

A

Just measure BP during expiration and inspiration (it is an abnormally large decrease in BP during inspiration)

91
Q

tetralogy of fallot clinical features

A

Angel with wings and belted wrapped around her neck on one door (pulmonic stenosis code) + heart man with huge right leg + train riding over aorta + one of the doors is a wall with a hole in it/4 components = Pulmonic stenosis + Right ventricular hypertrophy + Overriding aorta + Ventricular septal defect. Have to PROVe TOF.

92
Q

Indications for pacers with AV block

A
  • third degree block with or without symptoms
  • Symptomatic second degree block (I and II)
  • Advanced second degree AV block (block of 2 or more consecutive P waves)
93
Q

Left bundle branch block on ECG

A
  • W and M

- wide QRS (greater than 120 (3 small boxes)) + deep and broad s wave in V1 + broad notched R in V6

94
Q

antithrombotic therapy for mechanical prosthetic valves

A
  • warfarin + *aspirin
95
Q

CHADS-VASc scoring

A 
C-CHF = 1
H-HTN = 1
A2-Age = over 75 = 2
D-DM2 = 1
S2 = Prior stroke or TIA or VTE = 2
A = Age 65-74
Sc = sex (female) = 1
96
Q

Timing of complications post-MI

A
  • Ventricular septal rupture and free wall rupture are only pathologies that can happen in hours
  • Papillary muscle rupture – 2 days to 1 week
  • LV aneurysm only pathology that can happen months out
97
Q

Presentation of LV aneurysm post MI

A
  • subacute heart failure

- stable angina

98
Q

Free wall rupture vs inter ventricular septal rupture

A
  • Free wall rupture = effusion on TTE

- Interventricular septal rupture = new holosystolic murmur

99
Q

Papillary muscle rupture clinical features

A
  • new holosystolic murmur

- severe pulmonary edema

100
Q

Brugada syndrome ECG features

A

Huge bundle of sticks in the right corner + mountains on backwall with hat bone on left and hambone on right/ECG pattern of pseudo-right bundle branch block + ST elevations in V1-V3.

101
Q

Brugada syndrome management

A

He has an implanted cardioverter-defibrillator/prevent SCD with implantable cardioverter-defibrillator (ICD).

102
Q

Brugada syndrome clinical features

A

Jonny kenser dead on the floor in front of him + heart hanging above with ventricles oscillating rapidly/increased risk of ventricular tachyarrhythmias + SCD (sudden cardiac death).

103
Q

WPW treatment

A

Long term = catheter ablation
Short term of acute STABLE tachyarrythmia = Vagal maneuvers, Verapamil, adenosine are first line. Second line are procainamide and beta blockers.

104
Q

Differential for regular, narrow complex tachycardia

A

Sinus tach
A flutter
AVNRT

105
Q

Differential for irregular, narrow complex tachycardia

A

AFib
MAT
AFlutter with variable conduction

106
Q

Differential for regular, wide complex tachycardia

A

V tach

SVT with aberrancy (BBB)

107
Q

Differential for irregular, wide complex tachycardia

A

AFib with BBB

Polymorphic VT

108
Q

Differential for irregular, wide complex tachycardia

A

AFib with BBB

Polymorphic VT

109
Q

Key ECG feature of MAT

A

p waves of multiple morphologies

110
Q

CABG indications

A

1) Triple-vessel disease
2) Severe left main stem artery stenosis
3) Left main equivalent disease (70% or greater stenosis of LAD and proximal left circumflex)
4) Multivessel disease and Diabetes

111
Q

Indication for aldosterone antagonist in systolic heart failure

A
  • NYHA II-IV + EF less than or equal to 35% + normal potassium level + normal renal function (defined as Cr less than 2.5 and 2.0 in women)

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