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Cardiology 3 Flashcards

1
Q

stress test of choice for patient with paced ventricular rhyhthm

A

Pharmacologic radionuclide perfusion imaging

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2
Q

stress test of choice for patient with LBBB

A

Pharmacologic radionuclide perfusion imaging

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3
Q

Contraindications to pharmacologic stress test

A
  • reactive airway disease

- on dipyridamole or theophylline

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4
Q

First line for restless leg syndrome

A
  • avoid meds that worsen RLS (antidepressants, antidopaminergic agents)
  • behavioral interventions (exercise, reduction of caffeine, massage)
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5
Q

management of vertebral compression fracture

A
  • early mobility (ambulate and resume normal activity ASAP)

- PT

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6
Q

treatment duration of VTE

A

IF provoked – 3 months
IF temporary persistent of a provoking factor (eg prolonged immobility following leg surgery) – extend duration to total 6-12 months

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7
Q

rosacea management

A
  • skin care, sun protection, avoidance of flushing triggers (hot drinks, hot or cold weather, alcohol, spicy foods)
    IF mild topical antibiotics (metronidazole)
    OR topical azelaic acid
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8
Q

Treatment of more severe rosacea

A

oral abx (tetracyclines)

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9
Q

Most important predictive factor in determining a cancer patient’s prognosis

A

performance status

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10
Q

acute pericarditis vs STEMI on EKG

A
  • pericarditis = positional pain

- STEMI = localized ST elevations

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11
Q

ECG changes in acute pericarditis + timing

A

1) Diffuse, concave ST elevations across + reciprocal ST depression in leads aVR and V1 (within hours)
2) normalization of ST and PR segments (within first few days)
3) diffuse T wave inversions
4) normalization of ECG OR persistent T wave inversion (over next few weeks)

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12
Q

Management of patient with refractory AF with RVR

A

TEE to rule out left atrial appendage thrombus then cardioversion

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13
Q

What are the high-intensity statins?

A
  • Atorva 40 or higher

- Rosuvastatin 20 mg or higher

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14
Q

Statin intensity based on ASCVD

A

IF greater than 20% = high intensity statin

IF less than 20% = moderate intensity statin

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15
Q

Intensity of statin therapy in secondary prevention of ASCVD in patients with established ASCVD (ACS, stable angina, stroke or TIA, CABG)

A

Age less than 75 = high intensity

Age over 75 = moderate intensity

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16
Q

hypomagnesemia presentation

A
  • fatigue, weakness, muscle cramps, tremor, hyprreflexia
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17
Q

Common cause of hypomagnesemia

A

chronic PPI use

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18
Q

Indications for primary PCI with STEMI

A
  • within 12 hours of symptom onset

- within 90 minutes from first medical contact to device time at PCI facility

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19
Q

Differentiating STEMI from pericarditis on EKG

A
  • pericarditis = diffuse ST elevation + *depression of PR segment in the limb and left precordial leads
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20
Q

Definition of HCM

A

LV wall thickness greater than 15 mm at any location

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21
Q

Indications for beta blockers and CCBs in HCM

A

Patients with LVOT obstruction and symptoms of heart failure

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22
Q

management of HCM patient refractory to medical therapy

A
  • surgical septal myectomy or alcohol septal ablation
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23
Q

other cause of an S3

A
  • normal in healthy young adults
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24
Q

Percutaneous mitral balloon valvotomy vs. surgery for symptomatic mitral stenosis

A
  • percutaneous mitral balloon valvotomy is preferred if favorable valvular morphology
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25
Q

Contraindications to percutaneous mitral balloon valvotomy for mitral stenosis

A
  • moderate or severe MR

- LA thrombus

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26
Q

Management of congenital long QT syndrome

A

1) avoid meds associated with prolonged QT
2) avoid strenuous exercise + electrolyte abnormalities
3) start beta blocker (decrease risk of symptomatic arrhythmia’s and SCD)
IF syncope or VT –> implantable ICD

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27
Q

Definition of prolonged QT in males and females

A 
Male = 450
Female = 470
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28
Q

Other meds that can cause prolonged QT

A
  • TCA’s
  • SSRIs
  • opioids (methadone, oxycodone)
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29
Q

cor pulmonale is

A

RV failure due to pulmonary or chest wall disease

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30
Q

Diagnosis and management of patient with tender or pulsatile mass at cath site

A
  • hematoma with potential pseudo aneurysm formation

- stat US

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31
Q

Management of pseudoaneurysm arising from cath

A
  • US-guided compression or US-guided thrombin injection into the cavity
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32
Q

Why is cath needed prior to valve surgery?

A
  • define the coronary anatomy (around 40% of patients with severe AS require concurrent CABG)
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33
Q

description of EKG in hyperkalemia

A
  • wide complex/widened QRS + regular + no P waves + T wave peaking
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34
Q

Only indication for medical therapy in severe AR

A
  • patients who aren’t surgical candidates
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35
Q

Evidenced lifestyle interventions to reduce risk of CV disease

A
  • Mediterranean-style diet
  • Dietary approaches to stop hypertension (DASH) diet
  • moderate but not excessive EtOH intake
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36
Q

foods you should cut down on with mediterranean diet

A
  • decreased red meat, salt, saturated fats
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37
Q

Management of anti platelets before CABG

A
  • Stop P2Y12 inhibitors 5-7 days before surgery

- continue ASA (reduces rate of early graft occlusion and overall mortality)

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38
Q

DAPT duration after stent placement

A

At least 6-12 months

*Aspirin continued indefinitely

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39
Q

Management of DAPT after stent if surgery

A
  • Elective surgery: Defer surgery until after minimum DAPT duration
  • Urgent surgery: Continue P2Y12 or hold for shortest duration possible
  • Continue ASA unless high risk of severe surgical bleeding
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40
Q

Presentation of stent thrombosis

A
  • STEMI within first month after stent placement
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41
Q

Indications for AAA repair

A

1) Diameter greater than 5.5 cm
2) Increase in diameter of 0.5 cm or greater in *6 month period
3) symptomatic

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42
Q

When cardiac evaluation is required before surgery

A
  • 2 or more (history of ischemic heart disease, history of stroke, DM2 on insulin, preop creatinine greater than AND poor functional capacity (less than 4 METS)
  • this is in the absence of a high-risk cardiac condition
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43
Q

Presentation of atrial myxoma

A
  • constitutional symptoms (fatigue, low grade fever, weight loss)
  • systemic embolization (TIAs, strokes)
  • symptoms of mitral valve disease (dyspnea, orthopnea, cough, p edema)
44
Q

treatment of atrial myxomas

A
  • surgical resection
45
Q

VS + Other features of pericardial tamponade

A
  • hypotension + tachycardia

- rapid “x” descent in the neck veins

46
Q

Initial work up of chronic pericardial effusion

A
  • basic labs
  • TSH
  • anti-ds-DNA
  • complement levels
47
Q

Signs of tamponade on TTE

A

Hypotension + RV collapse

48
Q

Medication associated with higher rates of recurrent pericarditis in pericarditis

A
  • steroids
49
Q

myopericarditis clinical features

A

pericarditis + one of following:

  • elevated cardiac enzymes
  • new depressed LVEF
  • Imaging showing myocarditis (cardiac MRI)
50
Q

Management of HFpEF

A
  • exercise training in cardiac rehab
  • diuretics
  • BP management for after load reduction
  • adequate control of ventricular rate (below 80) (not aggressive)
51
Q

Meds that haven’t been shown to be beneficial in HFpEF

A

Beta-blockers
Angiotensin system blockers
Aldosterone antagonists

52
Q

Management of patient with mild AS who is short of breath at night

A
  • cardiac event monitor for paroxysmal AF (Frequent complication of MS that can cause symptomatic heart failure and pulmonary edema when laying flat at night)
53
Q

Initial evaluation of AF

A
  • TSH
54
Q

AF initial presentation

A
  • dyspnea, dyspnea on exertion
  • palpitations
  • dizziness, presyncope
55
Q

Management of rheumatic fever (patient presenting with mitral stenosis)

A
  • continuous antibiotic prophylaxis (to prevent recurrent GAS pharyngitis and limit risk of progression of rheumatic heart disease)
  • IM penicillin G benzathine every 3-4 weeks (first dose will also treat any current GAS colonization)
56
Q

rheumatic fever clinical features

A
  • fever, arthritis, chorea, heart failure
57
Q

management of HFrEf patient on entresto with chronic cough

A
  • stop entresto
58
Q

benefits of rate vs rhythm control of AF

A
  • rhythm control = higher rate of medication toxicity
59
Q

Rate vs rhythm control of AF

A
  • rate control generally preferred due to higher risk of SEs with antiarrythmic drugs (particularly risk of proarrhythmias, including tornado), but many prefer rhythm control in younger patients with a lower risk of proarrhythmias
60
Q

Next step after STEMI patient is treated with TPA in facility without cath lab

A

Transfer STAT to facility with cath lab (reocclusion is relatively common after initial repercussion)

61
Q

what are the antianginals?

A
  • beta blockers
  • CCBs
  • nitrates
  • *ranolazine
62
Q

Advise on second pregnancies in patients with a history of periparum cardiomyopathy and persistent LV dysfunction

A

Advise to avoid future pregnancy (high risk of further decline in LV function, recurrent heart failure, and death with subsequent pregnancies)

63
Q

Management of peripartum cardiomyopathy

A
  • standard heart failure management

IF hemodynamic instability –> urgent delivery

64
Q

Hemodynamics of pericardial tamponade

A

*equalization of RA and RV end diastolic pressure and pulmonary wedge pressure

65
Q

ECG abnormalities associated with ASD

A
  • first degree AV block
  • right axis deviation
  • incomplete or complete RBBB
66
Q

takotsubo treatment

A
  • supportive (recovery of LV function within a few weeks typically)
67
Q

Location + description of VSD

A
  • holosystolic
  • 3rd or fourth intercostal space along the left sternal border
  • often palpable thrill
68
Q

Hypotension in the acute setting of STEMI indicates

A

RVMI

69
Q

Management of RVMI

A
  • NO nitrates (decrease RV preload)

- bolus fluids

70
Q

echo intervals for AS surveillance

A

mild – q3-5 years
moderate – q1-2 years
severe – q6-12 month

71
Q

Absolute contraindications to fibrinolytic for STEMI

A
  • CVA within the last 3 months (ischemic or nonischemic)

- prior history of intracranial hemorrhage (time unlimited)

72
Q

Management of Mobitz type I and type II

A

IF symptomatic +2:1 – permanent pacemaker regardless of whether type I or II
*only in absence of reversible cause (medication SE or ischemia)
Type 1 Mobitz – typically requires no intervention

73
Q

Clinical features of unilateral diaphragmatic paralysis

A
  • supine hypoxemia
  • elevated hemidiaphragm
  • following cardiac surgery (occurs due to phrenic nerve injury) (or can be caused by viral infection, trauma, or a tumor)
74
Q

workup of suspected diaphragmatic paralysis

A

“sniff test” using fluoroscopy (normal diaphragm moves downward during inspiration and the paralyzed side has paradoxical upward movement)

75
Q

How to best hear for aortic regurgitation

A
  • have patient sit up, lean forward, and hold their breath in full expiration with diaphragm placed along left sternal border at 3rd or 4th intercostal space
76
Q

aortic regurgitation description

A
  • early decrescendo diastolic murmur

- high-pitched, blowing in quality

77
Q

Description of mitral stenosis

A
  • loud first heart sound
  • opening snap after S2 (best heard at apex)
  • low-pitched diastolic rumble at apex
78
Q

Ebstein’s anomaly clinical features

A
  • tricuspid regurg + RV abnormalities
79
Q

Tricuspid regurgitation clinical features

A
  • holosystolic murmur along left sternal border + increases in intensity with inspiration
80
Q

Murmur caused by ASD

A
  • mid-systolic ejection murmur due to increased flow through pulmonic valve
81
Q

Indication for ICD post - MI

A
  • EF below 30% at least 40 days post-MI and 3 months post revascularization
82
Q

Other indication for ICD in EF

A
  • EF equal to or less than 35% + NYHA class II or III symptoms
83
Q

Indications for ICD placement for secondary prevention

A
  • prior VF or unstable VT without reversible cause

- prior sustained VT with underlying cardiomyopathy

84
Q

Evidence -based benefit of inotropes in low flow and CHF exacerbations

A
  • decrease dyspnea

* actually increase mortality, hypotensive episodes, and arrhythmias

85
Q

Management of cocaine chest pain

A

IF acute STEMI – immediate cath lab (cocaine increases thrombogenicity)

  • benzos, aspirin, nitroglycerin
  • beta-blockers are contraindicated
86
Q

Management of AF with RVR

A
  • treat underlying cause (even if hemodynamically unstable) – sepsis, hypoxia, CHF, etc
87
Q

Etiologies of constrictive pericarditis

A
  • viral pericarditis
  • cardiac surgery or radiation therapy
  • TB pericarditis
88
Q

constrictive pericarditis clinical features

A
  • fatigue + DOE
  • signs of RH failure (peripheral edema, ascites, elevated JVP)
  • low voltage QRS or AF on EKG
89
Q

workup of suspected constrictive pericarditis

A

TTE

90
Q

Most common cause of mortality in patients after being cath’d

A

RP bleeds

91
Q

RP bleed clinical features

A

sudden hypotension + drop in Hgb + back pain

92
Q

AF management in this setting of mitral stenosis

A
  • Warfarin (regardless of CHADS-VASc)

* mitral stenosis carries an especially high risk of thromboembolic events

93
Q

Use of CHADS-VASc

A

NONVALVULAR AF

94
Q

Mitral valve prolapse murmur description

A
  • single or multiple non-ejection clicks

- mid to late systolic murmur of MR

95
Q

Affect of valsalva on murmurs

A

Decreases all murmurs except

  • HCM (decreased LV volume and increased gradient)
  • MVP (decreased LV volume and increased leaflet prolapse)
96
Q

How does valsalva affect murmurs

A

decreases venous return

97
Q

How does standing affect murmurs

A

decreases venous return

98
Q

Affect of standing on murmurs

A

Decreases all murmurs except (same as valsalva)

  • HCM (decreased LV volume and increased gradient)
  • MVP (decreased LV volume and increased leaflet prolapse)
99
Q

How does squatting affect murmurs

A
  • increases venous return

- increases after load by kinking of femoral arteries

100
Q

Effect of squatting on murmurs

A
  • increases – AR, MR, VSD

- decreases – HCM, MVP

101
Q

How does handgrip affect murmurs

A
  • increases after load, increases BP
102
Q

Effect of handgrip on murmurs

A
  • increases AR, MR, VSD

- decreases HCM, AS

103
Q

Limb lead reversal ECG

A
  • AVR and AVL are flipped so T wave positive in AVR
104
Q

Target INR for mechanical valves

A

Mechanical aortic = 2.5 for patients (unless additional RF’s)
Mechanical mitral = 3.0

105
Q

Restrictive cardiomyopathy vs. constrictive pericarditis

A
  • restrictive = abnormal elastic properties of the myocardium (typically due to infiltrative disease)
  • constrictive pericarditis = reduced chamber compliance from pericardium
106
Q

comedonal acne vs inflammatory

A 
inflammatory = red and painful
comedonal = isolated comedones
107
Q

water deprivation test interpretation

A

shrimp dick

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