cardiology 3 Flashcards
What is the minimum duration for a bare-metal stent?
1 month
How are DOACs cleared from the body?
DOACs are cleared by the kidneys.
What should be added to drug therapy for a patient with chronic stable angina despite aspirin use?
A long acting nitrate or a CCB.
What should a patient with a recent MI be referred for?
Cardiac rehabilitation.
What are the EKG findings for left bundle branch block (LBBB)?
No R wave in lead V1, deep S waves forming a characteristic W shape, wide notched R waves in leads I, aVL, V5, V6 forming a characteristic M shape, and loss of Q waves in the lateral leads.
What are the EKG abnormalities consistent with right ventricular strain?
Right bundle branch block, SI-QIII-TIII pattern, ST elevation in inferior leads (especially III, aVF), ST elevation in aVR, and T-wave inversion in V1-V3.
What is a Bifascicular block?
An RBBB with either left anterior fascicular block or left posterior fascicular block.
What is the classic auscultatory sign of constrictive pericarditis?
A pericardial knock.
What are the criteria for low risk in patients with stable angina?
Imaging does not identify features of left main artery or multivessel CAD.
What does ST segment elevation in lead aVR more prominent than V1 indicate?
Diffuse endocardial ischemia present.
What is the treatment for hemodynamically stable monomorphic VT?
Anti-arrhythmic drugs such as amiodarone, procainamide, or lidocaine.
What indicates ischemia in patients with LBBBs or a paced rhythm?
ST segment depression > 1 mm and concordant with the QRS complex.
What are the indications for an ICD in a patient with hypertrophic cardiomyopathy?
History of cardiac arrest due to V-fib, spontaneous sustained V. tach, and family history of sudden cardiac death in at least 2 first-degree relatives who had HCM.
What is the initial treatment for nearly all acute idiopathic or viral pericarditis?
NSAIDs with colchicine.
What is the goal of targeted temperature management (TTM)?
To achieve early management of fevers and interventional cooling as necessary.
What is the most likely cause of acute ST-segment elevation in a patient who recently had a stent inserted?
Stent thrombosis.
What are the typical changes in an acute myocardial infarction?
Changes in T waves, ST segments, and Q waves.
What is Mobitz type 2 second degree block an indication for?
Transcutaneous pacing regardless of symptoms.
What should be ruled out in a patient with symptomatic sinus bradycardia?
Medications, sleep apnea, hypothyroidism, MI, and electrolytes.
What is the most common peripheral vascular complication after cardiac catheterization?
A pseudoaneurysm.
What is the appropriate management for unstable wide-complex tachyarrhythmia?
Synchronized cardioversion.
What cardiac conditions need antibiotic prophylaxis for bacterial enteritis before dental procedures?
Prosthetic heart valves, valve repair with prosthetic material, heart transplant with valvulopathy, prior infective endocarditis, and certain types of congenital heart disease.
What is the treatment for an asymptomatic person with congenital long QT syndrome with no history of syncope?
A beta blocker.
What is the treatment for severe hypertension?
Use of IV medications should be reserved for symptomatic patients (i.e., heart failure, coronary ischemia, or hypertensive encephalopathy).
What is cardiac tamponade the leading cause of in patients with acute type A aortic dissection?
Death.
What are the three main components of a right bundle branch block (RBBB)?
An rsr complex forming a characteristic ‘rabbit ears’ or M shape in leads V1 and V2, tall secondary R wave in lead V1, and wide slurred S wave in leads I, V5, V6.
What should be performed if a patient with congenital cyanotic heart disease has a hematocrit > 65%?
Phlebotomy should be performed.
What evidence on an EKG indicates that an ST elevation is from an acute MI?
Reciprocal changes.
What is the typical cardiac involvement with sarcoidosis?
AV block, bundle branch block, arrhythmias, and heart failure.
What is the recommended duration for DAPT with aspirin and a P2Y12 inhibitor after stent placement following STEMI?
12 months.
What is recommended for 12 months after stent placement following STEMI?
P2Y12 inhibitor.
What are the antero-lateral leads in cardiac monitoring?
Leads 5 and 6.
What is the most common peripheral vascular complication after cardiac catheterization?
Pseudoaneurysm.
What is the most appropriate management for unstable wide-complex tachyarrhythmia?
Synchronized cardioversion.
For whom are glycoprotein IIb/IIIa inhibitors typically reserved?
Patients who have undergone percutaneous coronary intervention.
What is a common clinical sign of cholesterol crystal embolism?
Livedo reticularis and blue toe syndrome.
What are considered low-risk surgeries?
Endoscopic procedures, superficial procedures, cataract surgery, breast surgery, and ambulatory surgery.
What is the most common physical finding on cardiac auscultation in patients with hypertension?
An S4 gallop.
What is hereditary hemorrhagic telangiectasia?
An inherited autosomal dominant disorder associated with AVMs of the brain, skin, liver, and lungs.
When is DAPT with aspirin and a P2Y12 inhibitor indicated?
For ACS or after PCI.
What defines massive pulmonary embolism (PE) in terms of hypotension?
Systolic BP < 90 mmHg for 15 minutes, fall in systolic BP by >40 mmHg for 15 minutes, or requirement for vasopressors.
What are the EKG changes associated with left ventricular hypertrophy?
Downsloping ST-T changes and T wave inversion in anterolateral leads I, aVL, and V4-V6.
What are the criteria for considering a patient with HFrEF for an MRA?
Serum potassium levels <5 mEq/L and creatinine <2.5 mg/dL for men or 2 mg/dL for women.
What are the three main components of a right bundle branch block (RBBB)?
An rsr complex, tall secondary R wave in lead V1, and wide slurred S wave in leads I, V5, V6.
How should stable atrial fibrillation with preexcitation such as WPW be managed?
With agents that inhibit conduction through the atrioventricular node but not the accessory pathway.
What medications are contraindicated in stable monomorphic VT?
Digoxin, adenosine, beta-blockers, and calcium-channel blockers.
What should a patient with hemodynamically stable monomorphic VT nonresponsive to antiarrhythmic drugs undergo?
Synchronized electrocardioversion.
Is elevated JVP a common finding in cirrhosis and nephrotic syndrome?
False.
What is the likely diagnosis for acute chest pain with a low INR in a patient with a mechanical aortic heart valve?
Valve thrombosis.
What diagnostic test should be ordered for a patient with suspected valve thrombosis?
Echocardiogram.
What do current guidelines for STEMI recommend regarding aspirin and P2Y12 inhibitors?
Administer aspirin before primary PCI and a loading dose of the P2Y12 inhibitor as early as possible or at the time of PCI.
When is statin therapy indicated?
For patients with a 10-year ASCVD risk of 7.5% or higher despite lifestyle modification.
What findings may patients display in the first week after cholesterol embolization?
Peripheral eosinophilia, eosinophiluria, and hypocomplementemia.
What are the stages of EKG abnormalities of acute pericarditis?
Widespread ST elevation and PR depression, normalization of ST and PR segment, development of widespread T wave inversion, and ECG normalization or indefinite persistence of T wave inversion.
What is the classic triad of RV infarction in the setting of an inferior MI?
Hypotension, distended neck veins, and clear lungs.
What does GDMT involve for antihypertensive treatment?
ACEi/ARB classes, beta-blocker class, and mineralocorticoid receptor antagonists.
What is indicative of Wolff-Parkinson-White syndrome?
A young patient with palpitations, a short PR interval, and a delta wave.
What are the EKG characteristics of left bundle branch block (LBBB)?
No R wave in lead V1, deep S waves in leads I, aVL, V5, V6, and wide notched R waves in leads I, aVL, V5, V6.
What is the likely cause of elevated AST in a patient with heart failure and fluid overload?
Congestive hepatopathy.
When is phlebotomy indicated in adults with congenital cyanotic heart disease and erythrocytosis?
If hematocrit exceeds 65% with symptoms of hyperviscosity.
What is indicated if hematocrit exceeds 65% with symptoms of hyperviscosity in adults with congenital cyanotic heart disease?
Phlebotomy is indicated.
In the absence of volume depletion.
What can trigger a gout flare?
Thiazide diuretics can trigger a gout flare.
What should be evaluated in a patient taking steroids with an autoimmune disease who presents with epigastric and left upper quadrant pain?
Evaluate for coronary artery disease (CAD).
What is appropriate as primary prevention for patients with heart failure who’s LVEF is less than 35%?
An ICD (Implantable Cardioverter-Defibrillator) is appropriate.
In hypertrophic cardiomyopathy, how does the systolic crescendo-decrescendo murmur change with the Valsalva maneuver?
The murmur becomes louder with the Valsalva maneuver due to decreased preload.
What is a characteristic finding in patients with left bundle branch block (LBBB) or a paced rhythm?
QRS complexes that are discordant with the ST segments and T waves.
What do Type A aortic dissections involve?
The ascending aorta, the aortic arch, or both.
What is the typical treatment for a Type A aortic dissection?
Surgery is the typical treatment.
When suspecting reflex syncope, what test should be considered?
Consider tilt table test only for patients with recurrent syncopal episodes.
What is the most dangerous complication of Kawasaki disease?
Formation of coronary artery aneurysms which can result in thrombosis or stenosis.
What are the EKG findings for pericarditis?
Diffuse concave ST-segment elevations and PR segment depressions.
What are high intensity statins classified as?
Atorvastatin 40 to 80 mg daily and rosuvastatin 20 to 40 mg daily.
When should IV blood pressure medications be reserved?
For patients with hypertension who also have end-organ damage.
How can ischemia be diagnosed in patients with LBBBs?
If the ST segment depression is > 1 mm and concordant with the QRS complex.
What defines a scleroderma renal crisis?
New onset of accelerated arterial hypertension or rapidly progressive oliguric kidney failure.
What are low risk surgeries?
Endoscopic procedures, superficial procedures, cataract surgery, breast surgery, and ambulatory surgery.
When should an ICD be considered for a HFrEF patient?
If the patient is on GDMT for roughly 3 months with minimal or no improvement and has an EF of less than 30%.
Does cardiac tamponade typically have clear lungs?
Yes, cardiac tamponade typically has clear lungs.
What are the two categories of NSTE-ACS?
NSTEMI and unstable angina.
What is the best initial test for exertional dizziness and blurred vision?
Duplex ultrasonography of the subclavian artery.
What are the initial symptoms of Lyme disease?
Fever, myalgias, arthralgias, and erythema migrans.
When is elective surgical repair of an abdominal aortic aneurysm recommended?
When the diameter is greater than or equal to 5.5 cm in men or 5 cm in women.
What is a Bifascicular block?
An RBBB with either a left anterior fascicular block or a left posterior fascicular block.
Who should receive antibiotic prophylaxis for procedures?
Patients with prosthetic cardiac valves, prosthetic material used for cardiac valve repair, previous infective endocarditis, unrepaired cyanotic congenital heart disease, or a cardiac transplant with valve regurgitation.
What is the purpose of cardiac event monitors?
To detect less frequent arrhythmias.
What mechanical complication of an inferior myocardial infarction most likely causes cardiogenic shock?
Papillary muscle rupture.
What are the typical indications for biventricular pacing?
LVEF of less than 35%, sinus rhythm with LBBB morphology, and QRS complex duration of greater than 149 ms.
When are alpha blockers especially associated with orthostatic hypotension?
When taken intermittently.
What are signs of calcium channel blocker overdose?
Hypotension, bradycardia, hyperglycemia, and metabolic acidosis.
What is the minimum duration of DAPT for a drug-eluting stent for NSTEMI?
12 months of DAPT.
Is profound hypotension a common side effect of beta-blockers?
No, it is not a common side effect.
What type of EKG should all patients with an inferior MI have?
A right-sided EKG.
When should an ascending aortic aneurysm be repaired surgically?
When it exceeds 5.5 cm or enlarges more than 0.5 cm/year.
What criteria indicate an ICD for LV dysfunction after an MI?
LVEF less than 35% despite GDMT or malignant ventricular arrhythmia more than 24 hours after MI.
What does the tumor plop of atrial myxoma describe?
A prominent first heart sound and early low pitched diastolic sound in a patient with cerebral and peripheral emboli.
What causes variation in RR interval and benign sinus arrhythmia?
Variation with respiration, faster with inspiration and slower with expiration.
What is the first dose effect of alpha blocking agents?
An increased risk of orthostatic hypotension and syncope when starting alpha blocking agents.
What is the treatment of choice for a hemodynamically unstable tachyarrhythmia?
Direct-current cardioversion.
Does suppression of nonsustained V. tach and PVCs in asymptomatic patients with structural heart disease improve survival?
No, it does not improve survival.
What is the target blood pressure for patients with type 2 diabetes?
The target blood pressure is <130/80 mm Hg.
What is the goal for lipid-lowering therapy in type 2 diabetes?
To reduce the LDL cholesterol level by ≥50% from baseline to a target level of <70 mg/dL.
What clinical findings in hypertrophic cardiomyopathy would benefit from an ICD?
Septal wall thickness greater than 3 cm and left ventricular outflow obstruction greater than 30 mmHg.
What is the diagnosis for bilateral lower leg redness and hyperpigmentation in an older patient with a history of chronic leg edema?
Stasis dermatitis.
What should be added for a patient whose angina is not relieved by beta-blocker therapy at max dose?
Either a calcium channel blocker (CCB) or a long-acting nitrate should be added.
What are characteristic findings of rheumatic mitral stenosis?
A-fib and a diastolic rumbling murmur at the cardiac apex.
What are three typical signs of right-sided heart failure?
Elevated JVP, pedal edema, and tricuspid regurgitation.
What is the loading dose of clopidogrel for NSTEMI?
The loading dose is usually 300 to 600 mg orally.
What is the diagnosis for acute severe retrosternal chest pain that radiates to the back and neck with a diastolic decrescendo murmur?
Aortic dissection.
Are women at increased risk for cardiovascular disease after menopause?
Yes, women are at increased risk for cardiovascular disease after menopause.
What does DAPT with aspirin and a P2Y12 inhibitor help minimize?
The risk for stent thrombosis following stent placement.
Is vision loss more likely to occur with a carotid source of embolus than with a cardiac source?
Yes, vision loss is more likely to occur with a carotid source of embolus.
What is the role of a PGY12 inhibitor following stent placement?
A PGY12 inhibitor helps to minimize the risk of stent thrombosis following stent placement, such as clopidogrel.
Which source of embolus is more likely to cause vision loss?
Vision loss is more likely to occur with a carotid source of embolus than with a cardiac source.
What is indicated for ACS or after PCI?
DAPT with aspirin and a PGY12 inhibitor is indicated for ACS or after PCI.
What symptoms are typical of inferior vena cava obstruction associated with renal-cell carcinoma?
Weight loss and lower-extremity swelling are most typical of a diagnosis of inferior vena cava obstruction associated with renal-cell carcinoma.
What is the likely diagnosis for a young patient with periodic palpitations?
The diagnosis is likely Wolff-Parkinson-White syndrome.
What medication is indicated for refractory chronic stable angina?
Ranolazine is indicated for refractory chronic stable angina.
How does ranolazine work?
Ranolazine, an inhibitor of myocyte sodium channels, prevents cellular calcium overload, reduces diastolic wall tension, and improves oxygen supply-demand mismatch, thereby improving angina.
What does AKI complicated by livedo reticularis after cardiac catheterization indicate?
It is indicative of cholesterol crystal embolization.
What should patients with PCI avoid?
Patients with PCI should avoid non-aspirin nonsteroidal anti-inflammatory drugs and glucocorticoids because they impede myocardial healing.
What are the stages of EKG abnormalities of acute pericarditis?
- Widespread ST elevation and PR depression 2. Normalization of ST and PR segment 3. Development of widespread T wave inversion 4. ECG normalizes or indefinite persistence of T wave inversion.
What is characteristic of rheumatic mitral stenosis?
New onset atrial fibrillation and a diastolic rumbling murmur at the cardiac apex are characteristic of rheumatic mitral stenosis.
What is the goal of initial treatment for type B aortic dissection?
The goal is to reduce blood pressure to less than 120 mmHg and heart rate to about 60 bpm.
What are the likely findings in a patient with aortic regurgitation?
Low pitched diastolic rumble at the apex and decrescendo diastolic murmur at the left sternal border.
What is indicated for cardioversion of atrial fibrillation?
Ibutilide is indicated for cardioversion of atrial fibrillation.
Why should patients with Dressler syndrome avoid non-aspirin NSAIDs and steroids?
Because they impede myocardial healing.
What are the three main components of a right bundle branch block (RBBB)?
- An rsr complex (forming a characteristic ‘rabbit ears’ or M shape in leads V1 and V2) 2. Tall secondary R wave in lead V1 3. Wide slurred S wave in leads I, V5, V6.
When should coronary angiography be performed in high-risk non-ST-segment elevation myocardial infarction?
The timing of coronary angiography should be within 12 to 24 hours after presentation.
What is the management for patients with stable angina and an abnormal stress test indicating low cardiovascular risk?
The most appropriate management includes Aspirin, a statin, and at least one of the following: a beta-blocker, a CCB, or long-acting nitrate.
What does pulsus alternans refer to?
Pulsus alternans refers to beat-to-beat variation in arterial pulse related to severe LV systolic dysfunction or tamponade.
What is the most common cardiac anomaly with Turner syndrome?
The most common cardiac anomaly with Turner syndrome is a bicuspid aortic valve, followed by coarctation.
What are the indications for an ICD in a patient with hypertrophic cardiomyopathy?
- History of cardiac arrest due to V-fib 2. Spontaneous sustained V. tach 3. Family history of sudden cardiac death in at least 2 first-degree relatives who had HCM.
What is recommended for exercise in terms of duration?
It is recommended to engage in at least 150 minutes of moderate intensity exercise per week or 75 minutes of vigorous exercise per week.
What is the PR interval duration for first-degree AV block?
First-degree AV block has a PR interval >200 ms.
How do patients with diabetes mellitus experiencing an MI typically present?
Patients with diabetes mellitus experiencing an MI are more likely than other patients to present without chest pain.
