cardiology 4 Flashcards
What is the next step for cardiac catheterization?
Cardiac catheterization with coronary angiography within 12 to 24 hours.
Is dyspnea on exertion (DOE) and chest pain (CP) likely present in left outflow tract obstruction?
True.
What are the initial symptoms of Lyme disease?
Fever, myalgias, arthralgias, and erythema migrans.
Why should Amiodarone be used with caution for rate control of atrial fibrillation?
Due to the risk of pharmacologic cardioversion with subsequent risk of thromboembolism.
What is a typical cardiac manifestation of Lyme disease?
High degree AV block.
What can frequent ventricular ectopy be associated with?
Reversible cardiomyopathy if the ectopic beats represent more than 10 to 20% of overall heartbeats.
What are nonclassical symptoms of myocardial infarction?
Jaw, neck, ear, arm, and epigastric pain.
What does Dressler syndrome typically result in?
Pleuritic chest pain, fever, and occasionally a pericardial effusion after an MI.
What are the most appropriate procedures for diagnosing aortic dissection in hemodynamically stable patients?
CXR, TTE, or POCUS.
What defines nonischemic cardiomyopathy?
DOE, EF less than 35%, and LBBB with QRS greater than 150 ms.
What is the next step for a patient with nonischemic cardiomyopathy?
Refer for placement of ICD with biventricular pacing.
What are typical cardiac involvements with sarcoidosis?
AV block, bundle branch block, arrhythmias, and heart failure.
What should be administered to patients with symptomatic bradycardia and hemodynamic distress?
Atropine.
What is a Bifascicular block?
An RBBB with either left anterior fascicular block or left posterior fascicular block.
What are the ECG findings of left bundle branch block (LBBB)?
No R wave in lead V1, deep S waves, wide notched R waves in leads I, aVL, V5, V6, and loss of Q waves in the lateral leads.
What is the recommended antihypertensive therapy for a patient with type 2 diabetes, CKD, and blood pressure > 130/80?
An ACE inhibitor or ARB.
What should be done if atropine is ineffective in reversing symptomatic bradycardia?
Chronotropic drugs should be given until pacing can be performed.
What is the most appropriate preoperative test for a patient at risk for coronary artery disease?
Cardiac catheterization with coronary angiography.
What are the CHA2DS2-VASc score indications for anticoagulation?
Greater than or equal to 2 in men or 3 in women.
What are the heart failure symptoms in patients with aortic stenosis?
Exertional dyspnea rather than orthopnea or paroxysmal nocturnal dyspnea.
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.
What should a patient with coronary artery disease (CAD) be managed with?
Aspirin, a statin, and at least one of the following: a beta-blocker, a CCB, and/or a long-acting nitrate.
What is the recommended treatment for a patient with STEMI?
Early cardiac catheterization with coronary angiography within 24 hours.
What are cardiac myxomas?
Rare, benign, primary cardiac tumors that typically manifest with symptoms of cardiac obstruction, systemic inflammation, or embolization.
What is indicated for a patient with severe aortic stenosis who is asymptomatic?
Confirm the lack of symptoms with exercise testing.
What are tendinous xanthomas pathognomonic for?
Familial hypercholesterolemia.
What is the next step to address persistent mild hyperkalemia in a patient taking an ACE-I?
Increase the dose of the loop diuretic.
What is the diagnosis for acute severe retrosternal chest pain radiating to the back and neck?
Aortic dissection.
What is routinely recommended for patients with symptomatic coronary artery disease?
Aspirin and a beta-blocker.
Is an echo and ECG necessary to diagnose heart failure?
False; heart failure is a clinical diagnosis.
What is indicated in cyanotic congenital heart disease with erythrocytosis?
Therapeutic phlebotomy if hematocrit exceeds 65% or hemoglobin exceeds 20 with symptoms of hyperviscosity.
Is a beta-blocker routinely recommended for a patient with symptomatic coronary artery disease?
Yes.
Is an echo and EKG necessary to diagnose heart failure (HF)?
False.
Is heart failure (HF) a clinical diagnosis?
Yes.
In cyanotic congenital heart disease and erythrocytosis, when is therapeutic phlebotomy indicated?
If the hematocrit exceeds 65% or hemoglobin exceeds 20 with symptoms of hyperviscosity.
What are symptoms of hyperviscosity?
Headache, visual disturbance, transient ischemic attack, paresthesias, altered mentation, and fatigue.
How can ischemia be diagnosed in a patient with a ventricular paced rhythm?
With ST segment depression greater than or equal to 1 mm that is concordant with the QRS complex.
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 two categories of acute coronary syndrome?
NSTE-ACS and STE-ACS.
What is the next step for a patient with nonischemic cardiomyopathy, EF less than 35%, and LBBB with QRS greater than 150 ms?
Refer for placement of ICD with biventricular pacing.
What finding in a cardiac examination is consistent with left ventricular hypertrophy?
A sustained apical impulse.
What happens to brain natriuretic peptide levels after initiation of sacubitril-valsartan?
Circulating levels of brain natriuretic peptide increase, but not N-terminal pro-brain natriuretic peptide.
What are examples of low intensity statin therapy?
Simvastatin 10 mg, Pravastatin 10-20 mg, Lovastatin 20 mg, Fluvastatin 20-40 mg.
What class of medications is associated with orthostatic hypotension in older men with hypertension and benign prostatic hyperplasia?
Alpha-blockers.
What is the likely cause of sudden loss of consciousness in an older patient with a bifascicular block?
Bradyarrhythmia.
What is cholestyramine used for?
To decrease LDL.
What are the EKG characteristics of 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 is the diagnostic test of choice to confirm aortoduodenal fistulas after aortic aneurysm repair surgery?
CT angiography with delayed images.
How is severe hypertension defined?
Systolic blood pressure > 180 mmHg or diastolic > 120 mmHg.
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.
What are the lateral leads in EKG?
Leads I and aVL.
Is Eisenmenger syndrome unlikely without cyanosis or a loud P2?
True.
When should an ICD be considered for LV dysfunction after an MI?
If the patient has LVEF less than 35% despite GDMT or has malignant ventricular arrhythmia more than 24 hours after MI.
What should patients with HFrEF be treated with?
A beta-blocker and either an ACE-I, ARB, or ARNI.
What type of MI is usually a blockage of the right coronary artery?
Inferior MI.
What should be performed if a patient with congenital cyanotic heart disease has a hemoglobin level >20 g/dL and a hematocrit >65% with symptoms of hyperviscosity?
Phlebotomy should be performed.
What is the next step for a postmenopausal woman with atypical chest pain and resting EKG showing left ventricular hypertrophy with strain?
Exercise echo.
How long must sustained VT last?
Greater than or equal to 30 seconds.
What are common classes of drugs for treatment of atrial fibrillation (A-fib)?
Beta blockers, calcium channel blockers, amiodarone, and digoxin.
What is characteristic of rheumatic mitral stenosis?
A-fib and a diastolic rumbling murmur at the cardiac apex.
What are the clear indications for valve repair in chronic mitral regurgitation?
Symptoms, reduction in ejection fraction to less than 60%, and left ventricular end-systolic dimension greater than 40 mm.
What is the classic triad of RV infarction in the setting of an inferior MI?
Hypotension, distended neck veins, and clear lungs.
Who are the patients that the AHA limits antibiotic prophylaxis for procedures?
- Patients with prosthetic cardiac valves. 2. Patients with prosthetic material used for cardiac valve repair. 3. Patients with previous infective endocarditis. 4. Patients with unrepaired cyanotic congenital heart disease. 5. Patients with repaired congenital heart disease. 6. Patients with a cardiac transplant with valve regurgitation.
What is the PR interval for first degree AV block?
Greater than 200 ms.
What should a patient with severe symptomatic mitral regurgitation undergo before elective surgery?
Preoperative cardiac catheterization to assess for CAD.
What is the mean transvalvular pressure gradient associated with severe aortic stenosis?
> 40 mmHg or a peak velocity > 4 m/sec.
What happens to QRS complexes in patients with LBBBs or who have a paced rhythm?
They are discordant.
What is the left ventricular end-systolic dimension greater than?
40 mm
Is vision loss more likely to occur with a carotid or cardiac source of embolus?
Carotid source
What is the mean transvalvular pressure gradient associated with severe aortic stenosis?
> 40 mmHg
What is the peak velocity associated with severe aortic stenosis?
> 4 m/sec
What do patients with LBBB or a paced rhythm have in their QRS complexes?
Discordant with the ST segments and T waves
What is situational syncope similar to?
Vasovagal syncope
What is the recommended dose of adenosine in cardiac transplant patients?
Lower dose
What is a slurred upstroke of the QRS complex called?
Delta wave
What is the treatment for orthostatic hypotension following dialysis?
IV fluids
How is ischemia diagnosed in patients with LBBB or a paced rhythm?
If the ST segment depression is > 1 mm and concordant with the QRS complex
What suggests cardiac tamponade after a cardiac ablation procedure?
Hypotension and elevated JVP
What is the diagnostic test for cardiac tamponade?
Echocardiography
What is the treatment for cardiac tamponade?
Pericardiocentesis
What is the next diagnostic step for a healthy patient with signs of WPW?
Perform exercise stress test
What causes should be ruled out in a patient with symptomatic sinus bradycardia?
Medications, Sleep apnea, Hypothyroidism, MI, Electrolytes
What is the most likely cause of acute occlusion of a coronary artery at the site of a recently placed stent?
Stent thrombosis
What disease should be considered in a young lady with new onset hypertension difficult to control?
Fibromuscular dysplasia of the renal arteries
What is the purpose of the tilt table test?
Distinguish between different types of reflex syncope
When should an ascending aortic aneurysm be surgically repaired?
When it exceeds 5.5 cm in diameter or enlarges more than 0.5 cm/year
What are the typical manifestations of Dressler syndrome?
Pleuritic chest pain, fever, and occasionally a pericardial effusion
What type of murmur is associated with hypertrophic cardiomyopathy?
Systolic crescendo-decrescendo murmur that becomes louder with the Valsalva maneuver
What is considered a high ASCVD risk?
> 20%
What medication should typically be administered to a patient with an ST elevation myocardial infarction facing a delay before PCI?
Thrombolytic drug
Does a negative TTE effectively rule out infective endocarditis?
False
What is the diagnostic test of choice for infective endocarditis?
TEE
What are typical manifestations of Chagas disease?
Esophageal dysfunction, conduction system abnormalities, and dilated cardiomyopathy
What do Type A aortic dissections involve?
The ascending aorta, the aortic arch, or both
What is an indicator of aortic coarctation?
A systolic blood pressure difference of 20 mmHg between the arms and legs
When should we not initiate a beta-blocker in a newly diagnosed A-fib patient?
If the patient is asymptomatic or has a heart rate within normal limits
What is routinely recommended along with aspirin and a statin for patients with symptomatic coronary artery disease?
Beta-blocker
In which patients are nonclassic presentations of angina most common?
Older patients, diabetes mellitus, and women
What should a patient with severe symptomatic mitral regurgitation undergo before elective valve surgery?
Preoperative cardiac catheterization with coronary angiography
What is characteristic of rheumatic mitral stenosis?
New onset atrial fibrillation and a diastolic rumbling murmur at the cardiac apex
What is the treatment approach for HFpEF?
Usually consists of diuretic and antihypertensive classes of drugs
What procedures are deemed to be at greatest risk for infective endocarditis?
Those involving prosthetic cardiac valves, prosthetic material for valve repair, previous infective endocarditis, unrepaired cyanotic congenital heart disease, or repaired congenital heart disease
