Cardiology Flashcards
1
Q
Low Dose ASA for CVD and CRC
A
adults 50-59 years with ASCVD risk of 10% and no increased risk of bleeding
2
Q
HFrEF - mechanism & cause
A
impaired contractility
CAD/ischemia
3
Q
HFpEF - mechanism & cause
A
stiffed LV w/ abnormal relaxation
HTN, aging, obesity, DM, CAD
4
Q
HFrEF - therapy for all (symptomatic or asymptomatic)
A
ACE/ARB + BB
5
Q
HFrEF- ARNI (valsartan/sacubrintril)
A
for chronic HFrEF who tolerate ACE/ARB
6
Q
HFrEF - Aldosterone Antagonists
A
- symptomatic HF (III-IV)
- after acute MI
7
Q
Ivabradine
A
sinus node monitor
for HFrEF III-IV with EF <35%, sinus rhythm and HR >70
max dose of BB
8
Q
HFrEF - Isosorbide Dintrate-Hydralazine
A
symptomatic HF intolerant to ACEI/ARB
AA with III-IV HF
9
Q
Implantable Cardioverter-Defebrillators in HF
A
EF <35%, II or III
only in IV if transplant candidate or LVAD
10
Q
Cardiac Resynchronization Thearpy in HF
A
EF <35%, II-IV
sinus rhythm with either LBBB or QRS >150
11
Q
Phlebotomy in CHD Patients
A
Hct >65% + symptoms
12
Q
Anterior Infarct EKG
A
V3-V4
Septal V1-V2
13
Q
Lateral Infarct EKG
A
I, aVL, V5-V6
14
Q
Inferior Infarct EKG
A
II, III, aVF; need right sided EKG!
15
Q
Posterior Infarct EKG
A
St depressions V1-V4
ST elevations in inferior or lateral leads
16
Q
Initial Therapy for all ACS
A
Aspirin, Antiplatelet, nitrates, heparin
17
Q
Initial Therapy within first 24 hours for ACS
A
BB
Statin
ACEI, ARB, aldosterone antagonist if indicated
18
Q
Clopidogrel use in ACS
A
preferred agent if thrombolytic therapy is performed
19
Q
Ticagrelor use in ACS
A
preferred therapy for STEMI, NSTEMI
AE: dyspnea
20
Q
Prasugrel use in ACS
A
preferred in PCI performed
not for those older than 75 or history of TIA or stroke
21
Q
Treatment for Left Ventricular Apical Thrombus
A
anticoagulation with warfarin for 3 months
22
Q
Treatment of right ventricular infarction
A
bolus, positive inotropes (dopamine, dobutamine)
23
Q
Free Wall Rupture Symptoms
A
sudden CP, syncope –> PEA
Rx sugery/pericardiocentesis
24
Q
Acquired VSD after MI
A
septal wall rupture, usually within 3-5d
holosystolic murmur at LLSB
25
Acute Severe MR after MI
papillary muscle rupture w/in a few days
26
Treatment of all Stable Angina
Low Dose ASA, statin, BB
27
Alternate Treatments for Refractory Stable Angina
CCB, nitrates, Ranolazine
28
Stable Angina defined as
reproducible CP or pressure for at least TWO MONTHS
| precipitated by exertion or emotional stress
29
RCRI Risk Factors
```
DM treated with insulin
HF
CAD
CVD
CKD
```
30
When to start pre-operative beta blocker
3 RCRI risk factors or if needed for other medical condition (CAD)
31
4 METs =
1 flight of stairs
| heavy house work (scrubbing floors)
32
Aortic Stenosis Murmur
late peaking systolic murmur
| RSB, 2ICS
33
Murmur associated with Coarctation of the Aorta
harsh systolic murmur; often loudest over back/scapula
| can have murmur from collateral intercostal vessels
34
Coarctation of Aorta Presentation in Children
2-3 weeks w/ shock
weak pulses
poor feeding
35
Coarctation of Aorta Presentation in Adults
HTN, asymptomatic to HF, exertional leg fatigue
Figure 3 sign on x-ray
Rib notching on x-ray
36
Figure 3 Sign in Coarctation of Aorta
dilation above and below area of coarctation
37
Types of ASD
secundum > primum > sinus venous
38
Murmur of ASD
systolic murmur in pulm area (like pulm stenosis)
fixed S2 Split (delay of pulm valve to close)
can have diastolic murmur at LLSB (flow across tricuspid)
39
Holt-Oram Syndrome
ASD
| Upper limb defects
40
Axis - Normal
positive in I, AVF
41
Axis - LAD
positive in I, negative in AVF
42
Axis - RAD
Negative in I
| positive in AVF
43
Axis - Extreme RAD
negative in I, AVF
44
Sinus Rhythm means . . .
p waves before QRS
| upright p waves in I, II; inverted in avR
45
Aortic Regurgitation Murmur
```
LV dilation and large stroke volume =
bounding pulses
diastolic decrescendo murmur
- RSB (root), LSB (valve)
can have early peaking SEM
```
46
Bicupsid AV Murmur
incidental SEM
47
VSD Types
perimembranous
juxta-arterial
muscular
inlet
48
VSD murmur
due to pulmonary resistance
pan systolic murmur loudest at LLSB
can have diastolic rumble at apex (MV)
49
Murmurs and inspiration
increased right sided pressures so will increase the sound of right sided murmurs
50
Standing --> Squating & Murmurs
Increase LV Preload -->
| Increase LS stenosis, decreased LS regurg & HoCM
51
Leg Raise & Murmurs
Increase LV Preload -->
| Increase LS stenosis, decreased LS regurg & HoCM
52
Squat to Stand & Murmurs
Decrease LV Preload -->
| Decrease LF stenosis, increase LS regurg & HOCM
53
Valsalva & Murmurs
Decrease LV Preload -->
| Decrease LF stenosis, increase LS regurg & HOCM
54
Hand Grip & Murmurs
increase LV afterload
decrease LS stenosis
increase L sided regurg
decrease HOCM
55
HOCM Physiology
LVH
Diastolic Dysfxn
Systolic Anterior Motion of Mitral Valve
LV outflow obstruction
56
HOCM Rx
BB
| Surgery
57
Evaluation of Aortic Stenosis
ECHO +/- cardiac cath if unclear
58
Aortic Stenosis Mean Gradient
mild <20 mmHg
| severe >40 mmHg
59
AAA, size for surgical repair
5.5cm
| expansion >0.5cm/yr
60
AAA, size for more frequent monitoring
4-5cm; 6-12m monitoring w/ US
61
Infective Endocarditis, evaluating for large abscesses
TEE
62
Anticoagulation during pregnancy
warfarin is less then 5mg daily
| LMWH if >5 mg warfarin daily
63
Aortic Regurg Surgery for Asymptomatic Folks
asymptomatic and LV EVD >50 mmHg or EF <50%
64
Aortic Root/Ascending Aorta Indication for Surgery
> 45mm
65
Cardiac Amyloid Clues
preserved systolic, severe diastolic and pulm HTN/regurg
| pseudo-infarct, Q waves V1-3 w/o wall abnormalities
66
Acute Limb Ischemia next steps
anticoagulation + diagnostic angiography
67
Mitral Regurg Murmur
systolic murmur at apex +/- some locks
68
Mitral Regurg Pathophys problems
volume overload w/ LV dilation + LA HTN --> right side/pul HTN
69
Mitral Regurg Preferred Surger
repair > replacement > clip (if not candidate)
70
Mitral Regurg Indications for surgery
symp + LV >30
asymp + LV 30-60 +/- LV ESD >40mmHg
other cardiac surgery planned
new onset a fib or pulm HTN
71
Screening for Thoracic Aneurysms
Marfan, Ehlers-Danlos, Loeys-Dietz, family history, BAV
72
Thoracic Aneurysm Medical treatment
BP <130/80
| BB preferred
73
Treatment for Thoracic Aneurysm
>5.5 cm or 0.5cm/year repair
| CTD: consider 4.5-5.0
74
Surgery for Thoracic Aneurysm, open vs endovascular
open for ascending, arch, root
| endovascular for descending
75
VSD closure
Qp:Qs ratio >2, evidence of LV volume overload, or IE
76
Tetraology of Fallot - Main Problems!
subaortic VSD
infundibular or valvular pulmonary stenosis
aortic override
right ventrical hypertrophy
77
TOF associated genetics
DiGeorge/22q11.2
78
TOF repair
VSD patch closure and relief of PS/right ventricular outflow tract w/ transannular patch placement
79
Consequences of TOF repair
pulmonary valve regurg
80
ABI - values for PAD
< 0.9
81
ABI - when values are >1.4
usually due to noncompressible calcified arteries
perform toe-brachial index
<0.7 is diagnostic for PAD
82
ABI - when to do exercise ABI
high pretest probability and normal value between .91-1.40
83
Medical Therapy for PAD
ASA
smoking cessation, supervised exercise
cilostazol
84
Radiation and Pericardium
acute pericarditis is earliest
| constrictive pericarditis
85
Most Common Chemotherapy agents with cardiotoxicity
Anthracyclines, doxorubicin
| MABs: trastuzumab
86
Benign murmurs; decrease when . . .
standing!!
87
Differences between constrictive pericarditis and restrictive cardiomyopathy
restrictive: elevated BNP >100; evidence of pulm HTN, rise and fall of left and right systolic pressures with respiration
88
Cardiac Angiosarcomas
usually associated with pericardial effusions
| highly vascular
89
Cardiac Angiosarcomas
usually associated with pericardial effusions
| highly vascular
90
TIMI score - things to consider
```
age >65
3 cardiac RF (HTN, DM, HLD, tobacco, family hx)
Known CAD
ASA in last 7 days
severe angina (2 epi in 24 hours)
>0.5mm ST Changes
+ biomarkers
```
91
CHA2 DS2 Vasc
```
CHF, HTN
age, >65, >75 x 2
DM
Stroke/TIA x 2
Vasc Disease
Female
```
92
Benefits of Ordering TEE versus TTE
high pretest probability for abscess/IE complication
aortic abnormalities
left atrial thrombus
93
Premature CAD
less than 55 in males
| less than 65 in females
94
Ventricular Interdependence
constrictive pericarditis
95
Bridging Medical Therapy for Acute MR
nitroprusside
| balloon pump
96
Endocarditis Prophylaxis
hx of endocarditis
congenital heart disease
bioprosethetic valve
cardiac transplant w/ regurg
97
Anthracycline AE
irreversible dilated Cm
98
ICD indication
ventricular arrhythmia >30 sec or cardiac arrest
99
Contraindications to Vasodilators/Adenosine
produce hyperemia and flow disparity
CI in bronsospastic airway disease, sick sinus syndrome, hypotension, high degree AV block
must hold caffeine 12-24 hours before
100
Acute AR Dissection Target BP
<120 within 1 hour
101
VTE prophylaxis for mechanical heart valve
warfarin + low dose ASA
102
Anticoagulation during pregnancy
2nd and 3rd trimester - warfarin
103
Diagnostic test for CAD when LBBB is present
vasodilator stress test
104
Calcium Artery Scoring
intermediate risk, tells arthersclerosis nd not obstruction
| 1-99 mild, 100-399 mod, >400 severe
105
FFA (Cardiac Testing)
add to CTA and angiography to provide functional information and specificity for obstructive CAD
ratio of blood flow distal to stenosis to blood flow proximal
106
When to withhold BB from stress testing
exercise stress testing, at least 24 hours before
107
Contraindications to exercise stress testing
baseline EEG is abnormal
| - LBBB, LVH, paced, >1mm ST depression
108
Diagnosis of Ischemia on Exercise EKG Stress Testing
horizontal or downslopping ST segment at least 1mm
109
Diagnosis of Significant Obstructive Disease of EKG Stress Testing
hypotension or lack of BP augmentation
110
Dobuatmine Stress Testing
increases myocardical oxygen demand
| CI in baseline HTN, unstable angina, severe tachyarrhythmias, HCM, severe AS, large aortic aneurysms
111
Carney Complex
multiple atrial myxomas at a young age
112
Giant Cell Myocarditis
myocarditis with high AV block in young people
113
trasutuzmab cardic toxicity
reversible LV dysfxn
114
Severe AS mean gradient and valve area
>40
| <1
115
Severe AS, concern for low flow, low gradient test
dobutamine ECHO
116
Chronic Aortic Regurg Surgery when
symptoms
LV <50
LV dilation
117
Chronic Severe Mitral Regurg surgery
Symptoms, EF>30, LVESD >40
118
HCM Surgery
symptoms or syncope despite medical therapy
| outflow gradient >50
