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PGY-4 Board Prep > Cardiology > Flashcards

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

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2
Q

HFrEF - mechanism & cause

A

impaired contractility

CAD/ischemia

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3
Q

HFpEF - mechanism & cause

A

stiffed LV w/ abnormal relaxation

HTN, aging, obesity, DM, CAD

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4
Q

HFrEF - therapy for all (symptomatic or asymptomatic)

A

ACE/ARB + BB

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5
Q

HFrEF- ARNI (valsartan/sacubrintril)

A

for chronic HFrEF who tolerate ACE/ARB

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6
Q

HFrEF - Aldosterone Antagonists

A
  • symptomatic HF (III-IV)

- after acute MI

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7
Q

Ivabradine

A

sinus node monitor
for HFrEF III-IV with EF <35%, sinus rhythm and HR >70
max dose of BB

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8
Q

HFrEF - Isosorbide Dintrate-Hydralazine

A

symptomatic HF intolerant to ACEI/ARB

AA with III-IV HF

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9
Q

Implantable Cardioverter-Defebrillators in HF

A

EF <35%, II or III

only in IV if transplant candidate or LVAD

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10
Q

Cardiac Resynchronization Thearpy in HF

A

EF <35%, II-IV

sinus rhythm with either LBBB or QRS >150

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11
Q

Phlebotomy in CHD Patients

A

Hct >65% + symptoms

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12
Q

Anterior Infarct EKG

A

V3-V4

Septal V1-V2

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13
Q

Lateral Infarct EKG

A

I, aVL, V5-V6

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14
Q

Inferior Infarct EKG

A

II, III, aVF; need right sided EKG!

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15
Q

Posterior Infarct EKG

A

St depressions V1-V4

ST elevations in inferior or lateral leads

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16
Q

Initial Therapy for all ACS

A

Aspirin, Antiplatelet, nitrates, heparin

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17
Q

Initial Therapy within first 24 hours for ACS

A

BB
Statin
ACEI, ARB, aldosterone antagonist if indicated

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18
Q

Clopidogrel use in ACS

A

preferred agent if thrombolytic therapy is performed

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19
Q

Ticagrelor use in ACS

A

preferred therapy for STEMI, NSTEMI

AE: dyspnea

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20
Q

Prasugrel use in ACS

A

preferred in PCI performed

not for those older than 75 or history of TIA or stroke

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21
Q

Treatment for Left Ventricular Apical Thrombus

A

anticoagulation with warfarin for 3 months

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22
Q

Treatment of right ventricular infarction

A

bolus, positive inotropes (dopamine, dobutamine)

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23
Q

Free Wall Rupture Symptoms

A

sudden CP, syncope –> PEA

Rx sugery/pericardiocentesis

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24
Q

Acquired VSD after MI

A

septal wall rupture, usually within 3-5d

holosystolic murmur at LLSB

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25
Q

Acute Severe MR after MI

A

papillary muscle rupture w/in a few days

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26
Q

Treatment of all Stable Angina

A

Low Dose ASA, statin, BB

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27
Q

Alternate Treatments for Refractory Stable Angina

A

CCB, nitrates, Ranolazine

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28
Q

Stable Angina defined as

A

reproducible CP or pressure for at least TWO MONTHS

precipitated by exertion or emotional stress

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29
Q

RCRI Risk Factors

A 
DM treated with insulin
HF
CAD
CVD
CKD
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30
Q

When to start pre-operative beta blocker

A

3 RCRI risk factors or if needed for other medical condition (CAD)

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31
Q

4 METs =

A

1 flight of stairs

heavy house work (scrubbing floors)

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32
Q

Aortic Stenosis Murmur

A

late peaking systolic murmur

RSB, 2ICS

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33
Q

Murmur associated with Coarctation of the Aorta

A

harsh systolic murmur; often loudest over back/scapula

can have murmur from collateral intercostal vessels

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34
Q

Coarctation of Aorta Presentation in Children

A

2-3 weeks w/ shock
weak pulses
poor feeding

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35
Q

Coarctation of Aorta Presentation in Adults

A

HTN, asymptomatic to HF, exertional leg fatigue
Figure 3 sign on x-ray
Rib notching on x-ray

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36
Q

Figure 3 Sign in Coarctation of Aorta

A

dilation above and below area of coarctation

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37
Q

Types of ASD

A

secundum > primum > sinus venous

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38
Q

Murmur of ASD

A

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)

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39
Q

Holt-Oram Syndrome

A

ASD

Upper limb defects

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40
Q

Axis - Normal

A

positive in I, AVF

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41
Q

Axis - LAD

A

positive in I, negative in AVF

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42
Q

Axis - RAD

A

Negative in I

positive in AVF

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43
Q

Axis - Extreme RAD

A

negative in I, AVF

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44
Q

Sinus Rhythm means . . .

A

p waves before QRS

upright p waves in I, II; inverted in avR

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45
Q

Aortic Regurgitation Murmur

A 
LV dilation and large stroke volume =
bounding pulses
diastolic decrescendo murmur 
- RSB (root), LSB (valve)
can have early peaking SEM
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46
Q

Bicupsid AV Murmur

A

incidental SEM

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47
Q

VSD Types

A

perimembranous
juxta-arterial
muscular
inlet

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48
Q

VSD murmur

A

due to pulmonary resistance
pan systolic murmur loudest at LLSB
can have diastolic rumble at apex (MV)

49
Q

Murmurs and inspiration

A

increased right sided pressures so will increase the sound of right sided murmurs

50
Q

Standing –> Squating & Murmurs

A

Increase LV Preload –>

Increase LS stenosis, decreased LS regurg & HoCM

51
Q

Leg Raise & Murmurs

A

Increase LV Preload –>

Increase LS stenosis, decreased LS regurg & HoCM

52
Q

Squat to Stand & Murmurs

A

Decrease LV Preload –>

Decrease LF stenosis, increase LS regurg & HOCM

53
Q

Valsalva & Murmurs

A

Decrease LV Preload –>

Decrease LF stenosis, increase LS regurg & HOCM

54
Q

Hand Grip & Murmurs

A

increase LV afterload
decrease LS stenosis
increase L sided regurg
decrease HOCM

55
Q

HOCM Physiology

A

LVH
Diastolic Dysfxn
Systolic Anterior Motion of Mitral Valve
LV outflow obstruction

56
Q

HOCM Rx

A

BB

Surgery

57
Q

Evaluation of Aortic Stenosis

A

ECHO +/- cardiac cath if unclear

58
Q

Aortic Stenosis Mean Gradient

A

mild <20 mmHg

severe >40 mmHg

59
Q

AAA, size for surgical repair

A

5.5cm

expansion >0.5cm/yr

60
Q

AAA, size for more frequent monitoring

A

4-5cm; 6-12m monitoring w/ US

61
Q

Infective Endocarditis, evaluating for large abscesses

A

TEE

62
Q

Anticoagulation during pregnancy

A

warfarin is less then 5mg daily

LMWH if >5 mg warfarin daily

63
Q

Aortic Regurg Surgery for Asymptomatic Folks

A

asymptomatic and LV EVD >50 mmHg or EF <50%

64
Q

Aortic Root/Ascending Aorta Indication for Surgery

A

> 45mm

65
Q

Cardiac Amyloid Clues

A

preserved systolic, severe diastolic and pulm HTN/regurg

pseudo-infarct, Q waves V1-3 w/o wall abnormalities

66
Q

Acute Limb Ischemia next steps

A

anticoagulation + diagnostic angiography

67
Q

Mitral Regurg Murmur

A

systolic murmur at apex +/- some locks

68
Q

Mitral Regurg Pathophys problems

A

volume overload w/ LV dilation + LA HTN –> right side/pul HTN

69
Q

Mitral Regurg Preferred Surger

A

repair > replacement > clip (if not candidate)

70
Q

Mitral Regurg Indications for surgery

A

symp + LV >30
asymp + LV 30-60 +/- LV ESD >40mmHg
other cardiac surgery planned
new onset a fib or pulm HTN

71
Q

Screening for Thoracic Aneurysms

A

Marfan, Ehlers-Danlos, Loeys-Dietz, family history, BAV

72
Q

Thoracic Aneurysm Medical treatment

A

BP <130/80

BB preferred

73
Q

Treatment for Thoracic Aneurysm

A

> 5.5 cm or 0.5cm/year repair

CTD: consider 4.5-5.0

74
Q

Surgery for Thoracic Aneurysm, open vs endovascular

A

open for ascending, arch, root

endovascular for descending

75
Q

VSD closure

A

Qp:Qs ratio >2, evidence of LV volume overload, or IE

76
Q

Tetraology of Fallot - Main Problems!

A

subaortic VSD
infundibular or valvular pulmonary stenosis
aortic override
right ventrical hypertrophy

77
Q

TOF associated genetics

A

DiGeorge/22q11.2

78
Q

TOF repair

A

VSD patch closure and relief of PS/right ventricular outflow tract w/ transannular patch placement

79
Q

Consequences of TOF repair

A

pulmonary valve regurg

80
Q

ABI - values for PAD

A

< 0.9

81
Q

ABI - when values are >1.4

A

usually due to noncompressible calcified arteries
perform toe-brachial index
<0.7 is diagnostic for PAD

82
Q

ABI - when to do exercise ABI

A

high pretest probability and normal value between .91-1.40

83
Q

Medical Therapy for PAD

A

ASA
smoking cessation, supervised exercise
cilostazol

84
Q

Radiation and Pericardium

A

acute pericarditis is earliest

constrictive pericarditis

85
Q

Most Common Chemotherapy agents with cardiotoxicity

A

Anthracyclines, doxorubicin

MABs: trastuzumab

86
Q

Benign murmurs; decrease when . . .

A

standing!!

87
Q

Differences between constrictive pericarditis and restrictive cardiomyopathy

A

restrictive: elevated BNP >100; evidence of pulm HTN, rise and fall of left and right systolic pressures with respiration

88
Q

Cardiac Angiosarcomas

A

usually associated with pericardial effusions

highly vascular

89
Q

Cardiac Angiosarcomas

A

usually associated with pericardial effusions

highly vascular

90
Q

TIMI score - things to consider

A 
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
Q

CHA2 DS2 Vasc

A 
CHF, HTN
age, >65, >75 x 2
DM
Stroke/TIA x 2 
Vasc Disease
Female
92
Q

Benefits of Ordering TEE versus TTE

A

high pretest probability for abscess/IE complication
aortic abnormalities
left atrial thrombus

93
Q

Premature CAD

A

less than 55 in males

less than 65 in females

94
Q

Ventricular Interdependence

A

constrictive pericarditis

95
Q

Bridging Medical Therapy for Acute MR

A

nitroprusside

balloon pump

96
Q

Endocarditis Prophylaxis

A

hx of endocarditis
congenital heart disease
bioprosethetic valve
cardiac transplant w/ regurg

97
Q

Anthracycline AE

A

irreversible dilated Cm

98
Q

ICD indication

A

ventricular arrhythmia >30 sec or cardiac arrest

99
Q

Contraindications to Vasodilators/Adenosine

A

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
Q

Acute AR Dissection Target BP

A

<120 within 1 hour

101
Q

VTE prophylaxis for mechanical heart valve

A

warfarin + low dose ASA

102
Q

Anticoagulation during pregnancy

A

2nd and 3rd trimester - warfarin

103
Q

Diagnostic test for CAD when LBBB is present

A

vasodilator stress test

104
Q

Calcium Artery Scoring

A

intermediate risk, tells arthersclerosis nd not obstruction

1-99 mild, 100-399 mod, >400 severe

105
Q

FFA (Cardiac Testing)

A

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
Q

When to withhold BB from stress testing

A

exercise stress testing, at least 24 hours before

107
Q

Contraindications to exercise stress testing

A

baseline EEG is abnormal

- LBBB, LVH, paced, >1mm ST depression

108
Q

Diagnosis of Ischemia on Exercise EKG Stress Testing

A

horizontal or downslopping ST segment at least 1mm

109
Q

Diagnosis of Significant Obstructive Disease of EKG Stress Testing

A

hypotension or lack of BP augmentation

110
Q

Dobuatmine Stress Testing

A

increases myocardical oxygen demand

CI in baseline HTN, unstable angina, severe tachyarrhythmias, HCM, severe AS, large aortic aneurysms

111
Q

Carney Complex

A

multiple atrial myxomas at a young age

112
Q

Giant Cell Myocarditis

A

myocarditis with high AV block in young people

113
Q

trasutuzmab cardic toxicity

A

reversible LV dysfxn

114
Q

Severe AS mean gradient and valve area

A

> 40

<1

115
Q

Severe AS, concern for low flow, low gradient test

A

dobutamine ECHO

116
Q

Chronic Aortic Regurg Surgery when

A

symptoms
LV <50
LV dilation

117
Q

Chronic Severe Mitral Regurg surgery

A

Symptoms, EF>30, LVESD >40

118
Q

HCM Surgery

A

symptoms or syncope despite medical therapy

outflow gradient >50

PGY-4 Board Prep (18 decks)

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