Cardiology

Question 1

RCRI

Answer 1

High risk surgery 1
Ischemic Heart disease 1 
HF 1 
Cr >2.0 
Pre-op treatment with insulin 
CVA hx 

0-1 :low risk
2: moderate risk
>/=3 High risk- further testing indicated

Question 2

Pre-operative conditions that require further testing

Answer 2

1. Heart Failure
2. Recent hx of MI/ evidence of ischemic heart disease
3. Valvular Disease
4. Significant arrhythmia

Question 3

Peri-partum Cardiomyopathy

• Definition
• Treatment
• Risk Factors

Answer 3

LVEF <45% 1 month before or up to 5months after pregnancy

Treat with:

• Selective B-blockers
• Loop diuretic
• anticoag with warfarin if LV <35%
• if LV < 35% add bromocriptine (blocks prolactin) to improve LVEF
• Avoid ACE/ARB when preggers (teratogenicity)
• Deliver once diagnosed
• avoid all other pregnancies

Risk factors:

• Age >30yo
• Pre-eclampsia
• African American

Question 4

Co-arctation of the Aorta

• SX
• Associations
• Treatment

Answer 4

Sx:

• HTN in UE
• delayed pulses in the LE
• Continuous machine like murmur in the BACK
• Rib notching, figure 3 on CXR

Associations:

• Aortic dissection
• Intracranial aneurysms
• Bicuspid Aortic Valve
• Turner Syndrome

Treatment:

• Balloon dilation if >20mmHg of difference between UE and LE
• Balloon dilation if discrete area of aorta
• Balloon dilation if proximal HTN

Question 5

PDA

• SX
• Associations
• Treatment

Answer 5

Sx:

• Bounding pulses
• Machine like murmur under clavicle
• SOB, HF type symptoms

AssociationsL:
- Infective Endarteritis

Treatment:

• Closure indicated for moderate
• Tiny : observation
• Closure for LV enlargement in the absence of sx
• DO NOT CLOSE IF PAH

Question 6

Indications for Catheter Directed ablations

Answer 6

Re-entrant tachycardia
Focal atrial tachycardia
Aflutter 
AFib refractory to drugs 
Symptomatic Wolf parkinsons white 
Sustained Vtach- HD stable

Question 7

Stress Cardiomyopathy Findings

Answer 7

ST elevations with T wave inversions in the anterior leads (V1-V4)
mildly elevated troponin

Echo: apical and mid wall hypo-kinesis with basal wall hyperkinesis, depressed EF
Angio: Normal but apical ballooning, no evidence of obstructive CAD

Question 8

Conditions for which bridging is indicated

Answer 8

Mechanical Mitral Valve 
cage ball or tilting disc aortic valve 
VTE within 3 months 
Thrombophilia 
AF CHADs>/=6 
AF with rheumatic heart disease 
AF with TIA/stroke x 3m

Question 9

HOCM

• screening
• Diagnosis
• Risk for sudden cardiac death
• ablation indications
• treatment

Answer 9

Screening
- at age 12 with any 1st degree family member with it

Diagnosis
- LV wall thickness >15mm

Risk for sudden cardiac death

• hx of scd
• family hx of scd
• vtach (sustained, unsustained)
• LV wall thickness >30mm
• HF with EF <30
• blunted inc/decrease in SBP with exercise
• if 1+ risk for sudden cardiac death place and ICD

Ablation indications:
- LVOT gradient >50mmHg

Treatment:

• avoid strenuous activity in all patients
• if symptomatic and EF>50% then treat with b-blocker

Question 10

Murmurs that should have Echo

Answer 10

• asymptomatic patients with a systolic murmur that is grade 3/6 or higher
• a late or holosystolic murmur
• a diastolic or continuous murmur a
• patients with a murmur and accompanying symptoms.

Question 11

screening in HOCM

Answer 11

Start at age 12
12-18/21: q12-18months
>21yo: q5 years (more frequent if fatal arrthymia hx in family)
** HOCM can appear at any age