Cardiology

Question 1

In high-risk AF with stable CAD, is aspirin necessary?

Answer 1

No, not if CAD has been stable for >1 year

Question 2

Treatment for effusive constrictive pericarditis

Answer 2

NSAIDs and colchicine

Usually presents similarly to acute pericarditis, however has a subacute course. Look for:

• pulsus paradoxus
• Fever, leukocytosis, ESR, +/- friction rub

Consider pericardiectomy if no response to medical therapy

Question 3

What is cardiac syndrome X

Answer 3

Angina, abnormal stress testing, with NORMAL angiography

Seen in young patients, women, usually without traditional CVD risk factors

Question 4

Modifiable factor that is most impactful on CVD risk

Answer 4

Hyperlipidema

Question 5

ABI >1.40 is indicative of what condition

Answer 5

Non-compressible, calcified arteries. This result is considered uninterpretable

Consider toe-brachial index if not obtained. (TBI <0.7 is c/w PAD)

Question 6

Surgical treatment indications for mitral regurgitation

Answer 6

1) Symptomatic patient with LVEF >30%
2) Asymptomatic patients with LVEF 30-60%, or LV end-systolic diameter >40 mm
3) Patients undergoing another cardiac surgical procedure

Question 7

Features of ostium primum ASD

Answer 7

1) Fixed splitting of S2
2) Mitral regurgitation
3) Left-axis deviation

Ostium secundum ASD is NOT associated with Mitral disease (septum secundum is right sided, primum is left sided)

Question 8

What antithrombotic therapy is recommended after mechanical aortic valve replacement

Answer 8

Warfarin AND Aspirin

Question 9

What are the INR targets for valve replacement with the following:

1) aortic mechanical
2) mitral mechanical
3) aortic mechanical + additional risk factors?

What are the relevant additional risk factors?

Answer 9

1) mechanical aortic: 2.5
2) mechanical mitral: 3.0
3) mechanical aortic + RF: 3.0

Risk factors:

• Afib
• LV dysfunction
• Previous VTE
• hypercoagulable condition
• older generation mechanical valve

Question 10

Duration of DAPT for stents placed for stable angina (no acute coronary syndrome at time of placement)

Answer 10

Minimum 6 months

Note that DAPT for STEMI is 12 months minimum

Question 11

Severe mitral stenosis is associated with what valve area?

Answer 11

< 1.5 cm2

Question 12

Indications for bicuspid AV with thoracic aneurysm (ascending) replacement in asymptomatic patients

Answer 12

Aneurysm > 5.5 cm or > 5.0 cm with additional RF for dissection (FHx of dissection/rupture, or growth rate > 0.5 cm/yr).

Question 13

Symptomatic severe AS with echo findings c/w moderate AS, what is best next step?

Answer 13

Cardiac cathterization

Question 14

Best stress test in patients with underlying LBBB

Answer 14

Adenosine/vasodilator stress testing

Avoid exercise/dobutamine stress testing, as this may lead to false positive findings in the basilar septum

Question 15

Antithrombotic therapy for NSTEMI that is not treated with PCI

Answer 15

DAPT (tigacrelor > clopidogrel + aspirin)

Regardless of whether PCI is pursued, DAPT should be prescribed for a minimum of 12 months

Question 16

Indications for TTE in asymptomatic murmurs

Answer 16

1) Systolic murmur grade III or louder
2) late or holosystolic murmurs
3) diastolic or continuous murmur
4) murmur with accompanying symptoms

Question 17

Ranolazine is used for what? What class of drugs should be monitored when using this?

Answer 17

Decreases anginal symptoms, increases exercise times

Monitor with CYP3A inhibitors (ketoconazole, calrithromycin, ritonavir, verapamil, diltiazem). Consider dose reduction of ranolazine if also using these medications

Question 18

What side effect should be considered prior to starting ANRi therapy for HFrEF?

Answer 18

Orthostasis/lightheadedness

Question 19

Indications for closure of ostium secundum ASD

Answer 19

1) symptomatic disease (palpitations, DOE)
2) right heart enlargement
3) Orthodeoxia-platypnea syndrome

Monitor small ASD without symptoms and no evidence of right heart enlargement

Question 20

Indications for SBE prophylaxis

Answer 20

1) Unrepaired congenital heart disease or repaired lesions with residual defects or disease repaired within the last 6 months
2) history of endocarditis
3) cardiac transplant with valve regurgitation due to a structurally abnormal valve
4) prosthetic material used for cardiac valve repair (including annuloplasty rings or chords)
5)

Question 21

Best stress testing for patients with pacemaker

Answer 21

Pharmacologic stress

Paced ventricular rhythm can lead to false positive perfusion defects on exercise radionucleotide myocardial perfusion imaging

Question 22

AC recommendations during pregnancy for

1) Mechanical valve
2) Any other indication for AC

Answer 22

1) Warfarin, INR goal <5
2) If history of Afib or VTE –> LMWH*

*until last few weeks of pregnancy, then transition to unfractionated heparin