Cardiology Flashcards
In high-risk AF with stable CAD, is aspirin necessary?
No, not if CAD has been stable for >1 year
Treatment for effusive constrictive pericarditis
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
What is cardiac syndrome X
Angina, abnormal stress testing, with NORMAL angiography
Seen in young patients, women, usually without traditional CVD risk factors
Modifiable factor that is most impactful on CVD risk
Hyperlipidema
ABI >1.40 is indicative of what condition
Non-compressible, calcified arteries. This result is considered uninterpretable
Consider toe-brachial index if not obtained. (TBI <0.7 is c/w PAD)
Surgical treatment indications for mitral regurgitation
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
Features of ostium primum ASD
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)
What antithrombotic therapy is recommended after mechanical aortic valve replacement
Warfarin AND Aspirin
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?
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
Duration of DAPT for stents placed for stable angina (no acute coronary syndrome at time of placement)
Minimum 6 months
Note that DAPT for STEMI is 12 months minimum
Severe mitral stenosis is associated with what valve area?
< 1.5 cm2
Indications for bicuspid AV with thoracic aneurysm (ascending) replacement in asymptomatic patients
Aneurysm > 5.5 cm or > 5.0 cm with additional RF for dissection (FHx of dissection/rupture, or growth rate > 0.5 cm/yr).
Symptomatic severe AS with echo findings c/w moderate AS, what is best next step?
Cardiac cathterization
Best stress test in patients with underlying LBBB
Adenosine/vasodilator stress testing
Avoid exercise/dobutamine stress testing, as this may lead to false positive findings in the basilar septum
Antithrombotic therapy for NSTEMI that is not treated with PCI
DAPT (tigacrelor > clopidogrel + aspirin)
Regardless of whether PCI is pursued, DAPT should be prescribed for a minimum of 12 months
Indications for TTE in asymptomatic murmurs
1) Systolic murmur grade III or louder
2) late or holosystolic murmurs
3) diastolic or continuous murmur
4) murmur with accompanying symptoms
Ranolazine is used for what? What class of drugs should be monitored when using this?
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
What side effect should be considered prior to starting ANRi therapy for HFrEF?
Orthostasis/lightheadedness
Indications for closure of ostium secundum ASD
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
Indications for SBE prophylaxis
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)
Best stress testing for patients with pacemaker
Pharmacologic stress
Paced ventricular rhythm can lead to false positive perfusion defects on exercise radionucleotide myocardial perfusion imaging
AC recommendations during pregnancy for
1) Mechanical valve
2) Any other indication for AC
1) Warfarin, INR goal <5
2) If history of Afib or VTE –> LMWH*
*until last few weeks of pregnancy, then transition to unfractionated heparin
