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ABIM > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Aflutter leads best seen in

A

II, III, aVF

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2
Q

Takusoba

A

Nonexertional cp, with apical ballooning, often with ST elevations

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3
Q

Role of anti platelet in PAD

A

single anti platelet recommended in symptomatic pad, or asymptomatic to reduce risk of MI

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4
Q

indication for open vs. enxovascular repair of AAA

A

Infra renal - often EVAR

supra or juxta - often open

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5
Q

CVD risk enhancers

A

Risk enhancers include family history of premature atherosclerotic CVD (men aged ≤55 years, women aged ≤65 years), LDL cholesterol level of 160 mg/dL (4.14 mmol/L) or higher, metabolic syndrome, chronic kidney disease, chronic inflammatory conditions, history of premature menopause or previous history of preeclampsia, South Asian ancestry, or triglyceride level of 175 mg/dL (1.98 mmol/L) or higher.

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6
Q

Indications for cardiac surgery for IE

A
  1. infection persisting longer than 5-7 days while on appropriate abx
  2. symptomatic heart failure
  3. left sided involvement w s/ aureus, fungi, or highly resistant bugs
  4. heart block, abscess, penetrating lesion
  5. prosthetic valve
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7
Q

Increase in CAD risk in HIV pts

A

1.5-2x fold increase

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8
Q

Components of ASCVD calc

A
  1. age
  2. sex
  3. race
  4. total and HDL cholesterol
  5. systolic BP
  6. use of anti-hypertensives
  7. DM
  8. Smoking status
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9
Q

when to use exercise stres

A

if baseline normal EKG and can exercise - it is initial test of choice

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10
Q

paradoxical split s2

A
  1. can hear split in expiration

2. indicates pathology - later S2 (severe aortic stenosis, HCM, LBBB)

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11
Q

Indications for CRT

A

EF <35%
QRS >150s w/ LBBB
on goal directed therapy
sinus rhythm

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12
Q

Restrictive vs. Constrictive CM

A
  1. Elevated BNP

2. concordant rise and fall of left and right systolic pressures with respiration

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13
Q

Inspiration and preload

A

causes increased preload due to pumped of intraabdominal veins (increases pressure), decreased pressure of Pulm veins

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14
Q

Delayed enhancement of gad on MRI

A

c.w myocardial fibrosis

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15
Q

Constrictive CM

A

Due to external pericardial constraint (ventricular interdependence)

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16
Q

Restrictive CM

A

reduced compliance of elastic properties of the myocardium. usually has elevated BNP

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17
Q

Fabry’s disease

A

lysosomal storage disease, manifestations by 40

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18
Q

BP goal for aortic dissection

A

=120 in the first hour (first with BB, then nitroprusside)

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19
Q

Temporizing measure in cardiac tampoade

A

IV normal saline, esp if sap <100

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20
Q

Young kids w HCM and sports

A

can participate in low intesnitys sports (golfing)

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21
Q

first line tx of symptomatic pats with HCM

A

Nonvasodilating BB

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22
Q

Treatment of HCM for mod-severe symptoms

A

Catheter based alcohol septal ablation or open myomectomy in those that have s/s despite max medical therapy

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23
Q

ICD indications in HCM

A
  1. wall thickness massive (>30=mm)
  2. prior cardiac arrest
  3. hypotension during exercise
  4. syncope
  5. NSVT
  6. FH of SCD 2/2 HCM
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24
Q

Risk factors for ventricular free wall rupture

A
  1. older women
  2. anterior MI
  3. receiving anti-inflammatory agents
  4. delay in reperfusion
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25
Q

symptoms of free wall rupture

A

quick tamponade–>PEA

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26
Q

in stent re-stenosis symptoms

A

s/s ischemia

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27
Q

timing of in stent re-stenossi

A

months to years

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28
Q

cornerstone of HFpEF tx

A

diuretic therapy to maintain euvolemia

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29
Q

two causes of murmurs

A
  1. increased flow anemia, thyrotoxicosis, pregnancy)

2. turbulent flow

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30
Q

benign murmur intensity with standing

A

usually decrease

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31
Q

murmurs that require evaluation

A
  1. diastolic
  2. continuous
  3. symptoms
  4. or abnormalities on exam (clicks, )
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32
Q

preload with standing and valsalva

A

decreases (HCM murmur increases)

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33
Q

murmurs that increase with handgrip (increased co and peripheral R)

A

VSD

mitral and aortic regurgitation

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34
Q

fixed split s2 during I and E

A

ASD

35
Q

DAPT length for DES for stable angina

A

6 months

36
Q

P2Y12 inhibitors

A

clopidegrol, ticragrelor, prasugrel –> does not allow platelet activation

37
Q

DAPT length for DES in ACS

A

at least 12 months

38
Q

atrial myxoma presentation

A

Can present with obstruction, emboli or constitutional s/s 2/2 IL-6 (fatigue, fever, arthralgia) and early diastolic sound (tumor plop)

39
Q

presentation of cardiac lymphoma

A

usually Right atrial mass and immunocompromised

40
Q

Cards finding of Noonan syndrome

A

pulmonary stenosis, usually dysplastic (can have asd, vsd, hcm)

41
Q

Noonan syndrome features

A 
Pulm stenosis
short stature,
hypertelorism
neck webbing
intellectual impairment
42
Q

cards s/s a/w Downs

A

ASD, specifically ostium premium asd

43
Q

ICD indication in nonischemic CM

A

EF <35% + symptoms;

2. or NICM w/ unexplained syncope and LV dysfunction

44
Q

screening interval for bicuspid + TAA

A

q6 months for aneurysm >4.5cm or faster than 0.5cm per year, if smaller q12 months

45
Q

Surgical indication for AI

A

EF <50%, LV dilation >50mm

46
Q

AC in HCM + afib

A

Warfarin (even if low chads2vasc)

47
Q

CABG indications

A
  1. multi vessel + lvd
  2. DM _+ multivessel
  3. Left main dz
48
Q

Management of PVC

A
  1. first line if BB

2. ablation if not resolved or develop left ventricular dysfunction

49
Q

CI to cardiac transplant

A
  1. malignancy w/in 5 years
  2. renal dysfunction
  3. older than 70years
  4. other dz that decrease survival
50
Q

Mechanical valve AC + pregnancy

A

IF dose <5mg in first trimester - warfarin is preferred over other ac

  1. warfarin&raquo_space; all other AC in 2nd and 3rd trimesters
  2. IV UFH heparin around time of delivery
  3. if greater than 5mg in 1st trimester –> UFH
51
Q

Screening for HCM

A
  1. genetic counseling and testing is recommended for patients with HC for all first degree fam members regardless of symptoms. (AD disorder of B myosin gene)
52
Q

risk of CVD in RA

A

increases it 1.5-2 fold (like HIV). Risk of CVD increases with duration of underlying inflammatory condition.

53
Q

testing done prior to dx of inappropriate sinus tachycardia

A

EKG, tte to r/o structural abnormalities, ambulatory EEG for remote findings,
hyperthyroid, anemia, pheo

54
Q

Ticragrelor vs. clopidogrel vs. prasugrel

A

ticragrelor > clopidogrel for ACS

prasugrel only good when stents placed and no superiority found

55
Q

If patient has infective endocarditis per Duke criteria, straight to TEE

A

otherwise if less and probable, TTE first

56
Q

Increased risk of CVD 2/2 DM

A

2-4 x increase

57
Q

Statins in DM

A

Any patient with DM , 40-75 should be on moderate intensity statin

if increased risk factors calculate ASCVD and if >20% should be on high intensity statin

58
Q

Interaction between ranolazine and dilt/verapamil

A

Diltiazem and verapamil are moderate CYP3A inhibitors, which increase ranolazine (thus, decrease this dosage in pts if adding the above CCBs)

59
Q

Indications for device closure of osmium secundum ASD

A
  1. Right heart enlargement and symptomatic disease
  2. asymptomatic patients w/ shunt related hemodynamics
  3. orthorexia, platypnea syndrome (dyspnea/hypoxemai when sitting, fixed when lying down)
60
Q

Surgical closure of ASD indicatinos

A
  1. non secudnum ASD

large

61
Q

Utility of balloon aortic valvuloplasty

A

Bridge to trans catheter or surgical aortic valve replacement

62
Q

GDMT for heart failure

A

STEMI pts with LVEF <40, bb, ace-I and aldosterone antagonist

63
Q

first line tx for pericarditis

A

high dose aspirin (750-1000mg) OR NSAIDS ( 600mg) q8 hours for 102 weeks and adjuvant colchicine (0.5mg/day) for 3 months

64
Q

Most common etiologies if EI

A

staph and strep

65
Q

culture negative IE

A

2.2 fastidious IE

or partially treated

66
Q

Duke criteria Major (2) = clinical dx of IE

A
    • blood cultures

2. evidence a valve is involved (tte, new regurgitant murmur)

67
Q

Minor duke criteria

A
  1. predisposing valve (as, ms)
  2. fever
  3. other vascular phenomona
  4. immunological phenomena
68
Q

vascular phenomenon on IE

A

septic Pulm emboli
mycotic aneurysm
IC hemorrhage
Janeway lesions

69
Q

Immunological phenomenon of IE

A
  1. GN
  2. osler nodes (raised painful bumps)
  3. roth spots (retinal hemorrhages)
70
Q

Indications for sx for IE

A 
HF
access/annular involvement
fungal
abx resistance (+ cx for >7 days)
veg > 10mm
severe MR, AR
obstruction
71
Q

prosthetic valve IE org based on timing

A

early (< 2 months): S. epi

late (>2) normal IE bugs

72
Q

ppx for IE

A

previous IE
prosthetic valve
congenital HD (cyanotic)
cardiac transplant w valvular dz

73
Q

ppx for IE abx for dental procedures

A
  1. amoxicillin 2g prior to procedure or

2. azithro of penicillin allergic

74
Q

Jones criteria is for?

A

Rheumatic fever

75
Q

5 major jones criteria

A

carditis
polyarthritis
chroea
erythema marginatum

76
Q

5 major jones criteria

A 
carditis
polyarthritis
chroea
erythema marginatum (painless, kind of looks like drug rash?)
subcutaneous nodules
77
Q

4 minor criteria of Jones

A

arthralgia
increased sed rate, abc, crp
prolonged PR

78
Q

Percentage of pts with significant AS by 45 years

A

50%

79
Q

bicuspid valve management

A

monitor aortic aneurysm + valve

80
Q

AS murmur

A

crescendo-decrecendo (ejection murmur)

81
Q

class I indication for AS sx

A
  1. symptoms
82
Q

Severe AS sounds

A

paradox split S2 (quiet A2, loud P2)

83
Q

AR

A

decrescendo blowing murmur, diastolic (sounds same as PR)

ABIM (4 decks)

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