Cardiology

Question 1

HF stages and classes

Answer 1

AHA stages:
A - high risk, no structural disease
B - structural disease, no sx 
C - structural disease and symptoms
D - refractory, advanced therapy

NYHA classes:

1: no limitations
2: slight limitations w activity
3: marked limitation w activity
4: sx at rest or no activity possible

Question 2

Screening for family members w DCM

Answer 2

First degree relatives - echo every 3-5 years

3 generations family history needed

+/- in idiopathic DCM

Question 3

Initial evaluation of HF

Answer 3

CBC, UA, lytes, lipids, lfts, tsh

EKG

Consider HIV, hemochromatosis
Consider rheum, amyloid, pheo

CXR

TTE - repeat if clinical change

Ischemic eval, viability, MRI

Question 4

RHC indications in HF

Answer 4

Respiratory distress and questions left after clinical eval

If fluid status or SVR uncertain
Low BP
Renal dysfunction
Pressors 
Considering advanced therapy

Question 5

Stage A treatment

Answer 5

Control htn and hl

Lose weight, DM control, stop smoking, stop cardiotoxic shit

Question 6

Stage B treatment

Answer 6

ACE or ARB
BB
Statins if ischemia
Control BP
ICD if 40d after MI and EF <30

No nondihydropyridine CCB if no sx after MI

Question 7

Stage C treatment (HFrEF)

Answer 7

Sodium restriction
CPAP for OSA
Exercise/cardiac rehab

ACE/ARB
BB
Hydra/nitrate for AA
Spiro (ARB on top of ACE if not tolerated)

Diuretics for volume overload

Dig can decrease hospitalization

AC if AF

No CCB except amlodipine

ICD 40d post MI EF <35
CRT if EF <35 and LBBB w QRS >150, consider if QRS >120

Question 8

Stage D treatment

Answer 8

Fluid restriction
Inotropic support if there is a goal or if palliative
VADs as transition to definitive therapy or as destination
Transplant

Question 9

Decompensated HF workup

Answer 9

Consider ischemia w EKG and troponin

BP, nonadherence, AF, PE, CCBs or BBs, EtOH or drugs, DM, thyroid, infection, CV problem

Question 10

Decompensated HF treatment

Answer 10

Continue GDMT but don’t start BB

Diuretics, UF
Consider vasodilator (ntg to decrease preload, nipride for preload and afterload) for dyspnea
VTE prophylaxis
Fix hyponatremia

F/u 7-14 days

Question 11

Fixed defect on nuc stress

Answer 11

Scar
Hibernating myocardium
Artifact

Check gated images to compare wall motion

Question 12

TID

Answer 12

Transient ischemic dilation

Cutoff varies with modality

Poor prognostic sign for epicardial ischemia

Question 13

Normal MPI with decreased EF or global hypokinesis

Answer 13

Concern for global ischemia - either 3 vessel epicardial disease or micro vascular disease

Can check MBF on PET

Question 14

Wellens sign

Answer 14

Deep T wave inversions precordial leads - high grade LAD stenosis, high risk of MI

Question 15

HCM echo diagnosis

Answer 15

Septal thickness >15 mm

Question 16

Localization of WPW accessory pathway

Answer 16

1. P wave in V1. Upright = L, down = R

2. QRS transition point. After V2 = R lateral, L septal; before V2 = R septal, L lateral

Question 17

How does lasix get in the tubule

Answer 17

Carried on albumin, transported into tubule in descending tubule as an organic acid

Question 18

Heart failure and dialysis

Answer 18

Peritoneal dialysis is higher mortality than HD

Question 19

Beta blockers dialysis

Answer 19

Metoprolol is dialyzable

Carvedilol is not dialyzable