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MKSAP > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Dobutamine contraindications for stress echo/ekg

A

Tachyarrhythmia, severe AS, HOCM, baseline severe HTN, unstable angina, large aortic aneurysm

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2
Q

Adenosine contraindications for stress echo/ekg

A

Bronchospastic airway disease, hypotension, SSS, high degree AV block

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3
Q

Radionuclide angiography imaging (MUGA)

A

Allows for accurate and seriate LVEF measurements; used to help assess cardiotoxicity from chemotherapy usually

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4
Q

Therapy for high risk bleeding patients who have afib AND a recent stent placement

A

Plavix + Xarelto/Eliquis

Do not need DAPT in these patients but can consider in patient’s with lower HASBLED scores

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5
Q

In CAD patients, when should you exercise caution when starting a BB?

A

If they are on nondihydropyridine CCVs (verapamil, diltiazem) as they may have additive negative chronotropic and inotropic effects

-Should also not use these meds w/ LV dysfunction

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6
Q

CCB to avoid in patients w/ refractory angina

A

Nifedipine; acute BP drops will cause reflex tachycardia increased myocardial O2 consumption

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7
Q

Med to use first when maximally dosed BB as not helped angina

A

CCB

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8
Q

Why are nitrates only used once a day?

A

To avoid tolerance

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9
Q

Drug interaction to consider when starting ranolazine

A

CYP inhibition (dilt and verapamil both exhibit mild inhibition)

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10
Q

What to monitor after administering thrombolytic for STEMI

A

EKG at 60 and 90 minutes

Want 50% reduction in ST segment elevation, although, 25% of patients do not achieve reperfusion

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11
Q

Indication for Effient

A

Prasugrel (P2Y inhibitor) ACS TREATED w/ PCI

-Is more potent and has quicker onset of action relative to plavix

CIs: Prior TIA or stroke (higher risk of bleeding than Plavix), age >75

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12
Q

Benefit of Brillinta

A

(Ticagrelor, P2Y inhibitor) studies have shown greater potency and faster onset of platelet inhibition

PLATO trial: Significantly lower mortality rates compared to Plavix

ADR: Dyspnea

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13
Q

Antiplatelet therapy for ACS

A

At least one year of DAPT if patient has low bleed risk

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14
Q

DM medication that has reduced risk of cardiovascular death

A

Trulicity (liraglutide) : GLP-1 agonist

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15
Q

Type of shock needed to treat afib w/ hemodynamic compromise

A

R-R wave synchronized shock

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16
Q

CHADS VASC score needed for valvular afib

A

0

You always anticoagulate valvular afib

Valvular afib refers to mitral stenosis, rheumatic mitral valve disease, or mechanical heart valve NOT MVR

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17
Q

Duration of anticoagulation needed prior to cardioversion for afib

A

At least 3 weeks (assuming they have been in afib for >48hrs)

Then receive anticoagulation for four weeks after procedure

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18
Q

Indications for permanent pacemaker in symptomatic bradycardia

A
  • No reversible cause
  • Significant pauses (>3 seconds)
  • HR <40
  • A fib w/ pause of >5 seconds
  • Alternating bundle branch block
  • Mobitz type II or complete heart block
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19
Q

Capabilities of implantable cardioverter-defibrillator

A

Monitors and treats ventricular arrhythmias

  • Pacemaker present
  • Can also do antitachycardia management and defibrillate
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20
Q

Subcutaneous implantable cardioverter-defibrillator capabilities

A

Monitors and treats ventricular arrhythmias ONLY

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21
Q

Inappropriate sinus tachycardia

A

Baseline tachycardia w/ exaggerated increases w/ minor physical activity; usually has normal HR during sleep

Commonly in female health professionals

Can treat symptoms w/ BB, CCBs, ivabradine if needed

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22
Q

Class 1A antiarrhythmics

A

Disopyramidine
Quinidine
Procainimide

  • Decreases speed of depolarization and prolongs repolarization
  • Used for preexcitable afib, Brugada syndrome, afib, SVT, ventricular arryhthmias

ADR: Drug induced lupus w/ procainamide

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23
Q

CIs to Class 1A antiarrhythmics

A 
Ischemic Heart Disease 
Structural Heart Disease 
Third degree AV block w/o pacemaker
Prolonged QT 
ESRD

**Associated w/ increased mortality in these patients

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24
Q

Class Ib antiarrhythmics

A

Lidocaine
Mexiletine

Decreases speed of depolarization

Used for ventricular arrhythmias ONLY

ADR: HA, dizziness

CI: Liver disease

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25
Q

Class IC antiarrhythmics

A

Fleicainide
Propafenone

Decreases speed of depolarization and repolarization

Used for afib, SVT, ventricular arrhythmias

ADRs: HA, dizziness, neurologic symptoms

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26
Q

Contraindications to Class IC antiarrhythmics

A 
Ischemic Heart Disease 
Structural Heart Disease 
Sinus node dysfunction 
2nd or higher AV block 
Bundle branch disease w/o pacemaker
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27
Q

Class III antiarrhythmics

A

Sotalol, dofetilide

Prolongs the action potential by blocking K channels

Used for rate control of atrial and ventricular arrhythmias

ADRs: HA, dizziness, bradycardia, dyspnea w/ sotalol, torsades w/ dofetilide

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28
Q

Amiodarone info

A

Works through multiple mechanisms although primarily works by extending repolarization

Used for atrial and ventricular arrhythmias

CIs: Advanced liver, lung, or thyroid disease

Monitor labs q6 months and consider PFTs

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29
Q

Primary use of Class II (BBs) and Class IV (CCBs) antiarrhythmics

A

Inhibit AV conduction in supraventricular tachyarrhythmias or atrial arrhythmias

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30
Q

Pradaxa

A

Dabigatran (direct thrombin inhibitor); advantage to this is Idaracuizumab exists and can reverse effects

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31
Q

CHADS VASC score needed for valvular afib

A

0

You always anticoagulate valvular afib

32
Q

Duration of anticoagulation needed prior to cardioversion for afib

A

At least 3 weeks (assuming they have been in afib for >48hrs)

33
Q

Pradaxa

A

Dabigatran (direct thrombin inhitibitor); advantage to this is Idaracuizumab exists and can reverse effects

34
Q

What to examine w/ supraventricular tachycardias

A

RP interval

RP < PR = AVNRT, AVRT (WPW), junctional tachycardia

RP > PR = Sinus, atrial tachycardia

35
Q

Atrial flutter physiology

A

Reentry tachycardia around the tricuspid annulus

36
Q

Treatment for short QT syndrome or Brugada syndrome

A

ICD in ALL PATIENTS

37
Q

What to examine w/ supraventricular tachycardias

A

RP interval

RP < PR = AVNRT, AVRT, junctional tachycardia

RP > PR = Sinus, atrial tachycardia

38
Q

First line therapy for stable WPW

A

Catheter ablation

39
Q

Treatment for short QT syndrome

A

ICD in ALL PATIENTS

40
Q

Early Repolarization Syndrome

A

Characterized by J point elevation in the inferior and lateral leads; requires ICD placement in patients who have VF or cardiac arrest

41
Q

Activities to avoid if you have an ICD

A

Weight lifting or upper body exertion; can lead to stress and fracture of device

Also avoid welding equipment, high voltage machinery

42
Q

Patients to consider Watchman placement for

A 
Thrombocytopenia
Coagulation defects 
Recurrent bleeding
Need for prolonged DAPT
Poor oral anticoagulant compliance 
Fall risk
43
Q

Pulses in aortic stenosis

A

Pulsus tardus et parvus

Delayed and late

44
Q

Goal INR for mechanic aortic valve prosthesis with no other risk factors for thromboembolism

A

2.5

They also need to be on aspirin!

45
Q

When is the goal INR 3.0?

A

High risk factors for thromboembolism

Order generation AV VALVE (ball in cage)

Any mitral prosthesis

46
Q

Duke criteria

A

Major:

Positive blood culture (two separate, need to be 12hrs apart if atypical organism, or single culture if Coxiella)

Evidence of myocardial involvement (echo positive, can include new MVR if no discrete lesion seen)

Minor:

Predisposing risk factors

Fever

Vascular phenomena (emboli, ICH, Janeway lesions, conjunctival hemorrhages)

Immunologic phenomena (glomerulonephritis, Osler nodes,RF, Roth spots)

Microbiological evidence(positive blood culture not meeting above criteria)

47
Q

When is dental prophylaxis appropriate

A

History of endocarditis

Cardiac transplant WITH valve regurgitation

Prosthetic valve

Prosthetics used for cardiac repair

Congenital heart disease

48
Q

Duration of colchicine therapy for pericarditis

A

3 month, 0.5mg BID

Additionally, patients should avoid exercise/overexertion

49
Q

What to check when your ABI is >1.4 indicating calcified arteries?

A

Toe-brachial index

50
Q

HOCM therapies for symptoms

A

BBs that do NOT cause systemic vasodilation (metoprolol or bisoprolol)

Nondihydropyridine CCBs

Last: Disopyramide - has significant negative inotropic activity

51
Q

What to offer HOCM patients who still have symptoms despite maximal therapy?`

A

Open septal myectomy or catheter-based alcohol septal ablation

Can also give w/ provocable LVOT gradient >50mmHg or in patients w/ syncope unrelated to arrhythmia

52
Q

Patients w/ HOCM and afib

A

Needs warfarin

53
Q

Echo findings consistent w/ restrictive cardiomyopathy

A

Biatrial enlargement, severe diastolic dysfunction in the setting of normal ventricular size, wall thickness, and systolic function

If low voltage EKG also present, consider amyloidosis instead as RCM is an inheritable defect in sarcomeric unit

54
Q

Carney Complex

A

Mutation of PRKAR1A TSG

Lentigines (liver spots)
Atrial
Myxoma
Blue nevi

55
Q

Most common primary malignant cardiac tumor

A

Angiosarcoma; highly vascular and appear that way on CT or MR

Survival rate even w/ successful resection is <2 years

56
Q

Duration of colchicine therapy for pericarditis

A

3 months with .5mg BID

Also tell patients to avoid exercise for this time period

57
Q

Platypnea-orthodexia syndrome

A

Right-left cardiac shunting through a PFO due to transient increase in right atrial pressure

Requires PFO closure

58
Q

Ostium secondum ASD findings

A

EKG: Incomplete RBBB, P pulmonale, RAD

CXR: RAE, prominent pulmonary arteries

59
Q

Associated abnormalities w/ ostium primum defect

A

MVR due to mitral valve cleft, LVOT

60
Q

Associated abnormalities w/ sinus venosus ASD

A

Afib, anomalous pulmonary vein connection

61
Q

Repaired tetrology of Fallot abnormalities

A

EKG: RBB, QRS prolongation

CXR: Cardiomegaly w/ pulmonary or tricuspid valve regurgitation, Right sided aortic arch in 25%

62
Q

ASD and cardiac pacemaker placement

A

Higher risk of thromboembolism; reasonable to consider closure prior to placement

63
Q

Main indications for ASD closure

A

Right sided cardiac chamber enlargement
Dyspnea
Atrial arrhythmias
Crypotogenic stroke is a relative indication

64
Q

Noonan syndrome

A 
Pulmonary stenosis 
Mental retardation 
Short stature 
Webbed neck 
Ocular hypertelorism
65
Q

Pulmonary Stenosis repair indications

A

Balloon valvulotomy is performed for asymptomatic patients w/ a PA gradient >60 and pulmonary valve regurgitation that is less than moderate or symptomatic patients with appropriate valve morphology

-Severe pulmonary regurgitation can occur following repair

66
Q

What genetic syndrome is associated w/ TOF?

A

DiGeorge syndrome

67
Q

Complication associated w/ TOF repair

A

VSD patch closure and transannular patch placement of PS leads to pulmonary regurgitation

68
Q

Hematologic complication in patients w/ TOF or Eisenmenger syndromes

A

Erythrocytosis; therapeutic phlebotomy is indicated up to 3x/yearly if symptomatic w/ HA, HTN, visual disturbance, fatigue and if Hgb >20

69
Q

Additional measures need w/ congenital cyanotic heart disease prior to procedures

A

Abx prophylaxis for nonsterile procedures
IV filters to prevent paradoxical air embolism
Early ambulation, SCDs, and anticoagulation

70
Q

Pseudoclaudication

A

Mimics PAD, however, discomfort also includes neuropathies and does not always worsen w/ exercise

71
Q

What to do when ABI is 1.0 but still highly suspect PAD

A

Do an exercise ABI

72
Q

Black box warning and contraindication on cilostazol

A

Increased mortality in patients w/ heart failure

73
Q

Size for DESCENDING thoracic aortic aneurysm repair

A

> 6.0 cm

74
Q

Medication that can lower risk for cardiotoxicity w/ doxorubicin

A

Dexrazoxane

75
Q

Chemotherapy class that will cause REVERSIBLE cardiotoxicity (unlike the anthracyclines)

A

Trastuzumab

You may actually even restart therapy once the EF has returned to normal

76
Q

Risk calculator to use for pregnancy in cardiac patients

A

ZAHARA

MKSAP (15 decks)

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