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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
Class IC antiarrhythmics
Fleicainide Propafenone Decreases speed of depolarization and repolarization Used for afib, SVT, ventricular arrhythmias ADRs: HA, dizziness, neurologic symptoms
26
Contraindications to Class IC antiarrhythmics
``` Ischemic Heart Disease Structural Heart Disease Sinus node dysfunction 2nd or higher AV block Bundle branch disease w/o pacemaker ```
27
Class III antiarrhythmics
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
28
Amiodarone info
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
29
Primary use of Class II (BBs) and Class IV (CCBs) antiarrhythmics
Inhibit AV conduction in supraventricular tachyarrhythmias or atrial arrhythmias
30
Pradaxa
Dabigatran (direct thrombin inhibitor); advantage to this is Idaracuizumab exists and can reverse effects
31
CHADS VASC score needed for valvular afib
0 You always anticoagulate valvular afib
32
Duration of anticoagulation needed prior to cardioversion for afib
At least 3 weeks (assuming they have been in afib for >48hrs)
33
Pradaxa
Dabigatran (direct thrombin inhitibitor); advantage to this is Idaracuizumab exists and can reverse effects
34
What to examine w/ supraventricular tachycardias
RP interval RP < PR = AVNRT, AVRT (WPW), junctional tachycardia RP > PR = Sinus, atrial tachycardia
35
Atrial flutter physiology
Reentry tachycardia around the tricuspid annulus
36
Treatment for short QT syndrome or Brugada syndrome
ICD in ALL PATIENTS
37
What to examine w/ supraventricular tachycardias
RP interval RP < PR = AVNRT, AVRT, junctional tachycardia RP > PR = Sinus, atrial tachycardia
38
First line therapy for stable WPW
Catheter ablation
39
Treatment for short QT syndrome
ICD in ALL PATIENTS
40
Early Repolarization Syndrome
Characterized by J point elevation in the inferior and lateral leads; requires ICD placement in patients who have VF or cardiac arrest
41
Activities to avoid if you have an ICD
Weight lifting or upper body exertion; can lead to stress and fracture of device Also avoid welding equipment, high voltage machinery
42
Patients to consider Watchman placement for
``` Thrombocytopenia Coagulation defects Recurrent bleeding Need for prolonged DAPT Poor oral anticoagulant compliance Fall risk ```
43
Pulses in aortic stenosis
Pulsus tardus et parvus Delayed and late
44
Goal INR for mechanic aortic valve prosthesis with no other risk factors for thromboembolism
2.5 They also need to be on aspirin!
45
When is the goal INR 3.0?
High risk factors for thromboembolism Order generation AV VALVE (ball in cage) Any mitral prosthesis
46
Duke criteria
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
When is dental prophylaxis appropriate
History of endocarditis Cardiac transplant WITH valve regurgitation Prosthetic valve Prosthetics used for cardiac repair Congenital heart disease
48
Duration of colchicine therapy for pericarditis
3 month, 0.5mg BID Additionally, patients should avoid exercise/overexertion
49
What to check when your ABI is >1.4 indicating calcified arteries?
Toe-brachial index
50
HOCM therapies for symptoms
BBs that do NOT cause systemic vasodilation (metoprolol or bisoprolol) Nondihydropyridine CCBs Last: Disopyramide - has significant negative inotropic activity
51
What to offer HOCM patients who still have symptoms despite maximal therapy?`
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
Patients w/ HOCM and afib
Needs warfarin
53
Echo findings consistent w/ restrictive cardiomyopathy
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
Carney Complex
Mutation of PRKAR1A TSG Lentigines (liver spots) Atrial Myxoma Blue nevi
55
Most common primary malignant cardiac tumor
Angiosarcoma; highly vascular and appear that way on CT or MR Survival rate even w/ successful resection is <2 years
56
Duration of colchicine therapy for pericarditis
3 months with .5mg BID Also tell patients to avoid exercise for this time period
57
Platypnea-orthodexia syndrome
Right-left cardiac shunting through a PFO due to transient increase in right atrial pressure Requires PFO closure
58
Ostium secondum ASD findings
EKG: Incomplete RBBB, P pulmonale, RAD CXR: RAE, prominent pulmonary arteries
59
Associated abnormalities w/ ostium primum defect
MVR due to mitral valve cleft, LVOT
60
Associated abnormalities w/ sinus venosus ASD
Afib, anomalous pulmonary vein connection
61
Repaired tetrology of Fallot abnormalities
EKG: RBB, QRS prolongation CXR: Cardiomegaly w/ pulmonary or tricuspid valve regurgitation, Right sided aortic arch in 25%
62
ASD and cardiac pacemaker placement
Higher risk of thromboembolism; reasonable to consider closure prior to placement
63
Main indications for ASD closure
Right sided cardiac chamber enlargement Dyspnea Atrial arrhythmias Crypotogenic stroke is a relative indication
64
Noonan syndrome
``` Pulmonary stenosis Mental retardation Short stature Webbed neck Ocular hypertelorism ```
65
Pulmonary Stenosis repair indications
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
What genetic syndrome is associated w/ TOF?
DiGeorge syndrome
67
Complication associated w/ TOF repair
VSD patch closure and transannular patch placement of PS leads to pulmonary regurgitation
68
Hematologic complication in patients w/ TOF or Eisenmenger syndromes
Erythrocytosis; therapeutic phlebotomy is indicated up to 3x/yearly if symptomatic w/ HA, HTN, visual disturbance, fatigue and if Hgb >20
69
Additional measures need w/ congenital cyanotic heart disease prior to procedures
Abx prophylaxis for nonsterile procedures IV filters to prevent paradoxical air embolism Early ambulation, SCDs, and anticoagulation
70
Pseudoclaudication
Mimics PAD, however, discomfort also includes neuropathies and does not always worsen w/ exercise
71
What to do when ABI is 1.0 but still highly suspect PAD
Do an exercise ABI
72
Black box warning and contraindication on cilostazol
Increased mortality in patients w/ heart failure
73
Size for DESCENDING thoracic aortic aneurysm repair
>6.0 cm
74
Medication that can lower risk for cardiotoxicity w/ doxorubicin
Dexrazoxane
75
Chemotherapy class that will cause REVERSIBLE cardiotoxicity (unlike the anthracyclines)
Trastuzumab You may actually even restart therapy once the EF has returned to normal
76
Risk calculator to use for pregnancy in cardiac patients
ZAHARA

MKSAP (15 decks)

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