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Cardiology Flashcards

1
Q

Normal RA pressure

A

2-6

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2
Q

Normal RV pressure

A

25/5

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3
Q

Normal PA pressure

A

25/10

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4
Q

Full amio load

A

10g

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5
Q

normal wedge pressure

A

less than 12

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6
Q

GDMT is

A

beta blocker + ace or arb

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7
Q

Management of patient with high pretest for ACS in stem

A

cath/urgent angiography`

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8
Q

Indications for mitral valve repair with mitral regurgitation

A

1) Symptomatic with EF greater than 30%
2) Asymptomatic patients with LV dysfunction (LVEF of less than 60%)
3) pts undergoing another cardiac surgical procedure
4) AF or PHTN

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9
Q

to know about avastin and HTN

A
  • common SE
  • dose dependent
  • usually 2 months after starting
  • reversible
  • large increases in BP can happen
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10
Q

cardiotoxicities of paclitaxel

A

Bradycardia

Heart block

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11
Q

Clinical features of aortic coarctation

A
  • Radial artery to femoral artery pulse delay

- Systolic murmur heard over the left chest

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12
Q

Management of acute limb ischemia

A

Stat vascular consult
Heparin gtt
Urgent invasive angiography (need to define anatomic level of occlusion) (need to take to cath lab because then can treat too)

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13
Q

Anticoagulation of AF in patient with CAD on aspirin

A

Start NOAC, drop aspirin (increased risk of bleeding with no apparent incremental benefit) (unless recent active CAD (ACS or revascularization in the past 12 months)

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14
Q

CHADSV-VASc scoring

A 
CHF
HTN 
Age (2) -- over 65 = 1, over 75 =2
DM2 
S = Sex, female = 1
VASc = prior MI or PAD
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15
Q

Other bleeding RF’s

A

Low BMI
HTN
Female sex

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16
Q

first line for effusive constrictive pericarditis

A

NSAIDs and colchicine

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17
Q

Diagnosis of effusive constrictive pericarditis

A

Intrapericardial pressure is reduced to normal following drainage with pericardial window but intracardiac pressures remain elevated and equalized.

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18
Q

ACC/AHA recommendation on entresto

A

Substitute ACE or ARB for entresto + reduced EF + has tolerated ACE or ARB well

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19
Q

typical reason for elevated liver enzymes in low flow/heart failure

A

congestive hepatopathy

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20
Q

Indications for ablation with AF or AFib

A

Symptomatic despite adequate medical therapy and rate control

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21
Q

PDA murmur description + location

A
  • Continuous murmur beneath the left clavicle
  • Envelops the S2
  • “Machinery murmur”
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22
Q

Clinical presentation of moderate-sized PDA

A
  • Bounding pulses, wide pulse pressure, left heart enlargement and dysfunction, CHF
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23
Q

Clinical presentation of large-sized PDA

A

pulmonary hypertension, shunt reversal syndrome (eisenmenger)

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24
Q

Presentation/location of aortic regurgitation

A

Diastolic murmur

  • left sternal border
  • often systolic ejection click
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25
Q

VSD murmur description

A
  • Loud holosystolic murmur at left sternal border

- often palpable thrill

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26
Q

What is cardiac syndrome X?

A

Angina/typical chest pain and stress testing abnormalities in the absence of CAD on angiography.

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27
Q

Features of Takotsubo cardiomyopathy

A

nonexertional chest pain + EKG changes (ST-segment elevations) + elevated cardiac enzymes + antecedent physical stress

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28
Q

Initial step in management of intermittent claudication

A

Superrvised exercise training

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29
Q

proper medical term for acute limb ischemia

A

Critical limb ischemia

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30
Q

Next step after US with AAA that needs repair

A

CT angiography

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31
Q

Indications for repair with AAA

A

1) 5.5 cm or larger
2) growing 0.5 cm/yr or greater
3) symptomatic (abdominal or back pain/tenderness)

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32
Q

Relationship of alcohol intake and CVD

A
  • moderate alcohol intake has been linked with decreased incidence of CVD
  • heavy alcohol consumption is bad
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33
Q

Association between smoking and cardiovascular disease

A
  • active smoking is a strong RF for CVD
  • BUT smoking cessation substantially reduces CVD risk within 2 years with risk returning to level of a nonsmoker within 10 years
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34
Q

To do for clinic visit in patient with stable CHF

A

Measure kidney function and bytes with BMP
- NO routine echo if stable, only if change in clinical status OR new medication that may improve EF OR indicated for a device

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35
Q

Next step after WPW diagnosis

A 
Electrophysiology testing (confirm diagnosis, determine risk of SCD/risk stratification, potentially ablate and cure the arrhythmia)
TTE (exclude structural heart disease associated with accessory pathways)
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36
Q

Preconception counciling for patient with Marfan syndrome and a dilated aorta

A

Advise against pregnancy if aortic diameter is greater than 4.0 CM + stable over 6 months (too high a risk of aortic dissection and rupture) + consider elective surgical repair

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37
Q

Clinical features of papillary fibroelastoma

A

Small, mobile cardiac tumors that are typically attached to the endocardium by a stalk + associated with CVA/TIA + MI

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38
Q

Management of symptomatic papillary fibroelastoma

A

Surgery

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39
Q

Clinical features of atrial myxomas

A

Large + may cause TIA/CVA + obstructive symptoms

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40
Q

Nonbacterial thrombotic endocarditis clinical features

A

small vegetations + wart-like/irregularly shaped + associated with advanced malignancy or connective tissue disorders

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41
Q

Common comorbidity in patients with Eisenmenger syndrome

A

Iron deficiency

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42
Q

Indications for thrombolytics in STEMI

A

Symptom onset within 12 hours + PCI not available within 3 hours of medical contact

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43
Q

Typical lytic used for STEMI

A

full dose reteplase

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44
Q

How to calculate ABI’s

A

Higher ankle pressure (of either leg) is divided by higher brachial pressure (of either arm)

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45
Q

ABI intepretation

A
  1. 90 or less = PAD

1. 40 or greater = calcified, noncompressible arteries, not interpretable

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46
Q

Management of patient with ABI greater than 1.40

A

Measure toe pressure and calculate a toe-brachial index

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47
Q

Management of patient with borderline ABI (0.91-1.00) or normal ABI with high pretest for PAD

A

Exercise ABIs

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48
Q

management of patient with infective endocarditis and refractory bacteremia (persistent fever longer than 5 to 7 days while on antibiotics)

A

Cardiac valve surgery

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49
Q

Indications for cardiac surgery with IE

A 
Symptomatic heart failure
Heart block
Annular or aortic abscess
Fungal infections
Highly resistant organisms
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50
Q

Indications for balloon pump

A

Acute MR

Cardiogenic shock unresponsive to other interventions

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51
Q

Cardiac comorbidity to know among HIV patients

A

1.5x to 2x risk for CAD

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52
Q

What is typical angina?

A

1) Substernal pain or discomfort
2) Provoked by exertion or emotional stress
3) Relieved by rest and or nitoglycerin

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53
Q

Before choosing ICD always remember

A

Patient needs to be medically optimized with GDMT before pursuing ICD (many patients benefit and don’t need an ICD after)

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54
Q

Cardiac resynchronization therapy means

A

pacer

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55
Q

Cardiac resynchronization therapy indications in HFrEF

A

EF less than or equal to 35%

+ NYHA at least II despite GDMT + LBBB with QRS complex of 150 ms or greater

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56
Q

Restrictive cardiomyopathy vs. constrictive pericarditis

A

Restrictive cardiomyopathy = elevated BNP (normal in constrictive pericarditis) + concordant rise and fall of let and right systolic pressures with respiration (inverse relationship in constrictive due to ventricular interdependence (RV systolic pressure rises during inspiration coupled with a decrease in LV systolic pressure) + severe pHTN

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57
Q

Initial management of descending aortic dissection

A

Medical therapy to control heart rate and blood pressure (Start with IV beta blocker. If refractory, add sodium nitroprusside + opioids)

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58
Q

Complicated aortic dissection means

A 
shock
refractory pain
rapid aneurysmal expansion
rupture
malperfusion syndrome
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59
Q

Goal BP reduction in descending aortic dissection

A

Reduce BP to 120 mm Hg or less in the first hour

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60
Q

SE to know about with ticagrelor

A

Dyspnea (typically self-limited)

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61
Q

Timing + clinical features of in-stent restenosis

A

months to years after stent implantation + signs/symptoms of ischemia (chest pain, dyspnea)

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62
Q

stent thrombosis presentation

A

acute MI and/or death

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63
Q

Timing + clinical features of ventricular septal rupture after MI + when it occurs

A

3-5 days post STEMI presentation + worsening heart failure and shock + harsh holosystolic murmur at LLSB + typically from RCA or LAD infarct

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64
Q

hallmark of motion abnormalities of takotsubo

A

WMA abnormalities extending beyond a single coronary territory

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65
Q

Management of symptomatic severe pulmonary stenosis

A

ballon valvuloplasty

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66
Q

Indications for balloon valvuloplasty with pulmonary stenosis

A

symptomatic + doppler gradient of greater than 50 mm Hg or mean gradient grader than 30 mm Hg

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67
Q

next step in evaluation of sinus bradycardia

A

Exercise stress testing (need to assess for chronotropic incompetence, whether HR improves with exercise, and if not, need pacer)

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68
Q

most common cause of pathologic sinus bradycardia

A 
Intrinsic = SA dysfunction from age-related myocardial fibrosis
Extrinsic = med SE
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69
Q

agents of choice in treating HTN in pregnancy

A

Labetalol and methyldopa

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70
Q

Management + timing of asymptomatic severe MR with preserved LV EF

A

TTE q 6 months

71
Q

Management of asymptomatic PAD incidentally found in orthography for PCI

A

cardiac rehab, aggressive RF modification (don’t use cilostazol)

72
Q

Management of patient with HOCM who wants to play sports

A

Can only play sports that are static and low intensity (golf, curling, bowling, cricket) (most common cause of sudden death in young athletes)

73
Q

Indications for ICD in HOCM

A

1) Massive myocardial hypertrophy (wall thickness >30 mm)
2) previous arrest
3) blunted blood pressure response or hypotension during exercise
4) unexplained syncope
5) NSVT
6) family history of sudden death due to HCM

74
Q

Presentation of ventricular free wall rupture

A

Sudden-onset chest pain or syncope with rapid progression to PEA (causes rapid accumulation of blood in the pericardium and tamponade)

75
Q

Management of mitral stenosis when symptoms don’t correlate to anatomy

A

Exercise echocardiography (need to determine mitral gradient and pulmonary pressures during exercise. It can look structurally normal despite being severe because valve gradient may only become severe with exertion)

76
Q

Mitral stenosis clinical presentation

A
  • can be indolent (remain asymptomatic for years and have gradual decrease in activity)
  • similar to CHF – dyspnea, orthopnea, fatigue
77
Q

Medical therapy for mitral stenosis

A

Diuretics
Long-acting nitrates
(Reduce preload)

78
Q

Management of hemodynamically significant mitral stenosis

A

Percutaneous or surgical therapy

79
Q

When thrombolytics are indicated for STEMI

A

If patient can’t be transferred to a PCI-capable center within 2 hours

80
Q

Sequela to know of with bicuspid aortic valve

A

Ascending aortic aneurysms (patients with bicuspid aortic valves are prone to aneurysms)

81
Q

Indications for aortic valve repair in patients with a bicuspid aortic valve and a thoracic aortic aneurysm

A

Diameter of 5.5 cm or larger

OR symptomatic

82
Q

Clinical features of peripartum cardiomyopathy

A

LV systolic dysfunction with onset toward the end of pregnancy or in the months following delivery + absence of another cause

83
Q

Management of peripartum cardiomyopathy

A

GDMT except ACEi’s or aldosterone antagonists, which are teratogenic

84
Q

Takotsubo presentation

A

Mimics ACS: Chest pain + ST elevations on ECG + elevated troponin

85
Q

Which method to use for capturing arrhythmia outpatient

A

IF once or twice a week –> external event recorder
IF daily symptoms –> 24 hour ambulatory ECG monitor
IF very infrequent or rare episodes –> implantable loop recorder

86
Q

Factors that influence BNP levels and direction (which direction level goes)

A 
Kidney failure (increase)
Older age (increase)
Female sex (increase)
Obesity (decrease)
87
Q

BNP value that can reliably exclude heart failure

A

Less than 100 (unless obese, female, kidney failure, or older age)

88
Q

Management of critical limb ischemia

A

Immediate invasive angiography with endovascular revascularization

89
Q

Clinical features of critical limb ischemia

A
  • ABI below 0.40
  • absent pedal pulses
  • ulceration
  • cold to touch
90
Q

Management of AV block in the setting of ACS

A

Cath lab (revascularization may also correct conduction deficit)

91
Q

Indications for surgery in severe AR

A

Severe + one of following

  • symptomatic
  • EF less than ***50%
  • significant LV dilatation
92
Q

Management of severe AR

A

IF no surgical indication –> echo q6-12 months

*can use ACEs or ARBs in hypertensive but haven’t been shown to delay need for surgery.

93
Q

Management of patient post STEMI leading to CHF

A
  • ACEi within 24 hours of presentation (mortality benefit)
  • beta-blocker once stabilized and NO clinical signs/symptoms of CHF from STEMI. Beta-blockers should be started within 24 hours of STEMI presentation (decrease myocardial O2 demand, reduce ventricular arrhythmias and improve survival)
94
Q

Management of AF in HOCM

A

Warfarin regardless of CHADS-VASC (higher incidence of CVA in HOCM)

95
Q

Management of patient with discrepancy between symptoms of AS and echo findings

96
Q

Clinical features of cardiac tamponade + on imaging/EKG

A

Hypotension
Pulsus paradoxus
Enlarged cardiac silhouette
Electrical alternans

97
Q

Common cardiac manifestation of SLE

A

Pericarditis

98
Q

Evaluation for CAD among patients with intermediate CV risk accorded to ASCVD and to determine if patient is indicated for statin therapy

A

Coronary artery calcium scoring

99
Q

Diltiazem contraindication

A

HFrEF (nondihydropyridines are contraindicated in heart failure)

100
Q

Management of ACE inhibitor induced cough

A

switch to an ARB

101
Q

Management of ACE inhibitor induced angioedema

A

Switch to an ARB (but angioedema has been reported with ARBs as well, so with caution)

102
Q

Indications for CABG

A

1) Multivessel CAD and reduced EF

2) Multivessel disease and DM2

103
Q

First and second line management of symptomatic PVCs

A
  • first line = b-blockers or CCBs

IF frequent PVCs despite medical therapy or patients develop LV dysfunction –> catheter ablation

104
Q

Evaluation of symptomatic PVCs

A
  • Exercise stress testing to eval for ischemia + assess response of PVCs to exercise
  • TTE to rule out structural heart disease
105
Q

Management of patients with symptomatic mitral regurg who are not surgical candidates

A

Transcatheter mitral valve repair

106
Q

ABI diagnostic for PAD

A

Less than or equal to 0.90

107
Q

PAD and statin therapy

A

High intensity statin therapy regardless of ASCVD

108
Q

Management of end-stage heart failure

A
  • LVAD or transplant
109
Q

Pacemaker indication in CHF

A

1) EF less than or equal to 35%
2) NYHA II-IV despite GDMT + sinus rhythm
3) LBBB with QRS of 150 ms or greater
4) survival of at least 1 year

110
Q

Gold standard for end-stage heart failure

A

Cardiac transplantation

111
Q

Contrandications to cardiac transplantation

A

Age older than 65
Comortbidities (DM2, malignancies, kidney failure)
Lack of social support and adherence

112
Q

Pulmonary regurg clinical features

A

RH volume overload
parasternal lift
diastolic

113
Q

Indications for AAA repair

A

1) symptomatic (abdominal tenderness or pain)
2) rapid expansion in size (>0.5 cm/yr)
3) size greater than 5.5 cm

114
Q

First step if suspected perivalvular abscess

A

TEE (better visualization of abscess + important for surgical planning)

115
Q

Perivalvular abscess clinical features + classic patient

A
  • PR-interval prolongation on EKG (causes first degree AV block)
  • Pts with bicuspid aortic valve
116
Q

Evidence for supplemental O2 in setting of normal O2 sat for patients with acute MI

A

HARMFUL (systematic review has shown O2 therapy not be initiated in critically ill patients with an O2 sat of 93% or higher so guidelines strongly recommend against it).

117
Q

Guideline indications for PCI

A
  • Refractory symptoms while on optimal medical therapy
  • unable to tolerate optimal medical therapy
  • high risk features on stress or imaging
118
Q

Anticoagulation therapy in woman with mechanical valve contemplating pregnancy

A

Warfarin (high risk subset and warfarin is preferred)

119
Q

Eliquis during pregnancy?

A

Hasn’t been studied

120
Q

Antibiotics that cause QT prolongation

A

Macrolides

Fluoroquinolones

121
Q

Medication classes that causes QT interval prolongation

A

Antibiotics
Antipsychotics
Antidepressants

122
Q

VT vs. NSVT

A

VT = 30 seconds

123
Q

Indications for valve replacement aortic regurgitation + bicuspid valve

A

1) symptomatic
2) LV end systolic diameter of 50 mm
3) Reduced EF (less than 50%)
* Due to increased risk for sudden cardiac death and heart failure.

124
Q

Ivabradine indication + utility

A
  • EF less than 35% + in sinus rhythm taking GDMT

Reduces CHF hospitalizations in patients with EF less than or equal to 35%

125
Q

Aldactone indication

A
  • After ACEi + betablocker has been uptitrated to maximally tolerated doses
  • NYHA II-IV
126
Q

Management of relative of HOCM patient

A

Genetic counseling and testing regardless of whether pt is symptomatic

127
Q

Important RF for CAD to know about

A

Inflammatory disease (RA, SLE)

128
Q

Inappropriate sinus tachycardia clinical features

A

Diagnosis of exclusion + structurally normal heart + elevated resting heart rate that increases with light activity

129
Q

CAD evaluation in patient with LBBB on a baseline ECG

A

Adenosine single-photon emission CT/vasodilator stress test

*dobutamine or exercise stress test may result in false-positive perfusion defect

130
Q

New onset CHF initial workup

A

BNP
CBC, CMP, lipid panel
*TSH

131
Q

acute severe MR clinical presentation + pathophys

A
  • usually papillary muscle rupture following acute MI, then patient presents with acute CHF presentation
132
Q

Aortic stenosis features on exam

A

Crescendo-decrescendo systolic murmur + second right intercostal space + radiation to carotids

133
Q

Triscupid regurg clinical features

A

Loudest at left lower sternal border + increases with inspiration + can have signs of RH failure

134
Q

Management of type 1 NSTEMI, for which patient declines cath and is managed medically

A

Ticagrelor for 12 months (superior to plavix in trials) + ASA indefinitely

135
Q

Constrictive pericarditis clinical features

A

Indolent progression of right-sided heart failure + low or normal BNP (absence of ventricular shift)

136
Q

TTE findings in constrictive pericarditis

A
  • respiratory variation in filling of right and left ventricles
  • ventricular septal shift during respiration
  • IVC dilation
137
Q

Ostium secundum ASD murmur description + features on exam + EKG

A
  • Fixed splitting of S2
  • RV heave
  • Right-axis deviation
  • Incomplete right bundle branch block on EKG
138
Q

Mitral stenosis murmur description

A

Opening snap, followed by a diastolic murmur

139
Q

Milrinone drug class and use

A

IV inotrope similar to dobutamine, used for low flow

140
Q

PAD diagnosis of ABI

A

less than or equal to 0.9

141
Q

Management of PAD after patient doesn’t respond to supervised exercise program

A

Add cilostazol

142
Q

Management of PAD patient not responding to cilostazol

A

Invasive management (endovascular or surgical revascularization)

143
Q

Cardiac amyloidosis TTE features

A
  • Black patients older than 50
  • Severe concentric LV wall thickening
  • preserved systolic function
  • severe pHTN
144
Q

EKG for cardiac amyloidosis

A

Low voltage + “pseudoinfarct” pattern: Q waves in anteroseptal leads without regional wall motion abnormalities on TTE

145
Q

Indication for Hydralazine + isosorbide dinitrate in CHF + evidence

A 
Black + on maximal GDMT + NYHA class III or IV
- mortality benefit
146
Q

Management of mobitz II after STEMI

A

Emergent pacemaker (life threatening complication of anterior MI due to necrosis of septum and His-Purkinje system because it can progress to complete heart block)

147
Q

Next step when bicuspid valve and aortic enlargement are noted on TTE

A

CT angiography of aorta (commonly associated with aorta abnormalities)

148
Q

Bicuspid valve common comorbidity

A

Aorta abnormalities (aneurysm, dissection, coarctation)

149
Q

Greatest RF for atherosclerotic cardiovascular disease

A

DM2 (this is why all diabetics need to be on statins)

150
Q

Coronary Anatomy of new LBBB

A

LAD occlusion

151
Q

Clinical features of upper extremity PAD

A
  • Arm claudication
  • Dizziness with arm activity
  • BP differential in arms
152
Q

Workup of suspected upper extremity PAD

A

CT angiography of chest and neck

153
Q

First 2 steps with suspected aortic dissection

A

1) CT angio

2) Differentiate Type A from type B

154
Q

How to differentiate type A from type B dissection

A

*Look at CT
Type A = ascending aorta or arch
Type B = descending aorta

155
Q

Management of type A aortic dissection + why

A

Open surgical repair (high mortality rate and complications)

156
Q

Dissection clinical features

A
  • unequal BPs in arms and pulses
157
Q

When are TTE’s indicated for murmurs

A

1) Symptomatic
2) Systolic murmurs grade 3/6 or higher
3) Late or holosystolic murmurs
4) Diastolic or continuous murmurs

158
Q

Features of benign murmurs

A
  • brief
  • midsystolic
  • no radiation
159
Q

Clinical presentation of TR

A

Can be well tolerated for a while but likely eventually progress to
Right heart failure

160
Q

Description of TR

A

Holosystolic murmur along left lower sternal border + increases during inspiration

161
Q

medication change to make when CAD patient is switched to dilt or verapamil

A

Decrease ranolazine (dilt and verapamil are CYP3A inhibitors)

162
Q

SE to know about when ranolazine

A

CYP3A4 inhibition

163
Q

Management of RBBB

A

nothing really – history and physical unless evidence of structural heart disease

164
Q

management of first degree AV block

A

nothing really – history and physical unless evidence of structural heart disease

165
Q

Major SE to know about with entresto

A

hypotension

166
Q

How to switch from ACEI to entresto

A

wait at least 36 hrs after stopping ACEi

167
Q

term for ASD surgery

A

device closure

168
Q

Indications for ASD closure

A

Right heart enlargement

Symptomatic

169
Q

Management of severe AS in patient who isn’t surgical candidate

170
Q

Medical therapy for AS

A

NOT effective in slowing disease progression

171
Q

Most common serious complication of catheter ablation

A

cardiac tamponade

172
Q

cardiac tamponade presentation

A

Elevated JVP
Narrow pulse pressure
pulsus paradoxus
electrical alternans

173
Q

Diagnosis of cardiac sarcoidosis

A
  • Cardiac MRI + PET/CT

- NO bx (patchy involvement)

174
Q

Acute pericarditis treatment

A

High-dose ASA or NSAIDS + adjuvant colchicine therapy

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