Cardiovascular V Flashcards
What is the primary mitral valve abnormality in patients with hypertrophic obstructive cardiomyopathy?
Systolic anterior motion of the mitral valve
mitral valve leaflet move toward the interventricular septum, resulting in left ventricular outflow tract obstruction (harsh crescendo-decrescendo systolic murmur)
What is the recommended cooling technique for patients with exertional heat strokes?
Ice-water immersion
What is the recommended cooling technique for patients with non-exertional heat strokes?
Evaporative cooling (e.g. spraying lukewarm water while fans blow air on skin)
presents similarly to exertional heat stroke but typically affects elderly patients in the absence of strenuous activity
What is the recommended diagnostic test for patients with chest pain that have high-risk for CAD?
Coronary angiography
these patients should also be started on appropriate medical therapy
What is the recommended diagnostic test for patients with chest pain that have intermediate-risk for CAD?
Excercise stress ECG
coronary angiography is performed in patients with high-risk findings on initial stress testing or those with a high pretest probability of ischemic heart disease (see below)
What is the recommended diagnostic test for patients with chest pain that have low-risk for CAD?
No further testing
a positive stress test in low-risk patients is likely to be a false positive
What is the recommended lipid lowering therapy for patients <75 that have clinically significant atherosclerotic disease?
High-intensity statin
What is the recommended management for a 40-year-old male with paroxsymal atrial fibrillation and no history of diabetes, heart disease, or embolic event?
Observation (no therapy required)
CHA2DS2-VASc score is 0 in this patient
What is the recommended management for a hemodynamically stable Wolff-Parkinson-White syndrome patient with atrial fibrillation?
Procainamide
may also use other anti-arrhythmic drugs that do not cause AV block (e.g. IV ibutilide)
What is the recommended management for a hemodynamically unstable Wolff-Parkinson-White syndrome patient with atrial fibrillation?
Electrical cardioversion
What is the recommended management for a patient with a smoking/drinking history and atrial premature beats discovered on routine ECG (asymptomatic)?
Avoid alcohol and tobacco
this is a benign arrhythmia that doesn’t require treatment, however reversible risk factors should be avoided
What is the recommended management for a patient with first-degree AV block and a normal QRS duration (< 120 msec)?
Observation
likely due to delayed AV node conduction; prolonged QRS indicates delay below the AV node and warrants electrophysiology testing
What is the recommended management for costochondritis?
Reassurance and symptomatic pain management
What is the recommended pharmaceutical therapy to reduce overall cardiovascular mortality in patients with peripheral arterial disease?
antiplatelet agent (e.g. aspirin) and a statin
What is the recommended pharmaceutical treatment for acute pulmonary edema secondary to myocardial infarction?
IV furosemide (unless patient is hypotensive or hypovolemic)
What is the recommended reperfusion therapy for patients with NSTEMI that present within 12 hours of symptom onset but cannot undergo PCI?
Fibrinolysis
fibrinolysis is associated with higher rates of recurrent MI, intracranial hemorrhage, and mortality compared to PCI
What is the recommended screening protocol for abdominal aortic aneurysm?
One-time abdominal ultrasound for male active or former smokers aged 65-75 years
What is the recommended therapy for patients > 75 that have clinically significant atherosclerotic disease?
Moderate-intensity statin
What is the recommended treatment for a hemodynamically stable patient with a history of panic attacks that presents with chest tightness, lightheadedness, and the ECG below?
Adenosine
despite the history of panic attacks, this patient’s ECG is consistent with supraventricular tachycardia due to irregular P wave morphology (versus sinus tachycardia in panic attacks, which has regular P wave morphology)
What is the recommended treatment for a hemodynamically unstable patient with cardiac tamponade?
Emergency pericardiocentesis
What is the recommended treatment for patients with a CHA2DS2-VASc score > 2?
Oral anticoagulants
e.g. warfarin or non-vitamin K antagonist oral anticoagulants (e.g. apixaban, dabigatran, rivaroxaban, edoxaban)
What is the recommended treatment for patients with uremic pericarditis?
Hemodialysis
leads to rapid resolution of chest pain and reduces size of any associated pericardial effusion
What is the recommended treatment to reduce risk of stent thrombosis following drug-eluting stent placement?
Dual antiplatelet therapy for at least 12 months
i.e. aspirin and a P2y12 receptor blocker (e.g. clopidogrel, prasugrel, ticagrelor)
What is the treatment of choice for agitation in an NSTEMI patient with chest pain, agitation, dilated pupils, and normal cardiac enzymes?
IV benzodiazepines
this patient likely is experiencing cocaine toxicity; IV benzodiazepines improve symptoms of agitation, reduce myocardial O2 demand, and alleviate cardiovascular symptoms; aspirin, nitroglycerin, and CCBs are also effective in the initial management of chest pain (beta-blockers are contraindicated)
What is the treatment of choice for Dressler’s syndrome?
NSAIDs
anticoagulation should be avoided to prevent development of hemorrhagic pericardial effusion
What is the treatment of choice for peri-infarction pericarditis?
Supportive
NSAIDs are typically avoided (versus Dressler syndrome)
What laboratory finding has a high sensitivity for the diagnosis of congestive heart failure?
Elevated brain natriuretic peptide (BNP) levels
BNP levels > 400 pg/ML are suggestive of CHF, whereas levels < 100 pg/mL have a high negative predictive value for CHF
What level does a 2nd degree, Mobitz type I heart block typically occur?
AV node
What level does a 2nd degree, Mobitz type II heart block typically occur?
Below the AV node (e.g. bundle of His)
What medication is most likely responsible for weight gain, constipation, dry skin, and elevated LFTs in a patient being treated for hypertension, LV systolic dysfunction, and persistent atrial fibrillation?
Amiodarone
the patient likely has amiodarone-induced hypothyroidism with possible hepatocellular injury
What pharmaceutical treatment should be avoided in patients with MI that present with CHF or bradycardia?
Beta blockers
What phenomenon is illustrated in the image below?
Pulsus paradoxus
fall in systolic pressure > 10 mmHg during inspiration
What physical exam manuever is useful for distinguishing between cardiac- and liver disease-related causes of lower extremity edema?
Hepatojugular reflux
positive reflux is suggestive of cardiac causes (e.g. heart failure)
What physiologic effect results in increased intensity of a murmur due to hypertrophic obstructive cardiomyopathy?
Decreased preload
e.g. valsalva maneuver, standing, nitroglycerin administration
What thyroid disorder is associated with atrial fibrillation?
Hyperthyroidism
thus patients with new-onset AF should have TSH and free T4 levels measured
What two drugs/drug classes are used for dual anti-platelet therapy?
aspirin and P2y12 receptor blockers (e.g. clopidogrel)
useful for treatment of acute coronary syndromes and prevention of coronary events after stent placement
What valvular defect is a possible complication of aortic dissection?
Aortic regurgitation
may result in sudden onset worsening chest pain, hypotension, and pulmonary edema
What valvular defect is associated with a hyperdynamic pulse (e.g. bounding or “water hammer” pulses)?
Aortic regurgitation
What valvular defect is associated with bacterial endocarditis in IV drug users?
Tricuspid regurgitation
presents as a holosystolic murmur that increases with inspiration
What valvular defect is heard as a holosystolic murmur at the cardiac apex with radiation to the axilla?
Mitral regurgitation
common clinical features include exertional dyspnea, fatigue, atrial fibrillation, and signs of heart failure
What valvular defects (2) are associated with Marfan syndrome?
aortic regurgitation and mitral valve prolapse
Which class of anti-arrhythmic is characterized by prolonged PR intervals at faster heart rates?
Class IV (CCBs)
enhanced effect at faster heart rates is known as use dependence
Which class of anti-arrhythmic is characterized by prolonged QRS durations at faster heart rates?
Class I (especially class IC)
enhanced effect at faster heart rates is known as use dependence
Which of the following is most likely to occur in a patient with intermittent claudication secondary to peripheral arterial disease?
- Abdominal aortic aneurysm rupture
- Leg amputation (above- or below-knee)
- Myocardial infarction
Myocardial infarction
patients with PAD and intermittent claudication have an estimated 20% 5-year risk of non-fatal MI and stoke and a 15-30% risk of death due to cardiovascular causes
Which type of heart block is characterized by equal length PR intervals with intermittent dropped QRS complexes
2nd-degree, Mobitz type II
Which type of heart block is characterized by progressive lengthening of the PR interval followed by a dropped QRS complex?
2nd-degree, Mobitz type I (Wenckebach)
