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)
