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Medicine > Cardiovascular V > Flashcards

Cardiovascular V Flashcards

1
Q

What is the primary mitral valve abnormality in patients with hypertrophic obstructive cardiomyopathy?

A

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)

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2
Q

What is the recommended cooling technique for patients with exertional heat strokes?

A

Ice-water immersion

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3
Q

What is the recommended cooling technique for patients with non-exertional heat strokes?

A

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

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4
Q

What is the recommended diagnostic test for patients with chest pain that have high-risk for CAD?

A

Coronary angiography

these patients should also be started on appropriate medical therapy

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5
Q

What is the recommended diagnostic test for patients with chest pain that have intermediate-risk for CAD?

A

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)

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6
Q

What is the recommended diagnostic test for patients with chest pain that have low-risk for CAD?

A

No further testing

a positive stress test in low-risk patients is likely to be a false positive

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7
Q

What is the recommended lipid lowering therapy for patients <75 that have clinically significant atherosclerotic disease?

A

High-intensity statin

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8
Q

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?

A

Observation (no therapy required)

CHA2DS2-VASc score is 0 in this patient

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9
Q

What is the recommended management for a hemodynamically stable Wolff-Parkinson-White syndrome patient with atrial fibrillation?

A

Procainamide

may also use other anti-arrhythmic drugs that do not cause AV block (e.g. IV ibutilide)

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10
Q

What is the recommended management for a hemodynamically unstable Wolff-Parkinson-White syndrome patient with atrial fibrillation?

A

Electrical cardioversion

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11
Q

What is the recommended management for a patient with a smoking/drinking history and atrial premature beats discovered on routine ECG (asymptomatic)?

A

Avoid alcohol and tobacco

this is a benign arrhythmia that doesn’t require treatment, however reversible risk factors should be avoided

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12
Q

What is the recommended management for a patient with first-degree AV block and a normal QRS duration (< 120 msec)?

A

Observation

likely due to delayed AV node conduction; prolonged QRS indicates delay below the AV node and warrants electrophysiology testing

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13
Q

What is the recommended management for costochondritis?

A

Reassurance and symptomatic pain management

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14
Q

What is the recommended pharmaceutical therapy to reduce overall cardiovascular mortality in patients with peripheral arterial disease?

A

antiplatelet agent (e.g. aspirin) and a statin

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15
Q

What is the recommended pharmaceutical treatment for acute pulmonary edema secondary to myocardial infarction?

A

IV furosemide (unless patient is hypotensive or hypovolemic)

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16
Q

What is the recommended reperfusion therapy for patients with NSTEMI that present within 12 hours of symptom onset but cannot undergo PCI?

A

Fibrinolysis

fibrinolysis is associated with higher rates of recurrent MI, intracranial hemorrhage, and mortality compared to PCI

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17
Q

What is the recommended screening protocol for abdominal aortic aneurysm?

A

One-time abdominal ultrasound for male active or former smokers aged 65-75 years

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18
Q

What is the recommended therapy for patients > 75 that have clinically significant atherosclerotic disease?

A

Moderate-intensity statin

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19
Q

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?

A

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)

20
Q

What is the recommended treatment for a hemodynamically unstable patient with cardiac tamponade?

A

Emergency pericardiocentesis

21
Q

What is the recommended treatment for patients with a CHA2DS2-VASc score > 2?

A

Oral anticoagulants

e.g. warfarin or non-vitamin K antagonist oral anticoagulants (e.g. apixaban, dabigatran, rivaroxaban, edoxaban)

22
Q

What is the recommended treatment for patients with uremic pericarditis?

A

Hemodialysis

leads to rapid resolution of chest pain and reduces size of any associated pericardial effusion

23
Q

What is the recommended treatment to reduce risk of stent thrombosis following drug-eluting stent placement?

A

Dual antiplatelet therapy for at least 12 months

i.e. aspirin and a P2y12 receptor blocker (e.g. clopidogrel, prasugrel, ticagrelor)

24
Q

What is the treatment of choice for agitation in an NSTEMI patient with chest pain, agitation, dilated pupils, and normal cardiac enzymes?

A

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)

25
Q

What is the treatment of choice for Dressler’s syndrome?

A

NSAIDs

anticoagulation should be avoided to prevent development of hemorrhagic pericardial effusion

26
Q

What is the treatment of choice for peri-infarction pericarditis?

A

Supportive

NSAIDs are typically avoided (versus Dressler syndrome)

27
Q

What laboratory finding has a high sensitivity for the diagnosis of congestive heart failure?

A

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

28
Q

What level does a 2nd degree, Mobitz type I heart block typically occur?

A

AV node

29
Q

What level does a 2nd degree, Mobitz type II heart block typically occur?

A

Below the AV node (e.g. bundle of His)

30
Q

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?

A

Amiodarone

the patient likely has amiodarone-induced hypothyroidism with possible hepatocellular injury

31
Q

What pharmaceutical treatment should be avoided in patients with MI that present with CHF or bradycardia?

A

Beta blockers

32
Q

What phenomenon is illustrated in the image below?

A

Pulsus paradoxus

fall in systolic pressure > 10 mmHg during inspiration

33
Q

What physical exam manuever is useful for distinguishing between cardiac- and liver disease-related causes of lower extremity edema?

A

Hepatojugular reflux

positive reflux is suggestive of cardiac causes (e.g. heart failure)

34
Q

What physiologic effect results in increased intensity of a murmur due to hypertrophic obstructive cardiomyopathy?

A

Decreased preload

e.g. valsalva maneuver, standing, nitroglycerin administration

35
Q

What thyroid disorder is associated with atrial fibrillation?

A

Hyperthyroidism

thus patients with new-onset AF should have TSH and free T4 levels measured

36
Q

What two drugs/drug classes are used for dual anti-platelet therapy?

A

aspirin and P2y12 receptor blockers (e.g. clopidogrel)

useful for treatment of acute coronary syndromes and prevention of coronary events after stent placement

37
Q

What valvular defect is a possible complication of aortic dissection?

A

Aortic regurgitation

may result in sudden onset worsening chest pain, hypotension, and pulmonary edema

38
Q

What valvular defect is associated with a hyperdynamic pulse (e.g. bounding or “water hammer” pulses)?

A

Aortic regurgitation

39
Q

What valvular defect is associated with bacterial endocarditis in IV drug users?

A

Tricuspid regurgitation

presents as a holosystolic murmur that increases with inspiration

40
Q

What valvular defect is heard as a holosystolic murmur at the cardiac apex with radiation to the axilla?

A

Mitral regurgitation

common clinical features include exertional dyspnea, fatigue, atrial fibrillation, and signs of heart failure

41
Q

What valvular defects (2) are associated with Marfan syndrome?

A

aortic regurgitation and mitral valve prolapse

42
Q

Which class of anti-arrhythmic is characterized by prolonged PR intervals at faster heart rates?

A

Class IV (CCBs)

enhanced effect at faster heart rates is known as use dependence

43
Q

Which class of anti-arrhythmic is characterized by prolonged QRS durations at faster heart rates?

A

Class I (especially class IC)

enhanced effect at faster heart rates is known as use dependence

44
Q

Which of the following is most likely to occur in a patient with intermittent claudication secondary to peripheral arterial disease?

  1. Abdominal aortic aneurysm rupture
  2. Leg amputation (above- or below-knee)
  3. Myocardial infarction
A

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

45
Q

Which type of heart block is characterized by equal length PR intervals with intermittent dropped QRS complexes

A

2nd-degree, Mobitz type II

46
Q

Which type of heart block is characterized by progressive lengthening of the PR interval followed by a dropped QRS complex?

A

2nd-degree, Mobitz type I (Wenckebach)

Medicine (33 decks)

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