Cards

Question 1

Least interactions of statin

Answer 1

Pravastatin has the least interactions. atorvastatin, lovastatin, and simvastatin are primarily metabolized through the cytochrome P-450 3A4 isoenzyme and interact with diltiazem. Crestor interacts with CYP2C9 and can effect warfarin levels. Use atorvastatin in HIV patients

Question 2

Management of mitral stenosis

Answer 2

Severe stenosis (>10 mmHg gradient, LA enlargement) is best managed with balloon valvuluplasty IF favorable anatomy (no calcification, no thickening, good mobility, no subvalvular thickening) and only mild regurgitation, otherwise need valve replacement

Question 3

Evaluation of cardiac risk in younger woman

Answer 3

Best score is the Reynolds risk score as Framingham tends to under-estimate risk

Question 4

Cheyene stokes respiration in heart failure

Answer 4

Medically optimize first, including dieresis. If persists can use servo controlled ventilation.

Question 5

Murmur and need for echo

Answer 5

If:
>3/6
diastolic
continuous
holosystolic
late systolic
click if it is radiating to the neck or back

Question 6

Repair MR?

Answer 6

> LV 45 mm

LVEF

Question 7

Repair a AAA?

Answer 7

Greater than 5.5 cm or >0.5 cm in 1 year growth

Question 8

Bridge anticoagulation?

Answer 8

• Embolic stroke or systemic embolic event within the previous 12 weeks
• Mechanical mitral valve
• Mechanical aortic valve and additional stroke risk factors
• Atrial fibrillation and very high risk of stroke (eg, CHADS2 score of 5 or 6, stroke or systemic embolism within the previous 12 weeks)
• Venous thromboembolism (VTE) within the previous 12 weeks
• Recent coronary stenting
• Previous thromboembolism during interruption of chronic anticoagulation

Question 9

Indications for BiV pacing

Answer 9

Class III-IV symptoms, LVEF 120
OR
Class II, LVEF 150

Question 10

Constrictive pericarditis echo findings

Answer 10

shifting of the ventricular septum to and fro, not seen in restrictive cardiomyopathy

Question 11

Anti-coagulate in mitral stenosis?

Answer 11

If they have Afib, do not go by Chads2 score
LA >5.5 cm
Previous embolic event