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Cardiology Board Review > General Board Review > Flashcards

General Board Review Flashcards

1
Q

HTN Stages

A

Optimal: < 120/80
Elevated: 120-129/<80
Stage 1: 130-139/80-89
Stage 2 >140/>90

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2
Q

HTN Tx algorithm
1)
2)
3)

A

1) HCTZ/Chlorthalidone vs loop if CKD
2) ACE/ARB + CCB
3) Spironolactone or eplerenone

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3
Q

Vasodilator testing positive response

A

Decrease mPAP by ≥10mmHg
Decrease mPAP to ≤40 mmHg
No worsening in CO

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4
Q

PAH Tx suggestion based on WHO symptom class

A

Class 2-3: Endothelin antagonist (bosentan, ambrisentan) + PDE5i (tadalafil, sildenafil)
Class 4: Prostacyclines (epoprostenol, treprostinil, iloprost)

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5
Q

Riociguat indications

A

Group I & IV Pulm HTN

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6
Q

Treatment of recurrent pericarditis

A

1) CRP-guided NSAIDS Taper + colchicine (repeat initial treatment)
2) Steroid taper over 6-12 months, NSAID taper, colchicine 6 months
3) Immunomodulation - IVIG, anakinra, AZT
4) Radical pericardiectomy

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7
Q

NSAID regimen for Pericarditis

  • ASA
  • Motrin
  • Indomethacin
A

ASA 750-1000 mg q8˚ ** ASA only if post-MI pericarditis
Motrin 600 mg q8˚
Indomethacin 50mg q8˚

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8
Q

Contraindication to pericardiocentesis

A

Aortic dissection

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9
Q

Hemodynamically, rapid Y-descent indicative of …

A

Rapid early diastolic filling

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10
Q

Rapid Y-descent seen in …

A

Constrictive and restrictive pericarditis

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11
Q

ABI interpretation

A

Non-compressible: >1.4
Normal: 1 - 1.4
Borderline: 0.91 - 0.99
Abnormal: ≤0.9

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12
Q

Exercise ABI Positive response

A

ABI decreases by 20%
Ankle pressure decreases by >30 mmHg

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13
Q

Vorapaxar
Class:
Effect:

A

Class: Protease activated receptor-1 (PAR-1) antagonist
Effect: reduces thrombotic events in Patients with a history of MI or PAD, without history of TIA/CVA
May reduce ALI

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14
Q

Acute Limb Ischemia:

  • Viable: (sensory, motor, arterial/venous doppler)
  • Threatened
  • Irreversible
A
  • Viable: Sensory, motor, arterial and venous Doppler intact –> Urgent, tx 6-24˚
  • Threatened: mild/moderate sensory loss, no muscle weakness, no arterial Doppler, audible venous Doppler –> Emergency, tx < 6˚
  • Irreversible: ø sensation, paralysis/rigor, ø arterial or venous Doppler –> 1˚ amputation
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15
Q

AAA Surveillance US timing

A

3 - 3.9: q 3 years

4 - 4.9: q 12 months
5 - 5.4: q 6 months

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16
Q

AAA indications for surgery

A

Diameter > 5.5 cm (IIa: 5 - 5.4 cm)
Expansion > 1 cm/yr
Symptomatic
Ruptured or contained rupture

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17
Q

Endoleak types 1-5

A

1 - Incomplete seal proximal or distal
2 - from collaterals
3 - fail to anastomose b/w stent components
4 - leak through graft materials
5 - sac expansion w/o clear lesion

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18
Q

Marfan syndrome: - Medical management - Hint: Caveat

A

Atenolol + *Losartan*

Even without HTN

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19
Q

Indications for aortic repair:

  • Turner’s
  • Loeys-Dietz
  • Marfan (and if pregnant?)
  • Bicuspid AV
A

Turner: ≥ 2.5 cm/m2 (indexed 2˚ short stature)
Loeys-Dietz: > 4 cm (dangerous: *DIE*tz)
Marfan: ≥ 5 cm, >4 cm if pregnant
Bicuspid AV: ≥ 5.5 cm

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20
Q

Indications to anticoagulate for distal LE DVT

A
  • Unprovoked + Symptomatic
  • Active malignancy
  • Close to proximal deep vein
  • Prior hx DVT
  • +D-Dimer
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21
Q

Acute ischemia CVA tx
tPA window:
BP goal if tPA given:

A

tPA window: 3-4.5 hours
BP goal if tPA given: < 185/110

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22
Q

tPA contraindications

A
  • ICH
  • CVA, head trauma, brain/spine surgery within 3 months
  • Brain/spine tumor
  • Coagulopathy: Platelets < 100K; INR > 1.7
  • on OAC/DOAC
  • Endocariditis
  • Aortic dissection
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23
Q

Coronary artery calcium score and statins

A

0: ø statin
1-99: +/- statin
≥100: start a statin

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24
Q

Only 2 diets to reduce CV death

A

Mediterranean
DASH Diet

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25
Q

Components and interpretation Revised Cardiac Risk Index

A
  • CAD
  • HF
  • Cr ≥ 2
  • Prior TIA/CVA
  • DM

≥2 = high risk

High risk surgeries: Vascular, thoracic, transplant

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26
Q

Activities ≥ 4 METs

A

≥ 2 flights of stairs
≥ 4 blocks
Rake leaves or push lawn mower

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27
Q

When is it okay to hold DAPT:
• BMS
• DES

A

BMS: after 30 days
DES: after 3-6 monts (IIb)
≥6 months (I)

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28
Q

STEMI, Lytics & transfer

  • Sx timing
  • Time to PCI
A

Sx’s < 3 hours onset
Anticipate > 2 hours to PCI
–> give lytics and transfer

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29
Q

1˚ Lytics strategy in STEMI

  • Timing
  • Other meds
A
  • Give lytics < 30 minutes of arrival
  • Also anticoagulate minimum 48˚ - 8 days, or until revascularization
    • Heparin, lovenox, fondaprinux
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30
Q

tPA dose

A

15 mg IVP Then 0.75 mg/kg over 30 minutes (up to 50 mg) Then 0.5 mg/kg over 60 minutes (up to 35 mg)

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31
Q

MI Complications: Dynamic outflow obstruction

  • Associated infarct pattern
  • Treatment
A
  • Apical infarct/hypokinesis -> compensatory hyperdynamic basal function -> LVOT obstruction and hypotension
  • Tx: ß-blocker; avoid inotropes and IABP
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32
Q

MI Complications:

  • New murmur while lying supine –> ?
  • New murmur while bolt upright –> ?
A
  • Supine: Acute VSD
  • Upright: Acute MR
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33
Q

MI Complications: Free wall rupture - Presentation - Infarct pattern - Associated complication?

A
  • Old lady, 1st AMI, anterior MI - Anterior free wall MI - Associated PEA
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34
Q

Pseudoaneurysm vs True Aneurysm:

A

Pseudo: narrow neck, contained rupture

True: Wide neck, affects all layers of myocardium

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35
Q

AF + Conditions that skip CHADS2-Vasc

A

Valvular AF: ≥ moderate MS + Mechanical valve
HCM: Warfarin

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36
Q

NOAC/Drug interactions

A
  • Verapamil - decrease edoxaban and Pradaxa
  • Dronedarone - Pradaxa contraindicated
  • HIV Protease inhibitors (-navir’s): NOAC’s contraindicated
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37
Q

AF RFA Complications: Atrioesophageal fistula management

A

Go to surgery, don’t do endoscopy
- Endoscopy uses air –> further air embolus

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38
Q

Cough and hemoptysis s/p AF RFA:

  • Dx?
  • Management
A

Pulmonary vein stenosis

  • Dx via CT PE/Angiogram
  • Tx: Balloon, pulmonary vein stenting
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39
Q

AF + WPW
- Management

A
  • DCCV ± procainamide
  • INPATIENT ablation
  • ø AV nodal blocking agents
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40
Q

Sympomatic WPW Management

A

Risk stratification:
- Exercise stress test (I)
• Low risk: Abrupt loss of pre-excitation
- Hoter (I)
• Intermittent loss of pre-excitation
- EP Study (IIa)

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41
Q

WPW Ablation indications

A
  1. Rapid conducting AP
  2. Employment precluded
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42
Q

ARVC

  • Pathology
  • EKG findings (3)
  • Exercise good/bad?
A
  • Desmosome protein mutation - junctional plakoglobin
  • EKG:
    1. LBBB
    2. TWI V1-V3
    3. Epsilon wave
  • Exertion/exercise speeds progression
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43
Q

Pt with VT & Heart block.

  • Dx?
  • Dx test?
  • Tx
A

Dx: Sarcoid
Testing: FDG-PET scan
Tx: Immune suppression ± ICD

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44
Q

Brugada Syndrome

  • Mutation
  • ICD indications
  • Tx:
A
  • SCN5A LOSS of function (Na channel)
  • ICD Indications: Aborted arrest, Syncope + Brugada pattern ECG
  • Tx: Quinidine (Ito blocker balances loss of Na channel function); treat fever
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45
Q

Bidirectional VT on stress ECG. Dx?

A

Catecholaminergic Polymporphic VT
- CPVT if increasing PVC’s/bigeminy w/ HR > 120 BPM, stops when resting

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46
Q

CPVT:
- Tx:

A
  • *Nadolol* ± flecainide ± left cardiac sympathetic denervation
  • DO NOT PLACE ICD
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47
Q

CPVT pathology

A

RYR2 mutation –> Ca release channel

  • Leaky ryanodine receptor –> Diastolic Ca overload
  • Mimics digoxin toxicity
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48
Q

LQTS: wide QRS adjustment

A

QTC - (QRS-100)

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49
Q

LQTS 1, 2, 3:

  • Channel
  • Loss/gain function
  • Presentation
A

1: IKs, LOSS of function, Swimming/activity
2: IKr, LOSS of function, Really loud noise, just Reproduced
3: INa, SCN5A GAIN of function, SNooze

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50
Q

LQTS Rx

A

1: ßB with NADOLOL or propranolol
3: PROPRANOLOL ± mexitil/Ranexa

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51
Q

AAD elimination

  • Renal?
  • Hepatic
A
  • Renal: sotalol, dofetilide, digoxin, NAPA (procainamide byproduct)
  • Hepatic: most other AAD’s, amio, lido, mexitil, verapamil, dilt, propafenone
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52
Q

Who gets IE PPx (6-7)

A
  • Prosthetic valves
  • Transcatheter valves
  • Prosthetic materials for valve repair (annuloplasty)
  • Prior IE
  • Transplant recipients w/ valvulopathy (> mild dz)
  • CHD:
    • unrepaired cyanotic lesions
    • cyanotic lesion w/ palliative shunt/conduit
    • repair ≤6 months w/ prosthetic materials
    • repaired lesion w/ residual shunt
  • Mitraclip? WATCHMAN?
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53
Q

Procedures requiring IE PPx

A
  • Dental
    • manipulate gums, roots
    • perforation of oral mucosa
    • cleaning, extraction, root canal
  • Incision into active soft tissue infxn
  • Incision/biopsy into respiratory tract
    • Bronch WITH BIOPSY **
    • Tonsil/adenoidectomy
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54
Q

Antibiotics for IE PPx

A
  • Amoxicillin 2g PO
  • Ampicillin 2g IM/IV

If allergy -> Clinda 600mg or Azithromycin 500mg

* coverage for viridans strep

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55
Q

Management of IE + mechanical valve + CVA Sx’s

A

STOP anticoagulation for ≥ 2 weeks

  • Prevents hemorrhagic transformation
  • If needs valve sx, delay for 4 weeks
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56
Q

Reimplantation after IE + CIED

A
  • Eval actual need
  • Consider contralateral implant
  • Timing:
    • 72˚ after device removal
    • 14 days if valvular involvement
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57
Q

Mitral Stenosis: MVA, Gradient?

  • Severe:
  • Very Severe:
A

Severe:

  • MVA: ≤ 1.5
  • Gradient: ~8-10 mmHg

Very Severe:
- MVA: < 1

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58
Q

Anticoagulation with mechanical valves

  • On-X
  • Mech AV
A

On-X + ø risk factors: INR 1.5-2
Mech AV + ø risk factors: INR 2.5

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59
Q

Anticoagulation with bioprosthetic valves

A
  • 1st 3 months: INR 2.5
  • After 3 mos + ø risk factors: ASA only
  • After 3 mos + risk factors: ASA + OAC
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60
Q

CVA + Prosthetic valve … OAC?

A
  • If not on ASA when CVA ocurred –> add ASA (should have been on aspirin)
  • If initial goal INR 2.5 –> 3
  • If initial goal INR 3 –> 4
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61
Q

Bridging in mechanical valves
- Risk factors for thromboembolism?

A
  • AF
  • Previous thromboembolism
  • Hypercoagulable condition
  • LVEF < 30%
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62
Q

Bridging in mechanical valves
- Who gets bridged

A
  • AV mechanical valve w/o risk factors –> NO BRIDGE
  • Everyone else –> Bridge
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63
Q

Bridging in bioprosthetic valves

A
  • ø risk factors –> ø bridge
  • 1st 3 months of +Risk factors –> BRIDGE
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64
Q

Contraindications to pregnancy (7)

A
  • PAH
  • Severe Ventricular dysfunction (EF <30%, NYHA III-IV)
  • Prior peripartum CM w/ residual LV dysfxn
  • Severe VHD: Sev MS, AS; Severe (re)coarctation
  • Sev AO dilation:
    • >45 mm in Marfan
    • >50 mm in Bicuspid AV
    • Turner with ASI > 25 mm2
  • Vascular Ehlers-Danlos
  • Fontan with any complication
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65
Q

Acute pericarditis in pregnancy:
- Management

A
  • <20 weeks –> NSAIDs
  • >20 weeks –> Corticosteroids
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66
Q

HTN in pregnancy
- BP based tx

A
  • SBP ≥ 150 or DBP ≥ 95 mmHg: Treat
  • ≥170/≥110: Hospitalize and tx
  • Gestational HTN + proteinuria + sx’s –> deliver
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67
Q

Sinus Venosus ASD associated with…

A

Anomalous right upper Pulmonary vein

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68
Q

Echo shows increased RV, but no ASD… Dx?

A

Sinus Venosus ASD (can’t be visualized on TTE) + anomalous pulmonary veins

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69
Q

Primum ASD (AKA partial AV canal defect_ is a connection between …

A

Primum ASD/partial AV canal defect is a connection between RA + LV

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70
Q

Primum ASD associated with (2)

A

Cleft mitral valve
Down’s syndrome

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71
Q

Primum ASD EKG findings (2)

A

Left axis deviation
RBBB

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72
Q

Primum ASD LV gram

A

Goose neck deformity

  • Apex to AV elongated
  • Apex to MV shortened
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73
Q

Condition precluding sinus venosus and primum ASD surgical repair

A

Pulmonary HTN
To close, must have:
- PA pressure < 50% systemic
- PVR < 1/3 SVR

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74
Q

VSD physical exam and management based on size:

  • Small
  • Large
A

Small:

  • LOUD NOISE, thrill
  • no sx’s, no Rx

Large:

  • Mitral diastolic flow rumble
  • LV enlargement –> close
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75
Q

Pulmonary stenosis - associated with …

A

Noonan’s Syndrome

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76
Q

Pulmonary Stenosis management

A

Mod-Sev PS + Sx’s –> balloon
Mod-Sev PS + Sx’s + unable to balloon or had prior ballon –> Surgery

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77
Q

Coarctation of the aorta, association

A

Bicuspid AV + Turner symdrome

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78
Q

Ebstein Anomaly: CXR

A

Big heart hanging on string

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79
Q

Glenn Shunt

  • Shunt
  • Indication
A
  • SVC –> Right or main pulmonary artery
  • Single ventricle, hypoplastic left heart
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80
Q

Blalock-Taussig Shunt

  • Shunt
  • Indication
A

Aorta –> Right pulmonary artery
• Subclavian A –> pulmonary A
• ToF, pulmonary atresia, tricuspid atresia, univentricular heart

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81
Q

Potts Shunt

  • Shunt
  • Indication
A
  • Aorta –> Left pulmonary artery
  • ToF
  • Not really used anymore
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82
Q

Waterston Shunt

  • Shunt
  • Indication
A
  • Aorta –> Right pulmonary artery
  • ToF
  • Not really used anymore
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83
Q

Fontan

  • Shunt
  • Indication
A
  • IVC/SVC/RA –> pulmonary arteries
  • Hypoplastic left heart, tricuspid/mitral atresia
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84
Q

Single ventricle shunt/operation order

A
  1. Blalock-Taussig - R subclavian A to pulmonary A 2. Glenn - SVC to PA 3. Fontan - IVC to PA
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85
Q

Congenitally corrected transposition of the great arteries (CC-TGA) associations

A

VSD
PS
Left-sided valvular regurgitation
Systemic Ventricular dysfunction
Complete heart block

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86
Q

Triggered VT

  • EAD associated with …
  • DAD associated with …
A
  • EAD: TdP
  • DAD: CPVT
    • CPVT with Ca overload/Ryanodine mutation
    • Mimics digoxin toxicity
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87
Q

EKG findings localizing STEMI to LCx

A
  • *STE II > III*
  • STE I, V5, V6
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88
Q

Pseudoaneurysm, LV aneurysm, VSD:
- Associated infarct/location

A
  • Pseudoaneurysm: RCA/Inferior wall
  • LV Aneurysm: Transmural infarct, anterior/apical walls
  • VSD: Wrap-around LAD
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89
Q

Killip Class grading (I-IV)

A

I: ø signs of HF
II: Rales, S3, elevated JVP
III: Acute pulmonary edema
IV: Cardiogenic shock, hypotension, and evidence of peripheral vasoconstriction

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90
Q

EKG signs of LV aneurysm

A

persistent ST elevation with Q waves anteriorly, after STEMI

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91
Q

Hibernating myocardium: Dobutamine stress echo findings

A

BIMODAL RESPONSE:

  • Low Dob dose demonstrates some improvement in prior hypokinetic or akinetic areas (i.e., Contractile reserve)
  • Akinetic at higher Dob dose - Ischemic response
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92
Q

Pressor for HCM & shock

A

Phenylephrine
- Primarily alpha-1 activity –> increased afterload

93
Q

ARVC

  • Inheritance patten
  • Protein affected
A
  • Autosomal dominant
  • Desmosomal disease; plakoglobin
94
Q

Tafazzin protein mutation associated with … (2)

A

DCM
LV noncompaction

95
Q

Risk factors for anthracycline toxicity/CM

A
  • Total lifetime dose of anthracycline
  • IV bolus administration
  • Higher single doses
  • History of mediastinal radiation
  • Concommitant use of other cardiotoxic agents: cyclophosphamide, trastuzumab, paclitaxel
  • CV disease
  • Female
  • Extreme age: very old, very young
  • Increased length of time since anthracycline completion
96
Q

Indications for ICD in HCM

A

Class I:

  • SCD Hx, VF
  • Hemodynamically significant VT

Class IIa:

  • **1st degree relative with SCD**
  • Max wall thickness > 30mm
  • ≥ 1 recent syncopal episode
97
Q

Indication for ICD in HCM + NSVT

A

Requires other risk factors:

  • Resting LVOT gradient > 30 mmHg
  • Gadolinium enhancement –> myocardial fibrosis
  • LV apical aneurysm
98
Q

Most common cause of death 30 days after heart transplant:

A

MCC: 1˚ graft failure

99
Q

Most common viral etiology of myocarditis

A

Parvovirus

100
Q

Fabry disease:

  • Inheritance pattern
  • Protein deficiency?
A
  • X-linked –> spotty inheritance in family
  • Alpha-galactosidase A deficiency
101
Q

When to worry about creatinine

A
  • Men: > 2.5 mg/dL
  • Women: > 2 mg/dL

… with a K > 5

102
Q

Acute HF + High degree AV Block: dx?

A

Giant cell myocarditis or sarcoid
–> need biopsy

103
Q

Familial Cardiomyopathy
- How many generations need to be affected?

A

3 generations
clinical diagnosis; genetic testing not required

104
Q

Doxorubicin toxicity; when to stop doxorubicin?

A

EF decreases ≥ 10% to absolute EF < 50%

105
Q

Presentation of Giant Cell Myocarditis

A
  • Rapid progressing, fulminant
  • HF + VA’s + heart block
106
Q

Ejection click associated with …

A
  • AS, bicuspid valve with dilated aorta
  • PS with dilated PA
107
Q

TEE for re-evaluation of IE indications

A
  • New murmur
  • Embolism
  • Persistent fever >3-5 days
  • HF
  • Abscess
  • AV block
108
Q

3 main indications for early surgery for IE

A

HF
Perivalvular extension
Embolic event

109
Q

Cyanosis of the toes, but not the fingers pathognomonic for…

A

PDA

110
Q

Coarctation of the aorta: indications for intervention

A
  • Coarct gradient > 20 mmHg
  • High degree of collaterals based on imaging
  • systemic hypertension secondary to coarct
  • heart failure secondary to coarct
111
Q

Echo finding for coarctation of the aorta

A
  • elevated peak velocity across aortic Isthmus
  • diastolic forward flow in the abdominal aorta
112
Q

DVT/PE Dosing for Eliquis

A

Apixaban 10mg BID x 7 days
and then Apixaban 5mg BID afterwards

113
Q

DVT/PE dosing for Xarelto

A

Xarelto 15 mg BID x 21 days
and then Xarelto 20mg qD afterwards

114
Q

Management of hypertension in fibromuscular dysplasia

A

1) anti hypertensive agents 2) renal artery angioplasty (not stenting)

115
Q

Maximum safe dose of contrast calculation

A

Max Dose = 3.7 x CrCl

116
Q

SYNTAX Score interpretation (PCI vs CABG)

  • LM
  • 3V Dz
A

LM + >/= 33 —> CABG Wins
3V Dz + >/= 23 —> CABG Wins
OVERALL: >/= 23 -> CABG preferred

117
Q

Routine aspiration thrombectomy is associated with increased risk of what adverse outcome

A

Ischemic stroke

118
Q

Platypnea orthodeoxia syndrome: presentation, work up, etiologies

A
  • Shortness of breath with standing, better with lying down
  • PFO, ASD, atrial septal aneurysm
  • echo with bubble study to evaluate shunt first, right heart after
119
Q

Indications for intervention on asymptomatic AS

A
  • severe AS + EF<50%
  • very severe AS - peak velocity >5 m/s, mean gradient >/= 60 mmHg
120
Q

Antiplatelets after Lytics

  • Age consideration?
  • loading
A
  • Age >/= 75 -> no load, just 75 mg
  • Age <75 -> 300 mg load, followed by 75 mg qD
121
Q

Anticoagulation: Bivalirudin Dosing

A
  • Normal: 0.75 mg/kg bolus, then 1.75 mg/kg/hr
  • CrCl <30: 0.75 mg/kg bolus, then 1mg/kg/hr
  • HD: 0.75 mg/kg bolus, then 0.25 mg/kg/hr
122
Q

ASCVD Risk cutoffs

A
  • 5.5-7.4% -> selected patients for CAC
  • >/= 7.5% -> w/ risk -> Statin; w/o risk -> CAC
123
Q

Five A’s of Smoking Cessation

A

Ask
Advise
Assess willingness
Assist
Arrange

124
Q

Revised Cardiac Risk Index (RCRI)

  • Components
  • Interpretation
A
  • high risk (intraperitoneal, intrathoracic, suprainguinal vascular)
  • ASCAD
  • HF
  • CVA risk
  • IDDM
  • Cr > 2

—> >/=2 :: high risk

125
Q

Presentation for Chagas (3)

A

Apical aneurysm
CVA
GI dysmotility

126
Q

Conduction disease and then AV block
- Associated genetic disorder?

A

LMNA, laminopathy

  • LMNA gene mutation
  • Autosomal dominant
127
Q

Notch 1 gene mutation associations? (2)

A

Bicuspid AV
Early AV calcification

128
Q

TBX5 (T-box 5) association?

A

Holt-Oram syndrome
Chromosome 12
ASD, VSD, HCM

129
Q

Fibrillin-1 (FBN1) association?

A

AD
Marfan syndrome

130
Q

Collagen 3A1 (COL3A1) association?

A

Ehlers-Danlos

131
Q

Calcineurin inhibitor agents (2)

A
  • Cyclosporine
  • Tacorlimus
132
Q

Calcineurin inhibitor - mechanism (other than inhibiting calcineurin)

A

Inhibits IL-2

133
Q

Cyclosporine Side Effects

A

HTN, nephrotoxicity
Gingival hyperplasia, hirsutism

134
Q

Tacrolimus Side Effects

A

HTN, nephrotoxicity
Alopecia, neurotoxicity (headache), PRES, DM

135
Q

Antimetabolite Agents (2)

A

Azathioprine
Mycophenolate mofetil

136
Q

Azathiprine side effects

A

Myelosuppression

137
Q

Mycophenolate mofetil Side Effect

A

Myelosuppression
GI upset*

138
Q

Which antimetabolite requires serum level checks?

A

Mycophenolate mofetil (Celcept)

139
Q

Proliferation signal inhibitor agents (2)

A

Sirolimus
Everolimus

140
Q

Proliferation Signal Inhbitor side effects (6)

A

Edema/effusions
Interstitial pneumonitis
Hyper triglyceride is
Impaired wound healing
Mouth ulcer
GI upset

141
Q

“Standard” Anti-rejection regimen

A

Tacrolimus + Mycophenolate Mofetil

142
Q

Anti-rejection regimen of neurological issues (Seizure, HA) from tacrolimus

A

Cyclosporine/MMF

143
Q

Anti-rejection regimen if rejection, CAV, CMV

A

Tacrolimus + PSI

144
Q

Anti-rejection regimen if CKD or cancer issues

A

MMF + PSI

145
Q

Genetic mutation associated with Alcoholic Cardiomyopathy

A

Titian (TTN)

146
Q

Peripartum CM pathophysiology association

A

*PROLACTIN*

147
Q

Non-invasive risk stratification - Low:

  • CAC score?
  • CCTA findings
A

CAC < 100
CCTA with <50% stenosis lesions

148
Q

Non-invasive Risk Stratification - High

  • Stress ischemia: %
  • ST depression
  • Inducible WMA in how many territories?
  • CAC
A
  • Stress ischemia ≥ 10% or ≥ 2 coronary areas
  • ST depression > 2 @ low work or persisting into recovery
  • Inducible WMA in 2 coronary territories
  • CAC > 400 Agatston Unitis
149
Q

Aortic Stenosis:
- Timing of Follow up echo

A
  • Mild AS: q5 years
  • Mod AS: q2 years
  • Sev AS: q1 year
150
Q

Indication for surgery for asymptomatic Severe AS (4)

A
  • øsx + Severe AS + EF <50%
  • øsx + Severe AS + getting another cardiac surgery
  • øsx + Severe AS + abnormal ETT (drops pressure or EF)
  • øsx + VERY Severe AS (Vm ≥ 5m/s, Gradient ≥ 60 mmHg) + low surgical risk
151
Q

Bicuspid AV:
- Indications to replace AORTA (3)

A
  • ≥ 5.5 cm (I)
  • >5 cm + risk factors for dissection (Fam Hx, rapid progression)
  • >4.5 with severe AS or Severe AI
152
Q

Severe AI:

  • Vena contracts width
  • Pressure Half Time
A
  • Vena contracta: >0.6
  • PHT < 250
153
Q

AI
- Indications for surgery

A

Symptoms + …

  • EF = 55 % (I)
  • LV dilatation: ESD > 50mm (IIa); EDD > 65mm (IIb)
154
Q

AI:

  • Echo follow up after initial diagnosis
  • Echo monitoring by classification (mild, mod, sev)
A
  • Recheck echo in 3 months to establish chronicity; then yearly
  • Mild: q3-5 years
  • Mod: q1-2 years
  • Sev: q6-12 MONTHS
155
Q

Bicuspid AV Associations:

  • Chest pain + BAV = …
  • HTN + BAV = …
A
  • Chest pain + BAV = Aortopathy/dissection
  • HTN + BAV = Coarct
156
Q

Severe MS grading:

  • Mean gradient
  • PASP
  • Valve area
A
  • Mean gradient > 10 mmHg
  • PASP > 50 mmHg
  • Valve area < 1cm2
157
Q

Wilkins score includes what 4 items

A
  1. Leaflet thickening
  2. Leaflet mobility
  3. Leaflet calcification
  4. Subvalvular thickening
158
Q

Wilkins Score:
- Balloon valvuloplasty cutoffs?

A
  • ≤ 8 —> Valvuloplasty
  • ≥ 8 —> MVR

• can’t do balloon valvulopasty if > moderate MR

159
Q

Mitral stenosis: MVR indication (3)

A
  • Symptomatic
  • +LAA thrombus despite OAC
  • Unfavorable anatomy for balloon commissurotomy
160
Q

Severe Mitral regurgitation

  • ERO
  • RVol
  • Jet area
  • Regurgitatant fraction
A
  • ERO: ≥ 40
  • RVol: ≥ 60
  • Jet area ≥ 0.5
  • Regurgitatant fraction >55%
161
Q

Indications for surgery for ASYMPTOMATIC MR
- Rule of thumb

A

60/50/40 rule

  • EF drop ≤ 60% (Sx - I)
  • PA pressure > 50 mmHg (Repair - IIa)
  • ESD ≥ 40 mm (Sx - I)

… AF (MV repair IIa)

162
Q

Valvular obstruction vs patient-prosthetic mismatch

  • EOA
  • Acceleration time
A

Obstruction
- Acceleration time > 100 ms

PPM

  • iEOA < 0.65
  • AT ≤ 100 ms
163
Q

Indications for Re-Evaluation of infective endocarditis

A
  • Change in clinical symptoms (new murmur, embolism, fever >3-5 days, HF, concerns for abscess, AV block
  • Patients at high risk of complications - large veg or staph/fungal/enterococcus infections
164
Q

Valve thrombosis: thrombolysis vs surgery vs heparin

A

Thrombolysis
• Right sided valves
• If patient at higher surgical risk

Surgery
• Functional class 3-4 (I)
• Large thrombus
• Unclear if pannus

Heparin
• Small clot with class 1-2 symptoms, consider heparin -\> lysis -\> surgery
165
Q

Timothy Syndrome:

  • Presentation
  • EKG findings
  • Channel affected
  • LQT number?
A
  • Presentation: syndactyly, developmental disorder; cardiac and facial abn’s
  • EKG: 2:1 AV block, prolonged QT
  • Channel affected: L-type Ca
  • LQT number?: LQT 8
166
Q

Normal heart rate recovery with stress test

A

12 BPM within first minute

167
Q

Anderson-Tawil

  • Presentation
  • Channel Affected:
  • LQT #?
A
  • Presentation: wide-set eyes, low set ears, hypoK periodic paralysis
  • Channel Affected: IK1
  • LQT7
168
Q

Jervell & Lange-Nielson Syndrome

  • Presentation
  • Associations
  • Lab abnormality
A
  • Presentation: B/L sensorineural hearing loss
  • Associations: Iron deficiency anemia; LQT
  • Lab abnormality: Elevated Gastrin
169
Q

Asymptomatic MR indications for surgery (60/50/40 rule)

A
170
Q

Severe MR measurements

A
  • RVol ≥ 60
  • Reg Fraction >50%
  • Jet area > 5 mm
  • ERO ≥ 40

(60/50/5/40)

171
Q

Indications for angioplasty for renal artery stenosis (2)

A
  1. Severe bilateral dz > 75% stenosis
  2. Unilateral dz in solitary kidney
172
Q
  • Alveolar capillary engorgement and tortuosity = ? …
  • Association with ?
A
  • Pulmonary capillary hemangiomatosis
  • Asoociated with Pulmonary Veno-Occlusive dz
173
Q

How to Dx Pulmonary Veno-Occlusive disease

A

Lung biopsy

174
Q

Pulmonary veno-occlusive disease:

  • CXR findings:
  • CT findings:
  • RHC findings:
  • DLCO
A
  • CXR findings: Pleural effusions
  • CT findings: Ground glass and nodules
  • RHC findings: Inconsistent wedge, wedge normal to elevated
  • DLCO: reduced
175
Q

Severe Apnea Hypopnea Index

A

Severe: >30

176
Q

Genetic CM Genes

HCM (2)

A

MYH7

MYBPC3

177
Q

Genetic CM Genes

ARVC, Naxos

A

DES

DSP

PKP2

178
Q

Genetic CM Genes

LV noncompaction (1)

A

TAZ

179
Q

Genetic CM Genes

DCM (3)

A

TTN

LMNA

SCN5A

180
Q

Late Gadolinium Enhancement Patterns

DCM

A

Mid-wall stripe

181
Q

Late Gadolinium Enhancement Patterns

HCM

A

Septal enhancement

182
Q

Late Gadolinium Enhancement Patterns

Myocarditis

A

Epicardial, patchy

183
Q

LMNA CM rhythm features

A

sinus bradycardia with 1˚ AV block, degrading to AF, AT, VT

Arrhythmia precedes decreased EF

184
Q

LMNA CM management

A

ICD even if normal EF

185
Q

Anthracycline agents

A
  • Rubicins: Doxorubicin (adriamycin), Epirubicin, Doxorubicin, dauno
  • Mitoxantrone
186
Q

Tyrosine Kinase Inhibitor agents

A
  • -Tinib’s: axitinib, dasatinib, erlotinib, imatinib, nilotinib, sunitinib
187
Q

When to start cardioprotective meds in Chemo-related CM (4)

A
  • EF <50%
  • EF drop <10%
  • Abnormal GLS (>15% drop)
  • Abnormal troponin
188
Q

Metastatic melanoma tx’d with T-Cell checkpoint inhibitors associated with …

A

Fulminant myocarditis

Arrhythmia is an early sign

189
Q

Associations

ASD + Cleft MV =

A

ASD + Cleft MV = Primum ASD

190
Q

Associations

ASD + PAPVR =

A

ASD + PAPVR = Sinus venosus defect

191
Q

Associations

Big RV + increased PV velocity + normal looking PV =

A

Big RV + increased PV velocity + normal looking PV = ASD or PAPVR

192
Q

Two equations for CO

A

CO = SV x HR

CO = CSA x VTI x HR

193
Q

SVR equation

A

(MAP-CVP)/CO • 80

194
Q

PVR equation

A

(PAmean - PCWP) / CO

195
Q

Pericardial effusion tapped, RA pressures do not normalize … Dx?

A

Constrictive/Effusive Pericarditis

196
Q

Congenital absence of pericardium, features (4)

A
  • Laterally displaced apex/apical impulse
  • RBBB, RAD
  • CXR with leftward displacement of cardiac silhouette
  • TTE with teardrop-shaped heart
197
Q

s-FLT1 association?

A

Peripartum CM

198
Q

Surveillance Echo for AS based on severity

A

Generally Mild: 3-5 years Mod: 1-2 years Sev: 6 mos - 1 year

199
Q

Surveillance echo for MS by severity

A

Mild, >1.5: 3-5 years Mod, 1-1.4: 1-2 years Sev: 6 mos - 1 year

200
Q

4F-PCC dosing

A

Based on INR & body weight

  • INR 2-4: 25 U/kg
  • INR 4-6: 35 U/kg
  • INR >6: 50 U/kg
  • Max dose 5000 U at 100 Kg body weight

-or-

1000U for any bleed

1500U for intracranial bleed

201
Q

Indications for ICD in ToF

A
  • LV systolic or diastolic dysfunction
  • NSVT
  • QRS duration ≥180 msec
  • Extensive RV scarring
  • Inducible sustained VA at EPS
202
Q

Parameters for MitraClip suitability

A

LVEF: 20-50%

LVESD: ≤ 70 mm

PASP: ≤ 70 mm Hg

203
Q

Cardiac Power Output: - Equation - Abnormal?/interpretation

A

MAP x CO / 451

< 0.6 is bad, needs MCS

204
Q

PA Pulsatility Index (PAPi): - Formula - Interpretation/Abnormal?

A

(sPAP - dPAP) / RAP

~ < 0.9, consider RV support

205
Q

Mixed Venous Oxygen Saturation and interpretation

A

> 65 % (normal/high): Isolated distributive shock

< 65% (low): cardiogenic component

206
Q

Fick Equation with fudge factor

A

O2 consumption / arteriovenous O2 difference = (125 mL O2/min/m2) / [13.6 x hemoglobin x (O2 saturation – O2 mixed venous saturation)]

* the O2 saturations are as percentages; e.g., 94% = 0.94

207
Q

Definition of Chronotropic Incompetence on exercise stress test

A

< 70-80% age predicted maximal HR achieved with exercise

Mostly 80%?

208
Q

Dx?

A

Pericardial cyst

209
Q

Indications for LV aneurysm repair (3)

A
  • HF
  • VA’s refractory to antiarrhythmics and ablation
  • Recurrent thromboembolism despite OAC
210
Q

Diagnosis?

A

LV Pseudoaneurysm

211
Q

Diagnosis

A

SAM associated with Stress CM

212
Q

MI complicated by LVOT obstruction or SAM and MR: - Management

A

IV fluids Decrease HR and allow for LV filling with ßB … even if rales and mild hypotension

213
Q

Preferred stress modality in patients with LBBB or RV pacing

A

Vasodilator stress rMPI or stress echocardiography

Even if they are able to exercise

214
Q

Aortic Intramural Hematoma:

  • CT findings
  • Management
A
  • High attenuation, no contrast enhancement
  • Similar management to aortic dissection
215
Q

Describe INTERMACS Classes

A
  1. Critical cardiogenic shock, crash and burn; increasing lactic
  2. Progressive decline; sliding on inotropes
  3. Stable, but inotrope dependent; dependent stability
  4. Resting symptoms
  5. Exertion intolerant
  6. Exertion limited; no fluid overload, comfortable at rest, fatigues quickly with activity; “walking wounded”
  7. Advanced NYHA III
216
Q

Echo findings for prosthetic valve stenosis (4)

A
  1. Elevated transvalvular velocity and gradient
  2. Prolonged (>100 msec) acceleration time
  3. Reduced effective orifice area (<1 cm2)
  4. Reduced dimensionless index (<0.3)
217
Q

If concerns for HIT, which anticoagulant can be used if undergoing PCI?

A

Bivalirudin

218
Q

Which anticoagulant is associated with catheter thrombosis?

A

Fondaparinux

219
Q

Appropriate follow-up stress in asymptomatic SIHD patient timeline:

  • After PCI
  • After CABG
A
  • PCI - after 2 years
  • CABG - after 5 years
220
Q

Gold standard for diagnosis of coronary artery spasm

A

“Spontaneous pain with ST elevation on EKG in the absence of underlying obstructive CAD”

  • provocative tests not necessary
221
Q

Characteristics of patient who would benefit from CCTA: (3)

A
  1. Ongoing sx’s + prior normal testing
  2. Prior inconclusive testing results
  3. Unable to do stress nuke or stress echo

CCTA not beneficial if high pre-test prob CAD or established CAD

222
Q

Loading dose of ASA + Plavix if >75 years old

A

ASA 162 mg

Plavix 75 mg

223
Q

What’s the optimal activity goal for primary prevention of ASCVD?

A

Moderate intensity aerobic exercise for 30-60 minutes, at least 3-4 days/week

224
Q

AV block in the setting of STEMI:

  • When can you observe
A

Can observe if inferior MI, otherwise a-sx

Consider other stuff if LAD territory

225
Q

Indications to PCI spontaneous coronary artery dissection?

A
  • medically refractory ischemia
  • left main involvement
  • hemodynamic instability

… otherwise, observe, ßB, and antiplatelet agents

226
Q

What’s the optimal activity goal for secondary prevention of ASCVD?

A

Moderate intensity aerobic exercise, 30-60 minutes, 5-7 days/week

227
Q

Which statin is not metabolized via cytochrome P450 and is therefore good with transplant patients on immunosuppressants?

A

Pravastatin

good for P450… and transPlant

228
Q

NIHSS threshold for intervention?

A

≥6

for tPA or thrombectomy

229
Q

Carotid US:

  • Velocities and corresponding stenosis
A

≥50% = ≥ 180 cm/s

≥70% = ≥ 230 cm/s

Cardiology Board Review (2 decks)

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