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Cardiology > HF, ICDs > Flashcards

HF, ICDs Flashcards

1
Q

Defibrillators - primary prevention in CM

Who benefits?

A

Isch CM -strong if LVEF<30%

LVEF <35% or LVEF <40% w/ NSVT or inducible VT/VF (less strong)

Non-Isc CM
LVEF <35% - less strong but good if <70yo

Also >12mo survival, >40days post MI & on OMM

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2
Q

CRT - mortality benefit

A

SR w/ LBBB (Def)

LVEF<35%, Wide LBBB>150ms, NYHA II(-ambulatory IV), OMM 3/12,

Less strong: QRS 120-149ms but otherwise LVEF<35% etc (or maybe RBBB but >150ms)

AF (if >92% ventricular pacing), RBBB

If QRS<120ms may harm, no QOL improvement,

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3
Q

SGLT-2 - what does it block & where

A

blocks sodium glucose co-transporter in proximal tubule of kidney (S1 segment)

Causes reabsorption 90% glucose

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4
Q

SGLT2 in HF

  • example dose
  • details of ppl excluded
  • benefit
A

Both diab & nondiab.

Combined effect hospitalizations & CV death

10mg Dapaglifloxin

Exclusions: hypoTN, eGFR<30, sx LVEF<40%)

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5
Q

Severe IHD determined by

A
  • >10% LV dysfunction
  • LMCA/LAD prox (>50% stenosis)
  • multivessel 2-3 w/ impaired fxn <35%
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6
Q

Stable IHD (ie non ACS non Angina) PCI v OMM

A

PCI only beneficial in ACS or angina (no mortality benefit, or possible late benefit if mod-sec ischaemia w/o HF, L) main dis, ACS or mod angina)

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7
Q

RF modification in AF

A
  • Weight loss
  • ETOH reduction
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8
Q

Who to ablate in AF

A
  • Intolerant of antiarrhytmic and sx w/ AF
  • Consider in HFrEF (dec death & hosp if LV<35% & failed med Rx - CASTLE-AF)
  • No mort benefit but reduction in AF burdern
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9
Q

Who is more likely to fail AF ablation

A
  • Older
  • long standing persistent
  • Increased LA size
  • Valv/structural HD
  • if dont modify RF
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10
Q

List RF assoc w/ AF (what is the #1)

A
  • LA enlargemnt (#1)
  • dis that cause ie OSA, HTN, valv, CM
  • Obesity
  • Metabolic syndrome
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11
Q

Who benefits more from rhythm control in AF

A

younger, symptomatic

elderly, asymptomatic equiv rate/rhythm (AFFIRM)

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12
Q

Valvular AF - define?

A
  1. mechanical valve
  2. MS
    (Eg RhD)
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13
Q

How to differentiate VT from SVT

  • clinical hx
  • ECG (x7)
A

Clinical clues: Ventricule SCAR

  • elderly
  • IHD
  • Structural HD

ECG clues:

  • absence typical BBB morphology
  • Extreme axis deviation (dbl neg & avr pos)
  • QRS>160ms
  • AV dissociation
  • caputure/fusion beats
  • RSR complex w/ taller L) rabbit ear: most specific (RBBB is Rt rabbit ear)
  • neg concordance throughout precordial leads
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14
Q

Hypertrophic CM gene mutations (x2)

A

MYH7
MYBPC3

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15
Q

Haemodynamically significant Pb of LVOT in H(O)CM

A

>50mmHg

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16
Q

H(O)CM LV wall thickness

A

>15mm

(or >13mm if FHx +ve)

17
Q

Rx for H(O)CM

A

If symptomatic only

  1. Bblockers (+/- CCB)
  2. Disapyramide
  3. Surg
    - heart transplant if progressive LV dysfxn
    - surg myectomy, septal ablation
18
Q

H(O)CM - RF for SCD

A
  1. Hx VT/syncope
  2. Spon non sust VT (>3 beats @>120bpm) on holter
  3. LV thickness >30mm
  4. FHx SCD
  5. AbN BP response to exercise

Hx/Fhx + 120/30 (120bpm VT, 30mm wall thickness, BP)

19
Q

What to avoid if high risk SCD in H(O)CM

A

Cardiac glycosides

(Digoxin)

20
Q

TTE - Severe AS criteria

A

All of:

  • mean gradient >40mmHg
  • AVA <1cm
  • Vmax >4ms/s
Consider LFLG (severe AS) if **LVEF \<50%** and AVA \<1
 - dobutamine to increase SV by 20% (or gradient \>40)
 \+/- CTCA \>~1500
21
Q

TTE - severe MS criteria

A
  • AVA <1cm
  • mean gradient >10mmHg
22
Q

Indications for surgery MR

A

Primary MR
Severe (as clinically indicated) eg HF
But also new AF, LA enlargement, pulm HTN shows chronicity
LV dilatation - End sys diameter >45
LVEF <60 (aim 30-60%, usu goes up intiially)

If you have severe MR - get repaired (mitraclip) - even some 2ndary benefit

23
Q

Indications for surgery MS

A

Valve area <1cm (or <1.5cm if others elevated)
Mean gradient >10mmHg
PASP >50mmHg
& fishmouth appearance on TTE (can TOE with dobutamine if needed)

Perc balloon if young esp female planning preg
- avoids mechanical valve & need for AC (UNLESS HAS MR/AS)
Otherwise valve replacement but need DOAC

24
Q

Indications for surgery AR

A

Severe & sx (regardless of LV fnx)
Or asx w/ HF
Consider if having other cardiac surg eg CABG

25
Q

Indications for surgery AS

A

Severe w/ sx or HF

26
Q

LVLG AS Ax

A

AVA < 1cm but vmax <4cm or MG <40mmHG
Is this a pseudo AS or true AS but not enough flow?

AVR only if true severe AS - which is causing low LVEF
(otherwise poor flow gradient is due to shitty LH)

Give dobutamine to increase contractility to ‘push’ open AS then assess (if can push open, SV inc 20%, if not CTCA w/ cutoff 1200-2000 by gender)

27
Q

HOCM - crtieria

A

>15mm in any part (usu intravent septum) - >13mm if FHx

if LVOT >50mmHg : high risk for SCD so sync

28
Q

HOCM - indication for defib

A
  • LVOT > 50mmHG
  • Max wall thickness >30mm
  • Hx nsVT >3beats at >120bpm
  • AbN response to exercise
  • FHx SCH
  • Hx unexplained syncope

TTE (extensive GAD >15% LV mass, apical aneurysm, LVEF<50%)

29
Q

Most sensitive tests in HCM

A

ECG (inferolat TWI, q waves)

TTE (LV wall thickness >15mm, look for LVOT (>50mmHg)

Exercise stress echo can guide risk - if resting gradient <50mmHg

30
Q

HCM - inheritance & mutation

A

AD

w/ variable penetrance

genotype: MYH7 - bad (MYBPC3)

31
Q

HCM - screneing

A

Annual until 20s, then 3yrs

32
Q

CABG over PCI - who?

A

CABG:

  • LHF (LVEF <35%)
  • DM (presumed multivessel)
  • MVD or L)main + high syntax >33
  • C/I to DAPT
  • Recurrent in stent restenosis, other aorta or cardiac surgeries

PCI:
Old, frail, reduced mobility, MVD w/ low syntax (<22) AND NO DM, difficult anatomy

33
Q

Post TAVI Meds

A

DAPT for 3-6months then aspirin lifelong

Possibly aspirin monoRx

NOT DOAC!!!!!!!!!!!!!!!!!!!

Cardiology (7 decks)

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