IHD, CMP

Question 1

EKG finding in pericarditis

Answer 1

• ST elivation everywhere

- pR segment depression- most specific.

Question 2

Constrictive pericarditis clinical features

Answer 2

• Sxs of rt heart failure, sharp x and y descent;
• kusmaul sign( increase in JVD on inspiration);
• pericardial knock- in diastole (early after s2)

Question 3

Unique physical finding in cardiac tamponade

Answer 3

Pulsus paradoxus

Question 4

Chest pain in a young woman who smokes occurring in the middle of the night, precipitated by exercise, cold exposure, hyperventilation, emotional distress, cocaine
Dx?
Rx?

Answer 4

Prinzmetal’s angina

Rx- CCB, beta blockers

Question 5

Cardiac myxomas clinical presentation

• additional heart sound
• systemic sxs
• cardiac sxs

Answer 5

Mostly located in the left atrium=> obstruction of blood flow mimicking MV disease producing early diastolic sound( tumor plop)
- fatigue cough dyspnea pulmonary edema or hemoptysis
Systemic embolization - TIA, stroke, splenic infarcts
Constitutional sxs due to IL-6 production

Question 6

Secondary hypertension in a pt with hypercalcemia, renal stones, n neuropsychiatric sxs is most likely as a result of ?

Answer 6

Hyperparathyroidism

How? Unclear

Question 7

The primary mechanism responsible for the effect of nitroglycerin to treat anginal pain is?

Answer 7

Dialation of veins (capacitance vessels)—> decreases preload n heart size—> reduced oxygen requirements

Question 8

Blue toe, livedo reticularis , cerebral or intestinal ischemia, AKI, in a pt who has undergone cardiac catheterization or other vascular procedures recently is suggestive of the dx of?

Answer 8

Cholesterol embolism

Question 9

Define resistant hypertension

The most common n correctable cause is?

Answer 9

Persistent htn despite using 3or more antihypertensive drugs of different classes one being a diuretic
Renovascular(eg renal aa stenosis)

Question 10

Renovascular htn is suspected when —, —, —

Answer 10

• elevation in serum Cr>30% from baseline after starting ACE inhibitors or ARBs
• severe htn in a pt with recurrent flash pulmonary edema,
• severe htn in pts with diffuse atherosclerosis
• onset of severe htn after age 55
• in a pt with asymmetric kidney size or a small atrophic unilateral kidney
• presence of abd brui

Question 10

Mx of alcoholic DCMP other than drugs

Answer 10

Total abstinence from alcohol which may reverse the CMP if employed early in the course of the disease

Question 11

Best initial test in constrictive pericarditis?

Answer 11

CXR which shows calcification n fibrosis.

CT n MRI r both more accurate. Echo is also done to exclude RV hypertrophy or CMP

Question 13

Common cause of constrictive pericarditis in developing countries

Answer 13

TB

Question 14

Pathognomonic EKG finding for pericardial effusion

Answer 14

Electrical alternans ( due to the swinging movement of the heart in the pericardial cavity that causes a beat to beat variations in QRS axis n amplitude)
Low voltage QRS

Question 15

What’s dressler’s syndrome? Mx?

Answer 15

Pericarditis occurring weeks after MI

Rx- NSAIDs

Question 16

Best therapy for HOCMP

Drugs contraindicated

Answer 16

B-blockers, since they slow the heart n prolong diastole-> increased filling-> less outflow obstruction. Their antianginal effect helps as well.
CCBs like verapamil in pts who can’t tolerate B- blockers
- diuretics r contraindicated

Question 17

A non-hypertensive pt presenting with unexplained CHF predominantly diastolic dysfunction, conduction abnormalities, proteinuria n easy bruising
Echo shows increased ventricular wall thickness with normal LV cavity dimensions

Answer 17

Cardiac Amyloidosis

Question 18

Use of B blockers, ACEIs/ARBs, diuretics, spironolactone, digoxin in the different types of CMP

Answer 18

Hypertrophic- Yes (diuretics, spironolactone ); No ( beta blockers, digoxin); unclear benefit (ACEIs, ARBs)
Dilated CMP- all of the above can be used
- In HOCMP, ACEIs n diuretics definitely do not help. This is the main difference between HOCMP and HCM

Question 19

HOCMP is worsened by drugs n maneuvers such as?

Answer 19

worsened by anything that decreases LV chamber size: ACEIs, ARBs, Digoxin, hydralazine, valsalva n standing

Question 20

Among the infiltrative disorders the one commonly associated with DCMP, CHF, conduction abnormalities like sick sinus syndrome is

Answer 20

Hemochromatosis

Question 21

A pt admitted 5 days ago for a myocardial infarction has a new episode of chest pain. The most specific method to establish the dx of a new infarction is? 
CK-MB
Troponin 
Echo 
Stress testing 
Coronary angiography

Answer 21

CK-MB is the answer. Because it returns to normal in 2-3 days after MI.
Troponin can remain elevated for 2wks
Angiography can detect stenosis/obstruction but not myocardial necrosis
Stress test should never be performed in a pt having current chest pain.
Echo will show decreased wall movement but this could have been present from previous cardiac injury.