PPP Cardio

Question 1

Pathophysiology of dilated cardiomyopathy?
2 Things

Answer 1

1) Impaired systolic function - impaired contraction and decreased LVEF <40%
2) Cardiac chamber dilation leading to progressive enlargement of 1 or both ventricles. Ventricular dilation results in decreased contractility, tricuspid, and mitral valve insufficiency, and decreased ejection fraction leads to systolic dysfunction

Question 2

Epidemiology of dilated cardiomyopathy? What age range? What gender does it most affect?

Answer 2

90% of all cardiomyopathies, 20-60 yo, males

Question 3

Etiology of dilated cardiomyopathy:
1) Most common cause?
2) Most common cause of infectious myocarditis?
3) When does it occur during pregnancy?

Answer 3

1) Idiopathic 50%
2) Viral most common (Coxsackievirus B and echovirus, Chagas disease, and more viruses)
3) Late pregnancy and early postpartum period

Question 4

Etiology of dilated cardiomyopathy:
1) What toxic substances can cause?
2) Metabolic causes?
3) Medication causes?

Answer 4

1) Chronic alcohol abuse, cocaine, radiation
2) Thyroid disorders, Vitamin B1 (Thiamine) deficiency
3) Anthracyclines (doxorubicin), trastuzumab

Question 5

Left sided heart failure clinical manifestations? Pulmonary or Systemic?

Answer 5

Dyspnea on exertion, fatigue, impaired exercise capacity. Orthopnea, paroxysmal nocturnal dyspnea. Pulmonary

Question 6

Right sided heart failure symptoms? Pulmonary or Systemic?

Answer 6

Peripheral Edema, JVD, hepatomegaly, GI. Systemic

Question 7

PE of dilated cardiomyopathy?

Answer 7

S3 gallop hallmark and represents rapid filling of a dilated ventricle.
Lateral displacement of PMI due to cardio enlargement
Mitral/Tricuspid regurgitation
Left sided failure crackles (rales) due to pulmonary edema
Right sided failure peripheral edema, JVD, positive hepatojugular reflux with inspiration, ascites

Question 8

Medical treatment for dilated cardiomyopathy?

Answer 8

ACEI, BB, Mineralocorticoids (spironolactone/eplerenone), ARBs, diuretics, anticoagulation in pt with artificial valves, afib, and known mural thrombus

Question 9

Medications to avoid for dilated cardiomyopathy?

Answer 9

NSAIDs -> can exacerbated HF
CCB -> no mortality benefit of nondihydropyridine
Antiarrhythmic agents

Question 10

Gold standard for myocarditis?

Answer 10

endomyocardial biopsy

Question 11

Pathophysiology of restrictive cardiomyopathy?

Answer 11

Diastolic dysfunction in a non-dilated, rigid right ventricle which impedes ventricular filling

Question 12

Three leading causes of restrictive cardiomyopathy are?

Answer 12

Amyloidosis, Sarcoidosis, hemochromatosis

Question 13

What lvls of BNP are suggestive of restrictive cardiomyopathy?

Answer 13

400 pg/mL or greater

Question 14

In endomyocardial biopsy what is observed with amyloidosis and sarcoidosis?

Answer 14

Amyloidosis - apple-green birefringence with congo red stain under polarized light microscopy

Sarcoidosis - noncaseating granulomas

Question 15

Treatment for Restrictive cardiomyopathy?

Answer 15

No specifics. Treat underlying cause

EX) glucocorticoids for sarcoidosis or therapeutic phlebotomy for hemochromatosis

Question 16

Is hypertrophic cardiomyopathy autosomal or x-linked? dominant or recessive? What chromosome does it occur on?

Answer 16

Autosomal dominant on chromosome 14

Question 17

What would you hear on PE with a patient with HOCM?

Answer 17

S4 and pulsus bisferiens

Question 18

Best medications for HOCM?

Answer 18

Negative inotrophics such as BB, Nondihydropyridine CCB (Verapamil) and disopyramide

Question 19

What is contraindicated for HOCM?

Answer 19

Exertion, strenuous exercise, Digoxin
Also avoid nitrates, diuretics, ACEi/ARBs (vasodilation exacerbates obstruction)

Question 20

What diagnostic tools used to help evaluate atrial flutter?

Answer 20

ECG and TTE

Question 21

What is CHA2DS2-VASc and the scoring?

Answer 21

CHF
Hypertension
A2 - Age >75
Dm
S2 - stroke/tia/thromboembolism
Vascular disease
A - age 65-74
Sc - sex category (female is +1)

Scoring
0 (Male) or 1 (Female) are low risk, no anticoagulant therapy
1 (Male) is moderate risk, oral anticoag should be considered
2 or greater is high risk, oral anticoag is recommended

Question 22

What are the anticoagulant agents and their examples?

Answer 22

1) Non-vitamin K antagonist oral anticoagulants
a) Dabigatran - direct thrombin inhibitor
b) Factor Xa inhibitors - Rivaroxaban, Apixaban, Edoxaban
2) Warfarin
3) Dual antiplatelet therapy - Aspirin + Clopidogrel

Question 23

Management for stable narrow vs stable wide vs unstable PSVT?

Answer 23

Stable narrow - Vagal maneuvers + IV Adenosine if vagal does not work
Stable wide - IV Nondihydropyridine or IV BB or Digoxin
Unstable - Synchronized Cardioversion
Definitive is catheter ablation

Question 24

Differentiate between WAP and MAT

Answer 24

WAP - <100 BPM, >3 p wave morphology
MAT - >100 BPM, > 3 p wave morphology, usually with severe COPD

Question 25

Management for MAT?

Answer 25

Treat underlying cause
Nondihydropyridine CCB, avoid BB if pulmonary diseases. Magnesium and Potassium repletion if deficient

Question 26

WPW treatment? What to avoid?

Answer 26

IV Procainamide preferred, definitive is ablation
Avoid nodal blocking agents (BB/CCB/Digoxin) due to possible conduction down aberrant tract instead

Question 27

Describe a Still murmur.

Answer 27

Most common innocent (physiologic) murmur. Musical, vibratory, noisy, twanging, low-pitched early to mid systolic ejection murmur that is best heard in the inferior aspect of left lower sternal border and apex.

Question 28

Most common cause of right sided HF?

Answer 28

Left sided HF, pulmonary disease (COPD, pulmonary htn), and mitral stenosis

Question 29

Most common cause of left sided HF?

Answer 29

CAD, htn (inc afterload), valvular disease, cardiomyopathies