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1
Q

Schoistic injury

A

Injury that occurs after single exposure

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2
Q

What tracer has least radiation

A

Ammonia 13

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3
Q

Typical flutter on ekg

A

Upright in late part of p wave

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4
Q

1c agene affect on heart rate in a flutter

A

Speed up

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5
Q

Why paf

A

Triggers (automaticity etc)

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6
Q

Why persistent af

A

Substrate changes

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7
Q

Why do rhythm control (4)

A

Symptoms
Young
Tachy
Reversible

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8
Q

Who should get ablation

A

No structural disease or fails meds

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9
Q

Elevated hemisiaphram after after ablation

A

Phrenic nerve damage - do sniff test

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10
Q

Anticoag after afib ablation

A

Minimum 3
Months
If had high chads vascular
Before Continue after

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11
Q

Axis in vt

A

Northwest(neg in v1 and avf)

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12
Q

Keys to rvot vt (3)

A

Lbbb
Quick upstroke
Upright in 2,3, avf

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13
Q

Ekg arvd

A

Epsilon wave
Twi v1-3
Qrs v1 > v6

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14
Q

Ilvt ekg

Rx

A

Rbbb, superior axis
S. Wave v5/v6 s in inf leads
Rx verapamil

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15
Q

PVC burden for ablation

A

20,000 of one morphology

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16
Q

Class I indication for tilt table

A

If single episode with high risk job

Multiple syncope without cardiac cause

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17
Q

Normal hv
Normal ah
Snrt

A

40-55
60-120
Snrt 1.6-2

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18
Q

Class I for ep testing in syncope

A

CAD ef > 35
Palpitations
BBB

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19
Q

Which anti arrhythmia drugs are cleared by the kidney

A

Sotolol digoxin and dofetilide

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20
Q

Drugs that increase pacing threshold

A

Class I a and 1c

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21
Q

Drugs that increase dft

A

Class I and amiodarone

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22
Q

Drugs that decrease dft

A

All 111 except amiodarone

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23
Q

Which has higher pulm pressures, constriction or restriction

Cutoff for e prime in these entities?

A

Restriction

8

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24
Q

What is symptomatic carotid disease
Percentage cutoff for fixin

What about asymptomatic

A 
Within six months
Amarousis
Contralateral motor/sensory
Dysphasia
Stroke
Must be greater than 50%

Only 80%

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25
When give tpa for cva
Uonto 4.5 hours after cva
26
Modified hakki
Cardiac output/square root pressure gradient
27
Operate severe as
Symptoms Ef <50 Asymptomatic but poor treadmill test
28
Who should get tavr
Sts > 15 Structural issue Consider sts 8-15 Co morbidities
29
Mitral valve area by echo
220/pressure half time
30
What to do Sx out of proportion with echo in as. Ms?
Cath lab or exercise if asymptomatic Exercise
31
Who should get mitral stenosis fixed
If non pliable and need valve wait until class iii Sx If pliable do class 2, pap > 60 or new onset af
32
Anticoag in prosthetic valves Bio Mec Echo guidelines
Bio for 3 months Mechanical Mitral inr 3 Aortic inr 2.5 or 3 if have afib, hypercoag or thrombotic event or low ef Aspirin for everyone 81 Clopidigrik 6 month after tavr Echo at first follow up visit 6-8 weeks post op Annual tte only after 1st 10 years
33
Early diastolic sounds
Think pericardial knock or opening snap
34
Sensitivity Specificity Ppv Npv
Sensitivity is t/tp+fn Specificity is tn/tn+fp Ppv tp/tp+fp Npv. Tn/tn+fn
35
How long dapt: 1. After acs 2. After stent for stable
Stable disease 1. 1 month bare metal 2. 6 month des Acs 12 months Use ticagrelor or prasuguel over plavix
36
Benefit of bival over heparin
Overall mortality benefit at 1 year
37
Goal bp Goal bp if over 60 When to start two drugs
140/90 150/90 160/100
38
Percent ishevia on stress I should cath
10%
39
Loading doses of pgy12 Daily How long should you use?
Clopidigril 600 Prasugruel 60 Ticragelor 180 Daily Clopidigril 75 daily Prasuguel 10 daily Ticragelor 90 bid 1 year after acs
40
Dido | Fmc
30 min | 120 min
41
Anticoagulants in stemi with pci
Heparin | Bival Turin
42
Antiplatelet in stemi with fibrinolytics
Antiplatelets If >75 75mg no loading If <75 300mg load then 75
43
Anticoag in stemi with fibrinolytics
Heparin (60u per kg max 4000 Then 12u/kg max 1000 For 48h If <75 Enoxaparin 30mg boils Enoxaparin 1mf/kg If > 75 No bolts, .75 mg/kg If Cr/clearance <30 use 1 mg q 24 Use for 8 days Fondaparinux 2.5 ic daily Don't use if cr/Cl 30
44
Glenn BT Wattersten/Potts
Svc to pa Subclavian art to pa Aorta to pa
45
How do you know when you see tricuspid valve
Lower and always with rv
46
Bival vs fondaperinux
Bival only if stentong | Fondaparinjx only if no Cath
47
Phases of valsalva
Phase 1 bp go up Phase 2 (5-6 beats) bp goes down and heart rate goes up Phase 3 release - goes down Phase 4 bp goes up If Heart failure Square wave response: no changes
48
Qp:Qs
FA - mixed venous/ | PV - PA
49
What is axvy
Atrial contracfin Atrial diastole Ventricular contraction Atrial emptying
50
Who should get Early invasive strategy in nstemi
Angina, hemodynamically or electric instability, | High grace score
51
Indications for fondaperineux
Stemi With fibrinolytics | Nstemi Early
52
Interpretable ekg for stress test
Rbbb Normal <1mm st depression Lvh without repol
53
Unintepretable ekg
``` Wpw >1mm st depression Lbbb Vpace St tw Abn (lvh, dig) ```
54
Anticoag with fibrinolytics
Lovenox Heparin Fondaparinuc
55
Anticoag with stemi plus stent
Heparin Bival (less bleeding) NO FONDA
56
Bival vs fonda
Bival only if pci | Fonda only if no pci
57
Carotid sinus in type 1 block | In type w block
Type 1 block gets longer | In type 2 block gets shorter
58
What is left main disease?
Greater than 50%
59
Technicium vs thalium
Thalium is higher radiation but goes to Hybernating myocardium
60
Signs of balanced ischemia
TID Lung uptake Appearance of RV
61
When can you not exercise stress
Left bundle branch block
62
Who should get nuculeae study
Intermediate to high risk. Or can’t exercise. Or uninterpretable ekg
63
Under stress how does cardiac metabolism switch
From ffa to glucose
64
Why do carbohydrate restriction prior to pet
Look for sarcoidosis
65
Risk factor for PAD (4)
>65 50-64 with rf (dm, tobacco use,lipids, Htn) <50 + dm and one rf Atherosclerosis
66
What to do when Abi greater than 1.4 | What to do when normal but patient high risk?
Toe brachial index | Exercise testing
67
Spinal stenosis vs pad
Stenosis gets better when lean forward and worse when standing
68
When do invasive assessments for pad
Fail gdmt or cli Do duplex ultrasound Cta Mra
69
Medical therapy for PAD
Plavix or aspirin if asymptomatic with Abi < .9 or symptoms Statins for everyone Cilostizol improves symptoms
70
Surgical rx for PAD
Only when not getting gdmt
71
Who should get endovascular procedures for PAD
Hemodynamically significant aprtoilliac Disease or femeropopliteal Disease who fail gdmt Non healing wounds or gangrene
72
What is ALI | Class 1 rx
Less then 2 weeks Catheter based thrombolysis Amputation if not salvageable
73
Technical factors that favor surgical revasc
Common femoral art Long lesions below known Diffuse disease Small vessel or single vessel disease
74
Who benefits from cabg
50% left main 70% 3v Disease Prox LAD + 1
75
Who should get pci over cabg
Syntax score less than 23 and sts risk > 5%
76
Cabg or pci after sudden death?
Either
77
When do cabg over pci in multi vessel disease
Diabetes Large area of ischemia Ef <50 High syntax
78
Summary of crest trial
Stenting more cva Cea more mi Younger better with stents
79
Who should treat asymptomatic carotidnstenosis
Reasonable if > 80%
80
When to treat with tpa for cva
4.5 hours
81
Best bp for stroke
Tpa 185/110 | If no tpa 220/120
82
Carotid and cabg
Stent then cabg | Or cabg and cea same time
83
When fix Aaa
Infrarenal or juxtarenal at 5.5
84
Tumors that metastasize to heart
Lung, Melanoma breast Leukemia esophageal and renal
85
What is orthostatic hypo
20/10 drop
86
When is it ok to do stents for claudicatiob
Fail gdmt and femoropopliteal
87
When should you give vit k
Only if inr above 10
88
Differences between cryoablation and radiofreqjency ablation
Radio more durable but more risk | More complete Heart block
89
What drugs increase pacing threshold
Iv
90
Dofetilide contraindications
Verapimil, thiazides, dig, cyp3a
91
Prosthetic valve anticoag in pregnancy
If <5 keep Coumadin | If more than 5 use lovenox with ant 10a levels
92
Definition of severe ar
Vena contracts .6
93
Concerning pa pressures in mitral stenosis
> 30
94
How to calculate mixed venous
3*svc + ivc/4
95
Common coronary anomalies in tet of fallout
Lad from rca
96
Turner syndrome cardiac manifestation
Bicuspid aortic valve with as
97
What is a hypertensive crisis
Dbp >120 | Rx with nitroprusside
98
Primary alsostoronism Who Hownscreen Rx
If k < 3.5 and hypertensive Plasma aldo to renin > 20 Rx with spirinolactone
99
Continuity equation What is contractile reserve
Lvot squared x.785 X tvinoutfloew/tvi aorta | 20% increase in stroke volume
100
Why early invasive for nstemi
Grace > 140, worsening trop, New st depresssion wonen
101
What is Glenn
Svc to pa
102
Cyp3a4 inducer
Phenytoin Rifampin Carbamazepine St. John warf
103
Class I cabg
``` Left main 3 v disease with low ef <50 2v with proximal left main: low ef of ischemia High risk ua Stemi ```
104
What artery causes pap muscle rupture
Pda

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