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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
Q

When give tpa for cva

A

Uonto 4.5 hours after cva

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26
Q

Modified hakki

A

Cardiac output/square root pressure gradient

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27
Q

Operate severe as

A

Symptoms
Ef <50
Asymptomatic but poor treadmill test

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28
Q

Who should get tavr

A

Sts > 15
Structural issue

Consider sts 8-15
Co morbidities

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29
Q

Mitral valve area by echo

A

220/pressure half time

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30
Q

What to do Sx out of proportion with echo in as. Ms?

A

Cath lab or exercise if asymptomatic

Exercise

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31
Q

Who should get mitral stenosis fixed

A

If non pliable and need valve wait until class iii Sx

If pliable do class 2, pap > 60 or new onset af

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32
Q

Anticoag in prosthetic valves
Bio
Mec

Echo guidelines

A

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

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33
Q

Early diastolic sounds

A

Think pericardial knock or opening snap

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34
Q

Sensitivity
Specificity
Ppv
Npv

A

Sensitivity is t/tp+fn

Specificity is tn/tn+fp

Ppv tp/tp+fp
Npv. Tn/tn+fn

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35
Q

How long dapt:

  1. After acs
  2. After stent for stable
A

Stable disease

  1. 1 month bare metal
  2. 6 month des

Acs
12 months
Use ticagrelor or prasuguel over plavix

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36
Q

Benefit of bival over heparin

A

Overall mortality benefit at 1 year

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37
Q

Goal bp
Goal bp if over 60
When to start two drugs

A

140/90
150/90
160/100

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38
Q

Percent ishevia on stress I should cath

A

10%

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39
Q

Loading doses of pgy12
Daily

How long should you use?

A

Clopidigril 600
Prasugruel 60
Ticragelor 180

Daily
Clopidigril 75 daily
Prasuguel 10 daily
Ticragelor 90 bid

1 year after acs

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40
Q

Dido

Fmc

A

30 min

120 min

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41
Q

Anticoagulants in stemi with pci

A

Heparin

Bival Turin

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42
Q

Antiplatelet in stemi with fibrinolytics

A

Antiplatelets
If >75 75mg no loading
If <75 300mg load then 75

43
Q

Anticoag in stemi with fibrinolytics

A

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
Q

Glenn
BT
Wattersten/Potts

A

Svc to pa
Subclavian art to pa
Aorta to pa

45
Q

How do you know when you see tricuspid valve

A

Lower and always with rv

46
Q

Bival vs fondaperinux

A

Bival only if stentong

Fondaparinjx only if no Cath

47
Q

Phases of valsalva

A

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
Q

Qp:Qs

A

FA - mixed venous/

PV - PA

49
Q

What is axvy

A

Atrial contracfin
Atrial diastole
Ventricular contraction
Atrial emptying

50
Q

Who should get Early invasive strategy in nstemi

A

Angina, hemodynamically or electric instability,

High grace score

51
Q

Indications for fondaperineux

A

Stemi With fibrinolytics

Nstemi Early

52
Q

Interpretable ekg for stress test

A

Rbbb
Normal
<1mm st depression
Lvh without repol

53
Q

Unintepretable ekg

A 
Wpw
>1mm st depression
Lbbb
Vpace
St tw Abn (lvh, dig)
54
Q

Anticoag with fibrinolytics

A

Lovenox
Heparin
Fondaparinuc

55
Q

Anticoag with stemi plus stent

A

Heparin
Bival (less bleeding)
NO FONDA

56
Q

Bival vs fonda

A

Bival only if pci

Fonda only if no pci

57
Q

Carotid sinus in type 1 block

In type w block

A

Type 1 block gets longer

In type 2 block gets shorter

58
Q

What is left main disease?

A

Greater than 50%

59
Q

Technicium vs thalium

A

Thalium is higher radiation but goes to Hybernating myocardium

60
Q

Signs of balanced ischemia

A

TID
Lung uptake
Appearance of RV

61
Q

When can you not exercise stress

A

Left bundle branch block

62
Q

Who should get nuculeae study

A

Intermediate to high risk. Or can’t exercise. Or uninterpretable ekg

63
Q

Under stress how does cardiac metabolism switch

A

From ffa to glucose

64
Q

Why do carbohydrate restriction prior to pet

A

Look for sarcoidosis

65
Q

Risk factor for PAD (4)

A

> 65
50-64 with rf (dm, tobacco use,lipids, Htn)
<50 + dm and one rf
Atherosclerosis

66
Q

What to do when Abi greater than 1.4

What to do when normal but patient high risk?

A

Toe brachial index

Exercise testing

67
Q

Spinal stenosis vs pad

A

Stenosis gets better when lean forward and worse when standing

68
Q

When do invasive assessments for pad

A

Fail gdmt or cli
Do duplex ultrasound
Cta
Mra

69
Q

Medical therapy for PAD

A

Plavix or aspirin if asymptomatic with Abi < .9 or symptoms
Statins for everyone
Cilostizol improves symptoms

70
Q

Surgical rx for PAD

A

Only when not getting gdmt

71
Q

Who should get endovascular procedures for PAD

A

Hemodynamically significant aprtoilliac Disease or femeropopliteal Disease who fail gdmt
Non healing wounds or gangrene

72
Q

What is ALI

Class 1 rx

A

Less then 2 weeks
Catheter based thrombolysis
Amputation if not salvageable

73
Q

Technical factors that favor surgical revasc

A

Common femoral art
Long lesions below known
Diffuse disease
Small vessel or single vessel disease

74
Q

Who benefits from cabg

A

50% left main
70% 3v Disease
Prox LAD + 1

75
Q

Who should get pci over cabg

A

Syntax score less than 23 and sts risk > 5%

76
Q

Cabg or pci after sudden death?

A

Either

77
Q

When do cabg over pci in multi vessel disease

A

Diabetes
Large area of ischemia
Ef <50
High syntax

78
Q

Summary of crest trial

A

Stenting more cva
Cea more mi
Younger better with stents

79
Q

Who should treat asymptomatic carotidnstenosis

A

Reasonable if > 80%

80
Q

When to treat with tpa for cva

A

4.5 hours

81
Q

Best bp for stroke

A

Tpa 185/110

If no tpa 220/120

82
Q

Carotid and cabg

A

Stent then cabg

Or cabg and cea same time

83
Q

When fix Aaa

A

Infrarenal or juxtarenal at 5.5

84
Q

Tumors that metastasize to heart

A

Lung,
Melanoma breast
Leukemia esophageal and renal

85
Q

What is orthostatic hypo

A

20/10 drop

86
Q

When is it ok to do stents for claudicatiob

A

Fail gdmt and femoropopliteal

87
Q

When should you give vit k

A

Only if inr above 10

88
Q

Differences between cryoablation and radiofreqjency ablation

A

Radio more durable but more risk

More complete Heart block

89
Q

What drugs increase pacing threshold

A

Iv

90
Q

Dofetilide contraindications

A

Verapimil, thiazides, dig, cyp3a

91
Q

Prosthetic valve anticoag in pregnancy

A

If <5 keep Coumadin

If more than 5 use lovenox with ant 10a levels

92
Q

Definition of severe ar

A

Vena contracts .6

93
Q

Concerning pa pressures in mitral stenosis

A

> 30

94
Q

How to calculate mixed venous

A

3*svc + ivc/4

95
Q

Common coronary anomalies in tet of fallout

A

Lad from rca

96
Q

Turner syndrome cardiac manifestation

A

Bicuspid aortic valve with as

97
Q

What is a hypertensive crisis

A

Dbp >120

Rx with nitroprusside

98
Q

Primary alsostoronism

Who
Hownscreen
Rx

A

If k < 3.5 and hypertensive
Plasma aldo to renin > 20
Rx with spirinolactone

99
Q

Continuity equation

What is contractile reserve

A

Lvot squared x.785 X tvinoutfloew/tvi aorta

20% increase in stroke volume

100
Q

Why early invasive for nstemi

A

Grace > 140, worsening trop, New st depresssion wonen

101
Q

What is Glenn

A

Svc to pa

102
Q

Cyp3a4 inducer

A

Phenytoin
Rifampin
Carbamazepine
St. John warf

103
Q

Class I cabg

A 
Left main
3 v disease with low ef <50
2v with proximal left main: low ef of ischemia 
High risk ua
Stemi
104
Q

What artery causes pap muscle rupture

A

Pda

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