USMLE Cardiology Flashcards
biventricular pacemaker combined with an implantable cardioverter-defibrillator (ICD)
- left ventricular ejection fraction of 35% or below
- New York Heart Association (NYHA) functional class III or IV heart failure
- QRS interval of 120 msec or greater
When VSD Closure is recommended
if symptomatic need to Hemodynamic cardiac catheterizatio then if Pulmonary-to-systemic blood flow ratio (Qp:Qs) is 2.0 or more and there is clinical evidence of left ventricular volume overload, or the patient has a history of infective endocarditis
A FIB ablation and Anticoagulation
CHADS2 related Patient should be on Warfarin regardless 2-3 months post ablation however then reassess based on CHADS2
AAA and what to do with them
< 4
4-4.9
5-5.9
< 4 - Ultrasound every 2-3 yrs
4-4.9 - Ultrasound every 6-12 months
5-5.9 - Surgery for > 5.5
Anti-factor Xa
During pregnancy when patient on LMWH can be monitored to achieve the peak anti Xa levels (4 hrs after injection)
Aortic STENOSis
**Normal **
Mild stenosis
Moderate
Normal
- Mean gradient < 5 mmHg
- Valve Area 3.0-4.0 / no follow up
Mild
- Mean gardiet < 25
- Valvue area > 1.5
Moderate
- Mean gradiate 25-40
- Valve area 1.-1.5
- Ace i are well tolerated in patient with mild to moderate AS
Aortic valve replacement
Symptomatic or
LVEF < 50% on Echo or
(end systolic Diameter)LVSD > 55 or LVDD > 75 Else
Exams 6-12 months with reapeat echo
EKG changes
ASD
Pericardial Effusion
Wolf Parkinson White
- ASD: RBBB / rSr’ or rSR’ + may have heart block, or right axis diviation
- ASD also associted with RV hypertorphy and pulmonary htn
- WPW: short PR interval with delta waves
- Pericardial Effusion: Electrical Alterans / Echo will show early diastolic atrial collapse
Atrial Septal Defect (ASD)
fixed splitting of the second Heart sound a faint mid systolic ejection mumur in left second intercostal space
Increase flow throught he pulmonic valve cause the murmur
Bleeding risk on antiplatelet therapy when post PCI
< 6 months
> 6 months
< 6 months
Postpone surgery unless its a minor risk for bleed then may go to surgery contineu both meds ASA and antiplatlet
If not possible to postpone hold for 5 days.
> 6 months
hold plavis 5 days before
Fore intermetdiate and minor surgeries dont hold ASA
Cardiac tamponade
jugular venous distention and peripheral edema or a pulsus paradoxus greater than 10 mm Hg.
Carotid Endarterectomy -
Stenosis % / symptomatic \ asymptomatic
MEN
WOMEN
MEN
Asymptomatic 60-99%
Symptomatic 50-99%
Women
Both 70-99%
Constrictive pericarditis vs Restrictive Cardiomyopathy
Both entities cause restrictive filling. Atrial enlargement more severe in RCM. BNP higher in RCM
RCM - restrictive ventricular diastolic filling, severely dilated atria, and small- to normal-sized ventricular cavities.
Constrictive pericarditis should have a history of acute pericarditis, tuberculosis, malignancy, or chest irradiation.
Continuouse ambulatory ECG (CAE)
Looping event recorder
Implantable Loop Recorder
Postsymptom Event recorder
- CAE / 24-48 hrs on monitor
Looping and Event recorders are used for more infrequent symptoms and record ECG tracing only when triggered by patient.
ILR is under skin good for 3 yrs when all fails
Coranary artery and Failures
- RCA - ACUTE -3-5 days
- RCA - ACUTE 3-5 days
- LAD - Acute 3-5 days
- LAD - 5 days- 3 weeks
- RCA - ACUTE -3-5 days
- Papillary muscle rupture
- Sever MV regurgitation
- RCA / LAD - ACUTE 3-5 days
- Intervernticular septum rupture
- holosystolic murmur / Shock CP
- Intervernticular septum rupture
- LAD - 5 days- 3 weeks
- Free wall rupture
- pericardial effusion
Dioxin toxicity
Sx
Tx
even with subtherapeutic levels of digoxin
GI disturbance, vision changes, electolyte imbalance, cardiac arrhythmias
Cardiac: sinus arrest, atrial tachycardia, junctional tachycardia, atrioventricular block, premature ventricular contractions, and ventricular tachycardia
Fab fragmnets
Dissecting Aorta
- Ascending and complicated B Type - Surgical repair
- Uncomplicated Descending (Type B) HR < 60 SBP ~100-120 goal / No benefit from stenting then medical management.
Ebstein anomaly
Right Heart enlargement and severe TR + tall P waves with RBBB
Eisenmenger syndrome
Cyanotic Congenital heart dz with irreversible pulmonary Dz causing long standing cardiac shunt.
Endocarditis complicated by heart failure, abscess, severe regurgitation, or hemodynamic derangements,
valve replacement should be performed urgently - Not need to wait for Abx therapy.
Heart Murmurs
Valsalva / Standing
Squatting
Hand grip
Valsalva and Standing:
- Decrease venous return and
- decrease all the murmurs _EXCEPT HCM and MVP _
Squatting and Hand grip:
- Increase venous returen
- and increase after load Makes HCM and MVP softer
- Increase Aortic Reg / Mitral Reg and VSD