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Boards Review > USMLE Cardiology > Flashcards

USMLE Cardiology Flashcards

1
Q

biventricular pacemaker combined with an implantable cardioverter-defibrillator (ICD)

A
  • 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
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2
Q

When VSD Closure is recommended

A

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

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3
Q

A FIB ablation and Anticoagulation

A

CHADS2 related Patient should be on Warfarin regardless 2-3 months post ablation however then reassess based on CHADS2

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4
Q

AAA and what to do with them

< 4

4-4.9

5-5.9

A

< 4 - Ultrasound every 2-3 yrs

4-4.9 - Ultrasound every 6-12 months

5-5.9 - Surgery for > 5.5

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5
Q

Anti-factor Xa

A

During pregnancy when patient on LMWH can be monitored to achieve the peak anti Xa levels (4 hrs after injection)

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6
Q

Aortic STENOSis

**Normal **

Mild stenosis

Moderate

A

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
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7
Q

Aortic valve replacement

A

Symptomatic or

LVEF < 50% on Echo or

(end systolic Diameter)LVSD > 55 or LVDD > 75 Else

Exams 6-12 months with reapeat echo

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8
Q

EKG changes

ASD

Pericardial Effusion

Wolf Parkinson White

A
  • 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
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9
Q

Atrial Septal Defect (ASD)

fixed splitting of the second Heart sound a faint mid systolic ejection mumur in left second intercostal space

A

Increase flow throught he pulmonic valve cause the murmur

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10
Q

Bleeding risk on antiplatelet therapy when post PCI

< 6 months

> 6 months

A

< 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

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11
Q

Cardiac tamponade

A

jugular venous distention and peripheral edema or a pulsus paradoxus greater than 10 mm Hg.

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12
Q

Carotid Endarterectomy -

Stenosis % / symptomatic \ asymptomatic

MEN

WOMEN

A

MEN

Asymptomatic 60-99%

Symptomatic 50-99%

Women

Both 70-99%

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13
Q

Constrictive pericarditis vs Restrictive Cardiomyopathy

A

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.

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14
Q

Continuouse ambulatory ECG (CAE)

Looping event recorder

Implantable Loop Recorder

Postsymptom Event recorder

A
  • 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

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15
Q

Coranary artery and Failures

  • RCA - ACUTE -3-5 days
  • RCA - ACUTE 3-5 days
  • LAD - Acute 3-5 days
  • LAD - 5 days- 3 weeks
A
  • RCA - ACUTE -3-5 days
    • Papillary muscle rupture
    • Sever MV regurgitation
  • RCA / LAD - ACUTE 3-5 days
    • Intervernticular septum rupture
      • holosystolic murmur / Shock CP
  • LAD - 5 days- 3 weeks
    • Free wall rupture
    • pericardial effusion
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16
Q

Dioxin toxicity

Sx

Tx

A

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

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17
Q

Dissecting Aorta

A
  • Ascending and complicated B Type - Surgical repair
  • Uncomplicated Descending (Type B) HR < 60 SBP ~100-120 goal / No benefit from stenting then medical management.
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18
Q

Ebstein anomaly

A

Right Heart enlargement and severe TR + tall P waves with RBBB

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19
Q

Eisenmenger syndrome

A

Cyanotic Congenital heart dz with irreversible pulmonary Dz causing long standing cardiac shunt.

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20
Q

Endocarditis complicated by heart failure, abscess, severe regurgitation, or hemodynamic derangements,

A

valve replacement should be performed urgently - Not need to wait for Abx therapy.

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21
Q

Heart Murmurs

Valsalva / Standing

Squatting

Hand grip

A

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
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22
Q

Hemo dynamics in shock

  • Hypovolemic
  • Cardiogenic
  • Septic Shock
  • Right atrial pressure (preload)
  • Pulmonary wedge pressure (prelaod)
  • Cardiac index
  • Systemic vascular resistance
A

Hypovolemic

  • Low Right atrial pressure (preload)
  • Low Pulmonary wedge pressure (prelaod)
  • Low Cardiac index
  • high Systemic vascular resistance

Cardiogenic

  • High Right atrial pressure (preload)
  • High Pulmonary wedge pressure (prelaod)
  • very low Cardiac index
  • High Systemic vascular resistance

Septic Shock

  • Low Right atrial pressure (preload)
  • Low Pulmonary wedge pressure (prelaod)
  • High Cardiac index
  • Low Systemic vascular resistance
23
Q

Hepertrophic cariomyopathy

A

MC cause of sudden cardiac death in youg athletes

  • patients should avoid high intensitycompetitive sports
  • if Symptomatic Should be treated with Bbker or CCB
  • if medications dont help Septal tissue with surgery or Alcohol ablation
  • Hight risk for sudden death should recieve AICD
24
Q

High Bleeding risk procedures that may consider hold Warfarin

A

Open heart / AAA repair / Intracrainial surgery

Major cancer sergury

Urologic surgery

25
Q

HOCM

A

LV outflow tract obstruction / systolic murmur that is accentuated during maneuvers that decrease preload (valsalva) or increase with increase afterload (hand grip)

26
Q

Holosystolic Murmurs

MR ASS - Systolic murmurs

A

MR = best heart at apex and radiates to axilla

TR = Best heard a the left second and third intercostal spaces / murmur increases with inspiration

VSD = Best heard at the left third and fourth intercostal spaces / mumur is usually loud and accompanied by a thrill

27
Q

Hyperkalemia EKG

A

Peaked T waves

prolong PR / AV block / QRS widening

Atrial asystole

28
Q

milrinone

A

decompensated heart failure with acute kidney injury, the acute rise in creatinine is primarily due to hypoperfusion

29
Q

Mitral valve prolapse and regurgitation

A

early systolic click may be heard, followed by a midsystolic murmur. During a Valsalva maneuver, the timing of the systolic click moves closer to the S1, and the murmur is consequently longer in duration.

30
Q

Multifocal atrial tachycardia

A

Seen with COPD

Oxygen and bronchodialaters

31
Q

severe MVR

when to Replace?

A

if symptomatic

If New onset Afib

If pulmonary HTN > 50

if LVEF < 60% or end systolic > 40

32
Q

Myopericarditis

A
  • NSAIDs
  • Then Colchicine
  • Steriods have been associated with higher rate of recurrence
33
Q

Normal Pressures

  • CVP
  • RV
  • PA
  • PCWP
  • LV
A
  • Central venous pressure 3–8
  • R ventricular pressure systolic 15–30
  • diastolic 3–8
  • Pulmonary artery press. systolic 15–30
  • diastolic 4–12
  • Pulmonary vein/
  • Pulmonary capillary 2–15
  • wedge pressure
  • L ventricular pressure systolic 100–140
  • diastolic 3-12
  • Cardiac index 2.8-4.2 L/min/m2
  • Systemic vascular resistance 1150
34
Q

NYHA III/IV CHF due to LVEF < 40

A

Hydralazone and nitrate therapy (additional symptomatic and mortality for AA

35
Q

Pacemaker indications:

What are they bitch?

A

Symptomatic brady / Mobitz I or II

Third degree Heart block

Exercised induced second or Third degree blocks in absence of ischemia

36
Q

PAD

ASA

Clopidogrel

Cilostazol

Pentoxifylline

A

ASA - drug of Choice

ASA or Clopidogrel (expensive)

Vasodilator and inhibitore of platelet aggregation when first two or one dont work / CI in CHF

Improves symptons but not as promising

Revascularization : if ABI < 0.5

37
Q

PAF Paroxysmal atrial fibrillation

A

Two or more episodes of atrial fibrillation that terminate spontaneously in less then 7 days.

TEE done before cardioversion to rule out atrial appendage thrombus.

Flecainide is a good anti arrhythmic agent in the absence of ischemic or structural heart diease

38
Q

Pericardiectomy

A

is indicated for progressive constrictive pericarditis in patients with New York Heart Association class II or III heart failure.Not for transient constrictive pericarditis .

39
Q

Constrictive Pericarditis

A

If patient is give a liter of fluids the EDV of Right and Left will be almost the same

40
Q

POST Infarction Murmurs

  1. Aortic Dissection
  2. Free wall rupture
  3. Right Venticular Infarction
  4. VSD
  5. Acute MR / papillary muscle / chordea tendinea rupture
A
  1. Associated with inferior MI STEMI (asymetric BP + AR murmur)
  2. Anterior Infarction (Risk factor / first MI / elderley / female)
  3. Hypotention / clear lungs
  4. Ventidular septal infarcted holosystolic murmur few days post infarct
  5. may be like VSD / need echo
41
Q

PPH - Post prandial hypotension

How to lower effects

A

around 90 mins after eating.

  • Increase water intake before eating
  • avoiding ETOH with meals
  • Six smaller meals daily
  • Low carbohydrate meals
  • Waering custom fit compression stockings
42
Q

Pregnancy and HTN

A

> 140/90 mm HG before 20 gestation is HTN

Treate when exceeds 150/95 or end organ damage is obsereved

labetalol and methyldopa

43
Q

Pregnancy and Mechanical Valve

A

Unfractionate Heparin ggt, low molecular weight heparin, or warfarin

44
Q

Ranolazine

A

considered in patients who remain symptomatic despite optimal doses of β-blocker Adjust BBLK to heart rate of approximately 55 to 60/min and approximately 75% of the heart rate that produces angina with exertion

45
Q

RISK assessment 1. Framingham risk Score 2. Reynolds risk Score 3. QRISK2 System 4. SCORE risk Assessment

A
  1. uses BP, Cholesterol, smoke status, HDL, age (not good for younger women)
  2. Sex specific tool + CRPhs and Family history also present
  3. for UK
  4. European specific
46
Q

Risk of doxorubicin-induced dilated cardiomyopathy

A

doxorubicin in excess of 550 mg/m2, age older than 70 years at time of chemotherapy, the addition of another cardiotoxic agent, radiation therapy to the thorax, and hypertension

47
Q

STAGE I HTN

STAGE II HTN

A

STAGE I

diabetes / CKD / MI / Systolic failure : ACEi ARB

Stable CHF / RATE control / MI : BBLK

STAGE II

ACE i and Dihydropyridine Ca

48
Q

Takotsubo Cardiomyopathy

A

Apex non contractile** and **base is hypercontactile

(basal compensation), ischemic looking EKG, Mild elevation of Troponins, Transient dysfunction (see above) in the absence of COPD

49
Q

TCA EKG

A
  • Anticholinergic excess (confusion, tachycardia, fever, urinary retention, blurred vision)
  • PR, QRS and QT prolongation with ventricular arrhythmias
50
Q

Treatment of VT

A

Symptomatic - Shock Asymptomatic- IV antiarrhythmics like Amiodarone, procainamide, sotalol

51
Q

Two Major risk factors associated with MI

A

Dyslipidemia and tob abuse

then psychosocial stressors, DM, HTN, Obesity, ETOH abuse, physical inactivity, diet low in fruits and vegs

52
Q

Ventricular septal defect

A

Holosystolic murmur at the left lower sternal region

53
Q
A
54
Q
A

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