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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
HOCM
LV outflow tract obstruction / systolic murmur that is accentuated during maneuvers that decrease preload (valsalva) or increase with increase afterload (hand grip)
26
Holosystolic Murmurs MR ASS - Systolic murmurs
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
Hyperkalemia EKG
Peaked T waves prolong PR / AV block / QRS widening Atrial asystole
28
milrinone
decompensated heart failure with acute kidney injury, the acute rise in creatinine is primarily due to hypoperfusion
29
Mitral valve prolapse and regurgitation
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
Multifocal atrial tachycardia
Seen with COPD Oxygen and bronchodialaters
31
severe MVR when to Replace?
if symptomatic If New onset Afib If pulmonary HTN \> 50 if LVEF \< 60% or end systolic \> 40
32
Myopericarditis
* NSAIDs * Then Colchicine * Steriods have been associated with higher rate of recurrence
33
Normal Pressures * CVP * RV * PA * PCWP * LV
* 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
NYHA III/IV CHF due to LVEF \< 40
**Hydralazone and nitrate** therapy (additional symptomatic and mortality for AA
35
Pacemaker indications: What are they bitch?
Symptomatic brady / Mobitz I or II Third degree Heart block Exercised induced second or Third degree blocks in absence of ischemia
36
PAD ASA Clopidogrel Cilostazol Pentoxifylline
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
PAF Paroxysmal atrial fibrillation
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
Pericardiectomy
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
Constrictive Pericarditis
If patient is give a liter of fluids the **_EDV of Right and Left will be almost the same_**
40
POST Infarction Murmurs 1. Aortic Dissection 2. Free wall rupture 3. Right Venticular Infarction 4. VSD 5. Acute MR / papillary muscle / chordea tendinea rupture
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
PPH - Post prandial hypotension How to lower effects
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
Pregnancy and HTN
\> 140/90 mm HG before 20 gestation is HTN Treate when exceeds 150/95 or end organ damage is obsereved labetalol and methyldopa
43
Pregnancy and Mechanical Valve
Unfractionate Heparin ggt, low molecular weight heparin, or warfarin
44
Ranolazine
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
RISK assessment 1. Framingham risk Score 2. Reynolds risk Score 3. QRISK2 System 4. SCORE risk Assessment
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
Risk of doxorubicin-induced dilated cardiomyopathy
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
STAGE I HTN STAGE II HTN
STAGE I diabetes / CKD / MI / Systolic failure : ACEi ARB Stable CHF / RATE control / MI : BBLK STAGE II ACE i and Dihydropyridine Ca
48
Takotsubo Cardiomyopathy
**_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
TCA EKG
* **_Anticholinergic excess_** (confusion, tachycardia, fever, urinary retention, blurred vision) * **_PR, QRS and QT prolongation_** with ventricular arrhythmias
50
Treatment of VT
Symptomatic - Shock Asymptomatic- IV antiarrhythmics like Amiodarone, procainamide, sotalol
51
Two Major risk factors associated with MI
Dyslipidemia and tob abuse then psychosocial stressors, DM, HTN, Obesity, ETOH abuse, physical inactivity, diet low in fruits and vegs
52
Ventricular septal defect
Holosystolic murmur at the left lower sternal region
53
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