UWORLD Cardio

Question 1

New-onset A fib in hemodynamically stable patient emergency surgery

Answer 1

IV Bb or ND-CCB
Goal: 100-110/MIn

Anticoagulant not needed becuase risk of Afib related thromboembolic even in surgery is low

Question 2

CHA2D-VAS2

Thromboembolic risk

Answer 2

C: CHF
H: HTN
A2: ≥75yo (2 points)
D: DM
V: Vascular disease
A: 65-74yo
S2: Stroke or TIA (2 points)

Question 3

CHADS-VASc Score

Answer 3

Max: 9

Score =
1 moderate risk- possible anticoag

≥ 2 high- oral anticoagulant

Question 4

Mechanical heart valve antithrombotic TX

Answer 4

Life long Warfarin (ONLY). Evidence does not support other anti-coag or anti-platelet.

Add LDaspirin if severe CAD

Question 5

Therapeutic range for warfarin in pt with mechanical heart valves

Answer 5

Aortic Valve not risks= 2-3

Mirtal Valve or Aortic with risks= 2.5-3.5

Question 6

Goal of using diuretics in acute decompensated heart failure

Answer 6

Pulmonary Edema results from ^ PCWP due to ^ cardia preload.

Diuretics decrease cardiac preload.

Question 7

Decompensated Heart failure and Beta blockers

Answer 7

Avoid. Blockade of sympathetic activity inhibits compensatory mechanisms that maintain CO and organ perfusion.

Use only if cause is A-Fib

Question 8

Heart failure exacerbation and inotropic agents (dobutamine, milrinone)

Answer 8

Improving contractility only in patents with cardiogenic shock

CHF without cardiogenic shock do not administer: ^ hypotension, arrhythmia, death

Question 9

Clinical features of acute pericarditis

Answer 9

pleuritic chest pain (worsens with deep breaths, decreases with sitting) ± fever

pericardial friction rub (highly specific)

ECG: diffuse ST segment elevation & PR segment depression

Question 10

Peri- infarction pericarditis

Answer 10

acute pericarditis <4 days post MI.

reperfusion >3 hrs onset sxs increases risk.

Question 11

MI complication ventricular aneurysm

Answer 11

ECG: persistent ST elevation with deep Q waves same leadsa

Progressive left ventricular enlargement: HF, refractory anginia, ventricular arrhythmia, mural thrombus

Question 12

peri-infarction pericarditis TX

Answer 12

usually send limited.
High does aspirin (650mg Tid) for symptomatic relief

Avoid other NSAIDs and glucocorticoids, impair myocardial healing

Question 13

VIdopathic or viral acute pericarditis Tx

Answer 13

naproxen with colchicine

Question 14

Discontinue statin therapy post MI?

Answer 14

elevated CK with myopathy.

asymptomatic patient with a CK>10 times normal.

Question 15

Medications that increase warfarin effect ( ^ INR)

Answer 15

Metronidazole, quinolones
Azoles, amiodarone
Acetaminophen

Question 16

Medications that decrease warfarin effect (decrease INR)

Answer 16

Rifampin, phenytoin, St. johns wart
OCP
Green leafy veggies

Question 17

Aldosterone antagonists indicated for what patient populations?

Answer 17

NYHA class II, III, IV and LVEF < 35%

STEMI with LVEF <40 and wither Heart failure sxs or DM

Question 18

Optimal therapy for Heart Failure with reduced EF (HFrEF)

Answer 18

Initial: ACE/ ARB, BB, Diuretic

Step 2: Aldosterone antagonist
step 3: SGLT-2 inhibitor

Question 19

Avoid aldosterone antagonist in PT with

Answer 19

underlying Hyper K
advance renal failure

Question 20

New York Heart Association (NYHA) heart failure classification

Answer 20

1- no symptomatic limits
2-slight limits with physical activity
3- marked limits
4- inability to perform physical activity

Question 21

Pathophysiology of Compartment Syndrome

Answer 21

Increases pressure within a facial compartment that compromises blood flow.

Typically due to trama.
Can also occur with ischemia & reperfusion (^radical oxygen, interstitial edema and possible intracellular swelling)

Question 22

Diagnosis of acute compartment

Answer 22

Based clinical findings

delta pressure (diastolic- compartment pressure) <30 indicates acute compartment syndrome

Question 23

Continue or discontinue aspirin for cardiac cath

Answer 23

Aspirin is safe to continue during cath. Discontinued aspirin the patients risk for myocardial infarction

Question 24

MS and pregnancy

Answer 24

Risk for atrial fibrillation and pulmonary edema due to physiologic hypervolemia and increased left atrial and pulmonary venous pressure.

Question 25

MS ECG

Answer 25

- P mitrale ( broad notched waves) -Atrial tachyarrythmias -RVH (tall R waves in V1 &V2)

Question 26

Noonan Syndrome

Answer 26

AD. short stature, facial dysmorphism, and a spectrum of congenital heart defects. cardiac involvement 90%- pulmonic stenosis, ASD, hypertrophic cardiomyopathy

Question 27

aortic dissection and nitro

Answer 27

mono therapy contraindicated. can add to BB

Question 28

Mobitz II ECG

Answer 28

normal PR.... dropped QRS.... ecg is diagnostic showing intermittent nonconducted P waves and a regular PR interval;

Question 29

mangement of Mobtiz 2

Answer 29

high rate of progression to 3rd degree (complete block). treat reversible cause or permanent pacemaker

Question 30

MCC of sudden death in steering wheel injusry

Answer 30

Aortic injury: shearing force along the aortic arch where the aorta is firmly attached.  It is usually observed in the area of the ligamentum arteriosum, the aortic root, and the diaphragmatic hiatus.

Question 31

can cardiac contussion caue suden death?

Answer 31

yes but not common. Cardiac contusion produces sudden death when the injury involves the cardiac chambers or vessels.

Question 32

acute limb ischemia sxs

Answer 32

pain, pallor, paresthesia, pulselessness, poikilothermia, and paralysis

Question 33

management of acut limb ischemia

Answer 33

All patients with clinical signs and symptoms of ALI should receive anticoagulation (ie, intravenous heparin bolus followed by continuous heparin infusion) immediately while awaiting further i Anticoagulation prevents thrombus propagation and formation of new distal thrombus due to stasis.  Risk for irreversible myonecrosis within 4–6 hours and should have emergency surgical revascularization.

Question 34

Acute mirtal valve regurgitation

Answer 34

Rapid onset of pulmonary edema Acute LV failure (also causing acute RV failure) Hypotension, cardiogenic shock Jugular venous distension, pulmonary crackles Hyperdynamic cardiac impulse Apical systolic murmur (often absent) Diaphoresis, cool extremities (if shock is present)