Uworld Cardiology Flashcards
What artery supplies in the SA node in the majority of patients?
UWorld: 6023
The RCA supplies the SA node in 60% of patients.
What are the signs and symptoms of cardiogenic shock?
Uworld: 6023
Hypotension, cold extremities, and pulmonary edema
What medication is typically used in patients with cardiogenic shock + bradycardia due to a recent MI?
When would dobutamine be used for cardiogenic shock?
When would epinephrine be used for symptomatic bradycardia?
Uworld: 6023
IV atropine
Dobutamine is a Beta-1 agonist that treats cardiogenic shock through an increase in left ventricular contractility. This patient’s cardiogenic shock is mostly due to inadequate heart rate rather than inadequate contractility and is better addressed by atropine
Epinephrine is sometimes used for symptomatic bradycardia that does not respond to atropine, however epinephrine is a beta-1 and alpha-1 agonist which causes an increase in myocardial oxygen demand and therefore is contraindicated in patients with MI
Should you be worried about athletes having sinus bradycardia with or without first degree AV block and left ventricular hypertrophy?
Athletes participating in intense training can develop non-pathologic cardiovascular changes including resting sinus bradycardia with or without first-degree AV block and left ventricular hypertrophy detected by EKG. In the absence of other findings suggestive of underlying cardiac disease (unexplained symptoms or cardiac murmur), these patients should be reassured without further cardiac testing.
What are coronary artery disease equivalents? (3)
Uworld: 5022
- Diabetes Mellitus
- Chronic Kidney Disease
- Non-coronary atherosclerotic disease (Carotid, PAD, or AAA)
What breast cancer agent can cause cardiotoxicity and how does it work?
What should be done if a patient taking this drug develops heart failure
UWorld: 10010
Trastuzumab can cause cardiotoxicity. It is a monoclonal antibody that targets HER2.
Nothing, as patients with trastuzumab induced clinical heart failure, usually regain heart function.
Describe the indications for discontinuation of statins in statin induced myopathy?
UWorld: 5522
Describe the indications for discontinuation of statins in statin induced myopathy?
UWorld: 5522
UWorld: 9884
What can cause compartment syndrome and what are the symptoms of compartment syndrome?
Compartment syndrome is usually seen with traumatic injuries to the extremities (especially long bone fractures), but may occur in any condition that causes increased pressure in a confined tissue spaces and compromises blood flow (PAD with thrombectomy).
The symptoms are pain out of proportion to injury, PAIN ON PASSIVE STRETCH, PARESTHESIA, rapidly increasing and tense swelling.
What could be used for pharmacological stress testing?
Adenosine, dipyridamole, or dobutamine
Uworld: 5326
What is the only treatment for severe aortic stenosis?
What is considered a bridge to surgical or TAVR in patients with severe aortic stenosis and what is the issue with this bridging?
Aortic valve replacement is the only effective treatment for severe symptomatic AS, conservative medical therapy provides no survival benefits in such patients. In addition, because patients with severe AS are preload dependent, the use of diuretics or vasodilators can lead to inferior outcomes because of the drop in cardiac output.
Percutaneous balloon aortic valvotomy is considered only as a bridge to surgical or transcatheter aortic valve replacement in patients with severe symptomatic AS. It is associated with high rates of procedural complications and does not improve long-term prognosis in patients with severe AS
UWorld: 5326
What is the definition of severe aortic stenosis? (3)
Defined as
- aortic jet velocity > 4.0 m/sec
- mean transvalvular gradient > 40 mmHg on Echo
OR - Aortic Valve area < 1 cm2
When can patients who have undergone successful revascularization post MI or have no evidence of ischemia on exercise testing resume sex?
Within 3-4 weeks (Princeton guidelines)
Within 1 week (AHA guidelines)
UWorld: 5962
Describe what causes multifocal atrial tachycardia, how diagnosis is made, and how it is treated?
Multifocal atrial tachycardia most commonly occurs in elderly patients with severe lung disease (COPD). Diagnosis is made by EKG showing P waves of at least three different morphologies and an atrial rate > 100/min. Treatment involves management of the underlying illness.
UWorld: 5963
What are a common causes of Multifocal atrial tachycardia?
COPD, electrolyte disturbances (hypokalemia, hypomagnesemia) (Keep potassium above 4, and Mg2+ above 2.
Describe the management of vasovagal syncope?
Initial vs recurrent?
Initial management is aimed at providing education and reassurance about the benign nature and prognosis, and advising patients to avoid potential triggers of syncope.
In patients with recurrent episodes, physical counterpressure measures can abort or delay an episode of syncope and are recommended during the prodromal phase
What does a negative exercise stress test indicate?
Less than a 1% risk of cardiovascular events within the next year
