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
What should all patients with new onset unexplained heart failure have done?
Stress testing or coronary angiography
Uworld: 6396
What is the main cause of morbidity and mortality in Marfan Syndrome?
What should MFS patients have done for evaluation of this disorder?
Aortic root disease which manifests as aneurysmal dilation, aortic regurgitation, or dissection.
Should have an echo done prior to sports participation.
UWorld: 6396
What are the clinical features of marfan syndrome (MFS) and what causes this genetic disorder?
Tall Stature, Increased arm span to height ratio, and myopia, joint hypermobility, arachnodactyly, breastbone curves in or protrudes out
Autosomal dominant mutation in FBN1 gene
UWorld: 5373
What medications can cause digoxin toxicity?
Verapamil (inhibits renal secretion of digoxin)
Quinidine, Amiodarone, and Spironolactone
UWorld: 5373
What are the features of digoxin toxicity?
Nausea, vomiting, anorexia, fatigue, confusion, visual disturbances, and cardiac abnormalities
UWorld: 9938
What is the murmur associated with bicuspid aortic valve?
Ejection murmur with a click best heard at the lower left sternal border
Uworld: 9938
What is the genetics pattern of bicuspid aortic valve?
Autosomal dominant with incomplete penetrance, although it can occur sporadically
Uworld: 9938
What is the screening guidelines for bicuspid aortic valve?
Current guidelines recommend screening first degree relatives
When should an ICD be considered for patients with HOCM?
Uworld: 10008
When patients with HOCM (based on echo and positive family history) have:
- History of cardiac arrest
- Spontaneous VTach
- Family History of sudden death **
- Hypotension with exercise **
- Recurrent or exertional syncope **
- Extreme left ventricular hypertrophy **
How are patients with Wolff-Parkinson White syndrome treated?
Patients with wolff-parkinson-white syndrome are at risk of sudden cardiac death because the accessory pathway can lead to atrial fibrillation that can degenerate into VFib.
Catheter ablation to obliterate the accessory pathway is the preferred treatment.
How is Torsades treated?
IV magnesium (can be used for acute treatment as well as prevention)
What medication should be avoided in patients with Torsades?
Amiodarone because this just prolongs the QT interval
UWorld: 6007
What are some of the triggers for Torsades caused by QT prolongation?
- Electrolyte disturbances: Hypokalemia, Hypomagnesemia, and hypocalcemia
- Structural heart disease, heart failure, and left ventricular hypertrophy
- Adrenergic excess (exercise or sudden arousal)
UWorld: 6007
What are some of the medication causes of long QT syndromes and what can this lead to?
Common medications implicated in long QT include antipsychotics, antidepressants, macrolides, fluoroquinolones, and antifungals.
UWorld: 13449
What is one complication of a heart cath at the cath site and how is it diagnosed?
Pseudoaneurysm is a potential complication of arterial access for cardiac catheterization. It occurs when arterial bleeding remains confined within the periarterial connective tissue resulting in contained hematoma that communicates with the arterial lumen. Patients typically have a tender, pulsatile mass with a systolic bruit at the puncture site.
Diagnosed by US
How should patients with sinus bradycardia and AV block post MI be treated if atropine does not work?
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Temporary cardiac pacing is the treatment of choice in patients with persistent symptomatic bradyarrhythmias (hypotension, heart failure, syncope, dizziness)
Uworld 9622
What is contraindicated in patients with right ventricular MI?
Nitrates because it might cause severe hypotension
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What is contraindicated in patients with Acute Decompensated Heart Failure with left ventricular involvement?
Beta Blockers (may decrease heart rate and cause a decrease in cardiac output)
Uworld 5574
Describe the EKG findings of Brugada syndrome?
- RBBB block
- ST elevation in leads V1-V3
or - Long QT (men > 450 and women > 470)
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What is Anomalous origin of a coronary artery and what is something to worry about in these patients?
Common cause of sudden cardiac death in young adults. Patients may have premonitory symptoms of exertional angina, syncope, lightheadedness. EKG and Echo can be non-diagnostic. Diagnose with cath.
UWorld 9970
How is HOCM managed?
Beta blockers or Ca 2+ blockers are first line
If person has had prior VT or VFib and HOCM, put in an ICD.
UWorld 9915
What are the symptoms of Amiodarone Toxicity?
Thyroid Dysfunction, Hepatotoxicity, Cardiac Bradyarrhythmias, chronic interstitial pneumonitis, blue-grey skin discoloration, neurological symptoms (ataxia, peripheral neuropathy), visual disturbances.
Uworld: 5260
What are the cardiac side effects of TCAs?
Arrhythmias, prolonged QRS width, hypotension and acidemia.
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How is TCA toxicity treated? (Specifically cardiac symptoms?)
Sodium Bicarbonate
How is cocaine toxicity treated?
Benzodiazepines
What is one thing to watch out for in patients with cocaine toxicity and new onset neurological symptoms? How is this diagnosed?
Acute dissection of the ascending aorta with carotid artery involvement (may spread to carotids).
CT Angiogram
