21.8.2013(acute Heart Failure)

Question 0

Atrial and ventricular arrythmias are present in ______ % of DCM pts

Answer 0

50

Question 1

Mechanical ventilation in pulmonary Edema

Answer 1

Inability to maintain oxygenation by non invasive ventilation
Coexisting Hypercapnia

Question 2

Diagnosis of DCM is confirmed by

Answer 2

Echo

Radionuclide ventriculography

Question 3

Anti coagulation in DCM patients

Answer 3

H/O thromboembolic events
AF
Evidence of LV thrombus

Question 4

Vaccinations recommended in DCM

Answer 4

Influenza

Pneumococci

Question 5

Diastolic heart failure is common in

Answer 5

Elderly women

Most of whom have HT and DM

Question 6

Myocardial disorders associated with diastolic heart failure

Answer 6

RCM
obstructive and non obstructive HCM
Infiltrative cardiomyopathies
Constrictive pericarditis

Question 7

Most common inherited heart defect

Answer 7

HCM

Question 8

LV obstruction in HCM is enhanced by

Answer 8

Increased contractility

Decreased ventricular volume

Question 9

Components of HOCM

Answer 9

Assymmetric septal hypertrophy

Systolic anterior motion of mitral leaflet leading to MR and outflow obstruction

Question 10

SCD in HCM is common in

Answer 10

10-35yrs

Occurs during strenuous exertion

Question 11

Physical exam findings in HCM

Answer 11

Pulsus bisferiens
Forceful double or triple apical impulse
Systolic outflow murmur along left sternal border accentuated by manuevers that decrease ventricular preload

Question 12

Rx of HCM

Answer 12

Beta blockers

Verapamil,diltiazem

Question 13

SVT s are poorly tolerated in

Answer 13

HOCM

Question 14

ICD placement in HCM pts,risk factors

Answer 14

Genetic mutations associated with SCD
Sustained ventricular tachyarrythmias
H/O syncope or near syncope recurrent or exertional in young pts
Multiple non sustained episodes of VT
Hypotensive response to exercise
LV hypertrophy with wall thickness of 30mm
H/o SCD in relatives

Question 15

Surgical management of HCM

Answer 15

Septal myotomy-myectomy

Alcohol septal ablation

Question 16

Restrictive cardiomyopathy must be differentiated from

Answer 16

Constrictive pericarditis

Question 17

Causes of restrictive cardiomyopathy

Answer 17

Amyloidosis
Sarcoidosis
Hunter,hurler
Hemochromatosis 
Hypereosinophilic syndrome
Carcinoid heart disease

Question 18

ECG finding in amyloidosis induced restrictive cardiomyopathy

Answer 18

Low voltage QRS complexes

Poor R wave progression

Question 19

Cardiac catheterisation findings in restrictive cardiomyopathy

Answer 19

Dip and plateau pattern in RV and LV pressure tracing

Question 20

Drug to be avoided in cardiac amyloidosis

Answer 20

Digoxin

Question 21

ECG finding in cardiac sarcoidosis

Answer 21

Conduction block

Question 22

Peripartum cardiomyopathy

Answer 22

LV systolic dysfunction diagnosed in last month of pregnancy upto 6 months post partum

Question 23

Causes of Peripartum cardiomyopathy

Answer 23

Viral triggers- cox sackie,parvovirus,adeno,herpes
Fetal microchimerism
Prolactin cleavage product

Question 24

Risk factors for PPCM

Answer 24

``` Advanced maternal age Multiparity Multiple pregnancy Preeclampsia Gestational hypertension ```

Question 25

Warning signs that PPCM may be present

Answer 25

``` Cough Orthopnea PND displaced apical impulse New MR murmur ```

Question 26

Rx of PPCM

Answer 26

ACE inhibitors in postpartum,Hydralzine in pregnant Beta1 selective blockers(atenolol,metoprolol) Digoxin Diuretics

Question 27

Causes of constrictive pericarditis

Answer 27

``` TB idiopathic Viral pericarditis Post cardiotomy Chest irradiation Autoimmune connective tissue disease ESRD Malignancy(breast,lung,lymphoma) ```

Question 28

Key pathophysiologic feature in constrictive pericarditis

Answer 28

Equalisation of pressure in all four chambers

Question 29

Physical findings specific for constrictive pericarditis

Answer 29

Pericardial knock(loud S3) Kussmaul sign elevated JVP with prominent y descent

Question 30

Features of constrictive pericarditis differentiating it from restrictive cardiomyopathy

Answer 30

Ventricular interdependence Pericardial thickening,calcification,adherence Preserved or increased tissue Doppler velocities on ECHO Pulmonary hypertension mild or absent Septal bounce Equalisation of pressure seen in all cardiac chambers RVEDP/RVSP>1/3 BNP low or mildly elevated

Question 31

ECHO features of constrictive pericarditis

Answer 31

Thickened echogenic pericardium Tethering of pericardium to myocardium Dilated,incompressible IVC Septal bounce Inspiratory variation in mitral flow velocity curves Expiratory reversal of hepatic vein flow Preserved or increased tissue Doppler velocities of the mitral annulus

Question 32

Drugs to be avoided in constrictive pericarditis

Answer 32

Beta blockers and CCB | Pts have resting tachycardia to compensate for reduced stroke volume

Question 33

Causes of cardiac tamponade

Answer 33

``` More likely: Idiopathic pericarditis Infection(bacterial,fungal,viral) Neoplasms Post cardiotomy Autoimmune connective tissue disorders Uremia Trauma Radiation MI(Subacute) Drugs(Hydralzine,procainamide,isoniazid,phenytoin) Hypothyroidism ```

Question 34

Beck triad

Answer 34

Hypotension Elevated JVP muffled heart sounds

Question 35

Pts with cardiac tamponade feel more comfortable

Answer 35

Sitting forward

Question 36

ECG features of cardiac tamponade

Answer 36

Low voltage Tachycardia Electrical alternans

Question 37

Features suggestive of hemodynamically significant effusion

Answer 37

Dilated,incompressible IVC Significant respiratory variation of tricuspid and mitral inflow velocities Early diastolic collapse of right ventricle and right atrium Circumferential effusion

Question 38

Role of TEE in pericardial effusion

Answer 38

Loculated effusion,especially that which develops at atrial level after cardiac surgery

Question 39

Rx for cardiac tamponade

Answer 39

Maintain adequate filling pressures with IV fluids Avoid diuretics,nitrates or other preload reducing drugs Avoid efforts to slow sinus tachycardia

Question 40

Causes of MS

Answer 40

``` Rheumatic SLE RA Congenital Substantial mitral annular calcification Mitral valve prosthesis dysfunction Oversewn or small mitral valve annuloplasty ring Functional MS Myxoma LA thrombus IE vegetation Cor triatrium ```

Question 41

MS is aggravated by(pathophysiology)

Answer 41

Increase in trans valvular flow(increased cardiac output) | Decrease diastolic filling time(tachycardia)

Question 42

MS is aggravated by(conditions)

Answer 42

``` Fever Pregnancy AF with rapid ventricular response Exercise Hyperthyroidism ```

Question 43

Pulmonary Edema in MS

Answer 43

Rare

Question 44

Severity of MS

Answer 44

Duration of MDM(not intensity) | A2-OS gap(inversely related to severity)