ACCSAP Misc Flashcards
Which of the following genetic abnormalities is recognized as being responsible for the development of a BAV and its associated aortopathy?
no genetic mutation has been identified to date.
NOTCH1 mutations are associated with early developmental defects in the aortic valve and possibly a BAV, the presence of this mutation also has been linked to hypoplastic left heart and to calcium deposition in both the aortic valve and aorta. The fibrillin-1 mutation is associated with the Marfan syndrome. The absence or an abnormality in the X chromosome is associated with Turner’s syndrome. Aortic aneurysms may be present in both the Marfan and Turner’s syndrome. Turner’s syndrome patients frequently have a bicuspid valve as well as aortic coarctation. The TGF-beta1 gene mutation is associated with Loeys-Dietz syndrome and multiple aortic aneurysms.
Patient with acute left lower extremity ischemia. Her past medical history is significant for hypertension and chronic myelogenous leukemia. Her medications include amlodipine, hydrochlorothiazide, ethinyl estradiol/norgestrel, and nilotinib.
Which med was likely causative?
tyrosine kinase inhibitors are associated with an increased risk of thrombotic events. The second- and third-generation agents, such as nilotinib and ponatinib, have a higher risk of this complication.
Oral contraceptives are most commonly associated with venous thrombosis.
What is HF stage for patient being treated with an anthracycline chemotherapeutic agent
Exposure to potentially cardiotoxic cancer therapy agents is classified as stage A heart failure (HF).
Stage A: At high risk for HF, but without structural heart disease or symptoms of HF.
Stage B: Structural heart disease, but without signs or symptoms of HF.
Stage C: Structural heart disease with prior or current symptoms of HF.
Stage D: Refractory HF requiring specialized interventions.
What are characteristics of Ventricular Septal defect after transmural myocardial infarction (MI)?
sudden hemodynamic deterioration in the setting of a late-presenting, left anterior descending (LAD)-related MI with a new well-heard murmur is most consistent with an acute ventricular septal defect.
Patients with a diagnosis of hypertrophic cardiomyopathy (HCM) and clinical expression of the phenotype should not participate in competitive sports, except for low-intensity activities, independent of age, sex, magnitude of left ventricular hypertrophy (LVH), specific mutation, presence or absence of LV outflow tract obstruction at rest or exercise, fibrosis on cardiac magnetic resonance (CMR), absence of prior symptoms, and history of myectomy or septal ablation.
Patients who are genotype-positive and asymptomatic with no evidence of LVH by echocardiogram and CMR in the absence of a family history of HCM-related sudden death have no contraindication to participation (Class IIa).
Which of the following has been shown to improve cardiovascular risk prediction in patients with HIV, in addition to traditional Framingham risk factors? A. Triglyceride level. B. Use of fusion inhibitors. C. Use of integrase inhibitors. D. Duration of diabetes. E. CD4 counts.
CD4 counts
What HIV drug has adverse effect on cholesterol level?
Protease inhibitors
Simvastatin and lovastatin are contraindicated for use with protease inhibitors. Preferred starting doses of a statin in HIV patients taking protease inhibitor regimens include atorvastatin 10 mg daily or rosuvastatin 10 mg daily)
What are major risks of the following drug classes?
1) platinum-based chemotherapy
2) Tyrosine Kinase inhibitors (nilotinib)
3) Anthracycline-based chemo
1) platinum-based chemotherapy: Hypertension
2) Tyrosine Kinase inhibitors: Arterial thrombosis
3) Anthracycline-based chemo: Cardiomyopathy
What type of inheritance is Factov V Leiden and what type of risk of DVT does it confer?
Factor V Leiden is an autosomal dominant genetic disorder in which a mutation of factor V cannot be inactivated by activated protein C, resulting in an increased risk of thrombosis. Overall the lifetime risk of DVT is low (~5%)
Which of the following has a risk of DVT?
Thalidomide, ondansetron, ivabradine, entresto, PCSK9 inhibitors?
Oral immunomodulatory drugs, such as thalidomide and lenalidomide, have a documented association with increased risk for venous thromboembolic events.
What is the genetic mutation in Marfan Syndrom
Fibrillin 1 gene. Prevalence of approximately 1 in 5,000 individuals. Marfan syndrome is inherited in an autosomal dominant fashion.
What is the inheritance pattern of Familial dilated cardiomyopathy (FDC)?
About 80-90% of cases are inherited in the autosomal dominant fashion. It is rarely inherited in autosomal recessive or X-linked fashion
Which of the following is the most appropriate timing for future cardiovascular risk assessment in a patient recently started on androgen-deprivation therapy (leuprolide)?
3 months, for blood pressure, lipids, and fasting glucose. because the first effects of androgen-depreciation therapy typically occur in this time frame
