Cardio Flashcards
(99 cards)
1
Q
Congenital QTc syndrome
A
- > 440msec on ecg + FH of sudden cardiac death
- non selective beta blockers - proponolol or nadolol ( W >460, M >440)
-risk of V.Fib and sudden cardiac death during physical activity or emotional stress or loud sounds
2
Q
Indication for ICD in congenital QTc
A
- Post cardiac arrest patient + recurrent syncope on beta blocker
- QTC > 500msec
3
Q
What is the Wolff-Parkinson-White (WPW) electrocardiographic pattern?
A
An accessory pathway between the atria and the ventricles
It manifests with a short PR interval, a broad QRS complex, and a slurred upstroke of the QRS complex.
4
Q
What are the key electrocardiographic findings of the WPW pattern?
A
- Very short PR interval (< 120 msec)
- Broad QRS complex
- Slurred upstroke of the QRS complex
These findings are most indicative of the Wolff-Parkinson-White pattern.
5
Q
What is the estimated prevalence of WPW?
A
1 to 3 per 1000 individuals
6
Q
What is a major risk associated with the WPW pattern?
A
Increased risk for sudden cardiac death (SCD)
7
Q
What is a common cause of SCD in WPW patients?
A
Ventricular fibrillation caused by rapid conduction of atrial fibrillation down the accessory pathway
8
Q
List high-risk features for SCD in WPW patients.
A
- History of atrial fibrillation
- Syncope
- Structural heart disease
- Familial WPW syndrome
9
Q
What is the recommended management for patients with WPW before competitive sports?
A
Referral to a specialist for risk stratification with noninvasive and/or invasive testing
10
Q
What does a stress test look for in WPW patients?
A
Normalization of the QRS during exercise, indicating low risk for SCD
11
Q
True or False: Absence of structural heart disease on echocardiography or MRI is sufficient to assess the risk for SCD in WPW patients.
A
False
12
Q
Is Holter evaluation for arrhythmia routinely recommended for asymptomatic WPW patients?
A
No
13
Q
When is an electrophysiologic study indicated for WPW patients?
A
If the QRS does not normalize with stress testing or the patient has high-risk features for SCD
14
Q
What is an S4 gallop?
A
A common finding in patients with hypertension resulting from forceful left atrial contraction and movement of blood into a hypertrophied left ventricle.
15
Q
Does an S4 gallop indicate ventricular systolic failure?
A
No.
16
Q
Is further evaluation warranted for an S4 gallop?
A
No, but aggressive treatment of hypertension is indicated.
17
Q
What is the most common type of hypertension in individuals with elevated blood pressure?
A
Primary hypertension.
18
Q
When should evaluation for secondary causes of hypertension be considered?
A
If there are symptoms, historical features, or physical examination findings suggesting a specific secondary cause or one of the following criteria:
19
Q
List the criteria that indicate evaluation for secondary causes of hypertension.
A
- Onset of hypertension before age 30
- Drug-resistant hypertension
- Abrupt onset of hypertension
- Exacerbation of previously controlled hypertension
- Disproportionate target-organ damage for the degree of hypertension
- Accelerated or malignant hypertension
- Onset of diastolic hypertension in adults age 65 years or older
- Unprovoked or excessive hypokalemia
20
Q
What tests are used for secondary causes of hypertension?
A
- Urine catecholamine
- Renal Doppler studies
21
Q
Is echocardiography indicated for a young, asymptomatic, hypertensive person with normal exercise tolerance?
A
No.
22
Q
What findings might an echocardiogram demonstrate in a hypertensive patient?
A
- Left ventricular hypertrophy
- Heart failure with preserved ejection fraction (diastolic dysfunction)
23
Q
Would echocardiogram findings change the management of a young, asymptomatic, hypertensive patient?
A
No.
24
Q
What is the significance of aggressive treatment of hypertension?
A
To prevent progression of end-organ effects.
25
What condition should be considered in a young woman with new or difficult-to-control hypertension?
Fibromuscular dysplasia (FMD)
## Footnote
FMD is a vascular disorder that can cause secondary hypertension.
26
What does significant renal artery stenosis lead to in terms of kidney function?
Hypoperfusion of the kidney
## Footnote
This leads to activation of the renin-angiotensin-aldosterone system.
27
What system is activated due to renal artery stenosis?
Renin-angiotensin-aldosterone system
## Footnote
This system contributes to sodium and water retention.
28
What symptoms may patients present with when both kidneys are involved in FMD?
Acute worsening renal function or flash pulmonary edema
## Footnote
These symptoms result from volume overload.
29
What imaging findings may indicate fibromuscular dysplasia?
Asymmetric kidney size
## Footnote
This can be observed in diagnostic imaging.
30
Which imaging modalities can be used to diagnose FMD?
Duplex ultrasonography, CT, MRI, renal artery angiography
## Footnote
Renal artery angiography is considered the gold standard.
31
What is the serum creatinine level in patients with FMD typically at?
Upper limit of normal
## Footnote
This makes primary renal parenchymal disease less likely.
32
Fill in the blank: Significant renal artery stenosis activates the _______.
renin-angiotensin-aldosterone system
33
True or False: Imaging for fibromuscular dysplasia is always conclusive.
False
## Footnote
Imaging may show findings suggestive of FMD, but the diagnosis often requires renal artery angiography.
34
What should poorly controlled hypertension in a young patient raise suspicion for?
A secondary cause of hypertension
35
What condition should be considered if a patient shows a marked rise in creatinine after initiation of an angiotensin-converting-enzyme inhibitor?
Renal artery stenosis caused by fibromuscular dysplasia
36
What percentage increase in creatinine from baseline is highly suspicious of renovascular disease?
More than 30% to 50%
37
What physical examination finding should a clinician listen for when renal artery stenosis is suspected?
Abdominal bruit
38
What is an appropriate initial imaging study for suspected renal artery stenosis?
Renal artery duplex ultrasound
39
What are alternatives to renal artery duplex ultrasound for imaging renal artery stenosis?
CT angiography and MRI angiography
40
What is a limitation of CT angiography and MRI angiography in detecting stenoses?
Suboptimal sensitivity for detecting stenoses in the distal renal artery
41
True or False: Slight increases in creatinine are uncommon after initiation of medications that block the renin-angiotensin-aldosterone system.
False
42
What are the four 'statin benefit' groups according to the ACC and AHA guidelines?
Patients aged 40 to 75 years with diabetes mellitus
## Footnote
Other groups include individuals with established ASCVD, individuals with an LDL-C level of 190 mg/dL or higher, and individuals aged 40 to 75 years with a 10-year ASCVD risk of 20% or higher.
43
What is the recommended statin for patients aged 40 to 75 years with diabetes mellitus?
At least a moderate-intensity statin
## Footnote
Examples include atorvastatin 10–20 mg daily, rosuvastatin 5–10 mg daily, simvastatin 20–40 mg daily, pravastatin 40–80 mg daily, or lovastatin 40–80 mg daily.
44
What should patients with diabetes mellitus and multiple ASCVD risk factors receive?
A high-intensity statin
## Footnote
High-intensity statins include rosuvastatin 20–40 mg daily or atorvastatin 40–80 mg daily.
45
What is the LDL-cholesterol reduction goal for patients on a high-intensity statin?
≥50% reduction to a target LDL-cholesterol level of <70 mg/dL
## Footnote
Achieving this target reduces the risk of cardiovascular events.
46
True or False: Patients aged 40 to 75 years with diabetes mellitus should receive a high-intensity statin regardless of ASCVD risk factors.
False
## Footnote
They should receive a moderate-intensity statin unless they have multiple ASCVD risk factors.
47
What percentage of patients with acute myocardial infarction (AMI) experience cardiogenic shock?
5% to 8%
## Footnote
Cardiogenic shock is associated with high rates of morbidity and mortality.
48
What are the mechanical causes of post-AMI cardiogenic shock?
* Pump failure
* Acute mitral regurgitation (MR) caused by papillary muscle rupture
* Ventricular septal rupture
* Free wall rupture
## Footnote
These complications can lead to severe cardiovascular instability.
49
Which mechanical complication is most likely to cause cardiogenic shock after an inferior myocardial infarction?
Papillary muscle rupture
## Footnote
This occurs in patients without evidence of intracardiac shunting.
50
What hemodynamic findings are consistent with papillary muscle rupture?
* Normal right atrial pressure
* Elevated pulmonary capillary wedge pressure (with large V waves)
## Footnote
Large V waves are indicative of severe mitral regurgitation.
51
When does papillary muscle rupture typically occur after an inferior infarction?
3 to 7 days
## Footnote
Clinical manifestations include a new systolic murmur and pulmonary edema.
52
What might happen to the murmur in cases of complete papillary muscle rupture?
The murmur may be faint or even inaudible
## Footnote
This occurs due to severe valvular regurgitation.
53
What does right heart catheterization reveal in cases of papillary muscle rupture?
Large V waves in the pulmonary capillary wedge pressure (PCWP) recording
## Footnote
A large V wave alone is not diagnostic as it may also be present in ventricular septal rupture.
54
What is a characteristic feature of a ventricular septal rupture?
* Harsh systolic murmur
* Left parasternal thrill
* Step-up in oxygen saturation of pulmonary arterial blood relative to right atrial blood
## Footnote
These features indicate left-to-right intracardiac shunting.
55
What typically causes pump failure in the context of myocardial infarction?
A large anterior myocardial infarction
## Footnote
Normal right atrial pressure and large V waves on PCWP are not expected in pump failure.
56
What is the right atrial pressure in patients with cardiac tamponade?
Markedly elevated
## Footnote
These patients do not show evidence of pulmonary edema or large V waves on PCWP.
57
What conduction abnormalities are often associated with cardiac sarcoidosis?
Complete heart block, bundle-branch blocks, and ventricular arrhythmias
## Footnote
These abnormalities can indicate underlying cardiac issues related to sarcoidosis.
58
What does the presence of biventricular systolic dysfunction and electrocardiographic evidence of monomorphic ventricular tachycardia suggest?
Diagnosis of sarcoid cardiomyopathy
## Footnote
This combination of findings is significant in diagnosing cardiac sarcoidosis.
59
Why might endomyocardial biopsy be frequently normal in patients with cardiac sarcoidosis?
Patchy involvement of the myocardium by noncaseating granulomas
## Footnote
Only 20% of biopsies show the characteristic noncaseating granulomas.
60
What percentage of endomyocardial biopsies in cardiac sarcoidosis show characteristic noncaseating granulomas?
20%
## Footnote
This low percentage is important for understanding the limitations of biopsy in diagnosing cardiac sarcoidosis.
61
Can many patients with cardiac sarcoidosis be asymptomatic?
Yes
## Footnote
Asymptomatic cases can complicate the diagnosis and management of the disease.
62
In which patient demographic should cardiac sarcoidosis be considered as a diagnosis?
Otherwise healthy young patients with specific cardiac findings or patients with known sarcoidosis presenting with cardiac symptoms
## Footnote
This highlights the importance of considering cardiac sarcoidosis in the appropriate clinical context.
63
What is giant-cell myocarditis?
A rare form of myocarditis associated with ventricular tachycardia
64
What is the typical presentation of giant-cell myocarditis?
Severe and rapidly progressive heart failure
65
What is the consequence of not initiating glucocorticoid therapy early in giant-cell myocarditis?
Death quickly ensues
66
True or False: Patients with giant-cell myocarditis present with chronic heart failure.
False
67
Fill in the blank: Giant-cell myocarditis can be associated with _______.
[ventricular tachycardia]
68
What is the treatment that must be initiated early in giant-cell myocarditis?
Glucocorticoid therapy
69
What are premature ventricular beats or contractions (PVCs)?
PVCs are generally well tolerated and benign in a patient with a structurally normal heart.
70
What symptoms may frequent PVCs cause?
Symptoms may range from palpitations to chest tightness and exertional dyspnea.
71
What diagnostic tests are appropriate before choosing therapy for PVCs?
An echocardiogram and Holter monitor.
72
When might a stress test be considered in patients with PVCs?
To assess the PVC response to exercise and in individuals with intermediate or high probability of ischemic heart disease.
73
What treatment may be considered for frequent and symptomatic PVCs?
Treatment with beta-blockers.
74
When is referral for PVC catheter ablation indicated?
For patients whose symptoms persist despite medical therapy or who do not tolerate medical therapy.
75
In addition to symptomatic patients, when else is catheter ablation used?
In patients with a high burden of PVCs associated with left ventricular dysfunction.
76
What is a consideration in cases of high burden PVCs?
An arrhythmia-induced cardiomyopathy.
77
What should be considered if neither beta-blockers nor ablation is effective?
Antiarrhythmic medications.
78
What are the risks associated with many antiarrhythmic medications?
Many are associated with adverse effects or increased mortality.
79
Key learning point regarding patients with frequent PVCs?
Patients should be referred for catheter ablation if symptoms persist despite medical therapy or if they do not tolerate medical therapy.
80
What are situations that should delay surgery for further evaluation in patients with coronary artery disease?
Active cardiac conditions
## Footnote
Active cardiac conditions include unstable angina, decompensated heart failure, concerning arrhythmias, and severe valvular disease.
81
How long should elective surgery be delayed after placement of a bare-metal stent?
More than 30 days
## Footnote
Elective surgery should generally be delayed until more than 30 days after placement of a bare-metal stent.
82
How long should elective surgery be delayed after placement of a drug-eluting stent?
More than 6 months
## Footnote
Elective surgery should be delayed until more than 6 months after placement of a drug-eluting stent.
83
What should be continued if surgery is planned after the stent time points while the patient is still on dual antiplatelet therapy?
Aspirin
## Footnote
Aspirin should be continued if possible.
84
What should be restarted as soon as possible after surgery when a patient is on dual antiplatelet therapy?
P2Y12 inhibitor (e.g., clopidogrel, ticagrelor, or prasugrel)
## Footnote
Restart the P2Y12 inhibitor as soon as possible after surgery.
85
What is recommended if delaying surgery in a patient with recent percutaneous coronary intervention is inadvisable?
Consultation with a cardiologist
## Footnote
Consulting a cardiologist is recommended if delaying surgery is inadvisable.
86
What is the next step if the patient has no active cardiac conditions before proceeding with medium-risk noncardiac surgery?
Evaluate functional capacity
## Footnote
Evaluating functional capacity is the next step before proceeding with surgery.
87
What functional capacity level indicates that the patient can proceed to surgery without further cardiac testing?
≥4 metabolic equivalents
## Footnote
If the patient can reach ≥4 metabolic equivalents without symptoms, surgery can proceed without further cardiac testing.
88
What does an electrocardiogram show in atrioventricular nodal reentrant tachyarrhythmia (AVNRT)?
A regular, narrow-complex tachyarrhythmia with retrograde P waves in leads II, aVR, aVF, V4, V5, and V6.
## Footnote
Atrioventricular nodal reentrant tachyarrhythmia (AVNRT) and atrioventricular reciprocating tachycardia.
Both types involve reentrant circuits that utilize the atrioventricular node.
89
What may terminate narrow-complex regular tachyarrhythmias?
Vagal maneuvers.
## Footnote
Vagal maneuvers are non-invasive techniques used to stimulate the vagus nerve.
90
What is a reasonable first intervention in a stable patient with narrow-complex regular tachyarrhythmia?
Vagal maneuvers may be a reasonable first intervention.
## Footnote
These maneuvers can help slow the heart rate and potentially terminate the tachyarrhythmia.
91
What role does intravenous adenosine play in treating tachyarrhythmias?
It can be a diagnostic and therapeutic intervention for reentrant tachyarrhythmias involving the atrioventricular node.
## Footnote
Adenosine works by temporarily blocking conduction through the AV node.
92
What should adenosine do to reentrant tachyarrhythmias like AVNRT?
Terminate them.
## Footnote
Adenosine is effective in stopping tachyarrhythmias that involve the AV node.
93
What effect can adenosine have on atrial flutter or tachycardia?
It can slow the ventricular response to unmask atrial flutter waves or P waves.
## Footnote
This helps in revealing the correct diagnosis by making underlying rhythms visible.
94
What should be available immediately when administering adenosine?
A defibrillator.
## Footnote
This is important because adenosine may rarely cause atrial fibrillation or ventricular tachycardia.
95
True or False: Adenosine can cause atrial fibrillation.
True.
## Footnote
Although rare, it is a potential adverse effect of adenosine administration.
96
What does a left bundle-branch morphology indicate in ventricular tachycardia?
It indicates that the tachycardia originates from the right ventricle.
## Footnote
This morphology is observed in the context of right ventricular issues.
97
What is the most likely diagnosis for a patient with unexplained syncope and right ventricular systolic dysfunction?
Arrhythmogenic right ventricular dysplasia.
## Footnote
This condition is associated with T-wave inversions in leads V1 to V3 and a family history of sudden cardiac death.
98
What ECG finding is noted in leads V1 to V3 that suggests a specific cardiac condition?
T-wave inversions.
## Footnote
These findings can indicate underlying issues such as arrhythmogenic right ventricular dysplasia.
99
Fill in the blank: Ventricular tachycardia detected on Holter monitoring with a left bundle-branch morphology originates from the _______.
right ventricle.
