Cardio

Question 0

RE-LY - 2009

Answer 0

Noninferiority trial

Dabigatran vs Warfarin

Question 1

Warfarin reduces stroke risk by

Answer 1

~55%

Question 2

AFFIRM - 2002

Answer 2

Pts w non-valvular AF
Rate vs rhythm control non-inferior,
Rhythm control shows trends towards increased mortality

Question 3

RACE II -2010

Answer 3

Lenient (HR <80/min) in preventing cardiovascular events

Question 4

Antiarrythmic drugs - Class I

Answer 4

NaCB
1a - procainamide, quinidine
1b - lidocaine
1c - flecanaide, propafenone

Question 5

Anti arrhythmic drugs - Class II

Answer 5

BBs

Question 6

Anti arrhythmic drugs - Class III

Answer 6

KCBs

Amiodarone, sotalol, dofetilide

Question 7

Anti arrhythmic drugs - Class IV

Answer 7

CCBs

Question 8

Digoxin

Answer 8

Na-K ATPase inhibitor: increases contractility (IC Na increases, resulting in Ca influx)
AV node blockade - increases effective refractory period, slows heartrate

Question 9

Inotropic effect

Answer 9

+ increases myocardium contractility

- decreases myocardium contractility

Question 10

Chronotropic effect

Answer 10

+ increases HR

- decreases HR

Question 11

Dromotropic effect

Answer 11

+ increases AV node conduction speed

- decreases Av node conduction speed

Question 12

Maintenance of Sinus rythtm if no Heart disease (and HTN without LVH)

Answer 12

1st choice: flecanaide, propafenone, sotalol

2nd line: amio, dofetilide, cath ablation

Question 13

Maintenance of sinus rhythm if HTN & LVH

Answer 13

1st line: amio

2nd line: cath ablation

Question 14

Maintenance of sinus rhythm if CAD

Answer 14

1st line: dofetilide, sotalol

2nd line: amio or cath ablation

Question 15

Maintenance of sinus rhythm if CHF

Answer 15

1st line: amio, dofetilide

2nd line: cath ablation

Question 16

Dronedorone

Answer 16

Amio derivate
Not in CHF
Causes GI upset
Causes incr of creatinine 2ry to decreased tubular secretion

Question 17

Complications of AF ablation

Answer 17

Stroke
PV stenosis
LA tachycardias

Question 18

SCT-HEFT

Answer 18

Pts w NYHA II/III and EF<35% mortality benefit of Prophylactic ICD

Question 19

MADIT II.

Answer 19

Post-MI w EF=< 30% mortality benefit from prophylactic ICD

Question 20

Biventricikar device Tx

Answer 20

NYHA III/IV w EF120-130 ms

NYHA I/II w LBBB QRS>130 and EF=<30%

Question 21

When to Echo a murmur?

Answer 21

All diastolic
=< 2/6 if symptoms
=> 3/6 all

Question 22

When to intervene? - MS

Answer 22

Valvuloplasty, if
Symptoms; AF; increased PAP on exercise

(Severe, if VA 60 or PAP >30 mmHg on exercise)

Question 23

When to intervene! - AS

Answer 23

AVR - if symptomatic; if asymptomatic but EF4.0m/s, mean gr >40 mmHg)

Question 24

When to intervene? - MR

Answer 24

MV repair or MVR, if symptomatic, or if LV dysfunction (ESD >= 40, EF60 cc, regurg orifice area: >= 0.4 cm2, vena contracta >= 0.7 cm)

Question 25

When to intervene? -AR

Answer 25

AVR, if symptomatic, or LV dysfunction (ESD >= 55 mm, EF0.6 mm, regurg volume >60 cc, regurg orifice area >0.3 cm2)

Question 26

Electrical alterans

Answer 26

Dg for pericardial fluid

Question 27

Electrical alterans + hemodynamical instability

Answer 27

Pericardial Tamponade

Question 28

Pericarditis

Answer 28

Rub= 2 systolic, 1 diastolic Relieved by leaning forward Diffuse ST-elevation & PR depression

Question 29

Constructive pericarditis

Answer 29

Kussmaul's sign

Question 30

HOCM - incidence 1/500; no vigorous sports!! | ICD recommendations

Answer 30

Symptomatic (syncope or sudden cardiac death) | Asymptomatic high risk (family Hx of sudden cardiac death, septum >30 mm)

Question 31

A/C in pregnancy

Answer 31

1st trimester - UFH or LMWH Then - warfarin until wk 36 At the end cont UFH drip until delivery

Question 32

Coarctation aortae

Answer 32

Distal to L subclavian 50-80% a/w bicuspid aortic valve UE HTN CXR: 3-sign, rib-notching

Question 33

Smoking cessation and all cause mortality in pts w IHD

Answer 33

36%

Question 34

Anti-platelet in U/A - NSTEMI if medical therapy only

Answer 34

Asa 81 mg indefinitely | Plavix 75 mg x 1/12, ideally for 1yr

Question 35

Dual antiplatelet in pt w DES

Answer 35

Asa 81 mg x indefinitely Plavix 75 mg x min 1yr, or Prasugrel 10 mg, or ticagrelor 90 mg bid

Question 36

Dual antiplatelet Tx for U/A or NSTEMI w BMS

Answer 36

Asa 81 mg indefinitely Plavix 75 mg x 1/12, ideally x1yr, or prasugrel 10 mg daily or ticagrelor 90 mg bid

Question 37

Acute MR on PA catheter

Answer 37

PCWP 25 (elevated) & v waves to 40 mmHg

Question 38

Cardiogenic shock on PA catheter

Answer 38

PCWP 25 (elevated), w CI 1.5 (decreased)

Question 39

Tamponade on PA catheter

Answer 39

Equalization of pressures: | RA 20 mmHg, PAP 40/20, PCWP 20

Question 40

VSD on PA catheter

Answer 40

Sat 88% in PA

Question 41

Pulmonary embolism on PA catheter

Answer 41

PAP 50/30,PCWP 4