Cardiology Flashcards
(120 cards)
1
Q
The risk for cardiac transplant rejection is highest within the first 6 months after transplantation and then within the first year; how do you diagnose acute rejection?
A
Endomyocardial biopsy should be routinely performed within the first year after cardiac transplantation to diagnose rejection.
Note: Presenting signs and symptoms of acute heart failure, including abdominal discomfort, exertional dyspnea, and an S3.
2
Q
Patients with a non–ST-elevation acute coronary syndrome who have a high or intermediate TIMI risk score should be treated with?
A
An early invasive strategy, such as urgent angiography
3
Q
For chronic severe primary mitral regurgitation in symptomatic patients with left ventricular EF >30%, asymptomatic patients with left ventricular dysfunction, & patients undergoing another cardiac surgical procedure, what’s the next step in management?
A
Surgical Mitral valve repair is generally preferred to surgical valve replacement because it is associated with improved survival
4
Q
The monoclonal antibody bevacizumab is associated with the development of significant but reversible
A
HTN
5
Q
Is characterized by clinical features of upper extremity hypertension and a radial artery–to–femoral artery pulse delay as well as radiographic findings of “figure 3 sign” and rib notching, what’s the diagnosis?
A
Aortic coarctation
6
Q
Management of a patient with acute limb ischemia?
A
Invasive angiography should be performed immediately to define the anatomic level of occlusion and plan for revascularization
7
Q
For most patients with high-risk atrial fibrillation and stable coronary artery disease, what’s the most appropriate treatment?
A
Discontinue aspirin & begin oral anticoagulation
8
Q
In patients with suspected coronary artery disease who have baseline electrocardiographic (ECG) abnormalities that preclude the use of ECG stress testing, such as ST-segment depressions greater than 0.5 mm, left bundle branch block, ventricular paced complexes, digitalis effect, and preexcitation?
A
Stress testing with adjunctive imaging e.g. exercise stress echocardiography or a nuclear perfusion study
9
Q
Subacute signs of elevated right heart pressure, Pulsus paradoxus is present, and the echo w/ moderately sized pericardial effusion with evidence of tamponade. The intrapericardial pressure is reduced to normal following drainage, whereas the intracardiac pressures remain elevated & equalized despite drainage, consistent w/ a diagnosis of effusive constrictive pericarditis. What’s the treatment?
A
Ibuprofen & colchicine
10
Q
In patients with findings of low-flow, low-gradient aortic stenosis, the primary abnormality may be either severe ventricular dysfunction with pseudostenosis or critical aortic stenosis; what’s the next step in management?
A
Dobutamine echocardiography is needed to distinguish between the two entities.
11
Q
Treatment of cardiogenic shock?
A
Inotropes such as dobutamine or milrinone may be considered to improve cardiac function.
12
Q
Treatment for atrial flutter refractory to medical therapy?
A
Catheter ablation
13
Q
A continuous murmur beneath the left clavicle that envelops the S2 but no other cardiovascular features?
A
Patent ductus arteriosus
14
Q
Is characterized by angina and stress testing abnormalities in the absence of angiographically significant coronary artery disease?
A
Cardiac syndrome X
15
Q
Treat a patient with intermittent claudication with?
A
Supervised exercise training is recommended to improve symptoms and walking distance.
16
Q
In patients with an indication for abdominal aortic aneurysm repair, the choice between open surgical repair and endovascular aneurysm repair is driven in part by the location of the aneurysm and involvement of the renal and mesenteric arteries, therefore, what should be done prior to repair?
A
CT angiography of the abdominal aorta & iliac vessels
17
Q
Which risk factors most increases a patient’s risk for cardiovascular disease?
A
Hyperlipidemia
18
Q
In patients with heart failure, each follow-up visit should include evaluation of:
A
current symptoms and functional capacity; assessment of volume status, electrolytes, and kidney function; and review of the patient’s medication regimen for adequacy.
19
Q
Patients suspected of having Wolff-Parkinson-White syndrome should undergo
A
Electrophysiology testing for risk stratification for sudden cardiac death
20
Q
Women with Marfan syndrome considering pregnancy, should be advise?
A
Against pregnancy & have an increased risk for pregnancy-related aortic dissection and rupture.
Note: In women with Marfan syndrome and an ascending aortic diameter of 4.5 cm or greater, aortic repair surgery is recommended before pregnancy to reduce this risk. Generally, pregnancy is considered safe if the aortic diameter is smaller than 4.0 cm.
21
Q
Are small, independently mobile cardiac tumors that are typically attached to the left-sided valvular endocardium by a stalk; they may be associated with stroke, TIA, angina, MI, & peripheral embolization
A
Papillary fibroelastomas
22
Q
In patients with cyanotic conditions, such as Eisenmenger syndrome, iron deficiency is common, and should be treated with
A
Short-term iron therapy will improve exercise capacity and quality of life.
23
Q
For patients with ST-elevation myocardial infarction when symptom onset is within 12 hours and primary PCI is not available within 120 minutes of first medical contact, management should include?
A
Thrombolytic therapy e.g full-dose reteplase
24
Q
In patients with an ankle-brachial index greater than 1.40, what is the most appropriate diagnostic test to perform?
A
a toe-brachial index may be used to diagnose peripheral artery disease.
Note: Exercise ABI is not indicated to diagnose PAD, when resting ABI value is > 1.40.
25
Treat a patient with infective endocarditis and refractory bacteremia with
**_Cardiac valve surgery_**, for persistent infection lasting longer than 5 to 7 days while on appropriate antimicrobial therapy; symptomatic heart failure; left-sided involvement with *Staphylococcus aureus*, fungal infections, or highly resistant organisms; complications such as heart block, annular or aortic abscess, or destructive penetrating lesions; and prosthetic valve infective endocarditis and relapsing infection.
26
Recognize the potential for underestimation of cardiovascular risk in patients with?
HIV infection, there is a 1.5- to 2-fold increased risk for CAD.
27
In patients with an intermediate probability of obstructive coronary artery disease, a normal baseline electrocardiogram, and the ability to exercise, what's the next most appropriate diagnostic test?
Exercise electrocardiography
28
Patients with left ventricular dysfunction due to ischemic cardiomyopathy, left bundle branch block, and heart failure symptoms should receive guideline-directed medical therapy with?
Beta-blocker e.g Carvedilol, before initiation of device therapy
29
Patient presents with HFpEF, w/ elevated BNP & concordant rise & fall of left & right systolic pressures w/ respiration, the absence of pericardial thickening on cardiac MRI, & the presence of delayed enhancement of myocardium consistent with myocardial fibrosis on cardiac MRI.
**_Restrictive cardiomyopathy_** Note: B-type natriuretic peptide level (often \<100 pg/mL [100 ng/L] in constrictive pericarditis)
30
Patients with uncomplicated type B aortic dissection may be initially treated with medical therapy, including
β-blockers, sodium nitroprusside, and opioids.
31
Definitive treatment of cardiac tamponade is
Pericardiocentesis or surgical pericardial drainage
32
\_\_\_\_\_\_\_ is a well-recognized and often self-limited side effect of ticagrelor therapy.
Dyspnea
33
is a syndrome of reversible ventricular systolic dysfunction that is usually precipitated by an acute emotional or physiologic stressor; the hallmark is wall motion abnormalities that extend beyond a single coronary territory, identified by echocardiography or other imaging studies with normal coronary arteries found on heart cath?
Takotsubo cardiomyopathy
34
Is recommended for patients with symptomatic pulmonary valve stenosis who have appropriate valve morphology, a peak Doppler gradient of greater than 50 mm Hg or a mean gradient greater than 30 mm Hg, and valve characteristics favorable for percutaneous intervention?
Balloon valvuloplasty
*_Late-peaking systolic murmur located at the second left intercostal space; absence of an ejection click=_* **pulmonic stenosis**
35
Baseline ECG abnormalities that limit the ability to interpret exercise ECG findings are an indication for stress testing with adjunctive imaging or anatomic assessment of coronary arteries with test such as:
Coronary CT angiography (CTA)
36
In patients with sinus bradycardia & equivocal symptoms, what's the next step in management?
Exercise stress testing may be used to assess for chronotropic incompetence and determine suitability for pacemaker placement.
37
What are the agents of choice in treating pregnant patients with hypertension?
Labetalol and methyldopa
38
In patients with **asymptomatic severe mitral regurgitation** with preserved left ventricular function who do not have an indication for surgery, clinical and echocardiographic surveillance every?
6 to 12 months is recommended
39
In this patient with **_asymptomatic_** peripheral artery disease (PAD) and acute coronary syndrome treated with percutaneous coronary intervention, the most appropriate next step in management is?
cardiac rehabilitation
40
Notably, the guideline recommends that all patients with HCM, regardless of the presence of obstruction, should undergo assessment for
Sudden cardiac death risk factors at the time of diagnosis and every 1 to 2 years. The guideline also suggests that, for most patients with HCM, mild- to moderate-intensity recreational exercise is beneficial if done for the purpose of leisure.
HCM murmur = A grade 3/6 systolic crescendo-decrescendo murmur is heard best along the left sternal border; it decreases with squatting & is more pronounced in the upright position.
41
Is a rare complication of MI that produces **sudden-onset chest pain or syncope** **with rapid progression to pulseless electrical activity?**
Ventricular free wall rupture
42
patient has signs of **right-sided heart failure, but low BNP equal to \<100,** accompanied by fever, leukocytosis, an elevated ESR, & **friction rub**. Echo shows **ventricular interdependence** & **equalization of diastolic pressures in all heart chambers**. Cardiac MRI shows pericardial thickening with evidence of active inflammation. These features are consistent with the diagnosis of?
**_Transient constrictive pericarditis_**
Transient constrictive pericarditis most often is idiopathic but may follow cardiac surgery. Initial therapy consists of an **NSAID plus colchicine**.
Note: patients with restrictive cardiomyopathy would not demonstrate evidence of enhanced ventricular interdependence, and the BNP is typically \> 400 pg/mL
43
The cornerstone of treatment for patients with heart failure with preserved ejection fraction is
Diuretic therapy to maintain euvolemia
44
**Fixed splitting of the S****2****, a mitral regurgitation murmur, and left-axis deviation** on electrocardiogram are consistent with an?
**_Ostium primum ASD_**
Note: Patients with **ostium secundum ASD** have right heart volume overload **but do not generally have mitral regurgitation**. The ECG **may demonstrate first-degree AV block & incomplete RBBB, or it may be normal**. This patient's ECG finding of left axis deviation is not seen in patients with ostium secundum ASD.
45
Routine screening for lipid disorders and **calculation of 10-year atherosclerotic cardiovascular disease risk by using the Pooled Cohort Equations** should be performed in adults aged?
40 to 75 years
46
In patients with a mechanical prosthetic valve, what is the most appropriate antithrombotic therapy?
**_Warfarin & Aspirin_** (if low risk of bleed)
47
Atrial fibrillation w/ aberrant conduction results in an irregularly irregular rhythm & a wide-complex tachycardia w/ a QRS morphology (rSR pattern in lead V1, deep terminal S waves in leads I and V6) on ECG typical of RBBB. What's the most appropriate next step in management?
BB therapy & anticoagualtion
48
In patients with a thoracic aortic aneurysm greater than 4.5 cm in diameter who require coronary artery bypass graft surgery or surgery to repair valve pathology,
aortic repair should be performed at the time of cardiac surgery
49
The most likely cause of stroke in this patient with a left ventricular assist device (LVAD) is
LVAD-related thrombosis
The incidence of hemorrhagic and embolic strokes approaches 20% at 1 year after insertion of a left ventricular assist device.
50
Short, soft systolic murmurs (grade \<3) that are well localized to the left sternal border and are not associated with symptoms often?
Do not require further investigation
51
Duration of dual antiplatelet therapy in **a patient with stable angina** treated with drug-eluting stent placement?
Dual antiplatelet therapy is recommended for at **_least 6 months_**.
Note: **Patients with ACS treated with PCI (bare metal or drug-eluting stent placement**) should be optimally treated with DAPT **for at least 12 months**.
52
Patients with an **atrial myxoma** may present with constitutional symptoms, embolic phenomena from tumor fragmentation, or symptoms referable to intracardiac obstruction (dyspnea, syncope); treatment is?
**_Urgent surgical excision_**
53
An autosomal dominant D/O commonly associated with congenital cardiac lesions, including pulmonary stenosis; the valve is usually dysplastic. ________________ should be considered in all patients with pulmonary stenosis, particularly those with short stature, variable intellectual impairment, unique facial features, neck webbing, **hypertelorism**, and other cardiac abnormalities, including hypertrophic cardiomyopathy, atrial septal defect, and ventricular septal defect.
**_Noonan syndrome_**
NOTE: Turner syndrome is a genetic disorder that affects girls & women & is characterized by complete or partial absence of one of the X chromosomes. Affected persons have short stature, webbed neck, low-set ears, low hairline, & primary infertility. Cardiac defects include bicuspid aortic valve, aortic coarctation, & aortic aneurysm.
54
This is indicated in patients with nonischemic cardiomyopathy who have a EF less than or equal to 35% and who have NYHA functional class II or III symptoms; It is also reasonable for patients with nonischemic cardiomyopathy & unexplained syncope & significant LV dysfunction?
Implantable cardioverter-defibrillator (ICD) placement
55
In patients with **mitral stenosis** who have a discrepancy between the clinical findings and the echocardiographic findings, what should be done next?
**_Exercise echocardiography_**, should be pursued to assess the response of the mitral gradient and pulmonary pressures.
56
Patients with ST-elevation myocardial infarction complicated by cardiogenic shock should undergo
Emergent revascularization with primary percutaneous coronary intervention.
57
Patients with a bicuspid aortic valve and a thoracic aortic aneurysm should undergo echocardiography every
**_6 months_** if the aortic diameter is larger than 4.5 cm or the rate of enlargement exceeds 0.5 cm/year.
58
is left ventricular systolic dysfunction with onset toward the end of pregnancy or in the months following delivery in the absence of another identifiable cause; patients often present with features of heart failure?
Peripartum cardiomyopathy
59
In patients with infrequent episodes of palpitations, presyncope, or syncope, that occurs once or twice per week, is the most appropriate diagnostic testing option?
External event recorder
60
Common factors other than ventricular wall stress that influence B-type natriuretic peptide (BNP) levels include:
Kidney failure, older age, and female sex, all of which increase BNP levels; obesity reduces BNP levels.
61
In patients with critical limb ischemia, what's the next step in management?
Immediate invasive angiography with endovascular revascularization is often the most effective strategy to preserve tissue viability.
62
Patients with atrioventricular block and evidence of acute coronary syndrome should undergo
**_Cardiac catheterization_** for diagnosis and possible revascularization.
63
For patients with severe aortic regurgitation, indications for surgery are the presence of attributable symptoms, left ventricular ejection fraction less than 50%, or significant left ventricular dilatation; in the absence of these findings, surveillance echocardiography every
6 to 12 months is recommended.
Aortic regurgitation = diastolic decrescendo murmur best heard at the left lower sternal border.
64
In patients with ST-elevation myocardial infarction, an ACE inhibitor should be initiated within 24 hours of presentation; if the patient is intolerant of ACEI?
An angiotensin receptor blocker may be used
65
Patients with atrial fibrillation in the setting of hypertrophic cardiomyopathy should receive?
DOACs e.g. Dabigatran
66
In patients with symptoms of aortic stenosis and discrepancies between the physical examination and echocardiographic findings, the severity of stenosis should be established with?
**_Cardiac catheterization_** before aortic valve replacement is performed.
Surgical or transcatheter aortic valve replacement is not indicated in this patient until there is certainty that the aortic valve lesion is severe & can account for the patient's symptoms.
67
What's the most appropriate management of patients with a small uncomplicated ventricular septal defect?
Periodic follow-up with clinical evaluation and imaging in 3-5 years
68
Findings of **congestion, hypotension, pulsus paradoxus, enlarged cardiac silhouette on chest radiograph, and electrical alternans on electrocardiogram** support the diagnosis of?
Cardiac tamponade
69
In patients with borderline or intermediate 10-year risk for atherosclerotic cardiovascular disease, ______________________ may be used to further risk-stratify patients to guide primary prevention therapy.
Coronary artery calcium scoring
70
In patients with heart failure with reduced EF on ACEI and furosemide, what should be added?
β-blocker (specifically, metoprolol succinate, carvedilol, or **_bisoprolol_**), and an aldosterone antagonist (in symptomatic patients).
71
Treatment of a patient with multivessel coronary artery disease & left ventricular dysfunction with?
Coronary artery bypass graft surgery (CABG)
72
Patients with premature ventricular contraction–induced cardiomyopathy should be treated with
Catheter ablation
First-line therapy for symptomatic or frequent PVCs includes β-blockers or calcium channel blockers. Patients w/ continued frequent PVCs despite medical therapy or those who develop left ventricular dysfunction should undergo catheter ablation, which resolves most cases of PVC-induced left ventricular dysfunction.
73
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ is indicated for symptomatic patients with degenerative mitral regurgitation who are not surgical candidates.
**_Transcatheter mitral valve repair_**
Two surgical options are available: mitral valve repair & mitral valve replacement. Mitral valve repair is typically preferred to valve replacement because it is associated w/ better clinical outcomes. A nonoperative procedure, transcatheter mitral valve repair, is indicated for symptomatic patients with degenerative mitral regurgitation who are at prohibitive surgical risk, such as this patient. With this technique, the mitral valve is plicated using an approach from the femoral vein. In experienced centers, success rates are approximately 90%, with procedural mortality of approximately 2%.
74
Patients with peripheral artery disease should be treated with aspirin, diet, exercise &?
statins
75
Patients with end-stage heart failure should be considered for
Cardiac transplantation or mechanical circulatory support with left ventricular assist device (LVAD) placement.
Note: Cardiac transplantation remains the gold standard therapy for patients w/ end-stage heart failure. Indications: age \<65 to 70 years, no medical contraindications (diabetes w/ end-organ complications, malignancies within 5 years, kidney dysfunction, other chronic illnesses that will decrease survival), & good social support & adherence.
76
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_, presenting with a single S2, a parasternal lift, and a soft systolic pulmonary outflow murmur, is the most common structural disorder resulting from tetralogy of Fallot repair.
Pulmonary regurgitation
77
Patients with an abdominal aortic aneurysm smaller than 5.5 cm should undergo surveillance
Ultrasonography, with frequency determined by aneurysm size.
For AAAs \<4.0 cm, the 5-year risk for rupture is 2%, & some guidelines recommend a surveillance interval of 24-36 months. AAAs between 4.0 cm & 5.0 cm have a 5-year risk for rupture of 3% to 12%, and surveillance imaging is recommended more frequently (for example, every 6 to 12 months). AAAs 5.0 & 6.0 cm have a 5-year risk for rupture of 25%. Once an AAA reaches 5.5 cm in maximum diameter, surgical or endovascular repair is warranted.
78
The preferred imaging modality for evaluating patients with a high pretest probability of infective endocarditis or with potential complications of endocarditis, such as abscess, is?
**_Transesophageal echocardiography_**
Note: Transthoracic echo can help identify the presence of a vegetation; however, there is an increased likelihood of detecting perivalvular abscess w/ TEE because of the closer proximity of the ultrasound probe to the valve structures. TEE is preferred to TTE if this diagnosis is a consideration.
79
Patients w/ refractory angina symptoms while receiving optimal medical therapy, those who are unable to tolerate optimal medical therapy owing to side effects, or those with high-risk features on noninvasive exercise & imaging tests. What is the most appropriate management?
Diagnostic angiography and percutaneous coronary intervention
80
In pregnant patients with a mechanical valve prosthesis, what's the anticoagulation?
**_Warfarin_** is the preferred anticoagulation therapy during the first trimester if the dose is 5 mg daily or less; warfarin is preferred to all other anticoagulants during the second and early third trimesters.
81
QT-interval prolongation has many causes, including medications such as:
antiarrhythmic agents, antibiotics (macrolides and **_fluoroquinolones_**), antipsychotic drugs, and antidepressants; structural heart disease; and electrolyte abnormalities.
82
Asymptomatic patients w/ a bicuspid aortic valve & severe aortic regurgitation when the left ventricular end-systolic diameter reaches 50 mm or the left ventricular ejection fraction is less than 50%, what's the appropriate management?
**_Aortic valve & root replacement_**
In patients undergoing cardiac surgery, **repair of the ascending aorta is indicated when the diameter exceeds 45 mm**; thus, concomitant aortic root replacement, in addition to aortic valve replacement, is indicated in this patient.
83
Following heart failure hospitalization, \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_should be scheduled to reinforce heart failure education, ensure proper medication use, evaluate volume status, and uptitrate or initiate medications as needed.
Early follow-up (within 1 week)
84
for patients with hypertrophic cardiomyopathy (HCM) and for all first-degree family members of patients with HCM who have an identified genetic mutation, regardless of the presence or absence of symptoms, should have?
Genetic counseling & testing
85
Patients with **_rheumatoid arthritis_** have a 1.5- to 2-fold elevated risk for?
CAD compared with the general population.
86
Is characterized by **elevated resting heart rate**, with exaggerated increases in heart rate with light activity. The sinus rates typically decrease during sleep, as identified on this patient's ambulatory electrocardiographic monitor, what is the diagnosis?
Inappropriate sinus tachycardia (IST)
87
In patients with left bundle branch block, the preferred diagnostic test for coronary artery disease is?
A vasodilator stress test (such as **_Adenosine single-photon emission CT_**) because myocardial perfusion imaging with exercise or dobutamine stress may result in a false-positive perfusion defect in the basilar septum
88
The initial laboratory evaluation of patients with new-onset heart failure should include a B-type natriuretic peptide or N-terminal pro–B-type natriuretic peptide assay, complete blood count, serum electrolyte measurement, kidney function tests, liver chemistry tests, and
TSH measurement
89
A patient with evidence of a recent inferolateral MI presenting w/ decompensated heart failure & a soft, early systolic murmur with an S3 is audible in the apical area, what's the most likely diagnosis?
Mitral regurgitation, likely secondary to papillary muscle dysfunction (or rupture) and/or ventricular dysfunction.
90
In all patients with NSTEMI, who declines angiography, in addition to aspirin, what antithombotic regimen should be given?
Ticagrelor
Note: Prasugrel is only given after PCI. Clopidogrel is inferior to Ticagrelor.
91
Commonly characterized by symptoms of right-sided heart failure, low or normal B-type natriuretic peptide level, & the finding of pericardial thickening or calcification on imaging studies, what's the most likely diagnosis?
Constrictive pericarditis
92
Elevated central venous pressure, **fixed splitting of the S****2**, a right ventricular heave, and**right-axis deviation and incomplete RBBB** on ECG are characteristic findings in patients with?
Ostium secundum atrial septal defect (ASD)
93
In the evaluation of cryptogenic stroke, what's the most appropriate diagnostic testing option?
30-Day event-triggered loop recording
Noninvasive ambulatory electrocardiographic (ECG) monitoring for 30 days improves the detection of atrial fibrillation by fivefold compared with short-term ECG monitoring.
94
The mainstay of therapy for acute decompensated heart failure is
Intravenous diuretics
95
What is the first-line imaging modality used in patients suspected of having infective endocarditis to identify vegetations, determine the severity of valvular lesions, assess ventricular function, &detect complications?
Transthoracic echocardiography (TTE)
Note: because of cost, accessibility, & invasiveness, TEE, chest MRI, and cardiac CT are not the best initial imaging choices.
96
In patients with non–ST-elevation acute coronary syndrome, an ischemia-guided approach is appropriate for **patients at low risk** based on clinical risk score. What's the most appropriate management?
Exercise stress testing
97
Smoking cessation, exercise training, and __________________ are recommended to improve limb symptoms in patients with peripheral artery disease and intermittent claudication, already on aspirin.
Medical therapy (cilostazol)
Note: If this patient does not have improvement in his symptoms with cilostazol or cannot tolerate cilostazol therapy, he should be referred for invasive management (endovascular or surgical revascularization).
98
Hemodynamically stable patients with supraventricular tachycardia refractory to vagal maneuvers should be given?
Adenosine
99
This diagnosis should be suspected in **Black patients older than 50 years** who have left ***ventricular wall thickening that is not explained by loading conditions (for example, hypertension or aortic stenosis)*** and present with heart failure or features of diastolic dysfunction & severe pHTN?
Cardiac amyloidosis
Note: Diagnosis is established by histopathology; endomyocardial biopsy is more sensitive than abdominal fat pad biopsy.
100
In a patient with **aortic coarctation** with an end-to-end anastomosis performed at 4 years of age with a **grade 2/6 mid-peaking systolic murmur** noted at the second right intercostal space, what's the most likely cause of this patient's systolic murmur?
Aortic stenosis
A bicuspid aortic valve is present in more than 50% of patients with aortic coarctation.
101
All patients with heart failure with reduced ejection fraction should be treated with an ACE inhibitor and a β-blocker; β-blocker dosage should be
uptitrated every 2 to 4 weeks until the patient achieves a heart rate of approximately 60/min or has symptomatic hypotension.
102
Mobitz type 2 second-degree atrioventricular block is an uncommon but potentially life-threatening electrical complication of anterior myocardial infarction; what's the most appropriate treatment?
Emergent temporary or permanent pacing is indicated in this setting.
103
Bicuspid valve disease is commonly associated with abnormalities of the aorta, including aneurysm, dissection, and coarctation; therefore, all patients with a bicuspid aortic valve should be evaluated for possible aortopathy with?
CT or cardiac magnetic resonance imaging.
104
The factor associated with the highest risk for atherosclerotic cardiovascular disease (ASCVD) in a patient with DM, HTN & hyperlipidemia?
Diabetes mellitus
105
In all patients suspected of having infection of a cardiac implanted electronic device, what is the most appropriate management?
a minimum of two blood cultures should be drawn from separate sites.
106
In a patient with COPD & heart failure presenting with symptoms of dyspnea, paroxysmal nocturnal dyspnea, orthopnea, and peripheral edema. What's the most likely cause of this patient's symptoms?
Acute exacerbation of heart failure
107
What is the preferred method of reperfusion in patients with ST-elevation myocardial infarction, noted as new LBBB on EKG?
Primary percutaneous coronary intervention
108
Symptoms of upper extremity peripheral artery disease may include arm claudication, arm ischemia, or dizziness with arm activity; what's the most appropriate diagnostic test to perform next?
CT angiography of the chest & neck is useful to confirm the diagnosis and plan for intervention.
109
Patients with acute type A aortic dissection should be treated emergently with
Open surgical repair
Note: CT scan reveals a dissection plane extending through the aortic arch (*arrow*).
110
This diagnostic test is indicated for patients with systolic murmurs grade 3/6 or higher, late or holosystolic murmurs, diastolic or continuous murmurs, & murmurs with accompanying symptoms?
Transthoracic echocardiography
Note: Innocent murmurs are characteristically brief, are often midsystolic, do not radiate, & are associated with normal heart sounds & no hemodynamic abnormalities. Patients with grade 1 or 2 midsystolic murmurs (grade 1, faintest murmur that can be heard; grade 2, faint murmur but can be identified immediately) who are asymptomatic with no associated findings & those w/ continuous murmurs suggestive of a venous hum or mammary souffle (a continuous murmur heard over the breast in lactating women) do not warrant echo evaluation.
111
In patients suspected of having tricuspid regurgitation, with a grade 3/6 holosystolic murmur noted at the left lower sternal border, what is indicated to evaluate lesion severity, determine the cause, assess the size and function of the right-sided chambers, & estimate pulmonary artery pressures.
transthoracic echo
112
Ranolazine decreases symptoms of angina and modestly increases exercise times in patients with stable angina; it should not be used with strong CYP3A inhibitors, and dosage should be reduced when used in conjunction with moderate CYP3A inhibitors, such as
Diltiazem and verapamil
113
Asymptomatic first-degree atrioventricular block with bifascicular block, what's the most appropriate management?
Does not require pacemaker implantation
114
Guideline-directed medical therapy for symptomatic heart failure with reduced ejection fraction includes
an ACE inhibitor, β-blocker (specifically, metoprolol succinate, carvedilol, or bisoprolol), and aldosterone antagonist.
115
Indications for device closure of an ostium secundum atrial septal defect?
Right heart enlargement & symptomatic disease
116
This is indicated for symptomatic patients with aortic stenosis and intermediate or high surgical risk, as assessed by a multidisciplinary heart team?
**_Transcatheter aortic valve replacement_** has been found to be comparable to surgical intervention
117
In patients with ST-elevation myocardial infarction, left ventricular ejection fraction of 40% or less, and either heart failure symptoms or diabetes mellitus, already on ACEI, BB, & DAPT, what other medication should be added?
An aldosterone antagonist
118
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ occurs in approximately 1% of patients who undergo catheter ablation procedures for atrial fibrillation; it is the most common serious complication and is likely to result in death if not recognized and treated urgently. Patient present with pulses paradoxes & muffled hear sounds
Cardiac tamponade
119
Is indicated in patients with an ejection fraction less than or equal to 35%, New York Heart Association functional class II to IV heart failure symptoms despite guideline-directed medical therapy, sinus rhythm, and left bundle branch block with a QRS duration of 150 ms or greater?
Cardiac resynchronization therapy
120
In patients with acute pericarditis, first-line treatment is?
High-dose aspirin or NSAIDs and adjuvant colchicine therapy
Note: an ECG demonstrating widespread ST-segment elevation & PR-segment depression, and a small pericardial effusion. The elevated C-reactive protein level also supports acute pericarditis.
