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NRCME > Cardiology > Flashcards

Cardiology Flashcards

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1
Q

LVEF

A

helps determine CO –> helpful in dx HF

ex: LVEF of 65% means that 65% of overall amount of blood found in LV is pumped out w/ each cardiac contraction

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2
Q

Acceptable LVEF

A

40% in all conditions where clearance is dependent on LVEF

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3
Q

ETT

A

measure of exercise performance required for clearance evaluated by 2 indicators

–exercise to capacity of > 6 metabolic equivalents (METs) (through Bruce Stage II or equivalent)
–attain HR of >85% of predicted max (unless on BBs)
–rise in SBP >20mmHg w/o angina
–significant ST depression or elevation

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4
Q

CAD initial presentation

A

angina
chest pressure or pain w/ exertion or at rest
palpitations
presyncope or true syncope

refer to cardiology –> cert will be “incomplete”

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5
Q

acute MI

A

WP = 2 months

bi-annual ETT thereafter

no LVD

DQ = rest angina or changes in angina patter w/ in last 3 months

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6
Q

angina pectoris

A

implies that at least 1 coronary artery has hemodynamic narrowing

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7
Q

unstable angina

A

rest angina
changes in angina pattern
decreased response to meds

WP = 3 months w/out rest angina or changes in patterns

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8
Q

stable angina

A

max cert = 1 year if

cleared by cardio
tolerating meds well
pass annual PE
pass bi-annual ETT

DQ = unstable angina w/in 3 months of exam

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9
Q

CABG

A

WP = 3 months (min)

max cert = 1 year –> must have yearly annual ETT starting @ 5 years PO d/t to increased r/o re-occlusion overtime

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10
Q

PCI

A

max cert = 1 year –> must have yearly bi-annual ETT

WP = none if
–asx
–tolerating meds well
–no injury to vasc. access site

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11
Q

implanted cardiac devices

A

max cert 1 year

WP = depends on underlying dz
–sinus node dysfx or AV block = 1 month
–hypersensitive carotid sinus w/ syncope = 3 months

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12
Q

supraventricular arrhythmias

A

SVT & A-fib

not considered high r/f sudden death, but can cause LOC or compromise cerebral fx

a-fib = high r/f embolism/stroke

max cert = 1 year if
–HR controlled
–cleared
–adhering to meds

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13
Q

WP for SVT s/p ablation

A

1 month if:

asx

adequate anticoag tx

dx of
–AVRT/AVNRT
–WPW
–junctional tach
–atrial tach

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14
Q

ventricular arrhythmias

A

CAD, right outflow VT, idiopathic left VT

max cert = 1 year if
–asx
–non-sustained VT
–EF > 40&
–cleared

WP = 1 month

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15
Q

ventricular arrhythmias DQ

A

sustained VT
sx
non-sustained VT w/ EF < 40%
VT w/ concurrent dx of
–hypertrophic cardiomyopathy
–long QT syndrome
–brugada syndrome

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16
Q

CHD

A

max cert = 1 year for dx of

mild tricuspid anomaly
mild cardiac enlargement
mild RV dysfx

cleared, asx, echo

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17
Q

CHD DQs

A

sx (dyspnea, palps, emboli)
intra-cardiac lesion (ASD)
cardiac shunt
accessory conduction pathway

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18
Q

HF (systolic dysfx)

A

NYHA most common classification system

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19
Q

Class 1 HF

A

no limitations, no sx w/ ordinary activity

max cert = 1 year

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20
Q

Class 2 HF

A

slight, mild limitation of activity, comfortable at rest or mild activity

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21
Q

Class 3 HF

A

marked limitation of activity, comfortable @ rest only

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22
Q

Class 4 HF

A

confined to bed/chair; any physical activity elicits sx; sx @ rest

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23
Q

HF DQs

A

EF < 40%
sustained VT > 30 seconds
Class 2+

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24
Q

Heart transplant WP s/p transplant

A

1 year

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25
Max cert s/p heart transplant
1 year if: --cleared by cardiology AND transplant med --no sx of rejection --asx --tolerating meds well
26
Myocardial dz DQs
hypertrophic cardiomyopathy restrictive cardiomyopathy
27
Syncope
etiology = usually cardiac non-cardiac = neurocardiogenic - vasovagal WP = 3 months (cause is difficult to determine, sx often irregular) max cert = 1 year
28
AAA
cert depends on size and surgical recommendations max cert = 1 year if < 4 cm and asx > 4 cm + cardiac clearance routine US monitoring for size changes WP = 3 months s/p repair
29
AAA DQs
sx any recommendations for repair regardless of size > 4 cm but < 5 cm w/o clearance 5 cm or bigger increases in size of 0.5 cm regardless of size
30
Thoracic aneurysm
max cert = 1 year if < 3.5 cm WP s/p repair = 3 months DQ for size 3.5 cm or greater
31
Other aneurysms
max cert = 1 year if cleared by cardio WP s/p repair = 3 months DQ if any recs for repair or no clearance
32
Acute DVT
max cert = 1 year if treated w/ anticoags
33
Chronic thrombotic venous dz
max cert 2 years if asx
34
intermittent claudication
(lower extremity obstructive vascular dz) WP = 3 months s/p surgical intervention --> then max cert = 1 year DQ = pain @ rest
35
pulmonary emboli
WP = 3 months w/o further emboli and monitoring guidelines are met max cert = 1 year if long-term therapy is adhered to and well tolerated; asx DQ = sx
36
Grade 1 murmur
must strain to hear
37
Grade 2 murmur
can hear faint murmur w/out straining
38
Grade 3 murmur
easily hear moderately loud
39
Grade 4 murmur
easily hear moderately loud w/ a thrill
40
Grade 5 murmur
can hear when only a portion of stethoscope is in contact w/ skin
41
Grade 6 murmur
can hear when stethoscope is close to skin, but not in contact
42
Functional murmurs
usually benign systolic, grades 1-2, w/out sx of heart dz
43
murmurs to refer to cardio
systolic, grades 1-2, WITH s/s systolic grads 3+ holo-systolic or late systolic diastolic or continuous
44
Aortic regurgitation
Chronic, unless caused by endocarditis or severe acute aortic dissection
45
Mild-moderate aortic regurgitation
normal LV fx w/ little or not LV dilation
46
Severe aortic regurgitation
significant LV dilation
47
WP s/p AVR for aortic regurgitation
3 months
48
Max cert for aortic regurgitation w/o repair
6 months
49
Max cert s/p AVR for aortic regurgitation
1 year if: Mild dz (asx) Mod dz (asx w/ normal LV fx) Little or no LV dilation Echo at least q2-3 years for mild-mod dz
50
DQs for aortic regurgitation
sx moderate dz w/ more than mild LV dilation or abnormal LV fx EF < 50% failed ETT
51
Aortic stenosis max cert
1 year if mild-mod dz asx passed echo
52
WP s/p repair for aortic stenosis
3 months
53
DQs for aortic stenosis
angina HF A-fib LV dysfx w/ EF < 50% Thromboembolism severe stenosis that cannot be repaired
54
Mitral regurgitation WP s/p repair
3 months
55
Mitral regurgitation max cert
1 year if: mild-mod dz (asx) severe dz s/p repair and asx normal LV fx little or no LV dilation/enlargement normal pulmonary artery pressure clearance
56
Mitral regurgitation monitoring
moderate dz: echo q6 months severe dz s/p repair: echo q6-12 mos. + ETT
57
Mitral regurgitation DQs
sx failed ETT ruptured chordae tendinae or flail leaflet A-fib LV dysfx thromboembolism PAH
58
Mitral stenosis WP
dependent on surgical type --perc balloon mitral valvotomy = 1 month --commissurotomy = 3 months
59
Mitral stenosis max cert
1 year if mild-mod dz (asx) severe dz s/p repair and asx normal LV fx little or no LV dilation/enlargement no PAH clearance
60
Mitral stenosis annual monitoring
CXR + ECG + echo w/ doppler DQ = severe stenosis w/ no successful tx
61
MVP
max cert = 1 year annual monitoring = echo
62
MVP DQs
sx ruptured chordae tendinae or flail leaflet A-fib LV dysfx systemic emboli VT documented severe regurge syncope
63
Pulmonary valve stenosis WP
dependent on surgical type --perc balloon valvotomy = 1 month --commissurotomy = 3 months
64
Pulmonary valve stenosis DQs
Sx (dyspnea, palps, syncope) Pulmonary peak gradient > 50 mmHg in presence of normal CO RV pressure > 50% systemic pressure more than mild RV hypertrophy pulmonary valve regurge on echo main pulmonary artery diameter > 5 cm
65
Prosthetic valves
WP after surgery = 3 months Max cert = 1 year if asx & cleared Monitoring = monthly INR, echo, ETT
66
Prosthetic valves DQs
sx LVD (EF < 40%) thrombotic complications A-fib PAH inadequate anticoag AEB monthly INR
67
Anticoagulation therapy
Max cert = 1 year if stable on meds at least 1 month provide copy of monthly INR monitoring report & it is at therapeutic level

NRCME (8 decks)

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