MedicalCNS > Cardiology > Flashcards

Cardiology Flashcards

(61 cards)

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1
Q

Chest pain on normal coronaries

A

Microvascular dysfunction

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2
Q

Treatment of severe mitral regurgitation

A

Reduce left ventricular volume:
Ace(arb), beta blocker, aldosterone inhibitors

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3
Q

Ascending aorta aneurysm requires repair

A

5.5 cm

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4
Q

SVT terminated by vagal maneuvers

A

Atrioventricular nodal reentrant tachycardia

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5
Q

Cannon a waves

A

Dissociation of AV conduction

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6
Q

Widened QRS due to

A
  1. SVT with aberrancy
  2. Pre-excited tachycardia
  3. VT
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7
Q

Ventricular Tachycardia

A
  1. Positive in aVR
  2. QRS morphology concordant (all predominantly positive or negative) in precordial leads
  3. Exhibit extreme axis deviation
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8
Q

Severe mitral stenosis

A

Valva area < 1.5 cm2
Mitral gradient > 5-10 mmHg at normal heart rate
PASP > 50 mmHg

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9
Q

Beta blockers with mortality effects

A

Bisoprolol
Carvedilol
Metoprolol succinate

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10
Q

Acute limb ischemia

A

Paresthesia
Pain
Pallor
Pulselessness
Poikilothermia (coolness)
Paralysis

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11
Q

HFpEF pathophysiology

A
  1. LV hypertrophy
    2, LV fibrosis
  2. Chronotropic incompetence
  3. Microvascular dysfunction
  4. Inflammation
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12
Q

HFpEF

A

Elevated filling press
Structural abnormalities LVH, LAE
elevated BNP

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13
Q

DDX from HFpEF

A
  1. Restrictive CMP
  2. Hypertrophic CMP
  3. Storage disease
  4. Pericardial disease
  5. Valvular heart disease
  6. Primary RV failure
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14
Q

Causes of restrictive heart disease

A
  1. Amyloid
  2. Hemochromatosis
  3. Sarcoidosis
  4. Endomyocardial fibrosis
  5. Radiation/chemotherapy
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15
Q

Comorbidities in HFpEF

A
  1. Htn
  2. Obesity
  3. DM/prediabtes
  4. Chronic kidney disease
  5. Afib
  6. Chronotropic incompetence (left ventricular strain)
  7. Decrease oxygen uptake
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16
Q

Chronotropic incompetence

A

the inability of the heart to increase its rate commensurate with increased activity or demand

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17
Q

Treatment HFpEF

A
  1. Diuretic (1)
  2. SGLT2 inhibitors (2a)
  3. ARNI (2b)
  4. MRA (2b)
  5. ARB (2b)
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18
Q

Heart Failure
Goal of diuretic

A

> 100-150 ml/hr

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19
Q

CHF
Diuretic combination

A

Loop diuretic -double dose (2-2.5 x home diuretic divided into twice day(titrate q12-24hrs(max960mg/d)
Metalazone (low K, increamortality)
Acetazolamide (500 mg iv daily)
SGLT2 inhibitors

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20
Q

Increase in creatinine and congestion improved

A

Metra M et al Circ Heart Failure 2012; 5:54

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21
Q

Cardiac sarcoidosis

A

FDG, PET, cMRI, endometrial biopsy

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22
Q

Sarcoidosis

A

Dual isotope pet scanning (N-NH3 defects and matched F-FDG uptake)
Ammonia is perfusion.
FDG activity /metabolism

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23
Q

Severe aortic stenosis (be careful of low flow which may impair gradient)
May cause ventricular fibrosis, atrial enlargement, atrial enlargement)

A

Peak velocity Vmax > 4 m/s or mean gradient > 40 mm Hg
Aortic valve area < 1 cm squared (older women may have small l ventricular filling, restrictive filling)

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24
Q

Murmur louder with standing

A

Hypertrophic cardiomyopathy

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25
Type B dissection
IV beta blocker Nitroglycerin iv Pain control SBP 120 pulse 60
26
PVC BURDEN OF >10%
PVC induced cardiomyopathy
27
Pharmacologic testing in wheezing must avoid the following:
Adenosine Dipyridamole Regadenoson
28
CHF OBJECTIVES diuresis
After six hours 100-150 ml/hr
29
If creatinine goes up and decongestion occurs, ok hold diuretic
30
MINOCA INOCA ANOCA
Mi w/ non obstructive cad Ischemia w/ no obstructive cad Angina w/ non obstructive cad
31
Causes of MINOCA MI TO NON OBSTRUCTIVE CAD
Coronary embolism Coronary microvascular dysfunction Coronary spasm Coronary thrombosis Myocardial bridging Plaque rupture Spontaneous coronary dissection
32
Cardiac MRI HELPS w/ contrast
Myocardial edema Myocardial
33
Non obstructive coronary ischemia
Endothelial dysfunction and or VSMC hyperreactivity (autonomic dysfunction)
34
Vasomotor function
Important in determining cause for ischemia
35
Testing for cad
PET/SPECT structure and function CMR structure & function CORONARY CT angiography
36
CTA coronary angiography allows
Coronary calcification % stenosis in epicardial coronaries Congenital coronaries Intramyocardial bridging Bypass grafts
37
CTA angiography also help
FRACTIONAL FLOW RESERVE (functional assessment)
38
CTA to assess coronary fractional flow reserve
FFR value <0.8 is abnormal
39
PET SCAN HELPS W
Myocardial flow reserve
40
PET CT coronaries
Myocardial flow reserve < 2 predicts all cause mortality
41
Afib
Cha2ds-vasc equal to or > 2 in men, use anticoagulant Cha2dsvasc equal to or >3 in women, use doac
42
Pulse field ablation
Afib
43
ARNI first line Decrease in death, increase EF, decrease readmission rates
44
Alternativa to ARNI
Hydralazine/isosorbide dinitrate (start 20 mg each) Hydralazine 100 mg/ isosorbide 40 mg
45
Hold diuretic if you start ARNI
46
Start mineral corticoid antagonist i
Men creatinine is <2.5 Women creatinine 2
47
SGLT2 inhibitors EMPA -Reg outcomes NEJM 2015:373:2117-28
Female patients had more UTI in placebo group Male same Except mycotic infection
48
Diuretic adjuncts
Acetazolamide 500 mg iv daily Metolazone 5 mg or chlorothiaxidd 500 Remember to bolud.
49
CVP= J P + 5 cm
CVP = JVP + 5 cm
50
ARNI RELATIVE RISK REDUCTION 42%
JAMA Cardiology 2021:6(7):743-744
51
Metotolol succinate
52
ARNI GIRST LINE
Hydralazinr ISDN 50
53
Stop diuretic when start ARNI
54
After one year after stent, do not add aspirin to pts on DOAC/ac
Circulation 2023 Aug29:148(9):e9-e119
55
Mimics of HFpEF R/o valvular disorder Congenital heart disease
Cardiac amyloid Cor pulmonale High output syndrome Hypertrophic cardiomyopathy Infiltrative disorder Ischemic heart disease Pulmonary HTN Storage disorder
56
HFrEF
Congestion: start ARNI and SHLT2 inhibitions Low blood pressure: MRA, SGLT2 inhibe Patients at risk for hyperKALEMIA, start ARNI, SGLT2
57
Devices for chronic heart failure
Carotid biostimulator (EF <35%) Cardiac stimulator (LV <25%)
58
HCOM Start beta blocker, verapamil, diltiazem
Myosin inhibitors (vicampten, aficamten) Disopyramide Septal reduction
59
60
HFrEF ARNI VS ACE PARADIGM-HF McMurry JJV et al NEJM 2014
reduction 20% cardiovascular death 20% red hospitalization 26% red overall mortality
61
Hypertrophic cardiomyopathy risk factors for sudden death
Family history, LVH 30mm, left ventricular apical aneurysm, unexplained syncope, extensive gadolinium enhancement
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