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Cardiology Flashcards

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1
Q

Aflutter leads best seen in

A

II, III, aVF

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2
Q

Takusoba

A

Nonexertional cp, with apical ballooning, often with ST elevations

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3
Q

Role of anti platelet in PAD

A

single anti platelet recommended in symptomatic pad, or asymptomatic to reduce risk of MI

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4
Q

indication for open vs. enxovascular repair of AAA

A

Infra renal - often EVAR

supra or juxta - often open

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5
Q

CVD risk enhancers

A

Risk enhancers include family history of premature atherosclerotic CVD (men aged ≤55 years, women aged ≤65 years), LDL cholesterol level of 160 mg/dL (4.14 mmol/L) or higher, metabolic syndrome, chronic kidney disease, chronic inflammatory conditions, history of premature menopause or previous history of preeclampsia, South Asian ancestry, or triglyceride level of 175 mg/dL (1.98 mmol/L) or higher.

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6
Q

Indications for cardiac surgery for IE

A
  1. infection persisting longer than 5-7 days while on appropriate abx
  2. symptomatic heart failure
  3. left sided involvement w s/ aureus, fungi, or highly resistant bugs
  4. heart block, abscess, penetrating lesion
  5. prosthetic valve
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7
Q

Increase in CAD risk in HIV pts

A

1.5-2x fold increase

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8
Q

Components of ASCVD calc

A
  1. age
  2. sex
  3. race
  4. total and HDL cholesterol
  5. systolic BP
  6. use of anti-hypertensives
  7. DM
  8. Smoking status
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9
Q

when to use exercise stres

A

if baseline normal EKG and can exercise - it is initial test of choice

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10
Q

paradoxical split s2

A
  1. can hear split in expiration

2. indicates pathology - later S2 (severe aortic stenosis, HCM, LBBB)

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11
Q

Indications for CRT

A

EF <35%
QRS >150s w/ LBBB
on goal directed therapy
sinus rhythm

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12
Q

Restrictive vs. Constrictive CM

A
  1. Elevated BNP

2. concordant rise and fall of left and right systolic pressures with respiration

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13
Q

Inspiration and preload

A

causes increased preload due to pumped of intraabdominal veins (increases pressure), decreased pressure of Pulm veins

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14
Q

Delayed enhancement of gad on MRI

A

c.w myocardial fibrosis

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15
Q

Constrictive CM

A

Due to external pericardial constraint (ventricular interdependence)

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16
Q

Restrictive CM

A

reduced compliance of elastic properties of the myocardium. usually has elevated BNP

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17
Q

Fabry’s disease

A

lysosomal storage disease, manifestations by 40

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18
Q

BP goal for aortic dissection

A

=120 in the first hour (first with BB, then nitroprusside)

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19
Q

Temporizing measure in cardiac tampoade

A

IV normal saline, esp if sap <100

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20
Q

Young kids w HCM and sports

A

can participate in low intesnitys sports (golfing)

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21
Q

first line tx of symptomatic pats with HCM

A

Nonvasodilating BB

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22
Q

Treatment of HCM for mod-severe symptoms

A

Catheter based alcohol septal ablation or open myomectomy in those that have s/s despite max medical therapy

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23
Q

ICD indications in HCM

A
  1. wall thickness massive (>30=mm)
  2. prior cardiac arrest
  3. hypotension during exercise
  4. syncope
  5. NSVT
  6. FH of SCD 2/2 HCM
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24
Q

Risk factors for ventricular free wall rupture

A
  1. older women
  2. anterior MI
  3. receiving anti-inflammatory agents
  4. delay in reperfusion
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25
symptoms of free wall rupture
quick tamponade-->PEA
26
in stent re-stenosis symptoms
s/s ischemia
27
timing of in stent re-stenossi
months to years
28
cornerstone of HFpEF tx
diuretic therapy to maintain euvolemia
29
two causes of murmurs
1. increased flow anemia, thyrotoxicosis, pregnancy) | 2. turbulent flow
30
benign murmur intensity with standing
usually decrease
31
murmurs that require evaluation
1. diastolic 2. continuous 3. symptoms 4. or abnormalities on exam (clicks, )
32
preload with standing and valsalva
decreases (HCM murmur increases)
33
murmurs that increase with handgrip (increased co and peripheral R)
VSD | mitral and aortic regurgitation
34
fixed split s2 during I and E
ASD
35
DAPT length for DES for stable angina
6 months
36
P2Y12 inhibitors
clopidegrol, ticragrelor, prasugrel --> does not allow platelet activation
37
DAPT length for DES in ACS
at least 12 months
38
atrial myxoma presentation
Can present with obstruction, emboli or constitutional s/s 2/2 IL-6 (fatigue, fever, arthralgia) and early diastolic sound (tumor plop)
39
presentation of cardiac lymphoma
usually Right atrial mass and immunocompromised
40
Cards finding of Noonan syndrome
pulmonary stenosis, usually dysplastic (can have asd, vsd, hcm)
41
Noonan syndrome features
``` Pulm stenosis short stature, hypertelorism neck webbing intellectual impairment ```
42
cards s/s a/w Downs
ASD, specifically ostium premium asd
43
ICD indication in nonischemic CM
EF <35% + symptoms; | 2. or NICM w/ unexplained syncope and LV dysfunction
44
screening interval for bicuspid + TAA
q6 months for aneurysm >4.5cm or faster than 0.5cm per year, if smaller q12 months
45
Surgical indication for AI
EF <50%, LV dilation >50mm
46
AC in HCM + afib
Warfarin (even if low chads2vasc)
47
CABG indications
1. multi vessel + lvd 2. DM _+ multivessel 3. Left main dz
48
Management of PVC
1. first line if BB | 2. ablation if not resolved or develop left ventricular dysfunction
49
CI to cardiac transplant
1. malignancy w/in 5 years 2. renal dysfunction 3. older than 70years 4. other dz that decrease survival
50
Mechanical valve AC + pregnancy
IF dose <5mg in first trimester - warfarin is preferred over other ac 2. warfarin >> all other AC in 2nd and 3rd trimesters 3. IV UFH heparin around time of delivery 4. if greater than 5mg in 1st trimester --> UFH
51
Screening for HCM
1. genetic counseling and testing is recommended for patients with HC for all first degree fam members regardless of symptoms. (AD disorder of B myosin gene)
52
risk of CVD in RA
increases it 1.5-2 fold (like HIV). Risk of CVD increases with duration of underlying inflammatory condition.
53
testing done prior to dx of inappropriate sinus tachycardia
EKG, tte to r/o structural abnormalities, ambulatory EEG for remote findings, hyperthyroid, anemia, pheo
54
Ticragrelor vs. clopidogrel vs. prasugrel
ticragrelor > clopidogrel for ACS | prasugrel only good when stents placed and no superiority found
55
If patient has infective endocarditis per Duke criteria, straight to TEE
otherwise if less and probable, TTE first
56
Increased risk of CVD 2/2 DM
2-4 x increase
57
Statins in DM
Any patient with DM , 40-75 should be on moderate intensity statin if increased risk factors calculate ASCVD and if >20% should be on high intensity statin
58
Interaction between ranolazine and dilt/verapamil
Diltiazem and verapamil are moderate CYP3A inhibitors, which increase ranolazine (thus, decrease this dosage in pts if adding the above CCBs)
59
Indications for device closure of osmium secundum ASD
1. Right heart enlargement and symptomatic disease 2. asymptomatic patients w/ shunt related hemodynamics 3. orthorexia, platypnea syndrome (dyspnea/hypoxemai when sitting, fixed when lying down)
60
Surgical closure of ASD indicatinos
1. non secudnum ASD | large
61
Utility of balloon aortic valvuloplasty
Bridge to trans catheter or surgical aortic valve replacement
62
GDMT for heart failure
STEMI pts with LVEF <40, bb, ace-I and aldosterone antagonist
63
first line tx for pericarditis
high dose aspirin (750-1000mg) OR NSAIDS ( 600mg) q8 hours for 102 weeks and adjuvant colchicine (0.5mg/day) for 3 months
64
Most common etiologies if EI
staph and strep
65
culture negative IE
2.2 fastidious IE | or partially treated
66
Duke criteria Major (2) = clinical dx of IE
1. + blood cultures | 2. evidence a valve is involved (tte, new regurgitant murmur)
67
Minor duke criteria
1. predisposing valve (as, ms) 2. fever 3. other vascular phenomona 4. immunological phenomena
68
vascular phenomenon on IE
septic Pulm emboli mycotic aneurysm IC hemorrhage Janeway lesions
69
Immunological phenomenon of IE
1. GN 2. osler nodes (raised painful bumps) 3. roth spots (retinal hemorrhages)
70
Indications for sx for IE
``` HF access/annular involvement fungal abx resistance (+ cx for >7 days) veg > 10mm severe MR, AR obstruction ```
71
prosthetic valve IE org based on timing
early (< 2 months): S. epi | late (>2) normal IE bugs
72
ppx for IE
previous IE prosthetic valve congenital HD (cyanotic) cardiac transplant w valvular dz
73
ppx for IE abx for dental procedures
1. amoxicillin 2g prior to procedure or | 2. azithro of penicillin allergic
74
Jones criteria is for?
Rheumatic fever
75
5 major jones criteria
carditis polyarthritis chroea erythema marginatum
76
5 major jones criteria
``` carditis polyarthritis chroea erythema marginatum (painless, kind of looks like drug rash?) subcutaneous nodules ```
77
4 minor criteria of Jones
arthralgia increased sed rate, abc, crp prolonged PR
78
Percentage of pts with significant AS by 45 years
50%
79
bicuspid valve management
monitor aortic aneurysm + valve
80
AS murmur
crescendo-decrecendo (ejection murmur)
81
class I indication for AS sx
1. symptoms
82
Severe AS sounds
paradox split S2 (quiet A2, loud P2)
83
AR
decrescendo blowing murmur, diastolic (sounds same as PR)

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