Cardiology Flashcards
(174 cards)
1
Q
Normal RA pressure
A
2-6
2
Q
Normal RV pressure
A
25/5
3
Q
Normal PA pressure
A
25/10
4
Q
Full amio load
A
10g
5
Q
normal wedge pressure
A
less than 12
6
Q
GDMT is
A
beta blocker + ace or arb
7
Q
Management of patient with high pretest for ACS in stem
A
cath/urgent angiography`
8
Q
Indications for mitral valve repair with mitral regurgitation
A
1) Symptomatic with EF greater than 30%
2) Asymptomatic patients with LV dysfunction (LVEF of less than 60%)
3) pts undergoing another cardiac surgical procedure
4) AF or PHTN
9
Q
to know about avastin and HTN
A
- common SE
- dose dependent
- usually 2 months after starting
- reversible
- large increases in BP can happen
10
Q
cardiotoxicities of paclitaxel
A
Bradycardia
Heart block
11
Q
Clinical features of aortic coarctation
A
- Radial artery to femoral artery pulse delay
- Systolic murmur heard over the left chest
12
Q
Management of acute limb ischemia
A
Stat vascular consult
Heparin gtt
Urgent invasive angiography (need to define anatomic level of occlusion) (need to take to cath lab because then can treat too)
13
Q
Anticoagulation of AF in patient with CAD on aspirin
A
Start NOAC, drop aspirin (increased risk of bleeding with no apparent incremental benefit) (unless recent active CAD (ACS or revascularization in the past 12 months)
14
Q
CHADSV-VASc scoring
A
CHF HTN Age (2) -- over 65 = 1, over 75 =2 DM2 S = Sex, female = 1 VASc = prior MI or PAD
15
Q
Other bleeding RF’s
A
Low BMI
HTN
Female sex
16
Q
first line for effusive constrictive pericarditis
A
NSAIDs and colchicine
17
Q
Diagnosis of effusive constrictive pericarditis
A
Intrapericardial pressure is reduced to normal following drainage with pericardial window but intracardiac pressures remain elevated and equalized.
18
Q
ACC/AHA recommendation on entresto
A
Substitute ACE or ARB for entresto + reduced EF + has tolerated ACE or ARB well
19
Q
typical reason for elevated liver enzymes in low flow/heart failure
A
congestive hepatopathy
20
Q
Indications for ablation with AF or AFib
A
Symptomatic despite adequate medical therapy and rate control
21
Q
PDA murmur description + location
A
- Continuous murmur beneath the left clavicle
- Envelops the S2
- “Machinery murmur”
22
Q
Clinical presentation of moderate-sized PDA
A
- Bounding pulses, wide pulse pressure, left heart enlargement and dysfunction, CHF
23
Q
Clinical presentation of large-sized PDA
A
pulmonary hypertension, shunt reversal syndrome (eisenmenger)
24
Q
Presentation/location of aortic regurgitation
A
Diastolic murmur
- left sternal border
- often systolic ejection click
25
VSD murmur description
- Loud holosystolic murmur at left sternal border
| - often palpable thrill
26
What is cardiac syndrome X?
Angina/typical chest pain and stress testing abnormalities in the absence of CAD on angiography.
27
Features of Takotsubo cardiomyopathy
nonexertional chest pain + EKG changes (ST-segment elevations) + elevated cardiac enzymes + antecedent physical stress
28
Initial step in management of intermittent claudication
Superrvised exercise training
29
proper medical term for acute limb ischemia
Critical limb ischemia
30
Next step after US with AAA that needs repair
CT angiography
31
Indications for repair with AAA
1) 5.5 cm or larger
2) growing 0.5 cm/yr or greater
3) symptomatic (abdominal or back pain/tenderness)
32
Relationship of alcohol intake and CVD
- moderate alcohol intake has been linked with decreased incidence of CVD
- heavy alcohol consumption is bad
33
Association between smoking and cardiovascular disease
- active smoking is a strong RF for CVD
- BUT smoking cessation substantially reduces CVD risk within 2 years with risk returning to level of a nonsmoker within 10 years
34
To do for clinic visit in patient with stable CHF
Measure kidney function and bytes with BMP
- NO routine echo if stable, only if change in clinical status OR new medication that may improve EF OR indicated for a device
35
Next step after WPW diagnosis
```
Electrophysiology testing (confirm diagnosis, determine risk of SCD/risk stratification, potentially ablate and cure the arrhythmia)
TTE (exclude structural heart disease associated with accessory pathways)
```
36
Preconception counciling for patient with Marfan syndrome and a dilated aorta
Advise against pregnancy if aortic diameter is greater than 4.0 CM + stable over 6 months (too high a risk of aortic dissection and rupture) + consider elective surgical repair
37
Clinical features of papillary fibroelastoma
Small, mobile cardiac tumors that are typically attached to the endocardium by a stalk + associated with CVA/TIA + MI
38
Management of symptomatic papillary fibroelastoma
Surgery
39
Clinical features of atrial myxomas
Large + may cause TIA/CVA + obstructive symptoms
40
Nonbacterial thrombotic endocarditis clinical features
small vegetations + wart-like/irregularly shaped + associated with advanced malignancy or connective tissue disorders
41
Common comorbidity in patients with Eisenmenger syndrome
Iron deficiency
42
Indications for thrombolytics in STEMI
Symptom onset within 12 hours + PCI not available within 3 hours of medical contact
43
Typical lytic used for STEMI
full dose reteplase
44
How to calculate ABI's
Higher ankle pressure (of either leg) is divided by higher brachial pressure (of either arm)
45
ABI intepretation
0. 90 or less = PAD
| 1. 40 or greater = calcified, noncompressible arteries, not interpretable
46
Management of patient with ABI greater than 1.40
Measure toe pressure and calculate a toe-brachial index
47
Management of patient with borderline ABI (0.91-1.00) or normal ABI with high pretest for PAD
Exercise ABIs
48
management of patient with infective endocarditis and refractory bacteremia (persistent fever longer than 5 to 7 days while on antibiotics)
Cardiac valve surgery
49
Indications for cardiac surgery with IE
```
Symptomatic heart failure
Heart block
Annular or aortic abscess
Fungal infections
Highly resistant organisms
```
50
Indications for balloon pump
Acute MR
| Cardiogenic shock unresponsive to other interventions
51
Cardiac comorbidity to know among HIV patients
1.5x to 2x risk for CAD
52
What is typical angina?
1) Substernal pain or discomfort
2) Provoked by exertion or emotional stress
3) Relieved by rest and or nitoglycerin
53
Before choosing ICD always remember
Patient needs to be medically optimized with GDMT before pursuing ICD (many patients benefit and don't need an ICD after)
54
Cardiac resynchronization therapy means
pacer
55
Cardiac resynchronization therapy indications in HFrEF
EF less than or equal to 35%
| + NYHA at least II despite GDMT + LBBB with QRS complex of 150 ms or greater
56
Restrictive cardiomyopathy vs. constrictive pericarditis
Restrictive cardiomyopathy = elevated BNP (normal in constrictive pericarditis) + concordant rise and fall of let and right systolic pressures with respiration (inverse relationship in constrictive due to ventricular interdependence (RV systolic pressure rises during inspiration coupled with a decrease in LV systolic pressure) + severe pHTN
57
Initial management of descending aortic dissection
Medical therapy to control heart rate and blood pressure (Start with IV beta blocker. If refractory, add sodium nitroprusside + opioids)
58
Complicated aortic dissection means
```
shock
refractory pain
rapid aneurysmal expansion
rupture
malperfusion syndrome
```
59
Goal BP reduction in descending aortic dissection
Reduce BP to 120 mm Hg or less in the first hour
60
SE to know about with ticagrelor
Dyspnea (typically self-limited)
61
Timing + clinical features of in-stent restenosis
months to years after stent implantation + signs/symptoms of ischemia (chest pain, dyspnea)
62
stent thrombosis presentation
acute MI and/or death
63
Timing + clinical features of ventricular septal rupture after MI + when it occurs
3-5 days post STEMI presentation + worsening heart failure and shock + **harsh holosystolic murmur at LLSB** + typically from RCA or LAD infarct
64
hallmark of motion abnormalities of takotsubo
WMA abnormalities extending beyond a single coronary territory
65
Management of symptomatic severe pulmonary stenosis
ballon valvuloplasty
66
Indications for balloon valvuloplasty with pulmonary stenosis
symptomatic + doppler gradient of greater than 50 mm Hg or mean gradient grader than 30 mm Hg
67
next step in evaluation of sinus bradycardia
Exercise stress testing (need to assess for chronotropic incompetence, whether HR improves with exercise, and if not, need pacer)
68
most common cause of pathologic sinus bradycardia
```
Intrinsic = SA dysfunction from age-related myocardial fibrosis
Extrinsic = med SE
```
69
agents of choice in treating HTN in pregnancy
Labetalol and methyldopa
70
Management + timing of asymptomatic severe MR with preserved LV EF
TTE q 6 months
71
Management of asymptomatic PAD incidentally found in orthography for PCI
cardiac rehab, aggressive RF modification (don't use cilostazol)
72
Management of patient with HOCM who wants to play sports
Can only play sports that are static and low intensity (golf, curling, bowling, cricket) (most common cause of sudden death in young athletes)
73
Indications for ICD in HOCM
1) Massive myocardial hypertrophy (wall thickness >30 mm)
2) previous arrest
3) blunted blood pressure response or hypotension during exercise
4) unexplained syncope
5) NSVT
6) family history of sudden death due to HCM
74
Presentation of ventricular free wall rupture
Sudden-onset chest pain or syncope with rapid progression to PEA (causes rapid accumulation of blood in the pericardium and tamponade)
75
Management of mitral stenosis when symptoms don't correlate to anatomy
Exercise echocardiography (need to determine mitral gradient and pulmonary pressures during exercise. It can look structurally normal despite being severe because valve gradient may only become severe with exertion)
76
Mitral stenosis clinical presentation
- can be indolent (remain asymptomatic for years and have gradual decrease in activity)
- similar to CHF -- dyspnea, orthopnea, fatigue
77
Medical therapy for mitral stenosis
Diuretics
Long-acting nitrates
(Reduce preload)
78
Management of hemodynamically significant mitral stenosis
Percutaneous or surgical therapy
79
When thrombolytics are indicated for STEMI
If patient can't be transferred to a PCI-capable center within 2 hours
80
Sequela to know of with bicuspid aortic valve
Ascending aortic aneurysms (patients with bicuspid aortic valves are prone to aneurysms)
81
Indications for aortic valve repair in patients with a bicuspid aortic valve and a thoracic aortic aneurysm
Diameter of 5.5 cm or larger
| OR symptomatic
82
Clinical features of peripartum cardiomyopathy
LV systolic dysfunction with onset toward the end of pregnancy or in the months following delivery + absence of another cause
83
Management of peripartum cardiomyopathy
GDMT except ACEi's or aldosterone antagonists, which are teratogenic
84
Takotsubo presentation
Mimics ACS: Chest pain + ST elevations on ECG + elevated troponin
85
Which method to use for capturing arrhythmia outpatient
IF once or twice a week --> external event recorder
IF daily symptoms --> 24 hour ambulatory ECG monitor
IF very infrequent or rare episodes --> implantable loop recorder
86
Factors that influence BNP levels and direction (which direction level goes)
```
Kidney failure (increase)
Older age (increase)
Female sex (increase)
Obesity (decrease)
```
87
BNP value that can reliably exclude heart failure
Less than 100 (unless obese, female, kidney failure, or older age)
88
Management of critical limb ischemia
Immediate invasive angiography with endovascular revascularization
89
Clinical features of critical limb ischemia
- ABI below 0.40
- absent pedal pulses
- ulceration
- cold to touch
90
Management of AV block in the setting of ACS
Cath lab (revascularization may also correct conduction deficit)
91
Indications for surgery in severe AR
Severe + one of following
- symptomatic
- EF less than ***50%
- significant LV dilatation
92
Management of severe AR
IF no surgical indication --> echo q6-12 months
| *can use ACEs or ARBs in hypertensive but haven't been shown to delay need for surgery.
93
Management of patient post STEMI leading to CHF
- ACEi within 24 hours of presentation (mortality benefit)
- beta-blocker once stabilized and NO clinical signs/symptoms of CHF from STEMI. Beta-blockers should be started within 24 hours of STEMI presentation (decrease myocardial O2 demand, reduce ventricular arrhythmias and improve survival)
94
Management of AF in HOCM
Warfarin regardless of CHADS-VASC (higher incidence of CVA in HOCM)
95
Management of patient with discrepancy between symptoms of AS and echo findings
Cath
96
Clinical features of cardiac tamponade + on imaging/EKG
Hypotension
Pulsus paradoxus
Enlarged cardiac silhouette
Electrical alternans
97
Common cardiac manifestation of SLE
Pericarditis
98
Evaluation for CAD among patients with intermediate CV risk accorded to ASCVD and to determine if patient is indicated for statin therapy
Coronary artery calcium scoring
99
Diltiazem contraindication
HFrEF (nondihydropyridines are contraindicated in heart failure)
100
Management of ACE inhibitor induced cough
switch to an ARB
101
Management of ACE inhibitor induced angioedema
Switch to an ARB (but angioedema has been reported with ARBs as well, so with caution)
102
Indications for CABG
1) Multivessel CAD and reduced EF
| 2) Multivessel disease and DM2
103
First and second line management of symptomatic PVCs
- first line = b-blockers or CCBs
| IF frequent PVCs despite medical therapy or patients develop LV dysfunction --> catheter ablation
104
Evaluation of symptomatic PVCs
- Exercise stress testing to eval for ischemia + assess response of PVCs to exercise
- TTE to rule out structural heart disease
105
Management of patients with symptomatic mitral regurg who are not surgical candidates
Transcatheter mitral valve repair
106
ABI diagnostic for PAD
Less than or equal to 0.90
107
PAD and statin therapy
High intensity statin therapy regardless of ASCVD
108
Management of end-stage heart failure
- LVAD or transplant
109
Pacemaker indication in CHF
1) EF less than or equal to 35%
2) NYHA II-IV despite GDMT + sinus rhythm
3) LBBB with QRS of 150 ms or greater
4) survival of at least 1 year
110
Gold standard for end-stage heart failure
Cardiac transplantation
111
Contrandications to cardiac transplantation
Age older than 65
Comortbidities (DM2, malignancies, kidney failure)
Lack of social support and adherence
112
Pulmonary regurg clinical features
RH volume overload
parasternal lift
diastolic
113
Indications for AAA repair
1) symptomatic (abdominal tenderness or pain)
2) rapid expansion in size (>0.5 cm/yr)
3) size greater than 5.5 cm
114
First step if suspected perivalvular abscess
TEE (better visualization of abscess + important for surgical planning)
115
Perivalvular abscess clinical features + classic patient
- PR-interval prolongation on EKG (causes first degree AV block)
- Pts with bicuspid aortic valve
116
Evidence for supplemental O2 in setting of normal O2 sat for patients with acute MI
HARMFUL (systematic review has shown O2 therapy not be initiated in critically ill patients with an O2 sat of 93% or higher so guidelines strongly recommend against it).
117
Guideline indications for PCI
- Refractory symptoms while on optimal medical therapy
- unable to tolerate optimal medical therapy
- high risk features on stress or imaging
118
Anticoagulation therapy in woman with mechanical valve contemplating pregnancy
Warfarin (high risk subset and warfarin is preferred)
119
Eliquis during pregnancy?
Hasn't been studied
120
Antibiotics that cause QT prolongation
Macrolides
| Fluoroquinolones
121
Medication classes that causes QT interval prolongation
Antibiotics
Antipsychotics
Antidepressants
122
VT vs. NSVT
VT = 30 seconds
123
Indications for valve replacement aortic regurgitation + bicuspid valve
1) symptomatic
2) LV end systolic diameter of 50 mm
3) Reduced EF (less than 50%)
* Due to increased risk for sudden cardiac death and heart failure.
124
Ivabradine indication + utility
- EF less than 35% + in sinus rhythm taking GDMT
| Reduces CHF hospitalizations in patients with EF less than or equal to 35%
125
Aldactone indication
- After ACEi + betablocker has been uptitrated to maximally tolerated doses
- NYHA II-IV
126
Management of relative of HOCM patient
Genetic counseling and testing regardless of whether pt is symptomatic
127
Important RF for CAD to know about
Inflammatory disease (RA, SLE)
128
Inappropriate sinus tachycardia clinical features
Diagnosis of exclusion + structurally normal heart + elevated resting heart rate that increases with light activity
129
CAD evaluation in patient with LBBB on a baseline ECG
Adenosine single-photon emission CT/vasodilator stress test
| *dobutamine or exercise stress test may result in false-positive perfusion defect
130
New onset CHF initial workup
BNP
CBC, CMP, lipid panel
*TSH
131
acute severe MR clinical presentation + pathophys
- usually papillary muscle rupture following acute MI, then patient presents with acute CHF presentation
132
Aortic stenosis features on exam
Crescendo-decrescendo systolic murmur + second right intercostal space + radiation to carotids
133
Triscupid regurg clinical features
Loudest at left lower sternal border + increases with inspiration + can have signs of RH failure
134
Management of type 1 NSTEMI, for which patient declines cath and is managed medically
Ticagrelor for 12 months (superior to plavix in trials) + ASA indefinitely
135
Constrictive pericarditis clinical features
Indolent progression of right-sided heart failure + low or normal BNP (absence of ventricular shift)
136
TTE findings in constrictive pericarditis
- respiratory variation in filling of right and left ventricles
- ventricular septal shift during respiration
- IVC dilation
137
Ostium secundum ASD murmur description + features on exam + EKG
- Fixed splitting of S2
- RV heave
- Right-axis deviation
- Incomplete right bundle branch block on EKG
138
Mitral stenosis murmur description
Opening snap, followed by a diastolic murmur
139
Milrinone drug class and use
IV inotrope similar to dobutamine, used for low flow
140
PAD diagnosis of ABI
less than or equal to 0.9
141
Management of PAD after patient doesn't respond to supervised exercise program
Add cilostazol
142
Management of PAD patient not responding to cilostazol
Invasive management (endovascular or surgical revascularization)
143
Cardiac amyloidosis TTE features
- Black patients older than 50
- Severe concentric LV wall thickening
- preserved systolic function
- severe pHTN
144
EKG for cardiac amyloidosis
Low voltage + "pseudoinfarct" pattern: Q waves in anteroseptal leads without regional wall motion abnormalities on TTE
145
Indication for Hydralazine + isosorbide dinitrate in CHF + evidence
```
Black + on maximal GDMT + NYHA class III or IV
- mortality benefit
```
146
Management of mobitz II after STEMI
Emergent pacemaker (life threatening complication of anterior MI due to necrosis of septum and His-Purkinje system because it can progress to complete heart block)
147
Next step when bicuspid valve and aortic enlargement are noted on TTE
CT angiography of aorta (commonly associated with aorta abnormalities)
148
Bicuspid valve common comorbidity
Aorta abnormalities (aneurysm, dissection, coarctation)
149
Greatest RF for atherosclerotic cardiovascular disease
DM2 (this is why all diabetics need to be on statins)
150
Coronary Anatomy of new LBBB
LAD occlusion
151
Clinical features of upper extremity PAD
- Arm claudication
- Dizziness with arm activity
- BP differential in arms
152
Workup of suspected upper extremity PAD
CT angiography of chest and neck
153
First 2 steps with suspected aortic dissection
1) CT angio
| 2) Differentiate Type A from type B
154
How to differentiate type A from type B dissection
*Look at CT
Type A = ascending aorta or arch
Type B = descending aorta
155
Management of type A aortic dissection + why
Open surgical repair (high mortality rate and complications)
156
Dissection clinical features
- unequal BPs in arms and pulses
157
When are TTE's indicated for murmurs
1) Symptomatic
2) Systolic murmurs grade 3/6 or higher
3) Late or holosystolic murmurs
4) Diastolic or continuous murmurs
158
Features of benign murmurs
- brief
- midsystolic
- no radiation
159
Clinical presentation of TR
Can be well tolerated for a while but likely eventually progress to
Right heart failure
160
Description of TR
Holosystolic murmur along left lower sternal border + increases during inspiration
161
medication change to make when CAD patient is switched to dilt or verapamil
Decrease ranolazine (dilt and verapamil are CYP3A inhibitors)
162
SE to know about when ranolazine
CYP3A4 inhibition
163
Management of RBBB
nothing really -- history and physical unless evidence of structural heart disease
164
management of first degree AV block
nothing really -- history and physical unless evidence of structural heart disease
165
Major SE to know about with entresto
hypotension
166
How to switch from ACEI to entresto
wait at least 36 hrs after stopping ACEi
167
term for ASD surgery
device closure
168
Indications for ASD closure
Right heart enlargement
| Symptomatic
169
Management of severe AS in patient who isn't surgical candidate
TAVR
170
Medical therapy for AS
NOT effective in slowing disease progression
171
Most common serious complication of catheter ablation
cardiac tamponade
172
cardiac tamponade presentation
Elevated JVP
Narrow pulse pressure
pulsus paradoxus
electrical alternans
173
Diagnosis of cardiac sarcoidosis
- Cardiac MRI + PET/CT
| - NO bx (patchy involvement)
174
Acute pericarditis treatment
High-dose ASA or NSAIDS + adjuvant colchicine therapy
