Cardiology - General Flashcards Preview

American Board of Internal Medicine > Cardiology - General > Flashcards

Flashcards in Cardiology - General Deck (59):
1

List exogenous factors that prolong Qtc (9)

1. TCA Overdose
2. Hypokalemia
3. Hypocalcemia
4. Hypomagnesemia
5. Liquid protein diet
6. Starvation
7. CNS insult
8. Erythromycin
9. Ischemia

2

1. What is the only reversible form of restrictive cardiomyopathy?
2. How is it treated?

1. Hemochromatosis (genetic and acquired) - iron overload
2. a. Phlebotomy
b. Iron chelation if phlebotomy not tolerated

3

Describe anticoagulation around cardioversion for Atrial Fibrillation

1. Begin heparin and warfarin before cardioversion
2. Continue warfarin up to 4 weeks

4

How long is a QT?

Measure from begin of Q to end of T = 440

4

How long is one large EKG box?

0.2 seconds

4

What are exam findings with Aortic Regurgitation (4)?

1. Wide pulse pressure
2. Rapidly collapsing pulse
3. Pulsating nailbeds
4. Long diastolic murmur

4

When should post-MI patients with reduced LVEF receive a defibrillator after their MI?

40 days

4

With antiplatelet therapy, how do BMS and DES differ?

BMS = Aspirin and Clopidogrel (x 1 month)
DES = Aspirin and Clopidogrel (x 1 year)

4

What are indications for PCI (4)?

1. Fibrinolytic therapy contraindicated
2. STEMI more than 12 hours with cont pain or STE
3. History CABG
4. Cardiogenic shock

4

What diuretic should be used following severe left ventricular dysfunction after MI?

Eplerenone

4

1. What EKG features suggest right ventricular MI?
2. What is seen in right-sided EKG?
3. What worsens BP with right MI?

1. STE II, III and aVF
2. STE in V3 and V4
3. Nitroglycerin reduces filling

4

What are indications for myocardial biopsy (3)?

1. Hemochromatosis
2. Sarcoidosis
3. Amyloidosis

4

1. What are the four CHF NYHA Functional Classes?
2. What are added for certain classes (3)?

I: No symptoms
II: Slight limitation of activity
III: Marked limitation of activity**
IV: Inability to perform activity without symptoms**

**Spironolactone or Eplerenone
**Digitalis
***Black: Hydralazine with Isosorbide Dinitrate

4

1. Define Peripartum Cardiomyopathy
2. Describe cardiac recommendation

1. LVEF less 45% between 1m before and 5m after
2. Even if LVEF improves, discourage subsequent pregnancy because of high recurrence rate

4

1. What woud prompt Surgical Myectomy or EtOH Ablation in HCOM (4)?
2. What is an alternative to surgery?
3. What should be avoided in HCOM?

1. Surgical Myectomy or EtOH Ablation
a. Outflow obstruction, gradient more 50 mmHg
b. Septal wall thickness greater 18mm
c. NYHA Class III-IV
d. Refractory to treatment
2. HIGH RISK: implantable cardioverter-defibrillator (ICD)
3. Strenuous exercise, even if asymptomatic

4

1. What is Eisenmenger syndrome?
2. What is the baseline Hgb/Hct for patients?

1. Persistent VSD, PDA or ASD which leads to right-to-left shunt, leading to pulmonary hypertension.
2. Hgb 18-20 (Hct greater 65%)

4

What is a side effect of Adenosine?

Bronchospasm

5

Define the heart blocks

First Degree: PR greater than 0.2

Second Degree: Intermittent P waves
Mobitz I: Progressive prolongation until dropped
Mobitz II: Dropped beats, becomes 3rd degree

Third Degree (Complete): Dissociated P and QRS

6

Define LBBB (3)

1. QRS greater 0.12
2. V1 with QS or rS
3. V6 with RsR (rabbit) with inverted T

7

Define RBBB (3)

1. QRS greater 0.12
2. V1 with rsR (or R, rR, rSR or qR)
3. V6 with slurred S (also in I)

8

What characterizes ventricular tachycardia?

1. QRS greater 0.12
2. Rate greater 100

9

Define Brugada Syndrome EKG

1. Incomplete RBBB
2. Coved ST elevation in V1 and V2

10

Define SEVERE Aortic Stenosis

1. Valve area less than 1 cm2
2. Mean gradient greater 50 mmHg

11

What cardiac finding is present with ASD?

Fixed split S2 (pathognomonic)

12

What are criteria for a Bi-Ventricular pacemaker-defibrillator (3)?

1. NYHA III-IV
2. LVEF less than 35%
3. QRS wider 120

12

How is Atrial Fibrillation anticoagulation different if a patient has Rheumatic Valve Disease?

INR 2.5 to 3.5

12

What are HR goals for patients with Atrial Fibrillation?

Resting 60-80
Moderate activity 90-115

12

List the three glycoprotein IIb/IIIa inhibitors

1. Abciximab
2. Eptifibatide
3. Tirofiban

12

1. What are the varibable in TIMI scoring (7)?
2. How does the score translate to testing?

MNEUMONIC: AMERICA
1. Age greater than 65
2. Markers elevated
3. EKG depression
4. Risks more 3 (FHx, HLD, HTN, Tob, DM, obese)
5. Ischemic angina greater than 2 in 24h
6. CAD with greater than 50% stenosis
7. Aspirin use in past week

0-2 Low -
3-4 Intermediate - stress test
5-7 High - angiography

12

1. How often should ultrasound for THORACIC aneurysms be done with at risk patients?
2. When should surgery be done (4)?

1. Yearly until 4.5 cm then q6m
2. a. Symptoms
b. Ascending greater 5-6cm
c. Descending greater 6-7cm
d. Rapid growth 10mm/year

12

When is surgery indicated for Tricuspid Regurgitation (2)?

1. Severe
2. ONLY if other surgery is planned

12

What type of valve (bioprosthetic or mechanical) require lifelong anticoagulation?

Mechanical

12

What type of surgery does NOT require interruption of anticoagulation for patients with prosthetic heart valves?

Cataract

13

How is Atrial Fibrillation rate control different for patients with WPW?

Class IA: Quinidine or Procainamide
Class III: Amiodarone or Ibutilide

14

Who can have false normal ABI?

Diabetics with calcified vessels

16

1. What are indications for AVR (3)?
2. What are indications for aortic valvuloplasty (2)

1. a. Symptomatic Aortic Stenosis
b. Undergoing CABG
c. LV dysfx or hypotension during stress testing
d. AoRegurg with vent-dilation or low LVEF

2. a. Congenital aortic stenosis, NON-calcific
b. Nonsurgical candidates

17

1. What are medicine treatment options for chronic PAD (4)?
2. Which one has a specific contraindication?

1. Aspirin (over clopidogrel)
2. Statins for LDL less 100
3. Cilostazol (over pentoxifylline) for symptoms
- This vasodilator contraindicated CHF
4. Ramipril to reduce risk MI, stroke, death

18

Define Type A and Type B aortic dissections, and their treatment.

Type A - Ascending aorta or aortic arch
Treat with emergent surgery

Type B - Distal to left subclavian
Treat with endovascular stenting if malperfusion
Otw treat HTN (BB to reduce dilation and nitroprusside)

18

1. What are indications for procedural treatment of Pulmonic Stenosis (2)?
2. What is the treatment of choice?

1. a. Gradient greater 50 mmHg -or-
b. RVH

2. Pulmonic valvuloplasty

19

1. What are indications for AVR (4)?
2. What are indications for aortic valvuloplasty (2)

1. a. Symptomatic Aortic Stenosis
b. Undergoing CABG
c. LV dysfx or hypoTN during stress testing
d. AoRegurge with ven or low LVEF

2. a. Congenital aortic stenosis, NON-calcific
b. Nonsurgical candidates

21

1. What screening test should be done in patients with Aortic Insufficiency?
2. What drug can be used, contrary to AS?
3. What drugs are contraindicated?
4. What treatment is contraindicated?

1. Syphilis
2. Sodium nitroprusside
3. B-blockers
4. IABP

22

1. What disease process occurs prior to developing Mitral Stenosis?
2. What are indications (with caveat) for MVR?
3. What are indications for MV valvuloplasty?

1. 20-40 years after rheumatic fever
2. Mitral regurgitation UNLESS LVEF less 30%
3. TTE/TTE excludes LA thrombus and:
a. Sx with valve area less 1cm2
b. Exercise-limit and valve less 1.5cm2

23

1. What is drug treatment for acute MR (3)?
2. What is mechanical treatment for acute MR?

1. a. Nitroprusside to decrease MAP less 60
b. Hydralazine
c. Nitroglycerin

2. IABP

24

What valvular heart disease is attributable to Marfan Syndrome?

1. Mitral Regurgitation
2. Tricuspid Regurgitation

27

1. With "blowing" murmurs, think...
2. With "rumble" murmurs, think...

1. Regurgitation
2. Stenosis

33

What are indications for ICD (5)?

1. Sustained VT or VF
2. After MI with LVEF less than 35%
3. Nonsustained VT (nonisch) + LVEF less 35%
4. High risk HCOM
5. Long QT with syncope

36

1. An "a" wave means....
2. A "c" wave means...
3. A "v" wave means...

1. "a" = atrial contraction
2. "c" = ventricular contraction and resulting bulging of tricuspid into the right atrium during isovolumetric systole
3. "v" = atrial venous filling, think TRICUSPID

37

Contrast methods for anticoagulation interruption for AVR and MVR

Both AVR and MVR stop Warfarin 4-5 days prior...
- AVR let INR fall less 1.5
- MVR after INR 2.0 start heparin gtt and bridge

39

What are risk factors which would indicate AICD for HCOM (8)?

1. Prior cardiac arrest
2. Sustained VT
3. FHx sudden death less 40yo
4. Unexplained syncope x 2 in 1 year
5. LV thickness greater 30mm in diastole
6. Blunted BP less 20mmHg with stress test
7. Non-sustained VT
8. Heart failure

44

What are examples of great than 4 METs (4)?

1. Climb a flight of stairs
2. Walk up a hill
3. Do heavy housework
4. Walk ground level 4mph

45

Describe the different chemical stress tests, and list 4 contraindications for one of them.

Dobutamine - mimic catecholamine release


Adenosine/Dipyridamole - coronary vasodilation, contraindicated:
1. Hypotenion
2. Sick sinus
3. High AV block
4. Bronchospastic disease

46

1. What is the indication for Ranolazine?
2. When is it contraindicated (2)?

1. CHRONIC angina after nitrates and CCB/BB but watch for interactions!!!

2. a. Long Qtc
b. CKD with GFR <30

47

For patient intolerant of ACEI due to hyperkalemia or AKI, what combination can be used instead?

Hydralazine and Nitrates

49

What treatment for STEMI is not indicated for treatment of NSTEMI?

Thrombolytics

50

1. What is Kussmaul sign?
2. What is the differential (3)?

1. Paradoxical rise in JVD with inspiration, due to limited right ventricular filling

2. a. Constrictive pericarditis
b. Restrictive cardiomyopathy
c. Cardiac tamponade

51

What is a normal:
1. CVP
2. RV pressure
3. PA pressure
4. PCWP
5. LV pressure

1. 3-8
2. 15-30 / 3-8
3. 15-30 / 4-12
4. 2-15
5. 100-140 / 3-12

52

What are absolute contraindications to beta-blockers (6)?

1. Symptomatic reactive airway disease
2. Symptomatic bradycardia
3. Advance AV block
4. SBP < 80
5. Cardiogenic shock
6. Pulmonary edema

53

What is a loop diuretic alternative to Furosemide?

Bumetanide

54

What are two abnormal ABI numbers?

ABI > 1.2 or ABI < 0.8