CVM Flashcards
(124 cards)
1
Q
CAUSES OF STE
A
- Acute pericarditis
- LV aneurysm
- Takotsubo
- Coronary vasospasm
- Normal variant angina (formerly known as Prinzmetal angina)
2
Q
CABG indications
A
- Left main or Left main equivalent disease (proximal LAD + 2vessel OR 3 vessel disease)
- Multivessel disease + LV dysfunction
- High risk criteria on stress testing
- Angina refractory to medical therapy
3
Q
Nitrate/Nitroglycerin c/i
A
- use of PDE5 inh
- Severe AS
- Hypertrophic CMO
- Inferior / posterior infarction (danger of hypotension)
4
Q
Resting HR/BP for BB tx of chronic stable angina
A
HR 55-60
BP <130/80
5
Q
Diabetic medication classes that benefit CAD
A
SGLT2 inh (empagliflozin - jardiance) \ GLP 1 agonist (liraglutide - victoza)
6
Q
HCOM vs MVP murmur with Valsalva or Squatting to standing
A
HCOM - intensity increases
MVP - prolonged murmur (increases duration); mid-systolic click happens earlier
7
Q
RV diastolic or RA systolic free wall invagination “collapse”
Failure of IVC to diminish or “collapse” during inspiration
A
Cardiac Tamponade
8
Q
Most effective treatment of Constrictive Pericarditis
A
Pericardiectomy
Sometime can spontaneously resolve or respond to medical therapy with NSAIDs or prednisone
9
Q
Treatment of recurrent Pericarditis
A
ASA / NSAIDs x 2wks + Colchicine x 3 mos***
10
Q
EKG findings in Pericarditis
A
- diffuse STE
- PR segment depression
- Q waves don’t develop like they do in MI
11
Q
Normal splitting of S2 is heard during ? Inspiration OR expiration
A
Inspiration
12
Q
S2 splitting during both inspiration and expiration happens with what type of murmur
A
ASD
13
Q
S2 splitting during expiration happens with what types of murmur
A
AS
HCM
14
Q
Innocent murmurs in Pregnancy
A
Inc P2
S3
Early peaking systolic murmur over the upper left sternal border
15
Q
Severe AS ECHO finding
indication for valve surgery?
A
valve area <1cm2
mean transvalvular gradient >40mmHg
SYMPTOMS ONLY
16
Q
Severe AS PE findings
A
late peaking murmur
slow and delayed carotid pulse
murmur obscures A2
17
Q
AR - valve replacement indications
A
Symptomatic
Progressive LV dilatation
LVEF <50%
18
Q
Aortic coarctation is associated with what valve disease
A
Bicuspid Aortic Valve
19
Q
Coarctation of Aorta PE findings
A
Diminished femoral pulses
HTN
Systolic murmur and may have diastolic component as well
Notching of post. ribs on CXR
Indentation of the aortic wall at the coarctation site.
20
Q
Mitral Stenosis - med management
A
BB or CCB to control tachycardia and prolong diastolic filling
Coumadin for LA thrombus, AF, previous embolic event
21
Q
Contraindications to Percutaneous mitral balloon commissurotomy treatment for rheumatic MS
A
LA clot
Significant MR
Significant valvular calcifications
22
Q
AC?
- AF + mild AS
- AF + mod to severe AS
A
- NOAC depending on CHA2DS2-VASc
2. COUMADIN only regardless of CHA2DS2-VASc
23
Q
Medications that can cause primary MR
A
Ergotamine (serotonin, dopamine, epinephrine A.)
Pergolide (dopamine R A.)
Cabergoline (dopamine R A)
Bromocriptine (dopamine R A)
24
Q
3 Chronic MR surgery indications
A
Symptomatic but LVEF needs to be >30%
LVEF <60%
Progressive LV dilatation (>40mm) regardless of symptoms
25
Acute MR treatment
prior to SURGERY
- sodium nitroprusside MAP<60mmHg
- NE for hypotension
- intra-aortic balloon pump if unresponsive to therapy
26
JONES Criteria (acute Rheumatic Fever)
Group A strep infection/Elevated strep Ab titer PLUS
2 major OR 1 major +2minor
```
MAJOR
J oints (mono or polyarthritis)
♥️carditis, valve damage
Nodules (subcut extensor surf)
Erythema marginatum (painless)
Sydenham chorea
```
```
MINOR
P olyarthralgia
E EKG with PR prolongation
A rthralgia
C RP and ESR elevated
E levated temp (T >38C)
```
27
Antibiotic of choice for acute Rheumatic Fever
Prophylaxis needed to prevent 2nd infection?
PNC
1. NO CARDITIS: 5yrs or until 21 (whichever is longer)
2. CARDITIS + NO RESIDUAL HEART DX: 10 yrs or until 21
3. CARDITIS + RESIDUAL HEART DZ: 10 yrs or until 40
28
Perioperative AC management for mechanical aortic valve
Stop warfarin 5 days before surgery
| Restart after surgery
29
When is INR goal 2.5-3.5 indicated
Mitral mechanical valve
Aortic mechanical valve + AF
Dec LVEF
Previous embolism
30
3 indications for ASD closure
1. evidence of L-->R shunt with pulm flow : systemic flow ratio >1.5:1.0
2. volume overload of right side
3. symptoms
31
DAPT treatment in : NSTEMI with no stent placement
ASA81 + clopidogrel x 1 yr
| then ASA indefinitely
32
DAPT treatment in : NSTEMI s/p PCI BMS
ASA81 + P2Y12 inh (clopidogrel 75mg qd or ticaglecor 90 mg BID) x 1 yr
then ASA81 indefinitely
33
Diagnostic study for Arrhythmia:
- infreq arrhthmias lasting 1-2mins
- activated by patient so poor choice for pt's with syncope
Event monitor
34
Diagnostic study for Arrhythmia:
- EKG lead attached to pt
- saves previous 1-2 mis of EKG recorded when activated by pt
Loop recorder
35
Diagnostic study for Arrhythmia:
- long-term continuous EKG monitoring
- indicated for very infreq arrhythmias lasting 1-2 mins
Implanted recorder
36
AV nodal reentrant tachycardia tx
```
vagal maneuvers:
-carotid sinus pressure
-gagging or coughing
-valsalva maneuver
-immersing face in ice-cold water
Medications:
-adenosine (preffered)
-metoprolol, esmolol, verapamil, diltiazem
ABLATION is definitive treatment successful in 95% of cases
```
37
EKG findings: AV Reciprocating Tachycardia or WPW pattern
- short PR interval
- delta wave
- borderline or prolonged QRS complex
38
WPW pattern vs WPW syndrome
WPW syndrome is : WPW pattern + symptomatic arrhythmias involving the bypass tract
39
WPW (or AVRT) syndrome tx
1. Hemodynamically unstable
2. Narrow complex AVRT
3. Wide complex, Irregular AVRT
4. Drug resistant
5. asymptomatic AVRT (WPW) conduction without arrhythmia
1. Cardioversion
2. Procainamide (class Ia Na channel blocker)
3. Ibutilide (class III; delayed K channel blocker)
4. Ablation
- -> Radiofrequency is more safer, more cost effective and less invasive than surgical ablation ***
5. does not require tx or investigation
40
Medications to avoid with WPW syndrome + AFib
CCB, BB, digoxin because can convert AFib to VT / VF
41
3 MC causes of A Flutter
Pulm disease exacerbation
Pericarditis
Following open heart surgery
42
A Flutter Mx
Cardioversion (hemodynamically unstable)
Radiofreq catheter ablation (superior to medical therapy)
43
Ascending thoracic aneurysm elective repair dimension
Descending thoracic aneurysm elective repair dimension
Ascending : ≥ 50-60mm
Descending : ≥ 60-70mm
Symptoms of hoarseness, dysphagia, back pain
Rapid growth >10mm/yr or >5mm/yr for Marfan and other congenital syndromes
44
Ascending thoracic aneurysm ECHO surveillance
| ECHO surveillance if <50mm
<45mm : yearly
| ≥ 45 mm : q 6 mos
45
Treatment of aortic arch dissection
BB
| Vasodilator (nitroprusside)
46
Which antihypertensive medication should be avoided in acute aortic dissection b/c it results in increased shear stress
Hydralazine
47
AAA screening cricteria
1 time screening for MEN ≥ 65 yo who have ever smoked
or who have never smoked but have higher family risk
48
AAA need for surveillance
4 - 5.4 cm follow up with US in 6-12mos
49
ABI
1. ≤ 0.9
2. ≤ 0.4
3. ≥ 1.4
4. 1 - 1.3
1. PAD
2. ischemic rest pain
3. diabetes-related noncompressible calcified arteris
4. normal
50
What to do if ABI is ≥ 1.4
toe-brachial index
51
claudication due to PAD vs spinal stenosis
spinal stenosis claudication occurs with walking, standing(resting). Only resolves when sitting or flexing (bending forward)
52
contraindication to use of Cilostazol
decreased LV EF
53
In the absence of active cardiac condition 2 pt situations that do not require preop cardiac risk assessment are
1. low risk surgery (endoscopic, superficial breast, cataract, ambulatory)
2. patient able to climb flight of stairs, walk on level ground at 4miles/hour ( ≥ 4 METs)
54
Omega 3 FA supplement decreases ?
Trig
55
Monounsaturated fats affect on HLD
Dec LDL
| Either INC HDL or leaves it unchanged.
56
Large a waves and slow/blunted y descent
Tricuspid stenosis
Pulmonary stenosis
Pulm HTN
associated with Delayed atrial emptyting
57
Rapid x and y descent
Constrictive pericarditis
58
Cannon a wave
VTach or Complete heart block
| atrium is contracting against closed tricuspid valve
59
Large a and large v waves
HF
60
IE prophylaxis requirement
Prosthetic heart valve ***
Previous hx of IE
Unrepaired cyanotic CHD
Repaired CHD with prosthetic material for <6mos post procedure
Cardiac transplant recipients who develop cardiac valvulopahty
61
Which procedures require prophylaxis for IE
Procedures on ....
Respiratory tract
Infected skin
Musculoskeletal tissue
62
Equal a and v waves with a single rapid x and attenuated y descent
Cardiac tamponade
63
-EKG findings of STE which quickly resolve
-Crescendo-type angina
-CE often normal b/c ischemia is of short duration
is consistent with ....
Normal variant angina (formerly known as printzmatel)
64
Normal variant angina tx (2)
CCB
Nitrates
to prevent vasospasms
65
Coccaine abuse + BB effect
Acute coccaine intox leads to hyperadrenergic state. BB block the beta component of these effects leaving unopposed alpha effect leading to adverse consequences
66
Thrombolytic therapy during cp benefits which type of EKG findings ? ***
And harmful for which type of EKG finding?
new LBBB > ant STEMI > inf STEMI
harmful if ST depression
67
Equalization of diastolic pressure are seen in (2)
Constrictive pericarditis
| Cardiac tamponade
68
Indication for dipyridamole nuclear stress test (vs exercise treadmill test)
AFib
| -------
69
Which electrolyte abnormalities cause prolonged QT (3)
HypoCa
HypoMg
HypoK
70
```
Anterior MI
Anteroseptal
Anterolateral
Lateral
Inferior
Posterior
```
```
V2-4
V1-4
V4-6, I, aVL
I, aVL
II, III, aVF
tall R in V1-2 and ST depression in V1-2
```
71
```
Pt with AFib on Coumadin
undergoes PCI which is more appropriate?
--cont warfarin alone
--cont warfarin + ASA
--cont. warfarin + P2Y12inh
--cont. warfarin + DAPT
```
--cont. warfarin + P2Y12inh
72
4 components of Tetralogy of Fallot (TOF)
```
V-ROAR-V
V--VSD
RO--Right ventricular Outflow obstruction
OA--Overriding aorta
RV--Right Ventricular hypertrophy
```
73
NSTEMI pt blood thinner regimen
1. ASA
2. P2Y12 inh ticagrelor > clopidegrol
3. parenteral AC :
- -->enoxaparin SC
- -->bivalirudin IV
- -->fondaparinux SC
- -->unfractionated hep (preferred with GFR < 20 or ESRD on dialysis patients)
74
Using antipsychotic in patient with prolonged QT interval increases the risk of
POLYMORPHIC VTach (torsades de pointes)
75
Indication for emergent Aortic Dissection for type B aortic dissection
Occlusion of major aortic branch leading to end-organ ischemia
Persistent HTN or pain
76
Class I indication for temporary transvenous pacing (5)
- asystole
- sxic bradycardia
- bilateral bundle branch block or alternating
- new or indeterminate age bifascicular block
- 2nd degree Mobitz type 2
77
Peri-operative mx
- -pt undergoing hernia repair
- -on warfarin for AVR with prosthesis
- -when discontinuing ASA/warfarin 5 Ds before the procedure do you bridge the patient?
NO
78
pulmonary valve stenosis - surgical indication
SEVERE pulmonary valve stenosis require
| Balloon valvuloplasty or surgical valve replacement regardless of symptoms
79
Severe pulmonary valve stenosis findings
Late-peaking palpable systolic ejection murmur
Absence of ejection click
Features of RV pressure overload
80
Severe mitral stenosis (mean pressure gradient >10mmHg) + no symptoms + planning pregnancy ... Mx ?
MV intervention
81
TEE use indications (4)
Endocarditis / Vegetation
Acute MR/AR
Aortic dissection
Prior to cardioversion for Afib/Aflutter
82
Which EKG lead shows ischemic changes first (or is looked at) during exercise stress test?
V5
83
7 EKG changes that create limitation to EXERCISE stress testing? From most concerning to least concerning
```
WPW, LBBB, paced rhythm
LVH
RBBB
Digoxin
Nonspecific ST changes
```
84
Contraindication to dobutamine nuclear imaging
Arrhythmia***
| hyperTension
85
Contraindication to vasodilator (adenosine) nuclear imaging
Bronchospasms
| Worsen AV block
86
If a patient is able to exercise but does not have normal resting EKG
Exercise with nuclear perfusion imaging
87
Treatment of choice for pts that can't exercise and has contraindications to dobutamine or vasodilator nuclear imaging.
CT angiography OR
| Coronary angio
88
Which pharmacologic stress test is preferred when pt has LBBB or paced rhythm
Vasodilator (adenosine, dipyridamole, regadenoson)
89
PCWP is a measure of
LA pressure which represents LVEDP
90
Pulsus paradoxus (inspiratory fall in systolic BP) seen in (3)
Pericardial tamponade
Asthma
Tension pneumothorax
91
Pulsus bisferiens (bifid pulse with 2 aortic peaks) seen in (2)
AR
| HCM
92
PUlsus alternans (strong pulse weak pulse strong pulse) seen in (3)
Bigeminal PVCs
Severe LV dysfxn
Severe AS
93
JVP
| Large a wave is seen with (3)
TS
Severe PS
Severe noncompliant RVH
94
Irregular Cannon a waves (a is contracting against closed TV)
A-V dissociation
- -> VT
- ->3rd degree AVB
- ->ventricular pacing in a pt with sinus rhythm and complete heart block
95
Rapid x and y descent
Constrictive pericarditis
| Restrictive CMO
96
Rapid x descent with loss of y descent
Cardiac tamponade
97
Large v waves (RV contracts but TV is not entirely closed) - 2
```
RV infarction (w./ kussmaul sign)
TR
```
98
How do you differentiate Constrictive pericarditis and
| Restrictive CMO looking at JV pressure
Rapid x and y descent in both
Constrictive - Kussmaul sign and diastolic knock
Restrictive - no diastolic knock
99
In general during inspiration Right sided murmurs are louder...
Which Right sided murmur is SOFTER during inspiration?
Pulmonic Stenosis. which occurs with congenital pulmonic stenosis
100
Prognosis of CAD determined by these (3) factors
LV function
Exercise capacity < 4
Severity of angina
101
Most predictive RF for the presence of CAD
DM >> Active smoking
102
Which 4 groups benefit from statin
1. clinica AS CVC (CAD, CVA, PAD)
2. LDL ≥ 190
3. LDL 70-189 + DM
4. LDL 70-189 + 10 yr risk of ≥7.5%
Both 3 and 4 are ages 40-75yo
103
When to give Fibrinolytic therapy in a nonPCI facilitated hospital
If the PCI capable hospital is > 120 mins away
Symptom onset 12 hours
104
Indication for ICD implantation prior to discharge s/p STEMI
Sustained VT/VF > 48 hrs after STEMI
| provided the arrhythmia is not due to transient ischemia, reinfarction, or electrolyte abnormality
105
Pulsus parvus et tardus in carotid pulse is commonly seen with which VHD
AS
106
Late systolic murmur at the apex
MVP
107
3 Holosystolic murmurs
MR
TR
VSD
108
Redundant tricuspid leaflet arising lower in the ventricle which makes RA appear huge +/- TR murmur
Ebstein Anomaly
| -- associated with WPW syndrome
109
1. Murmur gets louder with valsalva for AS or HCOM
2. Murmur gets softer with valsalva for AS or HCOM
3. Carotid pulse has rapid upstroke and rapid downstroke- bifid
4. Carotid pulse is delayed
1. HCOM
2. AS
3. HCOM
4. AS
110
3 BB shown to prolong survival in HF
Bisoprolol 10mg qd
Carvediolol 25mg bid
Metoprolol sustained release 150-200mg qd
111
In hypertrophic CMO does severity of LV outflow gradient correlate or increased with the risk of sudden death
NO; can correlate with the severity of disease
112
HCOM therapy goals
1. slow down the heart HR50 with BB or verapamil
| 2. inc LV volume so it opens up outflow track
113
2 meds that inc risk of constrictive pericarditis
Procainamide
| Hydralazine
114
Complication of recurrent Pericaditis
Constrictive pericarditis
115
Common causes of Constrictive pericarditis (6)
```
Idiopathic
Post viral
TB - in developing countries
CTS
Radiotherapy
Coccidiomycosis
```
116
```
Kussmaul sign (insp rise in JVP)
Large x and y descent
Pericardial knock
Calcification of pericardium
Thickened pericardium
is c/w
```
Constrictive Pericarditis
117
Gold standard test to differentiate between Constrictive Pericarditis and Restrictive CMO
RHC
118
F>M
Abnormal flow from Aorta to Right side of heart
Differential cyanosis
Continous machinery murmur
PDA
119
PDA surgical or percutaneous closure indications
Symptomatic
120
- -Coronaries that pass between the great vessels
- -Sudden death in exercising young ppl
- -can px with cp with exertion
Anomualous Coronary Arteries
121
Heart conditions that have absolute contraindication to Pregnancy (3)
Cyanotic CHD
Eisenmenger's
Pulmonary HTN
122
2 causes of a pregnant pt ping with new onset Afib and Pulmonary edema
MS
| Secundum ASD
123
6 Indications for ICD placement in HCOM patients?
--massive myocardial hypertrophy (wall thickness ≥30 mm)
--previous cardiac arrest due to ventricular arrhythmia
--blunted blood pressure response or hypotension during exercise
--unexplained syncope
--NSVT on ambulatory electrocardiography
--FHx of sudden death due to HCM
124
Which valve does not need long-term AC ?
Mechanical or
Bioprosthetic
Bioprosthetic
