Heart Articles

Question 1

Hear failure is?

Answer 1

Common clinical syndrome characterized by :

• dypsnea,
• fatigue
• signs of volume overload

Volume overload

• peripheral edema
• pulmonary rales

Question 2

Diastolic heart failure w preserved left ventricle function accounts for how much HF?

Answer 2

40-50%

Question 3

PE findings for heart failure?

Answer 3

Displaced cardiac apex
3rd heart sound
Radiology findings
- venous congestion
- interstitial edema

Question 4

Heart failure definition

Answer 4

Structural or functional cardiac d/o that impaires the ability of the ventricle to fill w or eject blood

Question 5

Risk factors for progression from asymptomatic to symptomatic LV systolic disfunction?

Answer 5

HTN
Valve disease
DM

Question 6

DM and Heart Failure?

Answer 6

DM = one of the strongest risk factors for HF in women w CAD

Question 7

Framingham criteria value?

Answer 7

Systolic heart failure can be effectively r/o when framingham criteria are not met

SYSTOLIC HEART FAILURE

Question 8

Framingham criteria?

Answer 8

2 major or 1 maj 2 minor

MAJOR

• paroxysmal nocturnal dyspnea/orthopnea
• neck vein distention
• rales
• cardiomegaly
• acute pulmonary edema
• S3 gallop
• hepatojugular reflux

Minor criteria

• ankle edema
• night cough
• dypsnea on exertion
• pleural effusion
• tachycardia rate >120 bpm

Question 9

Common causes of heart failure

Answer 9

More common

• Coronary Artery Disease
• HTN
• Idiopathic cardiomyopathy
• Valvular disease

Less common

• arrhythmia
• collagen vascular disease (SLE, DM)
• hypertrophic cardiomyopathy
• myocarditis
• pericarditis
• postpartum cardiomyopathy
• restrictive cardiomyopathies
• toxic cardiomyopathy (ETOH, cocaine)

Question 10

Most important consideration when categorizing heart failure?

Answer 10

If Left ventrical ejection fracture is preserved or reduced (<50%)

Question 11

Classic diastolic HF pt?

Answer 11

Woman
Older
HTN
Afib
LVH

No HX of CAD

Question 12

Therapies for systolic vs diastolic HF?

Answer 12

Systolic - well validated therapies

Diastolic - no good EBM

Question 13

Simplest and most widely used method to gauge heart failure symptom severity?

Answer 13

New york heart association functional classification of HF

Question 14

New york heart association functional classification of HF

Answer 14

classes

I: no limitations of activity, no HF sx
II: mild limiation, HF sx w significant exertion
III: marked limitation, HF sx w mild exertion, comfortable at rest
IV: discomfort w any activity; HF sx at rest

Question 15

Blood test for eval of HF?

Answer 15

BNP
Calcium  and Magnesium
CBC 
Liver function
Serum electrolytes
TSH
UA

These will help r/o common causes of sx

Question 16

This test is a strong predictor of mortality at 2-3 months post cardiovascular event

Answer 16

BNP
- if greater than 200 pg/mL

N-terminal pro BNP
- greater than 5,180 pg/mL

Question 17

Value of framingham study?

Answer 17

Not so good at diagnosing HF but really good at r/o HF

Question 18

How do you confirm HF diagnosis?

Answer 18

Echocardiography

Question 19

Heart failure w angina?

Answer 19

coronary angiography - unless contraindication to revascularization

Improve sx and survival in pts w angina and reduced EF

Question 20

How are acute MI’s categorized?

Answer 20

STEMI or NSTEMI

Question 21

Classifications of acute MI?

Answer 21

1. Coronary artherothrombosis
2. Supply-demand mismatch
3. Sudden death (no biomarker or ECG)
   4a. PCI related
   4b. thrombosis of stent
4. CABGE related

Question 22

Usual cause of acute MI?

Answer 22

Rupture or erosion of plaque

Question 23

Thrombosis relationship to STEMI vs NSTEMI?

Answer 23

STEMI - total occluding thrombus

NSTEMI - partial occlusion or occlusion w collateral circulation

Unstable angina - same as NSTEMI

Question 24

What do MI’s need w/in 10 min?

Answer 24

ECG

Troponin levels

Question 25

How long do you need to r/o MI w troponin?

Answer 25

1-2 hrs of serial troponin

Question 26

Causes of troponin rise?

Answer 26

1. MI 2. Other cardiac 3. Renal failure 4. Respiratory failure 5. Stroke 6. intracranial hemorrhage 7. Septic shock 8. Chronic heart disease

Question 27

O2 recommendation for pts with acute MI?

Answer 27

Only when SPO2 <90

Question 28

Sublingual nitroglycerine is used for?

Answer 28

Relief of ischemic discomfort

Question 29

Meds for myocardial supply-demand mismatch?

Answer 29

``` O2 Analgesics (morphine 1-5mg) Nitrates (NO2 0.3-0.4 mg q 5 min) B-blocker CCB - for persisten ischema ```

Question 30

Meds for coronary thrombus?

Answer 30

Antiplatelet therapy - ASA - P2Y inhibitor Anticoagulant

Question 31

Meds for unstable atheroma or disease progression?

Answer 31

Statin therapy | ACEI

Question 32

Primary therapy for STEMI?

Answer 32

PCI (if w/in 90-120 min) - sx w/in 12 hrs Fibrinolytics

Question 33

PCI for STEMI uses what for therapy?

Answer 33

Stent - Bare metal - Drug eluding (preferred)

Question 34

NSTEMI and fibrinolytic therapy?

Answer 34

May be harmful in pts w/o ST elevation

Question 35

Antithrombotic therapy?

Answer 35

ASA - 162-325mg - then 81-325 q day P2Y inhibitor (high risk pts) - clopidogrel - prasugrel - ticagrelor

Question 36

Preferred P2Y for fibrinolytics?

Answer 36

Clopidogrel

Question 37

Anticoagulation agents?

Answer 37

Heparin Enoxaparin Bivalirudin Fondaparinux

Question 38

Words used by pts to describe palpitations?

Answer 38

Flip-flopping in chest Rapid fluttering in chest Pounding in neck

Question 39

Palpitations that have an abrupt onset and termination are often?

Answer 39

SVT | V-tach

Question 40

Ways for pts to terminate their own palpitations?

Answer 40

``` Carotid-sinus massage Vagal maneuvers (valsalva) ```

Question 41

Midsystolic click?

Answer 41

Mitral-valve prolapse

Question 42

Harsh holosystolic murmur along LSB increasing w valsalva?

Answer 42

Hypertrophic obstructive cardiomyopathy

Question 43

Palpitations are determined to be high risk or low risk for arrhythmia. How is this determined?

Answer 43

High risk - organic heart disease - myocaridal abnormality - previous MI (scar) - idiopatic dilated cardiomyopathy - valvular regur - stenotic lesion - hypertrophic cardiymopathies - fam/personal hx Low risk - no potential substrate for arrhythmias

Question 44

Ambulatory Heart monitoring devices

Answer 44

Holter - 24hr continuous recording Continuous-loop even recorder - saves previous 2 min when pt pushes button

Question 45

Preferred heart monitor for palpitations? Why?

Answer 45

Continuous loop recorder - worn for longer so more likely to catch the events Typically worn for 2 weeks but can be up to 1 month

Question 46

Indications for treadmill exercise testing?

Answer 46

Sx during/following exercise can be: - SVT - A- fib - Idiopathic VTac - premature depol

Question 47

Indications for electrophysiologic testing:

Answer 47

Documented rapid pulse w/o ECG findings - any tachyarrhythmia Palpitations preceeding syncopal episode - v-tach - SVT

Question 48

How are sustained supra-ventricular or ventricular arrhythmias causing palpitations managed?

Answer 48

Pharmacologic Invasive electrophysiologic management - radio-frequency ablation

Question 49

Premature contractions and non-sustained vtach in structurally normal heart?

Answer 49

Benign diagnosis - non life threatening

Question 50

The majority of outpatient palpitations are?

Answer 50

Benign - extensive investigation not warranted