HF

Question 1

Early conduction disease+ SCD

Answer 1

Familial DCM
such as lamin cardiomyopathy

Question 2

Peripartum CM timing
Chemo induced meds

Answer 2

w/in 5 months
anthracyclines (rubicin), trastuzumab, HER2 antagonists, TKIs (-nibs), cyclophosphamide

Question 3

ACEI to ARNI washout timing

Answer 3

36 hours

Question 4

HFrEF GDMT

Answer 4

BB
ARNI
Spiro
Empa
HFpEF: empa, spiro

Question 5

Significant HCM gradient
Symptomatic HCM despite BB

Answer 5

> 50
Septal myectomy/ ablation

Question 6

INTERMACS

Answer 6

1: cardiogenic shock
2: progressive decline
3: stable but inotrope dependent
4: frequent admissions and recurrent HF relapses
5: exertion intolerant
6: exertion limited

Question 7

Forrester

Answer 7

I: warm and dry
II: warm and wet
III: cold and dry
IV: cold and wet

Question 8

HFpEF diagnosis

Answer 8

resting PCWP >15 mm Hg or exercise PCWP >25 mm Hg. Neither normal BNP nor E/e’ excludes diagnosis.

Question 9

Peripartum CM risk factors

Answer 9

African-American race, gestation hypertension, advanced maternal age, and multiparity

Question 10

LV noncompaction diagnosis

Answer 10

maximum end-diastolic noncompacted-to-compacted myocardial thickness ratio >2.3 and trabeculated LV mass >20% of the global LV mass.

Ratio >2 and LV trabecular LGE are associated with adverse events.

Question 11

Chemo CM treatment

Answer 11

ACEI, BB
Chemo continuation is interdisciplinary decision

Question 12

Peripheral and/or autonomic neuropathy: weight loss, diarrhea or constipation, and orthostatic hypotension

Answer 12

Hereditary ATTR amyloid: amino acid substitution in a transport protein

Question 13

Anderson-Fabry

Answer 13

glycogen storage disease, caused by a mutation in the alpha-galactosidase gene and resulting in decreased lysosomal enzyme activity. GLA mutation

Question 14

Dobu or norepi or milrinone for inotropy

Answer 14

Milrinone causes more hypotension?

Question 15

Notch 1 mutation

Answer 15

bicuspid aortic valve and early aortic valve calcification.

Question 16

T-box 5 (TBX5) mutation

Answer 16

Holt-Oram syndrome

Question 17

Monitoring for chemo CM
Definition

Answer 17

Troponin, echo, BNP
reduction in LVEF of ≥10% or to a value of <53% in asymptomatic patients or ≥5% in symptomatic patients.

Question 18

Galectin-3

Answer 18

fibrosis after organ injury,
associated with increased HF readmission rates, arrhythmias, and mortality

Question 19

Symptomatic AF despite rate control

Answer 19

Pursue rhythm control with Amiodarone or dofetilide (QT prolongation and torsade de pointes) in HFrEF

Question 20

Amyloid ECG.
AL amyloid pathophys

Answer 20

low voltage, pseudoinfarct.
plasma cell dyscrasia

Question 21

ARVC diagnosis

Answer 21

RV WMA + FAC <33%
Anterior TWI
Get genetics

Question 22

immune checkpoint inhibitor (-mabs) myocarditis

Answer 22

pembro: conduction disease, PVCs, VT , afib, pericarditis, pericardial effusion, myalgia. interstitial inflammation with lymphocytes on path. Treat with steroids

Question 23

Pressure volume loops

Answer 23

Look at stroke volume, blood pressure and total volume

Question 24

Advanced amyloid

Answer 24

palliative care
bone marrow biopsy is for AL amyloid

Question 25

MYH7, myosin, actin alpha mutation SCN5A

Answer 25

HCM LQTS

Question 26

Biopsy

Answer 26

New HF + HDUS New HF+ dilated LV + arrhythmias or refractory to meds

Question 27

frequent ventricular arrhythmias, rapidly progressive HF, and increased LV wall thickness possibly due to edema

Answer 27

giant cell myocarditis. treat with steroids

Question 28

BNP sacubitril

Answer 28

elevated, use pro NT BNP instead

Question 29

Cardiorenal syndrome

Answer 29

1: HF causes AKI due to increased renal venous pressure and subsequent kidney congestion. Increased renin, increased vasopressin, less intestinal perfusion

Question 30

most common cause of HFrEF

Answer 30

CAD

Question 31

decreased LVOT VTI despite the hyperdynamic LV ejection fraction

Answer 31

low forward flow due to things like MR. Weightlifters can get sudden chordal rupture.

Question 32

VT/ v fib interrogation

Answer 32

greater number of ventricular electrograms compared to atrial electrograms

Question 33

Septal myectomy instead of alcohol ablation

Answer 33

LBBB. Disopyramide prolongs QT.

Question 34

IABP/Impella CI

Answer 34

LV thrombus

Question 35

Increased SCD in HCM

Answer 35

Family history of first-degree or close relative <50 yo SCD, Prior cardiac arrest or sustained VT, Recent arrhythmic syncope, LVH >30 mm, LV apical aneurysm, End-stage HCM with LV ejection fraction <50%, NSVT, extensive LGE

Question 36

Coxsackie myocarditis

Answer 36

diffuse interstitial edema and dense lymphocytic infiltrates, painful blisters

Question 37

Viral myocarditis most common causes

Answer 37

Parvovirus B19 and human herpes virus 6

Question 38

HF iron deficiency

Answer 38

ferritin <100 ng/mL; or ferritin 100-299 ng/mL or iron saturation is <20%. treat with intravenous (IV) iron sucrose or ferric carboxymaltose until the iron saturation is >20%

Question 39

ARVC diagnosis

Answer 39

genetic testing before biopsy in borderline cases

Question 40

Dilated CM+ ferritin >300, + serum iron/TIBC of >50%, transferrin sat >55%, transaminase elevation, and DM (T2* <20 msec on CMR (C282Y) gene

Answer 40

hemochromatosis Phlebotomy regardless of hgb level-removing iron, not hgb

Question 41

HFpEF workup

Answer 41

always look for CAD.

Question 42

Hemochromatosis CMR

Answer 42

decreased T2 times and decreased myocardial signals on T2-weighted images

Question 43

asymptomatic first-degree relatives of patients with familial DCM

Answer 43

serial echo q 3 years

Question 43

Serial echos for anthracycline chemo

Answer 43

Before, after, 6 months post. If the cumulative dose is >240 mg/m2, then an echocardiogram is recommended prior to each successive dose of 50 mg/m2.

Question 43

ACEI/ARNI mechanism

Answer 43

inhibit kinase-> increase bradykinin increase levels of substance P by inhibiting degradation

Question 43

systolic murmur heard throughout the precordium that increases in intensity with the Valsalva maneuver

Answer 43

HCM

Question 44

Acute HF tests

Answer 44

EKG and echo

Question 45

carpal tunnel syndrome, lumbar spinal stenosis, "self-curing" hypertension, peripheral neuropathy

Answer 45

ATTR amyloid

Question 46

idiopathic dilated cardiomyopathy workup

Answer 46

three-generational family history

Question 47

HFrEF bad prognostic factors

Answer 47

VO2 max of <14 mL/kg/min or <50% of predicted, mitral E/A ratio of >2, dilated LV

Question 48

Untreated AL amyloid prognosis

Answer 48

<1 year, treat with systemic chemotherapy and/or autologous stem cell transplant

Question 49

myocarditis pathophys

Answer 49

1) injury and activation of innate immunity; 2) acute, antigen-specific myocardial inflammation; and 3) chronic inflammatory dilated cardiomyopathy.

Question 50

Vacuolated cardiomyocytes seen in

Answer 50

doxorubicin-associated cardiomyopathy

Question 51

ARVC (disease of the desmosome) and HCM screening

Answer 51

all first degree relatives

Question 52

drug that causes atrial tachyarrhythmia

Answer 52

theophylline

Question 53

NSAIDs in HF cause

Answer 53

sodium and water retention, diuretic resistance, and increased systemic vascular resistance. Avoid.

Question 54

HFrEF BNP HFpEF BNP may not be elevated in

Answer 54

Always elevated women, younger, obesity

Question 55

Echo HF

Answer 55

higher E/e' ratios, higher transmitral E/A ratios

Question 56

sarcoid LGE

Answer 56

subepicardium and midmyocardium in the septum and basal lateral wall *sarcoid also causes scleral and conjunctival injection and rash.

Question 57

chemotherapy-related cardiac dysfunction

Answer 57

Type I CRCD: anthracyclines (i.e., doxorubicin) and generally results in myocyte destruction and clinical heart failure, permanent Type II: trastuzumab, loss of myocardial contractility, reversible

Question 58

Cyclophosphamide cardiac toxicity

Answer 58

myocardial ischemia but not a cardiomyopathy

Question 59

most specific finding for hemochromatosis

Answer 59

T2* <20 msec

Question 60

Post transplant SOB Risk factors for rejection

Answer 60

r/o rejection with biopsy younger age, female recipient, and African-American, cyclosporine+ mycophenolate

Question 61

Post transplant complications Coronary allograft vasculopathy timing

Answer 61

HF: first abnormality is often diastolic dysfunction, atrial arrhythmias. After 1 year

Question 62

Best predictor of long term survival in AL amyloid. Macroglossia is pathognomonic.

Answer 62

troponin, NT-proBNP

Question 63

LBBB, avoid this type of stress test

Answer 63

ETT Exercise nuclear (false positives), do pharm nuclear instead

Question 64

ARVC + recurrent VT/ appropriate/inappropriate ICD therapies from sinus tachycardia, SVT, or atrial fibrillation (AF) or flutter with rapid ventricular rate

Answer 64

BBs