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ACCSAP > HF > Flashcards

HF Flashcards

1
Q

Early conduction disease+ SCD

A

Familial DCM
such as lamin cardiomyopathy

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2
Q

Peripartum CM timing
Chemo induced meds

A

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

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3
Q

ACEI to ARNI washout timing

A

36 hours

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4
Q

HFrEF GDMT

A

BB
ARNI
Spiro
Empa
HFpEF: empa, spiro

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5
Q

Significant HCM gradient
Symptomatic HCM despite BB

A

> 50
Septal myectomy/ ablation

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6
Q

INTERMACS

A

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

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7
Q

Forrester

A

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

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8
Q

HFpEF diagnosis

A

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

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9
Q

Peripartum CM risk factors

A

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

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10
Q

LV noncompaction diagnosis

A

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.

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11
Q

Chemo CM treatment

A

ACEI, BB
Chemo continuation is interdisciplinary decision

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12
Q

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

A

Hereditary ATTR amyloid: amino acid substitution in a transport protein

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13
Q

Anderson-Fabry

A

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

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14
Q

Dobu or norepi or milrinone for inotropy

A

Milrinone causes more hypotension?

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15
Q

Notch 1 mutation

A

bicuspid aortic valve and early aortic valve calcification.

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16
Q

T-box 5 (TBX5) mutation

A

Holt-Oram syndrome

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17
Q

Monitoring for chemo CM
Definition

A

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

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18
Q

Galectin-3

A

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

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19
Q

Symptomatic AF despite rate control

A

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

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20
Q

Amyloid ECG.
AL amyloid pathophys

A

low voltage, pseudoinfarct.
plasma cell dyscrasia

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21
Q

ARVC diagnosis

A

RV WMA + FAC <33%
Anterior TWI
Get genetics

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22
Q

immune checkpoint inhibitor (-mabs) myocarditis

A

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

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23
Q

Pressure volume loops

A

Look at stroke volume, blood pressure and total volume

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24
Q

Advanced amyloid

A

palliative care
bone marrow biopsy is for AL amyloid

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25
Q

MYH7, myosin, actin alpha mutation

SCN5A

A

HCM

LQTS

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26
Q

Biopsy

A

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

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27
Q

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

A

giant cell myocarditis. treat with steroids

28
Q

BNP sacubitril

A

elevated, use pro NT BNP instead

29
Q

Cardiorenal syndrome

A

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

30
Q

most common cause of HFrEF

A

CAD

31
Q

decreased LVOT VTI despite the hyperdynamic LV ejection fraction

A

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

32
Q

VT/ v fib interrogation

A

greater number of ventricular electrograms compared to atrial electrograms

33
Q

Septal myectomy instead of alcohol ablation

A

LBBB.
Disopyramide prolongs QT.

34
Q

IABP/Impella CI

A

LV thrombus

35
Q

Increased SCD in HCM

A

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

36
Q

Coxsackie myocarditis

A

diffuse interstitial edema and dense lymphocytic infiltrates, painful blisters

37
Q

Viral myocarditis most common causes

A

Parvovirus B19 and human herpes virus 6

38
Q

HF iron deficiency

A

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%

39
Q

ARVC diagnosis

A

genetic testing before biopsy in borderline cases

40
Q

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

A

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

41
Q

HFpEF workup

A

always look for CAD.

42
Q

Hemochromatosis CMR

A

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

43
Q

asymptomatic first-degree relatives of patients with familial DCM

A

serial echo q 3 years

43
Q

Serial echos for anthracycline chemo

A

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.

43
Q

ACEI/ARNI mechanism

A

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

43
Q

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

A

HCM

44
Q

Acute HF tests

A

EKG and echo

45
Q

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

A

ATTR amyloid

46
Q

idiopathic dilated cardiomyopathy workup

A

three-generational family history

47
Q

HFrEF bad prognostic factors

A

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

48
Q

Untreated AL amyloid prognosis

A

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

49
Q

myocarditis pathophys

A

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

50
Q

Vacuolated cardiomyocytes seen in

A

doxorubicin-associated cardiomyopathy

51
Q

ARVC (disease of the desmosome) and HCM screening

A

all first degree relatives

52
Q

drug that causes atrial tachyarrhythmia

A

theophylline

53
Q

NSAIDs in HF cause

A

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

54
Q

HFrEF BNP
HFpEF BNP may not be elevated in

A

Always elevated
women, younger, obesity

55
Q

Echo HF

A

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

56
Q

sarcoid LGE

A

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

57
Q

chemotherapy-related cardiac dysfunction

A

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

58
Q

Cyclophosphamide cardiac toxicity

A

myocardial ischemia but not a cardiomyopathy

59
Q

most specific finding for hemochromatosis

A

T2* <20 msec

60
Q

Post transplant SOB
Risk factors for rejection

A

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

61
Q

Post transplant complications
Coronary allograft vasculopathy timing

A

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

62
Q

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

A

troponin, NT-proBNP

63
Q

LBBB, avoid this type of stress test

A

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

64
Q

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

A

BBs

ACCSAP (10 decks)

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