MKSAP Cardiology Flashcards
(113 cards)
1
Q
What are the indications for repair of mitral regurgitation?
A
Severe MR in
- symptomatic patients w/ EF >30%
- asymptomatic patients with EF 30-60% and/or LVESD >40 mm
- new onset afib
- pulmonary artery sys pressure >50 mmHg
2
Q
What are the indications for repair of aortic regurgitation?
A
Severe AR in
- asymptomatic pts w/ LV dilation (LV end-systolic dimension >50 mm) or EF <50%
- pts undergoing cardiac surgery w/ ascending aorta diameter >45 mm
- increase in pulmonary systolic pressure by 25 mmHg or to >60 mmHg during stress echo
- symptomatic patients
3
Q
What anti-coagulant is preferred in pregnancy and mechanical valve prosthesis?
A
Warfarin 5 mg or less can be used in first trimester. If higher dose needed can use UFH or LMWH. During second and third trimesters warfarin is preferred.
4
Q
What is the MOA of Ranolazine and when is it used? What drugs should be avoided? What should be monitored?
A
- Inhibits the late sodium current which decreases sodium dependent calcium currents -> reduced wall tension & myocardial O2 consumption
- Stable angina
- Avoid w/ strong CYP inhibitors like ketoconazole, clarithromycin, ritonavir. With moderate inhibitors like verapamil and diltiazem decrease dose by 50% (max dose 500 mg bid)
- QTc
5
Q
What valve disorders are associated with Noonan syndrome? Turner syndrome? Down syndrome?
A
- Pulmonary stenosis w/ dysplastic valve; HOCM, VSD, ASD
- Bicuspid aortic valve, aortic coarctation, aortic aneurysm
- ASD, VSD
6
Q
What complication of an ablation procedure can present 1-4 weeks later w/ TIA after food intake or sudden onset neurologic sx?
A
Atrioesophageal fistula
Can also present w/ fever, chest pain, seizures, hematemesis, and endocarditis
7
Q
What is low flow, low-gradient aortic stenosis and what is the management?
A
AS w/ low stroke volume (reduced EF) and low aortic gradient (<30 mmHg), in setting of small aortic valve area
Need dobutamine echo to distinguish between pseudostenosis (which can occur in severe LV dysfunction) vs anatomically severe AS
8
Q
What are cannon A waves associated with?
A
Complete heart block, pulmonary HTN, and VT
9
Q
What murmurs increase with standing and valsava? These murmurs decrease with squatting and leg raise. What murmurs increase w/ handgrip?
A
HOCM and mitral valve prolapse; for HOCM, LV chamber size decreases so degree of obstruction increases
MR, VSD, and AR increase w/ handgrip b/c increased CO and peripheral resistance
10
Q
Who should be screened for AAA? What is the surveillance frequency?
A
Adult males age 65-75 who have smoked 100 cigarettes in their lifetime
Aneurysms <4 cm monitor every 2-3 years
4.1-5.4 cm monitor every 6-12 months
11
Q
What drugs are contraindicated in severe aortic stenosis? Name 3.
A
Calcium channel blockers, beta blockers, nitrates
12
Q
What imparts the highest risk for MI? What is the goal reduction of cholesterol for primary prevention?
A
- Elevated cholesterol levels
2. 50% reduction in LDL in high risk patients, 30-50% reduction in moderate risk patients
13
Q
What are the criteria for metabolic syndrome?
A
At least 3 of the following: central obesity (>35 inches in women, >40 inches in men), hyperglycemia (fasting BG >100), low HDL (<40 in men, <50 in women), high TGs (>150), elevated BP (>130/85)
14
Q
What baseline EKG findings makes an exercise EKG not useful? Name 4. What baseline TTE findings makes a stress echo not useful?
A
- LVH, LBBB, paced rhythm, pre-excitation, >1 mm ST segment depression
- Baseline wall motion abnormalities
15
Q
What are contraindications to doing a dobutamine echo stress test? Name 5.
A
Severe baseline HTN, unstable angina, severe tachyarrhythmias, HOCM, severe AS, and large aortic aneurysm
16
Q
What are contraindications to vasodilator nuclear perfusion stress tests? (Adenosine, dipyridamole). Name 4.
A
Active bronchospastic airway disease (wheezing), theophylline use, sick sinus syndrome, hypotension, and high degree AV block
Need to hold caffeine 12-24 hours before test
17
Q
Name 3 different types of stress tests that can be performed with dobutamine.
A
Echo, nuclear perfusion, and cardiac MRI
18
Q
What type of stress test is preferred in LBBB?
A
Vasodilator-induced stress b/c of the potential for false-positive septal perfusion abnormalities w/ dobutamine
19
Q
For what murmurs should a TTE be obtained?
A
Systolic murmur 3/6 or higher, late or holosystolic murmur, diastolic or continuous murmur, or murmur w/ accompanying symptoms
20
Q
What are the ECG findings of STEMI?
A
ST elevation of 1 mm or more in 2 or more contiguous leads, except V2-V3 where it should be >1.5 mm in women or >2 mm in men
Posterior MI presents w/ 2 mm ST segment depression in V1-V4
21
Q
What are contraindications to prasugrel use and when should the dose be modified? What is one known side effect of ticagrelor?
A
- History of stroke and those age >75 y.o.
- Dose adjusted for weight <60 kg
- Dyspnea
22
Q
Which medication is indicated in all patients receiving thrombolytic therapy for STEMI?
A
Clopidogrel
23
Q
What do the TIMI and GRACE scores predict? Using these scores when should urgent revasc vs. delayed revasc be performed?
A
- TIMI - 14 day death, recurrent MI, and urgent revascularization rates
GRACE - 6 month mortality and MI risk - High risk (TIMI 5-7 or GRACE 141-372) get revasc within 24 hours; intermediate risk (TIMI 3-4 or GRACE 109-140) get revasc within 25-72 hours; low risk (TIMI 0-2 or GRACE 1-108) can have stress testing
24
Q
How long should patients with NSTEMI that are medically treated receive anticoagulation?
A
At least 48 hours, and it is generally continued until discharge
25
Name 2 prescription drugs that can cause coronary vasospasm?
5-FU, bromocriptine
26
What 2 post-MI complications present w/ abrupt pulmonary edema or hypotension and a loud holosystolic murmur and thrill? What is the management?
1. VSD (less severe pulmonary edema, step up in oxygen in right ventricle compared to right atrium)
Papillary muscle rupture (typically seen in inferior wall MI)
2. IABP, nitroprusside (afterload reduction), diuretics, surgery
27
What are the max doses of carvedilol and bisoprolol in HF?
Carvedilol 50 mg bid if weight >85 kg, otherwise 25 mg bid
| Bisoprolol 10 mg daily
28
What are the indications for ICD?
```
EF 35% or less with NYHA class II-III, or EF 30% or less with NYHA class I
40 days after MI, 90 days after CABG or PCI
```
29
What prophylaxis should some heart failure recipients take for the first 6 months?
CMV prophylaxis for those who received heart from CMV positive donor
30
What are the indications for surgery in infective endocarditis? Name 4.
Infection lasting >5-7 days while on appropriate abx; symptomatic HF; left sided involvement with Staph aureus, fungal infections, or highly resistant organisms; heart block, annular or aortic abscess, or destructive penetrating lesions; prosthetic valve infection; recurrent emboli; large vegetations (>10 mm) after 1 or more clinical or silent embolic events
31
What valve area and gradient are found in severe mitral stenosis? What is the next step in management if sx of mitral stenosis and echo findings do not correspond?
1. Valve area <1.5 cm^2, gradient >5-10 mmHg
| 2. Obtain stress echo b/c valve gradient may become elevated only with exercise
32
In what CV conditions is pregnancy contraindicated? Name 5.
Aortic stenosis, coarctation of aorta, EF <40% + NYHA class III or IV symptoms, hx of peripartum CM, unrepaired cyanotic heart disease, severe pulmonary HTN, Marfan syndrome w/ unrepaired aorta
33
When is C-section preferred? Name 3 conditions.
Severe decompensated CV disease, markedly dilated aorta, or in women receiving warfarin therapy
34
What drug should be given to those w/ peripartum cardiomyopathy with EF <35% besides GDMT?
Anti-coagulation with heparin or warfarin during late pregnancy and for at least 8 weeks post-partum
35
What are the indications for aortic repair in pregnant women w/ Marfan syndrome?
Aortic diameter >4.5 cm, or <4.5 cm + rapid dilatation of the aorta of personal/family history of aortic dissection
36
What medication is used to reduce the risk for doxorubicin cardiotoxicity?
Dexrazoxane
37
Which tyrosine kinase inhibitor is most frequently associated with cardiotoxicity?
Sunitinib -> HTN and HFrEF
38
What are contraindications to nitrates? Name 3.
HOCM, severe AS, or PDE-5 inhibitor use
39
What are the indications for thoracic endovascular aortic repair?
Descending aortic aneurysm diameter >6 cm, ascending aortic aneurysm >5 cm, rapid growth (>0.5 cm/year), or end organ damage
40
What are some drugs that can lead to pericardial effusion? Name 5.
Minoxidil
| Sulfa drugs, hydralazine, isoniazide, phenytoin, procainamide, methyldopa
41
What ABI is diagnostic of PAD? Resting ABI above what number indicates noncompressible, calcified arteries? What TBI is diagnostic of PAD? What decrease of postexercise ankle pressure or ABI is diagnostic of PAD?
1. 0.90 or less
2. >1.40
3. 0.70 or less, or great toe systolic pressure <40 mmHg
4. Decrease of ankle pressure >30 mmHg, or >20% decrease in ABI post-exercise
42
What are the preferred medications for thoracic aortic aneurysms?
Beta blockers
| Beta blockers + losartan in patients with Marfan syndrome
43
How often should U/S be repeated for TAA? What imaging is used to evaluate rapid expansion of TAA or aortic dimension >5.5 cm?
1. Yearly if <4.5 cm, every 6 months if >4.5 cm
| 2. CTA or MRA
44
When is surgery (over endovascular repair) indicated for TAA?
Involvement of major aortic vessels (renal arteries)
45
What is the diagnostic criteria for POTS? What are treatment options?
Increase in HR of 30 beats/min or more, or an increase of HR >120/min within 10 minutes of standing
Behavioral modification, compression stockings, exercise training, increased fluid intake, beta blockers, fludocortisone, SSRIs, midodrine, pyridostigmine
46
Which statins have the most drug-drug interactions?
Atorvastatin, lovastatin, simvastatin
47
Which drugs are class I anti-arrhythmics? What are contraindications for each group?
IA: Disopyramide, quinidine, procainamide
IB: Lidocaine, Mexiletine, Phenytoin
IC: Flecainide, Propafenone
2. Cannot use IA or IC in ischemic or structural disease, second or third degree AV block; cannot use IB in advanced liver disease
48
What is Brugada sign? What are the 3 types of Brugada sign/syndrome? What are the clinical criteria needed to make diagnosis of Brugada syndrome? Name 3. What is the management?
1. Coved ST segment elevation >2 mm in >1 of V1-V3 followed by a negative T wave
2. Type 1 is above; type 2 is >2 mm of saddleback shaped ST elevation; type 3 has type 1 or 2 morphology but with <2 mm of ST segment elevation
3. Above plus one of the following: documented VF or VT, fam hx of sudden cardiac death at age <45 y.o., coved type EKGs in fam members, syncope, nocturnal agonal respiration
4. ICD; quinidine can be considered
49
What group of patients with afib cannot receive DOACs?
Mechanical valve prosthesis, or moderate/severe mitral stenosis
50
What is the management for patients who undergo AV node ablation for afib?
Need a permanent pacemaker and still require anti-coagulation since they remain in afib
51
What medications can be used to manage PVCs?
Beta blockers, calcium channel blockers
| Class IC drugs (flecainide, propafenone), amiodarone (if structural heart disease)
52
What is idiopathic VT? What is the management?
VT in absence of structural heart disease; typically presents w/ palpitations in 3rd to 5th decades of life
Calcium channel blockers (esp verapamil) and beta blockers; can consider catheter ablation; ICD contraindicated b/c benign prognosis
53
What is needed for diagnosis of long QTc syndrome? What is the management?
QTc >500 ms on repeated EKGs + unexplained syncope or ventricular arrhythmia
Beta blockers are first line; if cardiac arrest or have recurrent events (syncope or VT) place ICD
54
What are EKG findings and clinical presentation of early repolarization syndrome?
Inferior and lateral early repolarization (J point elevation) more than 1 mm in patient with VF and/or cardiac arrest, particularly when provoked during exercise
55
How do you risk stratify asymptomatic patients w/ WPW? What is the management for patients w/ symptoms?
1. Exercise testing or procainamide challenge - low risk patients have intermittent loss of pre-excitation during faster HR w/ exercise or w/ procainamide challenge
2. Procainamide for narrow complex, Ibutilide for irregular and wide complex
56
What medication toxicity can present w/ 2:1 AV block, sinus bradycardia, ventricular tachycardia, anorexia, nausea, vomiting, abdominal pain, changes in color vision, scotomas, blindness? What is the management?
1. Digoxin
2. IV hydration; antibody fragments if life-threatening arrhythmias, end organ dysfunction due to hypoperfusion, hyperkalemia (K 5.5)
57
What is the management for a patient with afib and stable coronary artery disease?
Anti-coagulation alone - does not need anti-platelet if PCI >12 months ago
58
Which murmur is diastolic, decrescendo, and in LLSB? Which murmur is diastolic, decrescendo, heard best at apex in left lateral decubitus position, has loud S1, and opening snap after S2?
1. Aortic regurgitation
| 2. Mitral stenosis
59
Which murmur is systolic (holo, mid, or late), heard in the apex, and increases w/ handgrip? Which murmur is holosystolic, in LLSB, and increases during inspiration? Which murmur is diastolic, decrescendo, low pitched in LLSB and increases intensity during inspiration?
1. Mitral regurgitation
2. Tricuspid regurgitation
3. Tricuspid stenosis
60
Which murmur is systolic, crescendo-decrescendo, in the LUSB, and has an ejection click after S1? Which murmur is diastolic, decrescendo, and is in LLSB? Which murmur is holosystolic, in LLSB, and increases with handgrip?
1. Pulmonary valve stenosis
2. Pulmonary regurgitation
3. VSD
61
How often should TTE be repeated in mild, moderate, and severe AS?
3-5 years for mild, 1-2 years for moderate, 6-12 months for severe
62
What are 3 physical exam findings of severe aortic stenosis? What are the indications for replacement?
1. Late peaking systolic murmur, diminished or absent aortic component of S2, and delay in carotid upstroke (pulsus tardus)
2. Presence of sx, EF <50%, or concomitant cardiac surgical procedure for another indication
63
What are the criteria (vena contracta, regurg volume, orifice area) for severe AR?
VC >0.6 cm
Regurgitation volume >60 mL
Regurgitant orifice area >0.3 cm^2
64
What anti-hypertensives are preferred for patients with AR and HTN?
DHP calcium channel blockers, ACEis, or ARBs
65
What are the criteria for dilated ascending aorta repair in patients with bicuspid aortic valve?
1. Aortic diameter >4.5 cm already undergoing surgery or in those w/ Marfan or Ehlers-Danlos
>5 cm in those w/ bicuspid aortic valve if they also have risk factors for dissection (fam hx, progression >0.5 cm per year), otherwise 5.5 cm in these patients
66
When is PBMC (percutaneous ballon mitral commissurotomy) vs. surgery performed for severe MS?
```
PBMC if sx + favorable valve morphology, or no sx + valve area <1
Surgery if severely calcified valve, moderate to severe MR, LA thrombus, NYHA class III or IV, and/or non-pliable valve
```
67
What are the criteria (vena contracta, regurg volume, orifice area) for severe MR?
VC >0.7 cm
Regurgitant volume >60 cc
Regurgitant orifice area >0.4 cm^2
68
What is the goal INR for patients w/ mechanical aortic valve prosthesis?
INR 2.5 for those w/o risk factors for thromboembolism
INR 3.0 if risk factors for thromboembolism (hx of clot, hypercoaguable disorder, LV dysfunction, afib), ball in cage prosthesis, or any mitral prosthesis
Also need ASA 81 mg
69
How long does a patient with mitral or aortic bioprosthesis need anti-coagulation and what is the goal INR?
3-6 months after implantation
| Goal INR 2.5
70
What are the Duke criteria?
Major: positive blood cx OR evidence of endocardial involvement (mass, abscess, new partial dehiscence of prosthetic valve, new valve regurgitation) OR single positive blood cx for Coxiella or IgG titer >1:800
Minor: fever (>100.4), predisposing condition, positive blood cx not meeting major criterion, vascular phenomena (emboli, infarcts, janeway lesions, conjunctival hemorrhages), immunologic phenomena (GN, osler nodes, roth spots, RF)
71
What are the criteria for endocarditis prophylaxis? Name 4.
1. Hx of endocarditis
2. Cardiac transplant w/ valve regurgitation due to structurally abnormal valve
3. Prosthetic valve or prosthetic material used for valve repair
4. CHD including unrepaired cyanotic disease, repaired lesion w/ residual deficits, or disease repaired w/ prosthetic material within past 6 months
72
What are the indications for ICD placement in patients w/ HOCM? Name 4. What are the 2 indications for septal myectomy or ablation?
1. Sudden death in first degree relative, max LV wall thickness >30 mm, recent unexplained syncope, NSVT >3 beats, sustained VT or resuscitated sudden death event, failure to increase BP by at least 20 mmHg during exercise
2. LVOT gradient >50 mmHg, or recurrent syncope not related to arrhythmia
73
What 3 beta blockers are vasodilating and should be avoided in HOCM?
Carvedilol, labetalol, nebivolol
74
What 3 cancers have the highest metastatic potential to the heart? What is the most common benign cardiac tumor? Most common malignant cardiac tumor?
1. Melanoma, malignant thymoma, germ cell tumor
2. Atrial myxoma - usually in left atrium
3. Angiosarcoma - usually in right atrium and associated w/ pericardial effusion
75
What are the guidelines for screening and genetic testing in HOCM?
Genetic counseling/testing for first degree fam members if mutation is found
In absence of genetic mutation do TTE and ECG screening for first degree fam members
76
What are some medications that can lead to chronic MR? Name 3.
Bromocriptine, Ergotamine, Cabergoline, Pergolide
77
For how long should patients w/ hx of RF and rheumatic heart disease receive penicillin prophylaxis?
At least 10 years after last episode of rheumatic fever, or until age 40 years old whichever is longer
78
Which patients w/ mechanical heart valves need heparin bridge before surgery when warfarin is held? Name 4 criteria.
Mitral prostheses, multiple prosthetic valves, atrial fibrillation, previous embolism
79
What are the 3 indications for ASD closure? When is closure contraindicated? Which type of ASD can undergo percutaneous vs. surgical closure?
1. Symptoms, evidence of left to right shunt w/ pulmonary flow to systemic flow ratio >1.5, volume overload of R-sided cardiac chambers
2. Contraindicated in right to left shunt
3. Percutaneous closure for ostium secundum, surgical for ostium primum
80
What are some indications for VSD closure? Name 3. When should it not be attempted?
1. Progressive regurgitation of aortic or tricuspid valves, pulmonary:systemic flow ratio >2, progressive LV volume overload, recurrent endocarditis
2. Contraindicated in pulmonary HTN or right-to-left shunt, instead treat w/ pulmonary vasodilators
81
Of the fascicular blocks which has upright QRS in lead I and negative QRS in aVF? Which has negative QRS in lead I and positive QRS in aVF?
1. Left anterior
| 2. Left posterior
82
What are 4 conditions that lead to abnormal S2 splitting (split during inspiration & expiration)?
RBBB, pulmonary valve stenosis, VSD w/ left-to-right shunt, ASD w/ left-to-right shunt
*Conditions that further delay RV ejection
83
What is the definition of atrial tachycardia and what is seen on EKG?
Atrial rate >100 bpm
Does not originate in sinus node
P waves inverted in leads II, III, and aVF
84
What disorder presents w/ cyanosis and dyspnea in the upright position as a result of right-to-left shunting across a PFO?
Platypnea-orthodeoxia syndrome
85
What is the management of a large PDA w/ severe pulmonary HTN and shunt reversal?
Observation
| Can consider medical therapy for pulmonary HTN
86
What are the indications for pulmonary balloon valvuloplasty for pulmonary stenosis? Surgical repair?
1. Asymptomatic patients w/ peak doppler gradient >60 mmHg or mean gradient >40 mmHg + valve regurgitation less than moderate; symptomatic patients w/ peak gradient >50 mmHg or mean gradient >30 mmHg
2. Small annulus, more than moderate valve regurgitation, severe subvalvar or supravalvar PS, or another cardiac lesion requiring intervention
87
What are the indications for aortic coarctation repair?
Systolic peak pressure gradient >20 mmHg or radiologic evidence of severe coarctation w/ collateral flow
88
What are contraindications to TAVR? Name 3.
Mitral valve disease, significant AR, and bicuspid aortic valve
89
What is the medical management for acute aortic regurgitation?
IV sodium nitroprusside +/- diuretics and dobutamine until can go for surgery
90
What are the EKG findings in ostium primum ASD vs. secundum ASD? Which one is associated w/ MR?
Ostium primum: LAD, first degree AV block; associated w/ cleft in mitral or tricuspid valve so can have regurgitation
Ostium secundum: RAD, first degree AV block, incomplete RBBB
91
What are the criteria for severe MS?
| How often should TTE be repeated in mild/moderate MS vs. severe MS?
1. Mitral valve area <1.5 cm^2, diastolic pressure half time >150 ms, PASP >30 mmHg
2. Mild/moderate MS every 3-5 years; Severe MS every 1-2 years if mitral valve area 1-1.5, every year if MVA <1
92
What is the treatment for uncomplicated right sided native valve endocarditis caused by MSSA? What is the treatment for prosthetic valve IE? What is the treatment for community acquired native valve IE?
1. 2 weeks of nafcillin, oxacillin, or flucloxacillin
2. Vancomycin, gentamicin, rifampin
3. Vancomyin or Unasyn plus gentamicin
93
What are 3 lab findings associated with cholesterol or aortic atheroemboli? How is this diagnosed?
Thrombocytopenia, eosinophilia, urinary eosinophils
| Biopsy of muscle, skin, kidney, or other organs confirms diagnosis
94
What murmur presents w/ midsystolic murmur at 2nd left intercostal space and a diastolic flow rumble at the left sternal border?
Atrial septal defect
| *left-to-right shunt causes pulmonary midsystolic flow murmur, and tricuspid diastolic flow rumble due to increased flow
95
What are the 7 criteria in the TIMI score?
(AMERICA) - age >65, markers - positive troponin, EKG - ST changes > 0.5 mm, risk factors - >3 (HTN, HLD, DM, fam hx, current smoker), ischemia (2 or more anginal episodes in past 24 hours), CAD - known sx, ASA use in past 7 days
96
When is TEE recommended over TTE? Name 3 instances.
Intermediate or high suspicion for endocarditis when TTE is not diagnostic, when intracardiac device leads are present, or complications such as abscess have developed or are suspected (conduction abnormalities or persistent bacteremia)
97
What is the management for exercise chronotropic incompetence (inability to achieve 85% of age-predicted maximum HR)?
Pacemaker placement
98
Patients with unrepaired PDA are at increased risk for what?
Infective endocarditis
99
What are the preferred antiarrhythmics for afib in patients w/o CAD or structural heart dz? LVH? CAD w/o heart failure? Heart failure?
1. Flecainide, Propafenone
2. Amiodarone, Dronedarone
3. Sotalol, Dronaderone
4. Amiodarone, Dofetilide
100
What are the differences between type 1 & 2 amiodarone-induced thyrotoxicosis?
Type 1: in patients w/ pre-existing goiter/thyroid disease, low but detectable uptake on radioiodine scan, increased vascularity on thyroid U/S, tx w/ methimazole
Type 2: in patients w/o thyroid disease, very low uptake on radioiodine scan, decreased vascularity on U/S, treat w/ steroids and continue amiodarone
101
What are absolute contraindications to fibrinolytic therapy after STEMI? Name 5.
Any prior ICH, ischemic stroke in past 3 months, significant closed head or facial trauma within 3 months, active bleeding or bleeding diathesis, suspected aortic dissection, known malignant intracranial neoplasm, known structural cerebral vascular lesion (AVM)
102
What are some findings in HOCM that are not found in athlete's heart?
Prominent Q waves, inverted T waves, LVH criteria, enlarged left atria, asymmetric LV wall thickness and >15 mm, abnormal LV diastolic function, family history
103
Left atrial appendage occlusion can be used for stroke prevention in patients w/ afib that can't tolerate oral anti-coagulation. For how long after the procedure do they need anti-coagulation?
45 days
104
Which murmur is best heard with patient sitting up, leaning forward, and holding their breath in full expiration? Which two murmurs are best heard in the lateral decubitus position?
1. Aortic regurgitation
| 2. Mitral stenosis and 3rd heart sound
105
What are the differences between constrictive pericarditis and restrictive CM in regards to BNP level, presence of pulm HTN, presence of delayed enhancement of myocardium on MRI, concordance of systolic pressures with respiration?
Constrictive: BNP <100, no pulm HTN, RV systolic pressure rises during inspiration while there is a decrease in LV systolic pressure (enhanced ventricular interdependence)
Restrictive CM: BNP >100, severe pulm HTN present, delayed enhancement of myocardium on MRI, concordant rise and fall of systolic pressures w/ respiration
106
What are the first line anti-hypertensives for acute aortic dissection? What is the second line agent to add on?
1. IV beta blockers
| 2. Nitroprusside
107
What medication might be given for 3 months after anterior STEMI to prevent a common complication?
Warfarin - to prevent LV apical thrombus
108
What are the recommendations for screening for heart disease after chest radiation?
Start stress echo at 5-10 years after completion of therapy, or at age 30 whichever comes first
109
Should suprarenal and juxtarenal abdominal aortic aneurysms be repaired by open surgery or endovascularly?
Open surgery
110
What is the minimum duration for dual antiplatelet therapy in a patient w/ stable angina who received a bare mental stent? Drug-eluting stent with stable angina? ACS?
1. 1 month
2. 6 months
2. 12 months
111
What class of BP agents are most effective in patients taking NSAIDs?
Calcium channel blockers
112
What are the following (low vs. high) in hypovolemic, cardiogenic, and septic shock? RA pressure (normal ~4), PCWP (normal ~8), cardiac index (normal 2.8-4.2), SVR (normal ~1150), MvO2 (normal 60-80%)?
Hypovolemic: low RA pressure, low PCWP, slightly low cardiac index, high SVR, low MvO2
Cardiogenic: high RA pressure, high PCWP, very low cardiac index, high SVR, low MvO2
Septic: normal or low RA pressure, normal or low PCWP, high cardiac index, low SVR, high MvO2
113
What are 3 normal heart sounds in pregnancy?
Increased P2, S3, and an early peaking systolic murmur over upper left sternal border
