mksap related questions Flashcards
(56 cards)
What are the indications for CABG
Left main disease + severe 3-vessel disease w/reduced EF, severe 3-vessel disease with reduced LV systolic function, severe 3 vessel disease with proximal LAD involvement. Also patients w/DM + multivessel disease may benefit
What is an option for patients with refractory angina, severe disease and poor op candidate
EECP- enhanced external counterpulsation
What are indications for valvuloplasty in mitral valve stenosis
indications of severe MS with symptoms present. Severe MS- transmitral pressure gradients over 10mmg Hg, LA enlargement, mitral valve area less than 1.5, pulmonary pressures over 50. excellent outcomes with >80% at 10 years. once symptoms present survival is less than 15% in 10 yrs
valvuloplasty vs surgical intervention in MS
perc valvuloplasty is less invasive, no anticoagulation. surgical- lifelong anticoagulation. If mod to severe MR present, cant perform valvuloplasty. also must rule out LA thrombus first
holosystolic murmur at apex radiation to axilla
mitral regurge
low pitched middiastolic murmur following opening snap accentuates presystole
Mitral stenosis
peripartum cardiomyopathy timing and risk factors
EF <45% 3 months prior or 6 months after pregnancy. risk factors- age over 30, African American, gestational hypertension. 10% mortality. if ef under 35% rec anticoagulation
faint distal LE pulses, hypertension, rib notching
coarctation of the aorta
indications for biventricular pacemaker
qrs over 120, EF 35%, NYHA III- helps with mechanical resynchronization vs jus defibrillator (fatigue, exercise tolerance, dyspnea all worse)
prominent a wave in JVP, parasternal impulse, ejection click, systolic thrill, early systolic murmur INCREASING with inspiration
pulm valve stenosis
exertional syncope, late peaking systolic murmur at 2nd RIC
sustained apical impulse
no split S2
radiation to carotids
aortic valve stenosis
Fixed split S2, equal a and v waves of JV, RV impulse, ejection clic
asd
holosystolic murmur at left sternal border
increases with inspiration
RVH/ RA deviation
prominent v wave
TR
increasing intensity with moving from squat to stand and decreases with valsalva
MR
midsystolic murmur at LLSB increasing with valsalva
decreases with hand-grip
S3 gallop
HCOM
symptoms/signs of biventricular heart failure
TTE with diastolic dysfunction, septal hypertrophy, outflow tract obstruction
HCOM
treatment for HCOM
maximize negative ionotropes
surgical septal myectomy if NYHA III or IV symptoms and refractory to medical management
treatment of unstable angina
coronary angiography
calculate TIMI risk score to assess short-term risk- uses 4 historical and 3 presentation characteristics - age, troponin, ST deviation, recent h/o angina, recent h/o asa, + traditional cardiac risk factors: family hx, DM, htn- high number = high risk of fatal MI over the next 14 days
post cardiac transplant patient with atypical symptoms-
new onset heart failure, decreased exercise tolerance, syncope, cardiac arrest
transplant vasculopathy or CAD- present in ~ 1/2 patients within 5 yrs post-transplant
- usually atypical or asymptomatic –> routine Coronary angiography
atypical symptoms or asymptomatic findings 1 -2 years post cardiac transplant
cardiac transplant rejection
not seen ~10 yrs post- more likely transplant vasculopathy at that point
B cell lymphoma and symptoms c/w abdominal or central nervous system mass, nonspecific flu-like illness
posttransplant lymphoproliferative disease
treat by decreasing immunosuppression
side effects of cyclosporin
hypertension, nephrotoxicity, hypertriglycerides, hirsutism, gingival hyperplasia, tremor
primary prevention indication for ICD
NYHA class II or III + ischemic or non-I cardiomyopathy, EF 35% or less SCDHeFT trial - 23% reduction in risk of death over 5 years compared to amio or placebo
for worsening symptoms of NYHA III or IV despite ACEI and BB, can add
spironolactone –> further 35% reduction in mortality
