Pgs 1 - 24

Question 1

Typical Angina includes:

Answer 1

Substernal chest pain with exertion and relief with rest or nitroglycerin

Question 2

Atypical Symptoms:

Answer 2

Exertional dyspnea, fatigue, nausea and vomiting

Question 3

Signs of cardiac ischemia include:

Answer 3

New MR murmur and S3 and S4 gallops

Question 4

ST-elevation equivalents

Answer 4

New LBBB or Posterior MI (tall R waves and ST depressions in V1 - V3

Question 5

In patients with unstable angina/NSTEMI, immediate angiography is indicated if any of the following are present:

Answer 5

Hemodynamic instabillity
Heart Failure
Recurrent rest angina despite therapy
New or worsening MR murmur
Sustained VT

Question 6

TIMI Risk score 0 - 2

Answer 6

Low Risk

Question 7

TIMI Risk Score 3 - 7

Answer 7

Intermediate to high risk

Question 8

TIMI low risk management

Answer 8

Begin Aspirin, B-blocker, nitrates, heparin, statin, clopidogrel.

Predischarge stress test and angiography if testing reveals significant myocardial ischemia

Question 9

TIMI intermediate to high risk management

Answer 9

Begin Aspirin, B-blocker, nitrates, heparin, statin, clopidogrel, and early angiography

Question 10

Cardiac catheterization is indicated for patients with the following post-MI stress test results:

Answer 10

Exercise-induced ST-segment depression or elevation

Inability to achieve 5 METs during testing

Inability to increase SBP by 10 - 30 mm Hg

Inability to exercise (arthritis)

Question 11

Other causes of ST-segment elevation:

Answer 11

Acute pericarditis
LV aneurysm
Takotsubo (stress) cardiomyopathy
Coronary vasospasm (prinzmetal angina)
Acute Stroke
Normal variant

Question 12

Relative contraindication to thrombolytic agents?

Answer 12

BP > 180/110 mm Hg on presentation

Question 13

CABG is indicated acutely for STEMI in the presence of?

Answer 13

Thrombolytic PCI failure or mechanical complications (papillary muscle rupture, VSD, free wall rupture).

Question 14

Patients with right ventricular/posterior infarction may present with?

Answer 14

Hypotension or may develop hypotension following administration of nitroglycerin or morphine.

Question 15

Signs and symptoms of right ventricular/posterior infarction?

Answer 15

JVD with clear lungs, hypotension, tachycardia

Question 16

Most predictive ECG finding in right ventricular/posterior infarction?

Answer 16

St-segment elevation on right-sided ECG lead V4R

Question 17

Initial management of patients with right ventricular/posterior infarction?

Answer 17

IV fluids

Question 18

Patients with papillary muscle rupture and VSD should be stabilized with an?

Answer 18

Intra-aortic balloon pump, afterload reduction with sodium nitroprusside, and diuretics followed by emergency surgical intervention.

Question 19

ICDs are also indicated in post-MI patients meeting all of the following criteria:

Answer 19

> 40 days since MI

LVEF < or = to 35% and NYHA functional class II or III or LVEF < or = to 30% and NYHA functional class I

> 3 months since PCI or CABG

Question 20

ACEI or ARB is indicated post MI at time of discharge in patients with?

Answer 20

LV systolic dysfunction, hypertension, diabetes, or kidney disease

Question 21

Stable angina pectoris is defined as

Answer 21

Stable anginal symptoms of at least 2 months duration precipitated by exertion or stress and relieved by rest

Question 22

In patients with chronic stable angina, stress testing is most useful in patients with?

Answer 22

An intermediate pretest probability of CAD (>10% or <90%)

Question 23

Pretest probability is based on?

Answer 23

Patients age, sex, and symptoms; risk factors for CAD; and ECG findings

Question 24

Indications for Exercise ECG with myocardial perfusion imaging or exercise ECHO?

Answer 24

Patients who can Exercise
Pre-excitation (WPW) Pattern
> 1 mm ST depression
Previous CABG or PCI
LBBB
LV hypertrophy
Digoxin use

Question 25

Select coronary angiography for patients with high pretest probability of disease or:

Answer 25

LV dysfunction Class III or IV angina despite therapy Highly positive stress or imaging test High pretest probability of left main or three-vessel CAD (a Duke treadmill score < or = to - 11) Uncertain diagnosis after noninvasive testing History of surviving sudden cardiac death Suspected coronary spasm

Question 26

CCB use in patients with chronic stable angina

Answer 26

Are first line therapy for patients with absolute contraindications to B-blockers. In the setting of continued angina despite optimal doses of B-blockers and nitrates, CCBs can be added. Avoid short acting CCB

Question 27

Are Nitrates as effective as CCBs and BBs in reducing Angina?

Answer 27

Yes

Question 28

Prevent nitrate tachyphylaxis by:

Answer 28

Establishing a nitrate-free period of 8 - 12 hrs per day (typically overnight), during which nitrates are not used.

Question 29

When should Ranolazine be considered in patients with chronic stable angina?

Answer 29

Patients who remain symptomatic despite optimal doses of BB, CCB, and nitrates

Question 30

ACEI is a cardioprotective drug that:

Answer 30

reduces cardiovascular and all-cause mortality in patients with diabetes, hypertension, CKD, LVEF < or = to 40%, HF, or a history of MI.

Question 31

NHYA Class I

Answer 31

Structural disease but no symptoms

Question 32

NYHA Class II

Answer 32

Symptomatic; slight limitation of physical activity

Question 33

NYHA Class III

Answer 33

Symptomatic; marked limitation of physical activity

Question 34

NYHA Class IV

Answer 34

Inability to perfom any physical activity without symptoms

Question 35

Summarize the BNP level

Answer 35

BNP > 400 is compatible with HF BNP < 100 effectively excludes HF as a cause of acute dyspnea

Question 36

Endomyocardial biopsy in testing for HF is rarely indicated but can assist in the diagnosis of

Answer 36

Giant cell myocarditis, amyloidosis, Hemochromatosis

Question 37

What may falsely elevate the BNP?

Answer 37

Kidney failure, older age, female sex

Question 38

What reduces the BNP?

Answer 38

Obesity

Question 39

When is Hydralazine plus nitrates used in treatment of HFrEF?

Answer 39

Given in addition to standard therapy for NYHA class III-IV and EF < 40% in black and select nonblack patients (low output syndrome, hypertension) to reduce mortality. For patients who cannot tolerate ACEI or ARBS

Question 40

When are aldosterone antagonists used in treatment of HFrEF?

Answer 40

NYHA class III - IV HF to reduce mortality

Question 41

When is digitalis used in treatment of HFrEF?

Answer 41

Predominantly in patients who continue to experience symptoms despite guideline-directed medical therapy

Question 42

When is Ivabradine used in treatment of HFrEF?

Answer 42

EF < or = to 35% who are in sinus rhythme with a HR > or = to 70/min

Question 43

When is Valsartan-sacubitril used in treatment of HFrEF?

Answer 43

Substitute for an ACEI or ARB in HFrEF (NYHA class II or III) in patients who have tolerated ACEI or ARB therapy

Question 44

When is ICD placement used in treatment of HFrEF?

Answer 44

For ischemic and nonischemic cardiomyopathy in patients with and EF < 35% and NYHA functional class II - III or with an EF < 30% and NYHA functional class I For NYHA class II - III symptoms

Question 45

Cardiac resynchronization therapy used in treatment of HFrEF?

Answer 45

For NYHA class II - IV, LVEF < 35%, and LBBB with QRS duration > 150 ms

Question 46

Dilated cardiomyopathy is characterized by?

Answer 46

Dilation and reduced function of one or both ventricles manifesting as HF, arrhythmias and sudden death.

Question 47

Most common cause of dilated cardiomyopathy?

Answer 47

Idiopathic dilated cardiomyopathy (50%)

Question 48

Treatment for dilated cardiomyopathy?

Answer 48

Reversal of the underlying cause (alcohol, drug, tachycardia-mediated cardiomyopathies) Standard medical therapy for HF