Term
| what are the current global trends of cardiovascular disease morbidity and mortality |
|
Definition
| decreasing in the high income countries and increasing significantly in the low-medium ones |
|
|
Term
| in the New York Heart Association Functional Classification, what is the difference btwn NYHA class 3 and 4? |
|
Definition
|
|
Term
| what are the 2 parameters in the New York Heart Association Functional Classification |
|
Definition
|
|
Term
| 4 situations where a heart murmur would call for echo follow up |
|
Definition
1. all diastolic or continuous murmurs
of the systolic murmur:
2. grade 3 and up especially holo or late systolic
3. abnormal ECG or CXR
4. abnormal physical findings indicating cardiac disease |
|
|
Term
| what % of patients with SA node dysfunction develop supraventricular tachycardia (usually atrial fib and flutter) |
|
Definition
|
|
Term
| 6 condition which predispose to persistent atrial fibrillation in SA node |
|
Definition
| advanced age, hypertension, diabetes mellitus, left ventricular dilation, valvular heart disease, and ventricular pacing |
|
|
Term
| when should patients with tachycardia-bradycardia variant of SSS (SA node dysfunction) be anticoagulated |
|
Definition
| age>65, history of stroke, valvular heart disease, left ventricular dysfunction, or atrial enlargement |
|
|
Term
| what are the mortality rates with SA node dysfunction |
|
Definition
| not increased in comparison to the general population |
|
|
Term
| SA node dysfunction occurs MC with which type of MI? |
|
Definition
|
|
Term
| what disorders of potassium and magnesium may cause AV block? |
|
Definition
| hyperkalemia and hypermagnesemia |
|
|
Term
| 6 drugs that can cause AV block |
|
Definition
Beta blockers
Adenosine
Calcium channel blockers Antiarrhythmics (class I and III)
Digitalis
Lithium |
|
|
Term
| 6 drugs that cause both AV block and SA node dysfunction |
|
Definition
| Pentamidine (Abx pcp/trypanosoma) Narcotics Phenothiazines (antihistamines and neuroleptics) Amitiriptyline Cimetidine clonidine |
|
|
Term
| how do you perform temporary pacing for less than a few minutes? and for several days? |
|
Definition
transcutaneous pacing
transvenous temporary pacing - jugular or subclavian |
|
|
Term
| what is the indication of temporary pacing in patients with AV block |
|
Definition
| elimination of drugs as possible cause and institution of other drugs to solve problem - take some time to go into effect - meantime use temporary pacing |
|
|
Term
| according to the American heart association what are class 1 indications? |
|
Definition
| consensus of opinions that therapy is useful and effective |
|
|
Term
| according to the American heart association what are class 2a indications? |
|
Definition
| conflict - favoring treatment |
|
|
Term
| according to the American heart association what are class 2b indications? |
|
Definition
|
|
Term
| according to the American heart association what are class 3 indications? |
|
Definition
| conflict - discouraging treatment |
|
|
Term
| 2 class I indications for pacemaking in SA node dysfunction |
|
Definition
symptoms - tempral correlation btwn symptoms and dysfunction
sinus pause > 5 sec |
|
|
Term
| 2 class IIa indications for pacemaking in SA node dysfunction |
|
Definition
1. patient experiences syncope and later is found to have SA node dysfunction during which he has no symptoms
2. with heart rates <40 beats/min without a clear and consistent relationship between bradycardia and symptoms |
|
|
Term
| Class IIb indication for pacing in SA node dysfunction |
|
Definition
| Mildly symptomatic patients with waking chronic heart rates <40 beats/min |
|
|
Term
| what is the preferred method of pacing in SA node dysfunction |
|
Definition
| dual chamber (except in carotid sinus hypersensitivity) and AV synchronous pacing d/t reduced rates of atrial fib and increased quality of life. no affect on mortality |
|
|
Term
| what is the preferred method of pacing in carotid sinus hypersensitivity associated SA node dysfunction |
|
Definition
|
|
Term
| 5 CLASS I indications for permanent pacemaker placement in type 2 2nd and 3rd degree AV block |
|
Definition
1. in ECG - Periods of asystole >3 s or any escape rate <40 beats/min while awake or wide QRS
2. Postoperative AV block not expected to resolve
3. Catheter ablation of the AV junction
4. neuromuscular disease
5. Atrial fibrillation with bradycardia and pauses >5s |
|
|
Term
| 2 CLASS I indications for permanent pacemaker placement in any 2nd and 3rd degree AV block |
|
Definition
symptomatic bradycardia
exercised induced |
|
|
Term
| 4 CLASS IIa indications for permanent pacemaker placement? |
|
Definition
| First- or second-degree AV block with symptoms similar to pacemaker syndrome |
|
|
Term
| 2 CLASS IIb indications for permanent pacemaker placement? |
|
Definition
1. Marked first-degree AV block (PR interval >300 ms) in patients with LV dysfunction in whom shortening the AV delay would improve hemodynamics
2. Neuromuscular diseases with any degree of AV block |
|
|
Term
| 3. contraindications (Class 3 indications) to pacemaker placement d/t AV block |
|
Definition
1. Asymptomatic first-degree AV block
2. Asymptomatic type I second-degree AV block at the AV node level
3. AV block that is expected to resolve or is unlikely to recur (Lyme disease, drug toxicity) |
|
|
Term
| when should you not/contraindications/Class III indications for permanent pacemaker placement in SA node dysfunction |
|
Definition
1. asymptomatic patients, even those with heart rates <40 beats/min
2. SA node dysfunction in which symptoms are not associated with bradycardia
3. SA node dysfunction with symptomatic bradycardia due to nonessential drug therapy |
|
|
Term
| 4 Class I indications for Pacemaker Implantation in AV Conduction Block after the acute phase of Myocardial Infarction |
|
Definition
1. 2nd and 3rd degree permanent AV block and symptomatic
2. type 2 second degree permanent AV block within the his-purkinje with alternating Bundle Branch Block
3. type 3 permanent AV block within or below the his-purkinje
4. type 2 second and third degree temporary infarnodal AV block with bundle branch block |
|
|
Term
| Class IIb indication for Pacemaker Implantation in AV Conduction Block after the acute phase of Myocardial Infarction |
|
Definition
| 1. Persistent second- or third-degree AV block at the AV node level |
|
|
Term
| 3 Class I indications for permanent pacemaker implantation in bifascicular and trifascicular block |
|
Definition
1. Intermittent third-degree AV block
2. Type II second-degree AV block
3. Alternating bundle branch block |
|
|
Term
| 3 Class IIa indications for permanent pacemaker implantation in bifascicular and trifascicular block |
|
Definition
1. Syncope not demonstrated to be due to AV block when other likely causes (e.g., ventricular tachycardia) have been excluded
2. Incidental finding at electrophysiologic study of a markedly prolonged HV interval (>100 ms) in asymptomatic patients
3. Incidental finding at electrophysiologic study of pacing-induced infra-His block that is not physiologic |
|
|
Term
| Class IIb indication for permanent pacemaker implantation in bifascicular and trifascicular block |
|
Definition
| Neuromuscular diseases with any degree of fascicular block regardless of the presence of symptoms, because there may be unpredictable progression of AV conduction disease |
|
|
Term
| what is the MC arrhythmia? |
|
Definition
|
|
Term
| what is the indication for immediately terminating the AF? preffered method? success rates? |
|
Definition
| patient who is hemodynamically unstable. electrical cardioversion. >90% success rates |
|
|
Term
| in a patient presenting with AF and who is hemodynamically stable, 2 issues that need to be addressed |
|
Definition
1. acute rate control
2. anticoagulation |
|
|
Term
| 2 parameters in the decision to provide anticoagulation in a patient presenting with AF and needing acute rate control |
|
Definition
1. time - has the AF persisted for more than 12 hrs
2. are there risk factors for stroke (8) |
|
|
Term
| 8 risk factors for stroke in determining need for anticoagulation in AF |
|
Definition
History of stroke or transient ischemic attack
Mitral stenosis
Hypertension
Diabetes mellitus
Age >65 years
Congestive heart failure
Left ventricular dysfunction
Marked left atrial enlargement (>5.0 cm) |
|
|
Term
| 3 things that must be given attention initially in a patient presenting with atrial fibrillation |
|
Definition
Reversible causes of atrial fibrillation must be ruled out
• The true time of onset of the atrial fibrillation and the frequency of the episodes should be ascertained, if possible
• A careful estimation of the patient’s symptom burden should be made. |
|
|
Term
| 4 possible reversible causes of atrial fibrillation |
|
Definition
1. alcohol
2. hyperthyroidism
3. valvular dysfunction
4. obstructive sleep apnea |
|
|
Term
| in the acute setting of performing rate control to a patient with atrial fibrillation, what are the considerations for either a CCB or a beta-blocker/ |
|
Definition
| CCBs are relatively contraindicated in patients with heart failure, while beta-blockers can exacerbatere active airway disease |
|
|
Term
| when can cardioversion be preformed without prior anticoagulation in newly diagnosed atrial fibrillation |
|
Definition
| within 48 hours of the onset of atrial fibrillation, if the time of onset is clear |
|
|
Term
| If the time of onset of AF is unclear or if more than 48 hours have passed, there are two general strategies for proceeding to electrical cardioversion |
|
Definition
1. TEE + start anticoagulation at the same time. if no thrombus in left atrium - proceed to electrical cardioversion
2. start anticoagulation and maintain INR of 2-3 for 3 wks, after which cardioversion can be performed |
|
|
Term
| no matter the strategy chosen to perform cardioversion in the patient presenting acutely with atrial fibrillation, what should be the management afterwards |
|
Definition
| 1 months of anticoagulation |
|
|
Term
| considerations for choosing rhythm or rate control in the newly diagnosed patient with AF |
|
Definition
rate control - patients whose history
suggests a single episode, or episodes that previously self-terminated
rhythm control - frequent episodes or history suggesting ongoing AF for a long period |
|
|
Term
| 2 first line drugs in the rhythm control of a patient with newly diagnosed AF. 2 contraindications for their use |
|
Definition
Propafenone (Rythmol) and flecainide
(Tambocor)
CIs: CAD and significant structural heart disease |
|
|
Term
| 2 drug options in the rhythm control of a patient with newly diagnosed AF and CHD. CI and precautions |
|
Definition
| Sotalol (Betapace) and dofetilide (Tikosyn). sotalol is CIed in patients with CHF, and dofetilide carries a long list of drug interactions. Both must be used with extreme caution in patients with renal insufficiency, and hospital admission is required for initiation or upward titration of the dose |
|
|
Term
| which patients should avoid amiodarone for rhythm control of a patient with newly diagnosed AF? |
|
Definition
| younger patients because toxicity of amiodarone increases with the cumulative dose |
|
|
Term
| what is the pill-in-the-pocket strategy of performing rhythm control to newly diagnosed AF patients |
|
Definition
| patients are instructed to take their medication only when they have a bout of AF |
|
|
Term
| on which circumstances is it reasonable to recommend the pill in the pocket strategy of rhythm control of newly diagnosed AF? |
|
Definition
| patients with infrequent symptomatic recurrences of paroxysmal AF |
|
|
Term
| 2 agents used for the pill in the pocket approach to rhythm control. considerations? |
|
Definition
| Flecainide and propafenone are the agents of choice for this approach because of their safety profile and efficacy in chemical cardioversion |
|
|
Term
| which patients may start the pill in the pocket approach to rhythm control in the outpatient clinic and which should be admitted for observation during initiation of therapy? and why |
|
Definition
outpatient - lone paroxysmal episode
admission - structural heart disease or conduction abnormalities.
to observe for excessive PR prolongation or arrhythmias |
|
|
Term
| what about anticoagulation in the setting of the pill in the pocket approach to rhythm control? |
|
Definition
| no need. patients supposed to return to sinus rhythm in a few hrs and are expected to report to the ER if they don't to perform cardioversion within 48 hours |
|
|
Term
| what is a new option for rhythm control? how does it work? CIs |
|
Definition
Dronedarone (Multaq). works like amiodarone only w/o the side effects because it lacks iodine
CIed in patients with severe or newly decompensated CHF. may cause hepatic toxicity |
|
|
Term
| considerations for choosing rate (1) or rhythm control (2) in the long term |
|
Definition
rate control - asymptomatic patient
rhythm control - rate control cannot be achieved or symptomatic despite adequate control of the heart rate |
|
|
Term
| what % of patients go back to fibrillation after successful rhythm control management |
|
Definition
|
|
Term
| under which circumstances are patients with AF recommended for chronic long term anticoagulation |
|
Definition
| persistent or frequent and long-lived paroxysmal AF and risk factors determined by the CHADS score |
|
|
Term
| how is the scoring determined in CHADS score for the risk of stroke in AF |
|
Definition
1 point each for CHF, HTN, age 75
or older, and DM; 2 points for prior stroke or TIA |
|
|
Term
| what is the recommendation for patients with AF and a CHADS score of 0 |
|
Definition
|
|
Term
| what is the recommendation for patients with AF and a CHADS score of 1 |
|
Definition
| physician's judgement of whether to treat with aspirin or coumadin |
|
|
Term
| what is the recommendation for patients with AF and a CHADS score of 2 |
|
Definition
|
|
Term
| what is a reasonable strategy in select patients with a CHADS2 score of 2 or greater in whom warfarin cannot be used for reasons such as personal aversion to the medication, side effects, or nonbleeding complications or in patients whose INR is exceedingly difficult to keep within the therapeutic range |
|
Definition
|
|
Term
| what is a drug more efficient at perventing stroke as an anticoagulant in comparison to coumadin. how is it inferior to coumadin |
|
Definition
Dabigatran (PRADAXA)
more GI bleedings |
|
|
Term
| the standard dosage of dabigatran (pradaxa) is limited by what? |
|
Definition
| creatinine clearance > 30 |
|
|
Term
| what is the incidence of AF after open heart surgery? what are the initial mgmt steps |
|
Definition
| 25-50%, attempts at cardioversion |
|
|
Term
| what is a concern in the patient that had just undergone open heart surgery and develops new onset AF? |
|
Definition
| he cannot be anticoagulated so rate, rhythm and close monitoring of bouts of AF should be instituted |
|
|
Term
| what is a good choice of antiarhythmic drug in the acutely post open heart surgery patient who had developed new onset AF |
|
Definition
| amiodarone - very effective. should be stopped after a few months |
|
|
Term
| what is the problem with onset of AF in the setting of an acute severe illness such as sepsis and shock? what can be done? |
|
Definition
| patients are often treated for shock with vasopressors. you cannot add beta blocker or CCB for rate control because of their vasodilitatory effect. amiodarone or digoxine are options, cardioversion less so |
|
|
Term
| what is a potential adverse effect of antiarhythmics for the treatment of atrial flutter |
|
Definition
| they slow down the atrial beat rate to a level that might be low enough for the AV node to transfer to the ventricules in a 1:1 ratio causing ventricular tachycardia |
|
|
Term
| what is the treatment in high anaesthetic risk patients with atrial flutter? 3 drugs |
|
Definition
pharmacologic cardioversion
procainamide, amiodarone, or ibutilide |
|
|
Term
| what are the recurrence rates with successful pharmacologic cardioversion in atrial flutter |
|
Definition
|
|
Term
| in what type of conditions does multifocal atrial tachycardia usually occur |
|
Definition
|
|
Term
| definition of multifocal atrial tachycardia? ventricular rate? |
|
Definition
| 3 distinct P-wave morphologies and often at least 3 different PR intervals, and the associated atrial and ventricular rates are typically between 100 and 150 beats per minute |
|
|
Term
| what distinguishes multifocal atrial tachycardia from atrial fibrillation |
|
Definition
| The presence of an isoelectric baseline |
|
|
Term
| what distinguishes multifocal atrial tachycardia from sinus tachycardia with APCs? |
|
Definition
| The absence of any intervening sinus rhythm |
|
|
Term
| 2 ways to distinguish focal sinus tachycardia from focal reentrent atrial tachycardia |
|
Definition
1. adenosine - persistence of the AT in the presence of AV block
2. in focal reentrent the first p wave changes shape |
|
|
Term
| what is the treatment of focal atrial tachycardia? |
|
Definition
| pharmacologically same as AF and AFL, except less indications for anticoagulation: severe atrial dilatation, >5 cm left atrial diameter with a high risk of AF, and/or a history of coincident paroxysmal AF |
|
|
Term
| in the ECG of AVNRT what can be said of the APC that elicits the tachycardia |
|
Definition
| it has a prolonged PR expressing the conductance in the slow pathway |
|
|
Term
| 4 treatment options for AVNRT |
|
Definition
the logic is to slow the AV node
1. vagal stimulation: valsalva or carotid massage
2. adenosine
3. bb or CCB
4. cardioversion |
|
|
Term
| 4 of the MC anatomical sites for accessory pathways in descending order |
|
Definition
| left atrium to the left ventricle, followed by posterior septal, right free wall, and anterior septal APs |
|
|
Term
| what is the delta wave at the beginning of the QRS in AVRT? |
|
Definition
| muscle to muscle conduction that starts the QRS is slow and so the more gradual rise of the QRS |
|
|
Term
| what is a dangerous complication of WPW (accessory pathway) |
|
Definition
| development of AF, which will have rapid conduction to the ventricules |
|
|
Term
| what is a dangerous complication of WPW (accessory pathway) |
|
Definition
| development of AF, which will have rapid conduction to the ventricules |
|
|
Term
|
Definition
| every sinus beat is followed by a VPC |
|
|
Term
|
Definition
| every 2 sinus beats are followed by a VPC |
|
|
Term
| what is the meaning of the term "fully compensatory pause" in regards to VPCs? |
|
Definition
| the duration between the last QRS before the PVC and the next QRS complex is equal to twice the sinus rate |
|
|
Term
| what is a noncompensatory pause in regards to VPCs |
|
Definition
| very early VPC is able to enter the atria and resent the SA node so the next sinus beat comes earlier and the length btwn the beat before and after the VPC is shorter than 2 standard sinus beats |
|
|
Term
| what is a reversible complication of VPCs |
|
Definition
|
|
Term
| what is the treatment of VPCs in the setting of cardiac structural abnormalities? |
|
Definition
| antiarythmic drugs have not proven to reduce mortality from SCD |
|
|
Term
| how to distinguish btwn accelerated idioventricular tachycardia and slow VT? and why is it important |
|
Definition
gradual onset and offset and more variability in cycle length
AIVR is benign |
|
|
Term
| 5 conditions that may lead to AIVT? |
|
Definition
| MI, cocaine intoxication, myocarditis, digoxin intoxication, and postoperative cardiac surgery |
|
|
Term
| which conditions typically cause VT and not AIVT? |
|
Definition
| chronic infarction or cardiomyopathy |
|
|
Term
| what is the duration of a non-sustained VT |
|
Definition
|
|
Term
| 2 conditions that cause wide complex tachycardia |
|
Definition
| VT or SVT with aberrant ventricular conduction due to right or left bundle branch block |
|
|
Term
| 5 ways to distinguish VT from SVT with BBB on ECG? |
|
Definition
1. presence of a pre-excited QRS pattern indicates atrial arrhythmia
2. (1) the presence of a QRS duration >140 ms in the absence of drug therapy, (2) a superior and rightward QRS frontal plane axis, (3) a bizarre QRS complex that does not mimic the characteristic QRS pattern associated with left or right bundle branch block, and (4) slurring of the initial portion of the QRS |
|
|
Term
| The IV administration of verapamil and/or adenosine is not recommended as a diagnostic test |
|
Definition
|
|
Term
| why is defibrillation given in an asynchronous method |
|
Definition
| if it would try to synchronize to the QRS it might never give out an electrical shock |
|
|
Term
| what are the initial doses of defibrillation given in a state of non-sustained polymorphic VT, Ventricular flutter and VF |
|
Definition
| 100 biphasic or 200 monophasic |
|
|
Term
| which 2 medications should be given IV concurrently to attempts of defibrillation (w/o interrupting the Defibrillation) |
|
Definition
|
|
Term
| what is the treatment of any monomorphic wide complex rhythm that results in hemodynamic compromise |
|
Definition
| synchronous electrical shock |
|
|
Term
| what is the preventive treatment of VT in patients with structural heart disease |
|
Definition
|
|
Term
| what 2 options in addition to ICD in patients with a structural heart disease and a prior event of VT/VF |
|
Definition
1. sotalol or amiodarone (as long as they don't have long QT syndrome)
2. Catheter ablative therapy |
|
|
Term
| what is the definition of VT storm? |
|
Definition
| more than 2 events requiring ICD or defibrillation in 24 hrs |
|
|
Term
| a VT storm with inability to return for prolonged periods of time to sinus rhythm, is usually caused by which 2 conditions |
|
Definition
| acute MI or fulminant myocarditis |
|
|
Term
| 2 indications for ICD implantation in patients with non-ischemic cardiomyopathy |
|
Definition
| LV ejection fraction < 35% or a history of unexplained syncope with significant LV dysfunction |
|
|
Term
| what is The signature VT associated with digoxin toxicity |
|
Definition
|
|
Term
| what is the trigger for VT in the setting of long QT syndrome |
|
Definition
| early afterdepolarizations potentiated by intracellular calcium accumulation from a prolonged action potential plateau |
|
|
Term
| what is the MC genetic abnormality in long QT syndrome? what is the trigger? when is the first cardiac event? |
|
Definition
| LQT1, exercise or emotional stress, 80% experience a cardiac event by the time they are 20 |
|
|
Term
| what is Jervell and Lange-Nielsen syndrome? |
|
Definition
| two allele LQT1 syndrome - more arrhythmias, deafness |
|
|
Term
| what is the definition of short QT syndrome |
|
Definition
|
|
Term
| what are the complications of short QT syndrome? 2 treatments |
|
Definition
| AF and VF. ICD and Quinidine to lengthen the QT interval |
|
|
Term
| what is the diagnostic test used to elicit the typical ECG pattern of Brugada syndrome |
|
Definition
|
|
Term
| what is the drug treatment of brugada |
|
Definition
| isoproterenol or quinidine |
|
|
Term
| what are the indications for ICD in patients with Brugada |
|
Definition
| prior syncope or arrhythmia or positive ECG provocation test |
|
|
Term
| what is the pathophysiology of Catecholaminergic Polymorphic VT? what is the ECG pattern |
|
Definition
| ryonidine mutation causes leak of calcium from the SR to the cell. bidirectional complexes |
|
|
Term
| 3 conditions associated with life threatening arrhythmias in the young athlete |
|
Definition
| hypertrophic cardiomyopathy, arrhythmogenic cardimyopathy, and acute myocarditis |
|
|
Term
| what is the workup of a young athlete presenting with syncope |
|
Definition
|
|
Term
| what do you look for in the ECG of a young athlete presenting with syncope |
|
Definition
| preexcitation, QT prolongation, a Brugada-type ECG pattern or epsilon waves, and T-wave inversions consistent with a nonischemic RV or LV cardiomyopathy or myocarditis |
|
|
Term
| 2 ECG findings in Arrhythmogenic Rv Cardiomyopathy/Dysplasia (Arvcm/D) |
|
Definition
| t wave inversions, and epsilon wave(a terminal notch in the QRS complex) in leads V1-3 |
|
|
Term
| 4 arrhythmogenic conditions that allow the young athlete to participate in all competitive sports? |
|
Definition
Gene carriers for arrhythmia syndromes without phenotype VT
Asymptomatic Wolff-Parkinson-White syndrome
Premature ventricular complexes when no increase in PVCs or symptoms occur with exercise
Nonsustained ventricular tachycardia with no structural heart disease |
|
|
Term
| 3 arrhythmogenic conditions should restrict young athlete to low intensity competitive sports only |
|
Definition
| brugada, long QT syndrome and non-sustained polyphasic VT with associated structural abnormalities |
|
|
Term
| which arrhythmogenic condition should entail a restriction to preform any sports? |
|
Definition
| Catecholaminergic polymorphic VT |
|
|
Term
| what is the overall annual mortality rates in patients with HF? with HF and NYHA I? NYHA IV? |
|
Definition
|
|
Term
| what is a typical (40%) respiratory phenomenon in advanced HF? |
|
Definition
| Cheyne-stokes, periods of apnea raise PCO2, which elicit bouts of hyperventilation |
|
|
Term
| which biomarker may help distinguish btwn cardiac and pulmonary causes of dyspnea |
|
Definition
|
|
Term
| 5 groups of drugs that may percipitate acute decompensation in chronic HF |
|
Definition
Calcium antagonists (verapamil, diltiazem)
Beta blockers
Nonsteroidal anti-inflammatory drugs
Antiarrhythmic agents [all class I agents, sotalol (class III)]
Anti-TNF antibodies |
|
|
Term
| what intervention is recommended in patients with NYHA I-III, but notin patients with NYHA IV HF? |
|
Definition
|
|
Term
| what are the salt restrictions in CHF |
|
Definition
| mild - 2-3 grams, moderate-severe <2 gram |
|
|
Term
| what are the restrictions on drinking? |
|
Definition
| if patient is hyponatremic at Na<130, restriction should be <2 L of water daily |
|
|
Term
| in the treatment of new onset HF, when do you start ACEi? |
|
Definition
| after you have optimized the dose of diuretics, because they attenuate the effect of ACEi |
|
|
Term
| how do you start ACEi in HF |
|
Definition
| initiated in low doses, followed by gradual increments if the lower doses have been well tolerated |
|
|
Term
| 2 indications for beta blockers in HF |
|
Definition
| symptomatic or asymptomatic HF and a depressed EF <40% |
|
|
Term
| how do you administer beta blockers for the treatment of HF? |
|
Definition
| gradually, dose increase is done in no less than 2 week intervals, otherwise fluid retention would ensue |
|
|
Term
| when do you expect to find fluid retention as a result of initiating beta blockers in a patient with HF? what is the 1st mgmt of this? |
|
Definition
| 3-5 days after initiation, add diuretics |
|
|
Term
| what is the indication to start Aldactone therapy in patients with HF? |
|
Definition
| NYHA class IV or class III (previously class IV) HF who have a depressed EF (<35%) and are receiving standard therapy, including diuretics, ACE inhibitors, and beta blockers |
|
|
Term
| 2 conditions where aldosterone is not recommended as treatment for HF |
|
Definition
| creatinine is >2.5 mg/dL (or creatinine clearance is <30 mL/min) or when the serum potassium is >5 mmol |
|
|
Term
| what 2 drugs are recommended as part of standard HF therapy in addition to beta blockers and ACE inhibitors for African Americans with NYHA class II–IV HF |
|
Definition
|
|
Term
| which 5 Agents may be considered as part of additional therapy of symptomatic HF unresponsive to ACEi+BB |
|
Definition
| ARB, spironolactone, the combination of hydralazine and isosorbide dinitrate, and digitalis |
|
|
Term
| what is an indication for digitalis in HF |
|
Definition
| symptomatic LV systolic dysfunction who have concomitant atrial fibrillation |
|
|
Term
| what is the place of aspirin in HF? |
|
Definition
| although it may exacerbate HF, in patients with concomitant IHD low dose aspirin is indicated |
|
|
Term
| apart from the obvious indications for anticoagulation (venous, stroke, a-fib prevention), what is another situation where it is indicated to administer warfarin in HF? |
|
Definition
| patients with ischemic cardiomyopathy and recent anterior MI or documented LV thrombus for 3 months |
|
|
Term
| what % of patients with HF experience atrial fibrillation |
|
Definition
|
|
Term
| which are the only 2 anti arrhytmic drugs that do not have negative inotropic effects |
|
Definition
| amiodarone and dofetilide |
|
|
Term
| what is the preferred drug for restoring and maintaining sinus rhythm in patients with HF and concomitant A fib |
|
Definition
|
|
Term
| when administering amiodarone to a patient with heart failure what are 2 possible drug interactions |
|
Definition
| warfarin and digoxin - reduce dose of both |
|
|
Term
| 2 indications for cardiac resynchronization therapy (aka Biventricular pacing) in patients with HF |
|
Definition
| patients in sinus rhythm with an EF <35% and a QRS >120 ms and those who remain symptomatic (NYHA III–IV) despite optimal medical therapy |
|
|
Term
| indications for prophylactic ICD in patients with HF |
|
Definition
| patients in NYHA class II–III HF with a depressed EF of <35% who are already on optimal background therapy, including an ACE inhibitor (or ARB), a beta blocker, and an aldosterone antagonist |
|
|
Term
| 1st step is classifying the patient with acute decompensation of HF to one of 4 classes |
|
Definition
| normal LV filling pressure with normal perfusion (Profile A), elevated LV filling pressure with normal perfusion (Profile B), elevated LV filling pressures with decreased perfusion (Profile C), and normal or low LV filling pressure with decreased tissue perfusion (Profile L) |
|
|
Term
| how do you treat a patient presenting with acute HF decompensation, being profile C, "cold and wet" |
|
Definition
| Intravenous inotropic agents with vasodilating action [dobutamine, low-dose dopamine, milrinone] |
|
|
Term
| what is the treatment of a patient presenting with acute decompensation of HF, being of profile L, "cold and dry" |
|
Definition
| right-heart catheterization for the presence of an occult elevation of LV filling pressures. If LV filling pressures are low [pulmonary capillary wedge pressure (PCWP) <12 mmHg], a cautious trial of fluid repletion may be considered |
|
|
Term
| what is the effect of vasodilators used in HF? nitroglycerin, nitroprusside, and nesiritide |
|
Definition
| dilating effects on arterial resistance and venous capacitance vessels, which results in a lowering of LV filling pressure, a reduction in mitral regurgitation, and improved forward cardiac output without increasing heart rate or causing arrhythmias |
|
|
Term
| The most common side effect of IV or oral nitrates |
|
Definition
|
|
Term
| what is Nesiritide? (for the treatment of HF) |
|
Definition
| recombinant form of brain-type natriuretic peptide which lowers LV filling pressures |
|
|
Term
| what is the effect of inotropic agents? milrinone and dobutamine |
|
Definition
| stimulating cardiac contractility as well as producing peripheral vasodilation |
|
|
Term
| what are the indications to use inotropic agents |
|
Definition
| settings in which vasodilators and diuretics are not helpful, such as in patients with poor systemic perfusion and/or cardiogenic shock, patients requiring short-term hemodynamic support after an MI or surgery, and patients awaiting cardiac transplantation, or as palliative care in patients with advanced HF |
|
|
Term
| the effects of dopamine are dose related. explain |
|
Definition
|
|
Term
| Vasopressin Antagonists - Tolvaptan (oral) and conivaptan (IV) are not approved for the treatment of HF |
|
Definition
|
|
Term
| which 2 groups of patients get the top priority for heart transplantation |
|
Definition
| requiring hospitalization at the transplant center for IV inotropic support with a pulmonary artery catheter in place for hemodynamic monitoring or to patients requiring mechanical circulatory support [i.e., intra-aortic balloon pump (IABP), right or left ventricular assist device (RVAD, LVAD), extracorporeal membrane oxygenation (ECMO), or mechanical ventilation] |
|
|
Term
| which patients get second highest priority for heart transplantation |
|
Definition
| patients requiring ongoing inotropic support, but without a pulmonary artery catheter in place |
|
|
Term
| after the 1st and 2nd top criteria for heart transplantation, how is the rest of the list prioritized |
|
Definition
| according to time on the list, taking into account ABO blood type and body-size compatibility |
|
|
Term
| what are the general indications for heart transplantation in HF |
|
Definition
| younger and without significant comorbidities |
|
|
Term
| what are the survival rates of patients undergoing heart transplantation for HF |
|
Definition
| 83% and 76% survival 1 and 3 years posttransplant |
|
|
Term
| what is the immunosuppression three-drug regimen used by most centers after heart transplantation? |
|
Definition
| calcineurin inhibitor (cyclosporine or tacrolimus), an inhibitor of T cell proliferation or differentiation (azathioprine, mycophenolate mofetil, or sirolimus), and at least a short initial course of glucocorticoids |
|
|
Term
| the strategy of immunosuppression for heart transplantation consists of an initial induction with antibodies against T cells and continues with the three drug regimen |
|
Definition
|
|
Term
| how and on what grounds is the Diagnosis of cardiac allograft rejection made after heart transplantation |
|
Definition
| endomyocardial biopsy, either done on a surveillance basis or in response to clinical deterioration |
|
|
Term
| 3 immunosuppressive drugs used post heart transplantation that are associated with less coronary heart disease, at least in the short term |
|
Definition
| mycophenolate mofetil and the mammalian target of rapamycin (mTOR) inhibitors sirolimus and everolimus |
|
|
Term
| statins are also used post heart transplant b/c they also reduce the risk of CHD |
|
Definition
|
|
Term
| what is the major cause of death in the 1st post heart transplantation year |
|
Definition
|
|
Term
| 2 major indications for long-term ventricular assistance |
|
Definition
1. are at risk of imminent death from cardiogenic shock.
2. LVEF < 25%, peak VO2 < 14 mL/kg/min or are dependent on inotropic therapy or support with intra-aortic balloon counterpulsation |
|
|
Term
| how many patients with a left ventricular assist device actually reach transplantation |
|
Definition
| 75% of younger patients receiving a transplant by 1 year |
|
|
Term
| what are the survival rates of patients treated with left ventricular assist device which changed indications during the wait for transplant from "bridging" to "destination"? |
|
Definition
| survival rates of only 65% at 6 months and 34% at 1 year |
|
|
Term
| what is the difference btwn patent formen ovale and ostium secondum ASD |
|
Definition
| the latter presents functional and anatomic patency |
|
|
Term
| what are 2 manifestations of ASD before the 4th decade of life |
|
Definition
| physical underdevelopment and an increased tendency for respiratory infections |
|
|
Term
| what type of ASD occurs in down's syndrome |
|
Definition
|
|
Term
| 4 manifestations of ASD starting the 4th decade of life |
|
Definition
| atrial arrhythmias, pulmonary arterial hypertension, bidirectional and then right-to-left shunting of blood, and right heart failure |
|
|
Term
| what are the findings on auscultation of ASD |
|
Definition
| wide permanent split of S2, and loud P1, pulmonary midsystolic outflow murmur |
|
|
Term
| what is an additional finding on auscultation in patients with primum ostium ASD (down's) and not in the rest of the types of ASDs |
|
Definition
| an apical holosystolic murmur indicates associated mitral or tricuspid regurgitation or a ventricular septal defect (VSD) |
|
|
Term
| what other structures are commonly involved in primum ostium ASD |
|
Definition
|
|
Term
| 3 surgical options for the repair of secondum ostium ASD |
|
Definition
| patch of pericardium or of prosthetic material or percutaneous transcatheter device closure |
|
|
Term
| what is the indication for simple secondum ostium ASD repair |
|
Definition
| all patients with uncomplicated secundum ASD with significant left-to-right shunting, i.e., pulmonary-to-systemic flow ratios 2:1 |
|
|
Term
| surgical repair is not recommended for patients with VSD and... |
|
Definition
| pulmonary-to-systemic flow ratios of <1.5 to 2:1 |
|
|
Term
| 2 surgical treatment options in patients who have developed eisenmenger's syndrome |
|
Definition
| single-lung transplantation with intracardiac defect repair and total heart-lung transplantation |
|
|
Term
| what is the pharmacological treatment of bicuspid aortic valve |
|
Definition
| digoxin and diuretics, and if aortic valve is dilated - beta blockers |
|
|
Term
| what is the indication of aortic valve replacement in bicuspid aortic valve |
|
Definition
| adults with critical obstruction, (aortic valve area <0.45 cm2/m2), with symptoms secondary to LV dysfunction or myocardial ischemia, or with hemodynamic evidence of LV dysfunction |
|
|
Term
| what is the surgical treatment of asymptomatic children or adolescents or young adults with critical aortic stenosis without valvular calcification |
|
Definition
| aortic balloon valvuloplasty |
|
|
Term
| in which syndrome do you see supravalvular aortic stenosis |
|
Definition
| williams syndrome trisomy 18 |
|
|
Term
| where is the most common site of coarctation of the aorta |
|
Definition
| distal to the origin of the left subclavian artery |
|
|
Term
| what is a CNS complication of coarctation of the aorta |
|
Definition
| Circle of lewis aneurysms - 10% of patients |
|
|
Term
| what is a physical finding on palpation in coarctation of the aorta |
|
Definition
| Enlarged and pulsatile collateral vessels may be palpated in the intercostal spaces |
|
|
Term
| 2 options for auscultation in coarctation of the aorta |
|
Definition
| A midsystolic murmur over the left interscapular space may become continuous if the lumen is narrowed sufficiently to result in a high- velocity jet across the lesion throughout the cardiac cycle |
|
|
Term
| among the obvious findings (dilated subclavian, aorta), what else can be found on CXR in a patient with coarctation of the aorta |
|
Definition
| Notching of the third to ninth ribs |
|
|
Term
| level of severity in aortic stenosis according to the peak systolic pressure gradient |
|
Definition
| PSPG of 30-50 is considered moderate |
|
|
Term
| pulmonary stenosis causes syncope (like aortic stenosis) |
|
Definition
|
|
Term
| treatment of pulmonary stenosis |
|
Definition
|
|
Term
| severity of mitral stenosis |
|
Definition
| moderate - mitral valve orifice 1 cm2–1.5 cm2 |
|
|
Term
| what is the effect of moderate MS on CO? severe MS? |
|
Definition
moderate - the CO is normal or almost so at rest, but rises subnormally during exertion
severe - CO is subnormal at rest and may fail to rise or may even decline during activity |
|
|
Term
| how long does it take to develop symptoms in MS d/t rheumatic heart disease |
|
Definition
|
|
Term
| incidence of systemic embolization in MS |
|
Definition
|
|
Term
| how does The time interval between A2 and OS (opening snap) with the severity of MS? |
|
Definition
|
|
Term
| 2 right side (more pronounced with inspiration) murmurs associated with mitral stenosis (that already shows pulmonary hypertension) |
|
Definition
Carvallo's sign - TR
Graham Steell murmur - PR |
|
|
Term
| 4 earliest CXR findings in MS |
|
Definition
| straightening of the upper left border of the cardiac silhouette, prominence of the main pulmonary arteries, dilation of the upper lobe pulmonary veins, and posterior displacement of the esophagus by an enlarged LA |
|
|
Term
| when can you see kerley B lines (intralobular septa) on CXR in a patient with MS |
|
Definition
| when resting mean LA pressure exceeds approximately 20 mmHg |
|
|
Term
| Like MS, significant MR may also be associated with a prominent diastolic murmur at the apex due to increased antegrade transmitral flow, how do you tell them apart |
|
Definition
| in MR it commences later and there is often clear-cut LV enlargement |
|
|
Term
| the apical mid-diastolic murmur associated with severe AR (Austin Flint murmur) may be mistaken for MS, how can you tell them apart |
|
Definition
| AR is not intensified in presystole and becomes softer with administration of amyl nitrite |
|
|
Term
| what is the indication for catheterization in mitral stenosis |
|
Definition
| patients who have undergone PMBV or previous mitral valve surgery, and who have redeveloped limiting symptoms, especially if questions regarding the severity of the valve lesion(s) remain after echocardiography |
|
|
Term
| what are the indications of anticoagulation for patients with MS |
|
Definition
| no exclusive indications - AF or a history of thromboembolism |
|
|
Term
| what is the indication for mitral valvotomy in patients with MS + 2 exceptions |
|
Definition
symptomatic [New York Heart Association (NYHA) Functional Class II–IV] patients with isolated MS, whose effective orifice (valve area) is <1.5 cm2
in the patient who is entirely asymptomatic and/or who has mild stenosis (mitral valve area >1.5 cm2) there are 2 indications for mitral valvotomy - recurrent systemic embolization or severe pulmonary hypertension (PA systolic pressures >50 mmHg at rest or >60 mmHg with exercise) |
|
|
Term
| 4 considerations in opting for PMBV instead of surgical valvotomy |
|
Definition
1. relatively pliable leaflets
2. little or no commissural calcium
3. subvalvular structures should not be significantly scarred or thickened
4. no left atrial thrombus |
|
|
Term
| on deciding on the right approach, PMBV or open surgery, in mitral valvotomy, which test is preformed beforehand |
|
Definition
| 1. TTE to decide on the approach |
|
|
Term
| which test should be done prior to, and on the same day, of performing PMBV for mitral stenosis |
|
Definition
| 1. TEE to make sure there is no thrombus in the left atrium |
|
|
Term
| 2 elements that determine successful mitral valvotomy |
|
Definition
| 50% reduction in the mean mitral valve gradient and a doubling of the mitral valve area |
|
|
Term
| 3 indications for Mitral valve replacement (MVR) in patients with MS |
|
Definition
| significant associated MR, those in whom the valve has been severely distorted by previous transcatheter or operative manipulation, or those in whom the surgeon does not find it possible to improve valve function significantly with valvotomy |
|
|
Term
| what defines severe mitral regurgitation |
|
Definition
| regurgitant volume 60 mL/beat, regurgitant fraction (RF) 50%, and effective regurgitant orifice area 0.40 cm2 |
|
|
Term
| what is the basic classification of the indications for mitral valve repair/replacement in the case of MR? |
|
Definition
| is the etiology ischemic or not |
|
|
Term
| 5 indications for mitral valve repair in non ischemic severe mitral regurgitation |
|
Definition
1. symptomatic
asymptomatic:
2. LV dysfunction: LVEF<60 and/or LVESD> 4.0 cm
3. pulmonary hypertension
4. new onset atrial fibrillation
5. non of the previous ones but highly experienced center with more than 90% success rates |
|
|
Term
| what complication is seen in 4% of patients with severe mitral regurgitation with an ROA>0.4 cm? |
|
Definition
|
|
Term
| what is the surgical treatment (does not show survival benefit) of ischemic MR |
|
Definition
| mitral valve repair with undersized anuloplasty and concurrent coronary bypass surgery |
|
|
Term
| 3 syndromes that may cause mitral valve prolapse |
|
Definition
| Marfan's syndrome, osteogenesis imperfecta, and Ehlers-Danlos syndrome |
|
|
Term
| what cardiac anomaly is associated in 20% of patients with ostium secundum atrial septal defect |
|
Definition
|
|
Term
| what is the MCC of isolated severe MR requiring surgery? |
|
Definition
|
|
Term
| what is the MC clinical manifestation of mitral valve prolapse |
|
Definition
|
|
Term
| what is The prevalence of bicuspid aortic valve disease among first-degree relatives of an affected individual |
|
Definition
|
|
Term
| what complication is often associated with bicuspid aortic valve? |
|
Definition
|
|
Term
| important sign of aortic stenosis on physical examination |
|
Definition
| The peripheral arterial pulse rises slowly to a delayed peak (pulsus parvus et tardus). A thrill or anacrotic "shudder" may be palpable over the carotid arteries, more commonly the left |
|
|
Term
| severity of aortic stenosis |
|
Definition
| moderate AS is defined by a valve area of 1–1.5 cm2 |
|
|
Term
| 3 indications for aortic valve replacement |
|
Definition
| patients with severe AS (valve area <1 cm2 or 0.6 cm2/m2 body surface area) who are symptomatic, those who exhibit LV dysfunction (EF <50%), as well as those with BAV disease and an aneurysmal or expanding aortic root (maximal dimension >4.5 cm or annual increase in size >0.5 cm/year) |
|
|
Term
| 4 relative indications for aortic valve replacement in aortic stenosis |
|
Definition
abnormal response to treadmill exercise;
rapid progression of AS, especially when urgent access to medical care might be compromised;
very severe AS defined by a valve area <0.6 cm2;
severe LV hypertrophy suggested by a wall thickness of >15 mm |
|
|
Term
| what is the right timing to perform aortic valve replacement in aortic stenosis/ |
|
Definition
| within 3-4 months of symptoms onset |
|
|
Term
| what is the 10 yr survival of patients who undero aortic valve replacement for aortic stenosis |
|
Definition
|
|
Term
| what % of patients with a bioprosthetic valve for aortic stenosis develop primary valve failure after 10 yrs |
|
Definition
|
|
Term
| 3 definitions of severe aortic stenosis |
|
Definition
| AVA<1cm2, mean systolic gradient>40, Vmax>4m/s |
|
|
Term
| what is the role of Percutaneous Balloon Aortic Valvuloplasty in aortic stenosis? |
|
Definition
| congenital, noncalcific AS |
|
|
Term
| what is the indication for Transcatheter aortic valve implantation (TAVI) in aortic stenosis? |
|
Definition
| patients who have an indication for aortic valve replacement, but are too high risk to undergo surgery |
|
|
Term
| 4 signs in the arterial pulse of patients with AR |
|
Definition
"water-hammer" pulse, which collapses suddenly as arterial pressure falls rapidly during late systole and diastole (Corrigan's pulse), and
capillary pulsations, an alternate flushing and paling of the skin at the root of the nail while pressure is applied to the tip of the nail (Quincke's pulse), are characteristic of chronic severe AR.
A booming "pistol-shot" sound can be heard over the femoral arteries (Traube's sign),
and a to-and-fro murmur (Duroziez's sign) is audible if the femoral artery is lightly compressed with a stethoscope |
|
|
Term
|
Definition
1. classic decrescendo mid diastolic high pitched
2. mid systolic
3. end diastolic austin flint - the AR jet hitting the mitral valve |
|
|
Term
| what is the definition of severe AR |
|
Definition
| the central jet width assessed by color flow Doppler imaging exceeds 65% of the left ventricular outflow tract, the regurgitant volume is 60 mL/beat, the regurgitant fraction is 50%, and there is diastolic flow reversal in the proximal descending thoracic aorta |
|
|
Term
| 2 treatment that are CIed in acute severe AR |
|
Definition
| beta blockers (ok to use in chronic AR) and Intraaortic balloon counterpulsation |
|
|
Term
| what is the timing for surgery in acute severe AR |
|
Definition
| within 24 hrs of the diagnosis |
|
|
Term
| what is the consensus on pharmacological treatment in chronic severe AR? |
|
Definition
| vasodilators to keep systolic BP < 140 |
|
|
Term
| what is the pharmacological treatment to delay the aortic root enlargement in marfan syndrome and aortic root dilation |
|
Definition
|
|
Term
| what is the correct timing for surgery in chronic severe AR? how do you monitor it? |
|
Definition
after the onset of LV dysfunction but prior to the development of severe symptoms - echo every 6 months
Operation can be deferred as long as the patient both remains asymptomatic and retains normal LV function without severe chamber dilation (end-diastolic dimension >75 mm) |
|
|
Term
| 5 indications for performing aortic valve replacement in aortic regurgitation |
|
Definition
1. symptomatic
LV dysfunction:
2. LVEF <50%
3. LV end-systolic dimension >55 mm
4. end-systolic volume >55 mL/m2
5. LV diastolic dimension >75 mm |
|
|
Term
| in which side, right or left, do congestive symptoms develop first in dilated cardiomyopathy? restrictive? |
|
Definition
|
|
Term
| in which type of cardiomyopathy is it uncommon to find ventricular arrhythmias |
|
Definition
|
|
Term
| 3 bacterial causes of infective myocarditis to cause dilated cardiomyopathy |
|
Definition
| Q fever, Lyme disease, C.diphtheria |
|
|
Term
| 2 viral causes of infective myocarditis to cause dilated cardiomyopathy |
|
Definition
| Coxsackie, adenovirus, HIV, hepatitis C |
|
|
Term
| which 3 chemotherapeutic agents cause dilated cardiomyopathy |
|
Definition
| anthracyclines, trastuzumab, interferon |
|
|
Term
| 3 nutritional deficiencies that cause dilated cardiomyopathy |
|
Definition
| thiamine, selenium, carnitine |
|
|
Term
| 3 electrolyte deficiencies that cause dilated cardiomyopathies |
|
Definition
| calcium, phosphate, magnesium |
|
|
Term
| 2 metabolic disorders that cause dilated cardiomyopathy |
|
Definition
|
|
Term
| 3 endocrinopathies that cause dilated cardiomyopathy |
|
Definition
Thyroid disease
Pheochromocytoma
Diabetes |
|
|
Term
| what is the definitive diagnosis of myocarditis |
|
Definition
| Bx showing infiltrative lymphocytes and myocyte necrosis, but this is seen in 10-20% |
|
|
Term
| when does the function of the LV return to normal in over 50% of patients with viral myocarditis |
|
Definition
|
|
Term
| what is the treatment of viral myocarditis with a rapid downward progression of hemodynamics |
|
Definition
|
|
Term
| what % of HIV infected patients experience myocarditis |
|
Definition
|
|
Term
| which 4 factors can cause myocarditis in HIV |
|
Definition
| HIV itself, other viruses, antiviral treatment through toxic and hypersensitivity effects |
|
|
Term
| what is The most commonly diagnosed noninfectious cause of myocarditis granulomatous myocarditis, including both sarcoidosis and giant cell myocarditis |
|
Definition
| granulomatous myocarditis, including both sarcoidosis and giant cell myocarditis |
|
|
Term
| what is the presentation of Takotsubu acute cardiomyopathy |
|
Definition
| pulmonary edema, hypotension, and chest pain with ECG changes mimicking an acute infarction |
|
|
Term
| what is the prevalence of hypertrophic cardiomyopathy |
|
Definition
|
|
Term
| what is the MC presenting symptom in hypertrophic cardiomyopathy |
|
Definition
|
|
Term
| The gradient and the murmur in hypertrophic cardiomyopathy may be enhanced by which 2 maneuvers |
|
Definition
| maneuvers that decrease ventricular volume, such as the Valsalva maneuver, or standing after squatting |
|
|
Term
| The gradient and the murmur in hypertrophic cardiomyopathy may be decreased by which 2 maneuvers |
|
Definition
| by increasing ventricular volume or vascular resistance, such as with squatting or handgrip |
|
|
Term
| what % of patients with hypertrophic cardiomyopathy experience sudden cardiac death |
|
Definition
|
|
Term
| 4 ECG stages of acute pericarditis |
|
Definition
| In stage 1, there is widespread elevation of the ST segments, often with upward concavity, involving two or three standard limb leads and V2 to V6, with reciprocal depressions only in aVR and sometimes V1, as well as depression of the PR segment below the TP segment reflecting atrial involvement. Usually there are no significant changes in QRS complexes. In stage 2, after several days, the ST segments return to normal, and only then, or even later, do the T waves become inverted (stage 3). Ultimately, weeks or months after the onset of acute pericarditis, the ECG returns to normal in stage 4 |
|
|
Term
| what are the 3 MC causes of tamponade |
|
Definition
| neoplastic disease, idiopathic pericarditis, and renal failure |
|
|
Term
| what is Beck's triad in tamponade |
|
Definition
| hypotension, soft or absent heart sounds, and jugular venous distention with a prominent x descent but an absent y descent |
|
|
Term
| what ECG finding should raise the suspicion of cardiac tamponade |
|
Definition
| electrical alternans of the P, QRS, or T waves - alternation of QRS complex amplitude or axis between beats and a possible wandering base-line |
|
|
Term
| what finding on atrial pressure graph is usually present in constrictive pericarditis but not in tamponade |
|
Definition
|
|
Term
| what finding on Echo is usually present in tamponade but absent in constrictive pericarditis |
|
Definition
| Right atrial collapse and RVDC |
|
|
Term
| which sign on PE is absent on tamponade but present on constrictive pericarditis and restrictive cardiomyopathy |
|
Definition
| Kussmaul's sign - The cervical veins are distended and may remain so even after intensive diuretic treatment, and venous pressure may fail to decline during inspiration |
|
|
Term
| which sign on PE is absent on both tamponade and restrictive cardiomyopathy but present on constrictive pericarditis |
|
Definition
| pericardial knock - an early third heart sound |
|
|
Term
| 2 finding in echo that are present in constrictive pericarditis but not in cardiac tamponade |
|
Definition
| pericardial thickening and calcification |
|
|
Term
| which sign on PE is usually present in tamponade but in only 33% of constrictive pericarditive |
|
Definition
|
|
Term
| what is the explanation for pulsus paradoxus |
|
Definition
| both ventricles share a tight incompressible covering, i.e., the pericardial sac, the inspiratory enlargement of the right ventricle in cardiac tamponade compresses and reduces left ventricular volume; leftward bulging of the interventricular septum further reduces the left ventricular cavity as the right ventricle enlarges during inspiration |
|
|
Term
| what is the finding on doppler-echo in tamponade associated with the tricuspid valve in comparison with mitral valve |
|
Definition
| Doppler ultrasound shows that tricuspid and pulmonic valve flow velocities increase markedly during inspiration, whereas pulmonic vein, mitral, and aortic flow velocities diminish |
|
|
Term
| what is the MC site for pericardiocentesis in tamponade |
|
Definition
|
|
Term
| Pericardial effusion is a common cardiac manifestation of HIV; it is usually secondary to |
|
Definition
| infection (often mycobacterial) or neoplasm, most frequently lymphoma |
|
|
Term
| what is the explanation for the presence of the prominent y descent in constrictive pericarditis and its absence in tamponade |
|
Definition
| In constrictive pericarditis, ventricular filling is unimpeded during early diastole but is reduced abruptly when the elastic limit of the pericardium is reached, whereas in cardiac tamponade, ventricular filling is impeded throughout diastole |
|
|
Term
| what signs and symptoms affect the abdomen in chronic constrictive pericarditis |
|
Definition
| weight gain, increased abdominal girth, abdominal discomfort, a protuberant abdomen |
|
|
Term
| what is the most common type of primary cardiac tumor in all age groups |
|
Definition
|
|
Term
| 3 findings in Carney syndrome |
|
Definition
| (1) myxomas (cardiac, skin, and/or breast), (2) lentigines and/or pigmented nevi, and (3) endocrine overactivity (primary nodular adrenal cortical disease with or without Cushing's syndrome, testicular tumors, and/or pituitary adenomas with gigantism or acromegaly |
|
|
Term
| The most common clinical presentation of cardiac myxoma |
|
Definition
| mitral stenosis or regurgitation |
|
|
Term
| the most common tumors of the cardiac valves |
|
Definition
|
|
Term
| tumors metastatic to the heart are much more common than primary tumors |
|
Definition
|
|
Term
| at what age should screening for lipid disorders begin |
|
Definition
|
|
Term
| guidelines match the intensity of treatment of lipid disorders to an individual's risk - what are the risk classes |
|
Definition
Very high ACS, or CHD w/DM, or multiple CRFs, goal 70, drug 70
High - 10-year CHD risk of >20%, any evidence of established atherosclerosis, or diabetes, goal 100, drug 100
Moderately high - 2+ risk factors (10-year risk, 10–20%), goal 100, drug 130
Moderate - 2+ risk factors (risk <10%): goal 130, drug 160
low - 0–1 risk factor - goal 160, drug 190 |
|
|
Term
| what are the 5 elements that presence of 3 of them determine metabolic syndrome |
|
Definition
| abdominal circumferance, TG, HDL, BP 130/85, fasting glucose |
|
|
Term
| what is considered a positive exercise stress test |
|
Definition
| flat or downsloping depression of the ST segment >0.1 mV below baseline (i.e., the PR segment) and lasting longer than 0.08 s |
|
|
Term
|
Definition
| heart rate X blood pressure |
|
|
Term
| 7 CIs to cardiac stress testing |
|
Definition
| rest angina within 48 h, unstable rhythm, severe aortic stenosis, acute myocarditis, uncontrolled heart failure, severe pulmonary hypertension, and active infective endocarditis |
|
|
Term
| signs that indicate the presence of a high risk for coronary heart disease in non-invasive tests |
|
Definition
| inability to exercise for 6 min, i.e., stage II (Bruce protocol) of the exercise test; a strongly positive exercise test showing onset of myocardial ischemia at low workloads (0.1 mV ST-segment depression before completion of stage II, 0.2 mV ST depression at any stage, ST depression for >5 min after the cessation of exercise, a decline in systolic pressure >10 mmHg during exercise, the development of ventricular tachyarrhythmias during exercise); the development of large or multiple perfusion defects or increased lung uptake during stress radioisotope perfusion imaging; and a decrease in left ventricular ejection fraction during exercise on radionuclide ventriculography or during stress echocardiography |
|
|
Term
| what are the effects of nitrates on ischemich heart disease |
|
Definition
| improve exercise tolerance in patients with chronic angina and relieve ischemia in patients with unstable angina as well as patients with Prinzmetal's variant angina |
|
|
Term
| what is the effect of beta blockers in ischemic heart disease |
|
Definition
| reduce myocardial oxygen demand by inhibiting the increases in heart rate, arterial pressure, and myocardial contractility caused by adrenergic activation |
|
|
Term
| when are CCBs indicated in ischemic heart disease |
|
Definition
| when beta blockers are contraindicated, no tolerated or ineffective |
|
|
Term
| which CCBs can be given simultaneously with BBs? |
|
Definition
amlodipine, nifedipine etc. - synergistic
Diltiazem - only in patients with normal ventricular function and no conduction disturbances
Verapamil - shouldn't be given at all with BBs |
|
|
Term
| what is the strategy of antiplatelet treatment in patient with chronic stable IHD? |
|
Definition
| studies have not shown any benefit from the routine addition of clopidogrel to aspirin in patients with chronic stable IHD, Although combined treatment with clopidogrel and aspirin for at least a year is recommended in patients with an acute coronary syndrome treated with implantation of a drug-eluting stent, |
|
|
Term
| what is the role of ACEi in IHD? |
|
Definition
survivors of myocardial infarction
hypertension, LDL goals not reached with initial therapy with other drugs
high risk of vascular diseases such as diabetes or LV dysfunction |
|
|
Term
| when should ACEi not be used in IHD? |
|
Definition
| normal LV function and have achieved blood pressure and LDL goals on other therapies |
|
|
Term
| what is an approved treatment for patients who continue to experience angina in IHD on standard therapy: BB, CCB, and nitrates |
|
Definition
| Ranolazine - affects the sodium-dependent calcium channels during myocardial ischemia to prevent calcium overload |
|
|
Term
| 3 CIs of Ranolazine in IHD |
|
Definition
hepatic impairment
QTc prolongation
with use of drugs that inhibit the CYP3A metabolic system (diltiazem, verapamil) |
|
|
Term
| NSAIDs increase the risk of IHD |
|
Definition
|
|
Term
| 3 indications for percutaneous coronary intervention? when not to use |
|
Definition
1. MC - symptom-limiting angina pectoris, despite medical therapy, accompanied by evidence of ischemia during a stress test
2. unstable angina
3. MI
not to use in stable exertional angina, 3 vessel disease or left main |
|
|
Term
| 2 elements that render PCI successful |
|
Definition
adequate dilation (an increase in luminal diameter >20% to a residual diameter obstruction <50%)
relief of angina |
|
|
Term
| how are aspirin and a thienopyridine administered after PCI with placement of a bare metal stent? a drug-eluting stent? |
|
Definition
bare metal stent - 3 months of both post procedure
drug eluting stent - one year of thienopyridine and a lifetime of aspirin |
|
|
Term
| which 3 vessels are used in coronary artery bypass grafting |
|
Definition
| internal mammary artery or a radial artery, saphenous vein |
|
|
Term
| for which vessels is Long-term patency rates in CABG higher and for which lower? |
|
Definition
| internal mammary and radial artery have higher patency rates than saphenous vein |
|
|
Term
| in which procedure is the redevelopment of angina greater, PCI or CABG? |
|
Definition
|
|
Term
| in which procedure are stroke rates lower, PCI or CABG? |
|
Definition
|
|
Term
| definition of unstable angina |
|
Definition
| angina pectoris with at least one of three features: (1) it occurs at rest (or with minimal exertion), usually lasting >10 minutes; (2) it is severe and of new onset (i.e., within the prior 4–6 weeks); and/or (3) it occurs with a crescendo pattern (i.e., distinctly more severe, prolonged, or frequent than previously) |
|
|
Term
|
Definition
| UA + positive cardiac biomarkers |
|
|
Term
| what are the recommendations for a patient presenting to the ED with chest pain and over a 12 hour monitoring is found not to suffer from STEMI or NSTEMI/UA? |
|
Definition
| recommended an elective stress test of CT angiography |
|
|
Term
| The TIMI Risk Score for UA/NSTEMI - clinical risk stratification score to identify increasing risk of death, myocardial infarction, or urgent revascularization - 7 factors |
|
Definition
3 and over CAD risk factors
aspirin in the last week
2 anginal events within the last 24 hrs
prior obstruction >50%
age >65
elevated biomarkers
ST depression |
|
|
Term
| what effect do the cumulative factors in the TIMI risk score have on the risk associated with UA/NSTEMI? how can it be useful beyond just as a prognostic tool? |
|
Definition
0/1 factors - 5%
2 - 8%
3- 13%
4 - 20%
5 - 26%
6/7 - 41%
it is useful both in predicting the risk of recurrent cardiac events and in identifying those patients who would derive the greatest benefit from antithrombotic therapies more potent than unfractionated heparin, such as low molecular–weight heparin (LMWH) and glycoprotein IIb/IIIa inhibitors, and from an early invasive strategy |
|
|
Term
| when is a patient with UA allowed ambulation? |
|
Definition
| if the patient shows no recurrence of ischemia (discomfort or ECG changes) and does not develop a biomarker of necrosis for 12–24 h |
|
|
Term
| 2 CIs for the use of nitrates in UA/NSTEMI |
|
Definition
| hypotension or the use of sildenafil or other drugs in that class within the previous 24–48 h |
|
|
Term
| what is the ambulant pharmacological treatment of UA/NSTEMI (should be started at admission) |
|
Definition
Nitrates, BBs, statins
CCBs - if still symptomatic or BB CIed
[aspirin + clopidogrel] or [aspirin + prasugrel]
UFH/Clexane/Bivalirudin/Fondaparinux |
|
|
Term
| what is the definition of early invasive approach in the treament of UA/NSTEMI |
|
Definition
| PCI within 48 hours of presentation |
|
|
Term
| 5 group of drugs are recommended for the long term management of patients with ACS |
|
Definition
BBs
statins
ACEi/ARBs
aspirin + [clopidogrel or prasugrel] |
|
|
Term
| what is the treatment of an acute episode of prinzmetal's angina and prevention of recurrence |
|
Definition
|
|
Term
| which are the preferable cardiac biomarkers for diagnosing acute MI |
|
Definition
|
|
Term
| troponin T and I remain elevated for how long? |
|
Definition
|
|
Term
| when do CK-MB levels rise in the blood and when do they decrease in the setting of acute MI? |
|
Definition
| 4-8 hrs and decrease in 48-72 hrs |
|
|
Term
| why is troponin superior to CK-MB in the diagnosis of acute MI? |
|
Definition
|
|
Term
| which measurement of the cardiac biomarkers correlate with infarct size and which does not? |
|
Definition
| total amount of biomarkers released correlates where as peak levels don't |
|
|
Term
| in what situations is PCI preferred over fibrinolysis for the treatment STEMI |
|
Definition
diagnosis is in doubt
cardiogenic shock
bleeding risk is increased
symptoms have been present for at least 2–3 h when the clot is more mature and less easily lysed by fibrinolytic drugs |
|
|
Term
| when should fibrinolytics be ideally given to the patient with STEMI |
|
Definition
| within 30 mins of presentation - "door to needle" |
|
|
Term
| 3 fibrinolytic agents approved by the U.S. Food and Drug Administration for intravenous use in patients with STEMI |
|
Definition
| tissue plasminogen activator (tPA), streptokinase, tenecteplase (TNK), and reteplase (rPA) |
|
|
Term
| flow in the culprit coronary artery is classified for patency by the TIMI score |
|
Definition
grade 0 - complete occlusion of the infarct-related artery;
grade 1 - some penetration of the contrast material beyond the point of obstruction but without perfusion of the distal coronary bed;
grade 2 - perfusion of the entire infarct vessel into the distal bed, but with flow that is delayed compared with that of a normal artery
grade 3 - full perfusion of the infarct vessel with normal flow. |
|
|
Term
| in what situations is fibrinolysis preferable to PCI in the setting of NSTEMI |
|
Definition
| patients presenting in the first hour of symptoms, if there are logistical concerns about transportation of the patient to a suitable PCI center (experienced operator and team with a track record for a "door-to-balloon" time of <2 h), or there is an anticipated delay of at least 1 h between the time that fibrinolysis could be started versus implementation of PCI |
|
|
Term
| 5 absolute CIs to fibrinolytic therapy |
|
Definition
| history of cerebrovascular hemorrhage at any time, a nonhemorrhagic stroke or other cerebrovascular event within the past year, marked hypertension (a reliably determined systolic arterial pressure >180 mmHg and/or a diastolic pressure >110 mmHg) at any time during the acute presentation, suspicion of aortic dissection, and active internal bleeding (excluding menses). |
|
|
Term
| what % patients undergoing fibrinolysis with streptokinase experience an allergic reaction, mild hypotension? |
|
Definition
|
|
Term
| in what circumstances should Cardiac catheterization and coronary angiography be carried out after fibrinolytic therapy |
|
Definition
| (1) failure of reperfusion (persistent chest pain and ST-segment elevation >90 min), in which case a rescue PCI should be considered; or (2) coronary artery reocclusion (re-elevation of ST segments and/or recurrent chest pain) or the development of recurrent ischemia (such as recurrent angina in the early hospital course or a positive exercise stress test before discharge), in which case an urgent PCI should be considered |
|
|
Term
| killip classification for heart failure in the post MI hospital setting to determine risk of in-hospital death |
|
Definition
class I, no signs of pulmonary or venous congestion;
class II, moderate heart failure as evidenced by rales at the lung bases, S3 gallop, tachypnea, or signs of failure of the right side of the heart, including venous and hepatic congestion;
class III, severe heart failure, pulmonary edema; and
class IV, shock with systolic pressure <90 mmHg and evidence of peripheral vasoconstriction, peripheral cyanosis, mental confusion, and oliguria |
|
|
Term
| who should be prophylactically treated with ICD post MI |
|
Definition
patients who have had VT or VF more than 48 hours after initial presentation -
1. NYHA class II/III with LVEF 30-40%
2. NYHA class I with LVEF 30-35% |
|
|
Term
| what is the treatment of supraventricular arrhythmia in the post MI hospital setting |
|
Definition
digoxin if concurrent heart failure
CCB/BB - otherwise
electric shock - abnormal rhythm persists for >2 h with a ventricular rate >120 bpm, or if tachycardia induces heart failure, shock, or ischemia |
|
|
Term
| what is the treatment of bradycardia in post MI hospital settings |
|
Definition
| atropine (not isoproterenol) |
|
|
Term
| what treatment should be carried out in the post MI hospital patient with bradycardia d/t AV block and in what conditions |
|
Definition
| Temporary electrical pacing if it improves hemodynamics and its not an inferoposterior infarction with complete heart block associated with heart failure, hypotension, marked bradycardia, or significant ventricular ectopic activity |
|
|
Term
| how many days of hospitalization for uncomplicated STEMI |
|
Definition
|
|
Term
| long term treatment post MI |
|
Definition
BBs for at least 2 years and
statins, ACEi, aspirin, coumadin indefinitely |
|
|
Term
| medications that cause hypertension |
|
Definition
| High-dose estrogens, adrenal steroids, decongestants, appetite suppressants, cyclosporine, tricyclic antidepressants, monamine oxidase inhibitors, erythropoietin, nonsteroidal anti-inflammatory agents, cocaine |
|
|
Term
| 6 causes of wide pulse pressure d/t increased cardiac output |
|
Definition
a. Aortic regurgitation
b. Thyrotoxicosis.
c. Hyperkinetic heart syndrome.
d. Fever.
e. Arteriovenous fistula
f. Patent ductus arteriosus |
|
|
Term
| reasons to suspect renovascular disease as the cause of hypertension |
|
Definition
| severe or refractory hypertension, recent loss of hypertension control or recent onset of moderately severe hypertension, and unexplained deterioration of renal function or deterioration of renal function associated with an ACE inhibitor |
|
|
Term
| what is a screening test for renal artery stenosis |
|
Definition
OIH - renal blood flow
DTPA [99mTc]-diethylenetriamine pentaacetic acid (DTPA) scan - glomerular filtration rate before and after captopril |
|
|
Term
| what is a positive test on DPTA/OIH for renovascular hypertension |
|
Definition
| (1) decreased relative uptake by the involved kidney, which contributes <40% of total renal function, (2) delayed uptake on the affected side, and (3) delayed washout on the affected side |
|
|
Term
| what is the "gold standard" for evaluation and identification of renal artery lesions |
|
Definition
|
|
Term
| what % of the renal artery lumen need to be occluded in order to get hypertension |
|
Definition
|
|
Term
| what is the measure used to determine if a renal artery lesion causing hypertension would respond to vascular repair |
|
Definition
| A lateralizing renal vein renin ratio (ratio >1.5 of affected side/contralateral side) has a 90% predictive value |
|
|
Term
| what is the reason that Patients with fibromuscular disease have more favorable outcomes than do patients with atherosclerotic lesions |
|
Definition
| younger age, shorter duration of hypertension, and less systemic disease |
|
|
Term
what is the method of choice for surgical repair of renal artery atherosclerosis?
if this is not successful? |
|
Definition
PTRA
surgical revascularization or if or concomitant aortic surgery is required, e.g., to repair an aneurysm |
|
|
Term
| what is a good screening test for hyperaldosteronism as a cause of hypertension? |
|
Definition
| The ratio of plasma aldosterone to plasma renin activity (PA/PRA) |
|
|
Term
| which 3 drugs may affect the PA/PRA test for hyperaldosteronism |
|
Definition
| aldosterone antagonists, ARBs, and ACEi |
|
|
Term
| 3 confirmatory test for diagnosing hyperaldosteronism after PA/PRA |
|
Definition
| failure to suppress aldosterone in response to an oral/IV NaCl load, fludrocortisone, or captopril |
|
|
Term
| 4 possible lesions that may cause primary hyperaldosteronism |
|
Definition
adrenal adenoma
bilateral adrenocortical hyperplasia (idiopathic hyperaldosteronism)
adrenal carcinoma
ectopic malignancy, e.g., ovarian arrhenoblastoma |
|
|
Term
| what is the next step in the workup of a patient who's been diagnosed with primary hyperaldosteronism? |
|
Definition
| CT of the adrenals and if nothing is found adrenal scintography |
|
|
Term
| what is the first line therapy of hypertension (over 140/90) |
|
Definition
| a thiazide + [ACEi/ARB/BB] |
|
|
Term
| 4 conditions for which the BP goal is 130/80 |
|
Definition
| diabetes, coronary heart disease, chronic kidney disease, or additional cardiovascular disease risk factors |
|
|
Term
| which patients may benefit from reducing the systolic BP up to 120 |
|
Definition
| those with proteinuria 1g/d |
|
|
Term
| The term resistant hypertension refers to .... |
|
Definition
| patients with blood pressures persistently >140/90 mmHg despite taking three or more antihypertensive agents, including a diuretic, in a reasonable combination and at full doses. |
|
|
Term
| what is the BP goal for hypertensive encephalopathy treatment |
|
Definition
| The initial goal of therapy is to reduce mean arterial blood pressure by no more than 25% within minutes to 2 h or to a blood pressure in the range of 160/100–110 mmHg |
|
|
Term
| 3 drug options for the treatment of hypertensive encephalopathy |
|
Definition
| nitroprusside, labetalol, nicardipine |
|
|
Term
| in comparison to malignant hypertension with encephalopathy, what should be the treatment approach to malignant hypertesion w/o encephalopathy? |
|
Definition
| less aggressive using one of the following: captopril, clonidine, and labetalol. |
|
|
Term
| when should you start hypertensive treatment for patients with ischemic stroke that are not candidates for thrombolytic therapy? and for those who are? |
|
Definition
SBP>220 or DBP>130
undergoing thrombolysis: SBP>185 or DBP>110 |
|
|
Term
| when should you start antihypertensive therapy for patients with hemorrhagic stroke? |
|
Definition
|
|
Term
| whats the common site of TB aortic aneurysm |
|
Definition
|
|
Term
| whats the common site of syphilitic aortic aneurysm |
|
Definition
| ascending or arch of aorta |
|
|
Term
| which to vasculitides may cause aortic aneurysm and where? |
|
Definition
takayasu and giant cell arthritides
aortic arch and thoracic aorta |
|
|
Term
| the spondyloarthropathies may cause aortic aneurysms at what site |
|
Definition
|
|
Term
| which is the most common pathology associated with aortic arch and descending aortic aneurysms? what about ascending aorta |
|
Definition
atherosclerosis
cystic medial necrosis |
|
|
Term
| what are the indications for placement of a prosthetic graft in thoracic aortic aneurysm |
|
Definition
symptomatic thoracic aortic aneurysms, those in whom the ascending aortic diameter is >5.5–6 cm or the descending thoracic aortic diameter is >6.5-7 cm, and those with an aneurysm that has increased by >1 cm per year
in Marfan syndrome or bicuspid aortic valve, ascending thoracic aortic aneurysms >5 cm |
|
|
Term
| what is the recommended pharmacological treatment of thoracic aortic aneurysm |
|
Definition
|
|
Term
| over which size of abdominal aortic aneurysm does the risk of rupture increase incrementally |
|
Definition
|
|
Term
| is screening done for abdominal aortic aneurysm? |
|
Definition
| yes in men that have a history of smoking btwn the ages of 65-74 |
|
|
Term
| what should you do with the siblings and offsprings of patients who have been diagnosed with AAA or TAA or peripheral arterial aneurysms? |
|
Definition
| screen for AAA also in them |
|
|
Term
| 3 indications for surgical repair of AAA? |
|
Definition
| expanding rapidly, symptomatic or over 5.5 cm |
|
|
Term
| what is the ECG in aortic dissection? |
|
Definition
| normal, and this is a way to rule out acute coronary syndrome |
|
|
Term
| what is the goal of treatment for aortic dissection |
|
Definition
| reducing cardiac contractility and systemic arterial pressure, and thus shear stress. |
|
|
Term
| what is the medical treatment of aortic dissection |
|
Definition
| IV BB to reduce heart rate to 60 and IV nitroprusside to reduce SBP to 120 |
|
|
Term
| what are the indications for surgical repair of aortic dissection |
|
Definition
| acute ascending aortic dissections and intramural hematomas (type A) and for complicated type B dissections, including those characterized by propagation, compromise of major aortic branches, impending rupture, or continued pain |
|
|
Term
| what are the 3 parts of the surgical repair of aortic dissection |
|
Definition
| excision of the intimal flap, obliteration of the false lumen, and placement of an interposition graft |
|
|
Term
| what are the symptoms of Chronic Atherosclerotic Occlusive Disease |
|
Definition
| Claudication characteristically involves the buttocks, thighs, and calves and may be associated with impotence in males (Leriche syndrome) |
|
|
Term
| what is a non invasive test for peripherial artery disease |
|
Definition
| ankle:brachial index of blood pressure. in healthy over 1, in PAD less than 1 |
|
|
Term
| which drug may increase the distance of walking before onset of claudication |
|
Definition
| Cilostazol - phosphodiesterase inhibitor |
|
|
Term
| what test must be done in the definitive diagonosis of pulmonary hypertension |
|
Definition
|
|
Term
| which part of the cardiac catheterization helps determine if the patient with pulmonary hypertension is eligible for treatment with CCBs |
|
Definition
| drug testing with a short-acting pulmonary vasodilator to determine the extent of pulmonary vasodilator reactivity |
|
|
Term
| when administering a new drug for pulmonary hypertension, how should assessment of its efficacy be done? |
|
Definition
| Repeat assessments should be performed within 8 weeks of initiating a new drug, as patients who do not respond initially are not likely to respond with longer exposure |
|
|
Term
| which is the only combination therapy for pulmonary hypertension that has been proven to beneficial? |
|
Definition
| adding sildenafil to epoprostenol |
|
|
Term
| what is the name of the mechanism of restenosis which appears on bare metal stents more so than on drug eluting stents? |
|
Definition
|
|
Term
| is there an indication for PCI in stable angina? |
|
Definition
| no, only when symptoms worsen or evidence of severe ischemia on noninvasive testing occurs |
|
|
Term
| comparison of CABG vs. PCI with DES for three-vessel coronary disease or left main disease |
|
Definition
CABG - associated with higher rates of stroke
PCI+DES - associated with higher rates of revascularization procedures
mortality same |
|
|
Term
| what is the name of the mechanism of restenosis which appears on bare metal stents more so than on drug eluting stents? |
|
Definition
|
|
Term
| is there an indication for PCI in stable angina? |
|
Definition
| no, only when symptoms worsen or evidence of severe ischemia on noninvasive testing occurs |
|
|
Term
| is there an indication for PCI in stable angina? |
|
Definition
| no, only when symptoms worsen or evidence of severe ischemia on noninvasive testing occurs |
|
|
Term
| comparison of CABG vs. PCI with DES for three-vessel coronary disease or left main disease |
|
Definition
CABG - associated with higher rates of stroke
PCI+DES - associated with higher rates of revascularization procedures
mortality same |
|
|
Term
| what is The most common reason to decide not to do angioplasty, but to opt for CABG, |
|
Definition
| the presence of a chronic total occlusion (>3 months in duration). |
|
|
Term
| coronary lesion considered to be adequate for PCI and stent |
|
Definition
| proximal noncalcified subtotal lesion - "type A" |
|
|
Term
| patients with ACS at a high risk benefit from PCI - who is considered high risk in ACS |
|
Definition
| refractory ischemia, recurrent angina, positive cardiac-specific enzymes, new ST-segment depression, low ejection fraction, severe arrhythmias, or a recent PCI or CABG |
|
|
Term
| in which patients would you prefer bare metal stent over drug eluting stent/ |
|
Definition
low risk for restenosis: large vessels, non diabetic, focal lesion
CIs to drug eluting stents: medical non-compliance (dual anticoagulation for over 6 months), ACS-STEMI, chronic anticoagulation, anticipated surgery, high risk for bleeding |
|
|
Term
| how is mitral stenosis in pregnancy treated? |
|
Definition
|
|
Term
| what is a typical finding on auscultation of mitral stenosis |
|
Definition
| opening snap and accentuated S1 |
|
|
Term
| what is the treatment of VT after MI in a hemodynamically stable patient |
|
Definition
|
|
Term
| what is the diagnostic test for AAA? |
|
Definition
| CT with contrast or MRI (not US, which is used for screening) |
|
|
Term
| in the evaluation of CAD, when is the modality of choice either nuclear imaging or echocardiography? |
|
Definition
| resting electrocardiographic abnormalities, or if the patient has had prior coronary revascularization |
|
|
Term
| in the evaluation of CAD, what is the imaging modality of choice in a patient with LBBB, pacemaker or previous MI? |
|
Definition
|
|
Term
| when would you consider PET, in the evaluation of CAD? |
|
Definition
| morbidly obese or female with large/dense breasts |
|
|
Term
| absolute CI for stopping amiodarone |
|
Definition
|
|
Term
| which treatment reduces the ocurence of VF post MI |
|
Definition
|
|
Term
| what is the treatment of pulmonary artery hypertension that is responsive to adenosine on catheterization |
|
Definition
|
|
Term
| 3 ways to distinguish AS from HOCM |
|
Definition
1. valsalva or rapidly standing - increased murmur in HOCM and decreased in AS
2. beat after PVC - pulse pressure increases in AS and decreases in HOCM
3. carotid pulse - HOCM: bisferiens, jerky |
|
|
Term
| what sign on ECG with LBBB and RBBB suggests underlying ischemia? |
|
Definition
| concordance of the T wave to the last part of the QRS |
|
|
Term
| what would you find on auscultation of RBBB |
|
Definition
| wide splitting of S1 and S2 |
|
|
Term
| what is type A and type B aortic dissection? |
|
Definition
A - ascending aorta (BP higher in right arm and normal in left arm)
B- arch and descending aorta (BP normal in right arm and higher in left arm) |
|
|
Term
| what is the diagnosis method of choice for type A and type B aortic dissection? |
|
Definition
stable patient - type A: TTE, type B: MRI/CT/TEE
unstable patient: TEE |
|
|
Term
| Tx of aortic dissection w/o hypotension |
|
Definition
|
|
Term
| which drug is CIed in aortic dissection |
|
Definition
|
|
Term
| when is emergent/urgent surgical correction indicated in aortic dissection |
|
Definition
1. type A
2. type B with compromise of major aortic branches, impending rupture, or continued pain |
|
|
Term
| what is the long term treatment of patients with aortic dissection and intramural hematomas (w or w/o surgery) |
|
Definition
| BB and either ACEi or CCB |
|
|
Term
| what is the follow up regimen of aortic dissection |
|
Definition
| contrast CT/MRI every 6-12 months |
|
|
Term
| which treatment is most beneficial for decreasing complications following CABG |
|
Definition
|
|
Term
| claudication - a patient with leg pain while walking that goes away when resting. how is the diagnosis made? |
|
Definition
| ankle-brachial index test |
|
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Term
|
Definition
|
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Term
|
Definition
| left ventricular systolic dysfunction |
|
|
Term
| pulsus parvus et tardus - pulse is weak/small (parvus), and late (tardus) |
|
Definition
|
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Term
|
Definition
| high systemic resistance or low cardiac output |
|
|
Term
| CIs to elective cardiac catheterization |
|
Definition
| decompensated CHF; ARF; severe chronic renal insufficiency, unless dialysis is planned; bacteremia; acute stroke; active gastrointestinal bleeding; severe, uncorrected electrolyte abnormalities; a history of an anaphylactic/anaphylactoid reaction to iodinated contrast agents; and a history of allergy/bronchospasm to aspirin |
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|
Term
| which drug for HTN can cause constrictive pericarditis |
|
Definition
|
|
Term
| drugs that can cause pericarditis and pericardial effusion |
|
Definition
| procainamide, hydralazine, isoniazid, minoxidyl, anticoagulants, phenytoin |
|
|
Term
| T wave inversion in all precordial leads in a young athletes - what do you do? |
|
Definition
| echo to r/o hypertrophic cardiomyopathy |
|
|
Term
| what effect does amiodarone have on P450 |
|
Definition
|
|
Term
| which drug decreases Intestinal cholesterol absorption by LDL receptors |
|
Definition
|
|
Term
| which drug for lowering cholesterol increases LDL receptors in liver |
|
Definition
| statins and bile acid sequestrants |
|
|
Term
| which drugs decrease VLDL production |
|
Definition
|
|
Term
| what is the mechanism of fibrates for lowering VLDL |
|
Definition
|
|
Term
| what is the follow up needed for patients on ezetimibe |
|
Definition
|
|
Term
| Tx of WPW + AF in a hemodynamically stable patient |
|
Definition
| procainamide or ibutilide |
|
|
Term
| Tx of WPW + AF in a hemodynamically unstable patient |
|
Definition
|
|
Term
| treatment of QT prolonging drug leading to pause-dependent polymorphic VT |
|
Definition
| stop drug. correct Mg + K. emergency pacing to prevent pauses |
|
|
Term
| infective endocarditis within 2 months of prosthetic valve replacement |
|
Definition
| S. aureus, CoNS, facultative gram-negative bacilli, diphtheroids, and fungi |
|
|
Term
| Transvenous pacemaker– or implanted defibrillator–associated endocarditis |
|
Definition
|
|
Term
| treatment of pulmonary edema |
|
Definition
positive pressure ventilation, diuretics, nitrates, morphine, ACEi
if underlying cardiogenic cause can add: IV BNP (nesiritide), positive ionotropes (dopamine, dobutamine), intra aortic balloon pump |
|
|
Term
| when is intra aortic balloon pump indicated in pulmonary edema |
|
Definition
| caused by severe mitral regurgitation or ventricular septal rupture |
|
|
Term
| what distinguishes the murmur in HOCM from AS |
|
Definition
| when afterload increases HOCM decreases (such as with squatting or hand gripping) |
|
|
Term
| which treatment may help in hypertrophic cardiomyopathy if beta blockers, verapamil and diuretics do not control the symptoms |
|
Definition
|
|
Term
| which treatment can help reduce the risk of sudden death in hypertrophic cardiomyopathy |
|
Definition
|
|
Term
| the murmur in MVP behaves like... |
|
Definition
|
|
Term
| what is a treatment for pain and palpitations in MVP |
|
Definition
|
|
Term
| 2 CIs for intra aortic balloon pump |
|
Definition
| aortic regurgitation, aortic dissection |
|
|
Term
| 3 valvular abnormalities that cause syncope |
|
Definition
| mitral valve prolapse, bicuspid aortic valve, aortic stenosis |
|
|
Term
| how is the diagnosis of acromegaly made |
|
Definition
| first serum IGF1, to confirm- GH suppression by glucose |
|
|
Term
|
Definition
| תנועה סיסטולית קדמית של עלה המסתם המיטרלי SAM + היפרטרופיה משמעותית של הספטום + חסימת מוצא חדר שמאל בסיסטולה |
|
|
Term
| treatment of patient post-MI with sustained VT that has past? |
|
Definition
|
|
Term
| conditions that predispose to AIVR |
|
Definition
| acute myocardial infarction (MI), cocaine intoxication, acute myocarditis, digoxin intoxication, and postoperative cardiac surgery |
|
|
Term
| what is the treatment of sustained AIVR associated with bradycardia (usually in the setting of RV infarction associated with proximal right coronary artery occlusion) |
|
Definition
|
|
Term
| what is the MC pathogen involved in prosthetic valve infective endocarditis within a year after the replacement |
|
Definition
|
|
Term
| what is the MC pathogen involved in prosthetic valve infective endocarditis a year after replacement and there after |
|
Definition
|
|
Term
| what is the MC arrhythmia in digoxin intoxication |
|
Definition
| SVT with alternating AV blockטכיקרדיה עלייתית עם חסם AV משתנה |
|
|
Term
| mitral stenosis can cause recurrent PE - emboli to be lodged in the pulmonary system |
|
Definition
|
|
Term
| how do you diagnose brugada syndrome in a patient with an unequivocal ECG - saddleback ST elevations |
|
Definition
| procainamide challenge to elicit the classic pattern |
|
|
Term
| what is the management of recurrent VT in brugada syndrome |
|
Definition
| isoproterenol or quinidine administration |
|
|
Term
| what are the indications for ICD implantation in brugada |
|
Definition
| documented arrhythmia episodes and patients with syncope and positive spontaneous or provoked coved-type ECG ST-segment changes in V1–V3 |
|
|
Term
|
Definition
|
|
Term
| malignant hypertension - 4 clinical manifestations |
|
Definition
| encephalopathy, retinopathy, deteriorating renal function with proteinuria, microangiopathic hemolytic anemia |
|
|
Term
| what happens to A2 in severe aortic stenosis? |
|
Definition
|
|
Term
| murmur at beginning of diastole |
|
Definition
|
|
Term
|
Definition
|
|
Term
| relative contraindications of beta blockers in ischemic heart disease |
|
Definition
| asthma, AV block, severe bradycardia, Raynaud's phenomenon, mental depression |
|
|
Term
| when are BB contraindicated in CHF |
|
Definition
| acute decompensation of CHF |
|
|
Term
| when does MR complicate MI |
|
Definition
|
|
Term
| which electrolyte disturbance causes long QT syndrome |
|
Definition
| hypokalemia, hypomagnesemia, hypocalcemia |
|
|
Term
| which drugs cause long QT |
|
Definition
anti-arrhythmics: quinidine, amiodarone, sotolol, procainamide
antihistamines, macrolide-erythromycin, fluoroquinolones, TCA, domperidone, antipsychotic - halidol, methadone |
|
|
Term
| digoxin does not cause long QT |
|
Definition
|
|
Term
| risk factors for torsadess de pointes |
|
Definition
| subarachnoid hemorrhage, hypothermia, female sex, bradycardia, LVH, HF, acidosis, hypoxia, hypokalemia, hypocalcemia, hypomagnesemia, erythromycin, TCA, methadone, haloperidol, anti arrhythmic class 3 and 1A, diuretics (hypokalemia) |
|
|
Term
|
Definition
| perform EPS - if VT implant ICD |
|
|
Term
| what is the initial treatment for CHF |
|
Definition
| ACEi or diuretics (depending if there's fluid retention |
|
|
Term
| what is the indication for CRT in CHF |
|
Definition
|
|
Term
| non bacterial causes of pericarditis |
|
Definition
| NSAIDs, colchicine, steroids |
|
|
Term
| secondary prevention of pericarditis |
|
Definition
|
|
Term
| when does DCM become symptomatic |
|
Definition
|
|
Term
| hypothyroidism doesn't cause increase activity of coumadin |
|
Definition
| fever, malignancy, CHF, and advanced age do |
|
|
Term
| aortic stenosis heart sounds |
|
Definition
A2 low or absent
duration of murmur correlates with severity of stenosis
midsystolic murmur |
|
|
Term
| suspected aortic dissection and chronic coumadin therapy within the therapeutic range are both CIs to fibrinolysis |
|
Definition
|
|
Term
| acute VSD is an indication for intra aortic balloon pump |
|
Definition
|
|
Term
| diet for essential hypertension |
|
Definition
low sodium
high potassium and calcium |
|
|
Term
| the first marker to increase in MI |
|
Definition
|
|
Term
|
Definition
| worsening HF or ventricular arrhythmia |
|
|
Term
| most sensitive test for aortic dissection |
|
Definition
|
|
Term
|
Definition
|
|
Term
| test for severity and duration of BP |
|
Definition
|
|
Term
| in which prosthetic heart valve is bridging therapy with clexane ineffective |
|
Definition
|
|
Term
| DES - more rethrombosis, BMS - more restenosis |
|
Definition
|
|
Term
| CIs to use of dobutamine in stress test |
|
Definition
| אסטמה, COPD, ל"ד נמוך (90/60), שימוש בקפאין / תיאופילין לפני הבדיקה, 2nd / 3rd degree AV block או sick sinus syndrome. |
|
|
Term
| signs of pulmonary hypertension |
|
Definition
| קוצ"נ במאמץ, עייפות, אנגינה פקטוריס, סינקופה ובצקת פריפרית |
|
|
Term
| when do you see permanent canon a waves and when - temporary ones? |
|
Definition
permanent - junctional rhythm
temporary - complete AV block, A-V dissociation with VT |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| what finding indicates severe AS |
|
Definition
| הפיק של האיוושה מאוחר יותר |
|
|
Term
|
Definition
| חסמי בטא יכולים להוריד תדירות סינקופה ואנגינה פקטוריס בעת ל50 אחוז, אך לא מוריד SCD |
|
|
Term
| role of amiodarone in HCM |
|
Definition
| אמיודרן כנראה אפקטיבי בהורדת תדירות SVT והפרעות קצב חדריות וייתכן השפעה כל SCD |
|
|
Term
|
Definition
| CCB מסוג נונדיהידרו-דילטם וורפמיל –מוריד נוקשות של החדר-מעלה סבילות למאמץ |
|
|
Term
|
Definition
| מדיגוקסין, משתנים, ניטריטים, CCB מסוג דיהידרו, וואזודילטורים, בטא אגוניסט |
|
|
Term
| in the treatment of MI d/t cocaine use, which routine drug is omitted from treatment |
|
Definition
|
|
Term
| conditions of cannon a wave - atrium contracts against resistance |
|
Definition
o TS
o יל"ד ריאתי
o PS
o הפרעות קצב בהם העליה הימנית מתכווצת בעוד המסתם הטריקוספידאילי סגור. כמו VT , AV BLOCK שלם, AV DISSOCIATION |
|
|
Term
|
Definition
|
|
Term
|
Definition
• לרוב החולים יש פלאק לא חסימתי כ1 ס"מ לפני הספאזם
יכול להיות טרופונין
צעירים ומעשנים
• טיפול –ניטרטים ו-CCBבעיקר דה-הידרו. אספירין יכול להחמיר
שכיח יותר בright coronary |
|
|
Term
| apart from being a class 3 antiarrhythmic, amiodarone is also.... |
|
Definition
|
|
Term
| apart from being a class 1 antiarrhythmic, quinidine is also a... |
|
Definition
|
|
Term
| indications for intraaortic balloon pump |
|
Definition
• שוק קרדיוגני
• סיבוכי MI כמו קרע של ספטום או MR
• UA
• ועוד |
|
|
Term
|
Definition
הרוב זכרים
• בעולם המערבי הסיבה השכיחה ביותר היא הסתיידות תלויית גיל.
• הרבה פעמים, גם בחולים הקשים, הCO במנוחה הוא בגבולות הנורמלים הרי שהוא לא מצליח לעלות באופן נורמלי בזמן מאמץ.
o דיספנאה במאמץ-מוות תוך שנתיים
o אנגינה-בדכ מתפתח מאוחר יותר-מוות תוך 3 שנים
o סינקופה במאמץ –מוות תוך 3 שנים
o אין סימני CO נמוך כמו חולשה, כחלון וכחקציה עד שלב מתקדם כי CO נשמר לרוב במנוחה
סימני אי ספיקה שמאלית וימנית נראה בשלבים מתקדמים-מוות תוך שנה וחצי
THRILL סיסטולי בבסיס הלב, בסופרסטרנל נוטצ' ולאורך הקרוטידים
o הסתיידות מפחיתה את הקול של סגירת מסתם אאורטלי
o קול S4 באפקס-משקף את ההיפרטרופיה
o קול S3 בדרך כלל מופיע בשלב מאוחר כאשר הLV עובר התרחבות משמעותית
האוושה נשמעת הכי טוב בבסיס הלב במרווח בינצילעי שני מימין
להמנע מפעילות גופנית בחולים עם מחלה קשה גם בשלב אסימפטומטי
אלו עם הרחבה או אנוריזמה בשורש האאורטה עם קוטר מקסימלי מעל 4.5 או עליה שנתית בקצב של מעל ל0.5 ס"מ לשנה, גם אם אסימפטומטים |
|
|
Term
| CIs for elective cardiac catheterization |
|
Definition
• היפוקלמיה לא נשלטת
• איריטבליות חדרית לא נשלטת
• יל"ד לא מאוזן
• מחלת חום חריפה
• אי ספיקת לב לא מאוזנת
• PTT מעל 18
• רגישות לחומר ניגוד
• אי ספיקת כליות חמורה ,אלא אם כן מתוכנן דיאליזה |
|
|
Term
| CIs for BB in acute STEMI |
|
Definition
o ברדיקרדיה מתחת ל60
o לחץ סיסטולי מתחת ל100
o PR מעל 0.24 שניות
o חירחורים בריאות שיותר מ10 ס"מ מעל לסרעפת (אי ספיקה קשה או הפרעה קשה בתפקוד LV)
o גם תת לחץ דם אורטוסטטי
o מחלת ריאות קשה |
|
|
Term
| מי צריך קומדין לאחר STEMI |
|
Definition
• אוטם קדמי
• הפרעה קשה בפעילות חדר שמאל
• אי ספיקת לב
• היסטוריה של תסחיפים
• עדות באקו לטרומבוס מוראלי
• AF
• כל אלו יקבלו טיפול תרפואטי מלא בקלקסן או הפרין בזמן אשפוז ולאחר מכן לפחות 3 חודשי קומדין
• טרומואמבוליזם מסבך 10 אחוז מהSTEMI |
|
|
Term
| • מבחן מאמץ לא מייצג טוב את עורק הCX |
|
Definition
|
|
Term
|
Definition
o אנגינה במנוחה ב48 שעות אחרונות
o קצב לב לא יציב
o AS קשה
o מיוקרדיטיס
o אי ספיקת לב לא מאוזנת
o יל"ד ריאתי קשה
o אנדוקרדיטיס פעיל |
|
|
Term
| למי מבחן מאמץ סטנדרטי לא יעיל ועדיף מיפוי עם טליום/טכניציום במהלך מבחן מאמץ או מבחן פרמקולוגי |
|
Definition
o Preexcitation syndrome
o LBBB
o Paced ventricular rhythm -קוצב
o מעל 1 מ"מ של ירידה בst במנוחה
o WPW |
|
|
Term
| relative CIs for fibrinolysis |
|
Definition
| שימוש בנוגדי קרישה, פרוצדורה ניתוחית/חודרנית בשבועיים האחרונים,צורך בהחייאה קרדיופולמונרית ממושכת מעל 10 דקות בשבועיים האחרונים,נטייה ידועה לדמם, הריון, דימום עיני, מחלה פפטית פעילה, היסטוריה של ל"ד שכעת מאוזן |
|
|
Term
|
Definition
| מעכב פוספודיאסטראז 3 . יש לה אפקט סינרגיסטי עם אגוניסטים לרצפטורי בטא וכנראה עדיפה בחולים המטופלים בחסמי בטא. יותר אפקטיבית מדובוטומין ומאפשרת הורדה רבה יותר בלחצי מילוי של חדר שמאלי-יותר סיכוי ללחץ דם |
|
|
Term
| different doses of dopamine |
|
Definition
| • מינון נמוך של דופמין-מגרה רצפטור דופמנירגי וגורם לואזודילטציה של כלי דם כלייתים וספנכניקים. במינון בינוני מגרה בטא 2 וגורמים לעליה בCO עם שינוי מזערי בקצב לב או SVR. מינון גבוה-בעיקר דרך אלפא 1 וגורם לואזוקונסטריקציה שגורמת לעליה בSVR , עליה בלחצי מילוי של חדר שמאל ועליה בקצב לב |
|
|
Term
| what is the pharmacological treatment of arrhythmogenic right ventricular dysplasia |
|
Definition
| Sotalol, a beta blocker and a class III antiarrhythmic agent, is the most effective antiarrhythmic agent in ARVD |
|
|
Term
| Stress testing is recommended for low risk patients (table 2) with suspected ACS without recurrent ischemic discomfort after at least six to eight hours of observation if follow-up 12 lead ECG is normal or unchanged from previous tracings and two troponin levels at least six hours apart are normal - stress testing with imaging (either rMPI or echocardiography) is recommended for the following Patients who have an uninterpretable ECG for ischemia |
|
Definition
| LBBB, ventricular paced rhythm, LVH with strain pattern, or digoxin therapy |
|
|
