Board Basics: Cardiology IV

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1. IE or chordae tendineae rupture Causes of 10. Dx: Mitral regurg 63 y.o.

acute mitral Rx: Surgery - mitral valve repair or asymptomatic
regurg (2) replacement man found to
have MR on
2. Sudden shortness of breath, hypotension, Presentation
physical
shock of acute MR
exam. EF is
3. ... Presentation 52% and LV
of chronic MR filling
4. http://www.wilkes.med.ucla.edu/Systolic.htm Physical pressure is 52
Murmur: systolic at apex, radiating to apex findings in MR mm Hg. Dx?
or base Murmur Rx?
Other heart findings: S3, strong apical Other heart 11. Embolic events MVP usually
impulse, widely split S2, increased P2 findings Chest pain, palpitations, syncope asymptomatic,
Left sided HF HF? MR (most common cause) but when it is
5. IE Chronic MR symptomatic:
Mitral valve prolapse causes 12. Loud systolic click followed by late systolic MVP murmur
HCM murmur - systolic?
Marfan Location: apex. diastolic?
prolonged use of egotamine http://www.wilkes.med.ucla.edu/Systolic.htm Location
6. LVEF<60% or LV end diastolic volume Indication for 13. ECHO. Ambulatory ECG for arrhythmias Diagnosis of
>40mm surgery in MVP
asymptomatic
14. Treatment of CP or anxiety: beta-blockers Treatment of
MR
Unexplained TIA: ASA for MVP and MVP -
7. (1) PAH Symptomatic unexplained TIA and no thrombi medical
(2) Afib MR is cause Multiple TIA: Warfarin for multiple TIAs Treatment of
for repair. despite ASA cp or anxiety:
Name 2 other Unexplained
diseases TIA
which indicate Multiple TIA
repair of MR
15. significant MR, chordae elongation Indications for
8. Medical therapy for HF. Surgical surgery in
Reduce filling pressures with nitrates or repair (not MVP
nitroprusside. replacement
16. Lifestyle modifications, reassurance 28 year old
Inotropes: IABP or other inotropes in is preferred,
has
hypotension but place for
palpitations.
medical
Physical exam
therapy in MR.
normal
Medical
except for
treatment
isolated click.
9. Don't slow disease progression Use of ACE ECHO shows
and ARB in mild MR and
MR or MS 24 hour ECG
shows 728
monomorphic
PVCs.
Treatment?
17. (1) Marfan syndrome 3 causes of
(2) Epstein anomaly (tricuspid valve and R primary
ventricle) tricuspid
(3) AV canal malformation regurgitation
18. (1) IE 4 secondary causes of 33. ASD. R axis
(2) carcinoid TR deviation, partial
(3) Pulmonary hypertension RBBB (QRS not
(4) Rheumatic fever quite 120ms)
19. Holosystolic at LLSB Murmur. What? Where?
20. Echo Diagnosis of TR
Identify, describe
21. only if other cardiac surgery Treatment of TR
34. Ostium secundum Most common ASD is an isolated event:
planned
35. Partial RBBB, Left Describe ASD ostium primum ECG
22. physiologic. Doesn't require Mild or less severe
axis deviation, 1st
treatment TR:
degree block
23. TEE - suspect valve malfunction Following valve
36. Valve clefts --> Associated with Primum defects
replacement surgery,
regurgitation.
patient develops HF,
Sometimes VSD
emboli, and new
hemolytic anemia with 37. Right atrial or Indications for ASD Closure
schistocytes. Next? ventricle
enlargement,
24. INR 2.0-3.0 Anticoagulation goal
large L->R shunt,
for mechanical aortic
dyspnea or
valve
paradoxical
25. INR 2.5-3.5 INR goal for embolism
mechanical mitral
38. percutaneous Method of secundum closure
valve
device closure
26. 4-5 days before procedure When to stop
39. surgery Method of primum ASD closure
anticoagulation before
surgery or dental 40. generally well ASD in pregnancy
work? tolerated absent
PH
27. Cataracts Which procedure does
not require 41. R->L shunt Contraindication to ASD closure
anticoagulant 42. Follow clinically Treatment of small ASD without
stoppage? enlargement or symptoms
28. Prosthetic mitral valve, multiple What constitutes high 43. Dx: ASD
prosthetic valves, previous risk for thrombosis (secundum)
thrombosis, AF
29. Stop warfarin 4-5 days before Surgical management
surgery. Start inpatient heparin 24 for those at high risk
hours after procedure. Resume for thrombosis
warfarin and stop heparin when
INR has been therapeutic for 24 26 y.o. pregnant woman asymptomatic
hrs with new murmur. R parasternal lift,
30. None. Only warfarin for valvular NOAC use in normal S1, fixed splitting S2, 2/6
anticoagulation prosthetic valves systolic murmur at LUSB. This EKG. Dx

31. Fixed split S2, tricuspid diastolic Murmur of ASD

flow murmur,
32. Right axis (SR) ; Primum - L axis In Ostium secundum
Mnemonic: "PLease SIR" defect, what is axis? In
primum defect?
44. Aortic 55. R-->L shunt Contraindication
coarctation. to PDA closure
Figure 3, rib
56. 30% Prevalence of
notching
patent foramen
Confirmed by
ovale
MRA
Susceptible 57. agitated saline or color flow doppler Diagnosis
demographic: 58. Treat with antiplatelet meds (ASA) only Treatment?
immigrants after cryptogenic stroke. (Don't treat on Timing?
incidental discovery).
Identify, describe. How is diagnosis 59. Data insufficient for recommendation Indication for
confirmed? closure of PFO
Susceptible demographic
60. (1) Progressive aortic or tricuspid Indications for
45. Bicuspid aortic Associated with 50% of coarctation regurgitation closure of VSD
valve patients (2) Recurrent IE
46. Htn, unequal leg Coarctation -- clinical presentation (3) Recurrent volume overload
bp, 61. R --> L shunt Contraindication
47. Balloon dilatation. Treatment? Indications? to closure of
Indications: large VSD
Pressure gradient 62. HIghest risk: IE prophylaxis:
>20 mm Hg, Prosthetic valve patient
proximal htn HIstory of IE characteristics
48. Htn (75% of What commonly happens after Unrepaired cyanotic heart defect (4)
patients) coarctation repair? Valvulopathy following cardiac
transplantation
49. Dx: coarctation of *35 y.o. female immigrant gets leg
aorta with cramps and cold feet when walking 63. (1) Acquired valvular dysfunction (e.g., IE prophylaxis:
associated long distances. BP is 160/95. rheumatic fever) patients at
bicuspid valve. Auscultation : (2) HCM moderate risk
early systolic click, systolic murmur (3)
URSB. Dx? Management?* 64. Highest risk procedures IE prophylaxis:
50. AS murmur and Auscultation of coarctation with bileaflet Dental procedures with mucosal procedure (4)
ejection click and AV bleeding
systolic murmur GI, GU, or skin infections
Cardiac valve replacement surgery
51. Obtain bp in legs Young person with unexplained
--if substantially hypertension. Next? 65. Only patients at high risk AND Who should
lower than arms it undergoing high risk procedures receive IE
suggests aortic prophylaxis?
coarctation
52. PDA Machinery murmur below L clavicle
53. Large defect with Indications for closure of PDA
L->R (not R->L)
shunt. Small PDA
may be watched
54. Eisenmenger
syndrome (PH
with shunt
reversal R-->L).
Differential
cyanosis (feet
more cyanotic,
than hands)
Identify
66. Janeway lesions 71. focal neurological signs -- IE neurologic symptoms
IE septic emboli
72. perivalvular abscess In IE, what does an ECG
conduction abnormality
suggest?
73. TTE - low probability IE Indication for TTE, TEE
TEE - high probability IE,
and especially S. aureus
bacteremia
74. (1) Blood cultures with Major duke criteria (3)
compatible organism
(2) New valvular
regurgitation
Identify
(3) Echo positive
67. Osler nodes - IE
75. (1) Predisposing heart Duke minor criteria (5)
condition or IV drug use
(2) Fever
(3) Immunologic criteria GN
or RF positive
(4) Emboli
(5) BC positive for unusual
organism
76. (1) 2 major criteria Required for IE diagnosis
(2) 1 major and 3 minor
criteria
Identify
77. colon cancer Strep bovis or Clostridium
68. Roth spots - IE septicum endocarditis
suggest what?
78. no Endocarditis prophylaxis for
MVP or other low risk
characteristics?
79. Yes, low risk patieint, high Endocarditis prophylaxis for
risk procedure MVP and GU?
80. (1) Valvular dysfunction, HF Indications for surgery in IE
(2) Fungal or highly
resistant organism
infections
Identify
(3) Heart block
69. Septic emboli -IE (4) Annular abscess
(5) S. aureus prosthetic
valve endocarditis
(6) Systemic embolization
on antibiotics
81. Vancomycin (or unasyn) + Empiric IE therapy: community
gentamycin acquired
82. Vanc + gent + rifampin + Empiric IE therapy:
anti-pseudomonal nosocomial
Identify 83. Vanc + gent + rifampin Empiric IE therapy: Prosthetic
70. new murmur, new IE cardiac symptoms - heart valve IE
conduction 84. Usually 4-6 wks. Can be 2 Length of treatment
defect, CHF wks with R sided MSSA
85. first degree relatives of people Who should be 99. Aortic atheroma.
who have familial TA syndromes: screened for Treat
Turner, Familial, Marfan, Bicuspid THORACIC aneurysm? aggressively as
valve, Loeys-Dietz cardiac risk factor
with antiplatelets
86. hoarseness Some unexpected
and statins
dysphagia presentations of
recurrent pneumonia dissecting thoracic
SVC aneurysm
87. Marfan, cocaine Risk factors in younger Identify. Management
patients (2) 100. hydralazine Medicine contraindicated in acute
88. incidental Discovery of most (increases shear aortic dissection
thoracic aneurysms forces)

89. Type A - ascending aorta to the R Type A thoracic 101. Involvement of When should surgery for Type B TAA
subclavian takeoff aneurysm. Type B major aortic be scheduled?
Type B - from the R subclavian vessels
takeoff to the diaphragm 102. Dx: acute
90. immediate surgery Treatment of type A thoracic
aneurysm
91. medical management Treatment of type B
dissection of arch
92. chest pain radiating to back. HF, Presentation of thoracic Treatment: beta
AR, BP differential between the aneurysm (4) blocker,
arms nitroprusside,
93. stroke (carotid dissection), cardiac Serious complications (maybe
tamponade, thromboembolism of TAA enalaprilat or
fenoldopam),
94. MRA, TEE (if pat can't be moved) Diagnosis of TAA emergent
95. Dx: dissecting TAA with extension 50 y.o. man evaluated imaging. [Arch
to the R carotid for searing CP and L because of bp 73 y.o. man has 1 hour history of
sided hemiparesis. differential] severe, tearing substernal chest pain
96. Men > 55 mm (>50 in Marfan) Prophylactic surgery in BP 90/60 R arm. BP 130/70 L arm. This
Women: >45 mm TAA - Type B : Aortic CXR. Dx? Treatment?
Growth rate > 5 mm/year diameter for men, 103. Men 65-75 who Who should be screened for AAA?
women, growth rate have ever
97. Beta-blocker, nitroprusside, Drugs used in acute smoked. Men
enalaprilat (ace), fenoldopam dissection with FH of AAA

98. Annual echo Surveillance of thoracic 104. NO *Should women be screened for AAA?
aneurysm not needing 105. History and Diagnosis of AAA
surgery physical,
confirmed by
MRA or Contrast
CT
106. (1) > 5.5 cm AAA indications for surgery
(2) growing > 0.5
cm/ year
(3) symptomatic
107. 4-5 cm: US every Surveillance for AAA: 4-5 cm, smaller
6 months
smaller: US every
2-3 years
108. Hollenhorst 122. US How to locate the location embolism in acute
plaque ischemia
(pathognomonic
123. cilostazol Med used for symptomatic PAD if there's
for atheroemboli)
no HF hx
Associated with
aortic 124. BP<140/90 Medical treatment of PAD
atheroemboli Antiplatelet
- ASA
preferred
High
intensity
statin
therapy
Cilostazol
Identify. Associated with...
for
109. livedo reticularis, Physical findings suggestive of symptomatic
blue toes, atheroembolic disease PAD
transient vision Ramipril to
loss reduce risk
of death in
110. Aortic or cardiac Setting in which atheroembolisms may
PAD
surgery. occur
Catheterization 125. (1) Stop Best two ways to reduce symptoms of
smoking PAD1
111. thrombocytopenia, Hematologic findings c/w atheroemboli
(2)
eosinophilia (2)
Supervised
112. skin biopsy Procedure for confirmation of exercise
atheroembolic disease program
113. Dx: 67 y.o. man has AKI 10 days after a 126. angioplasty Pt with PAD has nonhealing ulcer.
atheroembolism. coronary catheterization. B/P 168/100. Management?
Order skin biopsy Bruits present over femoral and
127. OK Beta blockers in PAD?
to diagnose abdominal arteries. Legs have lacy,
Treatment: good purplish discoloration. Dx? 128. Begin 60 y.o. man has history of claudication of
control of all CV cilostazol -- both thighs and calves. ABI is 0.60 on L and
risk factors if it fails, 0.55 on R. Symptomatic despite an
then surgery intensive lifestyle management program.
114. Insufficient Screening for PAD?
perhaps Rx
evidence
129. AD
115. (1) smoking( Risk factors for PAD
Four: heart,
(2) age
skin, neuro,
(3) cholesterol
endocrine
(4) Htn
116. Spinal stenosis Pain that occurs when standing and
resolves with sitting (flexing the spine),
often bilateral
117. PAD ABI < 0.9
118. Normal ABI 0.9-1.40
119. Ischemic rest pain ABI < 0.4
Carney complex. Inheritance, how many
120. False negative. ABI > 1.40 Dx? Next?
organ system tumors?
Brachial toe
121. Pain 5 Ps of PAD
Paresthesia
Pallor
Pulselessness
Paralysis
130. Carney complex: Symptom complex including atrial myxomas
Atrial myxomas
blue nevi
schwannomas
endocrine tumors
131. MS + tumor "plop" Auscultation of of myxoma
132. Pedunculated tumor arising from L atrium Form and location of atrial myxoma
133. Risk of embolization and sudden death Why should they be resected? (2)