Mksap 16 Q&a Cardiology

Front 1

subjects included in the RALES study

Back 1

NYHA class III-IV heart failure and ejection fraction 35% or below, serum potassium level 5.0 meq/L (5.0 mmol/L) or below, and creatinine level 2.5 mg/dL (221 µmol/L) or below

Front 2

trial showed reduced risk of death and of hospitalization in patients with mild systolic heart failure (NYHA class II) who were randomized to the aldosterone blocker eplerenone versus placebo

Back 2

Eplerenone in Mild Patients Hospitalization and Survival Study in Heart Failure (EMPHASIS-HF)

Front 3

when to pick stress echo over exercise EKG?

Back 3

if with EKG abnormalities

Front 4

eponym for JVD with inspiration

Back 4

Kussmaul sign

Front 5

AF post MI, drug of choice

Back 5

amiodarone

Front 6

when does CABG have a survival benefit over medical therapy?

Back 6

left main disease, three-vessel disease with left ventricular systolic dysfunction, or multivessel disease with involvement of the proximal left anterior descending coronary artery

Front 7

which types of murmurs need echo?

Back 7

loud systolic murmur (≥3/6 in intensity) or any diastolic or continuous murmur

Front 8

when is transcatheter aoritic valve implantation indicated?

Back 8

if operative mortality is >50%

Front 9

name the infiltrative cardiomyopathies

Back 9

sarcoidosis, amyloidosis, hemochromatosis

Front 10

Transfer for primary PCI is a reasonable alternative to thrombolytic therapy in the setting of absolute contraindications to thrombolytic therapy or high-risk clinical features and if an acceptable time to transfer the patient to a PCI-capable hospital can be achieved

Back 10

(door to balloon time of 90 minutes or less)

Front 11

the recombinant form of the 32 amino acid human B-type natriuretic peptide, which is normally produced by the ventricular myocardium

Back 11

nesiritide (Natrecor)

Front 12

hip surgery patient with mech valve on warfarin, stopped 3 days before and no bridging given - what is the reasoning behind this recommendation?

Back 12

although annual risk of thromboembolic event is high, short term risk is low

Front 13

implication of murmur that increases with inspiration

Back 13

right sided murmur (Caravallo's sign)

Front 14

cardiac risk score for younger women

Back 14

Reynolds risk score

Front 15

first-line treatment for a hemodynamically stable VT

Back 15

IV antiarrhythmic s.a. amiodarone

Front 16

what is Ebstein anomaly

Back 16

a congenital heart defect in which the septal leaflet of the tricuspid valve is displaced towards the apex of the right ventricle of the heart.

Front 17

Nine risk factors strongly associated with acute MI in the INTERHEART study

Back 17

descending order: dyslipidemia, smoking, psychosocial stressors, diabetes mellitus, hypertension, obesity, alcohol consumption, physical inactivity, and diet low in fruits and vegetables

Front 18

six potentially lethal conditions (the “serious six”) of chest pain

Back 18

acute coronary syndrome, pericarditis with tamponade, pulmonary embolism, pneumothorax, aortic dissection, and esophageal rupture

Front 19

When is biventricular pacemaker for CRT indicated?

Back 19

left ventricular ejection fraction of 35% or below, New York Heart Association (NYHA) functional class III or IV heart failure, a QRS interval of 120 msec or greater, and on optimal heart failure medications

Front 20

AHA guidelines, for NSTEMI or UA treated medically, how long should clopidogrel be given?

Back 20

at least 1 month and ideally for up to 1 year.

Front 21

When is ranolazine contraindicated?

Back 21

prolonged QT

Front 22

complications of PCI

Back 22

hematoma formation at the arterial puncture site, pseudoaneurysm, arteriovenous fistula, cholesterol emboli syndrome, and retroperitoneal bleeding

Front 23

what to look for in PMH of patient with constrictive pericarditis?

Back 23

chest irradiation, connective tissue disease, kidney failure, malignancy, or tuberculosis

Front 24

strong evidence for constrictive pericarditis, vs restrictive

Back 24

ventricular interdependence and restrictive filling

Front 25

Indications for surgical intervention for mitral regurgitation include

Back 25

(1) left ventricular ejection fraction below 60%; (2) left ventricular end-systolic diameter greater than 40 mm; (3) severe pulmonary hypertension at rest (pulmonary artery systolic pressure >50 mm Hg) or during exercise (>60 mm Hg); or (4) new onset of atrial fibrillation.

Front 26

how is type B aortic dissection treated?

Back 26

Medical therapy of acute uncomplicated type B aortic dissection is preferred and is associated with a 30-day survival rate of greater than 90% (lower HR and BP)

Front 27

indications for AVR

Back 27

left ventricular ejection fraction is abnormal (<50%), response to exercise is abnormal (hypotensive or development of symptoms), rapid progression of stenosis or very severe stenosis (mean gradient >60 mm Hg) has occurred, or if other cardiac surgery is indicated and planned

Front 28

when is aortic valvuloplasty indicated?

Back 28

calcific aortic stenosis in patients with hemodynamic instability or decompensation, as a bridge to eventual aortic valve replacement

Front 29

contraindications to cilostazol

Back 29

heart failure or a left ventricular ejection fraction below 40%

Front 30

why is cilostazol contraindicated in heart failure?

Back 30

similar pharmacologic action to the inotropic drugs milrinone and inamrinone, which demonstrated increased mortality in heart failure patients with long-term use

Front 31

how is hypotension in HOCM patient treated?

Back 31

phenyephrine - severity of obstruction is more severe with small ventricular volumes, low afterload, and increased contractility

Front 32

diagnostic test to evaluate patient with sarcoidosis for myocardial involvement

Back 32

cardiac MRI, not endomyocardial biopsy

Front 33

TEE is the initial imaging test in these clinical situations

Back 33

detection of left atrial thrombus, evaluation of prosthetic mitral valve dysfunction, evaluation of suspected aortic dissection, and in patients with a moderate to high pretest probability of endocarditis

Front 34

positional symptoms of cyanosis and dyspnea that generally occur when the patient is sitting and resolve in the supine position

Back 34

platypnea-orthodeoxia

Front 35

causes of platypnea-orthodeoxia

Back 35

Right-to-left shunting across an atrial septal defect or patent foramen ovale causes cyanosis and dyspnea in the upright position due to deformation of the atrial septum and redirection of shunt flow

Front 36

normal hemogloobin level for a patient with cyanotic heart disease

Back 36

18 to 20 g/dL (180-200 g/L), with a hematocrit between 60% and 65

Front 37

how to Diagnose peripheral arterial disease in a patient with an uninterpretable ankle-brachial index

Back 37

get great toe pressuure measurement