Mksap 16 Cardio Part 8

Front 1

effect of standing from seated position or valsalva maneuver

Back 1

acutely reduces cardiac preload; shortens duration between S1 and MV click in MVP; differentiates dynamic LV outflow obstruction from fixed stenosis (if fixed, result in decreased intensity of systolic murmur)

Front 2

effect of isometric handgrip

Back 2

acute increase in arterial afterload, increases intensity of MR murmur

Front 3

the most common cause of aortic stenosis

Back 3

Calcific degeneration of a trileaflet aortic valve

Front 4

the second most common cause of aortic stenosis

Back 4

Congenital bicuspid aortic valve

Front 5

NOTE: No pharmacologic therapies, including statins,

Back 5

have been shown to reduce or delay the progression of aortic stenosis.

Front 6

the most common congenital heart lesion

Back 6

bicuspid aortic valve

Front 7

when is surgery for dilated ascending aorta indicated during AVR?

Back 7

At the time of AVR, replace ascending aorta if diameter >4.5 cm [likelihood of progressive dilation]; or if >5cm regardless of valve function

Front 8

when is IABP contraindicated in aortic regurgitation?

Back 8

moderate or severe AR [will increase diastolic flow and regurgitant volume]

Front 9

congenital lesions associated with bicuspid aortic valve

Back 9

coarctation of the aorta, interrupted aortic arch, Turner syndrome

Front 10

treatment of MR

Back 10

prompt cardiac surgery if acute; vasodilators, inotropes, IABP

Front 11

leading cause of native valve, prosthetic valve, and cardiac device infections

Back 11

staphylococcal infections (previously strep)

Front 12

NOTE: Although TEE requires greater operator training and sedation of the patient, it should be regarded as an acceptable primary diagnostic test without previous transthoracic echocardiography in certain clinical situations:

Back 12

intermediate or high pretest probability of endocarditis, particularly in patients with Staphylococcus aureus bacteremia; patients with prosthetic heart valves; evaluation for complications of endocarditis, such as intracardiac abscess, valve perforation, or fistula formation.

Front 13

Indications for surgery in infective endocarditis include: (...if mass is causing problems)

Back 13

(1) severe hemodynamic perturbation [severe left-sided valvular regurgitation or fistula formation and HF]; (2) persistent infection despite appropriate antibiotics (persistent bacteremia or intracardiac abscess, or involvement of prosthetic surface); (3) HR of recurrent embolic event [large vegetation]

Front 14

anticoagulation after implantation of prosthetic valve

Back 14

warfarin at least 3 months + asprin 75-100mg/d; after which biologic valves stop warfarin and continue aspirin and mechanical vales continue both (to INR of 2-3 for AVR and 2.5-3.5 for MVR)

Front 15

used for bridging anticoagulation in patients who have HIT

Back 15

bivalirudin

Front 16

low risk for valve thrombosis, bridging?

Back 16

stop coumadin 48-72 h and restart within 24 hours

Front 17

indications for PFO closure in asymptomatic patients?

Back 17

There is no indication for PFO closure in asymptomatic patients.

Front 18

ASDs located in the middle portion of the atrial septum near the fossa ovalis membrane

Back 18

ostium secundum

Front 19

ASD located in the lowest portion of the atrial septum near the cardiac crux

Back 19

ostium primum

Front 20

ASD located near the superior vena cava

Back 20

sinus venosus defects

Front 21

a communication between the coronary sinus and the left atrium

Back 21

coronary sinus defect or unroofed coronary sinus

Front 22

genetic syndromes associated with ASD

Back 22

Holt-Oram syndrome involves bilateral UE abnormalities and congenital heart defects, most commonly an ASD. Down syndrome associated with ostium primum or secundum ASDs or VSDs. Familial occurrence of ostium secundum ASD is recognized and linked to chromosome 5.

Front 23

clinical findings in ASD (5)

Back 23

JVD, parasternal impulse, systolic flow M2 at 2nd L ICS, fixed splitting of S2; diastolic flow rumble across TV in large shunts

Front 24

diagnostic work-up for ASD

Back 24

TTE for primum and secundum; TEE / CMR for sinus venosus and coronary sinus ASDs; EKG, CXR; exercise testing to document exercise limitation; diagnostic cath if with PAH to determine whether closure is indicated

Front 25

main indications for ASD closure (2)

Back 25

presence of symptoms and a Qp:Qs ratio greater than 1.5 to 2.0 to avoid long-term complications.

Front 26

Four types of VSD

Back 26

perimembranous VSD (>80%), subpulmonary VSD, muscular VSDs, inlet defects

Front 27

murmur in VSD (small VSDs)

Back 27

loud holosystolic m2, at L lower sternal border, obliterates S2, may be palpable

Front 28

when is closure of VSD indicated

Back 28

when there is a Qp:Qs ratio of 2.0 or greater and evidence of left ventricular volume overload or a history of endocarditis

Front 29

NOTE: Large VSDs with reversal of the cardiac shunt (becoming a right-to-left shunt) and pulmonary arterial hypertension (Eisenmenger syndrome) should not be closed;

Back 29

closure will result in clinical deterioration.