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Cardiology - ABIM

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QuestionAnswer
What is a Hollenhorst plaque? a golden-yellow intra-arterial refractile body characteristic of cholesterol emboli. This finding is suggestive of artery-to-artery embolization and may have originated from an ulcerative atherosclerotic plaque located in the internal carotid artery.
Criteria for LVH The sum of the deepest S wave in lead V1 or V2 and the tallest R wave in lead V5 or V6 is 35 mm or more; or The R wave in lead aVL is 11 mm or more.
Strain pattern “strain” pattern (asymmetric ST-segment depression and T-wave inversion)
Patients with asymptomatic bicuspid aortic valve should be monitored… Yearly with TTE if the aortic root or ascending aortic diameter is >4.5 cm.
When is aortic valve replacement recommended in asymptomatic patients? Severe aortic valve stenosis, with valve area <1 cm²
When is surgery recommended for an ascending aortic aneurysms in patients with a bicuspid aortic valve? When the ascending aorta diameter is >= 5.5cm or progressive dilation occurs at a rate of 0.5cm per year or greater
Who should be screened or HOCM? All first-degree relatives of patients with hypertrophic cardiomyopathy
How often should family members of HOCM patients be screened? Younger than 21 years old, then screen annually. If older than 21 years, screen at symptom onset or every five years (more frequently in families with malignant tachyarrhythmias or late onset).
What to do for patient with an implantable cardioverter-defibrillator (ICD) with planned shoulder surgery? ICD should be reprogrammed immediately before the procedure to asynchronous pacing (will not respond to heart's electrical response) with disabling of tachycardia detection and shocking function.
mitral valve area in severe mitral stenosis and in very severe mitral stenosis. mitral valve area is usually less than 1.5 cm2 in severe mitral stenosis and 1.0 cm2 or less in very severe mitral stenosis.
treatment for severe symptomatic mitral stenosis. Percutaneous balloon mitral valvuloplasty in NYHA functional class II, III, or IV if valve morphology favorable for PBMV in the absence of left atrial thrombus or moderate to severe mitral regurgitation
Intraventricular conduction delay is characterized by... widened QRS complex (≥110 ms)
Posterior myocardial infarction can be recognized by changes in the anterior precordial leads V1 through V3. The characteristic changes include increased R-wave amplitude and duration (R>S). often evidence of inferior wall MI, with Q waves in leads II, III, and aVF.
What stress test to give a patient with COPD who has baseline EKG abnormalities and is limited in her exercise tolerance? Dobutamine stress echo
What stress test considerations for a patient with active wheezing? Pharmacologic vasodilators, such as dipyridamole, adenosine, and regadenoson, can cause bronchospasm during cardiac stress testing
What is dobutamine? It is a Beta 1 receptor agonist, an inotropic agent
What is normal right atrial pressure 0 to 5 mmHg
What is normal pulmonary capillary wedge pressure? Less than 18
How to treat low cardiac output in heart failure when the patient is hypotensive? Use Nitro press side, which reduces systemic vascular resistance. Patient should be on invasive cardiac monitoring and this medication should only be used for a maximum of 48 hours
Name some medications that cause long QT syndrome Quinidine, amiodarone, stool, procainamide, tricyclic antidepressants, lithium
What causes upper extremity hypertension and a radial artery to femoral artery pulse delay? Aortic orientation
How to calculate Duke treadmill score Exercise time in minutes − (5 × ST-segment depression) − (4 × angina score). (Angina score: 0 = asymptomatic; 1 = nonlimiting angina; 2 = exercise-limiting angina.) Scores below −11 are high risk, and those above 5 are low risk.
Who should get cardiac cath? Patients with lifestyle limiting angina despite optimal medical therapy, high risk criteria on stress testing, ST segment elevation, hypotension
What is effusive constrictive pericarditis? Pericarditis that involves the visceral layer of the pericardium, which can be difficult to detect, even after treatment and relief of pericardial effusion by pericardiocentesis
How to treat constrictive pericarditis? 2 to 3 months trial of anti-inflammatory such as ibuprofen 800 mg three times daily, indomethacin 50 mg three times daily, or aspirin 650 mg three times daily with a slow taper over 2 to 3 weeks
Black patient with NYHA class III or IV heart failure symptoms, what should they be on? Hydrazine and isosorbide dinitrate
Left ventricular systolic dysfunction identified toward the end of pregnancy or in the months following delivery. Global reduction in contractility and left ventricular enlargement, no hypertrophy. What is the diagnosis? Peripartum cardiomyopathy
Should patients be on simvastatin 80? No because of a heightened risk of adverse muscle effects
Created by: christinapham