Cardiology Flashcards

[spacer height=”20px”]
[qwiz style=”width: 1000px !important; min-height: 500px !important; border-width: 4px !important; border-color: #0099cc !important; ” align=”center”]

[h] Cardiology Flashcards

[i] Master EL Husseiny’s Essentials of Cardiology in just 2 hour

[q] The worst risk factor for CAD in united states is …..?

[c*] Show me the answer

[f] Diabetes mellitus.

[q] The most common risk for CAD in united states is …..?

[c*] Show me the answer

[f] Hypertension.

[q] …… is  the most dangerous portion of a lipid profile for a patient?

[c*] Show me the answer

[f] Marked elevation in LDL.

[q] ……… results in the  greatest immediate improvement in patient outcomes for CAD?

[c*] Show me the answer

[f] Smoking cessation.

[q] Cholesterol crystal embolism (Atheroembolism) is most commonly seen as a complication of …….?

[c*] Show me the answer

[f] Cardiac catheterization and other vascular procedures.

[q] ……. are the most common complication of Cholesterol crystal embolism (Atheroembolism)?

[c*] Show me the answer

[f] Skin manifestations (blue toe syndrome and livedo reticularis).

[q]

…….. is acute myocardial damage most often occurring in postmenopausal women immediately following an overwhelming, emotionally stressful event?

[c*] Show me the answer

[f] Tako-Tsubo cardiomyopathy.

[q] Revascularization will not help in Tako-Tsubo cardiomyopathy, because …… ?

[c*] Show me the answer

[f] The coronary arteries are normal (non-ischemic cardiomyopathy ).

[q] The most common cause of chest pain that is not ischemic in nature is …..?

[c*] Show me the answer

[f] Gastrointestinal disorders (GERD).

[q] Chest pain + chest wall tenderness. The most likely diagnosis?

[c*] Show me the answer

[f] Costochondritis.

[q] Chest pain + Radiation to back, unequal blood pressure between arms. The most likely diagnosis?

[c*] Show me the answer

[f] Aortic dissection.

[q] Chest pain + Pain worse with lying flat, better when sitting up, young (<40), diffuse ST elevation. The most likely diagnosis?

[c*] Show me the answer

[f] Pericarditis.

[q] Chest pain + Epigastric discomfort, pain better when eating. The most likely diagnosis?

[c*] Show me the answer

[f] Duodenal ulcer disease.

[q] Chest pain + Bad taste, cough, hoarseness. The most likely diagnosis?

[c*] Show me the answer

[f] Gastroesophageal reflux.

[q] Chest pain + Cough, sputum, hemoptysis. The most likely diagnosis?

[c*] Show me the answer

[f] Pneumonia.

[q] Chest pain + Sudden-onset shortness of breath, tachycardia, tachypnea. The most likely diagnosis?

[c*] Show me the answer

[f] Pulmonary embolus.

[q] Chest pain + Sharp, pleuritic pain, hemodynamic instability with tracheal deviation. The most likely diagnosis?

[c*] Show me the answer

[f] Tension Pneumothorax.

[q] Exercise tolerance testing (ETT) is based on 2 factors:

1. …….

2. …….

[c*] Show me the answer

[f]

You can read the EKG.
The patient can exercise.

[q]

The 2 best methods of detecting ischemia if you cannot read the EKG because of a baseline EKG abnormality are …..?

[c*] Show me the answer

[f]

Nuclear isotope uptake: thallium or sestamibi.
Echocardiographic detection of wall motion abnormalities.

[q] How can you perform Exercise tolerance test if the patient has broken legs or ambutation?

[c*] Show me the answer

[f] If the patient cannot exercise, then an alternate method of increasing myocardial oxygen consumption must be performed:
1. Persantine (dipyridamole) or adenosine in combination with the use of nuclear isotopes such as thallium or sestamibi.

2. Dobutamine in combination with the use of echocardiography.

[q] Beta blockers, calcium channel blockers, and nitrates are antianginal agents that reduce the extent and severity of ischemia during exercise stress testing. These medications should be withheld for at least ……?

[c*] Show me the answer

[f] 48 hours prior to stress testing.

[q] ……. is the most accurate method of detecting coronary artery disease?

[c*] Show me the answer

[f] Angiography.

[q] Dual Anti-platelet therapy is more specific to ……?

[c*] Show me the answer

[f] Acute coronary syndromes (ACS) and to the use of coronary stenting to decrease the risk of restenosis.

[q] Prasugrel is dangerous in patients 75 and older because of an increased risk of ……?

[c*] Show me the answer

[f] hemorrhagic stroke.

[q] …… is the most common adverse effect of ACE inhibitors, occurring in up to 7% of patients?

[c*] Show me the answer

[f] Cough.

[q] ….. inhibit HMG-CoA reductase, a rate-limiting enzyme in the intracellular biosynthesis of cholesterol that converts HMG-CoA to mevalonate?

[c*] Show me the answer

[f] Statins.

[q] …. is a lipid lowering therapy that can cause myopathy or hepatotoxicity as a side effects?

[c*] Show me the answer

[f] Statins.

[q] The American College of Cardiology recommends a goal of LDL …. for those with coronary disease and diabetes?

[c*] Show me the answer

[f] below 70.

[q] Which Lipid lowering drug is associated with glucose intolerance and elevation of uric acid level, and is an excellent drug to add to statins if full lipid control is not achieved with statins?

[c*] Show me the answer

[f] Niacin.

[q] High-dose niacin therapy to treat lipid abnormalities frequently produces cutaneous flushing and pruritus. This side effect is explained by ……?

[c*] Show me the answer

[f]

Prostaglandin-induced peripheral vasodilatation and can be reduced by low-dose aspirin.

[q]

1. Lipid lowering drug lowers triglyceride levels somewhat more than statins; however, the benefit of lowering triglycerides alone has not proven to be as useful as the straight forward mortality benefit of statins?

2. Lipid lowering drug needs to be used with caution when used in combination with statins because of an increased risk of myositis?

[c*] Show me the answer

[f] Fibrates.

[q]

1. lipid lowering drug associated with gastrointestinal discomfort such as constipation and flatus?

2. Lipid lowering drug increase the risk for formation of cholesterol gallstones?

[c*] Show me the answer

[f] Cholestyramine.

 

[q] None of the calcium channel blockers have been shown to lower mortality in CAD. They  may actually increase mortality in patients with CAD because of their effect in …..? 

[c*] Show me the answer

[f] Raising heart rate due to reflex tachycardia.

[q] The most common side effect of Dihydropyridine Ca-channel Blockers is …..?

[c*] Show me the answer

[f] Peripheral edema.

[q] The most common side effect of NON-Dihydropyridine Ca-channel Blockers is …..?

[c*] Show me the answer

[f] Constipation (verapamil most often).

[q] The greatest risk factor for variant angina is ….?

[c*] Show me the answer

[f] Smoking.

[q] Medical therapy for variant angina typically involves …..?

[c*] Show me the answer

[f] Calcium channel blockers or nitrates. These medications work in variant angina by promoting vasodilation and preventing vasoconstriction. 

[q] ….. should be avoided in variant angina because they can promote vasoconstriction? 

[c*] Show me the answer

[f] B Blockers.

[q] The concept of using Dipyridamole and adenosine in diagnosing ischemic heart disease with the Exercise tolerance test is related to….?

[c*] Show me the answer

[f] Coronary steal phenomenon.

[q] The primary anti-ischemic effect of nitrate is due to …..?

[c*] Show me the answer

[f] Systemic vasodilation rather than coronary vasodilation. 

[q] The use of beta blockers should be avoided in those with acute coronary syndrome (ACS) due to cocaine intoxication  due to the risk of …..?

[c*] Show me the answer

[f] Unopposed cocaine-induced alpha agonist activity and resultant worsening vasoconstriction.

[q]  …… is the strongest predictor of stent thrombosis within the first 12 months?

[c*] Show me the answer

[f] Premature discontinuation of antiplatelet therapy.

[q] …… is the most important cardiac-specific marker in cases of MI?

[c*] Show me the answer

[f] Serum troponin.

[q]  …… is a good marker for evaluating reinfarction?

[c*] Show me the answer

[f] CK-MB.

[q] The most common cause of death in the first several days after a myocardial infarction is ……?

[c*] Show me the answer

[f] Ventricular arrhythmia (ventricular tachycardia, ventricular fibrillation).

[q] Indications of Coronary artery bypass grafting (CABG) are ….?

[c*] Show me the answer

[f]

Three vessels with at least 70% stenosis in each vessel.

Two-vessel disease in a patient with diabetes.

Left main coronary artery occlusion.

Persistent symptoms despite maximal medical therapy.

[q] Although nitrates act as venodilators and coronary vasodilators, their primary anti-ischemic effects are due to ……?

[c*] Show me the answer

[f] Systemic vasodilation rather than coronary vasodilation. Systemic venodilation lowers preload and left ventricular end-diastolic volume and reduces myocardial oxygen demand by reducing wall stress.

[q] Which one is superior in case of ST elevation MI (Angioplasty Vs. Thrombolytics)?

[c*] Show me the answer

[f] Angioplasty (PCI) is superior to thrombolytics in terms of:

Survival and mortality benefit.

Fewer hemorrhagic complications.

Likelihood of developing complications of MI (less arrhythmia, less CHF, fewer ruptures of septum, free wall [tamponade] and papillary muscles [valve rupture])

[q] “Door to balloon time” is ….?

[c*] Show me the answer

[f] under 90 minutes.

[q] The mortality benefit of thrombolytics extends out to …. from the onset of chest pain?

[c*] Show me the answer

[f] 12 hours.

[q] “Door to needle time” is …..?

[c*] Show me the answer

[f] under 30 minutes

[q] Absolute Contraindications to Thrombolytics are ……?

[c*] Show me the answer

[f]

Major bleeding into the bowel (melena) or brain (any type of CNS bleeding).

Recent surgery (within the last 2 weeks).

Severe hypertension (above 180/110).

Non-hemorrhagic stroke within the last 6 months.

Heme-positive brown stool is not an absolute contraindication to the use of thrombolytics.

[q] …. have been shown to limit ventricular remodeling and should be initiated within 24 hours of myocardial infarction in all patients without a contraindication?

[c*] Show me the answer

[f] ACE inhibitors.

[q] We use …. to prevent additional plaque thrombosis or recurrent coronary thrombosis in non ST Elevation ACS?

[c*] Show me the answer

[f] Antnticoagulant therapy (unfractionated heparin, enoxaparin, bivalirudin).

[q] tPA (thrombolytics) are beneficial only with ….?

[c*] Show me the answer

[f] ST elevation MI.

[q] In 90% of individuals occlusion of the right coronary artery can result in transmural ischemia of the inferior wall of the left ventricle, producing ST elevation in leads II, III, and aVF as well as possible sinus node dysfunction leading to Bradycardia because of ……?

[c*] Show me the answer

[f] Vascular insufficiency of the sinoatrial (SA) node.

[q] …. is seen in 30%-50% of patients with acute ST-elevation Ml of the inferior wall and is due to occlusion of the right coronary artery proximal to the origin of right ventricular branches?

[c*] Show me the answer

[f] Right ventricular myocardial infarction (RVMI).

[q] Patients with RVMI require … to maintain adequate right heart output?

[c*] Show me the answer

[f] High preload (Preload dependent). Patients with hypotension and low/normal jugular venous pressure (JVP) should be given high-flow intravenous (IV) fluids to increase RV preload (if JVP is elevated, IV fluids are less likely to be helpful).

Drugs that decrease preload, such as nitrates, diuretics and opioids, can cause profound hypotension and should be avoided. Drugs that slow the heart rate (beta blockers) or decrease contractility (calcium channel blockers) should be used with caution.

[q] “What is the most likely diagnosis?

Post-MI with profound shock + tachycardia + muffled heart sound + low voltage ECG –> …..?

[c*] Show me the answer

[f] Cardiac tamponad.

[q] “What is the most likely diagnosis?

Post-MI with new onset of a murmur + pulmonary congestion.

[c*] Show me the answer

[f] MR, VSD.

[q] What is the most accurate test for both valve rupture and septal rupture after MI?

[c*] Show me the answer

[f] Echocardiogram.

[q] Step-up in oxygen saturation as you go from the right atrium to the right ventricle post-MI?

[c*] Show me the answer

[f] VSD.

[q] Acute limb ischemia after myocardial infarction suggests ….?

[c*] Show me the answer

[f] Possible arterial embolus from left ventricular (LV) thrombus. Transthoracic echocardiogram with echo contrast must be performed to screen for LV thrombus.

[q] “What is the most likely diagnosis?

Post-MI with pleuritic chest pain that improves with sitting up. Cardiac auscultation should indicate a pericardial friction rub, and ECG typically reveals diffuse ST-segment elevation.

[c*] Show me the answer

[f] <4 days following MI –> Peri-infarction pericarditis (PIP). Treatment of PIP is usually supportive. Anti-inflammatory agents (nonsteroidal anti-inflammatory drugs, corticosteroids) are typically avoided due to impairment of collagen deposition and possible increased risk of serious post-MI complications (ventricular free wall rupture).

Weeks after a myocardial infarction –> Dressler syndrome. NSAIDs are the treatment of choice.

[q] “What is the most likely diagnosis?

Dyspnea + Orthopnea  + Paroxysmal nocturnal dyspnea  + S3 Gallop?

[c*] Show me the answer

[f] Congestive Heart Failure. CHF, especially its worst form, pulmonary edema, is a clinical diagnosis.

[q] What is the best initial test to evaluate ejection fraction?

[c*] Show me the answer

[f] Transthoracic echo.

[q] What is the most accurate test to evaluate ejection fraction?

[c*] Show me the answer

[f] Multiple-gated acquisition scan (MUGA) or nuclear ventriculography.

[q] When should you answer “nuclear ventriculography” in evaluating Ejection Fraction?

[c*] Show me the answer

[f] An example of when it is necessary would be a person receiving chemotherapy with doxorubicin; you are trying to give the maximum amount of chemotherapy to cure the lymphoma, but need to make sure you are not causing cardiomyopathy.

[q] When should you answer BNP in evaluating Ejection Fraction?

[c*] Show me the answer

[f] Answer “BNP level” in a patient with acute shortness of breath in whom the etiology of the dyspnea is not clear and you cannot wait for an echo to be done. A normal BNP excludes CHF as a cause of the shortness of breath.

[q] Drugs used for Systolic Dysfunction (Low Ejection Fraction) are ….?

[c*] Show me the answer

[f]

ACE inhibitors or angiotensin receptor blockers (ARBs).

Beta blockers.

Spironolactone.

Diuretics.

Digoxin.

[q] Beta blockers with evidence of clear mortality benefit with systolic dysfunction heart failure are?

 

[c*] Show me the answer

[f] There is evidence only for:

Metoprolol.

Bisoprolol.

Carvedilol.

[q] Drug for systolic heart failure only proven effective for more advanced and serious stages of CHF (class III and IV) in which the patient is short of breath either with minimal exertion or at rest?

[c*] Show me the answer

[f] Spironolactone.

[q] Adverse effect of spironolactone include ….?

[c*] Show me the answer

[f] Adverse effects include hyperkalemia and gynecomastia (Antiandrogenic effect).

[q] What is the management of a patient with severe CHF who develops gynecomastia?

[c*] Show me the answer

[f] Switch spironolactone to eplerenone.

[q] Diuretics use in patients with systolic heart failure is for symptoms control or for mortality benefit?

[c*] Show me the answer

[f] Diuretics control symptoms of CHF. They do not lower mortality.

[q] Use of antiduretics in patient with systolic heart failure can potentiate the digoxin toxicity, how?

[c*] Show me the answer

[f]  Diuretics –> hypokalemia —> Hypokalemia enhance digoxin toxicity.

[q] Digoxin use in patients with systolic heart failure is for symptoms control or for mortality benefit?

[c*] Show me the answer

[f] Digoxin is used to control symptoms of dyspnea and will decrease the frequency of hospitalizations. In fact, no positive inotropic agent (digoxin, milrinone, amrinone, dobutamine) has been proven to lower mortality.

[q] What is the most common presentation of digoxin toxicity?

[c*] Show me the answer

[f] Digoxin toxicity presents with nonspecific gastrointestinal (anorexia, nausea, vomiting).

[q] What is the most specific  presentation of digoxin toxicity?

[c*] Show me the answer

[f] Changes in color vision (Blurry yellow vision) are a more specific, but rarer, finding.

[q] What is the most serious  presentation of digoxin toxicity?

[c*] Show me the answer

[f] The most serious complication of digoxin toxicity is the development of potentially fatal cardiac arrhythmias of virtually any type. Digitalis toxicity causes increased ectopy and increased vagal tone. Atrial tachycardia with AV block occurs from the combination of these two digitalis effects, and is relatively specific for digitalis toxicity. Since it is rare for both ectopy and AV block to occur at the same time, when they do, the combination is fairly specific for digitalis toxicity

[q] What is the answer if the patient is still dyspneic after using ACE inhibitors, beta blockers, diuretics, digoxin, and mineralocorticoid inhibitor’s?

[c*] Show me the answer

[f]

Ivabradine.

Sacubitril/valsartan.

Hydralazine/nitrates

[q] Treatment of Beta blocker overdose is …?

[c*] Show me the answer

[f]

Intravenous fluids and atropine are the first-line treatment options.

Intravenous glucagon should be administered in patients with profound or refractory hypotension. Glucagon increases the intracellular levels of cyclic AMP and has been effective in treating both beta blocker and calcium channel blocker toxicity.

[q] What is the most important test to do acutely in case of pulmonary edema?

[c*] Show me the answer

[f] ECG is the most important test to do acutely, because the EKG can lead to a change in immediate therapy.

If atrial fibrillation, atrial flutter, or ventricular tachycardia is the cause of pulmonary edema, the first thing to do is to perform rapid, synchronized cardioversion in order to restore atrial systole and to return the atrial contribution to cardiac output.

[q] Your goal in management of pulmonary edema is ….?

[c*] Show me the answer

[f]

1. Preload Reduction:

The majority of patients in acute pulmonary edema can be managed with preload reduction. Removing 1 to 2 liters of fluid from the vascular space and the lungs is the best thing that can be done acutely to decrease symptoms.

2. Positive Inotropic Agents: Dobutamine can be used in the acute setting of patients placed in the ICU when their shortness of breath does not respond to therapy acutely with preload reduction.

3. Afterload Reduction: ACEIs and ARBs are used on discharge for long-term use in all patients with systolic dysfunction and low ejection fraction.

[q] Initial therapy of acute pulmonary edema is with ….?

[c*] Show me the answer

[f]

Oxygen.

Loop diuretics such as furosemide or bumetanide.

Morphine.

Nitrates.

[q] The best initial test for all valvular heart disease is …..?

[c*] Show me the answer

[f] Echocardiogram. Transesophageal echo is generally both more sensitive and more specific than transthoracic echo.

[q] The most accurate test for valvular heart disease is …..?

[c*] Show me the answer

[f] Catheterization is the most accurate test. Catheterization allows the most precise measurement of valvular diameter, as well as the exact pressure gradient across the valve.

[q] “What is the most likely diagnosis?

Patient with shortness of breath + Dysphagia  + Hoarseness + mid-diastolic rumbling murmur with presystolic accentuation after the opening snap + Left atrial hypertrophy in ECG and X-Rays.

[c*] Show me the answer

[f] Mitral stenosis. Treatment:

Balloon valvuloplasty done with a catheter.

Valve replacement only when a catheter procedure cannot be done, or fails.

[q] ….. are the most frequent cause of isolated aortic stenosis in elderly patients?

[c*] Show me the answer

[f] Age-dependent idiopathic sclerocalcific changes

[q] ….. is the cause of aortic stenosis in the majority of patients under 70 years old?

[c*] Show me the answer

[f] Bicuspid aortic valve.

[q]“What is the most likely diagnosis?

70 years old patient with exertional syncope + angina + Delayed and weak pulsation + systolic, crescendo-decrescendo murmur peaking in a diamond shape in mid-systole heard best at the second right intercostal space, and radiates to the carotid artery + single and soft second heart sound S2 + Left ventricular  hypertrophy in ECG and X-Rays.

[c] Show me the answer

[f] Aortic stenosis. Treatment:

Valve replacement is the only truly effective therapy for AS.

Balloon valvuloplasty is not routinely done for AS. This is because the main mechanism for developing AS is calcification, which does not improve very well with balloon valvuloplasty. Balloon/catheter procedures are done only if surgery is not an option secondary to the instability or fragility of the patient.

[q] “What is the most likely diagnosis?

Patient with symptoms of CHF + Holosystolic murmur heard best over the apex with radiation to the axilla + S3 Heart sound.

[c*] Show me the answer

[f] Mitral Regurgitation.

[q] When valve replacement is indicated in a patient with MR?

[c*] Show me the answer

[f] When LVESD is above 40 mm or the ejection fraction drops below 60%, surgical valve repair or replacement is indicated. Valve repair means either operatively, or with a catheter placing a clip or sutures across the valve to tighten it up.

Valve replacement is indicated when the heart starts to dilate. Do not wait for left ventricular end systolic diameter (LVESD) to become too large because the damage will be irreversible.

[q] Patient with marfan syndrome + corrigan sign + Head bobbing + High difference in SBP in lower limb than upper limb + Early decrescendo diastolic murmur, best heard with the diaphragm of the stethoscope along the left sternal border at the third and fourth intercostal spaces while the patient is sitting up, leaning forward, and holding a breath in full expiration.

[c*] Show me the answer

[f] Aortic Regurgitation.

[q] When valve replacement is indicated in a patient with AR?

[c*] Show me the answer

[f]

Replace or repair the valve before the left ventricle dilates excessively, while EF is still greater than 55% and left ventricular end systolic diameter less than 55 mm. Repairing the valve means tightening the ends of the valve with sutures.

[q] ….. occurs due to Myxomatous degeneration of the mitral valve leaflets and chordae ?

[c*] Show me the answer

[f] MVP occurs due to Myxomatous degeneration of the mitral valve leaflets and chordae (Marfan and Ehlers-Danlos syndrome).

[q] Patient with marfan syndrome + midsystolic click that, when severe, is associated with a murmur just after the click (mid-to-late systolic murmur)?

[c*] Show me the answer

[f] MVP.

[q] Inspiration (↑ venous return to right atrium) ↑ intensity of …. murmurs?

[c*] Show me the answer

[f] Right heart murmurs.

[q] Expiration (↑ pulmonary blood flow to the left atrium) ↑ intensity of …. murmurs?

[c*] Show me the answer

[f] ↑ intensity of left heart murmurs.

[q] Squatting and Supine position with leg elevated (↑ venous return, ↑ preload) ↑ intensity of most murmurs (↑ flow through stenotic or regurgitant valve) except ……..?

[c*] Show me the answer

[f] MVP + HOCM.

[q] Valsalva (↓ preload), standing up (↓ preload), amyl nitrate (venodilator  ↓ preload) ↓ intensity of most murmurs (↓ flow through stenotic or regurgitant valve) except ……?

[c*] Show me the answer

[f] MVP + HOCM.

[q] Hand grip (↑ afterload) ↑ intensity of most murmurs (↑ flow through stenotic or regurgitant valve) except ……..?

[c*] Show me the answer

[f] MVP + HOCM + AS.

[q] Wide splitting of the 2nd heart sound is seen with …..?

[c*] Show me the answer

[f] Pulmonic stenosis, right bundle branch block.

[q] Fixed splitting of the 2nd heart sound is seen with …..?

[c*] Show me the answer

[f] ASD.

[q] Paradoxical  splitting of the 2nd heart sound is seen with …..?

[c*] Show me the answer

[f] Aortic stenosis, left bundle branch block.

[q] Absent a wave in jugular venous tracing is seen with ….?

[c*] Show me the answer

[f] AF.

[q] Cannon a wave in jugular venous tracing is seen with ….?

[c*] Show me the answer

[f] Complete AV Block.

[q] …… is the best initial test and often the most accurate test for all of Cardiomyopathy?

[c*] Show me the answer

[f] Echocardiography.

[q] Viral myocarditis is a common cause of dilated cardiomyopathy in relatively young adults, particularly after ….. viral infection?

[c*] Show me the answer

[f] Coxsackievirus B.

[q] Young age Patient with dyspnea + chest pain + Syncope + Family history of sudden death + Crescendo-decrescendo murmur at the lower left sternal border + Symptoms worsened by anything that increases heart rate (exercise, dehydration, and diuretics) + symptoms Worsened by anything that decreases left ventricular chamber size (ACEIs, ARBs, digoxin, hydralazine, Valsalva, and standing suddenly)?

[c*] Show me the answer

[f] HOCM.

[q] ….. are the most commonly used agents for initial treatment of HOCM?

[c*] Show me the answer

[f] Beta blockers (metoprolol, atenolol). They prolong diastole and decrease myocardial contractility, which in turn decreases LVOT obstruction and improves symptoms of angina.

[q] Patient with symptoms of CHF (right heart failure) due to diastolic dysfunction with preserved EF + echocardiogram findings of increased ventricular wall thickness with normal left ventricular cavity dimensions (especially in the absence of hypertension) + low voltage on electrocardiogram?

[c*] Show me the answer

[f] Restrictive Cardiomyopathy.

[q] …… is the mainstay of therapy in patients with alcoholic cardiomyopathy and is associated with improvement or normalization of left ventricular function overtime?

[c*] Show me the answer

[f] Complete cessation of alcohol consumption.

[q] “What is the most likely diagnosis?
Patient presenting with sharp chest pain that changes in intensity with respiration (pleuritic) + pain is worsened by lying flat and improved by sitting up + pericardial Friction rub (described as high pitched, leathery, and scratchy) + EKG shows ST segment elevation in all leads and PR segment depression?

[c*] Show me the answer

[f] Pericarditis.

Treatment: NSAIDs and colchicine.

[q] “What is the most likely diagnosis?

Patient presenting with hypotension, distended neck veins, and muffled heart sounds + >10 mm Hg drop in systolic blood pressure during inspiration + EKG showing the amplitudes of the QRS complexes vary from beat to beat 2 months after anterior wall MI?

[c*] Show me the answer

[f] Pericardial Tamponade.

[q] “What is the most likely diagnosis?

Patient presenting with right heart failure (Edema, Ascites, Enlargement of the liver and spleen, JVD) + increase in JVD on inhalation + an extra heart sound in diastole from ventricular filling + chest x-ray shows calcification and fibrosis around the heart?

[c*] Show me the answer

[f] Constrictive Pericarditis.

[q] ….. is the most common cause of Constrictive Pericarditis in developing countries?

[c*] Show me the answer

[f] Tuberculosis.

[q] “What is the most likely diagnosis?

Patient with uncontrolled hypertension presenting with tearing chest pain of sudden onset, radiating to the back +/− markedly unequal BP in arms + CXR shows mediastinal widening + early diastolic murmur heard best at the left sternal border + CT showing intimal flap separating the true and false lumens in the aorta?

[c*] Show me the answer

[f] Aortic Dissection.

[q] …… is the single most important risk factor for the development of intimal tears leading to aortic dissection?

[c*] Show me the answer

[f] Hypertension.

[q] The best intial pharmacologic treatment for Aortic Dissection is …..?

[c*] Show me the answer

[f] Intravenous beta blockers are the treatment of choice for the initial medical management of patients with acute aortic dissection as they lower heart rate and blood pressure and reduce left ventricular contractility (decrease the shearing forces that are worsening the dissection).

[q] “What is the most likely diagnosis?

Postpartum female presenting with symptoms of systolic dysfunction CHF one moth after pregnancy

[c*] Show me the answer

[f] Peripartum Cardiomyopathy.

[q] “What is the most likely diagnosis?

Patient presenting with multiple episodes of syncope after exposure of painful stimuli or emotional distress + patient experience a prodrome with nausea, pallor, diaphoresis, and generalized sense of warmth prior to the syncopal episode + Cardiac monitoring immediately preceding the syncope typically shows sinus bradycardia and asystole due to sinus arrest?

[c*] Show me the answer

[f] Vasovagal syncope. Use physical counterpressure maneuvers during the prodromal phase in order to abort or delay an episode of syncope.

[q] “What is the most likely diagnosis?

Patient with history of rheumatic heart disease affecting the mitral valve presenting with fever, fatigue + change of the intensity of the murmur after exposure to dental procedure + flame shaped hemorrhage in the fingernails + positive blood culture for S. Mutans + vegetations seen on echocardiogram?

[c*] Show me the answer

[f] Infective Endocarditis.

[q] The best initial empiric therapy for Infective Endocarditis is ….?

[c*] Show me the answer

[f] Vancomycin and gentamicin.

[q] The best initial antibiotic prior to tonsillectomy in a patient with prosthetic valve is ….?

[c*] Show me the answer

[f] Amoxicillin

[q] Development of atrioventricular block in a patient with infective endocarditis should raise suspicion for …..?

[c*] Show me the answer

[f] Perivalvular abscess extending into the adjacent cardiac conduction tissues (perivalvular abscess).

[q] “What is the most likely diagnosis?

Intravenous drug user (IVDU) presenting with fever, generalized weakness, tricuspid regurgitation + wedge-shaped infarction in the lung?

[c*] Show me the answer

[f] Right-sided infective endocarditis (IE). Staphylococcus aureus is the responsible pathogen for more than half of IE cases in IVDU.

[q] All patients with S. Bovis bacteremia should have further evaluation with colonoscopy to look for ……?

[c*] Show me the answer

[f] Underlying occult malignancy (colon cancer).

[q] “What is the most likely diagnosis?

Patient presenting with oval macule that was initially uniformly red then develop a zone of central clearing as it expands one moth after camping in New England?

[c*] Show me the answer

[f] Erythema chronicum migrans (Lyme disease).

[q] Minor complication of Lyme disease are …..?

[c*] Show me the answer

[f] Joint involvement +  paralysis of the seventh cranial nerve (facial paralysis), possibly be bilateral.

[q] Major complication of Lyme disease are …..?

[c*] Show me the answer

[f]  CNS Symptoms (Meningitis, encephalitis, headache, and memory disturbance may develop as well).

Cardiac symptoms (Most common symptom is AV heart block. Myocarditis, pericarditis, and various forms of arrhythmias may develop as well).

[q] Treat minor symptoms and ECM Rash with …..?

[c*] Show me the answer

[f] Doxycycline or amoxicillin.

Doxycycline is contraindicated in young children as well as pregnant and lactating women because it can cause permanent discoloration of teeth and retardation of skeletal development in exposed children and fetuses. Oral amoxicillin is the treatment of choice in pregnant and lactating women as well as children age <8 years.

[q] Treat more serious manifestations such as meningitis, encephalitis, heart block or myocarditis with ….?

[c*] Show me the answer

[f] IV ceftriaxone.

[q] “What is the most likely diagnosis?

Patient presenting with constitutional symptoms, a mid-diastolic rumbling murmur heard best at the apex, positional cardiovascular symptoms (dyspnea and syncope), embolic symptoms, and a large pedunculated mass in the left atrium are the typical findings of atrial myxoma?

[c*] Show me the answer

[f] Atrial myxoma.

[q] “What is the most likely diagnosis?

Patient with history of Mitral stenosis presenting with palpitation + ECG shows an absence of P waves and irregularly irregular rhythm with varying R-R intervals?

[c*] Show me the answer

[f] Atrial fibrillation.

[q] ……….. is indicated in hemodynamically unstable patients with rapid AF (hypotension, cardiogenic shock, signs of ischemia, acute heart failure)?

[c*] Show me the answer

[f] Immediate synchronized electrical cardioversion.

[q] …… are the most frequent location of the ectopic foci that cause AF?

[c*] Show me the answer

[f] The pulmonary veins (PVs). This tissue has different electrical properties than the surrounding atrial myocytes and is prone to ectopic electrical foci and/or aberrant conduction, which can initiate AF.

[q] The best initial therapy for fibrillation and flutter is to control the rate with ….?

[c*] Show me the answer

[f] Beta blockers, calcium channel blockers, or digoxin.

[q] “What is the most likely diagnosis?

40 years old patient presenting with AF with no evidence of cardiopulmonary or structural heart disease + no hypertension, no DM, no smoking?

[c*] Show me the answer

[f] “Lone” Atrial Fibrillation. Patients with lone AF (score 0) are at low risk of systemic embolization and anticoagulant therapy is not indicated.

[q] When CHADS score is 0 for patient with AF → ….?

[c*] Show me the answer

[f] No anticoagulation.

[q] When CHADS score is 1 or less for patient with AF , use ….?

[c*] Show me the answer

[f] None, or use aspirin, or oral anticoagulant.

[q] When CHADS score is 2 or more for patient with AF, use ….?

[c*] Show me the answer

[f] NOAC or warfarin.

[q] “What is the most likely diagnosis?

Patient with history of Mitral stenosis presenting with palpitation + ECG shows absent p waves and replaced with sawtooth pattern with regular rythm?

[c*] Show me the answer

[f] Atrial flutter. Treat like atrial fibrillation.

[q] “What is the most likely diagnosis?

Young female presenting with palpitation with abrupt onset and offset + ECG shows absent p waves, no fibrillatory waves, no flutter waves, very regular rhythm?

[c*] Show me the answer

[f] Paroxysmal Supraventricular Tachycardia.

[q] …… is the most common form of paroxysmal supraventricular tachycardia (PSVT) and frequently develops in young patients with a structurally normal heart?

[c*] Show me the answer

[f] Atrioventricular nodal reentrant tachycardia (AVNRT).

[q] The best initial treatment of Paroxysmal Supraventricular Tachycardia is ….?

[c*] Show me the answer

[f] Vagal maneuvers (carotid sinus massage, Valsalva maneuver, eyeball pressure) increase parasympathetic tone in the heart and result in a temporary slowing of conduction in the AV node and an increase in the AV node refractory period.

[q] The drug of choice for Paroxysmal Supraventricular Tachycardia is ….?

[c*] Show me the answer

[f] Adenosine. Beta blockers (metoprolol), calcium channel blockers (diltiazem), or digoxin if adenosine is not effective.

[q] “What is the most likely diagnosis?

Patient with history of COPD presenting with tachycardia (heart rate > 100 beats/min) + ECG shows polymorphic P waves (3 morphologically distinct P waves)?

[c*] Show me the answer

[f] Multifocal Atrial Tachycardia (MAT). Treat MAT as you would atrial fibrillation, but avoid beta blockers because of the lung disease.

[q]  …… is indicated if sinus bradycardia is asymptomatic?

[c*] Show me the answer

[f] No treatment.

[q] Patients with symptomatic sinus bradycardia should be treated initially with …..,  and …… is “the most effective therapy”.

[c*] Show me the answer

[f] Intravenous atropine. Pacemaker.

[q] ……. is Age-related degeneration of the cardiac conduction system with fibrosis of the sinus node leading to bradycardia?

[c*] Show me the answer

[f] Sick sinus syndrome (SSS).

[q] How to manage this patient?

[c*] Show me the answer

[f] First-Degree AV block. The same management as sinus bradycardia.

[q] How to manage this patient?

[c*] Show me the answer

[f] A. Mobitz I or Wenckebach Block. The same management as sinus bradycardia. Observation in asymptomatic patients and correction of reversible causes (holding medications that affect AV node conduction).

[q] How to manage this patient?

[c*] Show me the answer

[f] B. Mobitz II Block. Treat it like third-degree AV block. Everyone with Mobitz II block gets a pacemaker even if they are asymptomatic.

[q] How to manage this patient?

[c*] Show me the answer

[f] Patients should be referred immediately for temporary pacemaker insertion while detailed evaluation for potential causes is performed. A permanent pacemaker is indicated in the absence of reversible causes.

[q] “What is the most likely diagnosis?

Patient presenting with SVT alternating with ventricular tachycardia.

Patient presenting with SVT that gets worse after diltiazem or digoxin.

ECG shows shortened PR-interval, a delta wave at the start of the QRS complex, and a widened QRS interval.

[c*] Show me the answer

[f] Wolff-Parkinson-White syndrome.

[q] The best pharmacologic treatment for patient with WPW syndrome presenting acutely with arrhythmia is …..?

[c*] Show me the answer

[f] Procainamide or amiodarone are useful for both atrial and ventricular rhythm disturbances. Digoxin and calcium channel blockers are dangerous in WPW. They block the normal AV node and force conduction into the abnormal pathway.

[q] The definitive treatment for patient with WPW syndrome is …..?

[c*] Show me the answer

[f] Radiofrequency catheter ablation is curative for WPW. The tip of the catheter is heated up and simply ablates or eliminates the abnormal conduction tract around the AV node. EP studies tell you where the anatomic defect is.

[q] The best initial management of all forms of pulselessness is ….?

[c*] Show me the answer

[f] CPR. CPR does not restart the heart; CPR keeps the patient alive until cardioversion can be performed.

[q] How to manage this patient?

[c*] Show me the answer

[f] Management is entirely based on the hemodynamic status:
– Hemodynamically stable VT:
o Treat with medications (IV amiodarone, lidocaine, procainamide).
o If all medical therapy fails, then cardiovert the patient.

– Hemodynamically unstable VT: Perform electrical cardioversion several times, followed by medications such as amiodarone, lidocaine, or procainamide.

[q] Routine therapy for PVC suppression is not indicated in asymptomatic patients. However, in patients with frequent symptomatic PVCs, ….. are first-line therapy.

[c*] Show me the answer

[f] Escalating doses of beta blockers (BBs) (metoprolol) or calcium channel blockers (CCBs).

[q] How to manage this patient?

[c*] Show me the answer

[f] The best initial therapy for ventricular fibrillation (VF) is an immediate, unsynchronized cardioversion followed by the resumption of CPR if this was not effective.

After another attempt at defibrillation, the most appropriate next step in management is epinephrine followed by another electrical shock.

Medications do not restart the heart. They make the next attempt at defibrillation more likely to succeed. Amiodarone or lidocaine is given next to try to get subsequent shocks to be more successful. Magnesium is given with ventricular arrhythmia without waiting for a level.

Amiodarone is superior to lidocaine for VF.

[q] How to manage this patient?

1. 

2. Organized rhythm on cardiac monitoring without a measurable blood pressure or palpable pulse in a cardiac arrest patient.

[c*] Show me the answer

[f]

– The recent advanced cardiac life support guidelines recommend managing PEA with cardiopulmonary resuscitation (CPR) and vasopressor therapy (epinephrine) to achieve adequate cerebral and coronary perfusion.

– CPR should be continued uninterrupted while attempts are made to identify and treat the reversible causes of PEA (5 Hs and Ts).

– Since the treatment of PEA is to correct the underlying cause, knowing the etiology is identical to knowing the treatment. PEA is caused by:

[q] Amiodarone can cause several potential adverse effects, and long-term monitoring of …….. is recommended for early detection and recognition of potential side effects from its use.

[c*] Show me the answer

[f] Pulmonary function and thyroid tests.

[q] Causes of long QT syndrome are …….?

[c*] Show me the answer

[f]

– Electrolyte derangement (HYPOCALCEMIA, HYPOKALEMIA, HYPOMAGNESEMIA).

– Drug-induced long QT (ABCDE):
AntiArrhythmics (class IA, III).
AntiBiotics (macrolides).
Anti“C”ychotics (haloperidol).
AntiDepressants (TCAs).
AntiEmetics (ondansetron).

– Inherited:

Romano-Ward syndrome: Autosomal dominant, pure cardiac phenotype (no deafness).

Jervell and Lange-Nielsen syndrome: autosomal recessive, sensorineural deafness.

[q]  ….. can prevent cardiac arrest from prolonged QT syndrome?

[c*] Show me the answer

[f] Beta blockers with pacemaker placement.

[q] How to manage this patient?

[c*] Show me the answer

[f] Immediate defibrillation is indicated in hemodynamically unstable patients, while intravenous magnesium sulfate is the first-line therapy for stable patients with recurrent episodes.

[q] “What is the most likely diagnosis?

[c*] Show me the answer

[f] Inferior wall Ischemia.

[q] “What is the most likely diagnosis?

[c*] Show me the answer

[f] Inferior wall Myocardial Infarction.

[q] “What is the most likely diagnosis?

[c*] Show me the answer

[f] Anterolateral wall Myocardial Infarction.

[x][restart]

[/qwiz]