CARDIO Rosh Review
Valvular atrial fibrillation due to mitral stenosis.
Rx - ANS-Warfarin, INR goal of 2.5
Regardless of CHAD-VASc
Which patients with moderate to severe mitral stenosis from rheumatic heart disease are
candidates for anticoagulation with warfarin? - ANS-Those with atrial fibrillation, prior embolic
events, or left atrial thrombus.
Normal ABI - ANS-0.9-1.3
Testing in patient with normal ABI and claudication sx. - ANS-Exercise testing with postexercise
decrease in ABI >20% = PAD
Which artery is likely affected in a patient with peripheral arterial disease who has pain in the
upper two-thirds of the calf? - ANS-Superficial femoral artery.
Guideline directed medical therapy in a HF pt with reduced EF and decreased exercise
tolerance - ANS-angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker
(but not both), beta-blocker, and diuretic as needed for volume status
Class II-IV disease, despite initial guideline-directed medical therapies, the addition of a
mineralocorticoid receptor antagonist (MRA)
Contraindication to mineralocorticoid receptor antagonists - ANS-CrCl <30 or potassium >5
Recommended in patients who have an acute MI and reduced EF <40% with symptoms of HF
or DM - ANS-Aldosterone receptor antagonist (mineralocorticoid RA)
Recommended for Black patients Class NYHA 3-4 HFrEF on GDMT - ANS-Hydralazine and
isosorbide dinitrate
What is the mechanism of action of ivabradine? - ANS-Inhibits the funny current (If).
Medication associated with myocarditis - ANS-doxorubicin
Worsening kidney function with HF on ACEi despite attempting to decrease the dose. Rx -
ANS-Hydralazine and isosorbide combination
D/c altogether if Cr worsens >3.5 or eGFR <20.
Which is a potential adverse effect of hydralazine? - ANS-Drug-induced lupus
, What is the primary concern with hypertrophic cardiomyopathy? - ANS-Sudden cardiac death.
Heart valves commonly implicated in radiation-induced valvular abnormalities. - ANS-Aortic and
mitral
midsystolic crescendo-decrescendo murmur at the right upper sternal border that radiates to the
right carotid or to the apex. - ANS-Aortic stenosis
apical holosystolic murmur that radiates to the left axilla, widely split P2 - ANS-Mitral regurg
Which body position is the murmur of mitral regurgitation best heard in? - ANS-Left lateral
decubitus position.
What are common adverse effects of colchicine? - ANS-Diarrhea, nausea, vomiting, and
pharyngolaryngeal pain.
Arrhythmia associated with COPD - ANS-multifocal atrial tachycardia
Rx: underlying dz and O2 therapy
treated for their underlying medical disorders but continue to have symptomatic MAT with
hemodynamic instability, what is a potential treatment? - ANS-Ablation of the atrioventricular
node and use of a permanent ventricular pacemaker.
GDMT in HFpEF - ANS-Yes: Diuretics (2nd: MRA)
+/- CCB, ACEi (treats HTN, no mortality benefit)
No: BB, ARB
Why do we avoid nitrates in inferior MI patients? - ANS-Hypotension decreases preload
Right ventricular MI are preload dependent
Needs PCI
Cardiac medication associated with hyperglycemia, secondary to inhibition of glucose uptake,
reduced insulin release, and increased insulin resistance - ANS-thiazide and thiazide-like
diuretics
What is the association between thiazide use and cholesterol levels? - ANS-Thiazides can
increase total and LDL cholesterol and triglyceride levels.
Which medications should be avoided in patients with left ventricular outflow obstruction from
hypertrophic cardiomyopathy? - ANS-Preload reducers (diuretics) and vasodilators
(nitroglycerin, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, and
dihydropyridine calcium channel blockers).
Valvular atrial fibrillation due to mitral stenosis.
Rx - ANS-Warfarin, INR goal of 2.5
Regardless of CHAD-VASc
Which patients with moderate to severe mitral stenosis from rheumatic heart disease are
candidates for anticoagulation with warfarin? - ANS-Those with atrial fibrillation, prior embolic
events, or left atrial thrombus.
Normal ABI - ANS-0.9-1.3
Testing in patient with normal ABI and claudication sx. - ANS-Exercise testing with postexercise
decrease in ABI >20% = PAD
Which artery is likely affected in a patient with peripheral arterial disease who has pain in the
upper two-thirds of the calf? - ANS-Superficial femoral artery.
Guideline directed medical therapy in a HF pt with reduced EF and decreased exercise
tolerance - ANS-angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker
(but not both), beta-blocker, and diuretic as needed for volume status
Class II-IV disease, despite initial guideline-directed medical therapies, the addition of a
mineralocorticoid receptor antagonist (MRA)
Contraindication to mineralocorticoid receptor antagonists - ANS-CrCl <30 or potassium >5
Recommended in patients who have an acute MI and reduced EF <40% with symptoms of HF
or DM - ANS-Aldosterone receptor antagonist (mineralocorticoid RA)
Recommended for Black patients Class NYHA 3-4 HFrEF on GDMT - ANS-Hydralazine and
isosorbide dinitrate
What is the mechanism of action of ivabradine? - ANS-Inhibits the funny current (If).
Medication associated with myocarditis - ANS-doxorubicin
Worsening kidney function with HF on ACEi despite attempting to decrease the dose. Rx -
ANS-Hydralazine and isosorbide combination
D/c altogether if Cr worsens >3.5 or eGFR <20.
Which is a potential adverse effect of hydralazine? - ANS-Drug-induced lupus
, What is the primary concern with hypertrophic cardiomyopathy? - ANS-Sudden cardiac death.
Heart valves commonly implicated in radiation-induced valvular abnormalities. - ANS-Aortic and
mitral
midsystolic crescendo-decrescendo murmur at the right upper sternal border that radiates to the
right carotid or to the apex. - ANS-Aortic stenosis
apical holosystolic murmur that radiates to the left axilla, widely split P2 - ANS-Mitral regurg
Which body position is the murmur of mitral regurgitation best heard in? - ANS-Left lateral
decubitus position.
What are common adverse effects of colchicine? - ANS-Diarrhea, nausea, vomiting, and
pharyngolaryngeal pain.
Arrhythmia associated with COPD - ANS-multifocal atrial tachycardia
Rx: underlying dz and O2 therapy
treated for their underlying medical disorders but continue to have symptomatic MAT with
hemodynamic instability, what is a potential treatment? - ANS-Ablation of the atrioventricular
node and use of a permanent ventricular pacemaker.
GDMT in HFpEF - ANS-Yes: Diuretics (2nd: MRA)
+/- CCB, ACEi (treats HTN, no mortality benefit)
No: BB, ARB
Why do we avoid nitrates in inferior MI patients? - ANS-Hypotension decreases preload
Right ventricular MI are preload dependent
Needs PCI
Cardiac medication associated with hyperglycemia, secondary to inhibition of glucose uptake,
reduced insulin release, and increased insulin resistance - ANS-thiazide and thiazide-like
diuretics
What is the association between thiazide use and cholesterol levels? - ANS-Thiazides can
increase total and LDL cholesterol and triglyceride levels.
Which medications should be avoided in patients with left ventricular outflow obstruction from
hypertrophic cardiomyopathy? - ANS-Preload reducers (diuretics) and vasodilators
(nitroglycerin, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, and
dihydropyridine calcium channel blockers).
