Cardiology boards ABIM questions and answers
What is a positive stress test ✔✔Flat or Down sloping St-segment depression >1 mm occurring 80 msec
after j point
When to stop a stress test ✔✔St segment depression > 2 mm, ventricular tachycardia, drop in SBP > 15,
chest pain, dyspnea, lightheadedness
Stress test of choice with a LBBB or ventricular pacing? ✔✔Myocardial perfusion imaging with
adenosine,NOT exercising!
Know the algorithm for stress testing ✔✔See page 5-3,figure 5-1
When to not use doutamine for stress ✔✔History of VT, severe HTN, Low BP, poor echo images
When to not use adenosine for stress ✔✔Bronchospasm, severe valvular dysfunction, severe carotid
stenosis, 2nd degree heart block, theophylline dependent
Normals for PA catheter pressures ✔✔RA <7, RV 30/7, PCWP 3-11
PA cath findings in tamponade or restrictive pericarditis ✔✔Diastolic pressures elevated and equalized
in all chambers, low BP
PA cath findings with RV AMI ✔✔Elevated RA and PA pressures, decreased or nl PCWP, hypotension,
and inferior MI. R side is decompensated, cannot fill L side of the heart
PA cath findings in cardiogenic shock ✔✔Elevated PCWP, RA pressure, and decreased SBP/cardiac
output
,PA cath findings in mitral stenosis with RV failure ✔✔Elevated RA, PA (very elevated), PCWP, nl SBP
PA cath findings in pulmonary HTN ✔✔Elevated PA, RA pressures, nl PCWP, SBP
Pulsus paradoxus ✔✔decrease in systolic BP of more than 10mmHg with normal inspiration; palpated as
weakened pulse with inspiration along with more heart contractions to pulse beats
What conditions give you pulsus paradoxus? ✔✔Constrictive or restrictive pericarditis, asthma, tension
pneumothorax
What gives you pulsus bisferiens (two systolic peaks per cycle) ✔✔Aortic regurgitation, HOCM
What causes pulsus alternans ✔✔Severe LV dysfunction
What causes pulsus tardus ✔✔Aortic stenosis
How do positional maneuvers affect blood flow and murmurs ✔✔-standing/valsalva - decreased cardiac
filling, decreases most murmurs except MVP and HOCM
-squatting/ lying down - increase cardiac volume, increased murmurs except MVP, HOCM
-sustained handgrip - increases systemic resistance, decreases murmur in HOCM, AS
What causes a physiologic split S2 ✔✔Increased blood volume in the RV prolongs systole and delays
pulmonary valve closure
What causes a fixed split S2 ✔✔Pulmonary stenosis, PE, LV pacer, RBBB, MR (early AV closure), ASD, RV
failue
What causes a paradoxic split S2 ✔✔LBBB, RV pacing, HOCM
What causes an S3? ✔✔Rapid LV filling - acute ventricular decompensation, severe AR or MR
, KNOW - S3 with LV dysfunction is a poor prognostic factor ✔✔...
What causes a S4? ✔✔Decreased ventricular compliance during atrial contraction - ischemic heart dz,
AS, MR, HOCM, hypertrophic or diabetic cardiomyopathy, HTN heart dz, concentric LVH
Can you have a S4 with atrial fibrillation? ✔✔No - no atrial contraction
What are the parts of the venous waveform? ✔✔A wave - atrial contraction
X descent - atria relax, RV fills rapidly
Bottom of x descent is TC valve closure
V wave - ventricle contacting against closed TC valve
Y descent - TC valve opens, passive emptying into ventricle
What gives elevated a and v waves ✔✔Pulmonary HTN, RV infarction
Large r side v waves ✔✔Septal rupture
Large v waves ✔✔TR (right), MR (left)
Rapid x and y descent ✔✔Constrictive pericarditis, restrictive cardiomyopathy, tamponade (x descent
only, loss of y descent)
Large a waves ✔✔TS,severe RVH (on right), MS
Cannon a waves ✔✔AV disassociation - complete heart block, ventricular pacing
Slow Y descent ✔✔Delayed atrial emptying - TS
What is a positive stress test ✔✔Flat or Down sloping St-segment depression >1 mm occurring 80 msec
after j point
When to stop a stress test ✔✔St segment depression > 2 mm, ventricular tachycardia, drop in SBP > 15,
chest pain, dyspnea, lightheadedness
Stress test of choice with a LBBB or ventricular pacing? ✔✔Myocardial perfusion imaging with
adenosine,NOT exercising!
Know the algorithm for stress testing ✔✔See page 5-3,figure 5-1
When to not use doutamine for stress ✔✔History of VT, severe HTN, Low BP, poor echo images
When to not use adenosine for stress ✔✔Bronchospasm, severe valvular dysfunction, severe carotid
stenosis, 2nd degree heart block, theophylline dependent
Normals for PA catheter pressures ✔✔RA <7, RV 30/7, PCWP 3-11
PA cath findings in tamponade or restrictive pericarditis ✔✔Diastolic pressures elevated and equalized
in all chambers, low BP
PA cath findings with RV AMI ✔✔Elevated RA and PA pressures, decreased or nl PCWP, hypotension,
and inferior MI. R side is decompensated, cannot fill L side of the heart
PA cath findings in cardiogenic shock ✔✔Elevated PCWP, RA pressure, and decreased SBP/cardiac
output
,PA cath findings in mitral stenosis with RV failure ✔✔Elevated RA, PA (very elevated), PCWP, nl SBP
PA cath findings in pulmonary HTN ✔✔Elevated PA, RA pressures, nl PCWP, SBP
Pulsus paradoxus ✔✔decrease in systolic BP of more than 10mmHg with normal inspiration; palpated as
weakened pulse with inspiration along with more heart contractions to pulse beats
What conditions give you pulsus paradoxus? ✔✔Constrictive or restrictive pericarditis, asthma, tension
pneumothorax
What gives you pulsus bisferiens (two systolic peaks per cycle) ✔✔Aortic regurgitation, HOCM
What causes pulsus alternans ✔✔Severe LV dysfunction
What causes pulsus tardus ✔✔Aortic stenosis
How do positional maneuvers affect blood flow and murmurs ✔✔-standing/valsalva - decreased cardiac
filling, decreases most murmurs except MVP and HOCM
-squatting/ lying down - increase cardiac volume, increased murmurs except MVP, HOCM
-sustained handgrip - increases systemic resistance, decreases murmur in HOCM, AS
What causes a physiologic split S2 ✔✔Increased blood volume in the RV prolongs systole and delays
pulmonary valve closure
What causes a fixed split S2 ✔✔Pulmonary stenosis, PE, LV pacer, RBBB, MR (early AV closure), ASD, RV
failue
What causes a paradoxic split S2 ✔✔LBBB, RV pacing, HOCM
What causes an S3? ✔✔Rapid LV filling - acute ventricular decompensation, severe AR or MR
, KNOW - S3 with LV dysfunction is a poor prognostic factor ✔✔...
What causes a S4? ✔✔Decreased ventricular compliance during atrial contraction - ischemic heart dz,
AS, MR, HOCM, hypertrophic or diabetic cardiomyopathy, HTN heart dz, concentric LVH
Can you have a S4 with atrial fibrillation? ✔✔No - no atrial contraction
What are the parts of the venous waveform? ✔✔A wave - atrial contraction
X descent - atria relax, RV fills rapidly
Bottom of x descent is TC valve closure
V wave - ventricle contacting against closed TC valve
Y descent - TC valve opens, passive emptying into ventricle
What gives elevated a and v waves ✔✔Pulmonary HTN, RV infarction
Large r side v waves ✔✔Septal rupture
Large v waves ✔✔TR (right), MR (left)
Rapid x and y descent ✔✔Constrictive pericarditis, restrictive cardiomyopathy, tamponade (x descent
only, loss of y descent)
Large a waves ✔✔TS,severe RVH (on right), MS
Cannon a waves ✔✔AV disassociation - complete heart block, ventricular pacing
Slow Y descent ✔✔Delayed atrial emptying - TS
