Critical thinking
Aftermath
It's All Connected
Hi/Lo
It's Hard
100
The equation "PAPs-PAPd/RAP" defines this parameter
What is the pulmonary artery pulsatility index (PAPi)?
- In patients with RV MI, PAPi correlates with RV stroke work and qualitative echocardiographic indices of RV dysfunction. Also predicts in-hospital mortality and/or requirement for mechanical circulatory support.
- In patients undergoing LVAD implantation, PAPi can predict postoperative RV failure.
100
An excess of gastrointestinal adverse events offset potential benefits for reduction in post-pericardiotomy syndrome with this inhibitor of microtubule polymerization
What is colchicine ?
- In the COPPS-2 randomized placebo-controlled trial, cardiac surgical patients assigned to colchicine experienced a 10% reduction in post-pericardiotomy syndrome(NNT=10) with no significant difference in incident atrial fibrillation. 8.3% increase in adverse events (NNH=12).
100
Mutations in ABCC6 cause this autosomal recessive disorder, associated with vision loss, yellow papules on flexor areas and vascular calcification.
What is pseudoxanthoma elasticum(Groenblad-Strandbery syndrome)?
- Famiies with PXE have a high prevalence of left ventricular diastolic dysfunction, accelerated atherosclerosis and peripheral arterial disease.
100
In patients with initially elevated office blood pressure, repeat measurement is typically associated with this change in measured blood pressure ?
What is improvement in systolic BP
- Among a large sample of patients with HTN, repeated measurement of an initially elevated BP was associated with a median of 8 mm Hg improvement in systolic BP.
100
This coronary artery calcium score is associated with 50th percentile for women between the ages of 45 to 54
What is 0 ?
200
Your patient hospitalized in CICU for cardiogenic shock develops an acute rise in pulmonary arterial oxygen saturation, which you attribute to this underlying cause of the new physical finding
What is the purple urine bag syndrome (or UTI)?
- In the presence of alkaline urine, degradation of indoxyl sulfate(a metabolite of tryptophan) to indigo and indirubin(red) by bacteria in the urinary tract can cause purple discoloration of the urine.
- Sepsis can be associated with an increase in the pulmonary arterial oxygen saturation due to increased cardiac output and impairment in oxygen extraction.
200
in 2017, a single-center trial showed a lower rate of mortality and severe complications with this agent as compared with norepinephrine for treatment of vasodilator shock after cardiac surgery
What is Vasopressin ?
- Hajjar et al. Anesthesiology 2017
200
The autoantibody in systemic sclerosis that is associated with cardiomyopathy is...
What is anti-scl 70 or anti-U3RNP?
- Anti-SCL 70 associated with cardiomyopathy, myocarditis and digital ulcers
- Anti-U3RNP associated with cardiomyopathy and pulmonary hypertension
- Anti-Th/To associated with pulmonary hypertension
- Anti-centromere associated with an increased frequency of pulmonary hypertension and digital ulcers.
200
Metabloic syndrome is defined by the presence of >=three(3) risk factors. The fasting glucose cut-off for metabolic syndrome is ...
What is >=100 mg/dl Or 5.6 mmol/L?
200
Calcified plaque is characterized by a well-delineated signal-poor region with sharply defined borders with this intravascualr imaging modality.
What is Optical coherence tomography ?
- Calcium appears as sharply defined, signal poor regions on OCT.
300
SOAP II demonstrated an excess of arrhythmia in patients with shock treated with this drug
What is dopamine ?
- SOAP II randomly assigned patients with shock(n=1679) to dopamine or norepinephrine and found no difference in death at 28 days.
- Arrhythmic events ere twice as common with dopamine(24.1% vs 12.4%)
- In the subgroup of patients with cardiogenic shock(n=280), mortality was significantly higher in patients randomized to dopamine(p=0.03)
300
Based on ACC/AHA/HRS 2019 guidelines, it is a class IIa recommendation to use double therapy with clopidogrel and either ---- or ---- to reduce the risk of bleeding compared to triple therapy (COR IIa, B-R).
What is Rivaroxaban 15 mg daily or dabigatran 150 mg bid
January CT, et al. 2019 ACC/AHA/HRS focused update on atrial fibrilaion
300
alpha-synuclein protein has been implicated in the pathogenesis of this disorder, associated with hoarseness, urinary incontinence(or retention) and orthostatic hypotension
What is multi-system atrophy (Shy-Drager syndrome)?
- 60-80% of patients with MSA exhibit orthostatic hypotension.
- Alpha-Synuclein-mediated degeneration of pre-ganglionic sympathetic neurons in the CNS compromises activation of intact post-ganglionic sympathetic neurons involved in the baroreflex, limiting appropriate release of norepinephrine upon standing.
300
2017 guidelines for management of high blood pressure eliminated this category that previously described patients with SBP 120-139 and/or DBP 80-89
What is prehypertension ?
300
Observed in some patients with end-stage renal disease, dysregulation of osteoprotegerin and osteopontin may contribute to this vascular pathology
What is Monckeberg's arteriosclerosis or (medial calcific sclerosis) OR Calciphylaxis ?
400
This antiplatelet medication has an average half-life elimination of 3-6 minutes.
What is cangrelor ?
- Cangrelor is a direct, parental P2y12 receptor antagonist with an average half life elimination of 3-6 minutes independent of renal or hepatic function.
- Complete offset of effect is anticipated within 1 hour of discontinuation
400
Quinidine has additive effect and should be used very cautiously in conjunction with this beta-blocker because of its need of cytochrome P-450 2D6 system for elimination.
What is Metoprolol ?
- Metoprolol is eliminated via cytochrome p-450 2D6 system
- Quinidine is a potent inhibitor of this enzyme, leading to decreased elimination of metoprolol.
- Other beta-blockers: atenolol, nadolol, bisoprolol are not eliminated through this system.
400
Mucin-secreting adenocarcinoma is associated with this disorder of the cardiac valves
What is non-bacterial thrombotic(marantic) endocarditis ?
- Carcinoma mucins are large, heavily glycosylated molecules and are often carriers of sialylated, fucosylated, sulfated glycans that can act as ligands for selecting.
- Most circulating mucins are cleared by liver but remnant can interact with P and L- selections and induce formation of platelet-rich micro thrombi.
400
This autosomal dominant heritable disorder associated with severe, early hypertension mimics the clinical syndrome of primary aldosteronism but with low or normal serum levels of aldosterone.
What is Liddle's syndrome ?
- Mutation at the 16p13-p12 locus results in dysregulation of the epithelial sodium channel (ENaC), impairing normal degradation of the channel by ubiquitin-proteasome system.
- Abnormally high concentration of ENaC in collecting ducts results in excessive volume retention and hypertension.
400
This form of coronary artery calcification has been associated with plaque instability and risk of ACS
What is spotty calcification or microcalcification ?
- Spotty calcification, low attenuation plaque and positive remodeling on coronary CT are more common in lesions associated with acute coronary syndromes.
- Heavy calcification, in contrast, tends to correlate with overall plaque burden and may reflect plaques less likely to rupture.
- Microcalcifications(<10 um) within thin fibrous caps have been hypothesized to mediate localized increases in mechanical stress contributing to rupture.