Cardiomyopathies
Which type of cardiomyopathy has the worst prognosis?
Restricted cardiomyopathy
MC type and chamber of heart failure
HFrEF
L Ventricular HF
What are the optimal and high ranges of LDL?
<100 mg/dL
>160 mg/dL
Which bradyarrhythmias is atropine NOT used for
Complete heart block
(Also not indicated for junctional rhythms or sick sinus syndrome)
Patient reports to the office with complaints of a red, throbbing lower leg. She is a smoker and on oral contraceptives. Wells score is calculated to be a 5.
What is your next step in diagnosis of your top differential?
Venous US w/ duplex
A 17-year-old, otherwise healthy, male football player collapses during a game. Paramedics arrive to find him in ventricular fibrillation and unresponsive.
What is the most likely diagnosis for this patient?
Hypertrophic Cardiomyopathy
This value is used to classify heart failure
LVEF
A 66-year-old man presents for a routine eye exam. The ophthalmologist notes a gray-white ring at the periphery of the cornea. The patient denies visual changes. His medical history is significant for hypertension and hyperlipidemia.
What is this ocular manifestation?
Arcus senilis
What are the 4 vagal maneuvers we discussed in class?
carotid sinus massage
valsalva
modified valsalva
diving reflex
Patient presents to the office with complaints of pain in his lower legs while walking around his house that improves at rest. He also states that putting his shoes on has been miserable.
Which testing modality is used to confirm the suspected diagnosis?
Ankle Brachial Index
A 62-year-old man presents with chest pressure and dyspnea one month after an inferior STEMI. TTE demonstrates thinning and dilation of the LV wall with reduced EF. He has frequent PVCs and runs of VT.
What subtype of dilated cardiomyopathy is this?
Ischemic cardiomyopathy from LV remodeling post-MI
A 67-year-old man with a history of hypertension presents with dyspnea, orthopnea, and leg swelling. BNP is 1,200. TTE reveals LVEF 28% and global hypokinesis. He is already on lisinopril and metoprolol.
Which medication should be added next to complete the core pillars of GDMT for his condition?
Spironolactone (MRA)
A triglyceride level of >500 mg/dL or more can lead to this possible sequela
Acute pancreatitis
A 70-year-old woman presents with symptomatic Afib lasting 36 hours. She has no heart failure and her BP is stable.
What is the next appropriate treatment step?
Immediate cardioversion
What is the MC vein for superficial venous thrombophlebitis?
Great saphenous
A 43-year-old woman experiences acute chest pain during a high-stress event. ECG shows ST elevations in the precordial leads, but angiography shows no coronary occlusion. TTE reveals transient apical ballooning.
What is the recommended pharmacological therapy for this patient?
3-6 months of cardioselective beta blockers and ACEi
A 58-year-old man with HFrEF presents for follow-up. He is on maximally titrated GDMT for 5 months. LVEF is 30%. He has NYHA class II symptoms. ECG shows LBBB.
What is the next therapeutic option/s for this patient?
CRT + ID placement
What would be the appropriate statin regimen for this patient?
Moderate intensity statin:
Low dose atorvastatin
Low dose rosuvastatin
High dose simvastatin
A 72-year-old man with known Afib presents for follow-up. His CHADS2-VASc score is 2. His HAS-BLED score is 1.
What is the correct anticoagulation recommendation?
Patient presents to the ED with complaints of a white, tingling, painful leg. Upon examination, his skin is now mottled and has 0 DP or PT pulses.
Is imaging necessary for this patient to confirm his diagnosis?
No; clinical suspicion is enough to get a free ticket to the cath lab for revascularization.
A 48-year-old man presents with progressive dyspnea and abdominal fullness. He has JVP elevation, Kussmaul’s sign, and peripheral edema. TTE shows normal EF with markedly reduced ventricular compliance and bi-atrial enlargement.
What ECG finding may you suspect in this patient?
Low voltage QRS d/t restrictive cardiomyopathy
A 74-year-old man with a history of HFrEF (LVEF 25%) presents to the emergency department with progressive weakness, palpitations, and lightheadedness over the past 24 hours. He reports no chest pain but says his muscles “feel heavy” and he nearly passed out while standing up earlier.
He was recently hospitalized for a CHF exacerbation and discharged on guideline-directed therapy including sacubitril/valsartan, metoprolol succinate, dapagliflozin, furosemide, and recently added spironolactone.
EKG shows bradycardia, wide QRS complexes, and peaked T waves.
What complication is this patient currently experiencing?
Hyperkalemia d/t spironolactone
A patient with severe primary hypercholesterolemia presents for a checkup. His current LDL level is 109 mg/dL. He is currently taking rosuvastatin and ezetimibe daily and is adherent to his regimen.
What should be added to his regimen to reach the <70 mg/dL goal?
PCSK9 inhibitor; Repatha (evolocumab) subQ qmonth
What malignant rhythm could a class Ia anti-arrhythmic put someone into?
Torsades de Pointes
The patient from 200 point question has been diagnosed with PAD. His ABI reading was 0.8.
What is the appropriate treatment regimen for this patient? (Medication classes only)