Cath Me If You Can
Examination Station
Rx-Rated
Miscellaneous Matters of the Heart
CRISPy Genes
Final Jeopardy!
100
Name 3 medications / medication classes that treat microvascular angina.
beta blockers
calcium channel blockers
ranolazine
ivabradine
nicorandil
trimetazidine
100
Define Stage 1 and Stage 2 hypertension (must get both correct).
Stage 1 = SBP 130-139 mmHg or 80-89 mmHg
Stage 2 = SBP ≥ 140 mmHg or DBP ≥ 90 mmHg
100
Name 2 indications where warfarin is indicated over DOAC in patients with atrial fibrillation.
valvular afib = afib with mod-severe MS
afib with mechanical heart valve
100
In a patient with classic claudication symptoms, which resting ABI value would prompt you to get a TBI?
Resting ABI >1.4
100
Name the most common gene assocated with Brugada syndrome.
loss of function in SCN5A gene
100
Name 3 RHC hemodynamic patterns which would prompt vasoreactivity testing AND what would findings would be consistent with vasoreactivity.
mPAP > 20 mmHg
PCWP ≤15 mm Hg
PVR > 2 Wood
vasoreactivity is present with a ≥10 mm Hg reduction in mPAP to <40 mm Hg without lowering CO
200
Which intracoronary medication can be given to induce coronary vasospam in the cath lab?
Intracoronary ergonovine or acetylcholine
- vasospastic/prinzmetal angina = temporary increase in coronary vascular tone
- predominantly younger women (smokers, at rest or at night), associated with Raynaud's & migraines
- can cause ST-elevation, elevated troponin, and arrhythmias
- reversed with IC NTG; long term tx with CCB & long acting nitrate
200
Name two provocative maneuvers can be done on exam that will increase the murmur of HOCM to help to distinguish it from the fixed murmur of aortic stenosis.
Valsalva
Standing from sitting
200
List 5 medications for hypertension which can be used in pregnancy.
Metoprolol, carvedilol, labetolol, nifedipine, methyldopa
Yellow but allowed- hydralazine, isosorbide dinitrate, amlodipine, HCTZ
200
Name the equation for cardiac power output.
CPO = (MAP x CO) / 451
normal is ~1 Watt; severe dysfunction is < 0.6 W
strong hemodynamic predictor of mortality
- persistently low or declining CPO values suggest the need for escalation of inotropes or MCS
- improvement in CPO supports de-escalation
200
Name the genetic mutation associated with familial PHTN.
loss of function of BMPR2
Bone Morphogenetic Protein Receptor 2
regulates vascular smooth muscle cell growth and remodeling
300
Which of these patients with HFpEF has the worst prognosis?
Patient C
has both HFpEF and combined pre and post-capillary pulmonary HTN
300
Name the key physical exam finding that differentiates Marfan's from other connective tissue disorders.
Ectopic lentis
- affects over 50% of patients with Marfan
- Marfan = fibrillin 1 gene
- lens typically shifts upward and outward (superotemporal subluxation)
300
Identify the cancer therapy class which is most likely to result in hypertension as a significant adverse effect.
VEGF inhibitors (typically TKIs)
300
Patient shocked 3 times by his ICD. Identify the rhythm shown in the EGM from device interrogation.
Atrial fibrillation
more atrial beats than ventricular, irregular
(VF fast, irregular with more ventricular beats, VT fast regular with less and dissociated atrial beats)
300
Name the biomarker associated with fibrosis and increased admissions in patients with heart failure.
Galectin-3
β‑galactoside‑binding lectin that plays a key role in cardiac fibrosis, inflammation, and ventricular remodeling
400
A 64 yo M is being transferred to a PCI capable facility 3 hours away for an inferior STEMI. Name the antiplatelet and/or anticoagulation regimen (including doses) in addition to the fibrinolytics they will receive which should be given prior to transfer.
aspirin 160-325 mg
clopidogrel 300 mg (clopdiogrel 75 mg once if age >75)
weight based heparin
CLARITY TIMI-28 trial
400
A newborn baby girl is noted to have wide-set eyes and webbed neck, along with a harsh systolic murmur. Echo shows an atrial septal defect, pulmonary stenosis, and HOCM. Name the diagnosis.
Noonan syndrome
- PS, ASD/VSD, and HOCM
- unlike classic congenital PVS (thin, dome-shaped commissural fusion), Noonan PV is dysplastic, thickened, and myxomatous with minimal commisural fusion (BPV fails)
- EKG shows an extreme superior (northwest) QRS axis deviation
400
A 65 year old patient on immune checkpoint inhibitors for melanoma presents in cardiogenic shock and complete heart block. Describe would be seen on endomyocardial biopsy.
Interstitial inflammation with lymphocyte (ICI myocarditis)
400
List 4 quantitative and semi-quantitative parameters for severe mitral regurgitation.
VCW > 0.7 (0.8 for biplane)
pulmonary vein systolic flow reversal
EROA ≥ 0.40 cm2
Regurgitant volume ≥ 60 ml
Regurgitant fraction ≥ 50%
mitral inflow is E-wave dominant (>1.2 m/s as opposed to A wave dominant in mild MR)
400
Name the two cardiac pathologies that elevated LP(a) is independently predictive of.
1) coronary artery disease
2) calcific aortic stenosis