Anatomy and Physiology
This is referred to as the pacemaker of the heart.
What is the SA node?
What are severe Aortic stenosis criteria ?
Severe aortic stenosis is typically defined by a small valve area (≤1.0 cm2), high peak velocity (≥4 m/s), and/or high mean gradient (≥40 mm Hg).
Name the most common tachycardia
Sinus tachycardia is the most common tachycardia and is typically the result of physiologic demand or distress, including exercise, pain, fever, hypovolemia, and anxiety.
A patient in systole is likely to receive which two drugs
Atropine and epinephrine
Choice of anticoagulation for mechanical heart valves.
What is the Goal INR for aortic and mitral mechanical heart valves.
Lifelong warfarin anticoagulation is indicated for all patients with a mechanical valve.
In patients with a mechanical aortic valve prosthesis (bileaflet or current-generation single-tilting disc) with no additional risk factors for thromboembolism (history of embolization, hypercoagulable disorder, LV dysfunction, atrial fibrillation), the goal INR for warfarin anticoagulation is 2.5. In patients with a mechanical aortic valve prosthesis with heightened risk factors for thromboembolism, an older-generation aortic valve prosthesis (ball-in-cage), or any mitral prosthesis, the target INR is 3.0. An INR range of 2.5 to 3.5 is acceptable.
The other name for the bicuspid valve.
What is Mitral Valve?
Define stages of heart failure per ACC/AHA
Stage A:
At risk for heart failure
People who are at risk for heart failure but do not yet have symptoms or structural or functional heart disease
Risk factors for people in this stage include hypertension, coronary vascular disease, diabetes, obesity, exposure to cardiotoxic agents, genetic variants for cardiomyopathy and family history of cardiomyopathy
Stage B:
Pre-heart failurePeople without current or previous symptoms of heart failure but with either structural heart disease, increased filling pressures in the heart or other risk factors
Stage C:
Symptomatic heart failurePeople with current or previous symptoms of heart failure
Stage D:
Advanced heart failurePeople with heart failure symptoms that interfere with daily life functions or lead to repeated hospitalizations
Name the 5 deadliest rhythm
VT, V fib, A systole, PEA, profound bradycardia
Sildenafil should not be used with which drug and explain why ?
Nitroglycerin due to risk of severe hypotension
Thrombolytic therapy is recommended for patients with STEMI when symptom onset is within ---- hours and PPCI is not available within ---- minutes of first medical contact.
Thrombolytic therapy is recommended for patients with STEMI when symptom onset is within 12 hours and PPCI is not available within 120 minutes of first medical contact.
Name 8 Risk factors for CV disease + name at least one inherited factor.
DM, HTN, Dyslipidemia, Obesity/ metabolic syndrome, Smoking, Systemic inflammation, HIV, Inherited factors (premature CAD)
Name different types of stress testing used in CAD.
Mention indications for stress testing with imaging.
Exercise stress test and stress test with imaging.
Stress testing with imaging is indicated in patients with an inability to exercise, baseline ECG abnormalities that limit interpretation of the exercise ECG, or indeterminate findings on the exercise ECG.
Give 4 common indications for permanent pacemaker implantation
Symptomatic bradycardia without reversible cause; permanent atrial fibrillation with symptomatic bradycardia; and complete heart block, high-degree atrioventricular (AV) block, or Mobitz type 2 second-degree AV block, irrespective of symptoms.
What is MOA of Digoxin ? and why it can be dangerous to use in Heart failure ?
MOA: Na-K ATP inhibition , increase myocardial contractility by accumulating calcium.
- 1) Narrow therapeutic index can cause severe dysrhythmia. 2) Risk for hypokalemia with diuretics which further increases risk of arrhythmia.
Indications for surgical repair of chronic severe primary mitral regurgitation.
Surgical repair of the mitral valve is indicated for chronic severe primary mitral regurgitation in symptomatic patients (regardless of LV systolic function) and asymptomatic patients with LV dysfunction (ejection fraction ≤60% and/or LV end-systolic dimension ≥40 mm).
Definition of premature Heart disease
< 55 years men
< 65 years for Women
Define most common location of Cardiac angiosarcoma and atrial myxoma respectively and the most common associated sign/symptoms.
Cardiac angiosarcoma :
atrial myxoma : Left atrium, typically cause constitutional symptoms of fever, weight loss, and fatigue; embolic phenomena; or symptoms related to obstruction
1) Name the initial study in patients with palpitations, presyncope, or syncope.
2) Also mention the test of choice if arrhythmia is frequent vs infrequent.
If symptoms occur daily, a 24- or 48-hour ambulatory ECG monitor (Holter monitor) may be used. Long-term ambulatory ECG monitors can be worn for up to 30 days if symptoms are less frequent.
Loop recorders : An implanted loop recorder may be warranted in patients with very infrequent events.
Indications for starting moderate intensity statin for primary prevention per USPSTF
The U.S. Preventive Services Task Force recommends moderate-intensity statin therapy for primary prevention in adults who have at least one atherosclerotic cardiovascular disease (ASCVD) risk factor and a calculated 10-year ASCVD event risk of 10% or higher.
Indications for early surgery in Infective endocarditis. Give at least 4
Early surgery may be considered in the presence of a large (>10-mm) left-sided vegetation to prevent embolic events.
This professor recorded first EKG
Willem Einthoven
Indications for CRT in HF patients.
Cardiac resynchronization therapy is indicated in patients with an 1) ejection fraction of 35% or less, 2) New York Heart Association functional class II to IV symptoms despite guideline-directed medical therapy, 3) sinus rhythm, and 4) left bundle branch block with a 5) QRS complex of 150 ms or longer.
What is most common SVT and how do you recognize/ diagnose it on EKG.
Atrioventricular nodal reentrant tachycardia, the most common form of supraventricular tachycardia, typically has a narrow QRS complex.
Atrioventricular nodal reentrant tachycardia is characterized electrocardiographically by a short RP interval with a retrograde P wave inscribed very close to the QRS complex, which is best seen in lead V1, appearing as a pseudo r′ wave.
Name the class of drug that is used to lower LDL cholesterol levels in patients with familial hypercholesterolemia or those at high risk for cardiovascular events despite statin therapy.
Name generic for at least two
PCSK9 Inhibitor
What is alirocumab (praluent) and evolocumab (Repatha)?
Indications for CABG at least 4
Over 50% left main coronary artery stenosis
Over 70% stenosis of the proximal left anterior descending (LAD) and proximal circumflex arteries
Three-vessel disease in asymptomatic patients or those with mild or stable angina
Three-vessel disease with proximal LAD stenosis in patients with poor left ventricular (LV) function
One- or two-vessel disease and a large area of viable myocardium in high-risk area in patients with stable angina
Over 70% proximal LAD stenosis with either an ejection fraction (EF) below 50% or demonstrable ischemia on noninvasive testing