Coronary Artery Disease
Definition of stable angina?
Causes of HFrEF?
Coronary artery disease, myocarditis, valvular heart disease, infiltrative processes, and hypertension.
Causes of sinus tachycardia?
Exercise, pain, fever/sepsis, hypovolemia, anemia, anxiety, hyperthyroidism, inappropriate sinus tachycardia, postural orthostatic tachycardia syndrome
Diagnosis suggested by late-peaking systolic murmur, a diminished or absent aortic component of the S2, and a weak and delayed carotid upstroke.
Severe aortic stenosis
Next best step in a 52 yr F w/ HTN with chest pressure for 6 weeks brought on by exercise and emotion with a normal exam and ECG?
Exercise EKG
- In patients with an intermediate probability of obstructive coronary artery disease, a normal baseline electrocardiogram, and the ability to exercise, exercise electrocardiography is recommended as the initial test of choice.
First line therapy in stable angina?
Aspirin (or clopidogrel in aspirin-intolerant patients), statin therapy, and β-blocker therapy.
BNP value that above which has a sensitivity and negative predictive value for heart failure above 95% and 90% respectively?
>400pg/ml
CHA2DS2-VASc score to start anticoagulation?
CHA2DS2-VASc score of 2 or greater in men or 3 or greater in women should be treated with oral anticoagulation to prevent stroke.
Definition of severe aortic stenosis and treatment
Severe aortic stenosis is typically defined by a small valve area (≤1.0 cm2) and either high peak velocity (>4 m/s) or high mean gradient (>40 mm Hg).
SAVR or TAVR
When should stress testing with adjunctive imaging be done over a simple stress exercise EKG?
Stress testing with adjunctive imaging should be performed in patients with suspected coronary artery disease who have baseline electrocardiographic (ECG) abnormalities that preclude the use of ECG stress testing, such as ST-segment depressions greater than 0.5 mm, left bundle branch block, ventricular paced complexes, digitalis effect, and preexcitation.
Methods to reduce CAD risk in patients with diabetes?
BP control <130/80 if ASCVD >15%, moderate to high intensity statin use, SGLT2 inhibitor or GLP-1 agonist use, aspirin use in existing CAD.
First line Goal Directed Medical Therapy for HFrEF?
Beta blocker, ACE/ARB (now switching to Entresto), Statin if ischemic cause of HFrEF
True or false? Rhythm control is superior to rate control in atrial flutter.
True! Catheter ablation is the definitive treatment of typical atrial flutter, owing to a very high success rate (>95%) and low complication rate.
Goal INR for aortic and mitral valve prostheses?
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 risk factors for thromboembolism, an older-generation aortic valve prosthesis (ball-in-cage), or any mitral prosthesis, the target INR is 3.
When should coronary artery calcium (CAC) scoring be performed in asymptomatic patients?
Borderline (5-7.5%) and intermediate (7.5-20%) 10 year ASCVD risk, in whom the decision to start statin therapy remains uncertain.
Minimum length of time required for DAPT after an NSTEMI, regardless of invasive or ischemia guided treatment strategy?
1 year
Indication for AICD?
Patients with heart failure who have an ejection fraction less than or equal to 35% and New York Heart Association functional class II or III symptoms while taking guideline-directed medical therapy for at least 3 months.
Long term treatment for AVNRT?
Patients with recurrent atrioventricular nodal reentrant tachycardia are treated with atrioventricular nodal blocking agents (β-blockers or calcium channel blockers) or catheter ablation.
Anticoagulation of choice for moderate to severe mitral stenosis with atrial fibrillation
Warfarin
Indications for a TTE after hearing a murmur?
Transthoracic echocardiography is indicated for patients with systolic murmurs grade 3/6 or higher, late or holosystolic murmurs, diastolic or continuous murmurs, and murmurs with accompanying symptoms.
Preferred mode of revascularization in Diabetes Mellitus with CAD?
Coronary artery bypass grafting (CABG)
Gold standard therapy for end stage heart failure?
Cardiac transplantation.
What is this pattern/syndrome? What is the treatment in symptomatic individuals?
Brugada syndrome - type 1 Brugada pattern, ≥2 mm J-point elevation, ST-segment coving (concave or linear downsloping ST segment) (arrowheads), and T-wave inversions in leads V1 to V3.
ICD implantation is indicated for syncope or ventricular arrhythmia
Indications for surgery in infective endocarditis?
(1) symptomatic heart failure and valvular dysfunction; (2) left-sided infective endocarditis caused by fungal infections or highly-resistant organisms; (3) associated complications, such as annular or aortic abscess, destructive penetrating lesions, or heart block; (4) persistent bacteremia or fevers lasting more than 5 to 7 days despite appropriate antimicrobial therapy.
Best tests for symptoms suggestive of arrhythmia (i.e. palpitations, dizziness etc) that occur:
1 - Every 24-48hrs
2 - 2-3 times a week
3- >30 days apart
1 - Holter monitor
2 - External event recorder (e.g. Zio patch)
3 - Implantable loop recorder