ITE Jeopardy

Cath Me If You Can

100

Name 3 medications / medication classes that treat microvascular angina.

beta blockers

calcium channel blockers

ranolazine

ivabradine

nicorandil

trimetazidine

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

300

Which of these patients with HFpEF has the worst prognosis? 

Patient C

has both HFpEF and combined pre and post-capillary pulmonary HTN

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

Examination Station

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

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

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)

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

Rx-Rated

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

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

300

Identify the cancer therapy class which is most likely to result in hypertension as a significant adverse effect.

VEGF inhibitors (typically TKIs)

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)

Miscellaneous Matters of the Heart

100

In a patient with classic claudication symptoms, which resting ABI value would prompt you to get a TBI?

Resting ABI >1.4

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

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)

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)

CRISPy Genes

100

Name the most common gene assocated with Brugada syndrome.

loss of function in SCN5A gene

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

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

Name the two cardiac pathologies that elevated LP(a) is independently predictive of.

1) coronary artery disease

2) calcific aortic stenosis

Final Jeopardy!

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