M.I. Oh My
Pick Up the Pace
Ultrasound Beam Me Up Scotty
Pratik's Favorite Valve
Cardiac Candids
100
This scoring classification is used to stratify heart failure severity in patients with an acute myocardial infarction.
What is the Killip Classification?
Will accept Diamond-Forrester classification: which is also used to categorize heart failure patients into profiles
100
What is the origin of this ectopy?
What is the RVOT?
The PVCs in this ECG have a left bundle, inferior-axis morphology. The precordial R-wave transition (totally positive QRS complexes in lead V3) is typically seen in RVOT VT.
100
Ultrasound machines assume that beams propagate through tissues at this speed.
What is 1540 m/s
100
This is visualized in the 3D TEE image.
What is a mechanical bi-leaflet mitral valve prosthesis?
100
At what echo boards testing center did this occur?
What is Pearson Vue, Lake Success?
200
Name any three components used to calculated a TIMI risk score for UA/NSTEMI
Age >65
>3 CAD risk factors
Known CAD >50%
ASA use in the last 7 days
Severe angina (>2 episodes in 24 hours)
EKG STE changes >0.5 mm
Positive cardiac marker
200
What is your next step to risk stratify this asymptomatic 16yo female athlete?
What is Exercise Stress Testing?
The ECG demonstrates evidence of pre-excitation, consistent with Wolff-Parkinson-White (WPW) pattern, as she is asymptomatic but has an ECG pattern consistent with WPW.
Noninvasive exercise testing for risk stratification is the next appropriate step. During exercise stress, complete and abrupt disappearance of the delta wave is suggestive of a low-risk pathway. Persistent pre-excitation suggests a higher-risk pathway placing the patient at risk of arrhythmias, including ventricular fibrillation.
200
Ultrasound cannot travel through what medium.
What is a vacuum?
Pressure waves must be transmitted through physical media with molecules that interact with each other.
200
These four quantitative and semi-quantitative echo parameters and their values are diagnostic for severe mitral regurgitation
What are:
EROA >0.4 cm2
Regurgitant Fraction >50%
Regurgitant Volume > 60 mL
Vena Contracta >0.7 cm
200
For which country does the chief provide interventional cardiology services?
What is NYU Bolivia?
300
The histopathology seen below is consistent with what diagnosis.
What is acute myocardial infarction?
There is plaque rupture and thrombus formation on the vulnerable atherosclerotic plaque
300
60-year-old woman is admitted to the hospital for palpitations and lightheadedness; she has fainted twice in the past month.
Tele strips are recorded during an episode of lightheadedness. What is the next best step?
What is implant PPM?
The strips show periods of symptomatic second-degree AV block (2:1 block). Premature ectopic beats also are seen. A pacemaker would be indicated for all types of symptomatic second-degree AV block.
300
What diagnosis is consistent with this M Mode finding?
What is chronic severe pulmonary hypertension?
This M-mode recording of the pulmonary valve illustrates the “flying-W sign”.
This tracing is characterized by the loss of the a-wave and mid systolic notching.
300
M-mode finding is consistent with what diagnosis.
What is atrial myxoma.
Tumor plop is seen in diastole filling the opening of the mitral valve.
300
This device is a cardiology fellow's favorite device to evaluate fluid status.
What is the CardioMEMS?
The CardioMEMS HF System is indicated for wirelessly measuring and monitoring pulmonary artery pressure and heart rate in NYHA Class II or III heart failure patients who either have been hospitalized for heart failure in the previous year and/or have elevated natriuretic peptides. The hemodynamic data are used by physicians for heart failure management with the goal of controlling pulmonary artery pressures and reducing heart failure hospitalizations.
400
This invasive test is diagnostic of microvascular dysfunction when the result is less than 2.5
What is coronary flow reserve?
Doppler guidewire in the coronary measures the ratio of mean velocity before and after administration of vasoactive agents (Adenosine).
400
A 30-year-old man with rheumatoid arthritis presents to your office for evaluation of syncope. His medications include prednisone 7.5 mg daily, methotrexate 15mg weekly, hydroxychloroquine 200 mg daily, and dapsone 50 mg daily.
Which of his medications is the most likely cause of the arrhythmia seen?
What is hydroxychloroquine?
In this patient, hydroxychloroquine is the likely culprit. His QT interval may return to normal once this medication is stopped. Thus, the first step in assessment of long QT syndrome is identification of treatable/reversible causes.
Prednisone, methotrexate, and dapsone do not prolong the QT interval and are incorrect choices.
400
A 32-year-old asymptomatic woman is referred to you for a systolic murmur.
What structural abnormality is present on this aortic valve M Mode.
What is subaortic membrane?
The image shown features an abrupt, very early posterior motion of the right cusp of the aortic valve, which is characteristic of the subaortic membrane.
Bicuspid aortic valve motion features an eccentric closure line. Hypertrophic obstructive cardiomyopathy may have premature closure of the aortic valve on M-mode, but this tends to occur toward mid systole, rather than early systole.
400
These four categories make up the Wilkins Score
What are Mobility, Thickening, Calcification, and Subvalvular Thickening
These criteria are used to determine if a patient with severe mitral stenosis would be a good candidate for balloon valvuloplasty. A score > 12 is prohibitive.
400
Which echo parameter should be less than 0.2 when using echo-enhancing agent (definity?) and which fellow is most likely to push definity on call?
What is mechanical index?
Potential for cavitation (bursting) of the bubbles. Lower setting oscillates the bubbles, higher setting destroys them.
Who are... One of the Dans
500
ST Elevation in which lead(s) is most sensitive for the following angiographic findings
What is V8?
Accept posterior leads, V7-V9
ST elevation >0.5mm in posterior leads is diagnostic of LCx infarct
500
A 60-year-old man comes to the emergency department with palpitations. His past medical history includes MI, dyslipidemia, hypertension. His blood pressure is 90/60 mm Hg. On examination, he is diaphoretic and appears uncomfortable.
This mechanism is responsible for the following EKG findings.
What is Re-entry?
Re-entry around a scar is the mechanism of monomorphic ventricular arrhythmia (VA) in patients with ischemic heart disease, such as this patient.
Mechanisms of VA include enhanced normal automaticity, abnormal automaticity, triggered activity induced by early or late afterdepolarizations, and re-entry. Re-entry requires a trigger to initiate the arrhythmia and a substrate to sustain it.
500
A 19-year-old young man was referred to a cardiology clinic for easy fatigability with sports and exercise. His vitals were within normal limits except oxygen saturation of 86%. What is seen on this Apical 4-chamber view?
What is Ebstein anomaly?
Ebstein anomaly, the apical displacement of the valve reduces the effective volume of the right ventricle available for pumping function and the valve itself may be regurgitant to a varying degree. Tricuspid regurgitation and poor forward flow results in right-to-left shunt at the atrial level. Right-to-left shunting can be worse during exertion leading to symptoms of exercise intolerance.
500
This equation is used to calculate the valve area in a patient with this M-Mode finding
What is 220/pressure half time?
Can only be used in rheumatic mitral stenosis. Cannot be used if there is a prior balloon valvuloplasty.
500
For each minute that cardiopulmonary resuscitation (CPR) and defibrillation are delayed, by how much is the probability of survival diminished?
What is 10%?
For every minute that passes from a witnessed cardiac arrest, survival declines by 7-10%. When a bystander performs CPR, the decline is more gradual, reportedly 3-4%.
