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AAFP - Board Review Questions - CARDIOLOGY

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Recommendations for ICD placement in heart failure
- EF < 35%
- QRS > 120 ms
- NSR
- NYHA class III or IV despite maximum medical therapy

* must have all 4 *
What is considered maximum medical therapy for heart failure?
- maximum ACE-I, maximum beta blocker, maximum diuretic
What is the NYHA classes?
For patient on NY classification of stage III and stage IV and ACC stage C and D

- Stage I: high risk for HF, no symptoms, no structural heart disease
- Stage II: mild symptoms, improved with rest and can tolerate minimal exertion
- Stage III: worsening symptoms with mild exertion, improved with rest only
- Stage IV: needs full rest, bed bound., cannot tolerate any ADL.
What is the American Academy of Cardiology HF classification?
American Academy of Cardiology Classification
- A: high risk only
- B: asymptomatic structural heart disease (LVH, for ex)
- C: structural heart dx with symptoms
- D: refractory Heart failure
Management of aortic aneurysm:
- ascending
- descending
ASCENDING
- immediate surgical intervention (a surgical emergency)

DESCENDING
- beta blocker to reduce pulse to 60 bpm.
- add nitroprusside if systolic BP is above 100
AAA screening recs
men only 65-75 yoa who have ever smoked
SVT management
1st: vagal maneuvers
2nd: adenosine
3rd: CCB or beta blocker
4th: propafenone or flecainide
5th: cardioversion
Best anti-hypertensive choice for AA
- diuretics or CCB
* they have a better chance at monotherapy control with either diuretics or CCB
By the aafp, what is the choice diagnostic tool for patients with a possible HF presentation?
2D echocardiogram
Initial testing for asymptomatic palpitation
- an EKG: to assess baseline rhythm when patient is not having palpitation
Describe required EKG findings during myocardial infarction
1) ST elevation >/equal to 1 mm in TWO OR MORE limb leads (aVr, aVl, aVf)

AND

2) ST elevation >/equal to 2 mm in two or more contiguous precordial leads (V1-V6)
Axillosubclavian vein thrombosis (ASVT):
- most common types of patients affected
- most common etiology
- second most common etiology
ASVT
- young, healthy patients
- #1 cause: a compressive anomaly in the thoracic outlet
- #2 cause: use of subclavian indwelling catheter
What is a normal ABI result?
0.9-1.2
- severe disease at < 0.5.
Initial length of Coumadin therapy recommendation for first presenting DVT
at least 3 months
- anywhere from 3-6 months is recommended initial therapy (for travel causes only, not for coagulation abnormalities)
Symptoms of CHF in infants will usually present during what event?
feeding!
- feeding is the most exertion a baby has to do, so profuse diaphoresis and dyspnea with feeding is concerning for heart abnormalities, including HF
Recommendations for HCM
- screening of family members
- medications
- participation in sports
FAMILY
- all family members should be screened with echo
it is an autosomal dominant condition

MEDS
- no shown benefit to lifelong beta blockers
- remember: pathophysiology is different in regards to remodeling. this is not LVH, this is HCM. Completely different muscle structure, so beta blockers won't help.

SPORTS
- no strenuous sports whatsoever, contact or not
Contra-indications to beta blockers in certain HF patients (4)
- hemodynamic instability
- bradycardia/symptomatic heart block
- heart block
- severe asthma
NSAIDs and HF recommendations
NSAIDS and 325 mg of aspirin are CONTRAINDICATED in patients with systolic heart failure
- increases sodium retention
- increases vascular resistance

NSAIDS have been shown to increase HF exacerbations and hospital admissions
First line anti-hypertensives for the elderly without co-morbidity
- thiazide diuretics
- CCB (dihydro AND non-dihydro pyridine)
List the following pre-op risk factors in the elderly for non-vascular surgery:
- minor RF
- moderate RF
- major RF
MAJOR
- unstable angina
- decompensated HF
- significant arrythmia
- severe valvular disease

MODERATE RF
- mild angina
- prior MI
- stable HF
- DM
- CKD

MINOR RF
- advanced age
- abnormal EKG
- LVH
- LBB
- T wave changes
- h/o stroke
- uncontrolled HTN
DVT prophylaxis for orthopedic surgery
lovenox -> not heparin.