NCCPA Cardiology Latest

NCCPA Cardiology (Latest / Answers 100% Correct

• Etiology Dilated Cardiomyopathy

Answer:

• Idiopathic - postviral MC
• Toxic (e.g. alcohol, coke)
• Infectious -Enterovirus MC (viral, bacterial, fungal, or parasitic such as Chagas)
• Pregnancy (post-partum)
• Ischemic

MC cardiomyopathy 95%

• Manifestations Dilated Cardiomyopathy

Answer: CHF - systolic failure. Hear S3, later- ally displaced PMI, mitral or tricuspid regurgitation

Rarely: CP, arrhythmias

• Dx Dilated Cardiomyopathy

Answer: Echo - LV dilation, low EF CXR - cardiomegaly, pulm edema, pleural effusion EKG - sinus tachy

• Trx Dilated Cardiomyopathy

Answer: CHF trx - ACEI, diuretics, BB, Digoxin, Na+ restriction

• Takotsubo Cardiomyopathy

Answer: Stress induced cardiomyopathy - ST elevations and trops

A bulging out of the left ventricular apex with a hypercontractile base of the left ventricle is often noted.

• Restrictive Cardiomyopathy and etiology

Answer: Impaired diastolic function with *pre- served contractility*. Ventricle is rigid and cant fill, really stiff.

MC d/t amyloidosis, also sarcoidosis, fibrosis, scleroderma, chemo etc.

• Manifestations Restrictive cardiomyopathy

Answer: R CHF signs mainly, can see Kussmaul's sign - JVP increases with inspiration

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• Dx Restrictive Cardiomyopathy

Answer:

Echo: ventricles *nondilated with normal wall thickness* Marked dilation of both atria.Diastolic dysfunction CXR: normal vernticular chamber size, enlarged atria, pulm congestion. EKG: Low voltage+/- arrhythmias

• Hypertrophic Cardiomyopathy and Etiology

Answer: GENETIC disorder. Subaortic outflow obstruction with narrowed LV outflow tract d/t thick septum. Also see diastolic dysfunction due to a stiff ventricle so it cant fill.

• Hypertrophic Cardiomyopathy Manifestation

Answer: See Dyspnea, angina, arrhythmias, syncope, even suddenc ardiac death esp in kids from extreme exertion.

Hear Harsh systolic *crescendo-descrescendo* murmur at LLSB whichh DE- CREASES in intensity when pt *squats, lies down, anything to increase venous return* and INCREASES with decreased venous return like *standing or valsalva*

• Dx Hypertrophic Cardiomyopathy

Answer: Echo: asymmetrical wall thickening esp septal >15mm. Systolic anterior motion of mitral valuve. Small LV

EKG: LVH

CXR: Cardiomegaly`

• Trx Hypertrophic Cardiomyopathy

Answer: BB 1st line, also CCB, Disopyramide. Want negative inotropes. Careful with digoxin, nitrates, or diruetics as increased contractility and nitrates/diuretics decrease volume.Surgery - septal myomectomy or ethanol ablation. Avopid exertion/exercise. ICD placement common.

• Afib

Answer: quizvering of atria, can cause thrombus to form. See irregularly irregular rhythm with narrow QRS, no P waves, fib waves atrial rate 350-600.

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• Trx Afib

Answer:

Stable:Rate control with BB- metoprolol. CCB -diltiazem, verapamil. Digoxin - for those with HoTN or CHF.Rhythm control with synchronized cardioversion.

Unstable: Synchronized cardioversion

• Anticoagulation for afib

Answer: Commonly used, assess via CHAD2DS2VASc Score.

>2 = high risk, need oral anticoagulation. Warfarin INR 2-3.

• CHA2DS2-VASc

Answer: CHF HTN

Age > 75 (+2) DM Stroke or TIA (+2)

Vascular Disease +1 Age 65-74 +1 Sex (Female) +1

• Anticaogulants for Afib

Answer: NOAC - direct thrombin inhibitors (dabigatran) or factor Xa inhibitors (rivaroxaban, apixaban, edoxaban)

Warfarin: Preferred in CKD, contraindicated to NOAC. Bridged with heparin until therapeutic and mintored with INR and PT. INR 2-3.

Dual naitplatelet therapy - ex Aspirin + clopidrogel. for pts that cant have anticoag- ulant monotherapy. Monotherapy is BETTER.

• First Degree Block

Answer: Prolonged PR interval, >0.20 seconds. No mgmt.

• Second Degree Block

Answer:

Mobitz I - Wenckebach - longer drop QRS. Mgmt with atropine if symptomatic.

Mobitz II - constant prolonged PRI and dropped QRS. Mgmt atropine or pacing. often converts to 3rd degree block

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