Cardiovascular Disease Management Flashcards
7 cards from real Internal Medicine Exam practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Cardiovascular Disease Management flashcards as text
A 70-year-old man with HFrEF (EF 28%) has persistent LBBB with QRS duration of 160 ms despite optimal medical therapy. His NYHA class is III. What device therapy is indicated?
Answer: Cardiac resynchronization therapy with defibrillator (CRT-D)
CRT-D is a Class I indication for HFrEF with LBBB morphology, QRS ≥150 ms, and NYHA class II–III on optimal medical therapy, reducing mortality and improving EF.
A 45-year-old marathon runner collapses during a race. ECG shows right bundle branch block with ST elevation in V1–V3 and a family history of sudden cardiac death. What is the most likely diagnosis?
Answer: Brugada syndrome
The spontaneous Type 1 Brugada pattern (coved ST elevation in V1–V3 with RBBB morphology) combined with family history of SCD is diagnostic of Brugada syndrome.
A 60-year-old woman with mitral stenosis (MVA 0.9 cm²) presents with increasing dyspnea. She has no mitral regurgitation and favorable valve morphology (Wilkins score 6). What is the preferred intervention?
Answer: Percutaneous mitral balloon commissurotomy (PMBC)
Symptomatic severe MS (MVA ≤1.0 cm²) with favorable valve morphology (Wilkins score ≤8, no significant MR) is best treated with PMBC, which is less invasive than surgery with similar outcomes.
A 55-year-old man is started on warfarin for mechanical mitral valve replacement. What is the target INR range?
Answer: 2.5–3.5
Mechanical mitral valve prostheses require a higher INR target of 2.5–3.5 due to greater thrombogenicity compared to aortic mechanical valves (target 2.0–3.0).
A 48-year-old woman with no prior cardiac history presents with chest pain and is found to have ST elevation in leads II, III, and aVF. Coronary angiography shows no obstructive disease but a spiral dissection in the right coronary artery. What is the most likely diagnosis?
Answer: Spontaneous coronary artery dissection (SCAD)
SCAD predominantly affects young women without traditional cardiac risk factors and presents as ACS with angiographic spiral dissection; conservative management is preferred over PCI.
A 72-year-old man with chronic kidney disease (eGFR 20) and a recent STEMI requires anticoagulation for concurrent atrial fibrillation. Which DOAC dose adjustment is most critical?
Answer: Apixaban 2.5 mg twice daily if criteria met; avoid dabigatran
Dabigatran is primarily renally cleared and should be avoided in severe CKD; apixaban has the least renal clearance and can be used with dose reduction (2.5 mg BID) in eligible patients.
A 67-year-old man develops hypotension, JVD, clear lung fields, and ST elevation in V1 and right-sided leads after inferior STEMI. What is the most appropriate fluid management?
Answer: Aggressive IV fluid resuscitation with normal saline
Right ventricular MI presents with the triad of hypotension, JVD, and clear lungs; the RV requires preload to maintain output, so IV fluids are the cornerstone of initial management.