Cardiovascular Disease Flashcards

A 58-year-old man with hypertension presents with sudden-onset tearing chest pain radiating to the back. BP is 180/100 in the right arm and 150/85 in the left arm. Which imaging study is most appropriate?

Answer: CT angiography of the chest

CT angiography is the gold standard for diagnosing aortic dissection, which is suggested by the tearing pain and blood pressure differential between arms.

A patient with known mitral stenosis develops sudden onset palpitations. ECG shows no P waves and irregularly irregular rhythm. What is the immediate concern?

Answer: Systemic thromboembolism

Atrial fibrillation in mitral stenosis significantly increases the risk of left atrial thrombus formation and systemic embolism, including stroke.

Which medication class is the preferred initial treatment for heart failure with reduced ejection fraction (HFrEF) to reduce mortality?

Answer: Beta-blockers and ACE inhibitors

Beta-blockers (carvedilol, metoprolol succinate, bisoprolol) and ACE inhibitors/ARBs are proven to reduce mortality in HFrEF and are the cornerstone of therapy.

A 65-year-old woman presents with exertional dyspnea and a harsh systolic crescendo-decrescendo murmur at the right upper sternal border radiating to the carotids. Echocardiogram shows an AVA of 0.7 cm². What is the next step?

Answer: Referral for aortic valve replacement

An AVA <0.8 cm² with symptoms defines severe symptomatic aortic stenosis, which requires valve replacement as definitive treatment.

A 70-year-old man is found to have a 5.6 cm infrarenal abdominal aortic aneurysm on ultrasound during screening. He is asymptomatic. What is the recommended management?

Answer: Elective surgical repair

AAAs ≥5.5 cm in men carry high rupture risk and warrant elective repair; this patient's 5.6 cm aneurysm meets the threshold.

Which finding on ECG is most consistent with hyperkalemia in a patient with chronic kidney disease?

Answer: Tall peaked T waves

Hyperkalemia classically produces tall, narrow, peaked T waves as one of the earliest ECG manifestations.

A patient with systolic heart failure (EF 30%) continues to have symptoms despite optimal doses of ACE inhibitor and beta-blocker. QRS duration is 155 ms on ECG. What therapy should be added?

Answer: Cardiac resynchronization therapy (CRT)

CRT is indicated in symptomatic HFrEF with LBBB morphology and QRS ≥150 ms despite optimal medical therapy, improving symptoms and mortality.

A 62-year-old man presents with exertional chest pain. Stress test shows 2 mm ST depression in leads V4–V6 at 85% of maximum heart rate. He has diabetes and hypertension. What is the most appropriate next step?

Answer: Coronary angiography

A strongly positive stress test (≥2 mm ST depression at submaximal heart rate) in a high-risk patient warrants coronary angiography to define anatomy and guide revascularization.

Which lipoprotein pattern is most associated with premature atherosclerotic cardiovascular disease?

Answer: Elevated LDL-C with small dense LDL particles

Small dense LDL particles are more atherogenic because they penetrate the endothelium more easily and are more susceptible to oxidation, driving plaque formation.

A 50-year-old woman with systemic lupus erythematosus presents with dyspnea, elevated JVP, and an echocardiogram showing a thickened pericardium with respiratory variation in mitral inflow >25%. What is the diagnosis?

Answer: Constrictive pericarditis

Constrictive pericarditis presents with elevated JVP, Kussmaul's sign, and exaggerated respiratory variation in Doppler inflow velocities, and is a known complication of SLE.

A 48-year-old male smoker with hyperlipidemia and hypertension has a resting ECG showing Q waves in leads II, III, and aVF. He has no chest pain history. What is the most likely explanation?

Answer: Prior inferior myocardial infarction

Pathological Q waves in the inferior leads (II, III, aVF) in the setting of multiple cardiovascular risk factors most likely represent a prior silent inferior MI.

A 66-year-old woman with atrial fibrillation and a CHA₂DS₂-VASc score of 4 is started on apixaban. She asks about dietary restrictions. What is the most accurate counseling?

Answer: No significant dietary restrictions required

Unlike warfarin, apixaban (a direct oral anticoagulant) does not require dietary vitamin K restriction or routine INR monitoring.

A 35-year-old competitive athlete collapses during a basketball game. Resuscitation is successful. ECG shows deep T-wave inversions in V1–V4 and left axis deviation. His father died suddenly at age 40. What is the most likely diagnosis?

Answer: Arrhythmogenic right ventricular cardiomyopathy (ARVC)

ARVC characteristically presents with T-wave inversions in right precordial leads, ventricular arrhythmias triggered by exercise, and a family history of sudden death.

A 74-year-old man with EF of 25% is on optimal HFrEF therapy. He has NYHA class III symptoms. His ICD was implanted 2 years ago. QRS is 110 ms. What additional therapy should be considered to reduce hospitalization?

Answer: SGLT2 inhibitor (dapagliflozin or empagliflozin)

SGLT2 inhibitors (dapagliflozin, empagliflozin) reduce HF hospitalization and cardiovascular death in HFrEF independent of diabetes status.

A 55-year-old woman with class II obesity presents for cardiovascular risk assessment. Her 10-year ASCVD risk is 8%. LDL is 125 mg/dL. What is the most appropriate initial intervention?

Answer: Lifestyle modification with shared decision-making about statin therapy

A 10-year ASCVD risk of 7.5–10% is considered borderline; guidelines recommend shared decision-making about statin initiation after lifestyle modification counseling.

A 60-year-old man is admitted for acute decompensated heart failure. He is volume-overloaded with creatinine 1.4 mg/dL. IV furosemide is started. What laboratory finding would indicate adequate diuresis response?

Answer: Urine output >0.5 mL/kg/hr and weight loss of 0.5–1 kg/day

Adequate decongestion is monitored by urine output and daily weight loss of 0.5–1 kg/day, balancing diuresis against worsening renal function.

A 38-year-old woman presents with dyspnea and is found to have a systolic BP of 160/90 in both arms and diastolic murmur over the back. CXR shows rib notching. What is the diagnosis?

Answer: Coarctation of the aorta

Coarctation of the aorta presents with upper extremity hypertension, a diastolic murmur over the back from collaterals, and rib notching from intercostal artery enlargement.

A 67-year-old man with known CAD presents with inferior ST-segment elevation. He has no contraindications. The nearest PCI-capable hospital is 3 hours away. What is the most appropriate reperfusion strategy?

Answer: Fibrinolytic therapy within 30 minutes, then transfer

When PCI cannot be performed within 120 minutes of first medical contact, fibrinolytic therapy should be given within 30 minutes followed by transfer for angiography.

Which finding would most support a diagnosis of pulmonary arterial hypertension (PAH) rather than pulmonary hypertension due to left heart disease?

Answer: Mean PAP >25 mmHg with PCWP ≤15 mmHg

PAH is defined as mean PAP >25 mmHg with a normal wedge pressure (PCWP ≤15 mmHg), distinguishing it from pulmonary hypertension driven by elevated left-sided filling pressures.

A 72-year-old woman with permanent atrial fibrillation and prior TIA is on warfarin with INR 2.5. She develops hematuria. Cystoscopy is negative for malignancy. What is the most appropriate next step in anticoagulation management?

Answer: Continue warfarin; bleeding risk outweighs stroke risk

In AF with prior TIA, stroke risk is high; warfarin should be continued because the annual stroke risk far exceeds the bleeding risk from hematuria with a negative workup.