What is the classic ECG finding for pericardial tamponade?

Electrical alternans.

What is pulsus paradoxus?

A systolic blood pressure drop of greater than 10 mm Hg during inspiration. Occasionally seen
in cardiac tamponade.

What is the most common etiology of ventricular fibrillation?

Myocardial ischemia.

What is the term for episodes of syncope related to paroxysmal atrioventricular block or
sinoatrial block?
Stokes-Adams syndrome.

What is the dosing of atropine?

0.5 mg IV push, which can be repeated every three to five minutes, if needed, to a total dose of
3 mg.

What are the two most common post-acute myocardial infarction dysrythmias?
Premature ventricular contractions and sinus bradycardia

What is the most common cause of cor pulmonale?

COPD.

What is the name of the ECG finding classically associated with large pericardial effusions?
Electrical alternans.

What is the most common tick-borne illness that can lead to atrioventricular heart block?
Lyme disease.

What is the most common heart valve affected in an IV drug abuser with infective endocarditis?
The tricuspid valve.

What is the most common cardiovascular cause of sudden death in young athletes?
Hypertrophic cardiomyopathy.

What is the most common etiology of QT prolongation?

Iatrogenic due to pharmacotherapy.

How does mitral stenosis result in hoarseness?

Left atrial enlargement can cause compression of the recurrent laryngeal nerve resulting in
hoarseness.

What classic ECG finding is associated with severe hypothermia?

Osborn Wave (J Wave).

What primary disease process is associated with sterile vegetation endocarditis on both sides of
the involved valve?
Systemic lupus erythematosus.

What is the normal range for the PR interval?

120-200 milliseconds.

How long should CPR continue after fibrinolytics are given to a patient with cardiac arrest prior
to pronouncing the patient dead if there is no return of spontaneous circulation?
At least 20 minutes.

Which vagal maneuver is relatively contraindicated in the elderly population?

Carotid massage, as the risk of embolic stroke from underlying carotid atherosclerosis is
present.

What is the mechanism of action of adenosine?

AV nodal conduction blockade.

What is the diagnostic modality of choice to diagnose dilated cardiomyopathy?

Echocardiography can evaluate chamber dilation and cardiac dysfunction.

Asymmetric pulses in the upper extremity will occur only if which artery is involved in an aortic
dissection?
Subclavian artery.

What is the upper limit of normal for a QTc interval?

For men, the upper level of QTc interval is 450 msec. For women, the upper level of QTc
interval is 470 msec.

List some causes of left bundle branch block?

Senile fibrosis of the conduction system, chronic hypertension, chronic cardiac ischemia,
chronic congestive heart disease and valvular disease.

In those with left-dominant coronary circulation, what artery does the posterior descending
artery stem from?
Left circumflex artery.

What is the appropriate dose of epinephrine during cardiac arrest in an adult?

The proper dose is 1 mg of epinephrine (10 ml of the 1:10,000 concentration).

On which side of the valve is the vegetation typically located in infectious endocarditis?
Superior.
What are the ECG findings of a right ventricular infarct?
ST elevation in V1. This is the only standard ECG lead looking directly at the right ventricle.

What is the treatment for the subtype of polymorphic ventricular tachycardia known as torsade
de pointes?
IV magnesium sulfate.

What medication, in addition to NSAIDs, is recommended in the treatment of recurrent

pericarditis?
Colchicine.

What is the mechanism by which warfarin can cause a hypercoaguable state early in
treatment?
Warfarin can cause a hypercoaguable state due to the more rapid depletion of protein C and
protein S compared to the clotting factors with longer half-lives.

What is the dose of atropine in symptomatic bradycardia with a pulse?

0.5 mg IV push.

What are the two most common dysrhythmias seen post-myocardial infarction?
Sinus bradycardia and PVCs.

In patients with aortic dissection, what is the recommended blood pressure goal?
Antihypertensives should be titrated to a systolic blood pressure of 110 mm Hg.

What is the initial dose of heparin to be given for acute coronary syndrome?
60 to 70 units/kg.

What are the two side effects associated with long term use of flecainide?
QRS widening and PR prolongation.

What is digoxin used for?

Its positive-inotropic and antidysrhythmic effects, at therapeutic doses, are used in treating
atrial fibrillation and congestive heart failure.

What are the most common electrolyte abnormalities that develop as a complication from
therapeutic hypothermia in post-cardiac arrest patients?
Hypokalemia, hypomagnesemia, and hypophosphatemia.

What commonly used recreational drug is associated with prolonging the QT interval?
Cocaine.

What is the most common cause of aortic stenosis?

Calcific degeneration.

What amount of electrical energy should be used to cardiovert hemodynamically unstable atrial
fibrillation with rapid ventricular rate?
120-200 joules for biphasic waveforms (200 joules for monophasic waveforms).

What is the earliest ECG finding in acute myocardial infarction?

Hyperacute T waves.

What findings on abdominal X-ray are consistent with the diagnosis of AAA?
X-ray may reveal calcification of a dilated, aneurysmal aorta.

What organism is classically associated with infectious endocarditis seen in patients with colon
cancer?
Streptococcus bovis.

What is the most rapid method of rewarming?

Cardiopulmonary bypass circuit.

Which medication has the greatest mortality benefit in acute coronary syndrome?
Aspirin.

What effect does the Valsalva maneuver have on the murmur associated with aortic stenosis?
It decreases the murmur.

What is the most common presenting symptom in patients with acute ischemic heart disease?
Central-chest discomfort.

Which two components of the cardiac cycle are impaired in heart failure with preserved
ejection fraction?
Left ventricular filling and relaxation.

What is a renal complication of streptococcal pharyngitis?

Post-streptococcal glomerulonephritis.

What is the most common bacteria responsible for infective endocarditis?

Staphylococcus aureus.

What are the two biggest reasons for higher numbers of individuals who are discharged with a
good neurologic outcome following sudden cardiac arrest?
Increased bystander cardiopulmonary resuscitation and early defibrillation

What is the most rapid method of rewarming?

Cardiopulmonary bypass circuit.
How long after an acute myocardial infarction does a left ventricular aneurysm occur?
Days to weeks.

What street drug is the most common cause of dilated cardiomyopathy?

Cocaine.

What is the genetic association with hypertrophic cardiomyopathy?

It is an autosomal dominant disease.

What is the significance of hypotension in a patient with an ascending aortic dissection?

Hypotension suggests the presence of a pericardial effusion and tamponade.

While AV block is first examined by determining the length of the PR interval, bundle branch
blocks are first examined by determining the length of which electrocardiographic entity?
The QRS complex.

Although rare, what is the most common bacterial cause of myocarditis?

Acute rheumatic fever caused by group A β-hemolytic streptococci.

What other laboratory test is classically elevated in myocarditis in addition to troponin?

Creatinine phosphokinase.

What is the name for the radiographic “scar” of healed primary pulmonary tuberculosis?
Ghon complex.

What patient factors are associated with atypical ACS presentation?

Female gender, advanced age, and diabetes are associated with atypical chest pain
presentation.

Which is more serious, type I (Mobitz I/Wenckebach) or type II (Mobitz II) second-degree AV
block?
Type II, which is more associated with complete heart block and cardiac arrest.

What is the natural history of Wellens’ syndrome?

It is unfavorable with a high incidence of symptom recurrence and myocardial infarction.

Name two diastolic murmurs?

Mitral stenosis and aortic insufficiency.

What is the name for a ventricular-originated rhythm with a rate < 100 beats/minute?
Idioventricular rhythm.

Which infectious disease can predispose to aortic dissection?

Tertiary syphilis.

What tick-borne illness can cause myocarditis?

Lyme disease.

When does the vessel-expansion, typically seen in the jugular vein as a double-pulsation, occur
in the cardiac cycle?
Just after S1 and during S2.

What is the 5 year mortality from symptom onset of a patient with heart failure?
50%.

What is the gold standard for diagnosing myocarditis?

Myocardial biopsy.

Will the patient’s pH increase or decrease with induced hypothermia?

Decrease. The pH is falsely lowered by 0.012 for every 1°C below 37°C.

What are the best initial medical therapies for hypertrophic obstructive cardiomyopathy?
Beta-blocker and calcium channel blocker medications.

Can Wellens’ Syndrome be caused by cocaine use?

Yes, cocaine-induced vasospasm can also cause Wellens’ Syndrome.

What is “Beck’s triad” of pericardial tamponade?

Hypotension, distended neck veins, and muffled heart sounds.

What side effects should patients be monitored for during procainamide infusion?
Hypotension, bradycardia, QRS prolongation, and QT prolongation.

What is the definition of commotio cordis?

A primary electrical event resulting in the induction of ventricular fibrillation from direct blow
to the anterior chest.

What are the names of the two congenital QT prolonging syndromes?

Jervell-Lange-Nielson and Romano-Ward.

0.2 seconds on an ECG is one small or one large block?

Large. Each small block is 0.04 seconds. Therefore, 5 small blocks to every 1 large block (5 x 0.04
= 0.2).

What are causes of left bundle branch block?

Myocardial ischemia, myocardial infarction or myocarditis, but most often is caused by the
degeneration of the conduction system with age.
Which chemotherapeutic agent is most commonly implicated in causing myocarditis?
Doxorubicin.

What is the most commonly used first line agent to treat hypertension?
Thiazide diuretics, such as hydrochlorothiazide or chlorthalidone.

Name another preexcitation syndrome?

Lown-Ganong-Levine syndrome.

What is the treatment of choice for a stable patient with sustained ventricular tachycardia?
Amiodarone, procainamide, or lidocaine.

Which pressors/inotropes can be used for a hypotensive patient with mesenteric ischemia?
Dobutamine, low-dose dopamine, and milrinone.

What is the classic chest X-ray finding of aortic dissection?

Widened mediastinum.

What is the classic triad associated with a ruptured abdominal aortic aneurysm?
Pain, hypotension, and a pulsatile mass.

What is the goal international normalized ratio (INR) in patients on warfarin?

2.5–3.0 in patients with mechanical heart valves and 2–3 in all other patients.

What is the most common type of lung malignancy?

Adenocarcinoma, which is one of the non-small cell lung cancer types.

What antiplatelet agent should be given to patients with ACS who have a true aspirin allergy?
Clopidogrel.

Patients presenting with acute lower extremity pain and pallor weeks post myocardial
infarction should be evaluated for what diagnosis?
Acute arterial occlusion secondary to embolic phenomena.

What is Levine’s sign?

A clenched fist over the chest in patients with ischemic chest pain.

What is a pseudoaneurysm?
Blood communicates with the arterial lumen but is contained solely within the adventitia or
surrounding soft tissue.

What are the six causes of high-output heart failure?

Hyperthyroidism, wet beriberi, arteriovenous fistula, Paget disease, severe anemia, and
pregnancy.

What is the recommended door to balloon time for a ST-elevation myocardial infarction?
90 minutes.

Does rectal aspirin have a similar benefit to chewed aspirin for acute myocardial infarction?
It is believed that 600 mg of rectally-administered aspirin provides a sufficient level of salicylic
acid within 90 minutes that meets or exceeds the level provided by standard doses of chewed
aspirin.

Which tachydysrhythmia is most commonly seen in Wolff-Parkinson-White syndrome?

Atrioventricular reentrant tachycardia (AVRT).

What laboratory test can help differentiate between acute heart failure and an exacerbation of
chronic obstructive pulmonary disease in a dyspneic patient?
Brain natriuretic peptide.

What is the most common cause of acute onset symptomatic tricuspid valve disease?
Endocarditis.

Which coronary artery is most commonly occluded in an inferior STEMI?

The right coronary artery (90% of cases).

What is the most common cause of aortic stenosis in people < 65 years old?
Congenital bicuspid valve.

What labs should be checked prior to starting an ACE inhibitor?

Creatinine and potassium, as it may cause an increase in either.

Which cardiac rhythm is associated with the lowest likelihood for return of spontaneous
circulation?
Asystole, which generally represents an end-stage rhythm after prolonged cardiac arrest caused
by VF or pulseless electrical activity (PEA).

What is the most common cause of pericarditis?

Idiopathic.

What causes the heart to be “boot-shaped” on chest X-ray in tetralogy of Fallot?

Right ventricular hypertrophy and an upturned cardiac apex.

What medication, if used within the last 24 hours, is a contraindication to administration of

nitroglycerin?
Sildenafil.
What is the first step in treating a hypercyanotic episode in a patient with tetralogy of Fallot?
Knee-to-chest position.

When are glucocorticoids indicated in the treatment of acute pericarditis?

If there is a contraindication to NSAIDs or for specific conditions (e.g., lupus, pregnancy).

Which cardiac tumor has the greatest predilection for causing emboli?
Myxoma.

What is the most common location of an abdominal aortic aneurysm?

The infrarenal abdominal aorta secondary to an absence of vasa vasorum
What is the classic ECG finding of a type I second-degree heart block?
Progressive PR interval lengthening until a dropped QRS complex.

What is the treatment of an unstable patient with a palpable pulse and ventricular tachycardia?
Synchronized cardioversion.

What therapy, when used in the acute phase, may be effective in preventing recurrent
symptoms of pericarditis?
Colchicine.

What is the name for post-myocardial infarction pericarditis?

Dressler syndrome.

Name three classes of medications which cause QT interval prolongation?

Antibiotics, phenothiazines, cyclic antidepressants.

What is the recommended goal for first medical contact to balloon time (previously door to
balloon time) in a STEMI?
The goal is <90 minutes.

What are the management implications of a type A dissection?

Type A dissections are any dissection involving the ascending aorta and should all be considered
for surgical repair because of the increased mortality rate seen with medical management.

What ultrasound finding is consistent with pulmonary edema?

B lines.

What are the main actions of diltiazem?

Calcium channel blockade into myocardial cells, resulting in decreased contraction, AV nodal
conduction, and, to a lesser degree, vasodilation.

What is the name of the accessory tract in WPW syndrome?

Bundle of Kent.

What is the emergent treatment of pericardial tamponade?

Pericardiocentesis.

Are reciprocal ECG changes necessary to make the diagnosis of ST elevation myocardial
infarction (STEMI)?
No, but when present, reciprocal depressions make the diagnosis of STEMI more specific.

What must be prescribed after placement of a mechanical prosthetic aortic valve?

Anticoagulation.

What is the pediatric and adult dose of intravenous epinephrine for cardiac arrest?
0.01 mg/kg IV (peds) and 1 mg IV (adult).

What is the difference between a body stuffer and a body packer?

Body packer ingests packets of drugs for the purpose of transporting them over international
borders. Body stuffer ingests packets of drugs to conceal them from law enforcement.

What are the components of the San Francisco syncope rule?

History of CHF, hematocrit <30%, abnormal ECG, dyspnea, systolic BP <90—defines high-risk
criteria for patients with syncope.

In underdeveloped countries, what underlying disease is most frequently associated with atrial
fibrillation?
Rheumatic heart disease.

What other type of fistula can develop as a complication of AAA?

Aortocaval fistula.

What is the only contraindication for aspirin in acute coronary syndrome?

True aspirin allergy – anaphylaxis.

What is the most common location for a AAA?

Below the level of the renal arteries (infrarenal).

In the U.S., what is the prevalence of COPD?

15 million.

In which subset of chest pain patients are beta blockers contraindicated?

Patients with cocaine-induced chest pain.

What cardiac dysrhythmia is most often associated with mitral stenosis?

Atrial fibrillation.

ST segment depression in leads V1 through V3 is concerning for what process?

Posterior STEMI.

Antiplatelet therapy in acute coronary syndrome is focused on treating which pathophysiologic

process?
Plaque thrombosis.

What diagnostic test is most sensitive in detecting valvular vegetations?

Transesophageal echocardiogram (TEE).

What kind of axis deviation is described by an ECG with a positively deflected QRS complex in
Lead I and a negatively deflected QRS complex in Lead II and aVF?
Left axis deviation.