Cardiology Board Review

589 Pages·2018·25.9 MB·English

by  Ramdas G. Pai

Cardiology Board Review
Cardiology Board Review
RamdasG.Pai
UniversityofCaliforniaRiversideSchoolofMedicine
California,USA
PadminiVaradarajan
LomaLindaUniversityMedicalCenter
California,USA
SudhaM.Pai
LomaLindaUniversityMedicalCenter
California,USA
Thiseditionfirstpublished2018
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LibraryofCongressCataloging-in-PublicationData:
Names:Pai,RamdasG.,author.|Varadarajan,Padmini,author.|Pai,Sudha
M.,1958-author.
Title:Cardiologyboardreview/byRamdasG.Pai,PadminiVaradarajan,Sudha
M.Pai.
Description:Hoboken,NJ:Wiley,2017.|Includesindex.|
Identifiers:LCCN2017026562(print)|LCCN2017028086(ebook)|ISBN
9781118699003(pdf)|ISBN9781118699010(epub)|ISBN9781118699027(pbk.)
Subjects:|MESH:HeartDiseases|ExaminationQuestions
Classification:LCCRC669.2(ebook)|LCCRC669.2(print)|NLMWG18.2|DDC
616.1/20076–dc23
LCrecordavailableathttps://lccn.loc.gov/2017026562
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CoverdesignbyWiley
Setin10/12ptWarnockProbyAptaraInc.,NewDelhi,India
10 9 8 7 6 5 4 3 2 1
Contents
Preface ix
 HistoryandPhysicalExamination 1
RamdasG.Pai
 Electrocardiography 13
RamdasG.PaiandSudhaM.Pai
 ChestX-RayinCardiology 51
PadminiVaradarajanandRamdasG.Pai
 StressTestingandRiskStratificationofAsymptomaticSubjects 80
PadminiVaradarajanandRamdasG.Pai
 Echocardiography 95
RamdasG.PaiandPadminiVaradarajan
 CardiacMagneticResonanceImaging 150
PadminiVaradarajanandRamdasG.Pai
 CardiacComputedTomography 172
RamdasG.Pai
 CardiacCatheterization 199
PrabhdeepS.Sethi
 AcuteCoronarySyndromes 210
RamdasG.Pai
 ChronicCoronaryArteryDisease 229
PadminiVaradarajan
 HeartFailure,Transplant,LeftVentricularAssistDevices,Pulmonary
Hypertension 245
RamdasG.Pai
 Cardiomyopathies 270
RamdasG.PaiandPadminiVaradarajan
vi Contents
 Hypertension 288
PadminiVaradarajanandRamdasG.Pai
 DiabetesMellitus 298
PadminiVaradarajan
 Lipids 305
PadminiVaradarajanandRamdasG.Pai
 ValvularHeartDisease 318
RamdasG.Pai
 AdultCongenitalHeartDisease 351
PadminiVaradarajanandRamdasG.Pai
 PericardialDiseases 376
RamdasG.Pai
 AorticDiseases 385
AhmedShafterandAshishMukherjee
 CarotidandVertebralArteryDisease 403
PrabhdeepS.Sethi
 PeripheralVascularDisease 416
AhmedShafterandAshishMukherjee
 CardiacArrhythmias 435
SudhaM.Pai
 PacemakersandDefibrillators 463
SudhaM.Pai
 CardiacMasses 468
PadminiVaradarajan
 SystemicDisordersAffectingtheHeart 501
RamdasG.Pai
 InterdisciplinaryConsultativeCardiology 505
RamdasG.Pai
 HeartDiseaseandPregnancy 515
PadminiVaradarajanandRamdasG.Pai
 RacialandGenderDisparities 521
SudhaM.PaiandRamdasG.Pai
Contents vii
 PharmacologicalPrinciplesofCardiacDrugs 524
ChristopherHauschildandLilyYam
 Anticoagulation 535
PadminiVaradarajan
 AspirinandAntiplateletTherapy 547
ChristopherHauschildandLilyYam
 StatisticalConcepts 553
RamdasG.Pai
 Genetics 562
PadminiVaradarajan
 CardiacEmergenciesandResuscitation 565
RamdasG.Pai
Index 571
Preface
Thisbookisaverycomprehensivereviewofallmajortopicsincardiologywithaninten-
tiontohelpthosepreparingforinitialandrecertificationexamsincardiologyandthose
whowanttoreviewcardiologyinaneasy-to-dofashion.Itisacompilationofover1300
questionsencompassingallthetopicsincardiology.Thishasbeeneditedbyaninter-
nationallyacclaimed teachingphysicianwithanexpertiseinallaspects ofcardiology.
The book is organized in a question-and-answer format and is divided into easy-to-
followchaptersrelatedtodifferentareasofcardiovascularmedicine.Theanswersare
explainedindetailandareaccompaniedbyreferencestomajortrialsincardiologyand
guidelines, and some clinical pearls where applicable. The explanations are clear and
evidencebased.Thebookhighlightsaspecialsectiononelectrocardiogramswhichare
ofhighresolution.Theanswerstothequestionsaregivenindepth,whichwillallowthe
examineestoprepareforthissectionandtaketheexamwithgreaterconfidenceasthis
sectionisscoredseparatelyfromthemainexam.Thechaptersonimaginghaveques-
tionsrelatingtochestX-ray,cardiaccomputedtomography,echo,stressecho,cardiac
magneticresonanceimaging,nuclearstresstesting,andsoon.Thebookalsodealswith
questionsrelatingtotopicsnotusuallyencounteredinsimilarbooks:forexample,racial
disparitiesinmedicine,cardiacemergencies,andsoon.Thebookalsofacilitatescritical
reviewofcardiovascularmedicinetoenhanceone’sdiagnosticandtherapeuticskills.

History and Physical
Examination
.. A25-year-oldwomanhasa2/6ejectionsystolicmurmurbestheardinthesecond
left intercostal space with normal S1. The S2 is split during inspiration, and P2
intensityisnormal.Noapicalorparasternalheave.Themurmurdiminishesduring
expirationandstandingup.Whatisthemurmurlikelydueto?
A. Physiologicalornormal
B. Atrialseptaldefect(ASD)
C. Bicuspidaorticvalve
D. Hypertrophicobstructivecardiomyopathy(HOCM)
.. A29-year-oldpregnantwomanwasfoundtoahaveasystolicmurmurbestheard
inthesecondleftintercostalspace.Itisroughandtherewasapalpablethrillinthe
sameareaandinthesuprasternalnotch.Patientisasymptomaticandhasnormal
exercisetolerance.Whatisthelikelyexplanationofthemurmur?
A. Pulmonarystenosis(PS)
B. Normalflowmurmurduetoincreasedcardiacoutput
C. Posteriormitralleafletprolapsecausinganinteriorlydirectedjet
D. Mammarysouffle´
.. A22-year-oldpatienthasahypoplasticradialsideoftheforearmandfingerized
thumb.Whatthismaybeassociatedwith?
A. ASD C. Coarctationofaorta
B. TetralogyofFallot D. Ebstein’sanomaly
.. A28-year-oldmanpresentedwithahistoryofshortnessofbreathonexertion.On
examination,thepulseratewas76bpmandbloodpressure(BP)126/80mmHg.
Theleftventricularapexwasprominentandforceful.TheS1andS2werenormal,
buttherewasa2/6ejectionsystolicmurmurbestheardinthethirdrightinter-
costal space. There was no appreciable variation with respiration, but there was
anincreaseinintensitywiththeValsalvamaneuverandstandingup.Itseemedto
belessprominentonsquatting.Therewasnoaudibleclick.Whatisthemurmur
likelydueto?
A. Valvularaorticstenosis C. Mitralvalveprolapse(MVP)
B. HOCM D. Innocentmurmur
.. A 36-year-old asymptomatic woman was found to have a systolic murmur best
heardintheapex,butalsointheaorticarea.Itwasmidtolatesystolicandwas
associatedwithasharpsystolicsound.Whatisthelikelycauseofthemurmur?
A. Posteriormitralleafletprolapse C. Valvularaorticstenosis
B. Anteriormitralleafletprolapse D. Aorticsubvalvularmembrane
.. A78-year-oldmanwithhypertensionanddiabetesmellituspresentedwithexer-
tional shortness of breath of 6months’ duration. Examination revealed a 4/6
crescendo–decrescendomurmurbestheardinthesecondrightintercostalspace.
CardiologyBoardReview,FirstEdition.RamdasG.Pai,PadminiVaradarajanandSudhaM.Pai.
©2018JohnWiley&Sons,Ltd.Published2018byJohnWiley&Sons,Ltd.
 CardiologyBoardReview
Thefirstcomponentofthesecondsoundwassoft.Themurmurwasalsoheard
Chapter1
alongtherightcarotidartery.Whatisthispatientlikelytohave?
A. Mildaorticstenosis C. Pulmonarystenosis
B. Moderateorsevereaorticstenosis D. MR
.. A thrill and a continuous machinery murmur in the left infraclavicular area is
indicativeofwhat?
A. Patentductusarteriosus(PDA)
B. Increasedflowduetoleftarmarteriovenous(AV)fistulafordialysis
C. Venoushum
D. PulmonaryAVfistula
.. Whichofthefollowingisnotafeatureofaorticcoarctation?
A. Acontinuousmurmurontheback
B. Lowerbloodpressureinlegscomparedwitharm
C. Radiofemoraldelay
D. Pistolshotsoundsonfemoralarteries
.. A22-year-oldnewlyimmigrantwomanwasreferredtohigh-riskpregnancyclinic
because of clubbing and cyanosis. Examination in addition revealed a paraster-
nalheave,4/6ejectionsystolicmurmurinthethirdleftintercostalspace,normal
jugularvenouspressure(JVP),andoxygensaturationof75%.Whatwillyourec-
ommendafterconfirmationofthediagnosis?
A. Continuepregnancywithsodiumrestriction
B. Continuepregnancy,butdeliverat28weeks
C. Adviseterminationofpregnancy
D. PerformpercutaneousASDclosureandcontinuepregnancy
.. WhatisthemurmurofASD?
A. Continuousduetoflowacrossthedefect
B. Ejectionsystolicduetoincreasedflowacrossthepulmonaryvalve
C. Mid-diastolicduetoincreasedflowacrossthetricuspidvalve
D. Continuousoverlungfieldsduetoincreasedflowinlungs
.. Whatisasystolicclickthatdisappearsoninspirationlikelydueto?
A. Pulmonaryvalvularstenosis C. MVP
B. Bicuspidaorticvalve D. Pulmonaryhypertension
.. A 36-year-old woman presented with an 8-month history of progressive exer-
tional dyspnea. Physical examination revealed heart rate of 74 bpm, regular, BP
126/78mmHg,nopedaledema.JVPandcarotidupstrokewerenormal.Cardiac
auscultation revealed normal S1, an accentuated P2 with narrow splitting of
S2, an ejection click, and a 2/6 ejection systolic murmur. What is the likely
diagnosis?
A. Pulmonaryhypertension C. Aorticstenosis
B. PS D. ASD
.. Causesofprominent“a”waveinjugularvenouspulsationsincludeallofthefol-
lowingexceptwhichoption?
A. PS D. Aorticstenosis
B. Pulmonaryhypertension E. ASD
C. Tricuspidstenosis