ABIM Cardiology flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

Time to primary PCI

Primary percutaneous coronary intervention should be performed within 90 minutes of first medical contact at a PCI-capable hospital, or within 120 minutes if transfer to a PCI center is required.

DAPT after acute coronary syndrome

Aspirin plus a P2Y12 inhibitor is standard for 12 months after acute coronary syndrome; ticagrelor or prasugrel is preferred over clopidogrel in the absence of high bleeding risk.

LDL goal in established ASCVD

For patients with established atherosclerotic cardiovascular disease, high-intensity statin therapy targets an LDL cholesterol below 70 mg/dL; ezetimibe or a PCSK9 inhibitor is added if that goal is not met.

Four pillars of HFrEF therapy

Guideline-directed therapy for heart failure with reduced ejection fraction combines an ARNI or ACE inhibitor/ARB, an evidence-based beta-blocker, a mineralocorticoid receptor antagonist, and an SGLT2 inhibitor.

Primary prevention ICD criteria

An implantable defibrillator is indicated when ejection fraction is 35% or lower despite at least three months of guideline therapy, with NYHA class II-III symptoms and expected survival beyond one year.

Cardiac resynchronization indication

Cardiac resynchronization is indicated for left bundle branch block with QRS duration of 150 ms or more and ejection fraction 35% or lower despite optimal medical therapy.

CHA2DS2-VASc anticoagulation threshold

Anticoagulation is recommended for atrial fibrillation when the CHA2DS2-VASc score is 2 or higher in men and 3 or higher in women; DOACs are preferred over warfarin.

Adenosine dosing for SVT

Adenosine is given as a 6 mg rapid intravenous push followed by a saline flush; if the rhythm does not terminate, a 12 mg dose may be repeated.

Long QT danger threshold

A corrected QT interval above 500 ms markedly increases torsades de pointes risk; offending drugs and electrolyte abnormalities should be corrected, and beta-blockade should be considered.

Pre-excited atrial fibrillation management

In Wolff-Parkinson-White syndrome with pre-excited atrial fibrillation, AV nodal blocking agents are contraindicated; ibutilide, procainamide, or synchronized cardioversion are preferred instead.

Severe aortic stenosis criteria

Severe aortic stenosis is defined by peak velocity of 4 m/s or more, mean gradient of 40 mmHg or more, or aortic valve area of 1.0 cm² or less.

Mechanical valve anticoagulation targets

Mechanical prosthetic valves require lifelong warfarin with a target INR of 2.0-3.0 for aortic position and 2.5-3.5 for mitral position, plus low-dose aspirin.

Primary mitral regurgitation surgery triggers

Mitral valve surgery is recommended for chronic primary severe regurgitation when symptoms develop or when ejection fraction falls to 60% or left ventricular end-systolic dimension reaches 40 mm.

Pericarditis diagnostic criteria

Acute pericarditis is diagnosed with at least two of four features: typical chest pain, pericardial friction rub, characteristic ECG changes, and new or worsening pericardial effusion.

Cardiac tamponade findings

Tamponade presents with hypotension, elevated jugular venous pressure, muffled heart sounds, pulsus paradoxus, and electrical alternans; treatment is urgent pericardial drainage, not diuretics.

Constrictive pericarditis features

Constrictive pericarditis shows a pericardial knock, septal bounce, annulus reversus, and respirophasic septal shift; pericardiectomy is definitive treatment for persistent symptoms.

Takotsubo cardiomyopathy

Takotsubo syndrome typically affects postmenopausal women after emotional or physical stress, producing apical ballooning without obstructive coronary disease; management is supportive.

Hypertensive emergency pressure reduction

In hypertensive emergency with end-organ damage, mean arterial pressure is lowered by no more than 25% in the first hour, except in aortic dissection, where systolic pressure is targeted below 120 mmHg.

Resistant hypertension definition

Resistant hypertension is blood pressure above goal despite three agents including a diuretic at maximally tolerated doses; spironolactone is the preferred fourth drug and secondary causes should be sought.

Aortic dissection treatment

Type A aortic dissection requires emergency surgery; type B is managed medically with intravenous beta-blockade first, then a vasodilator, targeting heart rate below 60 and systolic pressure near 120.

Pulmonary hypertension hemodynamic definition

Pulmonary hypertension is defined by mean pulmonary artery pressure above 20 mmHg at rest, with precapillary disease additionally showing pulmonary vascular resistance of 3 Wood units or more.

Thrombolysis in high-risk PE

Pulmonary embolism with hypotension or shock warrants systemic thrombolysis or catheter-directed therapy; anticoagulation alone is used for patients who remain hemodynamically stable.

Screening for CTEPH

Chronic thromboembolic pulmonary hypertension is screened with ventilation-perfusion scanning rather than CT angiography; surgical pulmonary endarterectomy is the preferred treatment for accessible disease.

Atrial septal defect closure indication

Secundum atrial septal defect closure is indicated when there is right ventricular enlargement with a pulmonary-to-systemic flow ratio above 1.5 and pulmonary vascular resistance is not severely elevated.

Tetralogy of Fallot cyanotic spell

A cyanotic spell in tetralogy of Fallot is treated with knee-chest position, oxygen, morphine, intravenous fluid, phenylephrine for systemic vasoconstriction, and beta-blockade if needed.

Eisenmenger syndrome precautions

Eisenmenger syndrome contraindicates pregnancy and systemic vasodilation; supplemental oxygen and pulmonary vasodilators may be used, and phlebotomy is reserved for symptomatic hyperviscosity.

Ten-year ASCVD risk threshold

A 10-year atherosclerotic risk of 7.5% or higher generally supports moderate- to high-intensity statin therapy after shared decision-making; risk above 20% is considered high.

Aspirin for primary prevention

Routine aspirin is not recommended for primary prevention; it may be considered in selected adults aged 40-70 at higher cardiovascular risk who have low bleeding risk.

Pooled cohort equations

The pooled cohort equations estimate 10-year ASCVD risk from age, sex, race, cholesterol, blood pressure, diabetes, smoking, and antihypertensive treatment, guiding statin decisions.

Revised Cardiac Risk Index

The Revised Cardiac Risk Index predicts perioperative major cardiac events using six factors: high-risk surgery, ischemic heart disease, heart failure, cerebrovascular disease, insulin-dependent diabetes, and creatinine above 2 mg/dL.

DAPT before elective surgery

Elective surgery is ideally deferred at least six months after drug-eluting stent placement and one month after bare-metal stent placement to limit perioperative stent thrombosis risk.

Perioperative beta-blocker rule

Chronic beta-blockers should be continued through surgery, but routine initiation on the day of surgery is discouraged because it increases bradycardia, hypotension, and stroke risk.