Iran Specialty Board - Cardiology flashcards

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

Type 2 myocardial infarction

Myocardial injury with ischemia due to oxygen supply-demand mismatch (e.g., sepsis, anemia, tachyarrhythmia) without acute atherothrombotic plaque rupture; troponin is elevated with clinical evidence of ischemia.

Primary PCI window

Preferred reperfusion for STEMI if achievable within 120 minutes of first medical contact; otherwise fibrinolysis within 12 hours of symptom onset followed by transfer for angiography.

TIMI risk score

Seven-item score (age, risk factors, known CAD, aspirin use, severe angina, ST deviation, elevated markers) estimating 14-day adverse events in unstable angina/NSTEMI.

HFrEF four pillars

ARNI/ACEi/ARB, evidence-based beta-blocker, mineralocorticoid receptor antagonist, and SGLT2 inhibitor; each reduces mortality and should be started early and titrated to target.

Sacubitril/valsartan washout

Requires a 36-hour washout after stopping an ACE inhibitor before initiation, because concurrent neprilysin and ACE inhibition increases bradykinin-mediated angioedema risk.

Cardiac amyloidosis clues

Low-voltage ECG despite thick ventricular walls, apical sparing on longitudinal strain imaging, and bone-tracer uptake on scintigraphy; AL type needs urgent hematology referral.

Severe aortic stenosis criteria

Peak jet velocity ≥4 m/s, mean gradient ≥40 mmHg, or aortic valve area ≤1.0 cm²; low-flow low-gradient cases need dobutamine stress echo or calcium scoring.

Acute severe aortic regurgitation

Presents with pulmonary edema and cardiogenic shock, often from endocarditis or dissection; surgery is urgent and intra-aortic balloon counterpulsation is contraindicated.

Mitral stenosis severity

Rheumatic in most cases; moderate when valve area 1.0-1.5 cm², severe when <1.0 cm²; balloon commissurotomy is preferred when morphology is favorable and no LA thrombus.

CHA2DS2-VASc threshold

Anticoagulation is indicated for atrial fibrillation when the score is ≥2 in men or ≥3 in women; DOACs are preferred except with mechanical valves or moderate-severe mitral stenosis.

VT versus SVT with aberrancy

VT is favored by AV dissociation, capture or fusion beats, extreme axis, QRS >160 ms, and precordial concordance; hemodynamic instability mandates immediate cardioversion.

Long QT syndrome management

QTc >500 ms marks high risk; beta-blockers are first-line, QT-prolonging drugs are avoided, and ICD is considered for syncope or cardiac arrest despite therapy.

Hypertensive emergency

BP >180/120 mmHg with acute end-organ damage; use IV therapy and lower mean arterial pressure by no more than about 25% in the first hour to avoid hypoperfusion.

Aortic dissection initial therapy

Start beta-blockade (esmolol or labetalol) to achieve heart rate <60 bpm and SBP 100-120 mmHg before adding a vasodilator, preventing reflex tachycardia and shear stress.

Ankle-brachial index

Ratio of ankle to brachial systolic pressure; ≤0.90 diagnoses peripheral artery disease, while >1.3 suggests noncompressible calcified arteries and requires further testing.

Tetralogy of Fallot

VSD, overriding aorta, right ventricular outflow obstruction, and RV hypertrophy; hypercyanotic spells are treated with knee-chest position, oxygen, morphine, and beta-blockade.

Eisenmenger syndrome

Pulmonary vascular disease reversing a left-to-right shunt to right-to-left; closure of the defect is contraindicated and patients need pulmonary vasodilator therapy and phlebotomy only for symptoms.

Kawasaki disease treatment

IVIG plus aspirin reduces coronary aneurysm risk; echocardiography is performed at diagnosis and follow-up; adjunctive corticosteroids are considered for high-risk patients.

Acute pericarditis criteria

At least two of chest pain, friction rub, new widespread ST elevation or PR depression, and new or worsening effusion; NSAIDs plus colchicine are first-line.

Cardiac tamponade signs

Beck triad, pulsus paradoxus, electrical alternans, and echocardiographic right atrial or ventricular diastolic collapse; urgent pericardiocentesis is the treatment.

Peripartum cardiomyopathy

Heart failure with LVEF <45% occurring in the last month of pregnancy through five months postpartum; standard HF therapy is used, but ACE inhibitors and ARNI are avoided during pregnancy and breastfeeding.

MINOCA evaluation

Myocardial infarction with non-obstructive coronaries; consider plaque disruption, spasm, dissection, embolism, and takotsubo, with cardiac MRI clarifying the underlying cause.

Pooled cohort equations

Estimate 10-year ASCVD risk; statins are recommended for LDL ≥190 mg/dL, diabetes age 40-75, or 10-year risk ≥7.5% after clinician-patient risk discussion.

LDL goals in ASCVD

Very high-risk patients target LDL <55 mg/dL with ≥50% reduction; high-risk patients target <70 mg/dL; add ezetimibe or a PCSK9 inhibitor when goals are not met.

Smoking cessation pharmacotherapy

Varenicline, bupropion, and nicotine replacement are first-line; combining behavioral counseling with pharmacotherapy gives the highest sustained quit rates.

Late gadolinium enhancement patterns

Subendocardial or transmural enhancement follows coronary territories in ischemic disease; mid-wall or epicardial patterns suggest nonischemic cardiomyopathy such as myocarditis or sarcoidosis.

Fractional flow reserve

Ratio of distal to aortic pressure during maximal hyperemia; ≤0.80 indicates a hemodynamically significant stenosis and identifies lesions likely to benefit from revascularization.

Post-arrest targeted temperature

Comatose survivors of cardiac arrest receive targeted temperature management at 32-36°C, with avoidance of hyperoxia, hypotension, and hyperthermia after rewarming.

Cardiogenic shock vasopressor

Norepinephrine is first-line to maintain perfusion pressure; inotropes such as dobutamine or milrinone are added for low cardiac output, and revascularization is urgent in ischemic shock.

Amiodarone monitoring

Baseline and periodic thyroid, liver, and pulmonary function tests plus ECG for QT prolongation; it interacts with warfarin and digoxin, requiring dose adjustment.

Digoxin toxicity antidote

Digoxin-specific Fab fragments; toxicity is worsened by hypokalemia, hypomagnesemia, and renal impairment, and presents with nausea, visual changes, and arrhythmias.

Number needed to treat

Reciprocal of the absolute risk reduction; it quantifies how many patients must be treated to prevent one event and increases when baseline risk is low.