CARDIAC

Question 1

Acute myocardial infarction

Answer 1

Deep substernal pain, visceral pain that radiates, nausea, fatigue, SOB, thready pulse, dysrhythmias ST elevation two contiguous leads, distant heart sounds

Question 2

stable angina

Answer 2

Best is HPI first to guide you

substernal pain/pressure, radiates to neck jaws arms(left), tachy, hypertension, tachypnea

diagnostic testing: EKG, cardiac enzyme (serial trop), Echo, Stress, CXR, CBC, D Dimer, ABG’s, EGD,

progressive testing dependent on EKG/Cardiac Enzymes

Question 3

pericarditis

Answer 3

sharp stabbing pain, worse with coughing, swallowing, deep breathing, lying flat, anxiety,

Question 4

Causes of palpitations

Answer 4

o Rhythm disorders
o Structural disorders
o Systemic conditions: anemia, AV fistula, post menopause,
o Psychosomatic: depression, somatic disorders
o Drugs: sympathomimetic drugs, weight loss drugs, BB withdrawal, vasodilators

Question 5

EKG: STEMI, NSTEMI, unstable angina

Answer 5

STEMI: ST segment elevation, pathologic Q waves (previous MI), LBBB new then assume MI

No ST elevation on EKG but Trop (+) then NSTEMI (** also will not have any q wave or ST elevation)

No ST elevation and no Trop then unstable angina

Question 6

Diagnostic Testing for palpitations

Answer 6

1. EKG (possible holter monitor)
2. Echo - structure of heart
3. CBC - hgb anemia?
4. BMP - electrolytes esp mag and K
5. TSH/T4 - hyperthyroidism specifically