Cardiac

Question 1

Bradycardia
Progessive prolongation of PR interval
Dropped beat

Answer 1

2nd degree = Mobitz type I = Wenckebach

Asx: reassurance
Sx: managed w/ atropine

Question 2

• Cannon-a waves (PE) = large-amplitude waves seen in the jugular veins - resistance to atrial emptying
• Regular P-P & R-R
• P and QRS disassociation
• Bradycardia

Answer 2

3rd degree block

Pacemaker
Atropine
Transcutaneous pacing to refractory

Question 3

Different P wave morphology

Answer 3

Multifocal Atrial Tachycardia = MAT

Tx: CCB = verapamil or diltiazem

Question 4

Only QRS present
Fast
regular

Answer 4

V tach

Unstable = desynchronized Cardioversion = defibrillation
Stable = lidocaine + Amiodarone + Procainamide

Question 5

Short PR interval
Delta wave

Answer 5

WPW = via bundle of kent

Tx: Procainamide

Question 6

Tachycardia
Regular
Narrow QRS
Sudden onset & offset of sx

Answer 6

SVT

1st: Carotid sinus massage
2nd: Adenosine

Question 7

Low voltage
Variation in direction + duration (QRS)

Answer 7

Cardiac Tamponade = hypotension + distant heart sounds + JVD

Question 8

Consistent PR interval
Dropped beat

Answer 8

2nd degree = Mobitz 2

Pacemaker

Question 9

Causes for diastolic heart failure (right)

Answer 9

Hypertrophic =
- Chronic HTN
- Friedreich ataxia

Restrictive cardiomyopathy =
- Amyloidosis = bruises + proteinuria + ventricular wall thickening
- Sarcoidosis = granulomatous
- Hemochromatosis = cirrhosis + DM + arthopathy + hypogonadism
- Pericarditis
- Loffler endocarditis
- Postradiation fibrosis
- Endocardial fibroelastosis

Question 10

Causes of Systolic function heart failure

Answer 10

Dilated cardiomyopathy =
- TTN gene
- Alcohol
- cox B
- Chagas disease + CAD (ischemia)

Question 11

HTN emergency tx w/ nitroprusside
Metabolic acidosis
Generalized tonic-clonic seizure

Answer 11

Cyanide toxicity

Question 12

acute chest pain radiating to back

aortic regurgitation (murmur) = 2/6 diastolic murmur in the upper sternal area

pleural effusion

widened mediastinum

Changes in BP by arm

Negative: ECG & cardiac enzymes

HTN

Answer 12

Aortic Dissection

Assoicated w/ Marfans

Question 13

• dyspnea
• orthopnea
• paroxysmal nocturnal dyspnea
• hemoptysis
• left-sided hemiparesis

Answer 13

Mitral Stenosis (MS) → A. fib → clots → stroke = left-sided hemiparesis

Question 14

Tests for anticardiolipin Ab

Answer 14

Thrombosis / thromboembolism
Associated w/ DVT & stroke

Cardiolipin = phospholipid found in blood that affects clot formation

Question 15

PQ interval - rx

Answer 15

Class 2 = BB
Class 4 = CCB

Question 16

R - rx

Answer 16

Class 1 = Na+ blocker

V tach

Question 17

ST interval - rx

Answer 17

Class 3 = K+ blocker

Question 18

MI medication management

Answer 18

Antiplatelet = aspirin

anticoagulation = heparin

decrease O2 demand → limit infarct size = BB

increase coronary blood flow (reduce preload) = Nitrates

Pain control/tachycardia = morphine

Question 19

PCI standard

Answer 19

STEMI sx w/n 2-3 hours & PCI w/n 90 min

Question 20

C/I thromolytic therapy

Answer 20

hypotensive
cardiogenic shock
bleeding risk
surgery
interal bleeding
stroke
Severe HTN
Aortic dissection

Question 21

3-5 days post MI complications

Answer 21

Ruptures = shock sx
- Papillary muscle (RCA) = Pulmonary edema
- Interventricular septum (RCA & LAD) = CP + systolic murmur

Question 22

5 days - 2 weeks post MI complications

Answer 22

Free wall rupture (LAD)

• Chest pain
• Distant heart sounds
• Shock, rapid progression to cardiac arrest

Complications: Pericardial effusion w/ tamponade

Question 23

Several months post MI complication

Answer 23

LV aneurysm (LAD)

Question 24

Young pt
persistent chest pain
increase Cardiac markers
decrease LV systolic function

Answer 24

Viral myocarditis

Note: Myocarditis can mimic CAD

Question 25

α1 blockade–mediated vasodilation drugs

Answer 25

• Terazosin, prazosin, doxazosin
• Antipsychotics (eg, risperidone)
• Antihistamines + TCAs