Cardiac

Question 1

DDx - chest pain (serious, potentially life-threatening)

Answer 1

ACS (unstable angina, STEMI, NSTEMI)
PE
Pneumothorax
Aortic or coronary artery dissection
Pericarditis
Pneumonia
Acute retropertioneal bleed
Arrhythmia

Question 2

Within 10 minutes of c/f STEMI/NSTEMI what should be done?

Answer 2

O2 via NC
Sublingual nitro unless BP<90, HR<50 or >100
Adequate analgesia (morphine, etc.)
Aspirin 325
12 lead EKG

Question 3

Rx unstable angina?

Answer 3

First line - beta-blockers to decrease HR and O2 demand
Nitrates - relax venous smooth muscle to decrease preload, O2 demand

CCBs - only if patient unresponsive to/unable to receive beta-blockers

Question 4

Rx NSTEMI

Answer 4

Early invasive (cath, revascularize if indiated)

Heparin (inhibits thrombin)
ASA (inhibits arachadonic acid)
Clopidogrel (inhibits ADP)

Question 5

Rx STEMI

Answer 5

PCI w/in 90 minutes
Beta-blockers
ACEI if no contraindication
High-dose statin

Question 6

Rx cardiogenic shock after acute MI

Answer 6

Emergency revascularization w/PCI or CABG regardless of timing
Fibrinolytics if unable to receive PCI/CABG
Inotropes/pressors (dobutamine or dopamine)
IABP - useful if not quickly stabilized after pharm Rx; alternative LVAD

Question 7

Define severe aortic stenosis

Answer 7

Aortic valve area <1 cm^2

Question 8

Findigns of severe aortic stenosis on exam

Answer 8

Crescendo-decrescendo systolic ejection murmur radiating to neck

LV apical impulse forceful and slightly enlarged

Question 9

Rx severe aortic stenosis

Answer 9

Surgical AV replacement or TAVR

Question 10

Rx re-entrant SVT

Answer 10

Adenosine

Question 11

Rx atrial tachycardi

Answer 11

Adenosine
Anti-arrhythmic
Catheter abltation

Question 12

Components of TIMI risk score?

Answer 12

65+
3+ CAD risk factors
Prior coronary stenosis >50%
ST deviaion
2+ anginal events <24hr
ASA in last 7 days
Elevated trop