Cardiac Workup

Question 1

what does an elongated Q wave indicate?

Answer 1

Possible previous MI

Question 2

what are the descending numbers for the lines for rate?

Answer 2

300
150
100
75
60
50

Question 3

for rhythm what should you look for?

Answer 3

each QRS complex is preceded by a P wave and each P wave is followed by a QRD complex

Question 4

2 indicators of ischemia

Answer 4

T-wave inversion

ST depression

Question 5

infarction indications

Answer 5

ST elevation

new LBBB in setting of CP, presumed STEMI until proven otherwise

Question 6

What are the lateral leads

Answer 6

I and AVL, V5 and V6

Question 7

is diffuse ST elevation likely a STEMI?

Answer 7

no, usually a pericarditis (will also have QRS complex alternanas)

Question 8

what are the inferior leads?

Answer 8

II, III and AVF

Question 9

What doe the inferior leads correspond to?

Answer 9

RCA (right circumflex artery)

Question 10

What do the lateral leads correspond to?

Answer 10

Circumflex vessels

Question 11

criteria for ST elevation MI

Answer 11

abnormalities in 2 continuous leads

Question 12

can you diagnose cardiomegaly with a AP?

Answer 12

No due to magnification

Question 13

with an aortic dissection what can be widened?

Answer 13

mediastinum

Question 14

why is CMP important?

Answer 14

renal function
LFTs
K+

Question 15

what are troponins meant to do?

Answer 15

Diagnose heart attacks, but can be elevated for other reasons

Question 16

value of other cardiac enzymes?

Answer 16

don’t have much role

Question 17

what is PBNP an indicator for?

Answer 17

CHF, but can be chronically elevated with renal dz

Question 18

what is the most valuable diagnostic tool in cardiology?

Answer 18

Echocardiogram

Question 19

what must you send with an arrhythmia to a cardiologist?

Answer 19

TSH level

Question 20

why do we care about PTNR?

Answer 20

want to know baseline before giving an anticoag

Question 21

why do we care about LFTs?

Answer 21

produce clotting factors

Question 22

High AST, High ALT, elevated PTNR- what do they likely have?

Answer 22

Liver Dz

Question 23

reasons people will have a murmur that aren’t structural problems?

Answer 23

hyperdynamic
sick
dehydrated

Question 24

what problem with the pericardium can echo diagnose?

Answer 24

Pericardial effusion (but not pericarditis)

Question 25

What is a more specific test for endocarditis?

Answer 25

Trans esophageal echo

Question 26

normal ejection fraction?

Answer 26

55-65% (same as gallbladder)

Question 27

what are wall motion abnormalities indicative of?

Answer 27

ischemic in that area (not getting good blood supply)

Question 28

what is hypokinesis?

Answer 28

part of the heart is barely moving (MI in that area)

Question 29

what is apical ballooning?

Answer 29

diagnostic of broken heart syndrome | Takotsubo cardiomyopathy

Question 30

How do you determine is someone has CAD or not

Answer 30

risk stratification

Question 31

what are some non-invasive stress stests

Answer 31

Exercise treadmill- young men stress echo- most common nuclear stress test

Question 32

what do you do a nuclear stress test for?

Answer 32

LBBB CABG can't do treadmill known CAD

Question 33

what is the preferred non-invasive test?

Answer 33

Stress echo

Question 34

what is an invasive evaluation for ischemic?

Answer 34

left heart catheterization

Question 35

what conditions do we defibrillate?

Answer 35

V-tach | V-fib

Question 36

what conditions do you cardiovert for?

Answer 36

must put cardiovert on the machine less energy is used used for hemodynamically unstable

Question 37

how long does it take to r/o a heart attack?

Answer 37

6 hours (takes that long for troponins to reveal themselves)

Question 38

how much ASA do you give for an MI?

Answer 38

2 baby aspirins chewed (160 mg)

Question 39

if you give nitroglycerin and chest pain goes away is it cardiac?

Answer 39

Not necessarily- possibly esophageal

Question 40

Meds for MI?

Answer 40

``` ASA O2 Nitro Morphine anticoags (heparin, lovenox) anti-platelets (aspirin, plavix) BBs statins ```

Question 41

Difference b/w unstable and STEMI

Answer 41

Unstable angina- manage like ischemic event but you have objective evidence other than hx (EKG and labs are normal) NSTEMI- hx and abnormal troponin or ECG

Question 42

what do people with a NSTEMI get?

Answer 42

``` Aspirin Lovenox or Heparin morphine PRN statins Beta blockers (oral) Nitroglycerin PRN will eventually get cathed ```

Question 43

Who goes to the cath lab sooner, STEMI or non-STEMI

Answer 43

STEMI