Cardiac Workup Flashcards
what does an elongated Q wave indicate?
Possible previous MI
what are the descending numbers for the lines for rate?
300 150 100 75 60 50
for rhythm what should you look for?
each QRS complex is preceded by a P wave and each P wave is followed by a QRD complex
2 indicators of ischemia
T-wave inversion
ST depression
infarction indications
ST elevation
new LBBB in setting of CP, presumed STEMI until proven otherwise
What are the lateral leads
I and AVL, V5 and V6
is diffuse ST elevation likely a STEMI?
no, usually a pericarditis (will also have QRS complex alternanas)
what are the inferior leads?
II, III and AVF
What doe the inferior leads correspond to?
RCA (right circumflex artery)
What do the lateral leads correspond to?
Circumflex vessels
criteria for ST elevation MI
abnormalities in 2 continuous leads
can you diagnose cardiomegaly with a AP?
No due to magnification
with an aortic dissection what can be widened?
mediastinum
why is CMP important?
renal function
LFTs
K+
what are troponins meant to do?
Diagnose heart attacks, but can be elevated for other reasons
value of other cardiac enzymes?
don’t have much role
what is PBNP an indicator for?
CHF, but can be chronically elevated with renal dz
what is the most valuable diagnostic tool in cardiology?
Echocardiogram
what must you send with an arrhythmia to a cardiologist?
TSH level
why do we care about PTNR?
want to know baseline before giving an anticoag
why do we care about LFTs?
produce clotting factors
High AST, High ALT, elevated PTNR- what do they likely have?
Liver Dz
reasons people will have a murmur that aren’t structural problems?
hyperdynamic
sick
dehydrated
what problem with the pericardium can echo diagnose?
Pericardial effusion (but not pericarditis)
What is a more specific test for endocarditis?
Trans esophageal echo
normal ejection fraction?
55-65% (same as gallbladder)
what are wall motion abnormalities indicative of?
ischemic in that area (not getting good blood supply)
what is hypokinesis?
part of the heart is barely moving (MI in that area)
what is apical ballooning?
diagnostic of broken heart syndrome
Takotsubo cardiomyopathy
How do you determine is someone has CAD or not
risk stratification
what are some non-invasive stress stests
Exercise treadmill- young men
stress echo- most common
nuclear stress test
what do you do a nuclear stress test for?
LBBB
CABG
can’t do treadmill
known CAD
what is the preferred non-invasive test?
Stress echo
what is an invasive evaluation for ischemic?
left heart catheterization
what conditions do we defibrillate?
V-tach
V-fib
what conditions do you cardiovert for?
must put cardiovert on the machine
less energy is used
used for hemodynamically unstable
how long does it take to r/o a heart attack?
6 hours (takes that long for troponins to reveal themselves)
how much ASA do you give for an MI?
2 baby aspirins chewed (160 mg)
if you give nitroglycerin and chest pain goes away is it cardiac?
Not necessarily- possibly esophageal
Meds for MI?
ASA O2 Nitro Morphine anticoags (heparin, lovenox) anti-platelets (aspirin, plavix) BBs statins
Difference b/w unstable and STEMI
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
what do people with a NSTEMI get?
Aspirin Lovenox or Heparin morphine PRN statins Beta blockers (oral) Nitroglycerin PRN will eventually get cathed
Who goes to the cath lab sooner, STEMI or non-STEMI
STEMI
