Cardio

Question 1

Diagnostic and laboratory studies

Abdominal Aortic Aneurysm

Answer 1

1: Initial imaging study of choice: Abdominal Ultrasound (also used to determine presence, size, and extent, and monitor progression)
2: GOLD STANDARD: Angiography

Question 2

Formulating most likely diagnosis

Abdominal Aortic Aneurysm

Answer 2

• Men >65 yo; smoker
• Asx until expanding/ruptures:
• Ruptured = sudden, severe, constant, back/flank abdominal/groin and/or in shock
• palpable pulsatile abdominal mass on PE

Question 3

Pharmaceutical therapeutics

Acute MI

Answer 3

IV fluids, O2, ASA, NTG, beta blocker, ACE- I, statins, anticoags, antiplatelets,

(every patient s/p MI leaves on S.A.B.A)

Question 4

Formulating most likely diagnosis

Acute MI , anterior

Answer 4

ST elevations in V1-V4

ST depressions in 2 other contiguous leads

Question 5

Pharmaceutical therapeutics

Adverse Drug Effect: Antiarrhythmics

Answer 5

• Amioderone SE’s = “Eye, thy, liver, lung” / optic neuritis, thyroid disease, hepatitis, pulmonary fibrosis
• Na+ channel blockers OD = Wide complex QRS

Question 6

Formulating most likely diagnosis

AFIB

Answer 6

EKG: Irregularly irregular rhythm, no P waves, usually narrow complex QRS.

Presents as either an arrhythmia or an embolic event (Green, red, yellow light)

Question 7

Pharmaceutical therapeutics

Aneurysm, thoracoadbominal

Answer 7

BBs - help to reduce shearing forces, decrease expansion, and ruptures risk

Question 8

Pharmaceutical therapeutics

Angina

Answer 8

Stable = Nitro/BB/CCB

Unstable = “MONA”

Question 9

Clinical Intervention

Aortic Aneurysm

Answer 9

Lifestyle mods (quit smoking is the main one), decrease DM, control cholesterol, regular exercise

Meds: BB, statin, daily low does ASA, plavix
anticoags,

Surgical Revascularization

(many AAA’s that rupture die of CV collapse prior to arrival 2 hospital)

Question 10

Clinical Intervention

Aortic Stenosis

Answer 10

• Aortic Valve replacement only effective treatment
• Mild AS: No exercise restrictions
• Severe AS: Avoid physical exertion/vasodilators (ex. nitrates or negative inotropes (Ex. BB/CCB)

Question 11

Clinical Intervention

Arrhythmia, Complete heart block

Answer 11

• Acute/symptomatic: Temporary pacing –> permanent pacemaker
• Definitive tx: Permanent pacemaker

Question 12

Formulating most likely diagnosis

Arrhythmia, PAC’S

Answer 12

PAC is a premature “beat”/QRS that has a P wave before it

Question 13

Formulating most likely diagnosis

Arrhythmia, Paroxysmal SVT

Answer 13

Heart rate >100 bpm; rhythm usually regular with narrow QRS complexes; P waves hard to discern due to rapid rate

Question 14

Clinical Intervention

Arrhythmia, Paroxysmal SVT

Answer 14

1: Vagal nerve stimulation with maneuver
2: Adenosine
3: CCB ( verapamil)
4: Cardioversion

Question 15

Clinical Intervention

Arrhythmia , V-FIB

Answer 15

These patients are in cardiac arrest, CPR and defibrillation (unsynchronized cardioversion)

Question 16

Clinical Intervention

Arrhythmia , V-TACH

Answer 16

• Stable sustained V-tach: Antiarrhytmics (amiodarone**, lidocaine, procainamide)
• Unstable V-tach WITH a pulse: synchronized cardioversion
• V-tach NO PULSE : Defibrillate (unsynchronized cardioversion + CPR
• If proceeds to tornadoes: IV MAG

Question 17

Pharmaceutical therapeutics

A-fib

Answer 17

1: Slow heart rate (BB/CCB)
2: Anticoag (almost always)
3: Convert (pharmacologically or electrically)

Question 18

Applying basic scientific concepts

Atrial Septal Defect

Answer 18

Oxygenated L-atrium blood crosses ASD and mixes with deoxygenated R-atrium blood; greater blood volume in R-atria can lead to R-HF, arrhythmia, pulmonary HTN

Question 19

Formulating Most likely diagnosis

Atrial Septal Defect

Answer 19

• Systolic ejection crescendo=decrescendo murmur best heard @pulmonic area (LUSB);
• Widely fixed split S2 that does NOT vary with respiration

Question 20

Clinical intervention

Cardiac Arrest

Answer 20

1: CPR
if in V-TACH or V-FIB : DEFIBRILLATE
Give epinephrine and other medications as indicated

Question 21

Formulating most likely diagnosis

Cardiac Tamponade

Answer 21

• Beck’s Triad: JVD, muffled heart sounds, hypotensive
• pulses paradoxus: >10mmHg decrease in SBP w/ inspiration
• Electrical alternans on EKG

Question 22

Using diagnostic and laboratory studies

Cardiac Tamponade

Answer 22

ECHO: Ventricles collapse in diastole (+ presence of an effusion)

Question 23

Clinical Intervention

Cardiogenic Shock

Answer 23

1: Emergent ECHO
2: O2, isotonic fluids, (only shock we do NOT use agressive fluids)
3: Positive inotropes
4: Pressors
5: Admit to ICU and tx underlying cause

Question 24

Formulating most likely diagnosis

Coarctation of the Aorta

Answer 24

• **Suspect in a child with secondary HTN
• BL lower extremity claudication
• Systolic murmur that radiates to back/scapula or chest
• Systolic BP in upper extremities > lower extremities
• Delayed or weak femoral pulses
• CXR: Rib notching/ “3” sign

Question 25

Clinical Intervention

Coarctation of the Aorta

Answer 25

Surgical Correction : Balloon Angioplasty +/- stent

PGE1 (prostaglandin) pre-op to decrease sis/improve lower extremity blood flow

(** remember prOstaglandins keep PDA Open)

Question 26

Applying Basic scientific Concepts

CHF

Answer 26

Poor pumping –> blood stalls and backs up in the circulation