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IM > Cardio > Flashcards

Cardio Flashcards

1
Q

What are the classic ECG findings during an anginal episode? (2)

A

ST-segment DEPRESSION

T-wave inversion

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2
Q

What is the gold standard for the diagnosis of CAD?

A

Coronary arteriography

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3
Q

What are the key steps in the medical management of a patient with unstable angina?

A 
β-blocker
ASA/anti-coagulate (heparin/warfarin)
nitroglycerin 
O2 (if hypoxic)
morphine

(BANO)

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4
Q

Describe how nitrates reduce angina:

A
  1. Venodilation causes venous pooling →↓preload →↓myocardial O2 consumption (demand)
  2. Coronary vasodilation →↑O2 delivery to the myocardium
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5
Q

Describe how each of the following drugs reduces angina:

  1. β-Blockers
  2. Nifedipine
  3. Verapamil
A
  1. ↓ Myocardial O2 use, ↓ afterload, ↑ coronary filling during diastole
    (↓ O2 demand) (↑ O2 supply)
  2. Coronary arteriolar vasodilation
    (↑ O2 supply)
  3. Slows cardiac conduction
    (↓ O2 demand)
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6
Q

What intervention is reserved for patients whose angina cannot be controlled medically?

A

Percutaneous transluminal coronary angioplasty (PTCA)

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7
Q

What is the common presentation of MI?

A

Crushing retrosternal chest pressure occurring at rest and radiating to left arm, neck, or jaw; diaphoresis;
nausea/vomiting; dyspnea; and anxiety

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8
Q

What is a common physical examination finding during an MI?

A

S4 gallop

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9
Q

Which are the six life-threatening causes of chest pain that must be ruled out in all patients?

A
  1. MI
  2. Cardiac tamponade
  3. Pulmonary embolism (PE)
  4. Pneumothorax (PTX)
  5. Aortic dissection
  6. Esophageal rupture

(My Chest Pain Panics All EDs)

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10
Q

What are the classic ECG abnormalities in an acute MI?

3

A

ST elevation/depressions
Q waves
T wave inversions (past/active)

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11
Q

Which ECG finding is very sensitive and specific for right ventricular infarction?

A

ST elevation in lead V4

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12
Q

Which coronary artery is likely to be occluded with these ECG abnormalities?

Large R and ST-segment depression in V1, V2

A

Right coronary (posterior infarction)

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13
Q

Which coronary artery is likely to be occluded with these ECG abnormalities?

Q waves and ST-segment elevation in leads V1-V4

A

Left anterior descending (anterior infarction)

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14
Q

Which coronary artery is likely to be occluded with these ECG abnormalities?

Q wave in leads I, aVL, V5, V6

A

Circumflex (lateral infarction)

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15
Q

Which coronary artery is likely to be occluded with these ECG abnormalities?

Q waves and ST elevation in leads II, III, aVF

A

Right coronary (inferior infarction)

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16
Q

Which serologic markers are typically used to diagnose and follow an MI? (3)

A

Troponin I

Repeat: Myoglobin > CK-MB

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17
Q

What are the clinical manifestations of right ventricular MI?

A 
ECG inf. changes: Q waves and ST elevation in leads II, III, aVF (RCA)
 hypotension
CLEAR LUNGS + JVD
jugular venous distension (JVD)
Tricuspid regurgitation
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18
Q

Which medical therapy should be avoided in a patient with a right ventricular infarction?

A

Nitroglycerin

initial therapy should involve IV fluids to ↑ preload

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19
Q

What arrhythmia has
PR interval >0.2 s prolongation,
often due to increased vagal tone?

A

Primary (1°) heart block

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20
Q

What arrhythmia has

PR interval gradually increases to the point at which a QRS complex is dropped?

A

2° Mobitz type I heart block (Wenkebach)

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21
Q

What arrhythmia has

PR interval >0.2 s with occasional dropping of the QRS complex at a fixed interval (ie, 2:1 or 3:1)

A

2° Mobitz type II heart block

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22
Q

What arrhythmia has

Irregularly irregular pulses and QRS complexes

A

Atrial fibrillation

23
Q

What arrhythmia has

Sawtooth appearance of P waves

A

Atrial flutter

24
Q

What arrhythmia has

Usually caused by conduction block within the bundle of His

A

2° Mobitz type II heart block

25
Q

What arrhythmia has

Complete dissociation between P waves and QRS complexes

A

3° or complete heart block

26
Q

What arrhythmia has treatment which includes anticoagulation, rate control, and/or cardioversion.

A

Atrial fibrillation

27
Q

What arrhythmia has

Wide QRS complexes not preceded by a P wave

A

Premature ventricular contraction (PVC)

28
Q

What arrhythmia has

Normal QRS morphology with a rate of 150-200 beats/min

A

Paroxsymal SVT

29
Q

Treatment of hemodynamically UNSTABLE
1. Pulseless V-Tach:

V-Tach with pulse

  1. Polymorphic VT:
  2. Monomorphic VT:
A
  1. CPR & Defibrillate
  2. Defibrillate
  3. Synchronized Cardioversion
30
Q

Treatment of hemodynamically STABLE patients
in V-tach:

If Refractory Vtach then treat with:

Long term tx of pts with VTach:

A

pharmacological cardioversion with
antiarrhythmics (amiodarone, procainamide, or sotalol)

Refractory → cardioversion

Long term = Beta blockers first line

31
Q

Which arrhythmia may be treated with carotid massage or Valsalva maneuver

A

Paroxsymal SVT

32
Q

Arrhythmia commonly caused by MI that may lead to hemodynamic instability

A

V-Tach

practice code with Dr. Meinke

33
Q

Arrhythmia where treatment with pacemaker is necessary.

A

Symptomatic 2° Mobitz type II heart block
3° heart block
Sick sinus node syndrome

34
Q 
ECG finding:
Short PR interval
delta wave
Widened QRS
P-waves follow QRS
A

Wolff-Parkinson-White

bypass AV node via Bundle of Kent
Tx: Unstable = cardioversion.
Stable = IV Procainamide

35
Q

Name four common chest x-ray (CXR) abnormalities in CHF:

A
  1. Cardiomegaly
  2. Cephalization of pulmonary vessels (↑ vascularity in lung fields)
  3. Kerley B lines (indicating pleural fluid in fissures)
  4. Pleural effusions
36
Q

What is the common presentation of pericarditis?

A

Pleuritic retrosternal chest pain (↑ when supine, ↓ when sitting up and leaning forward), dyspnea, cough, and fever

37
Q

What serologic test is elevated in rheumatic heart disease? (2)

A 
Antistreptolysin antibodies (ASO)
DNAse B
38
Q

Name the five major J♡NES criteria for rheumatic heart disease:

aside from constitutional symptoms

A
  1. Joint pain (migratory polyarthritis)
  2. ♡ Pancarditis (endo/myo & pericarditis +/- murmurs)
  3. Nodules (painless, firm on extensors)
  4. Erythema marginatum (annular, faintly red, non-itchy)
  5. Sydenham chorea
39
Q

Acute severe, tearing substernal pain radiating to the interscapular region of the back

A

aortic dissection

40
Q

Which examination findings are characteristic of an aortic dissection? (3)

A

Unequal BP in the extremities
New diastolic decrescendo murmur (aortic regurg)
Widened Mediastinum on CXR

41
Q

Pain in buttocks and thighs with walking

A

Aortoiliac occlusive disease

42
Q

Pain in calves with walking

A

Femoral-popliteal occlusive disease

43
Q

Abdominal angina

A

Chronic mesenteric arterial occlusive disease

44
Q

Pericarditis presents with

A

Pleuritic chest pain, fever, leukocytosis

Chest x-ray: pleural effusion ± enlarged cardiac silhouette

Echocardiography: pericardial effusion

pericardial friction rub

45
Q

List 4 causes of pericarditis

A 
Myocardial infarction (Dressler syndrome)
CABG or Percutaneous coronary intervention
trauma
46
Q

pericardial friction rub described as a

A

scratchy sound between S1 and S2

only heard in ACUTE episodes

47
Q

Pericarditis improved when ___ and worsens when ___

A

leaning forward

Laying back

48
Q

Pericarditis 2/2 SLE treated with

A

NSAIDs

49
Q

If you suspect pericarditis what imaging would you get?

A

Echocardiogram

50
Q

Dx of Cor Pulmonale
echocardiographic findings:
RV hypertrophy, TR w/ RA enlargement

Definitive dx via:

A

Right heart catheterization
showing elevated
pulmonary artery systolic pressure (>25 mm Hg)

51
Q

Lyme disease with cardiac involvement (Lyme carditis) usually presents with ___ on ECG

A

conduction abnormalities (atrioventricular block)

52
Q

Cardiac tamponade can occur as a catastrophic complication of acute

A

aortic dissection

53
Q

Echocardiography typically shows biventricular enlargement with diffuse ventricular wall hypokinesis.

A

Viral Myocarditis

54
Q

___ cardiomyopathy is a diagnosis of exclusion in patients with dilated cardiomyopathy and history of alcohol abuse in whom no other potential causes of cardiomyopathy (coronary artery disease, valvular heart disease) are suspected or identified.

A

Alcoholic

IM (15 decks)

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