Cardio 2

Question 1

what leads are involved in anterior MI

Answer 1

V2 through V4

Question 2

what artery is involved in anterior wall MI

Answer 2

left anterior descending artery - diagonal branch

Question 3

what leads are involved in septal wall MI

Answer 3

V1, V2

Question 4

what artery is involved in septal wall MI

Answer 4

left anterior descending artery - septal branch

Question 5

what leads are involved in lateral wall MI

Answer 5

aVL, I, V5, V6

Question 6

what artery is involved in lateral wall MI

Answer 6

left coronary artery - circumflex branch

Question 7

what is considered to be a STEMI equivalent

Answer 7

left bundle branch block esp when new

Question 8

reperfusion therapy for MI

Answer 8

percutaneous coronary intervention strongly preferred
or fibrinolytic

PCI ideally within 90 minutes of presentation and within 12 hours of chest pain onset

thrombolytics within 30 min of ED presentation if PCI not possible

Question 9

what leads are involved in inferior wall MI

Answer 9

II, III, aVF

Question 10

what artery is involved in inferior MI

Answer 10

right coronary artery - posterior descending branch

Question 11

what leads are involved win posterior wall MI

Answer 11

V1-V4

Question 12

what artery is involved in posterior wall MI

Answer 12

left coronary artery - circumflex bnrahc
right coronary artery - posterior descending branch

Question 13

what heart sound may you hear in inferior wall MI

Answer 13

S4

Question 14

in which MI will you have ST depression as opposed to elevations

Answer 14

posterior MI

Question 15

what is the gold standard for myocarditis dx

Answer 15

endomyocardial biopsy

Question 16

when should you suspect myocarditis

Answer 16

in a patient with new-onset heart failure or chest pain or arrhythmia, positive cardiac biomarkers, absence of traditional coronary risk factors, and a history of preceding viral illness or infection, acute myocarditis should be the differential diagnosis!!!!

Question 17

what should patients with myocarditis avoid

Answer 17

NSAIDs
cardiotoxic meds
heavy alcohol consumption
exercise

Question 18

what are the 2 most common causes of viral acute pericarditis

Answer 18

coxsackievirus A and B and echovirus

Question 19

what is the MC cause of acute pericarditis

Answer 19

idiopathic

Question 20

what is Dressler syndrome

Answer 20

post MI pericarditis + fever + pleural effusion that may occur after several weeks after the MI

Question 21

sx pericarditis

Answer 21

sudden onset pleuritic chest plain worse with deep inspiration or coughing
worse when supine and improved in seated position or by learning forward

pain may radiate to shoulder and trapezius ridge

pericardial friction rub (erb’s point) - intensity may be increased during auscultation by having pt sitting up and leaning forward

Question 22

what will EKG show for pericarditis

Answer 22

widespread diffuse ST segment elevation in V1-V6 with associated PR depression in those leads

leads aVR is associated w reciprocal ST depression and PR elevation

Question 23

what age of people are normally affected by acute rheumatic fever

Answer 23

children 5-15

Question 24

causative organism of acute rheumatic fever

Answer 24

Group A streptococcus (strep pyogenes)

Question 25

sx rheumatic fever

Answer 25

poly arthritis - 2 or more joints affected or migratory (lower –> upper joints); head, redness, swelling, severe joint tenderness may be present

active carditis - can affects valves (mitral and aortic); confers great morbidity and mortality

sydenham’s chorea - saint Vitus dance; may occur 1-8 months after initial infection; sudden involuntary, jerky, non0rhythmic, purposeless movements esp in head/arms

erythema marginatum - often accompanies carditis; macular, erythematous, non-pruritic annular rash w rounded, sharply demarcated borders - may have central clearing - on trunk and extremities - not face

subcutaneous nodules - rare; seen over joints, scalp, spinal column

Question 26

Jones criteria for rheumatic fever

Answer 26

Major:
Joint (migratory poly arthritis)
Oh my heart (active carditis)
Nodules (subq)
Erythema marginatum
Sydenham’s chorea

Minor:
Fever >/= 101.3F/38.5C
Arthralgia (joint pain)
Acute phase reactants (ESR, CRP, leukocytosis)
EKG: prolonged PR interval

PLUS
supportive evidence for recent GAS infection
-positive throat culture for GAS or
-rapid strep antigen or
-elevated/increased strep Ab titers (antideoxynuclease B or antistreptolysin O)

2 major OR 1 major + 2 minor

Question 27

tx rheumatic fever

Answer 27

anti-inflammatory - aspirin 2-6 weeks w taper; naproxen, corticosteroids if severe + carditis

abx - IM pCN G benzathine; macrolide are alternative

Question 28

what is the MC valve affected in rheumatic heart disease

Answer 28

mitral