Cardio Flashcards
Continuous machinery murmur at the left upper sternal border
PDA: small PDA would be asymptomatic, whereas a large PDA would present in infancy with signs of heart failure, including failure to thrive, poor feeding, and respiratory distress.
Harsh holosystolic murmur at the left lower sternal border, with diastolic murmur at apex
ventricular septal defect (VSD). Neonates with isolated small VSDs are usually asymptomatic, whereas those with large VSDs present with signs of heart failure by 3–4 weeks of age
Widely split, fixed S2 and systolic ejection murmur at the left upper sternal border
atrial septal defect (ASD). Small ASDs do not cause symptoms in infancy and childhood. Those with large ASDs may develop heart failure, or present later in life with dyspnea, fatigue, and atrial arrhythmias.
Loud S2 (pulm HTN), systolic ejection murmur, holosystolic murmur at left upper sternal border; dx, a/w?
Complete arterioventricular septal defect, most common cardio defect in Downs (2nd VSD, 3rd ASD); may lead to pulm HTN
Cardiac sign in infant with the high-arched palate, webbed neck, widely spaced nipples, and edematous hands and feet
Turner’s syndrome: Bicuspid aortic valve and coarctation of the aorta: delayed femoral pulses suggest coarctation, a/w a systolic murmur loudest below the left scapula.
5 days post MI, sudden loss of HR, BP, and consciousness, while the ECG show a sinus rhythm.
Free wall rupture (5-10days post MI), may prevent w β- blockers, ACEis, avoid anti-inflammatory agents such as ibuprofen and indomethacin.
Patient rx for HTN now displays symptoms of angina, tachycardia, rash, and joint pains
Hydralazine: Lupus like sx
SE ACEi’s
dry cough (10–20% of people), hyperkalemia (blocks aldosterone secretion), angioedema, renal failure
SE β-Blockers
depression and erectile dysfunction, hypoglycemia via adrenergic blockade, hyperkalemia, pulmonary reactivity, bradycardia
SE: Calcium channel blockers such as verapamil
act as reverse chronotropes: bradycardia and even atrioventricular block; gingival hyperplasia and constipation
pt p/w acute chest pain(MI), time to therapy <12 H and STE > 2–3 mm in the chest leads and 1 mm in the limb leads.
Classic acute MI, and he has fulfilled all indications for fibrinolytic therapy: give TPA
advance cardiac life support bradycardia algorithm mnemonic: symptomatic brady (HR<60)
“All Trained Dogs Eat Iams”: Atropine (.5mg up to 3mg), Transcutaneous pacing, Dopamine, Epinephrine, and Isoproterenol, given in that order.
pt p/w vague abdominal sx, neurologic (headache, delirium), visual (altered color perception, scotomata), and cardiac arrhythmias (hyperkalemia, especially w K sparing diuretics)
Digoxin Toxicity; give Antidigoxigenin antibody Fab fragments; also renally secreted
Diastolic heart failure (dyspnea and increased venous pressure) in the setting of a normal ejection fraction and normal valvular function.
Diastolic failure is due to the inability of the ventricle to relax and properly fill during diastole. This results in a normal or decreased end-diastolic volume.
Pt p/w heart failure, arrhythmias, or even sudden death, Ejection Fr
Left ventricular dilation and systolic dysfunction: Dilated (LV) results in decreased contraction -> decreased LV ejection fraction
physical examination findings suggestive of aortic insufficiency
Diastolic murmur, Corrigan’s pulse (water-hammer pulse), de Musset’s sign (head bobbing), Traube’s sign (pistol-shot sound over the femoral artery), Duroziez’s sign (to-and-fro murmur over the femoral artery), Quincke’s pulse (capillary pulsation in the nail beds), or Hill’s sign (popliteal artery pressure greatly increased over brachial pressure).
Vegetative growth on a native mitral valve
Mitral valve prolapse, particularly as a complication of rheumatic heart disease, is a risk factor for native valve infective endocarditis.
Pt w/ holosystolic murmur at apex radiates to axilla; dx/sx features?
Mitral regurge; dry cough and exertional dyspnea (LV dysfnc, pulmonary edema HTN), aFib (LA dilatation)
Pt p/w fever, fatigue, malaise, Janeway lesions, and immunologic phenomena such as Osler nodes.
Infective endocarditis: IVDA -> Staphylococcus aureus acute endocarditis; prosthetic valve-> coagulase-negative staph; subacute-> Streptococcus viridans
Neonate p/w cyanosis and tachypnea. harsh holosystolic murmur at L lower sternal border; CXR: egg-shaped silhouette due to the absent main pulmonary artery stem and small heart base.
Dextraposed transposition of the great arteries (D-TGA); Prostaglandin E1 keep the PDA open. Balloon atrial septostomy. Arterial switch surg
Neonate p/w systolic ejection murmur at L upper sternal border, radiating to interscapular region. PE: weak, delayed femoral pulses relative v. UE, HTN in UE. CXR “reverse 3” sign, notched ribs
Coarctation of the aorta: acyanotic heart disease
Neurologic adverse effects of lidocaine
slurred speech and confusion. Other common adverse effects include tremor, personality and mood changes, and hallucinations
Lidocaine use in arrhythmias?
Used for treatment of ventricular arrhythmias (Vtach), should not use prophylactically b/c risk of asystole
Chest pain, fatigue, and dyspnea, +Beck’s triad: hypotension, distant heart sounds, distended neck veins
Cardiac Tamponade
Absolute contraindications to thrombolytics
hx cerebrovascular hemorrhage, ischemic stroke w/in 3 months, structural cerebral vascular lesion, brain tumor, active bleed/ coagulopathy, head/facial trauma w/in 3 months, aortic dissection
Extrarenal sx ADPCKD (polycystic kidney)
Cardiac - valvular dz (mitral prolapse, aortic regurge), cerebral aneurysm, hepatic cysts
Palpitations, SOB, Chest pain, hx COPD, EKG: varied PR interval, 3+ P wave morphologies
MAT: Multifocal Atrial Tachycardia, etiology: hypoxia (check O2 sats), CHF, electrolytes, sepsis
Symptomatic Mitral regurge 2/2 ischemic cardiomyopathy rx?
Loop Diuretics (decrease preload) + ACEi / beta-blocker (decrease afterload)
Indications for CABG?
significant L main coronary artery stenosis, >70% proximal stenosis LAD/L-circumflex, 3 vessel dz, symptomatic ischemic resistant to meds
EKG findings in Hypothermia
Osborn/J-waves: Upward deflection following R-wave (lead II)
EKG changes Hypokalemia
Diffuse broadening of T waves, prominent U waves; p/w hyporeflexia, flaccid paralysis, rhabdo, tetany, arrhytmias
EKG changes Hyperkalemia
Peaked T-waves, widened or sinusidal QRS, prolonged PR, ST depression
Hyperkalemia Rx
C BIG K: Calium gluconate, Bicarb/ Insulin & Glucose, Kayexalate
EKG changes in TCA o/d
Widened QRS (first), heart block, prolonged QT and PR
Best initial rx for TCA o/d
Bicarb: to increase pH, attenuates Na channel block
premature wide bizzarely shaped QRS complexes
premature ventricular contraction
Pre-excitation syndrome, (WPW) features
Short PR, aberrant conduction made worst by AV blocking agents: digoxin, CCB, b-blockers and may progress to SVT, VT
Irregular rhythm w absent P-waves
A-Fib
A-Fib w/ STEMI treatment
Beta-Blockers: reduce O2 demand, reduce rate [or w CCB, Digoxin], O2, Nitro, ASA; get cardiac enzymes; angioplasty, fibrinolysis, CABG
Narrow PR, Wide QRS, w/ slurred upstroke on EKG
WPW (wolf-parkinson-white) syndrome
WPW rx stable patient; may present w/ Afib w/ rapid ventricular response (risk of Vfib)
Procainamide (1st choice), 2nd try Amiodarone; definitive rx radiofrequency ablation
WPW rx unstable (hypoperfused, hypotense, tachy) patient
Synchronized cardioversion
Regular narrow complex tachycardia (not WPW) treatment
Adenosine
Rx: HTN + BPH
alpha-1 antagonist (terazosin)
Rx: HTN + Essential tremor/ hyperthyroid/ post-MI/ angina pectoris/ Glaucoma/ Headache/ Diastolic CHF
Beta-blockers (metoprolol)
Rx: HTN + CHF/ MI/ CKD proteinuria
ACE inhibitors (lisinopril)
Rx: HTN + Diastolic CHF/ recurrent SVT/ headache/ Raynaud/ Esophageal spasms/ Angina pectoris
CCB (verapamil - SVT, dihydropyridine - Raynaud)
Rx: HTN + CHF/ Edema/ Osteoporosis
1st line HTN: Thiazide diuretics
Rx: HTN emergency (a/w organ damage)
IV Labetalol, or IV Nitroprusside
Tachy, stable w/ pulse, regular rhythm (SVT) rx?
Vagal maneuvers, Atropine, Amiodarone if unsuccessful
Rx for pt w/ blowing systolic murmur @aorta, JVD, pulmonary congestion, pedal edema, liver congestion
Aortic regurge: backward failure sd: L CHF (pulmonary congestion) -> R CHF (JVD…) ->Rx ACEi (Captopril/ Spioinolactone)
Pt w/ ACS sx, what given hx indicates Echo vs. EKG for dx?
Previous MI, previous LBBB, on Digoxin, pacemaker
Shock? Decreased CO, Low PCWP, Increased SVR, Low Venous O2
Hypovolemic
Shock? Decreased CO, High PCWP, Increased SVR, Low Venous O2
Cardiogenic
Shock? Decreased CO, Low PCWP, Low SVR, Low Venous O2
Neurogenic
Shock? Increased CO, Low PCWP, Decreased SVR, Increased Venous O2
Septic
Indications for Emergent Dialysis
refractory K>6.5, pH<7.1, Uremia, refractory fluid overload, BUN>100, dialyzable toxic o/d
Asymptomatic 68yoF w/ crescendo-decr. systolic murmur rt sternum, next step?
Echo (transthoracic echocardiogram) evaluate extent of Aortic Stenosis
Post MI, Ejection Fr<40% (HF), on beta blocker, 2nd Rx? (prevents cardiac remodeling)
ACEi: decreases afterload -> increased SV, CO; decreases EDV ED pr., pulmonary cap pr.; aldosterone mediated Na/H2O retention; Angiotensin II mediated catecholamine release vasoconstriction
Bone pain p/w: Nephrolithiasis, MS changes, Abd pain, Constipation, short QT; Dx/Rx?
Hypercalcemia: Rx 1. Aggressive IVF plus Furosemide, 2. Bisphosphonates, 3. Calcitonin
Propanolol SE?
Wheezing: Bronchospasms: c.i. COPD, asthma (may use B1 specifics like Metoprolol)
22 YO w/ ST elevation, chest pain, dx/rx?
likely amphetamine/cocaine coronary vasospasm induced MI, Rx Benzodiazepine
Antibiotic prophylaxis for heart conditions?
Prosthetic Valve, previous bacterial endocarditis, unrepaired cyanotic heart dz, valvuopathy in transplanted heart
etiology of 3rd degree block?
anterior MI, meds: Digoxin (dizzy, N&V, vision changes), beta-blockers, CCB
Cardiac Enzyme of choice for re-infarct?
Creatine Kinase (CK-MB): elevated in 3hrs, peak in 18-24h, duration
First cardiac enzyme to be elevated?
Myoglobin: elevates in 1-2hrs; peaks in 6-7h, duration
Most specific and sensitive Cardiac enzyme?
Troponin I: elevates in 3-12hrs; peaks in 24h, duration slow
Pulsatile abd mass, 185/120, dx test?
Abd US dx test of choice for suspected AAA
Acute digitalis toxicity (decreased av conduction, increased automaticity) arrhythmia?
atrial tachycardia with 2:1 block, accelerated junctional rhythm, and bidirectional ventricular tachycardia (Torsades de pointes)
Torsades de pointes (look for increased QT>440, sudden syncope) Rx?
Magnesium sulfate: decreases calcium influx -> reduces early depolarizations that perpetuate this dysrhythmia.
Pt p/w dyspnea (positional & w/ exertion), syncope, peripheral edema; Kussmaul’s sign (increased JVD w/ inspiration), LVH on echo, low voltage QRS; pmh sarcoidosis; dx?
restrictive cardiomyopathy (RCM): a/w infiltrative dz: ie. amyloidosis, sarcoidosis, or hemochromatosis -> restrict left ventricle filling -> decreased output and compliance, and increased filling pressure: CHF sx
Neonate, acyonotic p/w wide, fixed, split S2 with a systolic ejection murmur at the left upper sternal border or Mid-diastolic rumble at the left lower sternal border
Atrial septal defect: increased blood flow across pulmonic and tricuspid valves.
Systolic ejection murmur at the left upper sternal border, radiates to interscapular region, weak delayed femoral pulses relative to UE, HTN in UE; rx? EKG? CXR?
Coarction of the aorta; EKG L ventricular hypertrophy: high voltage QRS, downsloping ST, inverted T in V5, V6; CXR 3sign, rib notching
Tetralogy of Fallot (TOF) is composed of four defects:
Hypertrophied RV, RV obstructive Tract (RVOT) from pulmonary stenosis or atresia, VSD, Over riding Aorta
Infant w cyanotic spells, a normal S1, single S2, a harsh systolic crescendo–decrescendo ejection murmur at L.U sternal border radiates to the back; dx/ murmur etiology?
TOF: murmur due to right ventricular outflow tract obstruction via pulmonary artery stenosis or atresia, stenotic pulmonary valve (single S2)
Infant w cyanotic spells, single S2, a harsh systolic crescendo–decrescendo ejection murmur at L.U sternal border; dx/rx?
TOF; Knee to chest position (increase systemic vascular resistance) and Oxygen (pulmonary dilation) increased RV flow to pulmonary vs Aorta via VSD; surgery
Infant w holosystolic murmur that is loudest at the left lower sternal border
VSD (may also have diastolic rumble at apex from increased mitral flow)
Pt w/ photophobia, + Kernig’s/Bredzinsky, p/w petechia, increased bleeding time, PT, PTT, thrombocytopenia, schistocytes in blood
DIC secondary to meningococceal inf. (consumption of coagulation factors and activation of platelets)
Young women with early onset of HTN refractory to pharmacotherapy, p/w abdominal bruit
Renal artery stenosis f(ibromuscular dysplasia): duplex imaging of the renal arteries, and percutaneous transluminal angioplasty
Meds w/ longterm mortality benefit in LV systolic dysfunction EF
ACEi, ARBs, Aldosterone antagonists, BB (Metoprolol, Carvedilol, Bisoprolol), and combination Hydralazine/Nitrates in african americans
Post MI Meds given w mortality benefit for secondary prevention
Aspirin, BB, ACEi, Statins, also Clopidrogel if Non-STEMI/percutaneous catherization w stent
Pt p/w dyspnea, w. loud s1, mid-diastolic rumble at apex, irregular heart rate, from Asia
Mitral stenosis via Rheumatic dz -> L atrial enlargement -> A-Fib , pulmonary congestion
Pt w/ p edema, HSM, JVD, diastolic murmur at L lower sternal border, irregular HR
Tricuspid stenosis w/ Rt sided CHF, R atrial enlargement -> A-fib
60yo p/w acute sharp pain radiating to back and neck, BP 200/110, tachycardic, b/l LE weakness; dx/ a sx?
Aortic dissection; stroke (carotids), LE weakness (spinal/iliac art.), MI (coronary), pleural effusion, percardial effusion, renal failure (renal a.), abd pain (mesenteric), horner’s (superior cervical chain)
Heredetary Hemochromatosis Sx
Restricted/ dilated cardiomyopathy, conduction abnormalities; Hyperpigmentation; DM, hypogonad, hypothyroid; hepatomegaly, Liver enzymes, cirrhosis, HCC; Arthalgias
Mech Nitroglycerine angina relief?
Dilation of capacitance (veins) vessels, decreased preload and heart size and oxygen demand by cardiomyocytes
Pt w STEMI II, III ,AVF, holosystolic murmur at apex, crackles in lungs
Inferior MI w/ Papillary muscle displacement -> acute MR -> increased L atrial P -> pulmonary edema
Pt w/ hypotension, brady, kussmaul sign, JVD, clear lungs, STEMI II,III,aVF, ST depression I,aVL
Inf MI w/ Rt heart ischemia, Rt heart failure sx, SA node ischemia (low HR), Rx bolus IVF avoid Nitro/diuretics/opiods (decrease RV preload)
Amiodarone SE
Hepatitis (ALT,AST), hypothyroidism, fatigue, memory loss, blue skin, chronic interstitial pneumonitis, heart block, risk of torsades
Pressure drops more than 10mmHg with inspiration
Pulsus Paradoxus: sx in Cardiac Tamponade, severe COPD or Asthma,
PCWP: Pulmonary Capillary Wedge Pressure
Measure of L Atrial pressure (L Ventricular end dyastolic P / preload), normal range 6-12
Amlodipine SE (Dihydropyridine Ca channel blocker)
Peripheral Edema
Pt p/w headache, blurred vision, 220/130, proteinuria, Cr 4, hx scleroderma.. Dx? Blood abn?
Scleroderma Renal crises, with microangiopathic hemolytic anemia w/ schistocytes and thrombocytopenia
Thiazide SE
Hyperglycemia, increased LDL and triglycerides, Hypokalemia, hyponatremia, hypercalcemia
Pt p/w 2 wks fevers, SOB, weakness, dark urine, painful swollen distal and proximal interphalangeal joints
Infective Endocarditis w/ Osler’s joints
Osler’s Joints
painful violaceous joints fingers and toes w/ infective endocarditis
Janeway Lesions
macular, erythematous, non painful lesions in palms and soles w/ IE
Roth spots
edematous hemorrhagic lesions in the retina w/ IE
Beta Blocker O/D sx and Rx?
Hypotension, bradycardia, wheezing, cardiogenic shock, delirum, seizures, hypoglycemia; Rx IV Atropine (1st line), IV glucagon (refractory)
Pt/ p/w sharp positional chest pain, friction rub, BUN>60, Cr 5.1; dx? Rx?
Uremic pericarditis, 1st line hemodialysis
Pt w/ chronic afib p/w nausea, vomiting, weakness, diarrhea, vision changes, decreased appetite, confusion; dx?
Digoxin toxicity, renally cleared (recent AKI, diuretic use), monitor levels, may give anti-dig fab ab
Brain Natriuretic Peptide BNP: uses? Fnc?
Increased in CHF via stretch of ventricles (p/w S3) for diff SOB (v. pulm); diuresis, hypotension, antagonizes ReninAngiotensin, increased venous capacitence, decreased preload
Abd pain, pulsatile abdominal mass, hypotension
Ruptured AAA
S3 (ventricular gallop) in early diastole (after S2) during rapid ventricular filling phase, turbulent blood flow from increase volume
a/w increased filling Pr (mitral regurgitation, CHF, restrictive cardiomyopathy) and dilated ventricles (normal in children, pregnancy)
S4 (atrial kick) “TEN-es-see in late diastole (immediately before S1) after atrial contraction with blood forced into stiff ventricle
High atrial pressure; a/w ventricular hypertrophy, acute MI, aortic stenosis. Left atrium must push against stiff LV wall (decreased ventricle compliance) from longstanding HTN
Osler-Weber-Rendu syndrome; hereditary hemorrhagic telangiectasia
AD fibrovascular dysplasia w/ vascular lesions (telangiectasias, arteriovenous malformations, and aneurysms) throughout the body (lungs, brain, GI)
Syncope Post URI, distant HS, low BP, distended neck veins, clear lungs, pleural effusion on CXR, EKG?
Electrical alterans, effusions (tamponade) post viral percarditis
Chest pain 2 wks post MI, positional, EKG- diffuse ST elevations, ST depression in aVR; dx,rx?
Dressler’s sx pericarditis (days-months post MI autoimmune); NSAIDs
Persistent ST elevations (5days-3months) post MI w/ deep Q waves in STE leads, mitral regurge; dx/confirmation/complications?
Ventricular aneurysm, echo: hypokinetic LV wall motion; complications CHF, mural thrombi, ventricular arrhythmias
CHADS2 (0-ASA, 1-AC or ASA, 2+ AC) anti-coagulation in A-Fib
CHF, HTN, Age>74 x2, DM, Stroke (TIA) x2
Paradoxical Split S2 (A2 follows P2) best heard with expiration
Delayed myocardial relaxation, delayed closure of aortic valve; myocardial ischemia/infarct; L Ventricle outflow obstruction (aortic stenosis, LBBB)
Wide fixed split S2
Atrial Septal Defect
IV drug user p/w fever, tachycardia,multiple round nodules on cxr; dx?
Infective Endocarditis (S.Aureus) w/ likely Tricuspid regurg (holosystolic murmur increases with inspiration) and septic pulmonary emboli
Widened pulse pressure, systolic ejection murmur, brisk carotid upstroke, tachycardia, flushed leg, previous leg trauma, left ventricular deviation, dx?
High out put heart failure from AVF, with LV hypertrophy, increased CO via HR and SV
Cor pulmonale impaired R Ventricle function from pulmonary HTN (COPD, interstitial, thrombo-embolic, OSA); features?
Exersional dyspnea, P. Edema, JVD, S3, Hepatomegaly pulsatile liver, tricuspid regurge/murmur, pulm systolic P >25
Systolic murmurs?
AS (crescendo-decrescendo), MR/TR (holo, highpitched blowing), VSD (holo harsh), MVP(late systolic w/ click)
Diastolic murmurs?
MS (opening snap, delayed rumbling), AR (blowing-decrescendo)
Heart murmur effect w/ handgrip?
Increased SVR (afterload), SBP, regurgitant factor; Louder MR, AR, VSD, louder MP w later click, decreased AS, HCOM
Heart murmur effect w/ squatting?
Increased afterload, venous return, regurgitant factor; Louder AS, AR, VSD; softer HCOM, MVP w later click
Heart murmur effect w/ valsalva or standing?
Decreased venous return, louder HCOM, MVP (earlier onset of click); softer all others
Heart murmur effect w/ inspiration?
Louder Rt heart murmurs
Narrow complex tachy, irregular, no P waves >48 hr, stable pt, dx/rx?
Afib w rapid ventricular response; rx rate control w/ Diltiazem (CCB) or Metoprolol (BB), then anticoagulation (warfarin)
Mechanism of Digitalis in systolic heart failure w/ rapid ventricular rhythm (aFib/aFlutter)?
Positive inotropic and negative dromotropic (slow AV conduction)
Sudden pain radiating to back with decrescendo diastolic murmur; next step/ dx?
TEE to confirm aortic disection, p/w aortic regurge murmur, 20+bp dif R vs. L arm,
Vtach (w/ AV dissociation, fusion/capture beats) rx?
Amiodarone if stable, Synchronized cardioversion if unstable
EKG tall R in aVL, deep S in V3, repolarization changes in ant leads I, aVL, V4,5,6
Hypertrophic cardiomyopathy w/ LVH
Most common electrical origin of aFib?
Pulmonary Veins
Pt p/w peripheral edema, ascites, pericardial knock (mid-diastolic sound), JVD, Kussmaul’s sign (JVD doesn’t decrease w inspiration), pericardial calcification; dx?
constrictive pericarditis leading to right heart failure
Sinus tachycardia with electrical alterans (variation in QRS amplitude); dx/rx?
Percadial effusion (percarditis); rx pericardiocentesis
Paroxysmal supraventricular tachycardia mech and cold water immersion, (also adenosine)?
PSVT via re-entrant pathways through AV node; cold water increases vagal tone on AV node slowing re-entrant conduction
Syncope post MI; dx/mechanism?
Ventricular arrhythmias (vent. PMCs, Vtach, Vfib); re-entrant arrhythmias, via heterogeneity of conduction (immediate) or abnormal automaticity (delayed, 10-60min post MI)
ST elevation leads 2,3,aVF?
Inferior wall MI, RCA or LCX
ST elevation some or all leads V1-V6
Anterior wall MI, LDA
ST depression V1-V3, or ST elevation V1&aVL (LCX) or ST depression in V1&aVL (RCA)?
Posterior wall MI, LCX or RCA
ST elevation I, aVL, V5&V6, or ST depression 2, 3, aVF?
Lateral wall MI, LCX or diagonal
ST elevation V4-V6?
R Ventricle MI (in half of inferior wall MI) RCA
Reversible causes of pulseless electrical activity PEA/ asystole? 5H/5Ts
Hypovolemia, Hypoxemia, Hypothermia, Hypo/Hyperkalemia, Hydrogen ions (acidosis), Tension pneumothorax, Tamponade (cardiac), Thrombosis (coronary/pulm), Trauma, Toxins (benzo’s, narcotics)
Swan-Ganz catheder ranges of heart pressures?
PCWP/LA (6-12); RA/CVP (0-8); PA (15-25/8-15); RV (15-25/0-8); LV (90-140/4-12)
T-wave inversion?
MI, Myocarditis, previous pericarditis, myocardial contusion, digoxin toxicity
Post cardio cath procedure, pt p/w livido reticularis, blue toe, GI pain, Hollenhorst plaques in eyes, elevated Cr, Eosinophilia, Eosinophiluria, hypocomplementemia; dx?
Cholesterol crystal/ Atherosclerotic embolism
