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Cardio Flashcards

1
Q

Continuous machinery murmur at the left upper sternal border

A

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.

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2
Q

Harsh holosystolic murmur at the left lower sternal border, with diastolic murmur at apex

A

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

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3
Q

Widely split, fixed S2 and systolic ejection murmur at the left upper sternal border

A

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.

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4
Q

Loud S2 (pulm HTN), systolic ejection murmur, holosystolic murmur at left upper sternal border; dx, a/w?

A

Complete arterioventricular septal defect, most common cardio defect in Downs (2nd VSD, 3rd ASD); may lead to pulm HTN

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5
Q

Cardiac sign in infant with the high-arched palate, webbed neck, widely spaced nipples, and edematous hands and feet

A

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.

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6
Q

5 days post MI, sudden loss of HR, BP, and consciousness, while the ECG show a sinus rhythm.

A

Free wall rupture (5-10days post MI), may prevent w β- blockers, ACEis, avoid anti-inflammatory agents such as ibuprofen and indomethacin.

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7
Q

Patient rx for HTN now displays symptoms of angina, tachycardia, rash, and joint pains

A

Hydralazine: Lupus like sx

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8
Q

SE ACEi’s

A

dry cough (10–20% of people), hyperkalemia (blocks aldosterone secretion), angioedema, renal failure

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9
Q

SE β-Blockers

A

depression and erectile dysfunction, hypoglycemia via adrenergic blockade, hyperkalemia, pulmonary reactivity, bradycardia

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10
Q

SE: Calcium channel blockers such as verapamil

A

act as reverse chronotropes: bradycardia and even atrioventricular block; gingival hyperplasia and constipation

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11
Q

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.

A

Classic acute MI, and he has fulfilled all indications for fibrinolytic therapy: give TPA

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12
Q

advance cardiac life support bradycardia algorithm mnemonic: symptomatic brady (HR<60)

A

“All Trained Dogs Eat Iams”: Atropine (.5mg up to 3mg), Transcutaneous pacing, Dopamine, Epinephrine, and Isoproterenol, given in that order.

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13
Q

pt p/w vague abdominal sx, neurologic (headache, delirium), visual (altered color perception, scotomata), and cardiac arrhythmias (hyperkalemia, especially w K sparing diuretics)

A

Digoxin Toxicity; give Antidigoxigenin antibody Fab fragments; also renally secreted

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14
Q

Diastolic heart failure (dyspnea and increased venous pressure) in the setting of a normal ejection fraction and normal valvular function.

A

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.

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15
Q

Pt p/w heart failure, arrhythmias, or even sudden death, Ejection Fr

A

Left ventricular dilation and systolic dysfunction: Dilated (LV) results in decreased contraction -> decreased LV ejection fraction

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16
Q

physical examination findings suggestive of aortic insufficiency

A

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).

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17
Q

Vegetative growth on a native mitral valve

A

Mitral valve prolapse, particularly as a complication of rheumatic heart disease, is a risk factor for native valve infective endocarditis.

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18
Q

Pt w/ holosystolic murmur at apex radiates to axilla; dx/sx features?

A

Mitral regurge; dry cough and exertional dyspnea (LV dysfnc, pulmonary edema HTN), aFib (LA dilatation)

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19
Q

Pt p/w fever, fatigue, malaise, Janeway lesions, and immunologic phenomena such as Osler nodes.

A

Infective endocarditis: IVDA -> Staphylococcus aureus acute endocarditis; prosthetic valve-> coagulase-negative staph; subacute-> Streptococcus viridans

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20
Q

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.

A

Dextraposed transposition of the great arteries (D-TGA); Prostaglandin E1 keep the PDA open. Balloon atrial septostomy. Arterial switch surg

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21
Q

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

A

Coarctation of the aorta: acyanotic heart disease

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22
Q

Neurologic adverse effects of lidocaine

A

slurred speech and confusion. Other common adverse effects include tremor, personality and mood changes, and hallucinations

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23
Q

Lidocaine use in arrhythmias?

A

Used for treatment of ventricular arrhythmias (Vtach), should not use prophylactically b/c risk of asystole

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24
Q

Chest pain, fatigue, and dyspnea, +Beck’s triad: hypotension, distant heart sounds, distended neck veins

A

Cardiac Tamponade

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25
Q

Absolute contraindications to thrombolytics

A

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

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26
Q

Extrarenal sx ADPCKD (polycystic kidney)

A

Cardiac - valvular dz (mitral prolapse, aortic regurge), cerebral aneurysm, hepatic cysts

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27
Q

Palpitations, SOB, Chest pain, hx COPD, EKG: varied PR interval, 3+ P wave morphologies

A

MAT: Multifocal Atrial Tachycardia, etiology: hypoxia (check O2 sats), CHF, electrolytes, sepsis

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28
Q

Symptomatic Mitral regurge 2/2 ischemic cardiomyopathy rx?

A

Loop Diuretics (decrease preload) + ACEi / beta-blocker (decrease afterload)

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29
Q

Indications for CABG?

A

significant L main coronary artery stenosis, >70% proximal stenosis LAD/L-circumflex, 3 vessel dz, symptomatic ischemic resistant to meds

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30
Q

EKG findings in Hypothermia

A

Osborn/J-waves: Upward deflection following R-wave (lead II)

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31
Q

EKG changes Hypokalemia

A

Diffuse broadening of T waves, prominent U waves; p/w hyporeflexia, flaccid paralysis, rhabdo, tetany, arrhytmias

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32
Q

EKG changes Hyperkalemia

A

Peaked T-waves, widened or sinusidal QRS, prolonged PR, ST depression

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33
Q

Hyperkalemia Rx

A

C BIG K: Calium gluconate, Bicarb/ Insulin & Glucose, Kayexalate

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34
Q

EKG changes in TCA o/d

A

Widened QRS (first), heart block, prolonged QT and PR

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35
Q

Best initial rx for TCA o/d

A

Bicarb: to increase pH, attenuates Na channel block

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36
Q

premature wide bizzarely shaped QRS complexes

A

premature ventricular contraction

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37
Q

Pre-excitation syndrome, (WPW) features

A

Short PR, aberrant conduction made worst by AV blocking agents: digoxin, CCB, b-blockers and may progress to SVT, VT

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38
Q

Irregular rhythm w absent P-waves

A

A-Fib

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39
Q

A-Fib w/ STEMI treatment

A

Beta-Blockers: reduce O2 demand, reduce rate [or w CCB, Digoxin], O2, Nitro, ASA; get cardiac enzymes; angioplasty, fibrinolysis, CABG

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40
Q

Narrow PR, Wide QRS, w/ slurred upstroke on EKG

A

WPW (wolf-parkinson-white) syndrome

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41
Q

WPW rx stable patient; may present w/ Afib w/ rapid ventricular response (risk of Vfib)

A

Procainamide (1st choice), 2nd try Amiodarone; definitive rx radiofrequency ablation

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42
Q

WPW rx unstable (hypoperfused, hypotense, tachy) patient

A

Synchronized cardioversion

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43
Q

Regular narrow complex tachycardia (not WPW) treatment

A

Adenosine

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44
Q

Rx: HTN + BPH

A

alpha-1 antagonist (terazosin)

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45
Q

Rx: HTN + Essential tremor/ hyperthyroid/ post-MI/ angina pectoris/ Glaucoma/ Headache/ Diastolic CHF

A

Beta-blockers (metoprolol)

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46
Q

Rx: HTN + CHF/ MI/ CKD proteinuria

A

ACE inhibitors (lisinopril)

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47
Q

Rx: HTN + Diastolic CHF/ recurrent SVT/ headache/ Raynaud/ Esophageal spasms/ Angina pectoris

A

CCB (verapamil - SVT, dihydropyridine - Raynaud)

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48
Q

Rx: HTN + CHF/ Edema/ Osteoporosis

A

1st line HTN: Thiazide diuretics

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49
Q

Rx: HTN emergency (a/w organ damage)

A

IV Labetalol, or IV Nitroprusside

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50
Q

Tachy, stable w/ pulse, regular rhythm (SVT) rx?

A

Vagal maneuvers, Atropine, Amiodarone if unsuccessful

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51
Q

Rx for pt w/ blowing systolic murmur @aorta, JVD, pulmonary congestion, pedal edema, liver congestion

A

Aortic regurge: backward failure sd: L CHF (pulmonary congestion) -> R CHF (JVD…) ->Rx ACEi (Captopril/ Spioinolactone)

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52
Q

Pt w/ ACS sx, what given hx indicates Echo vs. EKG for dx?

A

Previous MI, previous LBBB, on Digoxin, pacemaker

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53
Q

Shock? Decreased CO, Low PCWP, Increased SVR, Low Venous O2

A

Hypovolemic

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54
Q

Shock? Decreased CO, High PCWP, Increased SVR, Low Venous O2

A

Cardiogenic

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55
Q

Shock? Decreased CO, Low PCWP, Low SVR, Low Venous O2

A

Neurogenic

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56
Q

Shock? Increased CO, Low PCWP, Decreased SVR, Increased Venous O2

A

Septic

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57
Q

Indications for Emergent Dialysis

A

refractory K>6.5, pH<7.1, Uremia, refractory fluid overload, BUN>100, dialyzable toxic o/d

58
Q

Asymptomatic 68yoF w/ crescendo-decr. systolic murmur rt sternum, next step?

A

Echo (transthoracic echocardiogram) evaluate extent of Aortic Stenosis

59
Q

Post MI, Ejection Fr<40% (HF), on beta blocker, 2nd Rx? (prevents cardiac remodeling)

A

ACEi: decreases afterload -> increased SV, CO; decreases EDV ED pr., pulmonary cap pr.; aldosterone mediated Na/H2O retention; Angiotensin II mediated catecholamine release vasoconstriction

60
Q

Bone pain p/w: Nephrolithiasis, MS changes, Abd pain, Constipation, short QT; Dx/Rx?

A

Hypercalcemia: Rx 1. Aggressive IVF plus Furosemide, 2. Bisphosphonates, 3. Calcitonin

61
Q

Propanolol SE?

A

Wheezing: Bronchospasms: c.i. COPD, asthma (may use B1 specifics like Metoprolol)

62
Q

22 YO w/ ST elevation, chest pain, dx/rx?

A

likely amphetamine/cocaine coronary vasospasm induced MI, Rx Benzodiazepine

63
Q

Antibiotic prophylaxis for heart conditions?

A

Prosthetic Valve, previous bacterial endocarditis, unrepaired cyanotic heart dz, valvuopathy in transplanted heart

64
Q

etiology of 3rd degree block?

A

anterior MI, meds: Digoxin (dizzy, N&V, vision changes), beta-blockers, CCB

65
Q

Cardiac Enzyme of choice for re-infarct?

A

Creatine Kinase (CK-MB): elevated in 3hrs, peak in 18-24h, duration

66
Q

First cardiac enzyme to be elevated?

A

Myoglobin: elevates in 1-2hrs; peaks in 6-7h, duration

67
Q

Most specific and sensitive Cardiac enzyme?

A

Troponin I: elevates in 3-12hrs; peaks in 24h, duration slow

68
Q

Pulsatile abd mass, 185/120, dx test?

A

Abd US dx test of choice for suspected AAA

69
Q

Acute digitalis toxicity (decreased av conduction, increased automaticity) arrhythmia?

A

atrial tachycardia with 2:1 block, accelerated junctional rhythm, and bidirectional ventricular tachycardia (Torsades de pointes)

70
Q

Torsades de pointes (look for increased QT>440, sudden syncope) Rx?

A

Magnesium sulfate: decreases calcium influx -> reduces early depolarizations that perpetuate this dysrhythmia.

71
Q

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?

A

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

72
Q

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

A

Atrial septal defect: increased blood flow across pulmonic and tricuspid valves.

73
Q

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?

A

Coarction of the aorta; EKG L ventricular hypertrophy: high voltage QRS, downsloping ST, inverted T in V5, V6; CXR 3sign, rib notching

74
Q

Tetralogy of Fallot (TOF) is composed of four defects:

A

Hypertrophied RV, RV obstructive Tract (RVOT) from pulmonary stenosis or atresia, VSD, Over riding Aorta

75
Q

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?

A

TOF: murmur due to right ventricular outflow tract obstruction via pulmonary artery stenosis or atresia, stenotic pulmonary valve (single S2)

76
Q

Infant w cyanotic spells, single S2, a harsh systolic crescendo–decrescendo ejection murmur at L.U sternal border; dx/rx?

A

TOF; Knee to chest position (increase systemic vascular resistance) and Oxygen (pulmonary dilation) increased RV flow to pulmonary vs Aorta via VSD; surgery

77
Q

Infant w holosystolic murmur that is loudest at the left lower sternal border

A

VSD (may also have diastolic rumble at apex from increased mitral flow)

78
Q

Pt w/ photophobia, + Kernig’s/Bredzinsky, p/w petechia, increased bleeding time, PT, PTT, thrombocytopenia, schistocytes in blood

A

DIC secondary to meningococceal inf. (consumption of coagulation factors and activation of platelets)

79
Q

Young women with early onset of HTN refractory to pharmacotherapy, p/w abdominal bruit

A

Renal artery stenosis f(ibromuscular dysplasia): duplex imaging of the renal arteries, and percutaneous transluminal angioplasty

80
Q

Meds w/ longterm mortality benefit in LV systolic dysfunction EF

A

ACEi, ARBs, Aldosterone antagonists, BB (Metoprolol, Carvedilol, Bisoprolol), and combination Hydralazine/Nitrates in african americans

81
Q

Post MI Meds given w mortality benefit for secondary prevention

A

Aspirin, BB, ACEi, Statins, also Clopidrogel if Non-STEMI/percutaneous catherization w stent

82
Q

Pt p/w dyspnea, w. loud s1, mid-diastolic rumble at apex, irregular heart rate, from Asia

A

Mitral stenosis via Rheumatic dz -> L atrial enlargement -> A-Fib , pulmonary congestion

83
Q

Pt w/ p edema, HSM, JVD, diastolic murmur at L lower sternal border, irregular HR

A

Tricuspid stenosis w/ Rt sided CHF, R atrial enlargement -> A-fib

84
Q

60yo p/w acute sharp pain radiating to back and neck, BP 200/110, tachycardic, b/l LE weakness; dx/ a sx?

A

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)

85
Q

Heredetary Hemochromatosis Sx

A

Restricted/ dilated cardiomyopathy, conduction abnormalities; Hyperpigmentation; DM, hypogonad, hypothyroid; hepatomegaly, Liver enzymes, cirrhosis, HCC; Arthalgias

86
Q

Mech Nitroglycerine angina relief?

A

Dilation of capacitance (veins) vessels, decreased preload and heart size and oxygen demand by cardiomyocytes

87
Q

Pt w STEMI II, III ,AVF, holosystolic murmur at apex, crackles in lungs

A

Inferior MI w/ Papillary muscle displacement -> acute MR -> increased L atrial P -> pulmonary edema

88
Q

Pt w/ hypotension, brady, kussmaul sign, JVD, clear lungs, STEMI II,III,aVF, ST depression I,aVL

A

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)

89
Q

Amiodarone SE

A

Hepatitis (ALT,AST), hypothyroidism, fatigue, memory loss, blue skin, chronic interstitial pneumonitis, heart block, risk of torsades

90
Q

Pressure drops more than 10mmHg with inspiration

A

Pulsus Paradoxus: sx in Cardiac Tamponade, severe COPD or Asthma,

91
Q

PCWP: Pulmonary Capillary Wedge Pressure

A

Measure of L Atrial pressure (L Ventricular end dyastolic P / preload), normal range 6-12

92
Q

Amlodipine SE (Dihydropyridine Ca channel blocker)

A

Peripheral Edema

93
Q

Pt p/w headache, blurred vision, 220/130, proteinuria, Cr 4, hx scleroderma.. Dx? Blood abn?

A

Scleroderma Renal crises, with microangiopathic hemolytic anemia w/ schistocytes and thrombocytopenia

94
Q

Thiazide SE

A

Hyperglycemia, increased LDL and triglycerides, Hypokalemia, hyponatremia, hypercalcemia

95
Q

Pt p/w 2 wks fevers, SOB, weakness, dark urine, painful swollen distal and proximal interphalangeal joints

A

Infective Endocarditis w/ Osler’s joints

96
Q

Osler’s Joints

A

painful violaceous joints fingers and toes w/ infective endocarditis

97
Q

Janeway Lesions

A

macular, erythematous, non painful lesions in palms and soles w/ IE

98
Q

Roth spots

A

edematous hemorrhagic lesions in the retina w/ IE

99
Q

Beta Blocker O/D sx and Rx?

A

Hypotension, bradycardia, wheezing, cardiogenic shock, delirum, seizures, hypoglycemia; Rx IV Atropine (1st line), IV glucagon (refractory)

100
Q

Pt/ p/w sharp positional chest pain, friction rub, BUN>60, Cr 5.1; dx? Rx?

A

Uremic pericarditis, 1st line hemodialysis

101
Q

Pt w/ chronic afib p/w nausea, vomiting, weakness, diarrhea, vision changes, decreased appetite, confusion; dx?

A

Digoxin toxicity, renally cleared (recent AKI, diuretic use), monitor levels, may give anti-dig fab ab

102
Q

Brain Natriuretic Peptide BNP: uses? Fnc?

A

Increased in CHF via stretch of ventricles (p/w S3) for diff SOB (v. pulm); diuresis, hypotension, antagonizes ReninAngiotensin, increased venous capacitence, decreased preload

103
Q

Abd pain, pulsatile abdominal mass, hypotension

A

Ruptured AAA

104
Q

S3 (ventricular gallop) in early diastole (after S2) during rapid ventricular filling phase, turbulent blood flow from increase volume

A

a/w increased filling Pr (mitral regurgitation, CHF, restrictive cardiomyopathy) and dilated ventricles (normal in children, pregnancy)

105
Q

S4 (atrial kick) “TEN-es-see in late diastole (immediately before S1) after atrial contraction with blood forced into stiff ventricle

A

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

106
Q

Osler-Weber-Rendu syndrome; hereditary hemorrhagic telangiectasia

A

AD fibrovascular dysplasia w/ vascular lesions (telangiectasias, arteriovenous malformations, and aneurysms) throughout the body (lungs, brain, GI)

107
Q

Syncope Post URI, distant HS, low BP, distended neck veins, clear lungs, pleural effusion on CXR, EKG?

A

Electrical alterans, effusions (tamponade) post viral percarditis

108
Q

Chest pain 2 wks post MI, positional, EKG- diffuse ST elevations, ST depression in aVR; dx,rx?

A

Dressler’s sx pericarditis (days-months post MI autoimmune); NSAIDs

109
Q

Persistent ST elevations (5days-3months) post MI w/ deep Q waves in STE leads, mitral regurge; dx/confirmation/complications?

A

Ventricular aneurysm, echo: hypokinetic LV wall motion; complications CHF, mural thrombi, ventricular arrhythmias

110
Q

CHADS2 (0-ASA, 1-AC or ASA, 2+ AC) anti-coagulation in A-Fib

A

CHF, HTN, Age>74 x2, DM, Stroke (TIA) x2

111
Q

Paradoxical Split S2 (A2 follows P2) best heard with expiration

A

Delayed myocardial relaxation, delayed closure of aortic valve; myocardial ischemia/infarct; L Ventricle outflow obstruction (aortic stenosis, LBBB)

112
Q

Wide fixed split S2

A

Atrial Septal Defect

113
Q

IV drug user p/w fever, tachycardia,multiple round nodules on cxr; dx?

A

Infective Endocarditis (S.Aureus) w/ likely Tricuspid regurg (holosystolic murmur increases with inspiration) and septic pulmonary emboli

114
Q

Widened pulse pressure, systolic ejection murmur, brisk carotid upstroke, tachycardia, flushed leg, previous leg trauma, left ventricular deviation, dx?

A

High out put heart failure from AVF, with LV hypertrophy, increased CO via HR and SV

115
Q

Cor pulmonale impaired R Ventricle function from pulmonary HTN (COPD, interstitial, thrombo-embolic, OSA); features?

A

Exersional dyspnea, P. Edema, JVD, S3, Hepatomegaly pulsatile liver, tricuspid regurge/murmur, pulm systolic P >25

116
Q

Systolic murmurs?

A

AS (crescendo-decrescendo), MR/TR (holo, highpitched blowing), VSD (holo harsh), MVP(late systolic w/ click)

117
Q

Diastolic murmurs?

A

MS (opening snap, delayed rumbling), AR (blowing-decrescendo)

118
Q

Heart murmur effect w/ handgrip?

A

Increased SVR (afterload), SBP, regurgitant factor; Louder MR, AR, VSD, louder MP w later click, decreased AS, HCOM

119
Q

Heart murmur effect w/ squatting?

A

Increased afterload, venous return, regurgitant factor; Louder AS, AR, VSD; softer HCOM, MVP w later click

120
Q

Heart murmur effect w/ valsalva or standing?

A

Decreased venous return, louder HCOM, MVP (earlier onset of click); softer all others

121
Q

Heart murmur effect w/ inspiration?

A

Louder Rt heart murmurs

122
Q

Narrow complex tachy, irregular, no P waves >48 hr, stable pt, dx/rx?

A

Afib w rapid ventricular response; rx rate control w/ Diltiazem (CCB) or Metoprolol (BB), then anticoagulation (warfarin)

123
Q

Mechanism of Digitalis in systolic heart failure w/ rapid ventricular rhythm (aFib/aFlutter)?

A

Positive inotropic and negative dromotropic (slow AV conduction)

124
Q

Sudden pain radiating to back with decrescendo diastolic murmur; next step/ dx?

A

TEE to confirm aortic disection, p/w aortic regurge murmur, 20+bp dif R vs. L arm,

125
Q

Vtach (w/ AV dissociation, fusion/capture beats) rx?

A

Amiodarone if stable, Synchronized cardioversion if unstable

126
Q

EKG tall R in aVL, deep S in V3, repolarization changes in ant leads I, aVL, V4,5,6

A

Hypertrophic cardiomyopathy w/ LVH

127
Q

Most common electrical origin of aFib?

A

Pulmonary Veins

128
Q

Pt p/w peripheral edema, ascites, pericardial knock (mid-diastolic sound), JVD, Kussmaul’s sign (JVD doesn’t decrease w inspiration), pericardial calcification; dx?

A

constrictive pericarditis leading to right heart failure

129
Q

Sinus tachycardia with electrical alterans (variation in QRS amplitude); dx/rx?

A

Percadial effusion (percarditis); rx pericardiocentesis

130
Q

Paroxysmal supraventricular tachycardia mech and cold water immersion, (also adenosine)?

A

PSVT via re-entrant pathways through AV node; cold water increases vagal tone on AV node slowing re-entrant conduction

131
Q

Syncope post MI; dx/mechanism?

A

Ventricular arrhythmias (vent. PMCs, Vtach, Vfib); re-entrant arrhythmias, via heterogeneity of conduction (immediate) or abnormal automaticity (delayed, 10-60min post MI)

132
Q

ST elevation leads 2,3,aVF?

A

Inferior wall MI, RCA or LCX

133
Q

ST elevation some or all leads V1-V6

A

Anterior wall MI, LDA

134
Q

ST depression V1-V3, or ST elevation V1&aVL (LCX) or ST depression in V1&aVL (RCA)?

A

Posterior wall MI, LCX or RCA

135
Q

ST elevation I, aVL, V5&V6, or ST depression 2, 3, aVF?

A

Lateral wall MI, LCX or diagonal

136
Q

ST elevation V4-V6?

A

R Ventricle MI (in half of inferior wall MI) RCA

137
Q

Reversible causes of pulseless electrical activity PEA/ asystole? 5H/5Ts

A

Hypovolemia, Hypoxemia, Hypothermia, Hypo/Hyperkalemia, Hydrogen ions (acidosis), Tension pneumothorax, Tamponade (cardiac), Thrombosis (coronary/pulm), Trauma, Toxins (benzo’s, narcotics)

138
Q

Swan-Ganz catheder ranges of heart pressures?

A

PCWP/LA (6-12); RA/CVP (0-8); PA (15-25/8-15); RV (15-25/0-8); LV (90-140/4-12)

139
Q

T-wave inversion?

A

MI, Myocarditis, previous pericarditis, myocardial contusion, digoxin toxicity

140
Q

Post cardio cath procedure, pt p/w livido reticularis, blue toe, GI pain, Hollenhorst plaques in eyes, elevated Cr, Eosinophilia, Eosinophiluria, hypocomplementemia; dx?

A

Cholesterol crystal/ Atherosclerotic embolism

2step (16 decks)

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