Cardio Angina and MI

Question 1

Cold water into ear and nystagmus away is lesion where?

Answer 1

No lesion. Normal

Question 2

Lesion if poor repetition?

If hemispatial neglect

Answer 2

Arcuate fasciculus

Nondom parietal lobe

Question 3

Tx of stable angina has 3 classes.

Answer 3

Calcium blockers, beta blockers, nitrates

Beta blockers improve survival. Calcum blockers improve vasodilation (BE CAREFUL OF HEART BLOCK)

Nitrates decrease preload, so less O2 demand on heart

Question 4

Calcium blocker used for prinzmetal is what?

Answer 4

diltiazam. Nitrates can be used

Avoid triptans, high dose aspirin (blocks vasodilation) and avoid nonselective B blockers

Question 5

Esophageal spasm can improve with what?

Answer 5

Nitrates, so don’t be fooled that spasm is actually angina

Question 6

Widened mediastinum on CXR is what?

Answer 6

Dissection. Pain would radiate to scapula

Question 7

Unstable angina is different than Non-Stemi?

Answer 7

unstable isnt enough of an affect to cause elevation of trops

NonStemi has trops but no ST elevation

Question 8

Unstable angina tx?

Answer 8

MONA:

Morphine, O2 (if hypoxic), Nitro, Aspirin

Beta blocker if no heart failure signs. Careful if asthma, COPD or diabetes

Statins

Antiplatelet to all CLOPIDOGREL for all. GPIIb/IIIa could be added like eptifibatide

Anticoagulant to all. Unfractionated heparin if percutatanous (use hep b/c can turn it off it its bad)

Potassium and magnesium

Question 9

Glycoprotein 2b/3a inhibt?

Answer 9

Tirofiban, epifibatide (lots of I’s for the IIb/IIIa inhibitors

Question 10

Heparin action?

Answer 10

Antithrombin

Question 11

Streptokinase in MI?

Answer 11

Used if no access to cath lab, otherwise you wait b/c don’t want to make them bleed

Question 12

CABG for what?

Answer 12

3 vessel disease
50% stenosis in left main
Or CAD with DM

Question 13

Unstable angina home tx?

Answer 13

Beta blocker
Aspirin
Nitro
Statin
Clopidogrel
ACEi or ARB
ALDOSTERONE ANTAGONIST

Question 14

Unstable angina treated like MI early on

Answer 14

Oh ok

Question 15

Chest pain with new left bundle branch block?

Answer 15

STEMI!

Question 16

ECG changes with MI?

Answer 16

Get tomb stoning, then flipping of T wave with Q wave. Then eventually just a q wave

Question 17

MI workup:

Answer 17

First ECG, if normal, cardiac enzymes

Serial Cardiac enzymes for 6 hours

Question 18

Leads with anterior MI?

Answer 18

V2-V5 (LAD)

Question 19

Septal MI?

Answer 19

LAD is V1-V4

Question 20

Inferior MI?

Answer 20

Posterior descending arter. II, III and aVF

Question 21

Lateral infarct?

Answer 21

I, aVL, V5, V6

LAD or circumflex more likely

Question 22

Who gets beta blocker in MI?

Answer 22

If not heart failure or severe asthma. USE METROPROLOL

Question 23

MI tx?

Answer 23

ABCS
MONA
B blocker if indicated
STATINS
Clopidogrel
Anticoag to all patients (Heparin if PCI bc shorter acting and reversible, enoxaparin if no PCI)
Potassium and magnesium

If STemI: need PCI (cath). If cath unavailable do fibrinolysis within 12 hours

Nonstemis? NO FIBRINOLYTICS!!!! still do PCI

Question 24

Long term management of mi?

Answer 24

ASA or clopidogrel
beta blocker
ACE or ARB
Aldosterone antagonist (spironolactone)
Statin
Lifestyle

Question 25

Complications post MI

Answer 25

First day or two is Vfib
Left ventricular failure/pulm edema
Cardiogenic shock
Ventricular free wall rupture about a week wall (tamponade)
Rupture of papillary muscle
Fibrinous pericarditis 3-5 days after MI
Dressler syndrome

Question 26

Papillary rupture presentation?

Answer 26

about 5 days post MI new regurge!!

VSD can happen

Question 27

Dressler syndrome?

Answer 27

autoimmune pericarditis weeks after MI