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IM Emma Holiday > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Best next step: Chest pain

A

EKG

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2
Q

**EKG: STEMI

A

ST elevation: Acute transmural MI

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3
Q

**EKG: LBBB

A

widened QRS complex & loss of Q waves with broad notched R waves in leads 1, V5 and V6

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4
Q

Next best step: STEMI or LBBB

A

Cath Lab

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5
Q

Thrombolytics contraindicated when…

A

Pt is bleeding, if pt has had a hemorrhagic stroke in the past or recent ischemic stroke or recently closed head trauma

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6
Q

Symptom complex for R Ventricular infarction

A

hypotension, tachycardia, JVD, lungs clear to auscaltation, does not have pulses parodoxus

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7
Q

Treatment for right ventricular infarction

A

Fluids.

**Don’t give nitro because they are having decreased preload and this will make that worse bc it’s a vasodilator.

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8
Q

Best next step: Chest pain, EKG normal

A

Cardiac enzymes series (3 sets, Q8)

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9
Q

Most sensitive marker for patient with recent past MI in hospital for chest pain and normal EKG

A

Myoglobin, because CK-MB and troponin can still be elevated from first heart attack where as myoglobin is the first to peak

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10
Q

Treatment NSTEMI

A

Morphine, oxygen, nitrates, aspirin, clopidogrel and a beta-blocker

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11
Q

Best test: NSTEMI

A

Coronary angiography: tells us if intervention is needed

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12
Q

Interventions for NSTEMI

A

Stents (PCI) or CABAGE

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13
Q

When do you do CABAGE instead of a PCI?

A

50%+ narrowing of Left main coronary artery or 3 vessel disease (or 2 vessel disease in a diabetic) or greater than 70% occlusion

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14
Q

Post-PCI meds

A

Aspirin, clopidogrel, nitrates (for chest pain), beta blocker, ace inhibitor and statin

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15
Q

Chest pain, normal EKG, normal cardiac enzymes

A

Unstable angina

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16
Q

Best next step: Unstable angina

A

Exercise EKG, exercise stress test

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17
Q

Meds to discontinue before and exercise stress test

A

Beta Blockers and Calcium channel blockers

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18
Q

Contraindications for exercise stress test

A

Old LBBB, wide QRS complex or if on digoxin

Perform ECHO instead

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19
Q

Best nest step: Patient cannot physically perform exercise stress test

A

Chemical stress test. Patient is given dobutamine or adenosine

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20
Q

What is a positive stress test?

A

Chest pain, ST depression or if BP drops

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21
Q

Best next step: Positive stress test

A

Cath lab

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22
Q

MCC of death in patient with previous MI?

A

Arrhythmia

V-fib is the worst

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23
Q

Post MI with new systolic murmur (5-7 days post MI)

A

Indicative of regurgitation from rupture papillary muscle

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24
Q

Murmur + acute hypotension + really sick post MI

A

Ruptured ventricular free wall

Also may see O2 concentration higher in right atrium then right ventricle due to rupture of wall

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25
Q

Post MI: persistent ST elevation ~1 month later with systolic mitral regurgitation murmur

A

Ventricular wall aneurysm

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26
Q

Cannon A waves

A

Large amplitude waves seen in the jugular veins

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27
Q

What causes canna A waves

A

Atrial ventricular dissociation

3rd degree heart block if AV node is ischemic

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28
Q

Pleuritic chest pain w/low grade temperature 5-10 weeks post MI

A

Dressler syndrome

*thought to be autoimmune pericarditis

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29
Q

Best treatment for Dressler syndrome

A

ASA or NSAIDs

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30
Q

Diffuse ST elevation

A

Pericarditis

31
Q

Chest pain worse with inspiration (pleuritic) and better when leaning forward

A

Pericarditis

32
Q

Best next step for pericarditis

A

NSAIDs

33
Q

Chest pain reproducible with palpation

A

Costochondritis

34
Q

Vague chest pain, new murmur, sick a few weeks back (viral)

A

Myocarditis

35
Q

Chest pain occurs at rest and is worse at night in woman with migraines

A

Prinzmetal angina

Characteristically worse in the morning

36
Q

Best definitive test: Prinzmetal angina

A

Coronary angiography with IV ergonovine or acetylcholine (provokes vasoconstriction)

37
Q

Treatment: Prinzmetal angina

A

Nitrates and CCB

38
Q

3 different P wave morphologies in a row

A

Multi Atrial Tachycardia

*bad pneumonia or respiratory disease

39
Q

Treatment: Multi Atrial Tachycardia

A

treat underlying disease, focus on improving oxygenation, if L ventricular function is preserved can use CCB, Beta blockers, digoxin, amiodarone, IV flecainide and IV propafenone

40
Q

EKG: Tachycardia with wide/bizarre QRS

A

V-tachycardia

41
Q

Treament: Hemodynamically stable V-tach

A

IV amiodarone, IV procainamide or IV sotalol

42
Q

Treament: Hemodynamically UNstable V-tach

A

Cardioversion followed with IV amiodarone to maintain sinus rhythm

43
Q

Short PR interval followed by QRS greater than 120s (wide) with slurred initial deflection

A

Wolf Parkison White

Delta wave represents early ventricular activation through bundle of his

44
Q

Treatment: WPW

A

Procainamide

45
Q

Contraindicated meds in WPW

A

Anything that slows AV conduction:

betablockers, digoxin, CCB

46
Q

2-3 saw tooth P waves followed by QRS, tachy

A

Atrial Flutter

47
Q

Treatment: Atrial flutter

A

Cardioversion (same as A-fib)

48
Q

Low K+ and low Mg with abnormal ECG

A

Tosades de Point

Also seen with TCA overdose

49
Q

27/28 y.o. pt with sudden terrible palpitations that go away suddenly

A

Supraventricular tachycardia

50
Q

First step management: SVT

A

Carotid massage

51
Q

Second step management: SVT

A

Carotid massge does not help then adenosine

52
Q

Peaked T wave on EKG

A

Hyperkalemia

53
Q

Patient type with peaked T wave on EKG

QRS wide, QT interval short and PR interval is long

A

Renal patient who missed dialysis
Crush injury
Burn victim

54
Q

Best treatment A-fib

A

Rate control: Beta blocker preferred but can use CCB and Cardioversion for unstable

55
Q

Systolic murmur, louder when squat and softer on valsalva

A

Aortic stenosis

56
Q

Systolic murmur, louder with valsalva, softer with squatting

A

HOCM

Valsalva decreases preload

57
Q

Late systolic murmur, louder with valsalva, softer with squatting

A

MVP

58
Q

Sytolic murmur, radiate to axilla, holosystolic (not pediatrics)

A

Mitral regurgitation

59
Q

Rumbling diastolic murmur with opening snap

A

Mitral stenosis

60
Q

MS ECHO and predisposed to…

A

Left atrial enlargement on ECHO and predisposed to A fib

61
Q

Blowing diastolic murmur with widened pulse pressure

A

Aortic regurgitation

62
Q

Best first step for suspected PE

A

Heparin

63
Q

Best first step for suspected pneumonia

A

CXR

64
Q

Best first step for CHF with murmur

A

Get ECHO to compare to previous ECHO

65
Q

Best first step for acute pulmonary edema

A

nitrates/lasix and morphine

66
Q

Looks like CHF in a young person suspect

A

Myocarditis

67
Q

Differentiate Pulmonary hypertension and CHF

A

PCWP is normal in Puml HTN
and high in CHF
*get right heart cath to check the PCWP

68
Q

Diastolic decrescendo murmur best heard at left sternal border with…

A

Aortic Regurgitation

Will have widened pulse pressure

69
Q

Complications of Aortic Regurgitation

A

Can progress to left heart failure

70
Q

Pulm auscultation findings: Normal Lung

Breath sounds, Percussion, Tactile fremitus

A

BS: bronchovesicular/vesicular
Per: Resonance
TacFrem: Normal

71
Q

Pulm auscultation findings: Atelectasis/Pleural effusion

Breath sounds, Percussion, Tactile fremitus

A

BS: Decreased/Absent
Per: Dullness
TacFrem: Decreased

72
Q

Pulm auscultation findings: Pneumothorax

Breath sounds, Percussion, Tactile fremitus

A

BS: Decreased/absent
Per: Hyperresonance
TacFrem: Decreased

73
Q

Pulm auscultation findings: Consolidation

Breath sounds, Percussion, Tactile fremitus

A

BS: Increased
Per: Dullness
TacFrem: Increased

IM Emma Holiday (2 decks)

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