Cardiology Flashcards by Ande Taylor

Best next step: Chest pain

EKG

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**EKG: STEMI

ST elevation: Acute transmural MI

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**EKG: LBBB

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

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Next best step: STEMI or LBBB

Cath Lab

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Thrombolytics contraindicated when…

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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Symptom complex for R Ventricular infarction

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

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Treatment for right ventricular infarction

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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Best next step: Chest pain, EKG normal

Cardiac enzymes series (3 sets, Q8)

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

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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Treatment NSTEMI

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

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Best test: NSTEMI

Coronary angiography: tells us if intervention is needed

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Interventions for NSTEMI

Stents (PCI) or CABAGE

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When do you do CABAGE instead of a PCI?

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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Post-PCI meds

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

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Chest pain, normal EKG, normal cardiac enzymes

Unstable angina

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Best next step: Unstable angina

Exercise EKG, exercise stress test

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Meds to discontinue before and exercise stress test

Beta Blockers and Calcium channel blockers

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Contraindications for exercise stress test

Old LBBB, wide QRS complex or if on digoxin

Perform ECHO instead

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Best nest step: Patient cannot physically perform exercise stress test

Chemical stress test. Patient is given dobutamine or adenosine

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What is a positive stress test?

Chest pain, ST depression or if BP drops

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Best next step: Positive stress test

Cath lab

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MCC of death in patient with previous MI?

Arrhythmia

V-fib is the worst

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

Indicative of regurgitation from rupture papillary muscle

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Murmur + acute hypotension + really sick post MI

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

Ventricular wall aneurysm

Cannon A waves

Large amplitude waves seen in the jugular veins

What causes canna A waves

Atrial ventricular dissociation | 3rd degree heart block if AV node is ischemic

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

Dressler syndrome | *thought to be autoimmune pericarditis

Best treatment for Dressler syndrome

ASA or NSAIDs

Diffuse ST elevation

Pericarditis

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

Pericarditis

Best next step for pericarditis

NSAIDs

Chest pain reproducible with palpation

Costochondritis

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

Myocarditis

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

Prinzmetal angina | Characteristically worse in the morning

Best definitive test: Prinzmetal angina

Coronary angiography with IV ergonovine or acetylcholine (provokes vasoconstriction)

Treatment: Prinzmetal angina

Nitrates and CCB

3 different P wave morphologies in a row

Multi Atrial Tachycardia | *bad pneumonia or respiratory disease

Treatment: Multi Atrial Tachycardia

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

EKG: Tachycardia with wide/bizarre QRS

V-tachycardia

Treament: Hemodynamically stable V-tach

IV amiodarone, IV procainamide or IV sotalol

Treament: Hemodynamically UNstable V-tach

Cardioversion followed with IV amiodarone to maintain sinus rhythm

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

Wolf Parkison White | Delta wave represents early ventricular activation through bundle of his

Treatment: WPW

Procainamide

Contraindicated meds in WPW

Anything that slows AV conduction: | betablockers, digoxin, CCB

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

Atrial Flutter

Treatment: Atrial flutter

Cardioversion (same as A-fib)

Low K+ and low Mg with abnormal ECG

Tosades de Point | Also seen with TCA overdose

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

Supraventricular tachycardia

First step management: SVT

Carotid massage

Second step management: SVT

Carotid massge does not help then adenosine

Peaked T wave on EKG

Hyperkalemia

Patient type with peaked T wave on EKG | QRS wide, QT interval short and PR interval is long

Renal patient who missed dialysis Crush injury Burn victim

Best treatment A-fib

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

Systolic murmur, louder when squat and softer on valsalva

Aortic stenosis

Systolic murmur, louder with valsalva, softer with squatting

HOCM | Valsalva decreases preload

Late systolic murmur, louder with valsalva, softer with squatting

MVP

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

Mitral regurgitation

Rumbling diastolic murmur with opening snap

Mitral stenosis

MS ECHO and predisposed to...

Left atrial enlargement on ECHO and predisposed to A fib

Blowing diastolic murmur with widened pulse pressure

Aortic regurgitation

Best first step for suspected PE

Heparin

Best first step for suspected pneumonia

CXR

Best first step for CHF with murmur

Get ECHO to compare to previous ECHO

Best first step for acute pulmonary edema

nitrates/lasix and morphine

Looks like CHF in a young person suspect

Myocarditis

Differentiate Pulmonary hypertension and CHF

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

Diastolic decrescendo murmur best heard at left sternal border with...

Aortic Regurgitation | Will have widened pulse pressure

Complications of Aortic Regurgitation

Can progress to left heart failure

Pulm auscultation findings: Normal Lung | Breath sounds, Percussion, Tactile fremitus

BS: bronchovesicular/vesicular Per: Resonance TacFrem: Normal

Pulm auscultation findings: Atelectasis/Pleural effusion | Breath sounds, Percussion, Tactile fremitus

BS: Decreased/Absent Per: Dullness TacFrem: Decreased

Pulm auscultation findings: Pneumothorax | Breath sounds, Percussion, Tactile fremitus

BS: Decreased/absent Per: Hyperresonance TacFrem: Decreased

Pulm auscultation findings: Consolidation | Breath sounds, Percussion, Tactile fremitus

BS: Increased Per: Dullness TacFrem: Increased