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Internal Medicine Clerkship > Cardiology > Flashcards

Cardiology Flashcards

0
Q

What two changes on EKG make you suspicious for MI?

A
  1. 2mm ST elevation
  2. new LBBB (wide, flat QRS)
  • these indicate STEMI
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1
Q

pt comes in w/ chest pain.. best 1st test?

A

EKG

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2
Q

What EKG findings are seen on EKG following MI from 6 hrs to years

A

T wave inversion

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3
Q

What EKG changes persist indefinitely after MI

A

Q waves

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4
Q

What three leads show ST elevation in an inferior infarct? What vessel is involved?

A

I, II, aVF

RCA

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5
Q

What 4 leads are involved in an anterior infarct? Vessel

A

V1-V4

LAD - is MC place for infarction

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6
Q

What leads have changes in a lateral infarction? vessel?

A

I, aVL, V4-V6

Circumflex

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7
Q

What should be done after STEMI is dx’d?

A
  1. Cath lab

2. thrombolytics if no cath lab and no C/I

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8
Q

If no STEMI is found on EKG and chest pain is present, what test should be done?

A

Cardiac enzymes

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9
Q

How long after MI can thrombolytics be administered? Contraindications? (5)

A

less than 6 hours

active bleeding, anticoagulants, any hx of hemorrhagic stroke, recent ischemic stroke, recent closed head trauma

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10
Q

How many times, how often should cardiac enzymes be checked

A

3x q 8 hrs –> may not be elevated if early enough

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11
Q

Which cardiac enzme elevates 1st?

A

Myoglobin - peaks in 2 hrs, normal by 24 hrs

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12
Q

When does troponin I rise? peak? normalize?

A

rises in 3-5 hours

Peaks in 24-48 hours

normal by 7-10 days - poor measure of reinfarction therefore

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13
Q

When does CK-MB rise? peak? When does it normalize?

A

rises in 4-8 hrs, peak in 24 hrs, normal by 72 hours

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14
Q

If no STEMI but cardiac enzymes are peaked, what is dx?

A

Non-STEMI MI

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15
Q

What 4 drugs do you treat NSTEMI with?

A
  1. Morphine
  2. O2
  3. ASA/ clopidogrel
  4. Beta blocker
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16
Q

Once MI has been confirmed, NSTEMI or STEMI what test needs to be done next and why

A

Coronary angiography - determines next step in tx

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17
Q

what four things are indications for CABG?

A
  1. Left main vessel dz
  2. 3 vessel dz (or 2 vessel dz + DM)
  3. Pain despite maximal medical therapy
  4. Post-infarction angina

*emergent CABG not often done - done after failure of PCI, mechanical complications of acute MI, cardiogenic shock, or life-threatening ventricular arrthymias per step up

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18
Q

What is standard non pharm tx of MI

A

PCI w/ stenting.

*If meet certain criteria, get CABG

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19
Q

what 6 drugs should a pt w/ MI be discharges home with?

A
  1. ASA
  2. Clopidogrel (if stent placed, use for 9-12 mo)
  3. Beta blocker
  4. ACE-I
  5. Statin
  6. short acting nitrate

*ASA, BB, ACE-I, Statin all shown to reduce mortality

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20
Q

MCC of death post MI

A

arrhythmias - esp v-fib

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21
Q

New systolic murmur 5-7 days after MI

A

Papillary muscle rupture - leads to mitral regurg

  • eval w/ echo; decrease preload w/ nitroprusside
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22
Q

Acute severe hypotension occurring w/in 2 weeks after MI

A

Ventricular free wall rupture –> most commonly 1-4 days after

  • need pericardiocentesis, emergent surgical repair
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23
Q

Increase in O2 concentration in RV following MI

A

Ventricular (Interventricular) septum rupture

  • emergent surgery indicated
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24
Q

Persistent ST. Elevation and new systolic MR murmur 1 month after MI

A

Ventricular wall aneurysm (pseudoaneurysm)

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25
Q

Pleuritic chest pain, low grade temp 5-10 weeks after MI? Tx?

A

Dressler’s syndrome (automimmune pericarditis)

  • tx with NSAIDS
26
Q

Cannon a-waves generally indicate what?

A

AV-dissociation –> 3rd degree heart block or v-fib

  • is 2/2 AV node ischemia; tricuspid valve doesn’t open and close in right timing
  • cannon a-waves are bounding jugular venous pulses
27
Q

Cheat pain in young healthy person that occurs at rest, worse at night and transient ST elevation during episodes

A

Prinzmetal’s angina

  • commonly occurs in young females with migraines
28
Q

What is the test for prinzmetals angina?

A

Ergonovine test

29
Q

Tx for prinzmetals?

A

CCB’s or nitrates

30
Q

Varying PR interval with 3 or more morphologically distinct p waves in the same lead

A

Multifocal atrial tachycardia

  • may be called “wandering atrial pacemaker” if rate is not tachycardic
31
Q

3 or more consecutive beats with normal QRS (under 120 ms) and rate over 120 on EKG

A

V-tach

32
Q

What is treatment for v-tach if hemodynamically unstable? What if vitals are stable?

A

Unstable –> shock/ cardiovert

Stable vitals–> amiodarone or lidocaine

33
Q

Short PR interval followed by a wide QRS (over 120) and a slurred initial deflection of QRS

A

WPW

34
Q

Treatment for WPW? What three drugs are absolutely contraindicated ?

A

Tx: procainamide

DO NOT : beta blocker, CCBs, digoxin

35
Q

Regular rhythm w ventricular rate of 125-150 and atrial rate of 250-300

A

A-flutter

36
Q

Tx for hemodynamically stable a-flutter? Unstable?

A

Stable : beta blockers or digoxin

Unstable : cardioversion

37
Q

What two electrolyte abnormalities can cause Torsades?

A

Low Mg or low K

38
Q

What two medication OD can cause Torsades?

A

TCAs or Li

39
Q

Regular rhythm w/ 150-220 on EKG and sudden onset of palpation a or dizziness

A

Supraventricular tachycardia

40
Q

Medical treatment for supraventricular tach

A

Adenosine

41
Q

Non-medical treatment for supraventricular tachycardia?

A

Carotid massage

  • is first line tx. can also put face in cold water
42
Q

Other than peaked T waves, what changes are seen on EKG with hyperkalemia? (QRS, QT, PR)

A

Wide QRS, short QT, prolonged PR

43
Q

Alternate beat variation in direction, amplitude, and duration of the QRS complex on EKG

A

Cardiac tamponade –> called electrical alternans

44
Q

Irregular r-r interval, undulating baseline, no p-waves on EKG

A

A-fib

45
Q

What hormonal issue can cause a-fib

A

Hyperthyroid

CHF and valvular dz can also– anything that can cause atrial dilation

46
Q

Pt presents w SOB, @ what O2 sats do they get oxygen

A

Under 90

47
Q

SOB + CHF or new murmur, what test is next?

A

Echo

48
Q

What three drugs does someone with acute pulmonary edema need to get?

A
  1. Nitrates
  2. Lasix
  3. Morphine
49
Q

SOB in young patient with no cardiomegaly on CXR?

A

Primary pulmonary HTN

50
Q

How can primary pulmonary HTN be confirmed?

A

Right heart cath –> will have normal PCWP

51
Q

What is presentation of right ventricular infarct?

A

Hypotension, tachycardia w/ no left heart failure sx like pulmonary crackles, JVD; also NO pulsus paradoxus

52
Q

What is tx for right ventricular infarction? What do you NOT give?

A

Vigorous fluid resuscitation

  • do NOT give nitrates (will decrease preload and worsen shock)
53
Q

If pt has chest pain, but EKG and cardiac enzymes are normal x3, what is dx?

A

Unstable angina

54
Q

What is best first test for cases of unstable angina?

What two drug classes need to be avoided?

A

Exercise EKG

*B blockers and CCBs

55
Q

What are the contraindications to doing EKG stress test? What should be done instead

A
  1. old LBBB
  2. baseline ST elevation
  3. pt on Digoxin
  • do exercise echo instead
56
Q

What test should be done if patient angina is so bad they can’t exercise?

A

Chemical stress test with dobutamine or adenosine

57
Q

What is done if any of the exercise tests are positive (chest pain reproduced, ST depression, hypotension)

A

on to coronary angiography

58
Q

young pt comes in with new-symptoms of CHF (orthopnea, new murmur, SOB, etc) what should you think of

A

Myocarditis–> esp if recent hx of flu-like illness

59
Q

Systolic CHF is dx’d with EF of less than what?

A

less than 55%

60
Q

What are 5 causes of ischemic or dilated cardiomyopathy?

A

Viral, EtOH, cocaine, Chagas, idiopathic (plus ischemia of course)

*EtOH is reversible if you stop drinking

61
Q

What is diastolic HF?

A

Normal EF, but heart can’t fill

62
Q

What are three causes of diastolic HF? Which is reversible?

A

HTN, amyloidosis, hemachromatosis

*hemachromatosis is reversible with phlebotomy (is a restrictive cardiomyopathy)

Internal Medicine Clerkship (2 decks)

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