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STEP II > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Chest pain best test

A
  1. EKG

2. Cardiac Enz

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2
Q

Anterior STEMI (Leads and Location)

A

LAD

STE: V1 through V4

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3
Q

Lateral STEMI (Leads and Location)

A

Circumflex

STE: I, aVL, V4 through V6

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4
Q

Inferior STEMI (Leads and Location)

A

RCA

STE: II, III, aVF

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5
Q

ST Depression Implication

A

Subendocardial injury

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6
Q

STEMI Criteria

A

2mm elevation OR New LBBB (see V1 & V2)

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7
Q

Cardiac enz (Rise-Peak- Return to Normal)

A

Myoglobin: 2hr & 24 hrs -> reinfarction marker
CKMB: 6hr-24 hrs-72hr
Tropnin: 4hr-24 to 48hr-7 to 10dy

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8
Q

Acute STEMI Treatement

Which Inc. survival?

A
  1. B-blocker** (dec. HR and Contractility = Dec O2 demand; Dec. remodeling) -> carvedilol
  2. Asprin** (dec. reocclusion)
  3. ACE inhibtor** (dec. remodeling)
  4. O2
  5. Statin (Atorvastatin 80)
  6. Nitrate (sx relief)
  7. Heparin (prevent thrombus progression)
  8. Coronary angiography w/in 48 hrs!
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9
Q

Post-revascularization Pts MUST be on?

Time frames?

A

Duel anti-platelets! -> Aspirin and Clopidogrel
3mo for barre metal
12mo for drug-eluding

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10
Q

CABG indications

A
  1. > 70% occlusion
  2. 3 vessel Disease (2 vessel if DM)
  3. L main involved
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11
Q

Contraindications to stress test?

A
  1. Old LBBB
  2. Baseline St elevations
  3. Using Digoxin
    * * Do Exercise Echo**
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12
Q

Drugs for Pharm Stress?

A

Dobutamine

Adenosine

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13
Q

1 cause of Post-MI Death?

A

Arrhythmia -> V. fib

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14
Q

Post-MI new Murmur?

A

Papillary muscle Rupture

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15
Q 
MI complications at: 
hrs 
days 
weeks
 months
A

Hrs: Arrhythmia
Dys: Pericarditis
Wks: Ruptures (Free wall or sepal or papillary muscles) & Dressler
Mth: Aneurysm

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16
Q

Post-MI severe hypotension

A

Ventricular wall rupture

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17
Q

Post-MI persistent ST elevation and MR(-like)murmur?

A

Ventricular Wall aneurysm

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18
Q

Post-MI, pleuritic chest pain + low fever

Tx?

A

Dressler Syndrome

Tx; NSAIDs and ASA

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19
Q

Chest pain BETTER leaning forward…

Tx?

A

Pericarditis

Tx NSAIDs

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20
Q

Chest pain worse with palpation of chest wall

A

Costochondriasia (usually viral)

21
Q

Chest pain AFTER viral infection (URI)

A

Myocarditis (Coxsackie B)

22
Q

Chest pain worse at night + transient ST elevation?

Dx & Tx?

A

Prinzmetal Angina
Dx: ergonovine test (reproduce pain)
Tx: Diltazem or verpamil OR Nitrates
NO B-blockers!!

23
Q

Progressive PR prolongation and dropped beat

A

Second degree, Type 1 heart block

24
Q

AV dissociation w/ bounding jugular pulse

A

3rd Degree heart block

25
Varying PR interval + 3+ different P-wave morphologies
Multifocal Atrial Tachycardia
26
3+ Wide QRS with no Ps
Ventricular Tachycardia
27
V tach Treatments:
Stable: Amilodipine (Procainamide, Lidocaine, Sotolol) Unstable: Syncronized Cardioversion
28
Short PR + Wide QRS + "slurred initial deflection) | Path? and Tx?
WPW (delta waves) Bundle of Kent Tx: Procainamide NO b blocker or Dioxin or CCB (slows AV conduction = makes worse)
29
``` Saw tooth (A rate 250-350 and V rate 125-150) (Tx? ) ```
A flutter: Stable: B blocker or Digoxin Unstable: cardioversion
30
Torsade De Pointes Tx?
Mg sulfate
31
Causes of TdP?
1. Low Mg 2. Low K 3. Lithium toxicity 4. TCA Overdose
32
Peaked T
HyperK
33
Pulsus paradoxus + hypotension + faint heart sounds + electrical alternanas
Cardiac tamponade
34
Irregular R-R and no P waves
A fibrillation rate control > Rhythm control (AFIRM study) Tx: B blocker or Digoxin
35
Systolic LOUDER with squatting SOFTER with valsalva (Cause & Tx?)
Aortic (Calcification or Bicuspid) | Tx: replacement
36
Systolic LOUDER with valsalva SOFTER with squatting
Hypertrophic obstructive cardiomyopathy
37
Effect of Valsalva
Dec. Intrathoracic pressure -> Dec. venous return -> Dec. Preload -> Dec. CO
38
Effect of squatting (initially) and handgrip
Inc. vascular resistance -> Inc. Afterload
39
Click and Systolic murmur
Mitral Valve Prolapse
40
holosystolic murmur + radiation to axilla
MR
41
Diastolic murmur w/ opening snap
Mitral stenosis
42
"blowing" diastolic murmur w/ wide pulse pressure
Aortic regurgitation
43
Suspect PE...first step?
Heparin!! Then CT (Ct > VQ)
44
Wells Criteria for PE
``` Score >4 = CT & 100 = 1.5 Immobalized = 1.5 Hx or DVT/PE = 1.5 Hemoptysis = 1 Hx of malignancy = 1 ```
45
New murmur
Echo!
46
Acute pulmonary edema tx?
1. Nitrates 2. Lasix 3. Morhine
47
Young + SOB +No cardiomegaly or pneumonia
pHTN | r/o CHF with PCWP
48
Pumonary Capillary wedge Pressure measure
L atrial pressure
49
CHF Tx | improve morality?
1. ACE** (prevent remodeling by aldo) 2. B-blocker** (prevent remobeling by Epi / norepi) 3. Spironolactone** (ONLY in NYHA Class 3 and 4 ) -> Eplerinone wont cause gynocomastia 4. Furosemide (improve SOB, edema) 5. Digoxin (dec. re-hospitalization)

STEP II (13 decks)

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