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MEDI IM shelf > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Patient comes in with chest pain… best 1st test

A

ECG

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2
Q

STEMI on ECG

A

2mm ST elevation
OR
LBBB (wide, flat QRS)

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3
Q

Timing of ST elevation…

A

immediately

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4
Q

Timing of T wave inversion

A

6 hrs to years

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5
Q

Timing of Q waves

A

forever

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6
Q

Anterior leads and vessel

A

V1-V4

LAD

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7
Q

Lateral leads and vessel

A

I, avL, V4-V6

Circumflex

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8
Q

Inferior leads and vessel

A

II, III, avF

RCA

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9
Q

R ventricular leads and vessel

A

V4 on R-sided EKG is 100% specific

RCA

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10
Q

Emergency reperfusion is…

A

go to cath lab
OR
thrombolytics *if no contraindications

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11
Q

Right ventricular infarct

A

Sx: tachycardia, hypotension, clear lungs, JVD
NO pulsus paradoxus
DON”T GIVE NITRO

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12
Q

Treatment RV infarct

A

DON”T GIVE NITRO

Vigorous fluid resuscitation

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13
Q

Chest pain…2nd best test

A

cardiac enzymes

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14
Q

How often check cardiac enzymes?

A

Q8H x3

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15
Q

Troponin I rise and peak and nL

A

Rise 3-5 h
Peaks 24-48 h
nL in 7-10 d

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16
Q

CKMB rise and peak and nL

A

Rise 4-8 h
Peaks 24 h
nL in 72 h

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17
Q

Myoglobin rise and peak and nL

A

Rise 1st
Peaks 2 h
nL by 24 h

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18
Q

Chest pain with elevated troponin…tx

A

NSTEMI/STEMI
MONA B PHAST

  • morphine
  • oxygen
  • nitroglycerin (except in RV infarct)
  • ASA 325 mg CHEWED
  • Beta blocker
  • Plavix

Heart imaging
ACEi
Statin
T?

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19
Q

Need coronary angiography within… (NSTEMI)

A

48 h to determine need for intervention

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20
Q

Standard tx for NSTEMI

A

PCI with stenting

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21
Q

CABG if…

A 
L main dz
3 vessel dz 
2 vessel + T2DM
> 70% occulusion
pain despite max medical tx
post-infarct angina
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22
Q

NSTEMI discharge meds

A 
ASA
Plavix (x9-12 mo if stent placed/x1 mo if bare metal stent)
BB
ACEi (if CHF or LV dysfxn)
Statin
Short acting nitro
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23
Q

Diagnosis of unstable angina when…

A

No ST-elevation and nL troponins x3

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24
Q

Work up for unstable angina

A

STRESS TEST

  • Exercise ECG (avoid BB or CCB before)
  • Exercise ECHO if old LBBB or baseline ST ele or on digoxin
  • Chemical stress test w/ dobutamine or adenosine if pt can’t exercise

or MUGA
- nuclear med test shows perfusion of areas of heart, avoid caffeine or theophylline b4

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25
Q

When is stress test positive?

A
  • chest pain reproduced
  • ST depression
  • hypotension

–> cath lab x coronary angiogram

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26
Q

Post-MI complications: MC COD?

A

arrhythmias = ventricular fibrillation

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27
Q

New systolic murmur 5-7 d s/p MI?

A

papillary muscle rupture

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28
Q

Acute severe hypotension s/p MI

A

ventricular free wall rupture

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29
Q

“Step up” in O2 concentration from RA–>RV s/p MI

A

Ventricular septal rupture

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30
Q

Persistent ST elevetaion ~ 1 mo s/p MI + systolic MR murmur?

A

Ventricular wall aneurysm

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31
Q

“Cannon A-waves” s/p MI

A

AV-dissociation

Either V-fib or 3rd degree heart block

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32
Q

5-10 w s/p MI with pleuritic CP and low grade temp?

A

Dressler syndrome
(Autoimmune pericarditis)

Tx w/ NSAIDs and ASA

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33
Q

A young healthy patient comes in with chest pain… Ddx

A

pericardidtis
costrochondriasis/MSK
myocarditis
Prinzmetal angina

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34
Q

A young healthy patient comes in with chest pain…and worse with inspiration/pleuritic, better when learning forward, friction rub, deiffuse ST elevation

A

pericarditis

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35
Q

A young healthy patient comes in with chest pain…and worse with palpation of chest wall

A

Costochondriasis or MSK-opathy

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36
Q

A young healthy patient comes in with chest pain…and vague cp and hx of viral infection and murrmur

A

myocarditis

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37
Q

A young healthy patient comes in with chest pain…that occurs at rest, worse at night, few CAD RFs, migraine HA, with transient ST elevation during episodes

A

Prinzmetal angina (CA vasospasm)

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38
Q

Dx and tx Prinzmetal angina

A

Dx: ergonovine stimulation test

Tx: CCB or nitrates

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39
Q

Progressive prolongation of PR interval followed by dropped beat

A

*** type heart block

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40
Q

Cannon-a waves on physical exam

“Regular P-P interval and regular R-R interval

A

*** type heart block

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41
Q

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

A

*** type heart block

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42
Q

*** type heart block (df p waves in same lead) management

A

Screen in an old person with chronic lung dz (COPD) in pending respiratory failure

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43
Q

Three or more consecutive beats with QRS <120 ms at a rate of > 120 bpm

A
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44
Q

Short PR interval followed by QRS > 120 ms with a slurred initial deflection representing early ventricular activation via the bundle of Kent

A

WPW

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45
Q

Regluar rhythm with a ventricular rate of 125-150 bpm and atrial rate of 250-300 bpm

A

atrial flutter

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46
Q

prologned QT interval leading to undulating rotation of the QRS complex around the EKG baseline in a patient with low MG and low K

A

Torsades de pointe

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47
Q

Torsades when…

A

hypomagnesemia
hypokalemia
Li OD
TCA OD

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48
Q

regular rhythm w/ a rate between 150-220 bpm and sudden onset of palpitations and dizziness

A
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49
Q

Renal failure patient/crush injury/burn victim with ‘eaked t-waves, widened QRS, short QT, and prologed PR

A
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50
Q

Alternate beat variation in direction, amplitude, and duration of the QRS complex in a patient with pulsus paradoxus, hypotesnion, distant heart sounds, JVD

A
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51
Q

Undulating baseline, no p waves, irregular RR interval in hyperthyroid pt, old pt with SOB/dizzi/palp with CHF or valve dz

A

atrial fibrillation

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52
Q

SEM crescendo/decrescendo, loud with squatting, softer with valsalva, + palsus parvus et tardus

A

ASS

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53
Q

SEM louder with valsalva, soften with squatting or handgrip

A

HOCM

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54
Q

Late systolic murmur with click louder with valsalva and handgrip, soften with squatting

A

MVP

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55
Q

Holosystolic murmur radiates to axilla with LAE

A

MRS

56
Q

Holosystolic murmur with late diastolic rumble in kids

A

VSD

57
Q

Continuous machine-like murmur

A

PDA

58
Q

Wide fixed and split S2

A

ASD

59
Q

Rumbling diastolic murmur with an opening snap, LAE, and afib

A

MSD

60
Q

Blowing diastolic murmur with widened pulse pressure and eponym parade

A

ARD

61
Q

Patient comes in with dyspnea… heart or lungs???

A

Don’t miss PE
PNA
CHF
ACS

62
Q

Dyspnea…suspect PE when…

A 
hx of cancer
s/p surgery
butt sitting
pregnant
plane ride
63
Q

Tx PE

A

D-dimer
CT chest
HEPARIN

64
Q

When give O2

A

<90% oxygen saturation

65
Q

Signs/sx of pneumonia…get

A

CXR

66
Q

Dyspnea with murmur…get

A

ECHO to check EF

67
Q

Dyspnea with hx CHF…get

A

ECHO to check EF

68
Q

Tx acute pulmonary edema

A

LMN
Lasix
Morphine
Nitrates

69
Q

Dsypnea in young pt with sxs of CHF with prior viral infection

A

Think myocarditis (coxsackie B)

70
Q

Dyspnea in young pt with no cardiomegaly on CXR

A

Consider primary pulmonary HTN

Right heart cath can tell CHF from pulmonary HTN (check PAP pulmonary artery pressure, LA pressure)

71
Q

Systolic CHF

A

decreased EF (<55%)
heart can’t pump
ischemic, dilated

72
Q

Causes systolic CHF

A 
viral
EtOH
cocaine
Chagas
idiopathic
73
Q

Alcoholic dilated cardiomyopathy prognosis and tx

A

REVERSIBLE

if stop the booze

74
Q

Diastolic CHF

A

normal EF

heart can’t fill

75
Q

Causes diastolic CHF

A

HTN
amyloidosis
hemachromatosis

76
Q

Hemachromatosis restrictive cardiomyopathy prognosis and tx

A

REVERSIBLE

with phlebotomy

77
Q

CHF tx

A 
ACEi
BB
Dig
Furosemide
Spironolactone
78
Q

Why ACEi in CHF

A

improves survival

prevents remodeling by aldosterone

79
Q

Why BB in CHF

A

improves survival

prevents remodeling by epi/norepi

80
Q

Why digoxin in CHF

A

decreases sxs
decreases hospitalizations
does NOT improve survival

81
Q

Why furosemide in CHF

A

decreases sxs (SOB, crackles, edema)

82
Q

Why spironolactone in CHF

A

improves survival in NYHA class III and IV

83
Q

normal P wave

A

120-200 ms

3-5 small boxes

84
Q

increased PR in:

A

first degree AV blcok
hyperthyroidism
CAD

85
Q

shortened PR in:

A

WPW
ectopic atrial rhythm
occasional junctional rhythm

86
Q

normal QRS

A

< 100 ms

87
Q

prolonged QRS length

A

> 120 ms

> 3 small boxes

88
Q

QRS complex represents…

A

ventricular depolarization
from inside out
from endocardium to epicardium

89
Q

MC causes of wide QRS

A

MC: conduction defects (bundle branch blocks)
LVH
hyperkalmeia
ventricular or paced rhythms

90
Q

“poor r wave progression” signifies…

A 
anterior/anteroseptal MI
LVH
fascicular blocks/partBBB
infiltrative or dilated cardiomyopathy
WPW
COPD
clockwise rotation of heart
91
Q

early R wave progression

A

should be smaller than S wave
and more S wave in V6 than R wave

posterior MI
RVH
RBBB
WPW

92
Q

large R waves in V1 and V2

A

RVH

93
Q

nL QT interval

A

= time in ventricular systole
shorter as HRH goes up

nL: 300-400 ms
slightly longer for females

94
Q

QTc corrects for… and equation

A

heart rate

QTC = QT + 0.00175 (HR - 60)

95
Q

prolonged QT caused by…

A 
hypoCA, hypo K, hypMg
type IA and type II AAD
TCAs
antipsychotics
macrolides
quinolone abx
methadone
c long QT dyndrome
96
Q

short QT caused by…

A 
(uncommon)
hyperCA, hyperK
acidosis
increased vagal tone
congenital channel assoc with sudden death*HOCM?
97
Q

ST elevation ddx

A 
acute injury/MI
pericarditis
ventricular aneurysm
prinzmental angina
myocarditis
Brugada's syndrome (STE with RBBB)
98
Q

ST depression ddx

A

MI
ventricular hypertophym BBB
paced or ventricular beats
digoxin

99
Q

digitalis intoxication

A

slow HR
nausea
ST depression

100
Q

inverted T waves…

A

ischemia

101
Q

T wave inversion nL in…

A

aVR, sometimes V1 and V2

102
Q

deeply inverted T waves thought to be cause by…

A

autonomic changes induced by increased ICP!

cerebral bleed

103
Q

Tall, hyperacute T waves ddx

A

hyperkalemia (K > 6)
early MI
CVA

usually localized to V2-5, not diffuse

104
Q

66 yo taking Lasix, ate too many prunes, and got diarrhea

A

U wave - hypokalemia

***may cause an artifactual increase in QT interval

105
Q

five small boxes = __ s

A

five small boxes = one big box = 0.2 s

count 5 big boxes = 1s
count 30 big boxes = 6s
multiple that amount in 30 box times 10 = rate

106
Q

Take __ into account when determining axis

A

age

as people age, axis tends to shift leftward

107
Q

RAD is axis > x

LAD is axis of x

A

RAD is > 105 *

LAD is -30 to -90

108
Q

causes of RAD

A

COPD
RVH
RBBB
dextrocardia

109
Q

causes LAD

A 
MC: LVH
LBBB
pregnancy, ascites, swing apex leftward/elevates diaphragm
inferior MI
advanced age
110
Q

conduction defects can be…

A

atrioventricular
AND
intraventricular

111
Q

sick sinus syndrome

A

AKA tachy-brady syndrome

long pauses/bradycardia with SVT/afib/aflutter

cardazem may cause

fix with rate control

112
Q

AV conduction defects are…

A

AV heart blocks

113
Q

fixed, prolonged PR interval

A

first degree AV block
prolonged PR > 0.2 s

no tx required

114
Q

PR interval lengthens weith each successive beat

A

type I second degree AV block (Wenckeback)

due to gradulally deteriorating conduction through AV until impulse is dropped

115
Q

causes and tx type I 2nd degree AV block

A

meds
degeneration of AV node
ischemia (especially inferior MI, RCA)

usually none, stop offending med, packemaker if high grade

116
Q

random drop of a QRS on ECG

A

type II 2nd degree AV block

may progress to 3rd degree AV block

117
Q

causes and tx type II 2nd degree AV block

A

ischemia, usually anterior MI, LAD

requires packmaker (bc may progress, unless low grade and HR is adequate)

118
Q

high grade AV block

A

PR interval dose lengthen before QRS is dropped

119
Q

p waves march out independently of QRS, regular P-P and regular R-R

A

3rd degree (complete) heart block

lack of conduction between atria and ventricles
may develop escape beats (junctional or ventricular)

120
Q

Escape rhythm… junctional vs. ventricular

if block is high in AV node:

if block is low in AV node:

A

junctional escape rhythm

ventricular escape rhythm

121
Q

junctional escape rhythm char.

A

narrow QRS
block high in AV node
rate 40-60

122
Q

ventricular escape rhythm char

A

wide QRS
block low in AV node
rate 20-40

123
Q

Intra-ventricular conduction defects include…

A

RBBB
LBBB
fascicular blocks (partial, not covered)

124
Q

BBB changes are..

A

when the R waves are separated because the ventricles depolarize separately

125
Q

RBBB characteristics

A

conduction across septum from left, axis shift to right

QRS > 120 ms in V5-V6
RSR’ in V1 “rabbit ears”
large R’ in V1
secondary ST&T changes in V1-V3

126
Q

RBBB causes and tx

A

occasionally normal
almost any right sided heart dz, pul HTN, PE
usually not ischemic

none

127
Q

LBBB characteristics

A

depolarization proceeds from right to left, axis shift to left

“tree stump” wide QRS in I and V5-V6
no Q in I, aVL, V5-6 (lose septal depolarization)
broad, deep QS in V1

128
Q

LBBB causes

A 
degenerative
HRN
acute MI
valvular anomalies
NOT in normal heart
129
Q

right atrial overload ECG features

A

tall, peaked, wide P waves in I + II* + V1*
> 2.5 mm tall
biphasic P wave in V1

130
Q

causes right atrial overload

A

pulmonary HTN
RV infarct
right sided valvular abnL
left sided valvular abnL

131
Q

left atrial overload ECG features

A

wide, notched P wave in I + II* + V1*
> 3 small boxes
NOT tall and pointy
biphase P wave in V1 that is 1 mm deep and 0.04 s in duraction

132
Q

causes left atrial overload

A 
mitral valve dz
LVH
HTN
aortic valve dz
cardiomyopathy
133
Q

RVH ECG features

A

RAD
classic changes when hypertrophy is advanced
ECG is less sensitive for RVH
reversal of normal precordial:

tall R wave in V1-V2
deep S in I + aVL + V5-V6

134
Q

RVH criteria

A

R > S in V1

R in V1 at least 7 mm

R in V1 + S in V6 at least 11mm

135
Q

LVH criteria (voltage plus…)

A

R in V5/V6 at least 30 mm
S in V1/V2 at least 30 mm

S in V1/V2 + R in V5/V6 > 35 mm

R in aVL > 11 mm

PLUS
- strain pattern in lateral leads
- LAO
OR 
- LAD
136
Q

most specific sign of LVH on ECG

A

R in aVL > 11 mm

137
Q

positive lead I
positive lead II
negative aVF
axis?

A

-15 degrees

MEDI IM shelf (6 decks)

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