Cardiology Flashcards
typical chest pain comprises of ________, ______ and ________
substernal chest pain, worsened or provoked with exertion and relieved by rest or nitroglycerin
best initial test in a patient with typical chest pain is ___
EKG
How to read an ECG….. (mnemonics)
2RAP PQRSTU 2R - rate and rhythm Axis - II has more positive deflection than I and III P waves. PR interval, QRS complexes and ST segments ; T & U waves
EKG findings of STEMI
> 1mm ST elevation in 2 anatomically contig. leads OR >2mm in V2 +V3 OR new LBBB (wide, flat QRS)
Localizing infarct:
Anterior: (artery)(lead)
Anterior: (LAD) (V1-V4)
Localizing infarct:
Lateral: (artery)(lead)
Lateral: (circumflex) (1, aVL, v4-v6,)
Localizing infarct:
Inferior: (artery)(lead)
Inferior: (RCA) (II, III, aVF)
Localizing infarct:
R. Ventricular: (artery)(lead)
R. Ventricular: (RCA) (V4 on R. sided EKG is 100% specific
Transfer patient for PCI if ____________
“door to balloon time” is <90mins
fibrinolytic contraindications:
6
-Any hemorrhagic stroke history (ischemic stroke in last 3 mos.)
• Intracranial cancer
• Cerebrovascular malformation
• Active internal bleeding or bleeding diathesis
• Suspected aortic dissection
• Significant closed head trauma in last 3 mos.
if it isn’t a STEMI, what do you do next?
cardiac enzymes
how often should troponin be checked
q3hrs. x3
if troponin is elevated what are the differential diagnosis? (5)
NSTEMI, PE, CHF, myocarditis and renal failure
A patient with typical chest pain, elevated troponin, what is the next step in diagnosis
coronary angiography
if blockage is seen on coronary angiography what is the standard management?
PCI with stenting and dual antiplatelet (ASA+ Clopidogrel) therapy for 6-12 months
when do you do CABG instead of PCI with stenting
if: L main dz., 3 vessel dz. (or 2 vessel dz. + DM or + ↓ EF)
sudden death post MI. cause?
fatal arrhythmia….V.fib
new systolic murmur 2-7 days after MI. cause?
papillary muscle rupture
acute severe hypotension post MI. cause?
ventricular free wall rupture
new onset harsh holosystolic murmur, CHF, higher O2 at RV post MI. Cause?
ventricular septal rupture
Persistent ST elevation ~1 mo later + MR post MI. Cause?
Ventricular wall aneurysm
QRS’s don’t follow P-waves after MI. Cause?
AV-dissociation, 3rd degree block
weeks-months later MI, pleuritic chest pain, and low grade temp
Dressler’s syndrome (post-MI syndrome), (autoimmune pericarditis)
most common arrhythmia presenting palpitations, tachycardia, dizziness in a pt with HTN or CAD
A-Fib
management of new onset A-Fib
cardiovert
management for chronic Atrial Fibrillation
rate-control and use CHADS2 score to estimate embolic risk
Fixed PR interval
- first degree heart block
- second degree heart block Type (Mobitz) II
variable PR interval
- second degree heart block Type (Mobitz) I wenkebach
- Third degree heart block
Pulmonary embolism on ECG
S1Q3T3
SEM crescendo/decrescendo, louder w/ squatting, softer w/ valsalva +
pulsus parvus et tardus
Aortic stenosis
SEM, louder w/ valsalva, softer w/ squatting or handgrip
HOCM
Late systolic murmur + mobile click (earlier w/ valsalva and handgrip,
later w/ squatting)
mitral valve prolapse
Holosystolic murmur heard best at apex, can radiate to axilla
Mitral regurgitation
Loud holosystolic murmur w/ diastolic rumble in kids
VSD
Continuous machine like murmur
PDA
Rumbling diastolic murmur with an opening snap
mitral stenosis
Blowing diastolic murmur with widened pulse pressure
Aortic regurgitation
