Cardiology Flashcards
How do you differentiate Prinzmetal’s Angina from Acute MI?
Normal Troponin
EKG: ST elevation that cannot be distinguished from MI
Occurs at rest
Patient may or may not have underlying CAD
Tx: nitrates to treat vasospasm
EKG definition of STEMI
> 2mm elevation in V2 or V3
or
1mm elevation in any other two contiguous leads
Biphasic T waves / Anterior T wave inversions is indicative of what pathology
Wellens’ syndrome
significant LAD blockage
Did the thrombolytics help?
What is evidence of reperfussion after thrombolysis in MI
Chest pain resolves
ST segments return to baseline
Appearance of repurfusion dysrhythmias (PVCs, non-sustained VT)
Complications of anterior MI
Mobitz II
Complete heart block
Complications of Inferior MI
Bradycardia
1st degree AV blocks
Persistent ST Elevation for weeks following an MI - indicative of what complication
Left ventricular aneurysm
ST elevation in lead III > II
Right ventricular infarction
Use nitrates and morphine with caution and give IV fluids if necessary
Differentiate High output heart failure vs low output heart failure
High output heart failure is when cardiac output is higher than normal
ex: thyrotoxicosis, anemia, av fistula, pregnancy, paget’s disease of bone
Low-output is when cardiac output can’t meet the body’s demands
ed: HTN, CAD, valvular heart disease, ischemic cardiomyopathy, chronic alcoholism
acute decompensated heart failure
Most sensitive and specific findings
Most sensitive finding: dyspnea on exertion
Most specific finding: paroxysmal nocturnal dyspnea, S3 gallop
Murmur of Aortic Stenosis
Crescendo-decrescendo systolic murmur that radiates to the carotids
BP med of choice in aortic stenosis
Hydralazine
Avoid BB and CCB
Vasopressor of choice in aortic stenosis
phenylephrine - increases diastolic pressure, improving coronary perfusion
What are the concerns with intubating a patient with aortic stenosis?
Preload dependent
Optimize with IV fluids and have push dose vasopressor available
Most common cause of mitral stenosis
Rheumatic fever
However, mitral regurgitation is the most common early valvular manifestation
Pregnant woman with murmur and pulmonary edema
Dx?
Mitral stenosis
Murmur of mitral regurgitation
Loud holosystolic murmur that radiates to the axilla
All patients with suspected pericarditis should have what test
Ultrasound to rule out tamponade
ACC/AHA guideline recommendation
Drug of choice for pregnancy-induced hypertension
hydralazine: direct arterial vasodilator
Superficial thrombophlebitis: who gets anti coagulated?
American college of Chest physicians recommends anticoagulation for patients with lower extremity superficial thrombophlebitis at increased risk for thromboembolism:
# Affected venous segment >5cm # Proximity to deep venous system < 5 cm # Presence of risk factors for DVT formation
What is the primary indication for thrombolytics in the setting of DVT
Phlegmasia cerulea dolens
Cerulea, Clot, Cyanosis
WPW treatment
Orthodromic (narrow complex): vagal maneuvers, adenosine
Antidromic (wide complex): Amiodarone or Procainamide
** Avoid Adenosine, BB, CCB, and digoxin. They block the AV node = patient will go into V Tach**
What rate defines neonatal bradycardia
Pulse < 100/m
Give positive pressure ventilation
Ensure adequate oxygenation/ventilation
If pulses < 60/min, start compressions
Absolute contraindications to therapeutic hypothermia after cardiac arrest
Bleeding (non compressible bleeding or underlying coagulopathy)
Severe sepsis
pregnancy
What should be avoided in LVAD patients
Chest compressions
Patients will LVAD may not have a palpable pulse
