Cardiology

Question 1

How do you differentiate Prinzmetal’s Angina from Acute MI?

Answer 1

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

Question 2

EKG definition of STEMI

Answer 2

> 2mm elevation in V2 or V3
or
1mm elevation in any other two contiguous leads

Question 3

Biphasic T waves / Anterior T wave inversions is indicative of what pathology

Answer 3

Wellens’ syndrome

significant LAD blockage

Question 4

Did the thrombolytics help?

What is evidence of reperfussion after thrombolysis in MI

Answer 4

Chest pain resolves
ST segments return to baseline
Appearance of repurfusion dysrhythmias (PVCs, non-sustained VT)

Question 5

Complications of anterior MI

Answer 5

Mobitz II

Complete heart block

Question 6

Complications of Inferior MI

Answer 6

Bradycardia

1st degree AV blocks

Question 7

Persistent ST Elevation for weeks following an MI - indicative of what complication

Answer 7

Left ventricular aneurysm

Question 8

ST elevation in lead III > II

Answer 8

Right ventricular infarction

Use nitrates and morphine with caution and give IV fluids if necessary

Question 9

Differentiate High output heart failure vs low output heart failure

Answer 9

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

Question 10

acute decompensated heart failure

Most sensitive and specific findings

Answer 10

Most sensitive finding: dyspnea on exertion

Most specific finding: paroxysmal nocturnal dyspnea, S3 gallop

Question 11

Murmur of Aortic Stenosis

Answer 11

Crescendo-decrescendo systolic murmur that radiates to the carotids

Question 12

BP med of choice in aortic stenosis

Answer 12

Hydralazine

Avoid BB and CCB

Question 13

Vasopressor of choice in aortic stenosis

Answer 13

phenylephrine - increases diastolic pressure, improving coronary perfusion

Question 14

What are the concerns with intubating a patient with aortic stenosis?

Answer 14

Preload dependent

Optimize with IV fluids and have push dose vasopressor available

Question 15

Most common cause of mitral stenosis

Answer 15

Rheumatic fever

However, mitral regurgitation is the most common early valvular manifestation

Question 16

Pregnant woman with murmur and pulmonary edema

Dx?

Answer 16

Mitral stenosis

Question 17

Murmur of mitral regurgitation

Answer 17

Loud holosystolic murmur that radiates to the axilla

Question 18

All patients with suspected pericarditis should have what test

Answer 18

Ultrasound to rule out tamponade

ACC/AHA guideline recommendation

Question 19

Drug of choice for pregnancy-induced hypertension

Answer 19

hydralazine: direct arterial vasodilator

Question 20

Superficial thrombophlebitis: who gets anti coagulated?

Answer 20

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

Question 21

What is the primary indication for thrombolytics in the setting of DVT

Answer 21

Phlegmasia cerulea dolens

Cerulea, Clot, Cyanosis

Question 22

WPW treatment

Answer 22

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**

Question 23

What rate defines neonatal bradycardia

Answer 23

Pulse < 100/m

Give positive pressure ventilation
Ensure adequate oxygenation/ventilation

If pulses < 60/min, start compressions

Question 24

Absolute contraindications to therapeutic hypothermia after cardiac arrest

Answer 24

Bleeding (non compressible bleeding or underlying coagulopathy)

Severe sepsis

pregnancy

Question 25

What should be avoided in LVAD patients

Answer 25

Chest compressions

Patients will LVAD may not have a palpable pulse