Cardiology - Emma Holliday Review

Question 1

A patient comes in with chest pain… Best 1st test?

Answer 1

EKG

Question 2

Chest pain if on EKG 2MM ST elevation or new LBBB?

Answer 2

STEMI

Question 3

EKG changes in STEMI immediately? T wave inversion? Forever?

Answer 3

Immediately - ST elevation
6 hrs to years - T wave inversion
Forever - Q waves

Question 4

Tx of STEMI?

Answer 4

Emergency reperfusion - Cath Lab or *thrombolytics if no CIs

Question 5

Symptoms of Right ventricular infarct?

Answer 5

Hypotension, tachycadia, clears lungs, JVD, and NO pulsus paradoxus

Question 6

What is CI in right ventricular infart?

Answer 6

Nitro

Question 7

Tx of right ventricular infarct?

Answer 7

Fluid resuscitation

Question 8

A patient comes in with chest pain… second best test?

Answer 8

Cardiac enzymes

Question 9

What cardiac enzymes do you check?

Answer 9

Myoglobin, CKMB, Troponin I

Question 10

When does myoglobin rise? peaks? normal?

Answer 10

1 hr
2 hrs
24 hrs

Question 11

When does CKMB rise? peaks? normal?

Answer 11

4-8 hrs
24 hrs
72 hrs

Question 12

When does troponin I rise? peaks? normal?

Answer 12

3-5 hrs
24-48 hrs
7-10 days

Question 13

Chest pain w/ No ST-elevation on EKG, and elevated cardiac enzymes?

Answer 13

NSTEMI

Question 14

Patient has a NSTEMI how often do you check cardiac enzymes?

Answer 14

q8 hrs X 3

Question 15

Tx of NSTEMI?

Answer 15

Morphine, oxygen, nitrates, ASA/clopidogrel, & B-blocker

Question 16

What must be done w/n 48 hrs in patient who had NSTEMI?

Answer 16

Coronary Angiography

Question 17

What is standard in NSTEMI after coronary angiography?

Answer 17

Percutaneous coronary intervention w/ stenting

Question 18

When do you do a CABG?

Answer 18

L main dz, 3 vessel dz, 2 vessel dz and DM, > 70% occlusion, pain despite max medical tx, post infarction angina

Question 19

STEMI/NSTEMI discharge meds?

Answer 19

ASA (+ clopidogrel for 9-12 months if stent placed)
B-Blocker
ACEi if CHF or LV-dysfunc
Statin
Short acting nitrates

Question 20

Chest pain with no ST-Elevation on EKG and normal cardiac enzymes x 3?

Answer 20

Unstable Angina

Question 21

Workup of unstable angina first test? Avoid what before the test?

Answer 21

Exercise EKG

B-blockers and CCBs

Question 22

When is a exercise EKG stress test CI? What do you do instead?

Answer 22

Old LBBB
Baseline ST-elevation
on Digoxin
Exercise Echo

Question 23

What needs to be done if a patient cannot exercise?

Answer 23

Chemical stress test w/ dobutamine or adenosine

Question 24

What is a MUGA?

Answer 24

Nuclear medicine test that shows perfusion of areas of the heart.

Question 25

What should be avoided in before a MUGA?

Answer 25

Caffeine | Theophyline

Question 26

Post-MI complications: MC cause of death?

Answer 26

Arrhythmias - V-Fib

Question 27

New systolic murmur 5-7 days post MI?

Answer 27

Papillary muscle rupture

Question 28

Acute severe hypotension post MI?

Answer 28

Ventricular free wall rupture

Question 29

Post MI: "Step-up" in O2 conc from RA --> RV?

Answer 29

Ventricular septal rupture

Question 30

Persistent ST elevation ~1 month later post MI + systolic MR murmur?

Answer 30

Ventricular wall aneurysm

Question 31

Cannon A-waves post MI?

Answer 31

AV-dissociation. Either V-fib or 3rd degree heart block

Question 32

5-10 wks post MI pleuritic CP and low grade temp?

Answer 32

Dressler's syndrome

Question 33

What is dressler's syndrome?

Answer 33

Autoimmune pericarditis

Question 34

Tx of dressler's syndrome?

Answer 34

NSAIDs and ASA

Question 35

A young healthy patient comes in with chest pain... if worse w/ inspiration, better w/ leaning forward, friction rub, & diffuse ST elevation?

Answer 35

Pericarditis

Question 36

A young, healthy patient comes in with chest pain... worse w/ palpation?

Answer 36

Costochondriasis

Question 37

A young healthy patient comes in with chest pain... if vague w/ hx of viral infxn and murmur?

Answer 37

Myocarditis

Question 38

A young healthy patient comes in with chest pain... if occurs at rest, worse at night, few CAD risk factors and migraine headaches, w/ transient ST elevation during episodes?

Answer 38

Prinzmetal's angina

Question 39

Dx of prinzmetal's angina?

Answer 39

Ergonovine stim test

Question 40

Tx of prinzmetal's angina?

Answer 40

CCB or nitrates

Question 41

Systolic ejection murmur crescendo/decrescendo, louder w/ squatting, softer w/ valsalva + parvus et tardus

Answer 41

Aortic stenosis

Question 42

Systolic ejection murmur louder w/ valsalva, softer w/ squatting or handgrip?

Answer 42

HOCM

Question 43

Late systolic murmur w/ click louder w/ valsalva and handgrip, softer w/ squatting?

Answer 43

MVP

Question 44

Holosystolic murmur radiates to axilla w/ LAE?

Answer 44

Mitral regurgitation

Question 45

Holosystolic murmur w/ late diastolic rumble in kiddos?

Answer 45

VSD

Question 46

Continuous machine like murmur?

Answer 46

PDA

Question 47

Wide fixed and split S2?

Answer 47

ASD

Question 48

Rumbling diastolic murmur with an opening snap, LAE and A-Fib

Answer 48

Mitral stenosis

Question 49

Blowing diastolic murmur with widened pulse pressure and eponym parade

Answer 49

Aortic regurgitation

Question 50

Patient comes in with shortness of breath what do you need to differentiate between?

Answer 50

Pulmonary or cardiac causes

Question 51

What history would lead you toward a PE?

Answer 51

hx of cancer, surgery, or immobility

Question 52

If you suspect PE what do you do?

Answer 52

Start heparin

Question 53

When do you give O2?

Answer 53

O2 < 90%

Question 54

Patient presents with SOB with signs and symptoms of pneumonia?

Answer 54

CXR

Question 55

Patient presents with SOB with murmur or Hx of CHF?

Answer 55

Echo for EF

Question 56

Patient presents with SOB and suspected acute PE?

Answer 56

Nitrates, lasix, and morphine

Question 57

Patient presents with SOB and young w/ sxs of CHF w/ prior hx of viral infxn? Typically what virus?

Answer 57

Myocarditis - Coxsackie B

Question 58

Patient presents with SOB and young w/ no hx of cardiomegaly on CXR?

Answer 58

primary pHTN

Question 59

What can distinguish CHF from pHTN?

Answer 59

Right heart cath

Question 60

EF of patient with systolic CHF?

Answer 60

<55%

Question 61

Causes of sCHF?

Answer 61

Ischemic or dilated | -Viral, EtOH, cocaine, chagas, idiopathic

Question 62

What cause of sCHF is reversible? How?

Answer 62

Alcoholic dilated cardiomyopathy | Stop drinking EtOH

Question 63

EF of patient with diastolic CHF?

Answer 63

Normal

Question 64

What is wrong with the heart in dCHF?

Answer 64

Heart cannot fill

Question 65

What improves survival in pts with sCHF?

Answer 65

ACEi - prevents remodeling of heart by aldosterone

Question 66

What B-blockers are used in pts with CHF?

Answer 66

Metoprolol and carvedilol

Question 67

When would you use spironolactone in CHF pts?

Answer 67

NYHA class III and IV

Question 68

How does digoxin help in CHF pts?

Answer 68

Decreases symptoms and hospitalizations not survival

Question 69

Progressive, prolongation of the PR interval followed by a dropped beat

Answer 69

Mobitz Type I - Winkebach

Question 70

Cannon-a waves on | physical exam. “regular P-P interval and regular R-R interval”

Answer 70

3rd degree Heart block

Question 71

“varrying PR interval with 3 or more morphologically distinct P waves in the same lead”. Seen in an old person w/ chronic lung dz in pending respiratory failure

Answer 71

Multiple Atrial Tachycardia

Question 72

“Three or more consecutive beats w/ QRS 120bpm”

Answer 72

V Tach

Question 73

Tx of V tach

Answer 73

Unstable - Shock | Stable - Lidocaine/adenosine

Question 74

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

Answer 74

Wolff-Parkinson-White

Question 75

Tx of Wolff-Parkinson-White?

Answer 75

Procainamide

Question 76

CI in WPW?

Answer 76

B-Blockers Digoxin -Slow AV conduction