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internal medicine-emma holiday > Cardiology - Emma Holliday Review > Flashcards

Cardiology - Emma Holliday Review Flashcards

1
Q

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

A

EKG

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2
Q

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

A

STEMI

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3
Q

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

A

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

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4
Q

Tx of STEMI?

A

Emergency reperfusion - Cath Lab or *thrombolytics if no CIs

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5
Q

Symptoms of Right ventricular infarct?

A

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

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6
Q

What is CI in right ventricular infart?

A

Nitro

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7
Q

Tx of right ventricular infarct?

A

Fluid resuscitation

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8
Q

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

A

Cardiac enzymes

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9
Q

What cardiac enzymes do you check?

A

Myoglobin, CKMB, Troponin I

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10
Q

When does myoglobin rise? peaks? normal?

A

1 hr
2 hrs
24 hrs

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11
Q

When does CKMB rise? peaks? normal?

A

4-8 hrs
24 hrs
72 hrs

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12
Q

When does troponin I rise? peaks? normal?

A

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

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13
Q

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

A

NSTEMI

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14
Q

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

A

q8 hrs X 3

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15
Q

Tx of NSTEMI?

A

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

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16
Q

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

A

Coronary Angiography

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17
Q

What is standard in NSTEMI after coronary angiography?

A

Percutaneous coronary intervention w/ stenting

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18
Q

When do you do a CABG?

A

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

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19
Q

STEMI/NSTEMI discharge meds?

A 
ASA (+ clopidogrel for 9-12 months if stent placed)
B-Blocker
ACEi if CHF or LV-dysfunc
Statin
Short acting nitrates
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20
Q

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

A

Unstable Angina

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21
Q

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

A

Exercise EKG

B-blockers and CCBs

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22
Q

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

A

Old LBBB
Baseline ST-elevation
on Digoxin
Exercise Echo

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23
Q

What needs to be done if a patient cannot exercise?

A

Chemical stress test w/ dobutamine or adenosine

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24
Q

What is a MUGA?

A

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

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25
Q

What should be avoided in before a MUGA?

A

Caffeine

Theophyline

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26
Q

Post-MI complications: MC cause of death?

A

Arrhythmias - V-Fib

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27
Q

New systolic murmur 5-7 days post MI?

A

Papillary muscle rupture

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28
Q

Acute severe hypotension post MI?

A

Ventricular free wall rupture

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29
Q

Post MI: “Step-up” in O2 conc from RA –> RV?

A

Ventricular septal rupture

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30
Q

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

A

Ventricular wall aneurysm

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31
Q

Cannon A-waves post MI?

A

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

32
Q

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

A

Dressler’s syndrome

33
Q

What is dressler’s syndrome?

A

Autoimmune pericarditis

34
Q

Tx of dressler’s syndrome?

A

NSAIDs and ASA

35
Q

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

A

Pericarditis

36
Q

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

A

Costochondriasis

37
Q

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

A

Myocarditis

38
Q

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?

A

Prinzmetal’s angina

39
Q

Dx of prinzmetal’s angina?

A

Ergonovine stim test

40
Q

Tx of prinzmetal’s angina?

A

CCB or nitrates

41
Q

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

A

Aortic stenosis

42
Q

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

A

HOCM

43
Q

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

A

MVP

44
Q

Holosystolic murmur radiates to axilla w/ LAE?

A

Mitral regurgitation

45
Q

Holosystolic murmur w/ late diastolic rumble in kiddos?

A

VSD

46
Q

Continuous machine like murmur?

A

PDA

47
Q

Wide fixed and split S2?

A

ASD

48
Q

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

A

Mitral stenosis

49
Q

Blowing diastolic murmur with widened pulse pressure and eponym parade

A

Aortic regurgitation

50
Q

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

A

Pulmonary or cardiac causes

51
Q

What history would lead you toward a PE?

A

hx of cancer, surgery, or immobility

52
Q

If you suspect PE what do you do?

A

Start heparin

53
Q

When do you give O2?

A

O2 < 90%

54
Q

Patient presents with SOB with signs and symptoms of pneumonia?

A

CXR

55
Q

Patient presents with SOB with murmur or Hx of CHF?

A

Echo for EF

56
Q

Patient presents with SOB and suspected acute PE?

A

Nitrates, lasix, and morphine

57
Q

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

A

Myocarditis - Coxsackie B

58
Q

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

A

primary pHTN

59
Q

What can distinguish CHF from pHTN?

A

Right heart cath

60
Q

EF of patient with systolic CHF?

A

<55%

61
Q

Causes of sCHF?

A

Ischemic or dilated

-Viral, EtOH, cocaine, chagas, idiopathic

62
Q

What cause of sCHF is reversible? How?

A

Alcoholic dilated cardiomyopathy

Stop drinking EtOH

63
Q

EF of patient with diastolic CHF?

A

Normal

64
Q

What is wrong with the heart in dCHF?

A

Heart cannot fill

65
Q

What improves survival in pts with sCHF?

A

ACEi - prevents remodeling of heart by aldosterone

66
Q

What B-blockers are used in pts with CHF?

A

Metoprolol and carvedilol

67
Q

When would you use spironolactone in CHF pts?

A

NYHA class III and IV

68
Q

How does digoxin help in CHF pts?

A

Decreases symptoms and hospitalizations not survival

69
Q

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

A

Mobitz Type I - Winkebach

70
Q

Cannon-a waves on

physical exam. “regular P-P interval and regular R-R interval”

A

3rd degree Heart block

71
Q

“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

A

Multiple Atrial Tachycardia

72
Q

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

A

V Tach

73
Q

Tx of V tach

A

Unstable - Shock

Stable - Lidocaine/adenosine

74
Q

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

A

Wolff-Parkinson-White

75
Q

Tx of Wolff-Parkinson-White?

A

Procainamide

76
Q

CI in WPW?

A

B-Blockers
Digoxin
-Slow AV conduction

internal medicine-emma holiday (9 decks)

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