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IM Shelf Review > Cardiology- San Antonio Review > Flashcards

Cardiology- San Antonio Review Flashcards

1
Q

First best test for chest pain?

A

EKG

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2
Q

STEMI Criteria

A
  1. 2mm ST elevation

2. NEW LBBB with a wide, flat QRS

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3
Q

What are the EKG leads showing infarct in RCA?

A

2, 3, aVF

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4
Q

With infarct of 2,3, aVF, where is the lesion?

A

RCA

Inferior infarct

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5
Q

Treatment for a STEMI?

A

Cath lab.

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6
Q

When can you give thrombolytics in STEMI?

A

Within 6hr of symptoms, or if you can’t get to a facility.

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7
Q

Thrombolytic contraindication?

A
  1. Actively bleeding
  2. Hx of hemorrhagic stroke
  3. Recent ischemic stroke
  4. Recent closed head trauma
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8
Q

Symptoms and treatment of right ventricular infarct?

A

Looks like shock, but clear lungs. Hypotension, tacky, JVD.

Tx vigorous fluid resuscitation.

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9
Q

Next test after normal EKG in patient with chest pain?

A

Serial cardiac enzymes. Typically 3 sets every 8 hours.

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10
Q

What enzyme is best for re-infarction?

A

Myoglobin

It rises and falls first.

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11
Q

What about coronary angiography?

A

You should do it within 48hr to determine need for intervention

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12
Q

When do you do a CABG?

A

If you have left main disease, or three vessels, or >70% occlusion.

If diabetic, only need 2 vessels.

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13
Q

Discharge meds after MI?

A
  1. Aspirin (+ clopidogrel if stent)
  2. B-blocker
  3. ACEi if CHF or LV
  4. Statin
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14
Q

Workup for unstable angina?

A
  1. Exercise stress test
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15
Q

Contraindications to exercise stress test?

A
  1. Old LBBB
  2. Baseline ST elevation
  3. On digoxin
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16
Q

Next test after positive exercise stress test?

A

Coronary angiography

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17
Q

Most common cause of death after MI?

A

Arrhythmia.

V-fib is scariest

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18
Q

New murmur 5-7 days post-MI?

A

Papillary muscle rupture leading to regurgitation

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19
Q

Acute severe hypotension post-MI?

A

Free wall rupture

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20
Q

“Step up” in O2 concentration between RA and RV?

A

Septal rupture.

Oxygenated blood coming across from the left heart.

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21
Q

Persistent ST elevation 1mo after MI?

A

Ventricular wall aneurysm

22
Q

“Cannon A-waves?”

A

AV dissociation. Tricuspid doesn’t open well. 3rd degree block

23
Q

What is Dressler’s syndrome?

A

Autoimmune pericarditis 5-10wks after MI.

Chest pain, low-grade temp.

24
Q

Dressler’s syndrome treatment?

A

Aspirin and NSAIDs.

25
Q

Young person with chest pain and diffuse ST elevation?

A

Pericarditis

26
Q

Pericarditis buzzwords?

A
  1. Worse with inspiration
  2. Better when leaning forwards
  3. Friction rub
  4. Diffuse ST elevation
27
Q

Pericarditis treatment?

A

Aspirin and NSAIDs.

28
Q

Chest pain worse with palpation?

A

Chostochondriasis

29
Q

Chest pain with viral infection and new murmur?

A

Myocarditis

30
Q

Nocturnal chest pain in a female with migraines. Transient ST elevation during episodes?

A

Prinzmetal’s angina

31
Q

Prinzmetal’s angina diagnosis?

A

Ergonovine stimulation test

32
Q

Prinzmetal’s angina treatment?

A

CCB or nitrates.

33
Q

Progressive prolongation of PR interval?

A

Mobitz 1

Weinkeback

34
Q

P and R totally unrelated?

A

Total heart block.

35
Q

What is MAT?

A

Multifocal atrial tachycardia

It’s bad news

36
Q

EKG with 3+ different p-waves

A

MAT

37
Q

How do we treat v-tach?

A

Depends on how they look

  1. Shock city if they’re trying to die.
  2. Amiodarone or lidocaine if they’re not dying.
38
Q

What about when you see delta-waves?

“Slurred initial deflection”

A

WPW.

39
Q

Treatment for WPW?

A

Procainamide.

40
Q

Regular rhythm with ventricular rate 125, and atrial rate 250?

A

Atrial flutter.

41
Q

Atrial flutter treatment?

A
  1. Shock if unstable.

2. B-blockers and digoxin if stable.

42
Q

Torsades?

A

They look like tornadoes

43
Q

Electrolytes with torsades?

A

Low potassium or low mag

44
Q

Young person with palpitations and dizziness?

A

SVT.

45
Q

SVT treatment?

A

Carotid massage.

46
Q

Peaked t-waves?

A

HYPERkalemia

Burn victim, dialysis patient, crush injury.

47
Q

Alternate beat variation, low voltage.

Also pulsus paradoxus, hypotension, distant heart sounds, JVD

A

Cardiac tamponade.

Makes sense, because the blood is dampening the voltage.

48
Q

Irregularly irregular with no p-waves?

A

A-fib

49
Q

A-fib patient presentation?

A

CHF, old guy, hypothyroid

50
Q

Treatment for a-fib?

A

Rate control is first-line.

  1. B-blockers
  2. Digoxin

IM Shelf Review (2 decks)

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