Cardiology- San Antonio Review Flashcards
First best test for chest pain?
EKG
STEMI Criteria
- 2mm ST elevation
2. NEW LBBB with a wide, flat QRS
What are the EKG leads showing infarct in RCA?
2, 3, aVF
With infarct of 2,3, aVF, where is the lesion?
RCA
Inferior infarct
Treatment for a STEMI?
Cath lab.
When can you give thrombolytics in STEMI?
Within 6hr of symptoms, or if you can’t get to a facility.
Thrombolytic contraindication?
- Actively bleeding
- Hx of hemorrhagic stroke
- Recent ischemic stroke
- Recent closed head trauma
Symptoms and treatment of right ventricular infarct?
Looks like shock, but clear lungs. Hypotension, tacky, JVD.
Tx vigorous fluid resuscitation.
Next test after normal EKG in patient with chest pain?
Serial cardiac enzymes. Typically 3 sets every 8 hours.
What enzyme is best for re-infarction?
Myoglobin
It rises and falls first.
What about coronary angiography?
You should do it within 48hr to determine need for intervention
When do you do a CABG?
If you have left main disease, or three vessels, or >70% occlusion.
If diabetic, only need 2 vessels.
Discharge meds after MI?
- Aspirin (+ clopidogrel if stent)
- B-blocker
- ACEi if CHF or LV
- Statin
Workup for unstable angina?
- Exercise stress test
Contraindications to exercise stress test?
- Old LBBB
- Baseline ST elevation
- On digoxin
Next test after positive exercise stress test?
Coronary angiography
Most common cause of death after MI?
Arrhythmia.
V-fib is scariest
New murmur 5-7 days post-MI?
Papillary muscle rupture leading to regurgitation
Acute severe hypotension post-MI?
Free wall rupture
“Step up” in O2 concentration between RA and RV?
Septal rupture.
Oxygenated blood coming across from the left heart.
Persistent ST elevation 1mo after MI?
Ventricular wall aneurysm
“Cannon A-waves?”
AV dissociation. Tricuspid doesn’t open well. 3rd degree block
What is Dressler’s syndrome?
Autoimmune pericarditis 5-10wks after MI.
Chest pain, low-grade temp.
Dressler’s syndrome treatment?
Aspirin and NSAIDs.
Young person with chest pain and diffuse ST elevation?
Pericarditis
Pericarditis buzzwords?
- Worse with inspiration
- Better when leaning forwards
- Friction rub
- Diffuse ST elevation
Pericarditis treatment?
Aspirin and NSAIDs.
Chest pain worse with palpation?
Chostochondriasis
Chest pain with viral infection and new murmur?
Myocarditis
Nocturnal chest pain in a female with migraines. Transient ST elevation during episodes?
Prinzmetal’s angina
Prinzmetal’s angina diagnosis?
Ergonovine stimulation test
Prinzmetal’s angina treatment?
CCB or nitrates.
Progressive prolongation of PR interval?
Mobitz 1
Weinkeback
P and R totally unrelated?
Total heart block.
What is MAT?
Multifocal atrial tachycardia
It’s bad news
EKG with 3+ different p-waves
MAT
How do we treat v-tach?
Depends on how they look
- Shock city if they’re trying to die.
- Amiodarone or lidocaine if they’re not dying.
What about when you see delta-waves?
“Slurred initial deflection”
WPW.
Treatment for WPW?
Procainamide.
Regular rhythm with ventricular rate 125, and atrial rate 250?
Atrial flutter.
Atrial flutter treatment?
- Shock if unstable.
2. B-blockers and digoxin if stable.
Torsades?
They look like tornadoes
Electrolytes with torsades?
Low potassium or low mag
Young person with palpitations and dizziness?
SVT.
SVT treatment?
Carotid massage.
Peaked t-waves?
HYPERkalemia
Burn victim, dialysis patient, crush injury.
Alternate beat variation, low voltage.
Also pulsus paradoxus, hypotension, distant heart sounds, JVD
Cardiac tamponade.
Makes sense, because the blood is dampening the voltage.
Irregularly irregular with no p-waves?
A-fib
A-fib patient presentation?
CHF, old guy, hypothyroid
Treatment for a-fib?
Rate control is first-line.
- B-blockers
- Digoxin
