Chest Pain/Cardiac Flashcards
STEMI in menopausal women with echocardiogram showing ballooning of the apex of the heart, cath neg, dx?
Takotsubo’s cardiomyopathy
STE relieved by nitro, STE resolves, dx?
Prinzmetal’s angina, coronary vasospasm
What medications other than nitrates can be given to suppress episodes of Prinzmetal’s angina?
CCBs
How will the hand grip physical exam technique alter the aortic stenosis murmur?
The hand grip technique will decrease the intensity of the murmur associated with aortic stenosis.
papillary muscle or the chordae tendineae acutely rupture, dx?
Acute mitral regurgitation
Clinical features are usually sudden in onset with rapid progression of pulmonary edema, hypotension, and features consistent with cardiogenic shock
Mgmt of acute mitral regurgitation
Medical stabilization consists of afterload and peripheral resistance reduction with the use of intravenous nitroprusside. This increases cardiac output and decreases mitral regurgitation. Surgical repair/replacement is required once medical stabilization has occurred
Pathophysiology of digoxin
Digoxin is a cardiac glycoside that directly inhibits sodium-potassium ATPase, which subsequently leads to an increased intracellular calcium concentration causing depolarization and increased cardiac contractility, thus its utility in congestive heart failure
Also blocks AV node, why it can be useful in Afib
EKG abnormalities of digoxin toxicity
ECG abnormalities of digoxin vary and can include bradycardia, PVCs, heart blocks, and bidirectional ventricular tachycardia.
What unique ECG findings would be seen in a patient with a pericardial effusion, distended neck veins, and hypotension?
Decreased voltages and electrical alternans
Definition of STEMI
The diagnosis of ST segment elevation myocardial infarction on ECG requires 1 mm of ST elevation in two contiguous leads with the exception of leads V2 and V3. In these two leads, greater than or equal to 2 mm in men greater than 40 years old and greater than or equal to 2.5 mm in men less than 40 years old is required for the diagnosis for ST elevation myocardial infarction. In women, greater than or equal to 1.5 mm elevation is required
ST segment elevation in leads V2 and V3 is consistent with a blockage in which coronary artery?
LAD
STEMI tx
PCI (Percutaneous Coronary Intervention) GOLD STANDARD - best if within 3 hours
Thrombolytic therapy
What is the international normalized ratio (INR) target when treating atrial fibrillation with warfarin?
2-3
Afib tx
Management of atrial fibrillation in a stable patient (no signs of decreased end-organ perfusion or severe hypotension) is typically diltiazem (a cardiac calcium channel blocker) or metoprolol (a beta-blocker)
Avoid BB in COPD pts
What is an appropriate electricity dose for defibrillation in ventricular fibrillation?
200J
Can an ECG be used to diagnose a new myocardial infarction in a patient with a history of a left bundle branch block on ECG?
Yes, with the use of Sgarbossa’s criteria
What does a notched P wave on ECG potentially indicate?
Left atrial enlargement
Mgmt SVT refractory to medical mgmt or unstable
Cardioversion 50 joules is appropriate management of supraventricular tachycardia that is either unstable or refractory to initial medical management.
Most likely sequelae of cardiac contusion
Pericardial effusion
Left ventricular aneurysm
STE indiscernible from MI, except w/o reciprocal changes;
>2wks post MI
time to revascularization initially decreases risk
Q or QS waves
WPW tx
procainamide
Verapamil contraindicated
Most common cardiac tumor
Mets
PEA Hs
hypothermia
hypoxia
hypovolemia
hyperK
PEA Ts
Thrombus (PE)
Toxicity
pTx
Tamponade
