CV 6

Question 1

What are the EKG findings that are diagnostic for STEMI?

Answer 1

1. NEW ST elevation in 2 or more contagious leads

> 1mm in all leads except V2 and V3
In V2/V3:
Men < 40 yo --> >2.5mm
Men > 40 yo --> >2.0mm
Women --> >1.5mm

2. New LBBB

Question 2

What are the four causes of Acute Pericarditis?

What physical maneuver improves the pleuritic CP of pericarditis?

What does EKG show?

TRX of idiopathic Pericarditis?

Answer 2

1. Viral or ideopathic
2. Autoimmune (SLE)
3. Uremia (renal failure)
4. Post MI

Pain improves when sitting up and leaning forward.

EKG = Diffuse ST elevation or PR depression

TRX = NSAID or Colchicine

Question 3

What is post infarction pericarditis (PIP)?

TRX?

How is PIP different from Dressler Syndrome?

Answer 3

PIP –> usually self-limiting pericarditis that occurs < 4 days of MI due to LOCAL INFLAMMATION. S/S same as any other pericarditis.

TRX –> High dose ASA (not nsaid/colchicine like normally bc inhibits healing and can increase risk of wall rupture)

Dressler Syndrome –> occur WEEKS AFTER MI due to Ab generated against pericardium due to MI.

Question 4

Multifocal Atrial Tachycardia is usually asymptomatic, but can present with rapid, irregular, pulse…

What does EKG classically show?

What are the three major causes of MAT?

What is the TRX?

Answer 4

EKG = Different P wave morphology, irregular R-R interval

1. COPD Exacerbation (most common)
2. Electrolytes (hypoK, hypoMg)
3. Catecholamine surge (sepsis)

TRX: Treat underlying cause. Can use Verapamil or Diltiazem if persisting.

Question 5

What two abnormal cardiac finding is seen in Athletes with very rigorous training, and represent NON-pathologic changes, requiring NO work up.

Answer 5

1. Bradycardia +/- 1st degree heart block

2. LV wall thickness that can meet EKG criteria for LV hypertrophy.

Question 6

What are the four Cardiac pathologies seen in Marfans?

How do you survey someone with marfans for cardiac pathology?

What is the indication for Aortic Valve replacement in Marfans?

Answer 6

1. Aortic root dilation/aneurysms
2. Aortic Regurg
3. Aortic Dissection
4. Mitral valve prolapse

Echo at dx and q 6 months

Valvular replacement if > 50mm to avoid dissection and rupture.

Question 7

How do you treat a PE?

Duration?

Answer 7

IF current malignancy –> Heparin to Warfarin bridge (5 day overlap)

IF NO cancer –> Oral Factor Xa (RIVAROXABAN)

TRX for 3-6 months for first PE. Lifelong anticoagulation if 2 or more.

Question 8

What do you do if you develop PE/DVT on Hormone Replacement Therapy?

Answer 8

• STOP HRT

- Replace with SNRI or SSRI

Question 9

An Aortic Dissection presents with tearing CP that radiates to the back…

What physical Exam finding is classic (hint: SBP)?

What do you see on CXR?

How do you TRX?

Answer 9

> 20mmHg SBP difference between arms.

CXR = widening mediastinum

TRX:

1. Pain control
2. IV beta blocker (goal SBP to 100-120)
3. Surgery if Ascending Dissection

Question 10

What is Debakey I, Debakey II and Debakey III Aortic Dissection?

Answer 10

Debakey I –> Ascending and Descending
Debakey II –> Ascending
Debakey II –> Descending

Question 11

How does Trastuzumab (chemo for Her 2 +ve breast cancer) affect the heart?

Prognosis?

Answer 11

5-25% experience Decreased LVEF. Usually Asymptomatic but occasionally will present with HF symptoms.

PROGNOSIS –> most cases fully reverse after medication is DC.

Question 12

What are the current BP guidelines?

Answer 12

1. Age > 60 (-) major disease
   < 150/90
2. Age < 60 or DM or CKD
   < 140/90

Question 13

What are the current first line anti-hyperTN agents to use in:

Blacks?
All other Ethnicity?
DM?

Answer 13

Blacks –> Thiazide or CCB (ACEI/ARB not first line)

Everyone else –> ACEI/ARB or Thiazide or CCB

DM –> ACEI/ARB first line

Question 14

What is the mainstay trx of BPH?

What other class of meds can be helpful, but not firs line?

Answer 14

Alpha-adrenrgic Agonist:

• Tamsulosin
• Terazosin
• Doxazosin

2nd line = 5-alpha-reductase inhabit
- Finasteride

Question 15

What are the 7 components of TIMI score?

How does the TIMI score dictate management in a patient coming in with Unstable Angine or NSTEMI?

Answer 15

Age > 65
3 or more CAD RFs
known CAD w 50% stenosis 
ASA in last 7 days
2 or more anginal episodes in 24 hours
Elevated Troponin 
ST change > .5 mm
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TIMI 0-2 —> Stress test

TIMI 3-7 or +ve Troponin –> Coronary Angiography <24 hours.