CV Cases and EKG Rhythm Strips

Question 1

33 y/o male presents with sudden syncope after complaining of a head cold for 1 week. His EKG will most likely show:

Answer 1

Pericarditis

Global ST elevation

Question 2

17 y/o male presents for a sports physical. He has a systolic murmur that gets louder when he stands from a squatting position. What would you expect on his EKG?

Answer 2

Left ventricular hypertrophy

Congenital - young patient, no time to develop HTN induced aortic stenosis yet

Question 3

Treatment for viral perdicarditis

Answer 3

Treat with non-steroidal anti-inflammatory medication

Question 4

PE of pericarditis

Answer 4

Rub and pleuritis pain

Question 5

Treatment for LVH

Answer 5

No treatment recommendation

Not recommended to play sports

Question 6

What would worsen LVH

Answer 6

Alcohol

Question 7

A 23 y/o female presents with left lower quadrant rebound tenderness and appears toxic. The pain began peri-umbilical and has now localized over what is the equivalent to McBurney’s point, but on the left. Her surgeon wants to take her to the OR, but is concerned about her EKG. As the consulting internist clearing her for surgery, what is you recommendation?

Answer 7

Sidus Inversus

Clear her for surgery

Question 8

What else would you do before surgery with sidus inversus?

Answer 8

Right sided EKG - reverse limb and chest leads!

Question 9

A 20 y/o college student comes to the ER after a party where he was observed inhaling large amounts of cocaine. He has retrosternal chest pain that began 50 minutes ago. His EKG shows

Answer 9

HUGE MI with reciprocal changes

Anterolateral

Question 10

How to treat the anterolateral MI in cocaine user

Answer 10

Send to the cath lab

Can directly apply medication to coronary arteries

Maybe give tpa - cocaine has not well understood clotting properties

Question 11

Can B blockers be used to treat MI

Answer 11

Yes, but contraindicated with cocaine use

Do not want unapposed A1 activity in a patient already vasocontricted

Question 12

A 55 y/o male dressed as Santa Claus is brought in by the paramedics unresponsive. He was last seen at the Park Meadows Mall toy-store where he was working for the season five hours ago. What does the EKG show?

Answer 12

Osborn waves

Hypothermia

Need to rewarm patient

Question 13

A 54 y/o female presents with irritability, says she has trouble concentration and she was in the ER last week with a kidney stone. She has solid lump in the base of her left neck. She had a 30pk/yr history of smoking. What does her EKG show?

Answer 13

Hypercalcemia - kidney stones

High calcium from paraneoplastic syndrome

Shortened QT

Question 14

A 66 y/o male, 50 pack-year smoker presents with tearing back pain. He has a widened mediastinum on CXR and a loud murmur of aortic insufficiency. What would the EKG show?

Answer 14

Aortic dissection

RCA tends to be involved in dissection

Can lead to inferior wall MI

ST elevation in II, III, and aVF

Question 15

If there in inferior MI and some lateral ischemia what is happening?

Answer 15

RCA is probably more dominant

Question 16

Initial approach with dissection and MI

Answer 16

Cath lab

Need image of what’s happening!

Question 17

A 30 y/o female has palpitations and presents to the emergency room. The ER physician gives her a beta blocker and several days later reads about her in the obituary section of the paper. What did her EKG look like?

Answer 17

WPW - Don’t give B blockers and non-DHP CCBs!

Question 18

50 y/o male has dizziness and passed out. He smokes 2 pks/day for 30 years and is on no medications. EKG shows

Answer 18

Severe bradycardia, no p wave

Question 19

How would you treat severe bradycardia?

Answer 19

Pacemaker

Question 20

A 28 y/o heroin user begins treatment in a methadone clinic. Three days later he is in the ER unresponsive with v fib or torsades on EKG.

What did his EKG look like before?

Answer 20

Long QT

Genetic, medications, hypokalemia

Question 21

What signs/technique’s might be present in a patient with long QT?

Answer 21

Hypocalcemia

Trouseaus sign - spasm of hand

Chvostek’s sign - spasm of face

Question 22

A 62 y/o female had palpitations and was prescribed a medication. She now presents to the emergency room after having passed out and hitting her head. What does her EKG show?

Answer 22

Prolonged PR

First degree block

Question 23

Medication causing first degree block/syncope?

Answer 23

Atenolol

Question 24

Why was patient placed on B blocker? What other meds could be used?

Answer 24

SVT

CCBs, digoxin, adenosin, amiodaron

Valsalva maneuver, facial ice bath, cardioversion, cardiac ablation, carotid massage, pacemaker

Question 25

62 y/o male presents with palpitations and lightheadedness. EKG shows: ventricular tachycardia (short series, not sustained)

How would you treat it?

Answer 25

B blockers, amiodarone, propafenone, AICD

Antiarrhythmics are risky

If EF less than 25% - AICD

Question 26

72 y/o female presents for a routine physical without complaint. She has hypertension, well controlled on losartan. All of her vital signs are normal. EKG shows: Ventricular trigemeny

Treatment would be?

Answer 26

No treatment

Don’t want to get rid of beats that may be part of her cardiac output

Question 27

A 92 y/o demented female is left home alone by her daughter for 30 minutes. The patient thinks her daughter has forgotten to give her medication and takes her lisinopril again. Since she has a very short term memory, she does this several times. Later they bring her to the ER with a complaint of dizziness. What does her EKG look like and why?

Answer 27

Short QRS, peaked and pointy T waves

Severe hypotension and hyperkalemia

Question 28

Medication responsible for EKG with u waves

Answer 28

Furosemide

Hypokalemia