CV IV

Question 1

evolution of MI

Answer 1

LAD > RCA > circumflex

0-4 hours - no change

4-24 hour - early coag necrosis - wavy fibers
-reperfusion = contraction bands

3-14 days - free wall rupture
-macros and granulation tissue at margins

2 weeks to several months - scar formation

Question 2

tamponade

Answer 2

can occur with transmural MI - rupture

also - can get mitral regurg - pap muscle rupture

Question 3

MI diagnosis

Answer 3

6 hours - EKG gold standard

cardiac troponin I - rises after 4 hours - elevated 7-10 days

CK-MB - rises after 6-12 hours - return to normal 48 hours
-good for diagnosing reinfarction

Question 4

ST elevation

Answer 4

transmural infarction

Q wave

Question 5

ST depression

Answer 5

subendothelial infarction

Question 6

V1-V2 EKG STEMI

Answer 6

anteroseptal

-LAD

Question 7

V3-4 EKG STEMI

Answer 7

anteroapical

-distal LAD

Question 8

V5-6 EKG STEMI

Answer 8

anterolateral

-LAD or LCX

Question 9

I aVL EKG STEMI

Answer 9

lateral

-LCX

Question 10

II, III, aVF EKG STEMI

Answer 10

inferior

-RCA

Question 11

MI complication

Answer 11

prehospital - arrhythmia

also - LV failure

Question 12

dressler syndrome

Answer 12

autoimmune phenomenon - fibrinous pericarditis

several weeks post MI

Question 13

mitral regurg after MI

Answer 13

papillary muscle rupture

Question 14

tx unstable angina and NSTEMI

Answer 14

anticoag
antiplatelet
beta-block
ACE I
statin
sx control - nitro/morphine

Question 15

MC cardiomyoathy

Answer 15

dilated

Question 16

dilated cardiomyopathy causes

Answer 16

chronic alcohol
coxsackie B
cocaine
chagas 
doxorubicin

see HF and S3

Question 17

hypertrophic cardiomyopathy

Answer 17

familial - auto dominant
-beta-myosin heavy chain mutation

syncope during exercise - young athlete

see S4 and systolic murmur

disarray of fibers
septal hypertrophy

Question 18

restrictive cardiomyopathy

Answer 18

sarcoid

amyloid

Question 19

loffler syndrome

Answer 19

eosinphilic infiltrate

Question 20

diastolic heart failure

Answer 20

decreased compliance

Question 21

systolic heart failure

Answer 21

decreased contractility

Question 22

right HF

Answer 22

from left HF

Question 23

decrease HF mortality

Answer 23

ACE I
ARB
B-blocker
spironolactone

Question 24

left heart failure

Answer 24

orthopnea
paroxysmal nocturnal dyspnea
pulmonary edema

Question 25

right heart failure

Answer 25

hepatomegaly - nutmeg liver
JVD
peripheral edema

Question 26

transudate

Answer 26

no inflammation

Question 27

exudate

Answer 27

inflammation

Question 28

distributive shock

Answer 28

warm and dry skin

-with sepsis, CNS injury, and anaphylaxis

Question 29

obstructive shock

Answer 29

cardiac tamponade

pulmonary embolus

Question 30

hypovolemic shock

Answer 30

decreased preload

Question 31

cardiogenic shock

Answer 31

decreased CO

Question 32

distributive shock

Answer 32

decreased afterload

Question 33

roth spot

Answer 33

white spot retina - endocarditis

Question 34

osler node

Answer 34

tender raised lesion finger or toe pad

-endocarditis

Question 35

janeway lesion

Answer 35

palm and sole

endocarditis

Question 36

subacute bacterial endocarditis

Answer 36

strep viridans

-on damaged/abnormal valve - gradual onset

Question 37

acute bacterial endocarditis

Answer 37

staph aureus

-on normal valve - rapid onset

Question 38

IV drug valve

Answer 38

tricuspid

Question 39

culture negative bacterial endocarditis

Answer 39

HACEK
haemophilus
actinobacillus
cardiobacterium
eikenella
kingella

Question 40

bacterial endocarditis valve

Answer 40

often mitral