EH: Cardiology

Question 1

Best 1st test for Cardio Patients, Next best test?

Answer 1

EKG

Cardiac Enzymes

Question 2

If 2mm ST elevation or new LBBB (wide, flat QRS)

Answer 2

STEMI

ST elevation immediately

T wave inversion 6hrs- years

Q waves last forever

Question 3

V1-V4

Answer 3

Anterior LAD

Question 4

I, avL, V4-V6

Answer 4

Lateral Circumflex

Question 5

II, III and aVF

Answer 5

Inferior RCA

Question 6

V4 on R-sided EKG is 100% specific

Answer 6

R ventricular

RCA

Question 7

Emergency reperfusion

Answer 7

Go to cath lab or *thrombolytics if no contraindications

Question 8

Hypotension, tachycardia, clear lungs, JVD,
and NO pulsus paradoxus

Answer 8

Right ventricular infarct

DON’T give Nitro

Tx w/ vigorous fluid resuscitation.

Question 9

Myoglobin enzymes

Answer 9

Rises 1st Peaks in 2hrs

nl by 24

Question 10

CKMB enzymes

Answer 10

Rise 4-8hrs Peaks 24 hrs

nl by 72hs

Question 11

Troponin I enzymes

Answer 11

Rise 3-5hrs Peaks 24-48hrs

nl by 7-10days

Question 12

MONA/C-B Tx therapy?

Answer 12

Morphine

Oxygen

Nitrates

Aspirin / Clopidogrel

B-blocker

Question 13

CABG if?

Answer 13

L main dz 3 vessel dz (2 vessel dz + DM)
>70% occlusion

Pain despite maximum medical tx

Post-infarction angina

Question 14

Cardio Discharge Meds?

Answer 14

Aspirin (+ clopidogrel for 9-12mo if stent placed)

B-blocker

ACE-inhibitor if CHF or LV-dysfxn

Statin

Short acting nitrates

Question 15

If no ST-elevation and normal cardiac enzymes x3…

Answer 15

Diagnosis is unstable angina

Question 16

Before an Exercise EKG you should avoid?

Answer 16

Avoid B-blockers and CCB before

Question 17

Can’t do EKG stress test if old LBBB

or

Baseline ST elevation

or

on Digoxin.

Do what instead?

Answer 17

Do Exercise Echo instead.

Question 18

If pt can’t exercise

Do chemical stress test w/

Answer 18

Dobutamine or Adenosine.

Question 19

Post MI main cause of death?

Answer 19

Arrhythmias.

V-fib

Question 20

Post-MI New systolic murmur 5-7 days s/p?

Answer 20

Papillary muscle rupture

Question 21

Post-MI Acute severe hypotension?

Answer 21

Ventricular free wall rupture

Question 22

Post MI “step up” in O2 conc from RARV?

Answer 22

Ventricular septal rupture

Question 23

Post MI Persistent ST elevation ~1mo later + systolic MR murmur?

Answer 23

Ventricular wall aneurysm

Question 24

Post MI “Cannon A-waves”?

Answer 24

AV-dissociation.

Either V-fib or 3rd degree heart block

Question 25

Post MI, 5-10wks later pleuritic CP, low grade temp?

Answer 25

Dressler’s syndrome (probably) autoimmune pericarditis. Tx w/ NSAIDs and Aspirin.

Question 26

If worse w/ inspiration, better w/ leaning forwards, friction rub & diffuse ST elevation?

Answer 26

pericarditis

Question 27

Chest Pain, If worse w/ palpation?

Answer 27

Costochondriasis

Question 28

If vague w/ hx of viral infxn and murmur?

Answer 28

Myocarditis

Question 29

If occurs at rest, worse at night, few CAD risk factors and migraine headaches, w/ transient ST elevation during episodes?

Answer 29

Prinzmetal’s angina Dx w/ ergonovine stim test Tx w/ CCB or nitrates

Question 30

EKG: “Progressive, prolongation of the PR interval followed by a dropped beat”

Answer 30

Wikebock Mobitz Type I

Question 31

EKG: Cannon-a waves on physical exam. “regular P-P interval and regular R-R interval”

Answer 31

3rd Degree Heart Block

Question 32

EKG: “varrying PR interval with 3 or more morphologically distinct P waves in the same lead”. Seen in an old person w/ chronic lung dz in pending respiratory failure (pneumonia)

Answer 32

Multifocal Atrial Tachycardia (MAT)

Question 33

EKG: “Three or more consecutive beats w/ QRS \<120ms @ a rate of \>120bpm”

Answer 33

Ventricular Tacycardia Defib if unstable Lidocaine or Amiodorone if stable

Question 34

EKG: “Short PR interval followed by QRS \>120ms with a slurred initial deflection representing early ventricular activation via the bundle of Kent”. Delta Waves present

Answer 34

Wolf-Parkinsone-White (WPW) Tx: Procainamide! DONT GIVE Anything that Slows AV conduction B-blockers, Digoxin, CCB, Verapamil, Diltiazam

Question 35

EKG: “Regular rhythm with a ventricular rate of 125-150 bpm and atrial rate of 250-300 bpm” Saw-tooth

Answer 35

Atrial Flutter Tx Unstable - Shock-em' - cardiovert Tx Stable - B-blockers or Digoxin

Question 36

EKG: “prolonged QT interval leading to undulating rotation of the QRS complex around the EKG baseline” In a pt w/ low Mg and low K. Li or TCA OD" Electrolyte Abnormality (Low Magnesium, Low Potassium) Tricyclic abnormality

Answer 36

Torsaides De Pointes

Question 37

EKG: “Regular rhythm w/ a rate btwn 150-220bpm.” Sudden onset of palpitations/dizziness and then they go away.

Answer 37

Supra Ventricular Tachycardia 1st Line Tx: Carotid Massage 2nd Line Tx: Adenosine

Question 38

EKG: Renal failure patient/crush injury/burn victim w/ “peaked T-waves, widened QRS, short QT and prolonged PR.” Renal Patient who missed dialysis Burn Victims

Answer 38

Hyperkalemia

Question 39

EKG: “Alternate beat variation in direction, amplitude and duration of the QRS complex” in a patient w/ pulsus paradoxus, hypotension, distant heart sounds, JVD Undulating Baseline

Answer 39

Tamponade Electrical Alternans

Question 40

EKG: “Undulating baseline, no p- waves appreciated, irregular R-R interval” in a hyperthyroid pt, old pt w/ SOB/dizziness/palpitations w/ CHF or valve dz Too much synthroid CHF who has Valve Disease

Answer 40

Atrial Fibriliation (A-fib) 1st Line Tx: Rate or Rhythem control? - Rate Control B-blocker

Question 41

SEM cresc/decresc, louder w/ squatting, softer w/ valsalva. + parvus et tardus

Answer 41

Aortic Stenosis

Question 42

SEM louder w/ valsalva, softer w/ squatting or handgrip. Valsalva decreases preload

Answer 42

HOCM

Question 43

Late systolic murmur w/ click louder w/ valsalva and handgrip, softer w/ squatting

Answer 43

Mitral Valve Prolapse

Question 44

Holosystolic murmur radiates to axilla w/ LAE

Answer 44

Mitral Regurgitation

Question 45

Holosystolic murmur w/ late diastolic rumble in kiddos

Answer 45

VSD

Question 46

Continuous machine like murmur-

Answer 46

PDA

Question 47

Wide fixed and split S2-

Answer 47

ASD

Question 48

Rumbling diastolic murmur with an opening snap, LAE and A-fib

Answer 48

Mitral Stenosis

Question 49

Blowing diastolic murmur with widened pulse pressure and eponym parade

Answer 49

Aortic Regurgitation

Question 50

If you suspect PE (history of cancer, surgery or lots of butt sitting)  then what?

Answer 50

Heparin!

Question 51

For acute pulmonary edema give?

Answer 51

Nitrates Lasix Morphine

Question 52

If young w/ sxs of CHF w/ prior hx of viral infx? SOB on exertion or need Pillows at Night

Answer 52

Consider Myocarditis (Coxsackie B)

Question 53

If pt is young and no cardiomegaly on CXR --\> consider?

Answer 53

pHTN Order Right Heart Cath - Measure Left Atrial Pressure

Question 54

Systolic CHF - decreased EF (\<55%) – Ischemic, dilated

Answer 54

* Viral, ETOH, Cocaine, Chagas, Idiopathic * Alcoholic dilated cardiomyopathy is reversible if you stop the booze.

Question 55

Diastolic- normal EF, heart can’t fill?

Answer 55

HTN, amyloidosis, hemachromatosis • Hemachromatosis restrictive cardiomyopathy is reversible w/ Phlebotomy.

Question 56

ACE-I ?

Answer 56

Improve survival- prevent remodeling by aldo

Question 57

B-blocker ?

Answer 57

(metoprolol and carveldilol) Improve survival- prevent remodeling by epi/norepi

Question 58

Spironolactone ?

Answer 58

Improves survival in NYHA class III and IV

Question 59

Furosemide ?

Answer 59

Improves sxs (SOB, crackles, edema)

Question 60

Digoxin

Answer 60

Decreases sxs and hospitalizations. NOT survival