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Family Medicine: Case Files > EH: Cardiology > Flashcards

EH: Cardiology Flashcards

1
Q

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

A

EKG

Cardiac Enzymes

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2
Q

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

A

STEMI

ST elevation immediately

T wave inversion 6hrs- years

Q waves last forever

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3
Q

V1-V4

A

Anterior LAD

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4
Q

I, avL, V4-V6

A

Lateral Circumflex

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5
Q

II, III and aVF

A

Inferior RCA

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6
Q

V4 on R-sided EKG is 100% specific

A

R ventricular

RCA

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7
Q

Emergency reperfusion

A

Go to cath lab or *thrombolytics if no contraindications

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8
Q

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

A

Right ventricular infarct

DON’T give Nitro

Tx w/ vigorous fluid resuscitation.

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9
Q

Myoglobin enzymes

A

Rises 1st Peaks in 2hrs

nl by 24

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10
Q

CKMB enzymes

A

Rise 4-8hrs Peaks 24 hrs

nl by 72hs

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11
Q

Troponin I enzymes

A

Rise 3-5hrs Peaks 24-48hrs

nl by 7-10days

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12
Q

MONA/C-B Tx therapy?

A

Morphine

Oxygen

Nitrates

Aspirin / Clopidogrel

B-blocker

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13
Q

CABG if?

A

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

Pain despite maximum medical tx

Post-infarction angina

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14
Q

Cardio Discharge Meds?

A

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

B-blocker

ACE-inhibitor if CHF or LV-dysfxn

Statin

Short acting nitrates

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15
Q

If no ST-elevation and normal cardiac enzymes x3…

A

Diagnosis is unstable angina

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16
Q

Before an Exercise EKG you should avoid?

A

Avoid B-blockers and CCB before

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17
Q

Can’t do EKG stress test if old LBBB

or

Baseline ST elevation

or

on Digoxin.

Do what instead?

A

Do Exercise Echo instead.

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18
Q

If pt can’t exercise

Do chemical stress test w/

A

Dobutamine or Adenosine.

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19
Q

Post MI main cause of death?

A

Arrhythmias.

V-fib

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20
Q

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

A

Papillary muscle rupture

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21
Q

Post-MI Acute severe hypotension?

A

Ventricular free wall rupture

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22
Q

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

A

Ventricular septal rupture

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23
Q

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

A

Ventricular wall aneurysm

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24
Q

Post MI “Cannon A-waves”?

A

AV-dissociation.

Either V-fib or 3rd degree heart block

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25
Q

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

A

Dressler’s syndrome

(probably) autoimmune pericarditis.

Tx w/ NSAIDs and Aspirin.

26
Q

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

A

pericarditis

27
Q

Chest Pain, If worse w/ palpation?

A

Costochondriasis

28
Q

If vague w/ hx of viral infxn and murmur?

A

Myocarditis

29
Q

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

A

Prinzmetal’s angina

Dx w/ ergonovine stim test

Tx w/ CCB or nitrates

30
Q

EKG:

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

A

Wikebock Mobitz Type I

31
Q

EKG:

Cannon-a waves on physical exam.

“regular P-P interval and regular R-R interval”

A

3rd Degree Heart Block

32
Q

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)

A

Multifocal Atrial Tachycardia (MAT)

33
Q

EKG:

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

A

Ventricular Tacycardia

Defib if unstable

Lidocaine or Amiodorone if stable

34
Q

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

A

Wolf-Parkinsone-White (WPW)

Tx: Procainamide!

DONT GIVE Anything that Slows AV conduction
B-blockers, Digoxin, CCB, Verapamil, Diltiazam

35
Q

EKG:

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

Saw-tooth

A

Atrial Flutter

Tx Unstable - Shock-em’ - cardiovert

Tx Stable - B-blockers or Digoxin

36
Q

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

A

Torsaides De Pointes

37
Q

EKG:

“Regular rhythm w/ a rate btwn 150-220bpm.”

Sudden onset of palpitations/dizziness and then they go away.

A

Supra Ventricular Tachycardia

1st Line Tx: Carotid Massage

2nd Line Tx: Adenosine

38
Q

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

A

Hyperkalemia

39
Q

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

A

Tamponade

Electrical Alternans

40
Q

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

A

Atrial Fibriliation (A-fib)

1st Line Tx: Rate or Rhythem control? - Rate Control
B-blocker

41
Q

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

A

Aortic Stenosis

42
Q

SEM louder w/ valsalva, softer w/ squatting or handgrip.

Valsalva decreases preload

43
Q

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

A

Mitral Valve Prolapse

44
Q

Holosystolic murmur radiates to axilla w/ LAE

A

Mitral Regurgitation

45
Q

Holosystolic murmur w/ late diastolic rumble in kiddos

46
Q

Continuous machine like murmur-

47
Q

Wide fixed and split S2-

48
Q

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

A

Mitral Stenosis

49
Q

Blowing diastolic murmur with widened pulse pressure
and eponym parade

A

Aortic Regurgitation

50
Q

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

51
Q

For acute pulmonary edema give?

A

Nitrates

Lasix

Morphine

52
Q

If young w/ sxs of CHF w/ prior hx of viral infx?

SOB on exertion or need Pillows at Night

A

Consider Myocarditis (Coxsackie B)

53
Q

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

A

pHTN

Order Right Heart Cath - Measure Left Atrial Pressure

54
Q

Systolic CHF - decreased EF (<55%)

– Ischemic, dilated

A
  • Viral, ETOH, Cocaine, Chagas, Idiopathic
  • Alcoholic dilated cardiomyopathy is reversible if you stop the booze.
55
Q

Diastolic- normal EF, heart can’t fill?

A

HTN, amyloidosis, hemachromatosis

• Hemachromatosis restrictive cardiomyopathy is reversible w/ Phlebotomy.

56
Q

ACE-I ?

A

Improve survival- prevent remodeling by aldo

57
Q

B-blocker ?

A

(metoprolol and carveldilol)

Improve survival- prevent remodeling by epi/norepi

58
Q

Spironolactone ?

A

Improves survival in NYHA class III and IV

59
Q

Furosemide ?

A

Improves sxs (SOB, crackles, edema)

60
Q

Digoxin

A

Decreases sxs and hospitalizations. NOT survival

Family Medicine: Case Files (21 decks)

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