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IM > Emma H review > Flashcards

Emma H review Flashcards

1
Q

*** scary new ekg changes that say STEMI

A

2mm ST elevation or new LBBB

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2
Q

wide flat QRS

A

LBBB

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3
Q

anterior infarct

A

LAD; V1-V4

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4
Q

lateral infarct

A

Circumflex; I, avL, V4-V6

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5
Q

Inferior infarct

A

RCA; II, III and aVF

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6
Q

R ventricular infarct

A

RCA; V4 on right sided ekg is 100% specific

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7
Q

*** V1-V4 lead changes

A

Anterior and LAD

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8
Q

*** II, III and avF changes

A

Inferior, RCA

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9
Q

thrombolytic window

A

6 hrs

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10
Q

CI to thrombolytics

A

active bleed, anticoagulated, recent ischemic stroke, hemorrhagic stroke, recent closed head trauma

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11
Q

hypotension, tachycardia, JVD but lungs are clear

A

R ventricular infarct - Don’t give nitro b/c risk of hypotension, give fluid with NS bolus!

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12
Q

patient with chest pain but normal EKG, what next?

A

cardiac enzymes, at least 3 sets q8hr

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13
Q

*** when does troponin rise and when normal by

A

rise 3-5 hrs, nl by 7-10 days

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14
Q

labs for repeat infarct

A

CKMB or myoglobin*

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15
Q

MI cocktail

A

morphine, oxygen, nitrates, aspirin/clopidogrel, bb

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16
Q

you find a lesion on coronary angiography, what to do?

A

PCI or CABG

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17
Q

when to CABG?

A 
L main disease
3 vessel disease or 2 vessel disease PLUS DM
>70% occlusion 
pain despite maximal medical tx
post-infarction angina
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18
Q

*** medication after MI

A 
aspirin + clopidogrel if stent
bb
ACEi in CHF of LV dysfunction
Statin
SA nitrates
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19
Q

*** pt with chest pain but normal EKG and cardiac enzymes, what to do?

A

stress test for suspect angina

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20
Q

*** when can’t you do a stress test

A

abnormal baseline EKG (LBB or baseline ST elevation)

on digoxin

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21
Q

findings of a + stress test

A

chest pain reproduced, ST depression, hypotension

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22
Q

Cause of death post-MI

A

arrhythmias, namely V-fib

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23
Q

New systolic murmur 5-7 days following MI

A

papillary muscle rupture with MR

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24
Q

acute severe hypotension following MI

A

ventricular free wall rupture

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25
Q

“step up” in O2 concentration from RA to RV following MI

A

ventricular septal rupture

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26
Q

*** persistent ST elevation ~ 1 mo later + systolic MR murmur post MI

A

ventricular wall aneurysm

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27
Q

cannon-A waves

A

bounding pulsations of jugular vein - AV dissociation, either v-fib or 3rd degree heart block (AV node ischemia)

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28
Q

5-10 weeks following MI. pleuritic CP

A

Dressler’s syndrome - thought to be autoimmune, treat with NSAIDs or aspirin

29
Q

CP, murmur, vague history of viral illness

A

myocarditis

30
Q

*** CP at rest, worse at night, also migraine HA and EKG shows transient ST elevation with episodes

A

Prinzmetal angina, dx with ergonovine stim tests

31
Q

*** pt is diagnosed with Prinzmetal angina following ergonovine stim test, what is tx?

A

CCB or nitrates

32
Q

progressive prolongation of PR interval followed by dropped beat

A

Mobitz type 1

33
Q

regular p-p and r-r intervals but no pattern between p and qrs

A

3rd degree heart block - would see cannon-a wave

34
Q

multifocal atrial tachycardia

A

rapid, irregular atrial rhythm arising from multiple foci in atria; severely sick pt with lung/heart path; poor prognosis

35
Q

normal QRS

A

< 0.12 sec = 3 small squares

36
Q

normal PR

A

< 0.2 sec = typically 3-5 small squares

37
Q

vtach tx

A

unstable = shock; stable = medical tx (lidocaine, amiodarone)

38
Q

delta wave

A

gradual up-sloping of QRS complex

39
Q

*** QRS > 120 ms with slurred initial deflection representing early ventricular activation via the bundle of Kent

A

WPW; tx with procainamide

40
Q

*** rx CI in WPW

A

anything that slows the AV node - bb, digoxin, verapamil, diltiazem

41
Q

regular rhythm with ventricular rate 125-150 and atrial rate 250-300

A

atrial flutter

42
Q

*** OD of ___ or ____ can lead to torsades

A

Lithium or TCA

43
Q

girl in her 20s with sudden palpitations found to have EKG with regular rhythm and rate 200, what is it and what to do?

A

SVT, tx is NON-rx first -> carotid massage or face in ice

44
Q

causes of hyperkalemia

A

burn victim, renal failure, crush injury

45
Q

EKG with undulating baseline, low-voltage; pt has pulsus paradoxus, hypotension, distant heart sounds, JVD

A

electrical alternans in cardiac tamponade

46
Q

why low voltage with EKG of tamponade

A

blood buffering voltage

47
Q

first line of afib tx

A

rate control

48
Q

causes of AS

A

age with calcific degeneration, congenital anomaly (bicuspid like Turners)

49
Q

*** systolic cresc/decresc murmur that is louder with squatting + parvus et tardus on palpation of pulse

A

AS

50
Q

*** late systolic murmur with click that is louder with valsalva and handgrip

A

MV prolapse

51
Q

*** holo-systolic murmur loudest at apex and radiates to axilla

A

MR

52
Q

continuous machine like murmur

A

PDA

53
Q

wide fixed split S2

A

ASD

54
Q

rumbling diastolic murmur with an opening snap

A

MS

55
Q

*** blowing diastolic murmur with widened pulse pressure

A

AR

56
Q

two diastolic murmurs especially important in the aging population

A

MS + AR

57
Q

how does squatting, inspiration, and handgrip affect blood flow?

A

INCREASES blood flow return to the heart

58
Q

how does standing and valsalva affect blood flow?

A

DECREASES blood flow return to the heart

59
Q

what maneuvers can you do to increase preload?

A

squatting, handgrip, inspiration

60
Q

what maneuvers decrease preload?

A

valsalva

61
Q

*** which murmurs are worsened by increased preload?

A

stenotic and regurgitant valves - AS, MS, AR, MR

62
Q

*** these two murmurs are made LOUDER by DECREASED preload

A

HCOM and MV prolapse

63
Q

why is HCOM worse with valsalva (decreased preload)

A

without blood to push thing open, the hypertrophied septum covers the aortic opening

64
Q

D\does less preload mean LOUDER floppy valves of MV prolapse?

A

YES

65
Q

what to do for pt with SOB + murmur + hx of CHF

A

get an echo

66
Q

acute pulmonary edema tx

A

nitrates, lasix, morphine

67
Q

young pt who has sx of CHF and recent hx of viral illness

A

myocarditis, most likely coxsackie

68
Q

*** what test can help you differentiate CHF from pulmonary HTN?

A

right heart cath

IM (17 decks)

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