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CARDIOLOGY AWR > HEART BLOOD SUPPLY, AREA SUPPLIED AND EKG LEADS > Flashcards

HEART BLOOD SUPPLY, AREA SUPPLIED AND EKG LEADS Flashcards

1
Q

INFERIOR WALL

A

RCA
LEADS II, III, AVF
IWMI

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2
Q

POSTERIOR WALL

A

RCA
V1, V2-R WAVES
RVWMI

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3
Q

RIGHT VENTRICLE

A

RCA
V3R, V4R IN RIGHT SIDE EKG

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4
Q

SA NODE

A

RCA
ARRHYTHMIAS

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5
Q

AV NODE

A

RCA
HEART BLOCKS

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6
Q

ANTERIO-SEPTAL

A

LAD
V1-V4

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7
Q

ANTERIOR

A

LAD
V3-V4

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8
Q

APICAL/LATERAL

A

LAD
V5-V6

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9
Q

SAL

A

LAD
S V1 V2 SEPTAL
A V3 V4A ANTERIOR
L V5 V6 LATERAL

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10
Q

APICAL/LATERAL

A

LAD-V5 V6
LEFT CIRCUMFLEX BRANCH ARTERY-V5 V6

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11
Q

APICAL

A

POSTERIOR DESCENDING ARTERY
V5-V6

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12
Q

HIGH LATERAL WALL

A

CIRCUMFLEX BRANCH/DIAGNOL BRANCH OF LCA
I, AVL

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13
Q

MI

A

ST ELEVATION

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14
Q

ISCHEMIA

A

ST DEPRESSION

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15
Q

LEAST COMMON AREAS FOR MI AND ISCHEMIA DUE TO COLLATERAL/DUAL BLOOD SUPPLY

A

V5-V6
APICAL LATERAL
AND APICAL HEART

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16
Q

IWMI II,III, AVF -RCA POST TPA
PATIENT BECOMES HYPOTENSIVE

A

MUST DO RIDE SIDE ECG TO R/O EXTENSION OF MI TO RVWMI V3R-V4R

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17
Q

LAD

A

WIDOW MAKER

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18
Q

CP
ON EXERTION
RELIEVED WITH REST

A

ALL 3+
CLASSICAL ANGINA

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19
Q

CP
ON EXERTION
RELIEVED WITH REST

A

2+/3
ATYPICAL ANGINA

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20
Q

CP
ON EXERTION
RELIEVED WITH REST

A

ONLYCP+
NONCARDIAC ORIGIN OF CHEST PAIN

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21
Q

CP+ ALONE AND
MALE 40 OR OLDER
FEMALE 60 AND OLDER

A

INTERMEDIATE PROBABLITY NEED TO
DO STRESS TEST

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22
Q

CP+ 2/3(ATYPICAL ANGINA
MALE 39 AND ABOVE
FEMALE 50 AND ABOVE

A

NEED TO DO STRESS ON HEART TO REPRODUCE ISCHEMIA

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23
Q

60 F WALKS DAILY ON TREADMILL WHEN INCREASES SPEED AND INCLINE GETS SOB ON EXERTION WITH CHEST HEAVINESS WITH NORMAL BASELINE ECG NEXT STEP?

A

DO EXERCISE EKG STRESS TEST

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24
Q

50M WALKS DOG DAILY, RECENTLY NOTED CP LASTING 15 MIN CANT RECALL RELIEVING OR AGGRAVATING FACTORS
HTN+ ON CHLORTHALIDONE
BASELINE EKG +LVH
NEXT STEP?

A

EXERCISE STRESS ECHO

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25
Q

60 M WITH EXERTIONAL CP, CANNOT WALK MORE THAN 1 BLOCK W/O DYSPNEA
NO EXACERBATING OR RELIEVING FACTORS
+PMHX COPD- +WHEEZE
BASELINE EKG NORMAL
NEXT STEP?

A

DOBUTAMINE STRESS TEST

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26
Q

65 F WITH EXERTIONAL DYSPNEA AND OCCASIONAL CP+
NO RELIEVING FACTORS
BASELINE EKG+LBBB NEXT STEP?

A

VASODILATOR PET
REGADENOSINE, DUPYRIDAMOLE

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27
Q

WHO CAN UNDERGO EKG EXERCISE STRESS TEST?

A

RBBB

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28
Q

48M WITH CP+ AND EKG +LBBB
RAGADENOSON MPI REVEALS ANTEROSEPTAL ISCHEMIA ARTERY?

A

HIGH GRADE LAD STENOSIS
V1-V4

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29
Q

62 F +EXERTIONAL CP, EKG STRESS TESTS -STOPPED AT 5 MIN D/T CP+ AND ST DEPPRESION IN I, AVL, V4-V6 ARTERY?

A

LEFT CIRCUMFLEX ARTERY STENOSIS
APICAL/LATERAL WALLMI

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30
Q

62 F WITH +HTN AND CP+ EKG WITH +LVH, EXERCISE ECHO STRESS TEST STOPPED IN 5 MIN DUE TO CP+ AND ST DEPRESSION IN II, III, AVF ARTERY?

A

RCA
IWMI

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31
Q

WHO GETS GATED POOL STUDIES OR MUGA SCAN?

A

IN PTS TO DETERMINE LV EF AND WALL MOTION ABNORMALITIES DECREASED LV EF IS POOR PROGNOSTIC FACTOR ON MUGA

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32
Q

WHEN NOT TO DO STRESS TEST

A

UNSTABLE ANGINA
OR
AS WITH SYMPTOMS

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33
Q

OBESE FEMALE WITH ATYPICAL CP+
DOES EXERCISE STRESS TEST , STOPS TEST AFTER 5 MIN D/T FATGIUE BUT NO CP.
HR INCREASED BY 50%
EKG- NORMAL NEXT STEP?

A

PHARM STRESS TEST DUE TO SUBMAXIMAL CARIAC STRESS STUDY

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34
Q

UNSTABLE ANGINA

A

-NEW ONSET SEVERE ANGINA <2 MONTHS
-ANGINA AT REST
-RECENT INCREASED FREQUENCY
-POST-INFARCT ANGINA

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35
Q

PT WITH +ANGINA CONTROLLED ON BB, ASA AND NITRATES PRESENT WITH RECENT INCREASED FREQUENCY AND CP NOW LASTS FOR>30 MIN
EKG-ST DEPRESSION IN II, III, AVF
MOST LIKELY MECH OF PATIENTS Cp?

A

ATHEROSCLEROTIC PLAQUE WITH INTERMITTENT RUPTUREMAND THROMBOLYSIS
UNSTABLE ANGINA

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36
Q

PT WITH +HX CHRONIC ANGINA CONTROLLED ON ASA AND NITRATES
WITH THE INCREASING FREQUENCY OF ANGINA NEXT STEP?

A

ADD BB

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37
Q

PT WITH +HX CHRONIC ANGINA CONTROLLED ON ASA AND NITRATES (12HR NITRATE FREE INTERVAL +) RECENTLY ADDED BB-METOPROLOL 12.5MG QD 6 MONTHS LATER COMES IN WITH ANGINA AFTER WALKING 2 BLOCKS PAIN RESOLVES AFTER FEW MINS OF REST. PE HR IS 80/M BP 140/90
NEXT STEP?

A

INCREASE METOPROLOL DOSE TIL HR<60

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38
Q

PT WITH +HX CHRONIC ANGINA CONTROLLED ON ASA AND NITRATES (12HR NITRATE FREE INTERVAL +) METOPROLOL 50MG BID 6 MONTHS LATER COMES IN WITH ANGINA AFTER WALKING 2 BLOCKS HR 55/M NEXT STEP?

A

ANGIOGRAM —>PCI

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39
Q

PT WITH CP+ ON EXERTION AND RELIEVED WITH REST. PAST 4HRS
EKG+ ST DEPRESSION WITH NORMAL TROP
PT GETS ASA, NTG, BB, HEPARIN AND SX RESOLVES THE NEXT STEP?

A

PCI
HAS TO BE DONE WITHIN 24 HOURS
IT HAS SHOWN TO DECREASE RATE OF RECURRENT MI AND DECREASE ALL CAUSE MORTALITY

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40
Q

PT ON ASA, NITRATES, BB, STATINS FOR HIGH CHOL.
HB NORMAL AND NO SIGNS OF INFECTIONOR STRESS WITH INCREASING EPISODES OF ANGINA ON EXERTION. ANGIOGRAM REVEALS MULTIVESSEL DISEASE NOT AMEANABLE TO TEVASCULARIZAATION
BEST MNGMT?

A

RANOLAZINE-DECREASES FREQUENCY OF ANGINA EPISODES AND IMPROVED EXERCISE TOLERANCE BUT NO DECREASE IN ALL CAUSE MORTALITY

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41
Q

PT SOPPED ASA D/T PUD 2 MONTHS AGO. WAS SRATED ON PPI
NO PRESENTS WITH CP
NEXT STEP?

A

start ASA

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42
Q

45 M OTHERWISE HEALTHY, NONSMOKER, NO DM, PRESENTS WITH NEW ONSET CP OF > 30 MIN DURATION WHILE SHOVELING SNOW. IN ER-EKG NORMAL NEXT STEP?

A

ADMIT TO CHEST PAIN UNIT

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43
Q

45 M OTHERWISE HEALTHY, NONSMOKER, NO DM, PRESENTS WITH NEW ONSET CP OF > 30 MIN DURATION WHILE SHOVELING SNOW. IN ER-EKG NORMALADMITTED TO CHEST PAIN UNIT
NEXT DAY
ENX-, TROP -, EKG NO CHANGES THE NEXT STEP?

A

STRESS EKG TEST

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44
Q

65 M WOKE UP EARLY AM WITH SEVERE RESTROSTERNAL CP LASTING 40 MIN WITH SWEATING AND DIAPHORESIS
ER EKG+ST DEPRESSION AND T WAVE INVERSION
PT STARTED ON ASA, IV NITRATES, BB, LMWH AND GPIIB/IIIA INHIBITORS.
ANGINA PAIN RESOLVES BUT
24 HOURS LATER ST DEPRESSION PERSISTS WHAT DOES THIS REPRESENT?

A

SILENT ISCHEMIA

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45
Q

65 M WOKE UP EARLY AM WITH SEVERE RESTROSTERNAL CP LASTING 40 MIN WITH SWEATING AND DIAPHORESIS
ER EKG+ST DEPRESSION AND T WAVE INVERSION
PT STARTED ON ASA, IV NITRATES, BB, LMWH AND GPIIB/IIIA INHIBITORS.
ANGINA PAIN RESOLVES BUT
24 HOURS LATER ST DEPRESSION PERSISTS MOST APPROPRIATE DIAGNOSTIC STEP?

A

CORONARY ANGIOGRAM

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46
Q

WHAT CAN REPRESENT AS AN ANGINAL EQUIVLANT?

A

IN ABSENCE OF PULMONARY DISEASE WITH SX+ EXERTIONAL DYSPNEA WITHOUT CP IN A PATIENT

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47
Q

42 F PRESENTS WITH RETROSTERNAL CP FOR PAST 2 HOURS
PMHX-
RUNS 2 MILES 3X/WEEK
EKG+NONSPECIFIC
T-WAVE CHANGES
TROP IS 22 NEXT STEP?

A

CORONARY ANGIOGRAM

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48
Q

IN ABSENCE OF PULMONARY DISEASE WITH SX+ EXERTIONAL DYSPNEA WITHOUT CP IN A PATIENT REPRESENTING ANGINA EQUIVELANT MC SEEN IN PATIENTS WITH?

A

DM
FEMALES
ELDERLY
POSTCABG

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49
Q

65 F HAS EXERTIONAL SOB DURING EXERCISE AND RELIEVED POST EXERCISE. MR MURMUR DURING EXERCISE WHICH DISAPEARS POST EXERCISE
S4+
ECHO+ MILD HYPOKINESIS AND EF 60% MOST LIKELY ETIOLOGY?

A

ISCHEMIC

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50
Q

46 M WITH CP+ LASTING 15 MIN
ER- CP RESOLVED
HR 72/M BP 118/76
EKG- ST ELEVATION, +ONLY DEEP TWAVE INVERSION IN V1,V2,V3,V4
WHAT DOSE THIS REPRESENT?

A

MYOCARDIAL ISCHEMIA
WELLENS SYNDROME/LAD T WAVE INVERSION SYNDROME
ANTEROSEPTAL ISCHEMIA V1-V4

51
Q

46 M WITH CP+ LASTING 15 MIN
ER- CP RESOLVED
HR 72/M BP 118/76
EKG- ST ELEVATION, +ONLY DEEP TWAVE INVERSION IN V1,V2,V3,V4
WHAT TO DO FOR THIS PATIENT NEXT?

A

STRAIGHT TO ANGIOGRAM
NOT ECHO
NOT STRESS TEST

52
Q

PT PRESENTS WITH CP+, EKG-
THALLIUM STRESS TEST WITH REVERSIBLE ISCHEMIA
CORONARY ATERIOGRAPHY IS NEGATIVE
WHAT IS DIAGNOSIS AND HOW DO YOU TREAT IT?

A

DX: MICROVASCULAR ANGINA/SYNDROME X

RX:
-CCBS
-BBS AND NITRATES

53
Q

PT WITH CP AT NIGHT 5-15 MIN AT REST
NEXT STEP?

A

EKG–>ST-T WAVE CHANGES–> ANGIOGRAM —> NEGATIVE–>NEXT DO AMBULATORY EKG–> POSITIVE–> VASOSPASTIC ANGINA

54
Q

PT WITH CP AT NIGHT 5-15 MIN AT REST
NEXT STEP?

A

EKG–>NO CHANGES–> STRESS TEST –> NEGATIVE–> AMBULATORY EKG–> POSITIVE ST ELEVATIONS–> ANGIOGRAM –> NEGATIVE–> VASOSPASTIC ANGINA

55
Q

TOC FOR VASOSPASTIC ANGINA

A

CCBS-AMLODIPINE, NIFEDIPINE,DILTIAZEM, VERAPIMIL

56
Q

ELDERLY M WITH +SYNCOPE.
EKG ON PRESENTATION -NORMAL
FEELS DIZZY AFTER DINNER
EKG SHOWS ST DEPRESSION IN II, III, AVF
REPEAT EKG AFTER 15 MIN -NORMAL
DX?
NEXT BEST STEP IN MGNMT?

A

DX: POSTPRANDIAL ISCHEMIA

NEXT STEP: CARDIAC CATH(ANGIOGRAM)

57
Q

ELDERLY M COMPLAINS OF LIGHTHEADEDNESS AFTER MEALS ESPECIALLY LUNCH AND DINNER FOR PAST COUPLE MONTHS
PASSED OUT 2X/6 MONTHS
BP 122/82
NEXT STEP?

A

SMALL FREQUENT MEALS

58
Q

LEAST LIKELY TO CASE ST ELEVATION?

A

UNSTABLE ANGINA

59
Q

OTHER CAUSES OF ST ELEVATION

A

-TRANSMURAL MI
-LV ANEURYSM POST MI-CONFIRM DX WITH ECHO
-ACUTE PERICARDITIS
-PRINZMETALS ANGINA
-TAKOTSUBO CARDIOMYOPATHY

60
Q

21 PT CP+ COCAINE+ BP160/100
STEPS IN ORDER FOR MNMGT?
AND PREVENTION OF CP IN FUTURE?

A

1-BZD
2-NITRATES
3-ASA
4-PCI

PREVENTION WITH CCB

61
Q

MYGLOBIN LEVELS

A

INCREASE IMMEDIATELY
-PEAKS IN 1-4 HOURS
-BACK TO NORMAL IN 24 HOURS
NORMAL RANGE 0-85NG/ML

62
Q

PT CP+, ST ELEVATIONS AND TROPS ELEVATTED
S/P TPA , ST RESOLVE, CP RESOLVED
NEXT BLOOD DRAW-TROPININ LEVELS EVEN HIGHER NEXT STEP?

A

NOTHING
GOOD SIGN MEANS GOOD REPERFUSION REOPS PEAK FASTER AND PEAK IS HIGHER THAN THOSE NOT SUCCESSFULLY REPERFUSED

63
Q

PT WITH ACUTE CP+, ST ELEVATION
PCI DONE
NEXT DAY CP+, BEST MARKER TO DIAGNOSE MI?

A

MYGLOBIN
INCREASES IN 1 HR–> PEAKS IN 1-4–>BACK TO NORMAL IN <24 HOURS

64
Q

65 M ADMITTED WITH PNA TO MICU ON IV ABX. EKG NORMAL
TROP 1.3 NEXT STEP?

A

ECHO

65
Q

INDICATIONS FOR THROMBOLYSIS WITH TPA?

A

**CP+ TYPICAL FOR INFARCTION>30 MIN WIHT LBBB
**ST ELEVATION 1MM IN 2 CONTIGUOUS LEADS
**<12HOURS POST MI
** PT >2HOURS AWAY FROM PCI CENTER AND NOT IN SHOCK

66
Q

ELEVATED TROPS ARE POOR PROGNOSTIC FACTORS AND CAN BE SEEN IN?

A

-CHF
-CRITICAL ILLNESS
-LVH
-HOCM
-PAD
-CORONARY VASOSPASM
-PE
-CKD
-PNA

67
Q

CONTRAINDICATIONS FOR THROMBOLYTIC RX
ABSOLUTE

A

**PREVIOUS HEMORRHAGIC STROKE
**ISCHEMIC STROKE <3 MO AGO
**INTRACRANIAL NEOPLASM
** ACTIVE INTERNAL BLLED

68
Q

CONTRAINDICATIONS FOR THROMBOLYTIC RX
RELATIVE

A

** ISCHEMIC STROKE>30 MO AGO
** RECENT INTERNAL BLEED OR MAJOR TRAUMA <2-4 WEEKS AGO
**BP>180/110
**PREGNANCY
**ACTIVE PUD

69
Q

INDICATIONS FOR PCI(PCI OR ANGIOPLASTY)

A

**ACUTE STEMI
**ST ELEVATION WITH CP>12HOURS
**MI WITH SHOCK AND PT <2 HOURS AWAY FROM PCI CENTER & <75 Y/O
**STEMI POST CABG PTS
**IF TPA IS CONTRAINDICATED
** UNSTABLE ANGINA

70
Q

FACTS ABOUT TICAGRELOR, PRASUGREL, CLOPIDOGREL

A

-P2Y12 ADP PLT INHIBITORS
-PT WITH MI ALLERGIC TO ASA THEN USE TICAGRELOR OR PRASUGREL
-PT GOING FOR PCI AFTER MI-USE TICA OR PRASU–NOT CLOPID
-PT GOING FOR CABG DO NOT USE TICAGRELOR OR PRASUGREL

71
Q

WHEN IS CABG BETTER THAN PCI

A

-LEFT MAIN DISEASE
-3 VESSEL DZ WITH DECREASED LV EF
-2 VESSEL DZ WITH PROXIMAL LAD AND DECREASED LV EF
-DM WITH CAD

TICAGRELOR AND PASUGREL ARE SUPERIOR TO CLOPIDOGREL IN PCI

72
Q

PT WITH CAD S/P PCI WITH STENT PLACEMENT WHICH MEDS TO D/C PATIENT HOME ON?

A

-ASA+
-TICAGRELOR+ (DAPT)
FOR AT LEAST 12 MONTHS

73
Q

PT WITH CAD S/P PCI WITH STENT PLACEMENT ON ASA+
TICAGRELOR+ (DAPT) STARTED 3 MONTHS AGO COMES IN WITH -LOW HB, +BRBPR AND EKG WITH ST DEPRESSION
PRBC TRANSFUSED
NEXT STEP?

A

CSC

74
Q

PT WITH STENT PLACED 3 MONTHS AGO ON ASA AND TICAGRELOR PRESENTS WITH GI BLEED
NEXT STEP?

A

-HOLD TICAGRELOR
-CONTINUE ASA
-RESTART TICAGRELOR ASAP

75
Q

PT WITH STENT PLACED 12 MONTHS AGO ON ASA AND TICAGRELOR PRESENTS WITH GI BLEED
NEXT STEP?

A

-D/C TICAGRELOR
-CONTINUE ASA 81MG QD

76
Q

PT WITH STENT PLACED 9 MONTHS AGO ON ASA AND TICAGRELOR GOING FOR KNEE REPLACEMENT SURGERY NEXT STEP?

A

DELAY SURGERY BY 3 MONTHS

77
Q

PT WITH AFIB HAS MI WITH PCI TREATMENT?

A

-DOAC PLUS CLOPIDOGREL X1 YEAR
-THEN DOAC ALONE AFTER 1 YEAR

78
Q

PT NOW WITH AFIB HAD MI 1 YEAR AGO WITH PCI ON ASA TREATMENT?

A

-D/C ASA
-START DOAC

79
Q

60 PT UNDERGOAS CABG
COUPLE OF MONTHS LATER HE IS DOING FINE BUT HAS PRB KEEP ACCOUNTS OCCASIONALLY
THIS REPRESENTS?

A

NEUROCOGNITITVE DEFECT

80
Q

PT WITH +RETROSTERNAL CP>1HOUR, DIAPHORETIC
EKG+ LBB, ST ELEVATED IN ANTERIOR LOADS
NO OLD EKG TO COMPARE
CK AND TROPS PENDING NEXT BEST STEP?

A

CATH/ANGIOGRAM

81
Q

PT WITH CP+ ST ELEVATIO IN ANTERIOR LEADS
S/P TPA WITH BP90/60
2 HOURS LATER-ST ELEVATION IN LATERAL LEADS AND SBP 80
PT IS + SOB
NO NEW MURMURS AT LSB OR APEX
CXR+PULMO EDEMA
NEXT BEST STEP?

A

PCI
IF CANT DO PCI NOW, THEN IABP INFLATE IN DIASTOL AND DEFLATE IN SYSTOLE

82
Q

PT WITH CP+ ST ELEVATIO IN ANTERIOR LEADS
S/P TPA WITH BP90/60
2 HOURS LATER-ST ELEVATION IN LATERAL LEADS AND SBP 80
PT IS + SOB
NO NEW MURMURS AT LSB OR APEX
CXR+PULMO EDEMA IS GOING FOR PCI AND ALLERGIC TO ASA
BEST RX?

A

TICAGRELOR OR PASUGREL

83
Q

PT IS POST IWMI AND 2HR LATER BP 90/60 SUSPESTING RV INFARCT NEXT DIAGNOSTIC STEP?
AND NEXT STP IN MNGMT?

A

DXIC: RIGHT SIDE EKG WITH V3R AND V4R

MGMT: BOLUS NORMAL SALINE FIRST
** IF BP CONTINUES TO DECREASE THEN NEXT STEP START DOPAMINE**

84
Q

PT WITH CP+ X3 HOURS
ER WKG+ ST ELEVATION IN II,III,AVF
TROPS NEG
NEXT STEP?

A

PCI

85
Q

PT WITH CP+ X3 HOURS
ER WKG+ ST ELEVATION IN II,III,AVF
TROPS NEG
PCI NOT AVAILABLE
NEXT BEST STEP IN MNGMT?

A

TPA

86
Q

PT WITH CP+ X3 HOURS
ER WKG+ ST ELEVATION IN II,III,AVF
TROPS NEG
PCI NOT AVAILABLE
TPA GIVEN WITH IN 30 MIN ARRIVAL
NEXT STEP IN MNGMT?

A

PCI AFTER 2 HOURS

87
Q

PT WITH CP+ X3 HOURS
ER EKG+ ST ELEVATION IN V2, V3, V4
TROPS +
TPA GIVEN WITH IN 30 MIN ARRIVAL
PT HAS DEVELOPED CRACKLES IN THE LUNGS AND SOB+
NEXT STEP IN MNGMT?

A

PCI ASAP

88
Q

PT PRESENT WITH 13 HRS OF CP+, TOOK ANTACIDS WITH NO RELIEF
EKG+ ST ELEVATION IN ANTERIOR LEADS
BP140/80
GIVEN ASA TO CHEW AND IV NITRATE AND IV BB AND IV MORPHINE
CLOSES PCI CENTER IS AT LEAST 1 HOURS AWAY NEXT BEST STEP?

A

TRANSFER AND DO PCI

89
Q

60 M PRESENTS TO SMALL COMMUNITY HOSP WITH CP AND FOUND TO HAVE AN ANTERIOR WALL mi.
NEAREST TERIERY CENTER IS 2HRS AWAY BEST STP IN MNGMT?

A

TPA AND THEN TRANSFER TO DO PCI

90
Q

65 M PRESENTS WITH AWMI WITH BP 80/60
PT WAS PUT ON IABP
NEAREST PCI CENTER IS 2.5 HOURS AWAY NEXT BEST STEP?

A

TPA AND THEN TRANSFER TO DO PC

91
Q

PT ADMITTED WITH MI
3 DAYS LATER PRESENT WITH CP RELIEVED WITH NTG NEXT STEP?

A

CARDIAC CATH(ANGIOGRAM)

92
Q

PT HAD CARDIAC CATH 6 HOURS AGO APPEARS DIAPHORETIC AND CLAMMY SKIN
BP80/60 HR 116/M PE-NO ERYTHEMA OR SWELLING AT PUNCTURE SITE
IVF BOLUS GIVEN
HB THIS AM WAS 14 NEXT STEP?

A

CT ABDOMEN TO CHECK FOR RETROPERITONEAL BLEED

93
Q

PT HAS CARDIAC CATH
2 DAYS LATER PRESENTS WITH PAIN IN RIGHT GROIN
PE+ERYTHEMATOUS AREA AND MILD SWELLING
NEXT STEP?

A

US-BECAUSE PSEDOANEURYSMS CAN GROW

94
Q

PT WITH MI 5 DAYS LATER(2-5 DAYS)LATER PRESENT WITH PERSISTENT CP+ WORSE ON DEEP BREATH
PERICARDIAL FRICTION RUB+
PT IS ON BB, ASA 81MG, STATIN, ACEI
CXR+EFFUSION
EKG+ DIFFUSE ST ELEVATIONS CONCAVITY UPWARDS AND PR DEPRESSION
DX?
RX?

A

DX: POST-MI INFARCTION SYNDROME (DRESSLER SYNDROME)
PERINFARCTION PERICARDITIS

RX: ASA HIGH DOSE 6-8G/DAY FOR 3-4 WEEKS PLUS COLCHICINE

95
Q

FACTORS SHOWN TO IMPROVE SURVIVAL IN MI-MEANING THEY ARE SHOWN TO DECREASE ALL CAUSE MORTALITY

A

-PCI
-THROMBOLYTIC RX AFTER QWAVE MI
-BB
-ASA
-AFTERLOAD REDUCTION (ACEI OR ARNI)
-STOP SMOKING
-STATINS
-ICD (40 DAYS LATER)
-CARDIAC REHAB

96
Q

PT WITH CP+
DIAGNOSED WITH AWMI AND TREATED IN CCU W/O COMPLICATIONS
EF 30%
D/C MEDS?

A

-DAPT X 12 MONTHS
-BB
-ACEI
-HMG COA REDUCTASE INHIBITOR(STATINS)
-ICD (40 DAYS LATER IN MEANTIME IF HIGH RISK FOR VT MAKE THEM WEAR CARDIAC DEFIB VEST)

97
Q

PT WITH MI 3 MONTHS AGO AND CURRENTLY ON ASA AND BB
WHAT WILL INCREASE HIS LONGTERM SURVIVAL?

A

START STATIN

98
Q

SEQUENCE OF MNGMT OF ACUTE CORONARY SYNDROME?

A

1-ASA
2-SL NTG
3-BB
4-ATORVASTATIN
5-UFH
6-TICAGRELOR** BEFORE PCI***
7-PCI

99
Q

PT WITH UNSTABLE ANGINA ASA, BB, STATIN STARTED
CREAT IS 1.8 NEXT STEP?

A

UFH

100
Q

POST MI COMPLICATIONS ARRHYTHMIAS
<48 HOURS

A

-NSVT-PVC 3-5 IN A ROW
ONLY OBSERVRE NO RX
-SUSTAINED VT-PVC FOR AT LEAST 30 SECS IN A ROW-MCC RECURRENT ISCHEMIA- NEEDS TO TAKE BACK FOR PCI AFTER STABALIZE
-HEART BLOCK

101
Q

POST MI COMPLICATIONS ARRHYTHMIAS
<48 HOURS
SUSTAINED VT-PVC FOR AT LEAST 30 SECS IN A ROW MNGMT

A

STABLE SUSTAINED VT
TOC: AMIODARONE OR LIDOCAINE

UNSTABLE SUSTAINED VT(CP+ OR +HOTN)
*QRS IS DISTINCT
—-SYNCHRONIZED CARDIOVERSION
OR
**QRS IS NOT DISTINCT
—DEFIBRILLATION

THEN LIDO OR AMIO

THEN PCI AND FIX

102
Q

POST MI COMPLICATIONS ARRHYTHMIAS
>48 HOURS

A

-NSVT-PVC 3-5 IN A ROW
ONLY OBSERVRE NO RX
-SUSTAINED VT-PVC FOR AT LEAST 30 SECS IN A ROW-MCC SCAR TISSUE- NEEDS ICD BEFORE D/C HOME

103
Q

POST MI COMPLICATIONS ARRHYTHMIAS
>48 HOURS
WITH SUSTAINED VTACH

A

STABLE SUSTAINED VT
TOC: AMIODARONE OR LIDOCAINE

UNSTABLE SUSTAINED VT(CP+ OR +HOTN)
*QRS IS DISTINCT
—-SYNCHRONIZED CARDIOVERSION
OR
**QRS IS NOT DISTINCT
—DEFIBRILLATION

THEN LIDO OR AMIO

THEN ICD PLACEMENT BEFORE D/C

104
Q

POST MI COMPLICATIONS
MECHANICAL RUPTURES

A

** POSTERIOR PAPILLARY MUSCLE RUPTURE–ACUTE MR
**D2-D14–SEPTAL RUPTURE –ACUTE VSD
**FREE WALL RUPTURE–CARDIAC TAMPONADE

105
Q

POST MI COMPLICATIONS
MECHANICAL RUPTURES
POSTERIOR PAPILLARY MUSCLE RUPTURE–ACUTE MR

A

RCA-IWMI
+PULMONARY EDEMA
+ TALL V WAVES(~45MM TALL)(NORMAL IS ~10MM)
IMMEDIATELY TEMP PLACE IABP - (DEFLATE IN SYSTOLE AND INFLATE IN DIASTOLE)
THEN TAKE FOR MV REPAIR NOT REPLACEMENT

106
Q

POST MI COMPLICATIONS
MECHANICAL RUPTURES
D2-D14–SEPTAL RUPTURE –ACUTE VSD

A

-ACUTE VSD MURMUR RADIATING THROUGH OUT THE PERICARDIUM
-INCREASE AUTOGRADIENT IN THE RV

THEN PLACE IABP ASAP

THEN TOC-VSD REPAIR

107
Q

POST MI COMPLICATIONS
MECHANICAL RUPTURES*hy
FREE WALL RUPTURE–CARDIAC TAMPONADE

A

FIRST- PT PASSED OUT
SEE - PULSUS PARADOXUS-+JVP BULGE, INCREASE HR, BP DROP
WILL SEE THE AMPLITUDE OF PULSE DECREASE WITH EACH BEAT.
THEN DO ECHO- SEE RA COLLASPE IN DIASTOLE AND EVENTUALLY ECHO WILL SHOW EQUALIZATION OF DIASTOLIC PRESSURES IN ALL CHAMBERS PCWP=RAP

THEN OR ASAP
TOC- SURGERY AND REPAIR NOT PERICARDIOCENTESIS

108
Q

VENTRICULAR ARRHYTHMIAS DURING ACUTE MI
VENTRICULAR ECTOPY OR NSVT

A

DO NO NOT TREAT JUST OBSERVE
- DO NOT NEED LONG TERM ANTIARRHYTHMIC RX

109
Q

VENTRICULAR ARRHYTHMIAS DURING ACUTE MI
SUSTAINED VENTRICULAR TACHY CARDIA OR V.FIB OCCURING WITH IN 48 HOURS POST MI

A
  • ARE INDEPENDENT RISK FACTORS FOR IN HOUSE MORTALITY
    BUT NOT RISK FOR SUBSEQUENT MORTALITY FROM ARRHYTHMIA AFTER D/C
  • DO NOT NEED LONG TERM ANTIARRHYTHMIC RX
110
Q

75 PRESENT WITH CP EKG+ MI AND TREATED WITH TPA, UFH, MITRATES, BB, ACEI
WITHIN 24 HRS PT DVPS NSVT OF <30SEC NEXT STEP?

A

OBSERVE ONLY

111
Q

MECH OF REPERFUSION ARRHTHMIAS?

A

TRIGGERED ACTIVITY; CHANGE IN CARDIAC FREQUENCY DUE TO ACCUMULATED CALCIUM

112
Q
A
113
Q

75 PRESENT WITH CP EKG+ MI AND TREATED WITH TPA, UFH, MITRATES, BB, ACEI
WITHIN 24 HRS PT DVPS SUSTAINED VT OF >30SEC AND UNSTABLE( CP+ OR LOW BP)NEXT STEP?

A

QRS IS DISTINCT -SYNCHRONIZED CARDIOVERSION THEN LIDO OR AMIO

QRS AND T WAVES NOT SEEN-NOT DISTINCT- DEFIBRILLITATION THEN LIDO OR AMIO

IF STABLE–THEN DO LIDO OR AMIO

AFTER ALL OF THE ABOVE BACK TO CATH(ANGIOGRAM)

114
Q

75 PRESENT WITH CP EKG+ MI AND TREATED WITH TPA, UFH, MITRATES, BB, ACEI
WITHIN 24 HRS PT DVPS SUSTAINED VT OF >30SEC AND UNSTABLE( CP+ OR LOW BP) SHOCKED STABALIZED AND REVERTS TO NSR AFTER CATH AND IS UNEVENTFUL
5 DAYS LATER PT READY TO DC DOES PT REQUIRE LONG TERM ANTI ARRHYTHMIC RX?

A

NO

115
Q

PT WITH VT OR VF 48 HOURS AFTER MI AND NO EVIDENCE OF REINFARCTION
NEXT STEP IN MNGMT

A

TREAT

116
Q

AFTER ACUTE TREATMENT OF VT OR VF THIS REPRESENTS AND INDEPENDENT RF FOR MORTALITY POST D/C THEREFORE BEFORE D/C

A

MUST HAVE ICD PLACED

117
Q

AFTER ICD PLACED IN VT/VF PT PRESENTING >48 HOURS POSTMI. SHOWS 2 DISCHARRGES FROM ICD IN THE PAST 2 MONTHS NEXT STEP?

A

START AMIODARONE AND CHECK TSH Q3 MONTHS

118
Q

AFTER ICD PLACED IN VT/VF PT PRESENTING >48 HOURS POSTMI. SHOWS 2 DISCHARRGES FROM ICD IN THE PAST 2 MONTHS WAS STARTED ON AMIO AND 4 MONTHS AFTER STARTING AMIO ICD SHOWS 4 SHOCKS NEXT BEST STEP IN MNGMT?

A

RADIOFREQUENCY CATHETER ABLATION

119
Q

50 M PRESENTS WITH SEVERE CP FOR PAST HOUR
IN ER EKG + PR DEPRESSION IN ALL LEADS

A

PR DEPRESSION IS SPECIFIC FOR+DIAGNOSIS OF PERICARDITIS

OTHER FINDINGS ON EKG+ ST ELEVATION IN ALL LEADS-SENSITIVE FOR PERICARDITIS BUT NOT SPECIFIC

120
Q

50 M PRESENTS WITH SEVERE CP FOR PAST HOUR
IN ER EKG + PR DEPRESSION IN ALL LEADS AND ST ELEVATION IN MOST LEADS
DX?
BEST RX?

A

DX: PERICARDITIS

RX: NSAIDS AND COLCHICINE

DO NOT USE STEROIDS-IT WILL CAUSE RECURRENT EPISODES

121
Q

AFTER GIVE NSAIDS AND COLCHICINE TO TREAT PERICARDITIS AND PREVENT REOCURRENCE WHAT IS NEXT STEP

A

ECHO-NEED TO R/OPERICARDIAL EFFUSION(40-60% WILL HAVE PERICARDIAL EFFUSION)

122
Q

WHAT IS EXPECTED TO BE SEEN IN PT WITH ACUTE PERICARDITIS ON EKG
IN FIRST 1-3 WEEKS?
AND
2-3 WEEKS LATER AFTER RXED?

A

FIRST 1-3 WEEKS: ST SEGMENT ELEVATIONS

3 WEEKS OR LATER - WILL SEE DEEP T WAVE INVERSIONS

123
Q

PT WITH RECURRENT PERICARDITIS TREATED WITH NSAIDS AND COLCHICINE.
PAIN HAS RESOLVED
BEST MED FOR PROPHYLAXIS IS?

A

COLCHICINE FOR 4 WEEKS

124
Q

PT POST CABG OR AVR 4 YEARS AGO NOW WITH INCREASING SOB FOR THE PAST 3-4 MONTHS.
PE+JVD 9CMS, +HPGMGLY AND+PEDAL EDEMA
ECG AND CXR- BOTH NORMAL
MOST LIKELY DX?

A

PERICARDITIS
POST PERICARDIOTOMY SYNDROME (CONSTRICTIVE PERICARDITIS)

CARDIOLOGY AWR (12 decks)

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