MTB 1 Flashcards
What makes the S4 gallop
Atrial systole as blood is ejected from atrium into a stiff ventricle
- seen in ischemia w noncompliant LV
What is Kussmaul sign?
Ass’d with?
Increase in JVP w inhalation
Constrictive pericarditis or Restrictive Cardiomyopathy
What condition do we see with displaced PMI
LVH
Dilated Cardiomyopathy
When do we see triphasic scratchy sound on auscultation
Pericardial Friction Rub
Leads in Anterior Wall MI
Leads V2-V4
Leads in Inferior wall MI
II, III, aVF
PR interval > 200 msec?
First-degree AV block
ST depression in Leads V1 and V2
Posterior wall MI
Pt w substernal chest pain arrives at ED. EKG shows ST elevation in V2, V4. Next best step?
Admin ASA
Angioplasty
How long is ST elevation present on EKG
1-6 weeks
Pt w new episode of pain a few days after first cardiac event - next step?
- EKG for new ST changes
2. Check CK-MB
MCC death first few days after MI
Ventricular Arrhythmia
- V tach, V fib
When do we use thrombolytics in NSTEMI
Never
Complications of PCI
- Rupture of coronary artery on balloon inflation
- Restenosis of vessel after angioplasty
- Hematoma at site of entry
Important in reducing recurrent stenosis after PCI
Drug-eluting stents inhibit T cell response
Which thrombolytic cannot be given repeatedly and why
Streptokinase causes allergenic response
Which thrombolytics are given as IV infusion
Streptokinase
Alteplase
Which thrombolytics are given as rapid bolus injection
Retaplase
Tenecteplase
Absolute CI to thrombolytics
CNS bleed Major bleeding into bowel Recent surgery - past 2 weeks Active peptic ulcer - bleeding Severe HTN, >180/110 Nonhemorrhagic stroke past 6 months Hemorrhagic stroke
Pt presents to ED with chest pain for past 1 hour, crushing, non-positional. EKG shows ST depression in V2, V4. ASA is given. Next best step?
LMW Heparin can prevent a clot from forming in coronary arteries
Which pts do GIIb/IIIa inhibitors reduce mortality
Pts with ST depression
Best for non-STEMI, PCI and stenting
With what pathology are TPAs beneficial
ONLY with STEMI
Which heart pathology is heparin used in
BEST for non-STEMI
Drugs that Increase bleeding with warfarin/Potentiate warfarin effect
NSAIDs Acetomenophen Amiodarone Cranberry Juice Ginkoba Vit E Thyroid hormone SSRI
Drugs that Decrease bleeding with warfarin/lower warfarin effect
Rifampin Carbamezapine OCPs Ginseng St Johns Wort Spinach
EKG of First Degree AV block
Prolonged PR interval
Third Degree AV block
Cannon A waves = atrial systole against closed tricuspid valve.
- cannon is bounding JV wave bouncing in neck
TX for symptomatic bradycardia
- Atropine
2. Pacemaker if ineffective
Right Ventricular Infarction
New inferior wall MI
Clear lungs
What does the right coronary artery supply
RV
AV node
Inferior wall of heart
Most specific EKG finding for Right Ventricular Infarction
ST elevation in V4R
TX for RV Infarction
High volume fluid replacement
TX for stable V tach
Amiodarone
Lidocaine
TX for Unstable V tach
Shock/Cardioversion/Defibrillation
TX for V Fib
Shock/Cardioversion/Defibrillation
When do we see tamponade/free wall rupture
Several days after infarction
Presentation of tamponade/free wall rupture
Sudden loss of pulse
Clear lungs
One cause of PEA
TX for tamponade/free wall rupture
Emergency pericardiocentesis on way to OR
How to distinguish V tach and V fib
EKG
Best long term therapy for V tach and V fib
Beta blockers
Presentation of valve or septal rupture
SOB, HypoTN, tachycardia
New onset of murmur
Pulmonary congestion
Step up in O2 sat from RA to RV
Septal Rupture
Most accurate test for valve rupture?
Septal rupture?
Echo
3 major mechanical complications of MI
- MR due to papillary m. rupture
- LV Free wall rupture
- Interventricular septum rupture
TX for mural thrombi
Heparin followed by Warfarin
Sudden loss of pulse, JVD?
Tamponade/wall rupture
IWMI in hx, clear lungs, tachycardia, hypoTN w nitroglycerin?
RV Infarction
New murmur + rales/congestion
Valve Rupture
New murmur + increase in O2 sat in RV
Septal Rupture
Postinfarction routine medications
ASA
Beta Blocker
Statin
ACE-I
Anterior wall infarctions have high likelihood of developing what?
Systolic Dysfunction
Nitrates and Sildenafil?
Causes HypoTN
4 hour interval in DM patients
MC cause of ED postinfarction
Anxiety
How long do pts have to wait post MI to engage in sexual activity
They do not have to wait.
Can resume immediately
