MTB Cardio Flashcards
Post menopausal sudden overwhelming emotional stress and anger with chest pain
Tako-Tsubo cardiomyopathy
Elevated troponin but normal angio and no vasospasm
Left ventricle dyskinesis causing ballooning
If the chest pain is not cardiac origin it is likely to be…
GI
GORD, ulcer, cholelithiasis, duodenitis, gastritis
Three features of chest pain tell whether or not the pain is ischemic in nature:
Respiration
Position
Tenderness
Radiation to back, unequal blood with widened pressure between mediastinum, chest arms
Aortic dissection Chest x-ray
Pain worse with lying flat, better when with ST elevation sitting up, young everywhere, PR (<40)
Pericarditis Electrocardiogram
Epigastric discomfort, pain better when eating
Duodenal ulcer disease Endoscopy
Bad taste, cough, hoarseness
Gastroesophageal Response to PPis;
Cough, sputum, hemoptysis
Pneumonia Chest x-ray
Sudden-onset shortness of breath, tachycardia, hypoxia
Pulmonary embolus Spiral CT, V/Q scan
Sharp, pleuritic pain, tracheal deviation
Pneumothorax Chest x-ray
Maximum heart rate =
220 minus the age of patient
Use CCBs (verapamil/diltiazem) in CAD only with:
- Severe asthma precluding the use of beta blockers
- Prinzmetal variant angina
- Cocaine-induced chest pain (beta blockers thought to be contraindicated)
- Inability to control pain with maximum medical therapy
Adverse Effects of CCBs
• Edema • Constipation (verapamil most often) • Heart block (rare)
Acute coronary syndromes are associated with an S? gallop
Acute coronary syndromes are associated with an S4 gallop because of ischemia leading to noncompliance of the left ventricle. The 54 gallop is the sound of atrial systole as blood is ejected from the atrium into a stiff ventricle. A decrease of blood pressure of greater than 10 mm Hg on inspiration is a pulsus paradoxus and is associated with cardiac tamponade.
An increase in jugulovenous pressure on inhalation is…
the Kussmaul sign and is most often associated with constrictive pericarditis or restrictive cardio-myopathy.
ST elevation in leads II, Ill, aVF
ST elevation in leads II, Ill, and aVF is consistent with an acute myocardial infarc-tion, but of the inferior wall. Untreated, the mortality associated with an IWMI is less than 5% at 1 year after the event.
ST elevation in leads V2-V4
Leads V2 to V4 correspond to the anterior wall of the left ventricle. ST seg-ment elevation most often signifies an acute myocardial infarction. With an AWMI, mortality untreated is closer to 30%to40%.
ST depression in leads V1 and V2
ST depressions in leads V1 and V2 are suggestive of a posterior wall myocardial infarc-tion. Infarctions of the posterior wall are associated with a very low mortality, and again, there is no additional therapy to give because of it.
S3 gallop rhythm
CHF
Sudden onset, clear lungs dyspnea
PE
S udden onset, wheezing, increased expiratory phase dyspnea
Asthma
Slower, fever, sputum, unilateral rales/rhonchi
Pneumonia
Decreased breath sounds unilaterally, tracheal deviation dyspnea
Pneumothorax
Circumoral numbness, caffeine use, history of anxiety
Panic attack
Pallor, gradual over days to weeks dyspnea
Anemia
Pulsus paradoxus , decreased heart sounds, JVD dyspnea
Tamponade
Palpitations, syncope dyspnea
Arrthymia
Long smoking history, barrel chest dyspnea
COPD
Systolic Dysfunction (Low Ejection Fraction) treatment
ACE inhibitors or angiotensin receptor blockers (ARBs) • Beta blockers • Spironolactone • Diuretics • Digoxin
Acute pulmonary oedema presentation
- Rales
- JVD
- s3 gallop
- Edema
- Orthopnea
Which investigation if the diagnosis of the etiology of the shortness of breath is not clear?
Brain natriuretic peptide
Normal BNP exclude APO
Acute pulmonary oedema treatment
Morphine
Oxygen
Nitrate
Diuretics furosemide
Mitral stenosis unique features of presentation
Dysphasia
Hoarseness
AF
Hemoptysis
Mitral stenosis treatment
1 Diuretics and sodium restriction when fluid overload is present in the lungs
- Balloon valvuloplasty done with a catheter
- Valve replacement only when a catheter procedure cannot be done, or fails
- Warfarin for atrial fibrillation to an INR of 2 to 3
- Rate control of atrial fibrillation with digoxin, beta blockers, or diltiazem/ verapamil
Aortic stenosis presentation
Angina: most common presentation
Syncope
CHF: poorest prognosis with 2-year average survival
Besides CHF, AR has a large array of relatively unique physical findings such as:
- Wide pulse pressure
- Water-hammer (wide, bounding) pulse
- Quincke pulse (pulsations in the nail bed)
- Hill sign (BP in legs as much as 40 mm Hg above arm BP)
- Head bobbing (de Musset sign)
Mitral valve prolapse presentation
The symptoms of CHF are usually absent. The most common presentation is: • Atypical chest pain • Palpitations • Panic attack
MVP murmur
Opposite to other murmurs
Valsalva or standing worsens
Increasing the venous return improves/diminishes the murmur
Murmurs that do not increase with expiration:
- HOCM
* MVP
In addition to previous MI and ischemia, dilated cardiomyopathy can be from:
- Alcohol
- Postviral myocarditis
- Radiation
- Toxins such as doxorubicin
- Chagas disease
Digoxin and spironolactone in HCM
Always wrong
Restrictive cardiomyopathy Causes are:
• Sarcoidosis • Amyloid • Hemochromatosis • Endomyocardial fibrosis • Scleroderma
Pericarditis ECG findings
ST elevation in all leads and PR depression
