Test No. 1 - Cardio Flashcards
no. 1 ddx for st segment elevation seen diffusely throughout EKG?
pericarditis
when does nitroglycerin become class III in patients with MI?
when sbs less than 90 or hr less than 50
why should nitroglycerine almost always be given prior to thrombolytics?
to rule out coronary spasm as cause of st segment elevation
pts comes to ER will MI, he later presents with hypotension, increased jugular venous pulse and appears to be heading into shock. no acute distress, regular pulse, clear lungs and no murmur. dx?
RVI (associated with inferior wall MI)
what is the to three moves that need to made in tx of RVI?
stop NG; give IV fluids; give IV dobutamine; IOW, volume load, give inotropic support.
nitrates should absolutely NOT be given until what other disease process is ruled out for pts with MI?
RVI
what is the educated guess behind why MI’s happen first thing in the morning?
catecholamine surge with elevated BP during that time period
which STEMI pts should have a CXR performed before reperfusion therapy?
those with suspected aortic dissection
what is the best method by which you can detect wall motion abnormalities in your pts?
2 D echo
one year old child presents to ER with AMI, what is the dx?
kawasaki’s disease
typical presentation - what is your most likely best guess? fever with STEMI
endocarditis or vasculitis
typical presentation - what is your most likely best guess? pregnancy with STEMI
spontaneous coronary dissection
typical presentation - what is your most likely best guess? stroke with STEMI
AD (into the RCA)
typical presentation - what is your most likely best guess? cocaine with STEMI
spasm (treat with NG, CCB)
what is the antidote for cocaine OD with STEMI?
phentolamine (non selective alpha antagonist)
most ACS are caused by what type of plaques?
non-obstructive
what is the best way to assess for presence of asymptomatic CAD?
hx, pe, testing
feeling of impending doom is typically associated with what disease process?
MI
what differentiates the pain caused by angina/MI vs. AD?
pain with AD is immediate and reaches maximum intensity quickly!
what are some cxr findings for AD? what about ekg?
widened mediastinum with no specific ekg changes
what cause of chest pain is relieved with NG and presents with normal coronaries on angio - no remarkable cardiac findings
esophageal spams
change in smoker’s cough is often typically indicative of what?
lung cancer
chest pain with stroke is most likely what?
Aortic dissection
chest pain with aortic insufficiency is what?
AD
28 y/o female with lupus presents with pleuritic knife like chest pain, low grade fever, sitting up and leaning fwd in stretcher - what is most likely dx?
pericarditis
college kid presents with severe chest pain - hx significant for heavy drinking night prior
boerhaave’s syndrome
smoker with chest pain and widened complex tachycardia - what should you do next?
cardiovert
what is the most common reason as to why pts get Dressler’s syndrome?
Heparin treatment
What is the worry that you have as PA when a pt gets Dressler’s syndrome?
that they will get pericardial effusion and cardiac tamponade
What are the signs of pericarditis on the EKG?
depressed PR; diffuse ST elevations
all diastolic murmurs are pathologic - T or F
TRUE!!!!
pt comes into the ER with MI, receives tx. later, the same pt has a drop in BP and increase in pulse. extremities are cool; pansystolic murmur present - III/VI @ apex, radiating to left shoulder with S3 gallop. Dx? and why?
mitral regurgitation due to papillary muscle rupture
pt comes into the ER with MI, receives tx. later, the same pt has a drop in BP and increase in pulse. extremities are cool; pansystolic murmur present - V/VI (thrill present) at left lower sternal border; moist rales bilaterally. Dx?
ventricular septal defect
what are your 3 pansystolic murmurs?
mitral regurg, tricuspid regurg, and ventricular septal defect
what is this: An increase in central venous pressure with inspiration ?
Kussmaul’s sign. Normally, there is a decrease in jugular venous pressure with inspiration. Kussmaul’s sign can be seen with restrictive cardiomyopathy. The heart is normal sized with restrictive cardiomyopathy.
Physical findings of _____ include: Murmur heard best at apex and left sternal border
Systolic ejection murmur
Pulsus bisferiens
Signs increased by Valsalva maneuver
hypertrophic subaortic stenosis
congenital heart defect in which the septal leaflet of the tricuspid valve is displaced towards the apex of the right ventricle of the heart.
ebstein anomaly
the most common cause of death in a young athlete
Hypertrophic Obstructive Cardiomyopathy (HOCM)
seen with tricuspid regurgitation. The sign is positive if there is an increase in the intensity of the murmur with inspiration
Carvallo’s sign
is usually congenital and frequently asymptomatic. The intensity of the click decreases with inspiration.
pulmonary stenosis
It produces a ‘continuous machinery murmur’ with late systolic accentuation, maximally heard at the second rib near the sternum.
pda
s more common in males and associated with other abnormalities, most common of which is bicuspid aortic valve. It may be asymptomatic for years and is often detected in routine x-ray. The signs will include wide splitting of the second heart sound and a systolic flow murmur over the pulmonary valve.
Coarctation of the aorta
what do you expect to find on the chest xray of a pt with coarctation of the aorta? (2)
Left ventricular hypertrophy (LVH) and a notch in the aorta
A prominent aorta, pulmonary artery, and left atrium on xray represents what?
patent ductus arteriosus
Right ventricular hypertrophy (RVH) and large pulmonary arteries on xray represents what?
atrial septal defect
what is the immediate diagnostic imaging modality of choice for patients with suspected aortic dissection?
CT scan
dilated IVC, RA collapse, and then RV collapse all point to what?
cardiac tamponade
a decrease in systolic contraction of an ischemic area (segment) of the myocardium is called what?
regional wall motion abnormality
i say pulsus tardus, you say ?
AS
if your cardiac apical impulse is lateral and downwardly displaced, what is wrong with the LV?
dilated
if you have a double systolic apical impulse, what is going on with your heart?
hypertrophic cardiomyopathy
what is going on with your heart if you have a sustained “lift” at the lower left sternal border?
RVH
why does the left ventricle hypertrophy with MR?
f a lot of blood leaks into the left atrium when the left ventricle contracts, less blood is pumped into the body via the aorta. The heart compensates for this. The wall of the left ventricle may become thicker, the ventricle may enlarge, and the heart rate may increase.
what is the worry with young patients who have MR? CHRONIC MR
they will develop AFIB which leads to an MI
which sound is more indicative of heart failure? s3 or s4?
s3!!!
