Texas Internal Medicine 1 Flashcards
Timing of EKG changes with MI ?
ST elevation (2mm+) = immediately T-wave inversion = hrs to years Q-waves = last forever
ST elevation in V1-V4 ?
Anterior heart wall
- LAD
ST elevation in II, III, aVF ?
2,3,floor = Inferior
- RCA
ST elevation in V4 with right sided EKG?
R-ventricle = RCA
- 100% specific
ST elevation in I, aVL, V4-V6
Lateral
- Circumflex
Hypotension Tachycardia Clear lungs JVD NO pulsus paradoxus Dx?
Right ventricle infarct
DON’T give nitro
Tx = aggressive fluid resuscitation
New wide flat QRS
New LBBB
- stemi
Patient comes in with chest pain. What are first 2 tests in order?
- EKG
2. Cardiac enzymes
When do the 3 cardiac enzymes peak?
Myoglobin = 2 hours
CKMB = 24 hours
Troponin I = 24-48 hours
When are the 3 cardiac enzymes normal?
Myoglobin = 24 hours
CKMB = 72 hours
Troponin I = 7-10 days
How treat NSTEMI?
MONA B Morphine Oxygen Nitrates Aspirin/clopidogrel B-blocker
When choose CABG over stenting?
If left main coronary disease
If 3 vessel disease
If 2 vessel + DM
. . . with > 70% occlusion, pain despite max medical therapy
What are discharge meds for post MI or post stent?
Aspirin \+ clopidogrel 9-12 mos if stent B-blocker ACEi Statin Short acting nitrates
What is diagnosis if chest pain + no ST elevation + normal enzymes x3?
Unstable angina
What are drugs for chemical stress test?
Dobutamine
Adenosine
What is positive finding on exercise EKG for unstable angina?
Chest pain is reproduced
ST depression
Hypotension
. . . will need coronary angiography if +
Main cause of death post MI ?
Arrhythmias especially V-fib
New systolic murmur 5-7 days s/p MI?
Papillary muscle rupture
Acute severe hypotension after MI?
Ventricular free wall rupture
Step up in O2 concentration from RA to RV s/p MI?
Ventricular septal rupture
Persistent ST elevation 1 mo s/p MI?
Ventricular wall aneurysm
Cannon A-waves s/p MI?
AV-dissociation
- V-fib
- 3rd degree heart block
5-10 weeks s/p MI get pleuritic chest pain + low grade temp?
Dressler Syndrome
- autoimmuni pericarditis
Tx: NSAIDs + aspirin
Chest pain worse w/ inspiration
…better w/ leaning forward
What expect on ascultation?
What expect on EKG?
Friction rub
Diffuse ST elevation
PERICARDITIS
Chest pain worse w/ palpation?
Constocondriasis
Chest pain w/ hx viral infection + murmur?
Myocarditis
Young patient w/ chest pain at rest, worse at night, few CAD risk factors + migraine HA
Prinzmetal’s angina
- see transient ST elevation during episodes only
