Cardiology

Question 1

typical chest pain comprises of ________, ______ and ________

Answer 1

substernal chest pain, worsened or provoked with exertion and relieved by rest or nitroglycerin

Question 2

best initial test in a patient with typical chest pain is ___

Answer 2

EKG

Question 3

How to read an ECG….. (mnemonics)

Answer 3

2RAP PQRSTU
2R - rate and rhythm
Axis - II has more positive  deflection than I and III
P waves. 
PR interval, 
QRS complexes and 
ST segments ; 
T & U waves

Question 4

EKG findings of STEMI

Answer 4

> 1mm ST elevation in 2 anatomically contig. leads OR >2mm in V2 +V3 OR new LBBB (wide, flat QRS)

Question 5

Localizing infarct:

Anterior: (artery)(lead)

Answer 5

Anterior: (LAD) (V1-V4)

Question 6

Localizing infarct:

Lateral: (artery)(lead)

Answer 6

Lateral: (circumflex) (1, aVL, v4-v6,)

Question 7

Localizing infarct:

Inferior: (artery)(lead)

Answer 7

Inferior: (RCA) (II, III, aVF)

Question 8

Localizing infarct:

R. Ventricular: (artery)(lead)

Answer 8

R. Ventricular: (RCA) (V4 on R. sided EKG is 100% specific

Question 9

Transfer patient for PCI if ____________

Answer 9

“door to balloon time” is <90mins

Question 10

fibrinolytic contraindications:

6

Answer 10

-Any hemorrhagic stroke history (ischemic stroke in last 3 mos.)
• Intracranial cancer
• Cerebrovascular malformation
• Active internal bleeding or bleeding diathesis
• Suspected aortic dissection
• Significant closed head trauma in last 3 mos.

Question 11

if it isn’t a STEMI, what do you do next?

Answer 11

cardiac enzymes

Question 12

how often should troponin be checked

Answer 12

q3hrs. x3

Question 13

if troponin is elevated what are the differential diagnosis? (5)

Answer 13

NSTEMI, PE, CHF, myocarditis and renal failure

Question 14

A patient with typical chest pain, elevated troponin, what is the next step in diagnosis

Answer 14

coronary angiography

Question 15

if blockage is seen on coronary angiography what is the standard management?

Answer 15

PCI with stenting and dual antiplatelet (ASA+ Clopidogrel) therapy for 6-12 months

Question 16

when do you do CABG instead of PCI with stenting

Answer 16

if: L main dz., 3 vessel dz. (or 2 vessel dz. + DM or + ↓ EF)

Question 17

sudden death post MI. cause?

Answer 17

fatal arrhythmia….V.fib

Question 18

new systolic murmur 2-7 days after MI. cause?

Answer 18

papillary muscle rupture

Question 19

acute severe hypotension post MI. cause?

Answer 19

ventricular free wall rupture

Question 20

new onset harsh holosystolic murmur, CHF, higher O2 at RV post MI. Cause?

Answer 20

ventricular septal rupture

Question 21

Persistent ST elevation ~1 mo later + MR post MI. Cause?

Answer 21

Ventricular wall aneurysm

Question 22

QRS’s don’t follow P-waves after MI. Cause?

Answer 22

AV-dissociation, 3rd degree block

Question 23

weeks-months later MI, pleuritic chest pain, and low grade temp

Answer 23

Dressler’s syndrome (post-MI syndrome), (autoimmune pericarditis)

Question 24

most common arrhythmia presenting palpitations, tachycardia, dizziness in a pt with HTN or CAD

Answer 24

A-Fib

Question 25

management of new onset A-Fib

Answer 25

cardiovert

Question 26

management for chronic Atrial Fibrillation

Answer 26

rate-control and use CHADS2 score to estimate embolic risk

Question 27

Fixed PR interval

Answer 27

- first degree heart block | - second degree heart block Type (Mobitz) II

Question 28

variable PR interval

Answer 28

- second degree heart block Type (Mobitz) I wenkebach | - Third degree heart block

Question 29

Pulmonary embolism on ECG

Answer 29

S1Q3T3

Question 30

SEM crescendo/decrescendo, louder w/ squatting, softer w/ valsalva + pulsus parvus et tardus

Answer 30

Aortic stenosis

Question 31

SEM, louder w/ valsalva, softer w/ squatting or handgrip

Answer 31

HOCM

Question 32

Late systolic murmur + mobile click (earlier w/ valsalva and handgrip, later w/ squatting)

Answer 32

mitral valve prolapse

Question 33

Holosystolic murmur heard best at apex, can radiate to axilla

Answer 33

Mitral regurgitation

Question 34

Loud holosystolic murmur w/ diastolic rumble in kids

Answer 34

VSD

Question 35

Continuous machine like murmur

Answer 35

PDA

Question 36

Rumbling diastolic murmur with an opening snap

Answer 36

mitral stenosis

Question 37

Blowing diastolic murmur with widened pulse pressure

Answer 37

Aortic regurgitation