Cardio

Question 1

What are the classic ECG findings during an anginal episode? (2)

Answer 1

ST-segment DEPRESSION

T-wave inversion

Question 2

What is the gold standard for the diagnosis of CAD?

Answer 2

Coronary arteriography

Question 3

What are the key steps in the medical management of a patient with unstable angina?

Answer 3

β-blocker
ASA/anti-coagulate (heparin/warfarin)
nitroglycerin 
O2 (if hypoxic)
morphine

(BANO)

Question 4

Describe how nitrates reduce angina:

Answer 4

1. Venodilation causes venous pooling →↓preload →↓myocardial O2 consumption (demand)
2. Coronary vasodilation →↑O2 delivery to the myocardium

Question 5

Describe how each of the following drugs reduces angina:

1. β-Blockers
2. Nifedipine
3. Verapamil

Answer 5

1. ↓ Myocardial O2 use, ↓ afterload, ↑ coronary filling during diastole
   (↓ O2 demand) (↑ O2 supply)
2. Coronary arteriolar vasodilation
   (↑ O2 supply)
3. Slows cardiac conduction
   (↓ O2 demand)

Question 6

What intervention is reserved for patients whose angina cannot be controlled medically?

Answer 6

Percutaneous transluminal coronary angioplasty (PTCA)

Question 7

What is the common presentation of MI?

Answer 7

Crushing retrosternal chest pressure occurring at rest and radiating to left arm, neck, or jaw; diaphoresis;
nausea/vomiting; dyspnea; and anxiety

Question 8

What is a common physical examination finding during an MI?

Answer 8

S4 gallop

Question 9

Which are the six life-threatening causes of chest pain that must be ruled out in all patients?

Answer 9

1. MI
2. Cardiac tamponade
3. Pulmonary embolism (PE)
4. Pneumothorax (PTX)
5. Aortic dissection
6. Esophageal rupture

(My Chest Pain Panics All EDs)

Question 10

What are the classic ECG abnormalities in an acute MI?

3

Answer 10

ST elevation/depressions
Q waves
T wave inversions (past/active)

Question 11

Which ECG finding is very sensitive and specific for right ventricular infarction?

Answer 11

ST elevation in lead V4

Question 12

Which coronary artery is likely to be occluded with these ECG abnormalities?

Large R and ST-segment depression in V1, V2

Answer 12

Right coronary (posterior infarction)

Question 13

Which coronary artery is likely to be occluded with these ECG abnormalities?

Q waves and ST-segment elevation in leads V1-V4

Answer 13

Left anterior descending (anterior infarction)

Question 14

Which coronary artery is likely to be occluded with these ECG abnormalities?

Q wave in leads I, aVL, V5, V6

Answer 14

Circumflex (lateral infarction)

Question 15

Which coronary artery is likely to be occluded with these ECG abnormalities?

Q waves and ST elevation in leads II, III, aVF

Answer 15

Right coronary (inferior infarction)

Question 16

Which serologic markers are typically used to diagnose and follow an MI? (3)

Answer 16

Troponin I

Repeat: Myoglobin > CK-MB

Question 17

What are the clinical manifestations of right ventricular MI?

Answer 17

ECG inf. changes: Q waves and ST elevation in leads II, III, aVF (RCA)
 hypotension
CLEAR LUNGS + JVD
jugular venous distension (JVD)
Tricuspid regurgitation

Question 18

Which medical therapy should be avoided in a patient with a right ventricular infarction?

Answer 18

Nitroglycerin

initial therapy should involve IV fluids to ↑ preload

Question 19

What arrhythmia has
PR interval >0.2 s prolongation,
often due to increased vagal tone?

Answer 19

Primary (1°) heart block

Question 20

What arrhythmia has

PR interval gradually increases to the point at which a QRS complex is dropped?

Answer 20

2° Mobitz type I heart block (Wenkebach)

Question 21

What arrhythmia has

PR interval >0.2 s with occasional dropping of the QRS complex at a fixed interval (ie, 2:1 or 3:1)

Answer 21

2° Mobitz type II heart block

Question 22

What arrhythmia has

Irregularly irregular pulses and QRS complexes

Answer 22

Atrial fibrillation

Question 23

What arrhythmia has

Sawtooth appearance of P waves

Answer 23

Atrial flutter

Question 24

What arrhythmia has

Usually caused by conduction block within the bundle of His

Answer 24

2° Mobitz type II heart block

Question 25

What arrhythmia has | Complete dissociation between P waves and QRS complexes

Answer 25

3° or complete heart block

Question 26

What arrhythmia has treatment which includes anticoagulation, rate control, and/or cardioversion.

Answer 26

Atrial fibrillation

Question 27

What arrhythmia has | Wide QRS complexes not preceded by a P wave

Answer 27

Premature ventricular contraction (PVC)

Question 28

What arrhythmia has | Normal QRS morphology with a rate of 150-200 beats/min

Answer 28

Paroxsymal SVT

Question 29

Treatment of hemodynamically UNSTABLE 1. Pulseless V-Tach: V-Tach with pulse 2. Polymorphic VT: 3. Monomorphic VT:

Answer 29

1. CPR & Defibrillate 2. Defibrillate 3. Synchronized Cardioversion

Question 30

Treatment of hemodynamically STABLE patients in V-tach: If Refractory Vtach then treat with: Long term tx of pts with VTach:

Answer 30

pharmacological cardioversion with antiarrhythmics (amiodarone, procainamide, or sotalol) Refractory → cardioversion Long term = Beta blockers first line

Question 31

Which arrhythmia may be treated with carotid massage or Valsalva maneuver

Answer 31

Paroxsymal SVT

Question 32

Arrhythmia commonly caused by MI that may lead to hemodynamic instability

Answer 32

V-Tach | practice code with Dr. Meinke

Question 33

Arrhythmia where treatment with pacemaker is necessary.

Answer 33

Symptomatic 2° Mobitz type II heart block 3° heart block Sick sinus node syndrome

Question 34

``` ECG finding: Short PR interval delta wave Widened QRS P-waves follow QRS ```

Answer 34

Wolff-Parkinson-White | bypass AV node via Bundle of Kent Tx: Unstable = cardioversion. Stable = IV Procainamide

Question 35

Name four common chest x-ray (CXR) abnormalities in CHF:

Answer 35

1. Cardiomegaly 2. Cephalization of pulmonary vessels (↑ vascularity in lung fields) 3. Kerley B lines (indicating pleural fluid in fissures) 4. Pleural effusions

Question 36

What is the common presentation of pericarditis?

Answer 36

Pleuritic retrosternal chest pain (↑ when supine, ↓ when sitting up and leaning forward), dyspnea, cough, and fever

Question 37

What serologic test is elevated in rheumatic heart disease? (2)

Answer 37

``` Antistreptolysin antibodies (ASO) DNAse B ```

Question 38

Name the five major J♡NES criteria for rheumatic heart disease: aside from constitutional symptoms

Answer 38

1. Joint pain (migratory polyarthritis) 2. ♡ Pancarditis (endo/myo & pericarditis +/- murmurs) 3. Nodules (painless, firm on extensors) 4. Erythema marginatum (annular, faintly red, non-itchy) 5. Sydenham chorea

Question 39

Acute severe, tearing substernal pain radiating to the interscapular region of the back

Answer 39

aortic dissection

Question 40

Which examination findings are characteristic of an aortic dissection? (3)

Answer 40

Unequal BP in the extremities New diastolic decrescendo murmur (aortic regurg) Widened Mediastinum on CXR

Question 41

Pain in buttocks and thighs with walking

Answer 41

Aortoiliac occlusive disease

Question 42

Pain in calves with walking

Answer 42

Femoral-popliteal occlusive disease

Question 43

Abdominal angina

Answer 43

Chronic mesenteric arterial occlusive disease

Question 44

Pericarditis presents with

Answer 44

Pleuritic chest pain, fever, leukocytosis Chest x-ray: pleural effusion ± enlarged cardiac silhouette Echocardiography: pericardial effusion pericardial friction rub

Question 45

List 4 causes of pericarditis

Answer 45

``` Myocardial infarction (Dressler syndrome) CABG or Percutaneous coronary intervention trauma ```

Question 46

pericardial friction rub described as a

Answer 46

scratchy sound between S1 and S2 | only heard in ACUTE episodes

Question 47

Pericarditis improved when ___ and worsens when ___

Answer 47

leaning forward Laying back

Question 48

Pericarditis 2/2 SLE treated with

Answer 48

NSAIDs

Question 49

If you suspect pericarditis what imaging would you get?

Answer 49

Echocardiogram

Question 50

Dx of Cor Pulmonale echocardiographic findings: RV hypertrophy, TR w/ RA enlargement Definitive dx via:

Answer 50

Right heart catheterization showing elevated pulmonary artery systolic pressure (>25 mm Hg)

Question 51

Lyme disease with cardiac involvement (Lyme carditis) usually presents with ___ on ECG

Answer 51

conduction abnormalities (atrioventricular block)

Question 52

Cardiac tamponade can occur as a catastrophic complication of acute

Answer 52

aortic dissection

Question 53

Echocardiography typically shows biventricular enlargement with diffuse ventricular wall hypokinesis.

Answer 53

Viral Myocarditis

Question 54

___ cardiomyopathy is a diagnosis of exclusion in patients with dilated cardiomyopathy and history of alcohol abuse in whom no other potential causes of cardiomyopathy (coronary artery disease, valvular heart disease) are suspected or identified. 

Answer 54

Alcoholic