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Internal Medicine Clerkship > Cardiology > Flashcards

Cardiology Flashcards

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0
Q

What two changes on EKG make you suspicious for MI?

A
  1. 2mm ST elevation
  2. new LBBB (wide, flat QRS)
  • these indicate STEMI
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1
Q

pt comes in w/ chest pain.. best 1st test?

A

EKG

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2
Q

What EKG findings are seen on EKG following MI from 6 hrs to years

A

T wave inversion

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3
Q

What EKG changes persist indefinitely after MI

A

Q waves

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4
Q

What three leads show ST elevation in an inferior infarct? What vessel is involved?

A

I, II, aVF

RCA

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5
Q

What 4 leads are involved in an anterior infarct? Vessel

A

V1-V4

LAD - is MC place for infarction

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6
Q

What leads have changes in a lateral infarction? vessel?

A

I, aVL, V4-V6

Circumflex

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7
Q

What should be done after STEMI is dx’d?

A
  1. Cath lab

2. thrombolytics if no cath lab and no C/I

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8
Q

If no STEMI is found on EKG and chest pain is present, what test should be done?

A

Cardiac enzymes

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9
Q

How long after MI can thrombolytics be administered? Contraindications? (5)

A

less than 6 hours

active bleeding, anticoagulants, any hx of hemorrhagic stroke, recent ischemic stroke, recent closed head trauma

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10
Q

How many times, how often should cardiac enzymes be checked

A

3x q 8 hrs –> may not be elevated if early enough

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11
Q

Which cardiac enzme elevates 1st?

A

Myoglobin - peaks in 2 hrs, normal by 24 hrs

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12
Q

When does troponin I rise? peak? normalize?

A

rises in 3-5 hours

Peaks in 24-48 hours

normal by 7-10 days - poor measure of reinfarction therefore

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13
Q

When does CK-MB rise? peak? When does it normalize?

A

rises in 4-8 hrs, peak in 24 hrs, normal by 72 hours

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14
Q

If no STEMI but cardiac enzymes are peaked, what is dx?

A

Non-STEMI MI

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15
Q

What 4 drugs do you treat NSTEMI with?

A
  1. Morphine
  2. O2
  3. ASA/ clopidogrel
  4. Beta blocker
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16
Q

Once MI has been confirmed, NSTEMI or STEMI what test needs to be done next and why

A

Coronary angiography - determines next step in tx

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17
Q

what four things are indications for CABG?

A
  1. Left main vessel dz
  2. 3 vessel dz (or 2 vessel dz + DM)
  3. Pain despite maximal medical therapy
  4. Post-infarction angina

*emergent CABG not often done - done after failure of PCI, mechanical complications of acute MI, cardiogenic shock, or life-threatening ventricular arrthymias per step up

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18
Q

What is standard non pharm tx of MI

A

PCI w/ stenting.

*If meet certain criteria, get CABG

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19
Q

what 6 drugs should a pt w/ MI be discharges home with?

A
  1. ASA
  2. Clopidogrel (if stent placed, use for 9-12 mo)
  3. Beta blocker
  4. ACE-I
  5. Statin
  6. short acting nitrate

*ASA, BB, ACE-I, Statin all shown to reduce mortality

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20
Q

MCC of death post MI

A

arrhythmias - esp v-fib

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21
Q

New systolic murmur 5-7 days after MI

A

Papillary muscle rupture - leads to mitral regurg

  • eval w/ echo; decrease preload w/ nitroprusside
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22
Q

Acute severe hypotension occurring w/in 2 weeks after MI

A

Ventricular free wall rupture –> most commonly 1-4 days after

  • need pericardiocentesis, emergent surgical repair
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23
Q

Increase in O2 concentration in RV following MI

A

Ventricular (Interventricular) septum rupture

  • emergent surgery indicated
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24
Persistent ST. Elevation and new systolic MR murmur 1 month after MI
Ventricular wall aneurysm (pseudoaneurysm)
25
Pleuritic chest pain, low grade temp 5-10 weeks after MI? Tx?
Dressler's syndrome (automimmune pericarditis) * tx with NSAIDS
26
Cannon a-waves generally indicate what?
AV-dissociation --> 3rd degree heart block or v-fib * is 2/2 AV node ischemia; tricuspid valve doesn't open and close in right timing * cannon a-waves are bounding jugular venous pulses
27
Cheat pain in young healthy person that occurs at rest, worse at night and transient ST elevation during episodes
Prinzmetal's angina * commonly occurs in young females with migraines
28
What is the test for prinzmetals angina?
Ergonovine test
29
Tx for prinzmetals?
CCB's or nitrates
30
Varying PR interval with 3 or more morphologically distinct p waves in the same lead
Multifocal atrial tachycardia * may be called "wandering atrial pacemaker" if rate is not tachycardic
31
3 or more consecutive beats with normal QRS (under 120 ms) and rate over 120 on EKG
V-tach
32
What is treatment for v-tach if hemodynamically unstable? What if vitals are stable?
Unstable --> shock/ cardiovert Stable vitals--> amiodarone or lidocaine
33
Short PR interval followed by a wide QRS (over 120) and a slurred initial deflection of QRS
WPW
34
Treatment for WPW? What three drugs are absolutely contraindicated ?
Tx: procainamide DO NOT : beta blocker, CCBs, digoxin
35
Regular rhythm w ventricular rate of 125-150 and atrial rate of 250-300
A-flutter
36
Tx for hemodynamically stable a-flutter? Unstable?
Stable : beta blockers or digoxin Unstable : cardioversion
37
What two electrolyte abnormalities can cause Torsades?
Low Mg or low K
38
What two medication OD can cause Torsades?
TCAs or Li
39
Regular rhythm w/ 150-220 on EKG and sudden onset of palpation a or dizziness
Supraventricular tachycardia
40
Medical treatment for supraventricular tach
Adenosine
41
Non-medical treatment for supraventricular tachycardia?
Carotid massage * is first line tx. can also put face in cold water
42
Other than peaked T waves, what changes are seen on EKG with hyperkalemia? (QRS, QT, PR)
Wide QRS, short QT, prolonged PR
43
Alternate beat variation in direction, amplitude, and duration of the QRS complex on EKG
Cardiac tamponade --> called electrical alternans
44
Irregular r-r interval, undulating baseline, no p-waves on EKG
A-fib
45
What hormonal issue can cause a-fib
Hyperthyroid CHF and valvular dz can also-- anything that can cause atrial dilation
46
Pt presents w SOB, @ what O2 sats do they get oxygen
Under 90
47
SOB + CHF or new murmur, what test is next?
Echo
48
What three drugs does someone with acute pulmonary edema need to get?
1. Nitrates 2. Lasix 3. Morphine
49
SOB in young patient with no cardiomegaly on CXR?
Primary pulmonary HTN
50
How can primary pulmonary HTN be confirmed?
Right heart cath --> will have normal PCWP
51
What is presentation of right ventricular infarct?
Hypotension, tachycardia w/ no left heart failure sx like pulmonary crackles, JVD; also NO pulsus paradoxus
52
What is tx for right ventricular infarction? What do you NOT give?
Vigorous fluid resuscitation * do NOT give nitrates (will decrease preload and worsen shock)
53
If pt has chest pain, but EKG and cardiac enzymes are normal x3, what is dx?
Unstable angina
54
What is best first test for cases of unstable angina? | What two drug classes need to be avoided?
Exercise EKG *B blockers and CCBs
55
What are the contraindications to doing EKG stress test? What should be done instead
1. old LBBB 2. baseline ST elevation 3. pt on Digoxin * do exercise echo instead
56
What test should be done if patient angina is so bad they can't exercise?
Chemical stress test with dobutamine or adenosine
57
What is done if any of the exercise tests are positive (chest pain reproduced, ST depression, hypotension)
on to coronary angiography
58
young pt comes in with new-symptoms of CHF (orthopnea, new murmur, SOB, etc) what should you think of
Myocarditis--> esp if recent hx of flu-like illness
59
Systolic CHF is dx'd with EF of less than what?
less than 55%
60
What are 5 causes of ischemic or dilated cardiomyopathy?
Viral, EtOH, cocaine, Chagas, idiopathic (plus ischemia of course) *EtOH is reversible if you stop drinking
61
What is diastolic HF?
Normal EF, but heart can't fill
62
What are three causes of diastolic HF? Which is reversible?
HTN, amyloidosis, hemachromatosis *hemachromatosis is reversible with phlebotomy (is a restrictive cardiomyopathy)

Internal Medicine Clerkship (2 decks)

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