Cardiology

Question 1

Chest pain best test

Answer 1

1. EKG

2. Cardiac Enz

Question 2

Anterior STEMI (Leads and Location)

Answer 2

LAD

STE: V1 through V4

Question 3

Lateral STEMI (Leads and Location)

Answer 3

Circumflex

STE: I, aVL, V4 through V6

Question 4

Inferior STEMI (Leads and Location)

Answer 4

RCA

STE: II, III, aVF

Question 5

ST Depression Implication

Answer 5

Subendocardial injury

Question 6

STEMI Criteria

Answer 6

2mm elevation OR New LBBB (see V1 & V2)

Question 7

Cardiac enz (Rise-Peak- Return to Normal)

Answer 7

Myoglobin: 2hr & 24 hrs -> reinfarction marker
CKMB: 6hr-24 hrs-72hr
Tropnin: 4hr-24 to 48hr-7 to 10dy

Question 8

Acute STEMI Treatement

Which Inc. survival?

Answer 8

1. B-blocker** (dec. HR and Contractility = Dec O2 demand; Dec. remodeling) -> carvedilol
2. Asprin** (dec. reocclusion)
3. ACE inhibtor** (dec. remodeling)
4. O2
5. Statin (Atorvastatin 80)
6. Nitrate (sx relief)
7. Heparin (prevent thrombus progression)
8. Coronary angiography w/in 48 hrs!

Question 9

Post-revascularization Pts MUST be on?

Time frames?

Answer 9

Duel anti-platelets! -> Aspirin and Clopidogrel
3mo for barre metal
12mo for drug-eluding

Question 10

CABG indications

Answer 10

1. > 70% occlusion
2. 3 vessel Disease (2 vessel if DM)
3. L main involved

Question 11

Contraindications to stress test?

Answer 11

1. Old LBBB
2. Baseline St elevations
3. Using Digoxin
   * * Do Exercise Echo**

Question 12

Drugs for Pharm Stress?

Answer 12

Dobutamine

Adenosine

Question 13

1 cause of Post-MI Death?

Answer 13

Arrhythmia -> V. fib

Question 14

Post-MI new Murmur?

Answer 14

Papillary muscle Rupture

Question 15

MI complications at: 
hrs 
days 
weeks
 months

Answer 15

Hrs: Arrhythmia
Dys: Pericarditis
Wks: Ruptures (Free wall or sepal or papillary muscles) & Dressler
Mth: Aneurysm

Question 16

Post-MI severe hypotension

Answer 16

Ventricular wall rupture

Question 17

Post-MI persistent ST elevation and MR(-like)murmur?

Answer 17

Ventricular Wall aneurysm

Question 18

Post-MI, pleuritic chest pain + low fever

Tx?

Answer 18

Dressler Syndrome

Tx; NSAIDs and ASA

Question 19

Chest pain BETTER leaning forward…

Tx?

Answer 19

Pericarditis

Tx NSAIDs

Question 20

Chest pain worse with palpation of chest wall

Answer 20

Costochondriasia (usually viral)

Question 21

Chest pain AFTER viral infection (URI)

Answer 21

Myocarditis (Coxsackie B)

Question 22

Chest pain worse at night + transient ST elevation?

Dx & Tx?

Answer 22

Prinzmetal Angina
Dx: ergonovine test (reproduce pain)
Tx: Diltazem or verpamil OR Nitrates
NO B-blockers!!

Question 23

Progressive PR prolongation and dropped beat

Answer 23

Second degree, Type 1 heart block

Question 24

AV dissociation w/ bounding jugular pulse

Answer 24

3rd Degree heart block

Question 25

Varying PR interval + 3+ different P-wave morphologies

Answer 25

Multifocal Atrial Tachycardia

Question 26

3+ Wide QRS with no Ps

Answer 26

Ventricular Tachycardia

Question 27

V tach Treatments:

Answer 27

Stable: Amilodipine (Procainamide, Lidocaine, Sotolol)
Unstable: Syncronized Cardioversion

Question 28

Short PR + Wide QRS + “slurred initial deflection)

Path? and Tx?

Answer 28

WPW (delta waves)
Bundle of Kent
Tx: Procainamide
NO b blocker or Dioxin or CCB (slows AV conduction = makes worse)

Question 29

Saw tooth (A rate 250-350 and V rate 125-150)
(Tx? )

Answer 29

A flutter:
Stable: B blocker or Digoxin
Unstable: cardioversion

Question 30

Torsade De Pointes Tx?

Answer 30

Mg sulfate

Question 31

Causes of TdP?

Answer 31

1. Low Mg
2. Low K
3. Lithium toxicity
4. TCA Overdose

Question 32

Peaked T

Answer 32

HyperK

Question 33

Pulsus paradoxus + hypotension + faint heart sounds + electrical alternanas

Answer 33

Cardiac tamponade

Question 34

Irregular R-R and no P waves

Answer 34

A fibrillation
rate control > Rhythm control (AFIRM study)
Tx: B blocker or Digoxin

Question 35

Systolic
LOUDER with squatting
SOFTER with valsalva
(Cause & Tx?)

Answer 35

Aortic (Calcification or Bicuspid)

Tx: replacement

Question 36

Systolic
LOUDER with valsalva
SOFTER with squatting

Answer 36

Hypertrophic obstructive cardiomyopathy

Question 37

Effect of Valsalva

Answer 37

Dec. Intrathoracic pressure -> Dec. venous return -> Dec. Preload -> Dec. CO

Question 38

Effect of squatting (initially) and handgrip

Answer 38

Inc. vascular resistance -> Inc. Afterload

Question 39

Click and Systolic murmur

Answer 39

Mitral Valve Prolapse

Question 40

holosystolic murmur + radiation to axilla

Answer 40

MR

Question 41

Diastolic murmur w/ opening snap

Answer 41

Mitral stenosis

Question 42

“blowing” diastolic murmur w/ wide pulse pressure

Answer 42

Aortic regurgitation

Question 43

Suspect PE…first step?

Answer 43

Heparin!! Then CT (Ct > VQ)

Question 44

Wells Criteria for PE

Answer 44

Score >4 = CT &  100 = 1.5
Immobalized = 1.5
Hx or DVT/PE = 1.5
Hemoptysis = 1 
Hx of malignancy = 1

Question 45

New murmur

Answer 45

Echo!

Question 46

Acute pulmonary edema tx?

Answer 46

1. Nitrates
2. Lasix
3. Morhine

Question 47

Young + SOB +No cardiomegaly or pneumonia

Answer 47

pHTN

r/o CHF with PCWP

Question 48

Pumonary Capillary wedge Pressure measure

Answer 48

L atrial pressure

Question 49

CHF Tx

improve morality?

Answer 49

1. ACE** (prevent remodeling by aldo)
2. B-blocker** (prevent remobeling by Epi / norepi)
3. Spironolactone** (ONLY in NYHA Class 3 and 4 ) -> Eplerinone wont cause gynocomastia
4. Furosemide (improve SOB, edema)
5. Digoxin (dec. re-hospitalization)