Cardiology Flashcards
(190 cards)
1
Q
stable angina is due to
A
fixed atherosclerotic lesion
2
Q
stable angian occurs when
A
oxygen deman exceeds available blood supply
3
Q
7 risk factors for stable angina?
A
- diabetes mellitus (worst risk factor)
- hyperlipidemia (high LDL)
- hypertension (most common risk factor)
- smoking
- age (men > 45, women > 55)
- low level of HDL
- family hx of prematrue coronary artery dz (CAD) or MI in first relatives
4
Q
5 clinical presentation for CAD?
A
- asymptomatic
- stable angina pectoris
- unstable angina pectoris
- MI (either NSTEMI or STEMI)
- sudden cardiac death
5
Q
what is the goal of LDL in all CAD pts?
A
below 100 mg/dl
6
Q
2 prognostic factors for CAD
A
- Lt. ventricular function (ejection fraction): less than 50% –> inc mortality
- vessels involved: Lt main coronary a (poor prognosis b/c it covers approximately 2/3 of the heart)
7
Q
4 clinical features of stable angina?
A
- chest pain or substernal pressure sensation
- brought on by factors that inc myocardial oxygen deman such as exertion or emotion
- relieved by rest or nitroglycerin
- pain that does NOT change with breating nor with body position
8
Q
3 characteristics of pain of stable angina
A
- last less than 10 to 15 min (usually 1 to 5 min)
- frightening chest discomfort, usually described as heaviness, pressure, squeezing, tightness (rarely described as sharp or stabbing pain)
- pain is often gradual in onset
9
Q
best initial test for all forms of chest pain?
A
ECG
10
Q
3 applications of stress ECG (exercise testing)?
A
- to confirm diagnosis of angian
- to evaluate response of therapy in pts with documented CAD
- to identify pts with CAD who may have a high risk of actue coronary events
11
Q
4 symptoms that give the positive result for stress test?
A
- ST segment depression
- chest pain
- hypotension
- significan arrythmia
12
Q
define metabolic syndrome X
A
any combination of hypercholesterolemia, hypertriglyceridemia, impaired glucose tolerance, diabetes, hyperuricemia, HTN
13
Q
6 ways to dianogse CAD
A
- physical exams are normal in most pts with CAD
- resting ECG (usually normal)
- stress test (stress ECG, stress echocardiography)
- pharmacological stress test (if pt can’t exercise)
- holter monitoring (ambulatory ECG)
- cardiac catheterization with coronary angiography
14
Q
what is stress test particularly useful for what pt group?
A
pts with an intermediate pretest probability of CAD based on age, gender, symptoms.
15
Q
name 3 types of stress tests
A
- stress ECG
- stress echocardiography
- info gain from stress tests can be enhanced by myocardial perfusion imaging after IV administration of a radioisotope such as thallium 201 during exercise
16
Q
what is the sensitivity of stress ECG?
A
75% if pts are able to exercise sufficiently to increase heart rate to 85% of max predicted value for age.
17
Q
how do you calculate tat max heart rate using stress ECG?
A
220 - age
18
Q
on ECG of a pt who is going through an exercise induced ischemia will show
A
ST segment depression (subendocardial ischemia)
19
Q
other than ST segment depression of ECG, what is the + findings from a stress test?
A
onset of heart failure or ventricular arrhythmia during exercise
20
Q
what is the next step for pts with a positive stress test?
A
cardiac catheterization
21
Q
when do you perform stress echocardiography?
A
before and immediately after exercise
22
Q
positive signs from stress echo?
A
wall motion abnormalities (eg. akinesis or dyskinesis) not present at rest
23
Q
why is stress echo favored over stress ECG?
A
more sensitive in detecting ischemia, can assess LV size and function, can diagnose valvular dz, and can be used to identify CAD in the presence of preexisting ECG abnormaltieis
24
Q
what is the definitive test for CAD?
A
cardiac catheterization with coronary angiography
25
4 indications for cardiac catheterization with coronary angiography
1. after a positive stress test
2. in a pt with angina in any of the following situations:
- when non-invasive tests are nondiagnostic
- angina that occurs despite medical therapy
- angina that occurs soon after MI
- angina that is a diagnostic dilemma
3. if pt is severely symptomatic and urgent diagnosis and management are necessary
4. for evaluation of valvular dz, and to determine the need for surgical intervention
26
what is coronary angiography also called?
coronary arteriography
27
what is coronary angiography (arteriography)?
most accurate way of identifying the presence and severity of CAD
the standard test for delineating coronary anatomy
28
what is the major purpose of coronary angiography (arteriography)?
to identify pts with severe coronary dz to determine whether revascularization is needed
29
how is unstable angina diff from stable angina?
in unstable, the oxygen demand is unchanged (whereas in stable, there is inc oxygen demand)
in unstable, the supply is dec due to the 2ndary to reduced resting coronary flow
30
3 typical pts that may have unstable angina?
1. pts with chronic angina with increasing freq, duration, and intensity of chest pain
2. pts with new onset angina that is severe or worsening
3. pts with angina at rest
31
what is the distinction btw USA and NSTEMI?
cardiac enzyme (only NSTEMI has elevated elevation of troponin or CK-MB)
32
what are 2 common things about USA and NSTEMI?
1. no ST elevation
| 2. no pathologic Q wave
33
4 differential diagnosis for heart pain due to heart, pericardium, and vascular causes
1. stable angina, unstable angina, and variant angina
2. MI
3. pericarditis
4. aortic dissection
34
5 diff diagnosis for heart pain due to lung issues
1. pulmonary embolism
2. pneumothorax
3. pleuritis (plueral pain)
4. pneumonia
5. status asthmatica
35
4 diff diagnosis for heart pain due to GI issues
1. GERD
2. diffuse esophageal spasm
3. peptic ulcer dz
4. esophageal rupture
36
5 diff diagnosis for heart pain due to chest wall issues?
1. costochondritis
2. muscle strain
3. rib fracture
4. herpes zoster
5. thoracic outlet syndrome
37
3 diff diagnosis for heart pain due to psychiatric issues?
1. panic attack
2. anxiety
3. somatization
38
one drug that can cause MI?
cocaine
39
what are 3 treatment options for stable angina (CAD)?
1. risk factor modification
2. medical therapies
3. revascularization
40
what is acute coronary syndrome?
1. clinical manifestations of atherosclerotic plaque rupture and coronary occlusion
2. the term ACS generally refers to unstable angina, NSTEMI or STEMI
41
what are the 2 important things when you are diagnosing unstable angina?
1. perform a diagnostic workup to exclude MI in all pts
2. pts with USA have a high risk of adverse events during stress testing. These pts should be stabilized with medical management before stress testing or should undergo catheterization initially.
42
4 medical medical therapies for stable angina?
1. aspirin
2. beta blockers (1st line choices: atenolol, metoprolol)
3. nitrates
4. calcium channel blockers
43
what is the purpose of giving beta blockers for stable angina pts?
reduce HR, BP, and contractality --> dec cardiac work --> dec oxygen consumption
44
how often do you need to measure cardiac enzyme?
cardiac enzyme are drawn serially every 8 hrs until 3 samples are obtained.
the higher the peak and the longer enzyme levels remain elevated, the more severe the myocardial injury and the worse the prognosis.
45
in MI, what 3 drugs are shown to reduce mortality?
aspirin, beta blockers, ACE inhibitors
46
what CAPRICORN trial showed?
beta blocker carvedilol reduces risk of death in pts with post-MI LV dysfunction.
47
what is carvedilol?
alpha and beta antagonist
48
what is another alpha and beta antagonist other than carvedilol?
labetalol
49
has thrombolytic therapy and CCB have shown to prove to be beneficial for unstable angina?
no (do NOT give thrombolytic for NSTEMI or unstable angina!)
50
what are the 2 common things in unstable angina and NSTEMI?
no ST elevation and no pathologic Q waves
51
3 main treatments for unstable angina?
1. hospital admission with continuous cardiac monitoring --> establish IV access and give supplemental oxygen and provide pain control with nitrate/morphine
2. aggressive medical management (treat as in MI except for fibrinolysis)
3. cardiac catheterization/revascularization
52
what are the 9 medical managements for unstable angina pts?
1. aspirin
2. clopidogrel (reduces the incidence of MI in pts with USA compared to with aspirin alone in CURE trial.
3. beta blockers
4. LMWH (keep PTT at 2 to 2.5 times normal if using LMWH, PTT is not monitored with LMWH)
5. nitrates (1st line therapy)
6. oxygen if pt is hypoxic
7. glycoprotein IIb/IIIa inhibitors (abciximab, tirofiban)
8. morphine
9. electrolytes to replenish K+ and Mg2+
53
what does TIMI stand for?
Thrombolysis in Myocardial Infarction
54
what is TIMI risk score for?
prognostication scheme that categorizes risk of death and ischemic events in pts with unstable angina/non-ST segment elevation MI
55
what is atrial fibrillation?
1. most common arrhythmia besides sinus tachycardia
| 2. irregularly irregular rhythm (irregular RR intervals on ECG) with absence of P waves.
56
name 11 causes for AF?
PIRATES
Pulmonary (COPD, PE)
Pheochromocytoma
Pericarditis
Ischemic heart dz and HTN
Rheumatic heart dz
Anemia
Atrial myxoma
Thyrotoxicosis
hypoThyroidism
Ethanol, Cocaine
Sepsis
57
5 clinical signs for AF?
1. fatigue (most common)
2. tachypnea (rapid breathing), dyspnea
3. palpitations, angina
4. lightheadedness, syncope
5. irregularly irregular rhythm palpated on physical exam
58
4 differential for AF?
1. paroxysmal atrial contractions
2. paroxysmal ventricular contractions
3. multifocal atrial tachycardia
4. atrial flutter with variable AV conduction
59
4 work ups for AF?
1. check ECG --> narrow QRS, variable PR intervals, irregular or absent P waves
2. check echo --> may show thrombus in the Lt. atrium but more often will show a dilated Lt. atrium
3. check TSH, hyperthyroidism is a reversiable cause of AF
4. perform baseline coagulation studies (INR/aPTT) prior to the initiation of anticoagulation therapy determined by the CHADS2 score for those with nonvalvular AF
60
name ( ) risk factors for CHF
1. MI
2. HTN
3. valvular heart dz (mitral stenosis, endocarditis)
4. pericardial dz
5. cardiomyopathy
6. AIDS
7. alcohol abuse
8. pul HTN
9. chronic ischemic heart dz (most common)
61
how is BNP useful?
inc BNP can be used to distinguish dyspnea due to heart failure from other cause of dyspnea
62
5 causes for 2' HTN?
Running Doesn't Elevate Our Pressure
1. Renal
2. Drugs
3. Endocrine
4. Other
5. Pregnancy
63
3 renal cause for 2' HTN
1. renal artery stenosis from fibromuscular dysplasia in young women
2. atherosclerotic dz
3. renal parenchymal dz (polycystic kidney dz, renal cell carcinoma)
64
5 causes that increase pulse pressure?
1. aortic regurge
2. aortic stiffness (aging --> calcification --> dec compliance)
3. hyperthyroidism
4. obstructive sleep apnea
5. exercise
65
4 causes that dec pulse pressure?
1. aortic stenosis
2. cardiogenic shock
3. cardiac tamponade
4. advanced heart failure
66
the diagnosis of bundle branch block is mainly based on the widened
QRS (at least 3 small squares = 0.12 sec)
67
on EKG, to diagnose BBB check for
RR'
68
on EKG, for Rt. BBB, what leads should you be looking for RR'?
V1, V2
69
on EKG, for Lt. BBB, what leads should you be looking for RR'?
V5, V6
70
what EKG leads should you look for MI in LAD (anterior)?
V1 - V4
71
what EKG leads should you look for MI in circumflex (lateral)?
I, avL, V4-V6
72
what EKG leads are important for MI in RCA (inferior)?
II, III, avF
73
what EKG leads should you look for MI in RCA in the Rt. ventricular?
V4 on Rt sided EKG is 100% specific
74
pt with chest pain comes in and you did EKG, what 2 things should you be looking for?
1. 2 mm ST elevation
| 2. LBBB (wide, flat QRS)
75
name 3 contraindications for thrombolytics?
1. bleeding
2. taking anticoagulants
3. hemorrhagic stroke
4. recent ischemic stroke
5. recent closed head trauma
76
when do you ST elevation if you have MI?
immediately
77
when do you see T wave inversion in MI?
6 hrs - years
78
how long does Q waves last on EKG?
forever
79
treatment for STEMI?
restore blood flow
1. Cath lab
2. give thrombolytics (within 6 hrs)
80
5 Sxs for Rt. ventricular infarct?
1. hypotension
2. tachycardia
3. clear lungs
4. JVD
5. no pulsus paradoxus
81
do you give nitrate for Rt. ventricular infarct? why?
No, they need inc preload (not dec)
82
what is the treatment for Rt. ventricular infarct?
vigorous fluid resuscitation
83
pt with chest pain with normal EKG, what is the next step?
order cardiac enzyme (if elevated, it's NSTEMI)
84
how many cardiac enzymes should you order?
3 sets (every 8hrs)
85
what is the most sensitive cardiac enzyme for MI?
myoglobin b/c it is the 1st to go up (peaks in 2 hrs)
86
name 3 cardiac enzymes you want to order?
1. myoglobin
2. CKMB
3. troponin 1
87
when is the peak time for CKMB and how long does it last?
4-8hrs, peaks 24hrs, stays for 72 hrs
88
when does troponin I peaks and how long does it last?
rise in 3-5 hrs, peaks 24-48 hrs, lasts 7-10 days
89
the most sensitive cardiac enzyme for 2nd infarct?
myoglobin (b/c it peaks in 2 hrs)
90
for NSTEMI what are the 6 treatments?
1. morphine
2. oxygen
3. nitrates
4. aspirin
5. clopidogrel
6. beta blockers
91
for pts with NSTEMI after you give treatments, what are the next steps?
do coronary angiography within 48 hrs to determine need for intervention
92
for pts with NSTEMI, after the coronary angiography, what are the 2 treatment (intervention) options?
1. PCI (Percutaneous coronary intervention) with stenting (gold standard)
2. CABG (coronary artery bypass grafting)
93
when is CABG (coronary artery bypass grafting) preferred over PCI with stenting?
1. if Lt. main dz
2. 3 vessel dz
3. 2 vessel dz + DM
4. >70% occlusion
5. pain despite max medical tx
6. post infarction angina
94
pts with NSTEMI who got either PCI with stent or CABG, what are the 6 discharge meds?
1. aspirin
2. clopidogrel for 9-12 mo if stent placed
3. b blocker
4. ACE inhibitors if CHF or LV dysfxn
5. statin
6. nitrate for chest pain
95
a pt currently having Chest pain turned out to have normal EKG and no cardiac enzyme (x3) elevation. what is the most likely dx?
unstable angina
96
what are the work-ups for unstable angina?
exercise EKG: avoid b-blockers and CCB before
97
if a pt with angina has old LBBB or baseline ST elevation or on digoxin, can you do EKG stress test?
no, do echo instead.
98
what if a pt with angina can't exercise? what do you do?
do chemical stress test with dobutamine or adenosine
99
what is MUGA?
multigated acquisition scan (nuclear medicine test) is a noninvasive diagnostic test used to evaluate the pumping function of the ventricles
100
before MUGA test, what should a pt avoid?
caffeine or theophyline before
101
what are the 3 indications during the stress test that should lead you to do the coronary angiography?
1. chest pain is reproduced
2. ST depression
3. hypotension
102
MC cause of death for post-MI?
arrhythmia (v-fib)
103
new systolic murmur 5-7 days after MI?
papillary muscle rupture
104
acute severe hypotension after MI?
ventricular free wall rupture
105
a pt step up and O2 conc from RA --> RV?
ventricular septal rupture
106
persistent ST elevation 1 month later + systolic murmur, what is the cause?
ventricular wall aneurysm
107
cannon A waves?
AV-dissociation, either V-fib or 3rd degree heart block
108
5-10 wks later pleuritic CP, low grade temp?
Dressler, autoimmune pericarditis
109
treatments for Dressler?
NSAIDs and aspirin
110
a young healthy pt comes in with chest pain, you do a EKG and see diffuse ST elevation, dx?
pericarditis
111
describe the characteristics of chest pain from pericarditis?
worse with inspiration, better with leaning fowards, friction rub and diffuse ST elevation
112
what is the major risk factor for the development of atherosclerosis and increases risk for myocardial infarction and stroke?
uncontrolled HTN
113
primary HTN is also know as
essential or idiopathic HTN
114
risk factors of HTN?
1. family hx
2. obesity
3. sodium sensitivity
4. DM
5. metabolic syndrome
(smoking is NOT a risk factor)
6. alcohol
115
what is the bp range of preHTN?
120-139, 80-89
116
treatment for preHTN?
lifestyle modifications
117
bp range for stage 1 HTN?
140-159, 90-99
118
treatment for stage 1 HTN?
thiazide type diuretics
119
bp range for stage 2 HTN?
>160, >100
120
treatment for stage 2 HTN?
thiazide type + another class
121
10kg of weight loss can lower how much bp?
5-20 mmHg
122
DASH diet can reduce how much bp?
8-14 mmHg
123
reduce dietary sodium to 2.4 g per day how much bp can you lose?
2-8 mmHg
124
after lifestyle modification, what is the 1st DOC to lower bp?
25 mg thiazide diuretics
125
DOC for HTN pts with coronary artery dz or Lt. ventricular systolic dysfunction?
beta blocker
126
HTN pts with significant LV systolic dysfunction should avoid what drug?
CCB (can exacerbate the condition)
127
5 contraindications to thiazide?
1. gout
2. pregnancy
3. electrolyte disorders
4. incontinence
5. BPH
128
contraindications to beta blockers?
1. heart block
2. sick sinus syndrome
3. obstructive lung dz
129
beta blockers can have benefits with what types of comorbidities?
1. CAD
2. LV systolic dysfunction
3. stable angina
4. atrial arrhythmias
5. prior MI
130
4 contraindications to ACE inhibitors?
1. pregnancy
2. bilateral renal stenosis
3. angioedema
4. hyperkalemia
131
7 common causes for 2' HTN?
1. renovascular
2. renal parenchymal injury
3. obesity
4. pharmacologic toxic
5. endocrine issues
6. coarctation of aorta
7. sleep apnea
132
what is the level of significant proteinuria?
more than 500 mg/day
133
what is the most effective known modifiable risk factor for primary HTN?
weight loss
134
medications that inc bp?
1. oral contraceptives
2. ethanol
3. NSAIDs (dec sodium excretion, but baby aspirin is fine) --> inc bp by blocking COX-2 in the kidney
135
does chronic smoking lead to HTN?
no, smoking is NOT is associated with inc bp
136
what is a major cause of HTN in obese males?
primary hyperaldosteronism
137
4 lab findings of primary hyperaldosteronism with HTN?
1. resistant HTN
2. low serum potassium
3. high sodium levels
4. metabolic alkalosis
138
triad symptoms of pheochromocytoma
1. sweating
2. headache
3. tachycardia
139
2 ways to diagnose pheochromocytoma?
1. 24 hr urinary metanephrine collection
| 2. CT or MRI to localize tumor
140
DOC for hypertensive crisis in pheochromocytoma?
1. nitroprusside
| 2. phentolamine
141
mech of 2' HTN due to obstructive sleep apnea?
1. inc catecholamine release at night
| 2. hypoxia/reperfusion leading to endothelial dysfunction
142
definition of hypertensive emergency?
systolic > 180, diastolic > 120 + end organ damages
143
medications/treatment for hypertensive emergency?
1. there is no strict general guideline currently
| 2. slow decline in BP to 160/100 mmHg on oral therapy is generally recommended
144
clinical signs for hypertensive emergency?
1. retinal hemorrhage, exudates, papilledema
2. hypertensive encephalopathy: cerebral edema with mental status changes
3. malignant nephrosclerosis
4. pulmonary edema
5. aortic dissection
145
treatment for hypertensive emergency?
gradual pressure reduction except for aortic dissection that needs an immediate reduction of bp to 120/80
146
define dyslipidemia (LDL, HDL, TG)
LDL > 150 mg/dl
| HDL 200 mg/dl
147
4 risk factors for atherosclerosis?
1. dyslipidemia
2. tobacco smoking
3. uncontrolled HTN
4. diabetes
148
3 morbidity/mortality for coronary atherosclerosis?
1. heart failure
2. arrhythmia
3. sudden death
149
3 follow ups for pts with known coronary dz?
1. echo for cardiac function
2. stress test to determine functional status
3. coronary angiography to classify lesion location and severity
150
3 DOC for pharmacologic stress test
1. adenosine
2. regadenoson
3. dobutamine
151
mech of adenosine, regadenoson?
dilate healthy coronary artery and monitor via nuclear imaging
152
complications of rupture of aortic atherosclerosis
1. livedo reticularis (skin necrosis)
2. digital gangrene
3. renal dysfunction
4. retinal emboli
5. central nervous system/ocular dysfunction, such as stroke, retinal plaques, and neuropathy
153
rupture of TAA is unlikely when the TAA is less than
4 cm
154
what is the rupture rate of TAA greater than 6 cm in diameter?
35% per 5 yrs
155
2 clinical signs for TAA?
1. pts with proximal aortic aneurysm may have aortic valve insufficiency and a diastolic murmur
2. widened mediastinum on chest x-ray
156
DOC for TAA?
beta blocker --> dec pulse pressure
| aggressive bp control is most important
157
5 indications that surgery is needed for TAA?
1. symptoms are intolerable
2. aortic diameter > 5 cm ascending or > 6 cm descending
3. aortic diameter growth exceeds 10 mm/year
4. aortic valve surgery for another cause is imminent and the TAA is greater than 4.5 cm
5. dissection is present in a high risk area
158
3 risk factors for TAA?
1. HTN
2. bicuspid aortic valve
3. connective tissue dz (Marfan)
159
2 cases when surgery is needed for AAA
1. aneurysm bigger than 5.5 cm
| 2. rate of expansion exceeds 0.5 cm/6month
160
what are the 2 shockable rhythm?
v tach, v fib
161
synchronized cardioversion is for pts with
arrhythmia with a pulse
162
non synchronized cardioversion is also known as
defibrillation
163
non synchronized cardioversion (defibrillation) is for pts with
arrhythmia (v fib or v tach) without a pulse
164
in what cardiac situation is the 1st step is 1 mg of IV epi? (instead of shocking)
if pt is asystole or has pulsless electrical activity (PEA)
165
v fib is always
pulsless
166
v tach can be
pulsless or with pusle
167
treatments for atherosclerosis of cerebral vessels?
best treated with antiplatelet rather than anticoagulants
1. clpidogrel
2. aspirin
3. dipyridamole
4. cilostazol (PDE3 inhibitor)
168
how many hours after symptoms, is it not recommend to use thrombolytic?
4.5 hrs?
169
signs and symptoms of peripheral arterial dz?
1. diminished pulses in the leg distal to the level of blockage
2. pallor
3. hair loss
4. nonhealing wounds
5. ulcers
6. gangrenous toes
170
name of the diagnostic test for PAD?
ankle branchial index (ABI)
171
how is ABI recorded?
as a ratio btw the ankle blood pressure of the leg in question and the bp in the Rt or Lt arm
172
what is a normal ABI value?
0.91 - 1.3
173
iatrogenic mesenteric ischemia may be caused by the overuse of
vasoconstrictors in shock states (phenylephrine, other alpha agonists)
174
the aorta gives off the
Left main coronary arteries (LMCA)
| Rt. coronary arteries
175
LMCA gives off two branches?
1. Lt anterior descending (LAD)
| 2. Lt circumflex (LCx)
176
what supplies the lateral wall of the LV?
LCx (Lt circumflex)
177
what are the 3 main coronary arteries?
RCA, LAD, LCx
178
6 medications for stable angina/coronary artery dz?
1. aspirin
2. statin
3. nitrates
4. beta blockers
5. CCB
6. ranolazine (sodium channel blocker)
179
EKG sign for USA?
ECG can be normal, but typically show ST depression or T wave inversions during chest pain
180
7 medications for USA?
1. high dose aspirin and another antiplatelet med such as clopidogrel
2. heparin
3. nitrates for chest pain
4. betablockers
5. statins
6. oxygen
7. morphines
181
what score system is used to make the decision on which pts with USA/NSTEMI should go to the catheterization lab?
TIMI scoring
182
USA pts should undergo cardiac catheterization and possible percutaneous intervention (PCI) with balloon angioplasty under what situations?
1. two or more of the risk factors (TIMI score > 2)
2. course complicated by
1) ongoing pain unrelieved by meds
2) tach or bradyarrhythmia
3) heart failure symptoms
4) persistent ST changes on ECG
183
what is a good door to balloon time (time from presentation to PCI)?
90 min
184
a pregnant woman with ST elevations should undergo
cardiac catheterization in an emergent fashion
185
systemic inflammatory response syndrome are characterized by 2 or more of the following 4
1. fever (>38C), hypothermia (20 bpm) or PaCO2 90bpm)
| 4. inc WBC count (12,000 cell/hpf)
186
treatments for NSTEMI?
1. dual antiplatelet therapy
2. anticoagulant
3. statin
4. nitrates
5. beta blockers if bp is stable
187
for NSTEMI pts, decision to go to cardiac catheterization lab should be depend on
TIMI score (if higher than score 2)
188
2 examples of paradoxic splitting?
LBBB, aortic stenosis
189
in what situation is S3 considered normal?
in athletes and young people, indicate vigorous relaxation
younger than 3 yr old
190
treatment for aortic stenosis?
aortic valve replacement
