CARDIOVASCULAR

Question 1

CP at rest >20 minutes, transient ST or T-wave changes. Trop normal.

Answer 1

Unstable Angina

Question 2

What might a new LBBB be?

Answer 2

STEMI

Question 3

Easy EKG HR identification

Answer 3

300/150/100/75/60

Question 4

Lateral MI leads

Answer 4

I, aVL, V5, V6

Question 5

I, aVL, V5, V6

Answer 5

LATERAL MI

Question 6

Inferior MI leads

Answer 6

II, III, aVF

Question 7

II, III, aVF

Answer 7

INFERIOR MI

Question 8

Septal MI leads

Answer 8

V1, V2

Question 9

V1, V2

Answer 9

SEPTAL MI

Question 10

Anterior MI leads

Answer 10

V1, V2, V3, V4

Question 11

V1-V4

Answer 11

ANTERIOR MI

Question 12

Troponin elevation times

Answer 12

elevation at 4-6 hours, peak at 24-36 hours, normal 5-12 days

Question 13

When should we consider a fibrinolytic for a STEMI?

Answer 13

If unable to get PCI within 90 minutes (TPA within 30 minutes, still send to cath lab)

Question 14

When do we give oxygen for CP?

Answer 14

Only if hypoxic

Question 15

Thrombolytic 1 time dose

Answer 15

Tenecteplase (TNKase)

Question 16

30% of interior infarcts also involve what?

Answer 16

Right ventricle

Question 17

What must we do on all inferior infarcts?

Answer 17

Right side EKG b/c 30% of inferior MIs also involve right ventricle. Right side EKG is MIRROR IMAGE

Question 18

What is the right ventricle critical to?

Answer 18

cardiac output - preload/strech/filling

Question 19

What is the most specific lead to determine a right side MI?

Answer 19

V4’ / V4r

Question 20

Good ventricular wall stretch (filling) is needed for maximal ejection. Increased filling (preload) too much will decrease cardiac output.

Answer 20

Sterling’s Law

Question 21

3 characteristics of PRELOAD

3 characteristics of AFTERLOAD

Answer 21

Preload: right side of heart, managed by fluid, venous system

Afterload: left side of heart, BP/resistance dependent, arterial system

Question 22

What does increasing afterload also increase?

Answer 22

Heart workload

Question 23

What 3 meds decrease preload?

Answer 23

Lasix, morphine, nitro

Question 24

What meds decrease afterload?

Answer 24

Any vasodilator (nipride, ntg)

Question 25

Symptoms of left sided HF? Right sided HF?

Answer 25

Left = pulmonary edema + dependent edema Right = venous congestion + anasarca

Question 26

What BP med is used for eclampsia?

Answer 26

Hydralyzine

Question 27

-Vaso-dilators that decrease afterload -Veno-dilators that decrease preload -Arterilar-dilators that decrease afterload

Answer 27

-Vaso-dilators = alpha-blockers (catapres, clonodine) -Veno-dilators = morphine, nitro, lasix -Arterilar-dilators = hydralyzine, CCB

Question 28

What is the treatment goal for hypertensive crisis?

Answer 28

Decrease BP by 20-30% over 2-3 hours, treat until relief of symptoms

Question 29

This affects endocardium and valves; symptoms are Janeway lesions and Roth's spots. Check sed rate for diagnosis.

Answer 29

Endocarditis

Question 30

What are Janeway lesions? When do we see them?

Answer 30

Micro-emboli causing lesions to hands/fingers seen in endocarditis

Question 31

What are Roth's spots? When do we see them?

Answer 31

Micro-hemorrhages on retina seen in endocarditis

Question 32

Inflammatory, CP relieved by leaning forward, EKG shows ST changes in all leads

Answer 32

Pericarditis

Question 33

Beck's Triad

Answer 33

-JVD -Muffled heart sounds -low BP

Question 34

This causes Beck's triad; associated with pulsus paradoxus; treat with pericardiocentesis

Answer 34

Cardiac Tamponade

Question 35

What is pulsus paradoxus?

Answer 35

SBP increases by 10mmHg or more during inspiration

Question 36

Where on the heart does a blunt cardiac injury cause damage?

Answer 36

Anterior (sometimes inferior)

Question 37

This causes vasospasm of vessels esp in fingers

Answer 37

Raynaud's

Question 38

This causes thrombi of vessels esp in fingers

Answer 38

Buergers

Question 39

What is pain like in PVD?

Answer 39

Pain increases with use and is relieved with rest

Question 40

Non-obstructing clot on vessel wall waiting to break off and travel downstream

Answer 40

Thrombus in situ

Question 41

Virchow's Triad (DVT)

Answer 41

-venous stasis -hypercoagulability -endothelial injury

Question 42

What do we see on CXR in an aortic aneurysm?

Answer 42

Widened mediastinum

Question 43

Allen's Test procedure

Answer 43

-examiner grasps the patient’s wrist and applies finger pressure to block the vascular supply from the radial and ulnar arteries. -The patient then makes a fist three to four times so as to force the venous blood out of the hand via the posterior veins. -After 1 minute, the patient lets the arm hang down and opens the now pale hand. The examiner now releases compression, first from one artery then from the other. -This procedure is repeated with the radial artery released and compression on the ulnar artery maintained.

Question 44

What is the phlebostatic axis?

Answer 44

MAL, 4th ICS

Question 45

What 3 things does a good arterial wave have?

Answer 45

-rapid upstroke -clear dicrotic notch -definite end diastole

Question 46

Complications of an a-line

Answer 46

-dislodgement -bleeding -infection -etc

Question 47

1st degree AV block

Answer 47

PR >0.2 (1 large box)

Question 48

Heart block Wenckeback

Answer 48

2nd degree type ONE

Question 49

Associated with endocarditis: tender, purple-pink nodules found on the distal fingers and toes, pain usually proceeds nodule development, and they disappear in hours to days, leaving no sequelae.

Answer 49

Osler Nodes