Cardiovascular

Question 1

A patient with an inferior MI is placed on a Nitroglycerin drip. Why should you have extra caution with this patient?

Answer 1

Nitroglycerin may precipitate HYPOTENTION via venous dilation.

Question 2

A patient is experiencing a STEMI via EKG findings. BP is 82/50. What should you avoid giving to this patient?

Answer 2

Nitroglycerin

Question 3

A patient is experiencing a Non-STEMI via EKG findings. Besides the standard “MONA” tx, what should this patient receive?

Answer 3

BB IV (Metroprolol; Atenolol)
Heparin IV
Nitroglycerin drip* (unless systolic BP is <90)

Question 4

What is the classic presentation of MI on EKG?

Answer 4

ST elevations of at least 1mm in 2 contiguous leads

Question 5

What are signs of myocardial ischemia on an EKG?

Answer 5

ST segment depression

Symmetrically inverted T waves*

Question 6

In the setting of a Non-STEMI, what will you see on an EKG?

Answer 6

Flat ST depression

Symmetrically inverted T waves*

Question 7

List the risk factors of the CAD?

Answer 7

1. HTN
2. Hypercholesterolemia/Hyperlipidemia
3. Cigarette smoking
4. DM
5. Advanced age
6. Family Hx of early CAD < 55
7. Male gender and post-menopausal woman

Question 8

What will vital signs look like with patients with CAD?

Answer 8

1. HTN/Hypotension (Cardiogenic shock)

2. Tachycardia/Bradycardia

Question 9

What anti-platelet agents are appropriate for tx of patients with unstable angina, STEMI and Non-STEMI?

Answer 9

Aspirin
Clopidogrel
Glyoprotein IIb/IIIa inhibitors

Question 10

What should you be mindful of when treating patients with both aspirin and clopidogrel experiencing unstable angina, STEMI, and Non-STEMI;

Answer 10

jhj

Question 11

What population do the glycoprotein IIb/IIIa inhibitors work best?

Answer 11

High rish patients:
elevated serum tropinin
ischemic ST segment changes
ongoing ischemia

Question 12

Give some examples of glycoprotein IIb/IIIa inhibitors.

Answer 12

Abciximab
Epifibatide
Tirofiban

Question 13

What is the first line agent for bradycardia? Why is this the preferred agent?

Answer 13

Atropine

Because excess vagal stimulation is the most common cause of bradycardia

Question 14

What is sick sinus syndrome?

Answer 14

sinus arrest with alternating paroxysms of atrial tachyarrhythmias & bradyarrhythmias

Question 15

What is most helpful in determining the presence of an AV block?

Answer 15

PR interval

Question 16

What classifies as a 1st-degree block?

Answer 16

Constant prolonged PR interval (>.20 seconds)

Question 17

What classifies a second-degree block?

Answer 17

Progressive lengthening of PR interval –> dropped QRS complex

Question 18

For a stable patient with Atrial Fibrillation, what is the temporary management?

Answer 18

Vagal stimulation
Beta-blockers
Calcium-channel blockers

Question 19

Hearing some doctors talk about a patients EKG, you hear “AV dissociation.” What does this mean for the patient? And is the temporary management?

Answer 19

3rd degree heart block*

• It means there is no association between the P waves and the QRS complexes
• this decreases cardiac output

Temporary management: temporary pacing; PPM

Question 20

Hearing some doctors talk about a patients EKG, you hear “AV dissociation.” What is the definitive treatment for this patient?

Answer 20

Permanent pacemaker

Question 21

For an unstable patient with Atrial Fibrillation, what is the temporary management?

Answer 21

Direct (synchronized) cardioversion

Question 22

For a patient with Atrial Fibrillation, what is the definitive management?

Answer 22

Radiofrequency ablation

Question 23

Does Atrial fibrillation have a regular rhythm?

Answer 23

Yes, it has an irregular RATE

Question 24

If a patient has an “irregularly irregular rhythm” with a narrow QRS–what else would you expect to see on the EKG?

Answer 24

ATRIAL FIBRILLATION

• No P waves (characterized by the presence of fibrillatory waves @ 350-600bpm)
• Ventricular rate is usually 80-140bpm (rarely >170)