ECOM - Cardio

Question 1

Left Branch Bundle Block

Answer 1

• Deep S wave and no R wave in V1 (“W” shaped); wide, tall and broad, or notched (“M”-shaped)
• R waves in I, Vs, and V6
• May indicate IAM
  -Sgarbossa Criteria

Question 2

Smith-Modified Sgarbossa Criteria

Answer 2

■ Concordant ST elevation (STE) > 1mm in > 1 lead
■ Concordant ST depression 1mm in 1 lead of V1 -V3
■ Excessive discordant STE in 1 lead with 1 mm STE, where excessive discordance is defined as STE to the maximum QRS amplitude ratio
2:25%

Question 3

Right Branch Bundle Block

Answer 3

• RSR’ complex (“rabbit ears;” “M”-shaped); qR or R morphology with a wide R wave in V1
  -QRS pattern with a wide S wave in I, Vs, and V6

Question 4

Irrigation area and Stroke Symptoms

Middle Cerebral Artery

Answer 4

Lateral surface

Contralateral pareiss and sensory loss in the face and arm; gaze toward lesion; contralateral homonymous heminanopsia
- Aphasia

Question 5

Anterior cerebral artery

Answer 5

Anteromedial surface

Contralateral paresis and sensory loss in the leg; cognitive or personality changes; urinary incontinence

Question 6

Posterior cerebral artery

Answer 6

Post and inf surfaces

Contralateral homonymous hemianopsia with macular sparing. Alexia w/o agraphia.

Weber Syndrome: Occlusion of branch of PCA leading to ipsilateral CNIII palsy, contralateral hemiparesis, and parkinsonian rigidity.

Question 7

Lacunar

Answer 7

Subcortical region

Thalamic pain syndrome in contralateral affected area of body.

Question 8

PICA/Wallenberg/Lateral Medullary Syndrome

Answer 8

Disarthria, disphagia, vertigo, nystagmus, hiccups, ipsilateral Horner Syndrome, loss of pain/temp sensation on ipsilateral face and contralateral body

Question 9

Carotid artery dissection

Answer 9

Sudden headache, neck pain, Horner syndrome.

Caused by oropharyngeal injury

Question 10

Contraindications to tPA therapy

Answer 10

SAMPLE STaGES

-Stroke or head trauma last 3 months
- Anti-coagulation with INR >1.7 or PTT >40 s or PT >15 s
- MI last 3 months
- Prior intracranial hemorrhage/neoplasm
- Low platelet count <100.000
- Elevated BP >180/>110
- major Surgery last 14 days
- TIA last 6 months
- GI/urinary bleeding last 21 days
- Elevated glucose >400/<50
- Seizures present at onset of stroke

Question 11

Acute Treatment Ischemic Stroke

Answer 11

IV thrombolysis with alteplase/tPA in pts without contraindications.
- <3-4.5 hrs since onset

+Asprin if >3 hrs onset
+Maintain BP <185/110 with labetalol, nicardinpine, clevidipine
+ Maintain BG 140-180
+ Elevate head 30 degrees, hypertonic soultion or mannitol, hyperventilation.