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Emma H review Flashcards

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1
Q

*** scary new ekg changes that say STEMI

A

2mm ST elevation or new LBBB

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2
Q

wide flat QRS

A

LBBB

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3
Q

anterior infarct

A

LAD; V1-V4

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4
Q

lateral infarct

A

Circumflex; I, avL, V4-V6

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5
Q

Inferior infarct

A

RCA; II, III and aVF

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6
Q

R ventricular infarct

A

RCA; V4 on right sided ekg is 100% specific

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7
Q

*** V1-V4 lead changes

A

Anterior and LAD

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8
Q

*** II, III and avF changes

A

Inferior, RCA

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9
Q

thrombolytic window

A

6 hrs

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10
Q

CI to thrombolytics

A

active bleed, anticoagulated, recent ischemic stroke, hemorrhagic stroke, recent closed head trauma

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11
Q

hypotension, tachycardia, JVD but lungs are clear

A

R ventricular infarct - Don’t give nitro b/c risk of hypotension, give fluid with NS bolus!

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12
Q

patient with chest pain but normal EKG, what next?

A

cardiac enzymes, at least 3 sets q8hr

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13
Q

*** when does troponin rise and when normal by

A

rise 3-5 hrs, nl by 7-10 days

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14
Q

labs for repeat infarct

A

CKMB or myoglobin*

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15
Q

MI cocktail

A

morphine, oxygen, nitrates, aspirin/clopidogrel, bb

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16
Q

you find a lesion on coronary angiography, what to do?

A

PCI or CABG

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17
Q

when to CABG?

A 
L main disease
3 vessel disease or 2 vessel disease PLUS DM
>70% occlusion 
pain despite maximal medical tx
post-infarction angina
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18
Q

*** medication after MI

A 
aspirin + clopidogrel if stent
bb
ACEi in CHF of LV dysfunction
Statin
SA nitrates
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19
Q

*** pt with chest pain but normal EKG and cardiac enzymes, what to do?

A

stress test for suspect angina

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20
Q

*** when can’t you do a stress test

A

abnormal baseline EKG (LBB or baseline ST elevation)

on digoxin

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21
Q

findings of a + stress test

A

chest pain reproduced, ST depression, hypotension

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22
Q

Cause of death post-MI

A

arrhythmias, namely V-fib

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23
Q

New systolic murmur 5-7 days following MI

A

papillary muscle rupture with MR

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24
Q

acute severe hypotension following MI

A

ventricular free wall rupture

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25
"step up" in O2 concentration from RA to RV following MI
ventricular septal rupture
26
*** persistent ST elevation ~ 1 mo later + systolic MR murmur post MI
ventricular wall aneurysm
27
cannon-A waves
bounding pulsations of jugular vein - AV dissociation, either v-fib or 3rd degree heart block (AV node ischemia)
28
5-10 weeks following MI. pleuritic CP
Dressler's syndrome - thought to be autoimmune, treat with NSAIDs or aspirin
29
CP, murmur, vague history of viral illness
myocarditis
30
*** CP at rest, worse at night, also migraine HA and EKG shows transient ST elevation with episodes
Prinzmetal angina, dx with ergonovine stim tests
31
*** pt is diagnosed with Prinzmetal angina following ergonovine stim test, what is tx?
CCB or nitrates
32
progressive prolongation of PR interval followed by dropped beat
Mobitz type 1
33
regular p-p and r-r intervals but no pattern between p and qrs
3rd degree heart block - would see cannon-a wave
34
multifocal atrial tachycardia
rapid, irregular atrial rhythm arising from multiple foci in atria; severely sick pt with lung/heart path; poor prognosis
35
normal QRS
< 0.12 sec = 3 small squares
36
normal PR
< 0.2 sec = typically 3-5 small squares
37
vtach tx
unstable = shock; stable = medical tx (lidocaine, amiodarone)
38
delta wave
gradual up-sloping of QRS complex
39
*** QRS > 120 ms with slurred initial deflection representing early ventricular activation via the bundle of Kent
WPW; tx with procainamide
40
*** rx CI in WPW
anything that slows the AV node - bb, digoxin, verapamil, diltiazem
41
regular rhythm with ventricular rate 125-150 and atrial rate 250-300
atrial flutter
42
*** OD of ___ or ____ can lead to torsades
Lithium or TCA
43
girl in her 20s with sudden palpitations found to have EKG with regular rhythm and rate 200, what is it and what to do?
SVT, tx is NON-rx first -> carotid massage or face in ice
44
causes of hyperkalemia
burn victim, renal failure, crush injury
45
EKG with undulating baseline, low-voltage; pt has pulsus paradoxus, hypotension, distant heart sounds, JVD
electrical alternans in cardiac tamponade
46
why low voltage with EKG of tamponade
blood buffering voltage
47
first line of afib tx
rate control
48
causes of AS
age with calcific degeneration, congenital anomaly (bicuspid like Turners)
49
*** systolic cresc/decresc murmur that is louder with squatting + parvus et tardus on palpation of pulse
AS
50
*** late systolic murmur with click that is louder with valsalva and handgrip
MV prolapse
51
*** holo-systolic murmur loudest at apex and radiates to axilla
MR
52
continuous machine like murmur
PDA
53
wide fixed split S2
ASD
54
rumbling diastolic murmur with an opening snap
MS
55
*** blowing diastolic murmur with widened pulse pressure
AR
56
two diastolic murmurs especially important in the aging population
MS + AR
57
how does squatting, inspiration, and handgrip affect blood flow?
INCREASES blood flow return to the heart
58
how does standing and valsalva affect blood flow?
DECREASES blood flow return to the heart
59
what maneuvers can you do to increase preload?
squatting, handgrip, inspiration
60
what maneuvers decrease preload?
valsalva
61
*** which murmurs are worsened by increased preload?
stenotic and regurgitant valves - AS, MS, AR, MR
62
*** these two murmurs are made LOUDER by DECREASED preload
HCOM and MV prolapse
63
why is HCOM worse with valsalva (decreased preload)
without blood to push thing open, the hypertrophied septum covers the aortic opening
64
D\does less preload mean LOUDER floppy valves of MV prolapse?
YES
65
what to do for pt with SOB + murmur + hx of CHF
get an echo
66
acute pulmonary edema tx
nitrates, lasix, morphine
67
young pt who has sx of CHF and recent hx of viral illness
myocarditis, most likely coxsackie
68
*** what test can help you differentiate CHF from pulmonary HTN?
right heart cath

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