Foundations of Emergency Medicine (2020)

Question 1

Cardiology

What underlying pathologic process distinguishes myocardial infarction from anginal/unstable angina?

Answer 1

Atherosclerotic plaque rupture → exposed endothelium → clot attaches
→ reduced blood flow; if cell death occurs (usually due to complete
vascular obstruction) then positive trop and MI; if no cell death occurs
then negative trop and angina/unstable angina

Question 1

Cardiology

What is the difference between transmural and non-transmural
infarction?

Answer 1

• Transmural: usually STEMI, large vessel affected, benefit from thrombolytics/PCI;
• Non-Transmural: usually NSTEMI, smaller subendocardial artery, may benefit from PCI but no thrombolytics

Question 2

Cardiology

What defines Unstable Angina?

Answer 2

• Stable Angina + pain at rest, new pain, increasing pain severity, hemodynamic changes with pain

Question 3

Cardiology

Acute chest pain at night, EKG with STEMI, all symptoms and EKG changes resolve with nitro?

Answer 3

• Prinzmental’s Angina (coronary spasm, most do not have CAD; treat with CCBs)

Question 4

Cardiology

What are early to late EKG changes with ACS?

Answer 4

• Hyperacute T’s and Giant R (very early and transient)
• STE
• STD (ischemia or reciprocal)
• Q waves (1 square wide, 1/3 height QRS)
• TWI

Question 5

Cardiology

Biphasic T-wave in V2/V3

Answer 5

• Wellen’s Syndrome: biphasic (type A) or deeply inverted, symmetric (type B) TW in septal leads = early signal of proximal LAD lesion

Question 6

Cardiology

Chest Pain with STE V1-V4 with
STD II, III, aVL

Answer 6

Anterior MI 2/2 LAD occlusion, may affect large territory of LV, septum and conduction sysytem (high grade blocks, wide complex bradycardias), commonly have shock, possible ruptures

Question 7

Chest Pain with STE I, aVL, V5, V6 with STD V1

Answer 7

Lateral MI 2/2 LAD vs LCx occlusion, may affect LV

Question 8

Chest Pain with STE II, III, aVF
with STD V1-V4

Answer 8

Inferior MI 2/2 occlusion of PDA (RCA > LCx), may affect AV node (usually transient narrow complex bradycardias), may cause papillary muscle rupture