IM Cardio Flashcards
(100 cards)
What is the the treatment of choice for prinzmetal angina?(3)
calcium channel blockers and nitrates
advise to avoid known triggers, including smoking and stress.
a 52-year-old woman presents to the ED complaining of recurrent episodes of chest pain. These episodes occur mostly at rest, typically in the early morning hours, and are described as a constricting sensation in her chest lasting for about 15 minutes. She denies any exertional component to her pain. Her past medical history is significant for migraine headaches but is otherwise unremarkable. She does not smoke and has no family history of coronary artery disease. On examination, her blood pressure is 130/85 mmHg, heart rate is 70 bpm, and physical examination is normal. During one of her visits, she experiences an episode of chest pain, and an ECG performed at that time shows transient ST-segment elevation. Her troponin levels at this visit are positive. Coronary angiography is performed, revealing no significant fixed stenosis, but coronary artery spasm is provoked with intracoronary acetylcholine, confirming the diagnosis of
prinzmetal variant angina
a 63-year-old man presents to the clinic with a 6-month history of chest discomfort. He describes the discomfort as a pressure-like sensation in the center of his chest, typically occurring during his daily morning walks and resolving with rest or nitroglycerin. The discomfort lasts for about 3-5 minutes each time and is sometimes accompanied by shortness of breath. He has a history of hypertension and hyperlipidemia, and he smokes ten cigarettes a day. His father had a myocardial infarction at the age of 55. On examination, his blood pressure is 140/90 mmHg, heart rate is 78 bpm, and his cardiovascular examination is normal. An ECG shows no acute changes. Given his symptoms and risk factors, he undergoes a stress test, which reveals reversible ischemia in the anterior wall of the left ventricle. Coronary angiography is performed, showing 70% stenosis in the left anterior descending artery. The patient is diagnosed with stable angina and is started on aspirin, a statin, a beta-blocker, and a sublingual nitroglycerin for anginal episodes
What is the treatment of choice for stable angina?
Asprin, Statin and a beta blocker
In patients with classic symptoms of angina, nuclear ____ is the most widely used test for diagnosis of ischemic heart disease.
Stress testing
How does stable angina differ from unstable angina?
it is Chest pain that is predictable and brought on by exertion, emotional stress, or cold weather. The pain typically resolves with rest or nitroglycerin.
No myocardial necrosis
True or False. In stable and unstable angina troponin is typically normal
true
What are the two types of NSTEMI’s?
Non-occluded coronary artery with myocardial necrosis
and
Subendocardial (not through the entire heart muscle wall)
Early wide, bizarre QRS complex greater than 0.12 seconds and no identifiable p wave
premature ventricular contraction (PVC)
What ekg findings are consistent with PAC’s?
Abnormally shaped p wav
What EKG findings are consistent with paroxysmal supraventricular tachycardia
arrow complex tachycardia, no discernible p wave
What EKG findings are consistent with Atrial Fibrillation?
Irregularly irregular rhythm with disorganized and irregular atrial activations and an absence of P waves
What EKG findings are consistent with Atrial Flutter?
regular sawtooth, pattern and narrow qrs
What is the most appropriate inital management in a patinet with PVC’s?
Reassurance and lifestyle modifications
a 45- year-old male admitted to the hospital because of several months of sudden onset of recurrent weakness accompanied by flushing of the face and dizzy spells. The patient also had recurrent spells of chest pain localized to the sternal area. The symptoms last for 10-15 seconds and sometimes 30 seconds to a minute and go away without treatment. During his stay in the ICU, the patient had similar symptoms several times, and the monitor showed long periods of asystole with no ventricular activity. This was associated with blood pressure drops, and the patient felt dizzy
Predominantly affecting older adults. DX?
Sick sinus syndrome
What is sick sinus syndrome / sinus node dysfunction?
dysfunction in the sinus node’s automaticity and impulse generationZ
What is the most common cause of sinus node dysfunction?
idiopathic SA node fibrosis, which may be accompanied by degeneration of lower elements of the conducting system.
other causes inclue drugs, excessive vagal tone
What causes bradycardia tachycardia syndrome and how will it be treated?
The SA node is diseased and not responding properly. will likely need a permanent pacemaker
50 percent of patients with sick sinus syndrome develop ___
alternating bradycardia and tachycardia also known as tachybrady syndrome
What is sinus arrest?
prolonged absence of sinus node activity (absent P waves) >3 seconds
Which of the following is first-line treatment for symptomatic bradyarrhythmias due to sick sinus syndrome (SSS)?
permanent pacemaker
How can you identify sinus arrhythmia on EKG?
Normal, minimal variations in the SA Node’s pacing rate in association with the phases of respiration. Heart rate frequently increases with inspiration, decreases with expiration
characterized by a phasic variation in the R-R interval on the ECG, which corresponds to the respiratory cycle.
A 22-year-old woman presents for a routine check-up. During the examination, her heart rate is noted to increase during inspiration and decrease during expiration. This finding is most likely due to which of the following mechanisms?
Variation in vagal tone during the respiratory cycle = sinus arrythmia
What rhythm is described as Three or more consecutive VPBs, displaying a broad QRS complex tachyarrhythmia
Ventricular Tachycardia
