MKSAP Cardiovascular Flashcards Preview

Internal Medicine > MKSAP Cardiovascular > Flashcards

Flashcards in MKSAP Cardiovascular Deck (38):

Diagnosis of non-ST-elevation MI

Characteristics: chest pain at rest, absence of ST elevation on ECG, and elevated MI biomarkers

- ST depression is often seen.


Diagnosis of acute pericarditis

Three classic features: 1. pleuritic chest pain, 2. friction rub, 3. diffuse concordant ST-segment elevation on ECG

- Chest pain that's worse when supine.
- Often can see PR segment depression.
- Fever is often present.

Friction rub: 3 components - atrial systole, ventricular contraction, and rapid ventricular filling; squeaky, scratchy and high-pitched


ST-elevation MI treatment

- PCI is the preferred treatment above thrombolytics.
- Most effective if completed within 12 hours of the onset of chest pain.


Contraindications to thrombolytic therapy

1. prior intracerebral hemorrhage
2. ichemic stroke within 3 months
3. suspected aortic dissection
4. active bleeding


Aortic dissection

1. severe-onset chest pain radiating to the back
2. BP differential between arms
3. Murmur of aortic regurgitation
4. Widened mediastinum of CXR


Treating RVMI

- Volume expansion with normal saline

Physical exam findings: Classic triad - 1. hypotension, 2. clear lung fields, 3. elevated estimated central venous pressure

ECG: ST-segment elevation of right-sided leads

Treatment: Reperfusion therapy, IV fluids, possibly inotropic support with dobutamine if IV fluids are not sufficient (second-line due to risk of worsening infarction due to increased O2 demand)


Noncardiac, GERD chest pain

- Symptoms can present with radiation and can last minutes to hours (even 18 hrs)
- Stress test pretty much r/o cardiac ischemia making an empiric trial of PPIs reasonable.


Diagnosis of Third degree AV block

- Complete absence of atrial impulses to the ventricle
- Most common caused of marked bradycardia w/ ventricular rates usually 30-50.

Causes: Lyme carditis (acute-onset, high-grade AV conduction defects occasionally associated with myocarditis)


First-degree AV block

PR interval greater than 0.2 sec
- Often associated with a soft S1


Diagnosis of panic disorder

- Symptoms peak within 10 minute of onset and usually last from 15-60 minutes

Treatment: CBT and SSRI



Classic triad: 1. sudden severe headaches, 2. diaphoresis, and 3. palpitations

Other symptoms: pallor, hyperglycemia, weight loss, arrhythmias, catecholamine-induced cardiomyopathy


Mobitz type II second-degree heart block

- Associated with disease of the conduction system (bundle-branch block, etc.)

Treatment: pacemaker


Treatment of worsening symptoms of chronic stable angina

- Increase beta blocker dosage
- Beta blockers should be titrated to achieve a resting HR of approximately 55 to 60 bpm and approximately 75% of the HR that produces angina w/ exertion.

- consider coronary angiography only after angina persists despite maximal medical therapy.



- Used to treat chronic stable angina
- Only added to baseline therpy that includes a beta-blocker, calcium channel blocker, and long-acting nitrate.


Diagnosis of PE

Symptoms: chest pain, dyspnea, asymmetric leg edema, elevated CVP, tachypnea, and tachycardia

Diagnosis: CT pulmonary angiography


Echocardiogram during chest pain

- Normal wall motion excludes coronary ischemia or infarction.


Ascending aortic dissection

1. acute aortic regurgitation
2. MI
3. cardiac tamponade
4. hemopericardium
5. hemothorax or exsanguination


Descending aortic dissection

- Splanchnic ischemia, renal insufficiency, lower extremity ischemia, or focal neurologic deficit due to spinal cord ischemia


Evaluation os suspected CAD

-Exercise stress test
- Especially useful in pts w/ intermediate probability of CAD w/ a normal baseline ECG, who are able to exercise


Adenosine nuclear perfusion stress test contraindication

- Significant bronchospastic disease.


Atrial flutter

- multiple P waves in a sawtooth pattern w/ 2:1 ventricular conduction.
- Most noticeable in inferior leads.
- Sawtooth patternshows negative deflections in inferior leads, but positive deflection in V1.


SA node dysfunction

- AKA sick sinus syndrome
-Symptomatic sinus bradycardia (in between episodes of tachycardia due to a fib) and tachycardia-bradycardia syndrome
- A. fib is the most common tachyarrhythmia observed

Can be due to sinus arrest, sinus exit block, and sinus bradycardia

Treatment: pacemaker implantation


Ventricular tachycardia

- Wide-complex QRS tachycardia
- Rate 140-250


LDL cholesterol in CAD

- Below 100


Atrial fibrillation

Rate between 350 and 600


Multifocal atrial tachycardia

- Associated with chronic lung disease w/ three of more P-wave configurations on ECG.


Atrioventricular reentrant tachycardia

AKA Wolff-Parkinson White syndrome
- Short PR interval (


Indications for coronary revascularization

Pt has chronic stable angina + one or more of these:
1. Angina pectoris refractory to medical therapy
2. a large area of ischemic myocardium
3. high-risk coronary anatomy (left main stenosis or 3 vessel disease)
4. Significant stenosis w/ reduced LV systolic function


Unstable angina treamtment

Admission to the CCU and IV heparin and nitroglycerin


Torsades de pointes

polymorphic ventricular tachycardia
- Rate of 200-300


Ventricular tachycardia

- Any wide complex QRS should be considered to be this unless proven otherwise


Cannon waves

- large a waves in jugular pulsations
- Signifies AV dissociation


Indications for inta-aortic balloon pump

1. ACS w/ cardiogenic shock unresponsive to medical therapy
2. acute mitral regurgitation secondary to papillary muscle dysfunction
3. ventricular septal rupture
4. refractory angina


Pathologic Q waves

-Width greater than 1mm and depth >25% the heighth of the QRS.


Always comes before CABG

Coronary angiography


Increased vagal tone

- Associated with inferior wall MI


Ventricular septal defect

- New systolic murmur, hypotension, and respiratory distress 1-3 days following an MI.
- Palpable thrill.


New onset murmur following MI

mitral regurgitation or ventricular septal defect