MKSAP Cardiovascular Flashcards Preview

Internal Medicine > MKSAP Cardiovascular > Flashcards

Flashcards in MKSAP Cardiovascular Deck (38):
1

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.

2

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

3

ST-elevation MI treatment

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

4

Contraindications to thrombolytic therapy

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

5

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

6

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)

7

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.

8

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)

9

First-degree AV block

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

10

Diagnosis of panic disorder

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

Treatment: CBT and SSRI

11

Pheochromocytoma

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

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

12

Mobitz type II second-degree heart block

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

Treatment: pacemaker

13

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.

14

Ranolazine

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

15

Diagnosis of PE

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

Diagnosis: CT pulmonary angiography

16

Echocardiogram during chest pain

- Normal wall motion excludes coronary ischemia or infarction.

17

Ascending aortic dissection

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

18

Descending aortic dissection

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

19

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

20

Adenosine nuclear perfusion stress test contraindication

- Significant bronchospastic disease.

21

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.

22

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

23

Ventricular tachycardia

- Wide-complex QRS tachycardia
- Rate 140-250

24

LDL cholesterol in CAD

- Below 100

25

Atrial fibrillation

Rate between 350 and 600

26

Multifocal atrial tachycardia

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

27

Atrioventricular reentrant tachycardia

AKA Wolff-Parkinson White syndrome
- Short PR interval (

28

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

29

Unstable angina treamtment

Admission to the CCU and IV heparin and nitroglycerin

30

Torsades de pointes

polymorphic ventricular tachycardia
- Rate of 200-300

31

Ventricular tachycardia

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

32

Cannon waves

- large a waves in jugular pulsations
- Signifies AV dissociation

33

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

34

Pathologic Q waves

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

35

Always comes before CABG

Coronary angiography

36

Increased vagal tone

- Associated with inferior wall MI

37

Ventricular septal defect

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

38

New onset murmur following MI

mitral regurgitation or ventricular septal defect