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
1. severe-onset chest pain radiating to the back
2. BP differential between arms
3. Murmur of aortic regurgitation
4. Widened mediastinum of CXR
- 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 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
3. cardiac tamponade
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.
- 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
- Wide-complex QRS tachycardia
- Rate 140-250
LDL cholesterol in CAD
- Below 100
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
- Any wide complex QRS should be considered to be this unless proven otherwise
- 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
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.