1. Rupture of coronary artery on balloon inflation 2. Restenosis of vessel after angioplasty 3. Hematoma at site of entry

MTB 1 Flashcards by Nadia Mahmud

What makes the S4 gallop

Atrial systole as blood is ejected from atrium into a stiff ventricle
- seen in ischemia w noncompliant LV

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What is Kussmaul sign?

Ass’d with?

Increase in JVP w inhalation

Constrictive pericarditis or Restrictive Cardiomyopathy

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What condition do we see with displaced PMI

LVH

Dilated Cardiomyopathy

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When do we see triphasic scratchy sound on auscultation

Pericardial Friction Rub

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Leads in Anterior Wall MI

Leads V2-V4

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Leads in Inferior wall MI

II, III, aVF

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PR interval > 200 msec?

First-degree AV block

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ST depression in Leads V1 and V2

Posterior wall MI

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Pt w substernal chest pain arrives at ED. EKG shows ST elevation in V2, V4. Next best step?

Admin ASA

Angioplasty

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How long is ST elevation present on EKG

1-6 weeks

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Pt w new episode of pain a few days after first cardiac event - next step?

EKG for new ST changes

2. Check CK-MB

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MCC death first few days after MI

Ventricular Arrhythmia

- V tach, V fib

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When do we use thrombolytics in NSTEMI

Never

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Complications of PCI

Rupture of coronary artery on balloon inflation
Restenosis of vessel after angioplasty
Hematoma at site of entry

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Important in reducing recurrent stenosis after PCI

Drug-eluting stents inhibit T cell response

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Which thrombolytic cannot be given repeatedly and why

Streptokinase causes allergenic response

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Which thrombolytics are given as IV infusion

Streptokinase

Alteplase

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Which thrombolytics are given as rapid bolus injection

Retaplase

Tenecteplase

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Absolute CI to thrombolytics

CNS bleed
Major bleeding into bowel
Recent surgery - past 2 weeks
Active peptic ulcer - bleeding
Severe HTN, >180/110
Nonhemorrhagic stroke past 6 months
Hemorrhagic stroke

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Pt presents to ED with chest pain for past 1 hour, crushing, non-positional. EKG shows ST depression in V2, V4. ASA is given. Next best step?

LMW Heparin can prevent a clot from forming in coronary arteries

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Which pts do GIIb/IIIa inhibitors reduce mortality

Pts with ST depression

Best for non-STEMI, PCI and stenting

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With what pathology are TPAs beneficial

Study These Flashcards

ONLY with STEMI

Which heart pathology is heparin used in

Study These Flashcards

BEST for non-STEMI

Drugs that Increase bleeding with warfarin/Potentiate warfarin effect

Study These Flashcards

NSAIDs
Acetomenophen
Amiodarone
Cranberry Juice
Ginkoba
Vit E 
Thyroid hormone
SSRI

Drugs that Decrease bleeding with warfarin/lower warfarin effect

``` Rifampin Carbamezapine OCPs Ginseng St Johns Wort Spinach ```

EKG of First Degree AV block

Prolonged PR interval

Third Degree AV block

Cannon A waves = atrial systole against closed tricuspid valve. - cannon is bounding JV wave bouncing in neck

TX for symptomatic bradycardia

1. Atropine | 2. Pacemaker if ineffective

Right Ventricular Infarction

New inferior wall MI | Clear lungs

What does the right coronary artery supply

RV AV node Inferior wall of heart

Most specific EKG finding for Right Ventricular Infarction

ST elevation in V4R

TX for RV Infarction

High volume fluid replacement

TX for stable V tach

Amiodarone | Lidocaine

TX for Unstable V tach

Shock/Cardioversion/Defibrillation

TX for V Fib

Shock/Cardioversion/Defibrillation

When do we see tamponade/free wall rupture

Several days after infarction

Presentation of tamponade/free wall rupture

Sudden loss of pulse Clear lungs One cause of PEA

TX for tamponade/free wall rupture

Emergency pericardiocentesis on way to OR

How to distinguish V tach and V fib

EKG

Best long term therapy for V tach and V fib

Beta blockers

Presentation of valve or septal rupture

SOB, HypoTN, tachycardia New onset of murmur Pulmonary congestion

Step up in O2 sat from RA to RV

Septal Rupture

Most accurate test for valve rupture? | Septal rupture?

Echo

3 major mechanical complications of MI

1. MR due to papillary m. rupture 2. LV Free wall rupture 3. Interventricular septum rupture

TX for mural thrombi

Heparin followed by Warfarin

Sudden loss of pulse, JVD?

Tamponade/wall rupture

IWMI in hx, clear lungs, tachycardia, hypoTN w nitroglycerin?

RV Infarction

New murmur + rales/congestion

Valve Rupture

New murmur + increase in O2 sat in RV

Septal Rupture

Postinfarction routine medications

ASA Beta Blocker Statin ACE-I

Anterior wall infarctions have high likelihood of developing what?

Systolic Dysfunction

Nitrates and Sildenafil?

Causes HypoTN | 4 hour interval in DM patients

MC cause of ED postinfarction

Anxiety

How long do pts have to wait post MI to engage in sexual activity

They do not have to wait. | Can resume immediately

MTB 1 Flashcards

(54 cards)