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Powerpoint Notes Flashcards

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1
Q

Best first test for chest pain

A

EKG

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2
Q

STEMI definition

A

2mm ST elevation or new Left Bundle Branch Block (wide, flat QRS)

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3
Q

STEMI EKG changes

A

ST elevation seen immediately
T wave inversion (lasts 6 hrs to years)
Q waves last forever

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4
Q

STEMI tx

A

Reperfusion (cath lab if possible or thrombolytics if no contraindications)

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5
Q

Anterior wall EKG leads and associated artery

A

LAD

V1-V4

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6
Q

Lateral wall EKG leads and associated artery

A

Circumflex

I, avL, V4-V6

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7
Q

Inferior wall EKG leads and associated artery

A

RCA

II, III, and aVF

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8
Q

Right ventricular wall EKG leads and associated artery

A

RCA

V4 on Right sided EKG is 100% specific

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9
Q

Thrombolytic contraindications

A

Active bleeding
past hemorrhagic stroke
recent closed head trauma/ischemic stroke
If > 6 hours since event

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10
Q

Signs of Right Ventricular Infarct

A

hypotension, tachycardia, JVD w/ clear lungs, and no pulsus parodoxus

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11
Q

Tx of right ventricular infarct

A

Vigorous fluid resuscitation (NOT nitrogen)

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12
Q

Tx of anginal pain

A

MONA (O2 and Nitrates with aspirin then morphine)

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13
Q

Second best test for chest pain (post EKG)

A

Cardiac enzymes (check q8hrs x 3)

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14
Q

If normal EKG but elevated enzymes

A

Non-STEMI

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15
Q

Cardiac enzymes in order of rise

A

myoglobin (peaks in 2hr-> normal by 1 day)
CK-MB (rise in 4-8 hrs-> peaks 24hr-> normal by 3 days)
Troponin I (rise in 3-5hrs-> peaks 24-48 hrs-> normal by 7-10 days)

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16
Q

Non-STEMI tx

A

morphine, O2, nitrates, aspirin/clopidogrel, and beta-block

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17
Q

Non-STEMI management

A

Do coronary angiography w/in 48hrs to determine need for intervention

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18
Q

Non-STEMI intervention (2)

A

1st: PCI w/ stenting
2nd: CABG

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19
Q

Indications for CABG

A
  1. left main dz
  2. 3 vessel dz (2 if diabetic)
  3. > 70% occlusion
  4. pain despite all meds
  5. post-infarct angina
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20
Q

Non-STEMI discharge meds

A
  1. aspirin (w/ clopidogrel for 9-12 mo if stent placed)
  2. ACEI if CHF/LV dysfunction
  3. Statin
  4. Nitrates
  5. beta-blockers
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21
Q

If no EKG changes and normal cardiac enzymes-> dx

A

unstable angina

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22
Q

Unstable angina w/u

A
  1. exercise EKG (exercise echo or chemical stress test)

2. MUGA

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23
Q

MCC of death post MI

A

Arrhythmias (V-fib)

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24
Q

5-7 days Post MI new systolic murmur

A

Papillary muscle rupture

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25
Post MI acute severe hypotension
ventricular free wall rupture
26
Post MI step up in O2 conc from RA to RV
Ventricular septal rupture
27
Persistent ST elevation 1 mo post MI + systolic murmur
Ventricular wall aneurysm
28
Cannon A waves (bounding JVP)
AV-dissociation (V-fib/3rd degree heart block)
29
Pleuritic chest pain w/ low grade temp 5-10 wks later
Dressler (autoimmune pericarditis)
30
Dressler Tx
NSAIDs and aspirin
31
Symptoms of pericarditis
better leaning forward, worse with inspiration
32
Signs of pericarditis
friction rub and diffuse ST elevation
33
Chest pain thats worse with insipiration
costochondritis
34
Vague chest pain with hx of viral infection and murmur
myocarditis
35
Chest pain at rest, worse at night, few CAD risk factors and migraine headaches
Prinzmetal's angina (transient ST elevation during episodes)
36
Prinzmetals angina dx
Ergonovine stimulation test
37
Prinzmetals tx
CCBs or nitrates
38
EKG: progressive, prolongation of PR interval followed by dropped beat
Mobitz type 1 (Winckebach)
39
EKG: regular P-P and R-R intervals that are not associated
3rd degree heart block (cannon a waves on physical)
40
EKG: varying PR interval with 3+ morphologically distinct p waves in same lead
Multifocal atrial tachycardia
41
Multifocal atrial tachycardia vignette
Old pt w/ chronic lung dz in pending respiratory failure
42
EKG: 3+ consecutive beats w/ QRS 120
Ventricular tachycardia
43
V-tach tx
if stable: lidocaine or amiodarone | if unstable: shock
44
EKG: short PR interval followed by slurred initial deflection
Wolff-Parkinson-White (delta wave due to early ventricular activation via bundle of Kent)
45
WPW tx
Procainamide
46
Contraindicated meds in WPW
beta blockers, verapamil and diltiazem, and digoxin
47
EKG: regular rhythm w. ventricular rate 125-150 and atrial rate 250-300
atrial flutter (sawtooth)
48
Atrial flutter tx
unstable: shock stable: beta-blockers or digoxin
49
EKG: prolonged QT with undulating rotation of QRS around EKG baseline
Torsades
50
Clinical presentation of Torsades
Patient has low Mg and low K (can be due to Li or TCA OD)
51
EKG: regular rhythm and rate b/w 150-220
Supraventricular tachy
52
Supraventricular tachy presentation
young patient with sudden palpitations and dizziness
53
SVT tx
1st try carotid massage then adenosine
54
EKG: peaked t-waves, wide QRS, short QT, and prolonged PR
HYPERKALEMIA
55
Clinical background of patient with hyperkalemia
Renal failure/crush injury/burn victim
56
EKG: variation in direction, amplitude, and duration of QRS
Electrical alternans in cardiac tamponade
57
Signs of cardiac tamponade
pulsus parodoxus, hypotension, distant heart sounds, and JVD
58
EKG: undulating baseline, no p-waves, irregular R-R interval
A-fib
59
A-fib treatment
rate control > rhythm control; beta-blockers
60
Aortic stenosis murmur
Systolic, crescendo-decrescendo, louder w/ squat and softer w/valsalva; + parvus et tardus
61
Etiology of aortic stenosis
calcific changes in elderly, earlier in bicuspid pts
62
Tx of aortic stenosis
valve replacement
63
Hypertrophic cardiomyopathy murmur
systolic, louder w/ valsalva and softer w/squat or handgrip
64
MVP murmur
late systolic murmur + click; louder w/ valsalva and softer w/ squatting
65
Mitral regurgitation murmur
Holosystolic, radiates to axilla
66
VSD murmur
holosystolic + late diastolic rumble, in kids
67
PDA murmur
continuous, machine-like
68
ASD murmur
wide, fixed split S2
69
Mitral stenosis murmur
rumbling diastolic w/ opening snap; left atrial enlargement + A-fib
70
Aortic regurgitation
blowing diastolic with widened pulse pressure and eponym parade
71
SOB + Cancer hx/recent surgery/long travel management
give Heparin for suspected PE
72
When to give O2 in pt with SOB
if O2
73
SOB + signs of pneumonia first test
chest x-ray
74
SOB + murmur or CHF hx
get echocardiogram to check EF and compare w/ previous
75
Management of acute pulmonary edema
nitrates, lasix, and morphine
76
SOB in young pt with signs of CHF w. preceding viral infection
Think myocarditis due to Coxsackie B
77
SOB in young pt w. no cardiomegaly on CXR
consider pulmonary HTN
78
How to differentiate CHF and pulmonary HTN
Right heart catheterization: CHF (pulmonary capillary wedge pressure = surrogate for left atrial pressure & therefore increased) Primary pulmonary HTN (pulmonary capillary wedge WNL)
79
EF in systolic vs diastolic CHF
Systolic: less than 55% Diastolic: normal
80
Causes of systolic CHF
MCC: ischemia, dilation others: viral, EtOH (reversible), Chagas, idiopathic
81
Causes of diastolic CHF
HTN, amyloidosis, hemochromatosis (reversible)
82
CHF tx
1. ACEI (prevent Aldo remodeling) 2. B-block (metoprolol and carvedilol prevent remodeling by epi/norepi) 3. Spironolactone (in severe CHF) 4. Furosemide for symptoms 5. Digoxin: decrease sxs NOT survival
83
What are the indications for urgent dialysis
``` A: acidosis E: electrolyte imbalance (high K) I: ingestion O: overload of fluid U: symptomatic uremia ```
84
Determinant of systolic bp
Cardiac contractility
85
Determinant of diastolic bp
Peripheral resistance
86
Determinant of pulse pressure
Stroke volume

Internal Medicine (1 decks)

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