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132 Cards in this Set
- Front
- Back
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What is CAD? What are different terms for CAD?
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CAD is Coronary Artery Disease. CAD is the same as Atherosclerotic Heart Disease, and Ischemic Heart Disease. CAD imply Insufficient Perfusion of Coronary Arteries from an Abnormal Narrowing of Vessels, Leading to Insufficient Oxygen Delivery to Myocardial Tissue.
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Pt with Chest Pain, no risk factor, no past medical hx. Most likely dx?
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Pt with Chest Pain, no risk factor, no past medical hx. Most likely dx - Gastrointestinal disorder (GERD, Ulcer disease, Cholelithiasis, Duodenitis, Gastritis).
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When is cardiac protective effect worn off in Women?
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Cardiac protective effect worn off in Women between 55 and 60 years of age due to menopause and reduced Estrogen.
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What is rare to see in Menstrating women?
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Menstrating women rarely have Myocardial Infarction
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What is most likely to Benefit a pt Risk of Coronary Disease?
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Most likely to Benefit a pt Risk of Coronary Disease - Exercise, Weight Lsos, Lower LDL.
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What are the Risk Factors for CAD?
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Risk Factors for CAD - 1 Diabetes Mellitus, 2 Tobacco Smoking, 3 Hypertension (140 by 90), 4 Hyperlipidemia, 5 Family Hx of Premature CAD (Male relative Under 55, Female relative Under 65), 6 Age Above 45 in Men and Above 55 in Women.
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What is the Worse Risk Factor for CAD? The Most Common Risk?
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The Worse Risk Factor for CAD - Diabetes Mellitus. The Most Common Risk - Hypertension.
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How is Premature CAD defined?
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Premature CAD defined as Being in a Family Member who is Male relative Under 55, or Female relative Under 65.
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How is Family Hx defined for CAD?
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Family Hx defined for CAD - 1 Only CAD in First-Degree relatives, 2 Only Premature CAD is a family member (Male relative Under 55, or Female relative Under 65).
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Which of the following is Most dangerous to a pt in terms of risk for CAD? A. Elevated Triglycerides, B. Elevated Total Cholesterol, C. Decreased HDL, D. Elevated LDL, E. Obesity.
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Most dangerous to a pt in terms of risk for CAD - Elevated LDL
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What is Tako-Tsubo Cardiomyopathy? Lx? Tx?
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Tako-Tsubo Cardiomyopathy - Acute myocardial damage most often occuring in PostMenopausal Women immediately following an Overwhelming, Emotionally stressful event (Earthquake, Lightning strike, and Hypoglycemia). Due to Massive Catecholamine Discharge. Lx - Ballooning andLeft Ventricular Dyskinesis. Tx - Beta blockers and ACE Inhibitors (like Ischemic disease Tx).
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What can Sudden Overwhelming emotional Stress and Anger cause?
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Sudden Overwhelming emotional Stress and Anger cause Chest Pain and Sudden Death.
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What are some Unreliable Unproven risk factors for CAD?
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Unreliable Unproven risk factors for CAD - Elevated Homocysteine levels, Chlamydia infection, Elevated C-reactive protein levels.
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Correcting which Risk factors for CAD will result in Most Immediate Benefit for pt?
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Correcting which Risk factors for CAD will result in Most Immediate Benefit for pt - Tobacco Smoking (Risk reduce by 50 perc within a year after stopping. Risk reduce by 90 perc within 2 years)
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Describe Ischemic Pain? Symptoms that Rule out Ischemia?
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Ischemic Pain is 1 Dull or Sore, 2 Squeezing or Pressure-like. Symptoms of Non-Ischemic Pain - 1 Sharp Knifelike or Point-like, 2 Last for a Few seconds, 3 Changes with Respiration (Pleuritic), 4 Changes with Position of Body, 5 Changes with Touch of Chest Wall (Tenderness).
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Chest Wall Tenderness - causes of Chest Pain? Most Accurate Lx?
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Chest Wall Tenderness - causes of Chest Pain - Costochondritis. Most Accurate Lx - Physical Exam
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Radiation to back, Unequal Blood Pressure between arms - causes of Chest Pain? Most Accurate Lx?
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Radiation to back, Unequal Blood Pressure between arms - causes of Chest Pain - Aortic Dissection. Most Accurate Lx - CXR with Widened mediastinum, Chest CT, MRI, or TEE confirms the disease
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Pain Worse with Lying Flat, Better when Sitting Up - causes of Chest Pain? Most Accurate Lx?
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Pain Worse with Lying Flat, Better when Sitting Up - causes of Chest Pain - Pericarditis. Most Accurate Lx - Electrocardiogram with ST Elevation everywhere, PR Depression
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Epigastric Discomfort, Pain better when Eating - causes of Chest Pain? Most Accurate Lx?
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Epigastric Discomfort, Pain better when Eating - causes of Chest Pain - Duodenal Ulcer Disease. Most Accurate Lx - Endoscopy
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Bad Taste, Cough, Hoarseness - causes of Chest Pain? Most Accurate Lx?
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Bad Taste, Cough, Hoarseness - causes of Chest Pain - Gastroesophageal Reflux. Most Accurate Lx - Response to PPIs. Aluminum Hydroxide and Magnesium Hydroxide. Viscous Lidocaine.
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Cough, Sputum, Hemoptysis - causes of Chest Pain? Most Accurate Lx?
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Cough, Sputum, Hemoptysis - causes of Chest Pain - Pneumonia. Most Accurate Lx - CXR
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Sudden-onset, Shortness of Breath, Tachycardia, Hypoxia - causes of Chest Pain? Most Accurate Lx?
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Sudden-onset, Shortness of Breath, Tachycardia, Hypoxia - causes of Chest Pain - Pulmonary Embolus. Most Accurate Lx - Spiral CT, V-Q Scan
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Sharp, Pleuritic Pain, Tracheal Deviation - causes of Chest Pain? Most Accurate Lx?
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Sharp, Pleuritic Pain, Tracheal Deviation - causes of Chest Pain - Pneumothorax. Most Accurate Lx - CXR
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Chest Pain with what symptom has the Worse Prognosis?
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Chest Pain with what symptom has the Worse Prognosis - Shortness of Breath
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Chest Pain and Fever. Suggestive Dx?
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Chest Pain and Fever. Suggestive Dx - PE or Pneumonia
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Chest pain. Best Initial Lx? Next Lx? Next Lx? Most Accurate Lx?
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Chest pain. Best Initial Lx - EKG (Usually Normal in Office setting). Next Lx - Enzymes (CK-MB_Troponin - Only in Acute Emergency setting, or Transfer to ER if in Office). Next Lx - Exercise Tolerance-Stress Testing if Etiology is Not clear from Cardiac Enzymes. Most Accurate Lx - Coronary Angiography.
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In Chest Pain, when to do Cardiac Enzymes? What Cardiac Enzymes?
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In Chest Pain, do Cardiac Enzymes after EKG in Emergency Setting for Acute Chest pain (Minutes to Hours). In Office setting, Do Not order Cardiac Enzyme, Transfer pt to ER. Cardiac Enzymes - CK-MB_Troponin.
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In Chest Pain, what is consider Acute? Chronic?
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In Chest Pain, what is consider Acute - Minutes to Hours (Send to ER, do EKG, then Cardiac Enzymes CK-MB_Troponin). Chronic Chest Pain - Days to Weeks - No Cardiac Enzymes.
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What is Stress Testing? When to order it? Requirement?
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Stress Testing - Exercise Tolerance Testing. Order it when 1 Etiology is Not Clear and 2 EKG is not Diagnostic. ETT is based on - 1 EKG readable, 2 Pt can Exercise (Can Get Heart Rate Up Above 80 perc of maximum. Maximum HR is 220 minus pt age.) EKG detects Ischemia as ST depression and Exercise increases Oxygen Consumption.
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Cannot Read EKG due to Baseline Abnormality. Next step?
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Cannot Read EKG due to Baseline Abnormality. Next step of Detecting Ischemia - 1 Nuclear Isotope Uptake (Thalium or Sestamibi), 2 EchoCardiographic detection of Wall Motion Abnormality.
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Why EKG is Not Readable?
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EKG is Not Readable due to Baseline Abnormality - 1 Left Bundle Branch Block, 2 Left Ventricular Hypertrophy, 3 Pacemaker Use, or 4 Effect of Digoxin.
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What is isotope of Potassium? How is it useful?
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Isotope of Potassium - Thallium. It is useful in Chest Pain testing. Nomral myocardium will Pick Up Thallium the same way Potassium is picked u by Sodium-Potassium ATPase. If Myocardium is Aliver and Perfused, Thallium or other nuclear Isotopes will be Picked Up. Normal myocardium will Move on Contraction. Abnormalities will be Detected by Seeing Decreased Wall Motion - Dyskinesis, or Akinesis, or Hypokinesis.
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What is the difference between Ischemia and Infarction?
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Difference between Ischemia and Infarction - Ischemia is Simple Decreased Perfusion - will be Detected by Seeing a Reversal of Decrease in Thallium Uptake or Wall Motion that will Return to Normal after a period of rest. Ischemia - Reversible Wall Motion or Thallium Uptake between Rest and Exercise. Infarction - Irreversible or Fixed.
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Chest pain pt, EKG equivocal, Cannot Exercise. Next Step?
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Chest pain pt, EKG equivocal, Cannot Exercise - Cannot do Exercise Stress Testing. Next Step - Increase Myocardial Oxygen COnsumption - 1 Persantine (Dipyridamole) or Adenosine in combination with the use of Nuclear Isotopes (Thallium or Sestamibi), 2 Dobutamine in Combination with use of Echocardiography (Dobutamine will Increase myocardial Oxygen Consumption and Provoke Ischemia detected as Decreased Wall Motion on an Echocardiogram.
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Dipyridamole used? AE? CountraIndication
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Persantine (Dipyridamole) combine with Nuclear Isotopes (Thallium or Sestamibi) for Nuclear Stress Testing. Dipyridamole Increase Myocardial Oxygen Consumption. AE - Bronchospasm. CountraIndication - Asthmatics.
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Chest Pain, EKG equivocal. EKG readable, able to Exercise. Lx?
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Chest Pain, EKG equivocal. EKG readable, able to Exercise. Lx - Exercise Tolerance.
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Chest Pain, EKG equivocal. EKG Unreadable, able to Exercise. Lx?
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Chest Pain, EKG equivocal. EKG Unreadable, able to Exercise. Lx - Exercise Thallium, or Exercise Echo.
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Chest Pain, EKG equivocal. EKG readable, Unable to Exercise. Lx?
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Chest Pain, EKG equivocal. EKG readable, Unable to Exercise. Lx - Dipyridamole Thallium, or Dobutamine Echo
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Chest Pain, EKG equivocal. How is Ischemia detected in various Exercise Tolerance testing?
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Chest Pain, EKG equivocal. Ischemia detected in various Exercise Tolerance testing. 1 Exercise Tolerance - ST Depression. 2 Exercise Thallium and 3 Dipyridamole Thallium - Decreased Uptake of Nuclear Isotope. 4 Exercise Echo and 5 Dobutamine Echo - Decreased Wall Motion. Exercise is Dipyridamole is Dobutamine is Adenosine. Isotope Thallium is Echo. Exercise Thallium is Exercise Echo. Dipyridamole Thallium is Dobutamine Echo.
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What are equivalents in Exercise Tolerance Testing?
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Exercise is Dipyridamole is Dobutamine is Adenosine. Isotope Thallium is Echo. Exercise Thallium is Exercise Echo. Dipyridamole Thallium is Dobutamine Echo. 1 Exercise Tolerance - ST Depression. 2 Exercise Thallium and 3 Dipyridamole Thallium - Decreased Uptake of Nuclear Isotope. 4 Exercise Echo and 5 Dobutamine Echo - Decreased Wall Motion.
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What is the purpose of Coronary Angiography?
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Angiogrphy is used to detect Anatomic location of CAD. The purpose of Coronary Angiography is determine 1 Bypass Surgery, or 2 Angioplasty. Stenosis less than 50 perc of diameter is Insignificant.. Surgically Corerctable disease begins with at Least 70 perc stenosis.
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What is Holter Monitoring? When is it used?
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Holter Monitoring - Continuous Ambulatory EKG monitor that Records Rhythm. Used for 24 hour period, can continue to 48 to 72 hours. Detects Rhythm Disorders (1 Atrial Fib, 2 Flutter, 3 Ectopy - Premature Beats, 4 Ventricular Tachycardia). Holter Does Not detect Ischemia, and Not Accurate for Evaluating ST segment. When is it used
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48 yo woman with chest pain that has been occurring over last several weeks. Pain is not reliably related to exertion. Comfortable now. Location of Pain is Retrosternal. No past medical hx and EKG is normal. Most appropriate Next Step in management? A. Ck-MB, B. Troponin, C Echocardiogram, D. Exercise Tolerance Testing, E. Angiography, F. CT Angiography, G. Cardiac MRI, H. Holter monitor.
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48 yo woman with chest pain, comfortable, unclear etiology. D. Exercise Tolerance Testing should be done in Stable pt with chest pain whose diagnoses are not clear. ETT is Not used in Acute Coronary Syndrome while pt is having Pain Currently. If pt is having Acute chest Pain, Do Not put pt on a Treadmill to exercise.
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What is the general function of the following test in chest pain - Cardiac Enzymes? Echocardiography? Exercise Tolerance Testing?
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The general function of the following test in chest pain - Cardiac Enzyme s - Evaluate Acute Coronary Syndromes. Serial Troponin measurements are done Prior to Stress test. Echocardiography evaluate - 1 Valve Function, 2 Wall Motion, and 3 Ejection Fraction. Exercise Tolerance Testing Evaluate Stable pt with Chest pain whose Diagnoses are Not Clear. ETT is Not used in Acute Coronary Syndrome cases Currently having Chest Pain and Diagnosis is Already Clear. Do Not put pt on Treadmill to Exercise if they are Currently having Chest Pain.
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Chronic Angina. Tx? Acute Coronary Syndrome Tx? Chronic Angina Tx with Best Mortality Benefit?
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Chronic Angina - not Acute Coronary Syndrome - Tx 1 Aspirin, 2 Beta Blockers, 3 Nitroglycerin (Oral, Transdermal). Acute Coronary Syndrome Tx - Nitroglycerin (Sublingual, Paste, and IV). Chronic Angina Tx with Best Mortality Benefit - Aspirin and Beta Blockers.
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When is Clopidogrel used?
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Clopidogrel used in 1 Aspirin Intolerance (Allergy), 2 Recent Angioplasty with Stenting. Clopidogrel Rarely asso with Thrombotic Thrombocytopenic Purpura.
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What is Prasugrel? What class? Tx for? AE?
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Prasugrel is a new Thienopyridine med in class as Clopidogrel and Ticlopidine. Prasugrel is an Antiplatelet Med used in pt Undergoing Angioplasty and Stenting. AE - Dangerous in pt 75 and older because of Increased Risk of Hemorrhagic Stroke.
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What is Ticlopidine? Tx for? AE?
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Ticlopidine Inhibit Platelets in Rare pt who is Intolerant of Both Aspirin and Clopidogrel. Cannot use Ticlopidine if reason foar Aspirin and Clopidogrel Intolerance is Bleeding. AE - Neutropenia.
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ACE Inhibitors and Angiotensin Receptor Blockers Tx for? AE?
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ACE Inhibitors and Angiotensin Receptor Blockers Tx for 1 Low Ejection Fraction, or Systolic Dysfunction - Best Mortality Benefit, 2 Regurgitant Valvular Disease. AE - 1 Cough is most common in ACEI, 2 Hyperkalemia
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What Px exclude CAD?
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Px exclude CAD - 1 Pleuritis (Pain change with Respiration), 2 Position (Pain change with Body Position), 3 Tenderness - Chest Wall
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Pleuritic Pain. Dx?
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Pleuritic Pain. Dx - 5 P - 1 Pericarditis, 2 Pleuritis, 3 Pneumonia, 4 Pulmonary Embolism, 5 Pneumothorax.
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Chest Pain in Changes with body position. Dx?
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Chest Pain in Changes with body position. Dx - Pericarditis
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Chest Pain with Chest Wall Tenderness. Dx?
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Chest Pain with Chest Wall Tenderness. Dx - Costochondritis
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MCC of Chest Pain that is Not cardiac in etiology?
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MCC of Chest Pain that is Not cardiac in etiology - GI (GERD)
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Chest Pain in Epigastric area, Sore Throat, Bad Metallic Taste in mouth, Cough. Next Step?
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Chest Pain in Epigastric area, Sore Throat, Bad Metallic Taste in mouth, Cough. Next Step - PPI
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Alcoholic in ER with Chest Pain, Nausea, Vomiting, Epigastric Tenderness. Next Step?
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Alcoholic in ER with Chest Pain, Nausea, Vomiting, Epigastric Tenderness. Next Step - Check Amylase and Lipase levels.
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Chest Pain, Right Upper Quadrant Tenderness, Mild Fever. Next Step?
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Chest Pain, Right Upper Quadrant Tenderness, Mild Fever. Next Step - Abdominal Sonogram for Gallstones.
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Clues to Ischemic Disease as Cause of Chest Pain?
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Clues to Ischemic Disease as Cause of Chest Pain (STOReD) - 1 Substernal, 2 Time - Lasting 15 to 30 minutes, 3 Oxygen demand - Exertion, 4 Radiating to Jaw or Left arm, 5 Dull Pain.
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CAD possible Abnormal Physical findings?
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CAD possible Abnormal Physical findings - 1 CV, 2 Chest, 3 General Exam, 4 Extremities. 1 CV (aaa S3 Gallop - Dilated Left Ventricle, bbb S4 Gallop - Left Ventricular Hypertrophy, ccc Jugulovenous Distension, ddd Holosystolic Murmur of Mitral Regurgitation), 2 Chest (Rales - suggest CHF), 3 General Exam (aaa Distressed Patient, bbb Short of Breath, ccc Clutching Chest) , 4 Extremities (Edema).
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CAD possible Abnormal Physical findings - CV?
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CAD possible Abnormal Physical findings - 1 CV, 2 Chest, 3 General Exam, 4 Extremities. 1 CV (aaa S3 Gallop - Dilated Left Ventricle, bbb S4 Gallop - Left Ventricular Hypertrophy, ccc Jugulovenous Distension, ddd Holosystolic Murmur of Mitral Regurgitation), 2 Chest (Rales - suggest CHF), 3 General Exam (aaa Distressed Patient, bbb Short of Breath, ccc Clutching Chest) , 4 Extremities (Edema).
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CAD possible Abnormal Physical findings - Chest?
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CAD possible Abnormal Physical findings - 1 CV, 2 Chest, 3 General Exam, 4 Extremities. 1 CV (aaa S3 Gallop - Dilated Left Ventricle, bbb S4 Gallop - Left Ventricular Hypertrophy, ccc Jugulovenous Distension, ddd Holosystolic Murmur of Mitral Regurgitation), 2 Chest (Rales - suggest CHF), 3 General Exam (aaa Distressed Patient, bbb Short of Breath, ccc Clutching Chest) , 4 Extremities (Edema).
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CAD possible Abnormal Physical findings - General Exam?
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CAD possible Abnormal Physical findings - 1 CV, 2 Chest, 3 General Exam, 4 Extremities. 1 CV (aaa S3 Gallop - Dilated Left Ventricle, bbb S4 Gallop - Left Ventricular Hypertrophy, ccc Jugulovenous Distension, ddd Holosystolic Murmur of Mitral Regurgitation), 2 Chest (Rales - suggest CHF), 3 General Exam (aaa Distressed Patient, bbb Short of Breath, ccc Clutching Chest) , 4 Extremities (Edema).
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CAD possible Abnormal Physical findings - Extremities?
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CAD possible Abnormal Physical findings - 1 CV, 2 Chest, 3 General Exam, 4 Extremities. 1 CV (aaa S3 Gallop - Dilated Left Ventricle, bbb S4 Gallop - Left Ventricular Hypertrophy, ccc Jugulovenous Distension, ddd Holosystolic Murmur of Mitral Regurgitation), 2 Chest (Rales - suggest CHF), 3 General Exam (aaa Distressed Patient, bbb Short of Breath, ccc Clutching Chest) , 4 Extremities (Edema).
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S3 Gallop, Dx?
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S3 Gallop, Dx? Dilated Left Ventricle. S3 after S2.
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S4 Gallop, Dx?
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S4 Gallop, Dx? Left Ventricular Hypertrophy. S4 before S1.
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Jugulovenous Distension, Dx?
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Jugulovenous Distension, Dx? CHF
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Holosystolic Murmur, Dx?
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Holosystolic Murmur, Dx? Mitral Regurgitation
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Rales, Dx?
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Rales, Dx? Pulmonary Edema suggestive of CHF
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Distressed Patient, Short of Breath, Clutching Chest, Dx?
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Distressed Patient, Short of Breath, Clutching Chest, Dx? CAD General Exam
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Extremities Edema, Dx?
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Extremities Edema, Dx? CHF
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Dilated Left Ventricle, ascultatory finding?
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Dilated Left Ventricle, ascultatory finding? S3 Gallop
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Left Ventricular Hypertrophy, ascultatory finding?
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Left Ventricular Hypertrophy, ascultatory finding? S4 Gallop
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CHF, visual inspection finding?
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CHF, visual inspection finding? Jugulovenous Distension, Extremity Edema
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Mitral Regurgitation, ascultatory finding?
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Mitral Regurgitation, ascultatory finding? Holosystolic Murmur
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CHF, ascultatory finding?
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CHF, ascultatory finding? Rales -Pulmonary Edema suggestive of CHF
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CAD General Exam, visual inspection finding?
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CAD General Exam, visual inspection finding? Distressed Patient, Short of Breath, Clutching Chest
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Ascultatory finding - S1 , Components?
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Ascultatory finding - S1 , Components? Mitral and Tricuspid Valve Closing. Small Valves Close First. Normal - Mitral before Tricuspid Valve Close.
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Ascultatory finding - S2 , Components?
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Ascultatory finding - S2 , Components? Aortic and Pulmonic Valve Closing. Big Valves Close Second. Normal - Aortic before Pulmonic Valve Closing
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Chest pain. Lx - Best Initial?
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Chest pain. Lx - Best Initial? EKG.
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72 yo Male, Chest Pain, Radiating to Left shoulder, Pressure on Chest. Next Step?
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72 yo Male, Chest Pain, Radiating to Left shoulder, Pressure on Chest. Next Step? Aspirin. When pt has very clear case of Ischemic Pain choose Treatment First.
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In Chest Pain, what are Wrong Lx - Best Initial?
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In Chest Pain, what are Wrong Lx - Best Initial? Troponin, CK-MB, Stress Testing, Echo, Angiography
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Chest pain. Lx - Most Accurate?
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Chest pain. Lx - Most Accurate? 1 CK-MB, or 2 Troponin
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CK-MB, When does it Rise after start of Chest pain?
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CK-MB, When does it Rise after start of Chest pain? 3-6 Hours
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Troponin, When does it Rise after start of Chest pain?
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Troponin, When does it Rise after start of Chest pain? 3-6 Hours
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Myoglobin, When does it Rise after Chest pain?
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Myoglobin, When does it Rise after Chest pain? 1-4 Hours
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CK-MB, How long does it Stay Elevated?
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CK-MB, How long does it Stay Elevated? 1-2 Days
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Troponin, How long does it Stay Elevated?
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Troponin, How long does it Stay Elevated? 7-14 Days (1-2 Weeks)
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What cardiac enzyme Rise first?
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What cardiac enzyme Rise first?Myoglobin (1-4 Hours)
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Reinfarction of Heart a few days after initial infarction, What Lx?
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Reinfarction of Heart a few days after initial infarction, What Lx? CK-MB (Stay elevated 1-2 Days)
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When to do Stress Testing?
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When to do Stress Testing? 1 Not Acute. 2 Initial EKG, and_or 3 Enzymes tests Do Not Establish the Dx.
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What is Dobutamine?
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Dobutamine Increases Oxygen Consumption in Cardiac muscle and Provoke Ischemia.
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What is Thallium?
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Thallium is Isotrope of Potassium. If cardiac muscle is alive and Perfused, Thallium or other nuclear isotopes will be Picked Up. Abnormalities detected by seeing Decreased Thallium Uptake.
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When to answer Diyridamole Thallium, or Adenosine Thallium Stress test, or Dobutamine Echo?
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When to answer Diyridamole Thallium, or Adenosine Thallium Stress test, or Dobutamine Echo? Pt Can Not Exercise to Target Heart Rate of Greater than 85 Percent of Maximum. Reasons - Pulmonary, Brain, Physical (LOAD - Lower Extremity Ulcer, Obesity, Amputation, Deconditioning). 1 COPD, 2 Weakness or Previous Stroke, 3 Dementia, 4 Amputation, 5 Deconditioning, 6 Lower Extremity Ulcer, 7 Obesity.
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When to answer Exercise Thallium testing, or Stress Echocardiography?
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When to answer Exercise Thallium testing, or Stress Echocardiography? EKG is Unreadable for Ischemia (LAW PD) - 1 Left Bundle Branch Block, Left Ventricular Hypertrophy, 2 Any Baseline Abnormality of ST segment of EKG (ST Depression Greater than 1mm), 3 Pacemaker in Place, 4 Digoxin use, 5 WPW (Wolf Parkinson White Syndrome) - Accessory path from SA to AV node - Slur Delta wave (chopped off Q wave)
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Obese pt stress testing?
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Obese pt stress testing? Sestamibi Nuclear Stress testing - 1 Obese, or 2 Large Breasts - sestamibi radioisotope Greater ability to Penetrate tissue
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Most Accurate method to evaluate Ejection Fraction?
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Most Accurate method to evaluate Ejection Fraction? Nuclear Ventriculogram
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When to use Nuclear Ventriulogram?
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When to use Nuclear Ventriulogram? Most Accurate Method to evaluate Ejection Fraction.
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What is Acute Coronary Syndrome?
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Acute Coronary Syndrome - Acute Chest Pain with features suggestive of Ischemic Disease.
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ACS Tx - Initial Best?
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ACS Tx - Initial Best - Aspirin. Instant effect on inhibiting platelets.
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What lower mortality in STEMI?
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Lower mortality in STEMI - 1 Thrombolytics (within 12 Hours), 2 Primary Angioplasty - PCI (within 90 Minutes) - PCI. They are Dependent on Time (Benefit diminishes with delay). Primary Angioplasty means Angioplasty during an acute episode of Chest Pain. Infarction is Single best evidence for Mortality benefit with Angioplasty. If PCI is Inaccessible in 90 Minutes, Give Thrombolytics (if chest pain is within 12 hours). Remember CA TABS (1 Clopidogrel, 2 ACEI or ARB only in LV or Systolic Dysfunction, 3 Thrombolytics, 4 Aspirin, Angionplasty or PCI, 5 Beta Blocker (Metoprolol), 6 Statins (if LDL not at Goal). BAS not urgent to give (Not time dependent) - 1 Beta Blocker, 2 ACEI or ARB, 3 Statins (Atorvostatin) - for all ACS (Unstable Angina, NSTEMI, STEMI).
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PCI Indication?
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PCI Indication - 1 Chest Pain with STEMI within 90 minutes, 2 ContraIndication to Thrombolytics.
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Thrombolytic Indication?
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Thrombolytic Indication - 1 Chest pain within 12 Hours, 2 ST Elevation in 2 or More Leads, 3 New Left Bundle Branch Block (LBBB). Thrombolytic shoul be given in 30 minutes.
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What is STEMI?
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STEMI is part of Acute Coronary Syndrome (Unstable Angina, NSTEMI, STEMI).
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What is Stable Angina?
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Stable Angina is part of Coronary Artery Disease.
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Lower mortality in STEMI and Time Dependent?
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Lower mortality in STEMI - 1 Thrombolytics (within 12 Hours), 2 Primary Angioplasty - PCI (within 90 Minutes) - PCI. They are Dependent on Time (Benefit diminishes with delay). Primary Angioplasty means Angioplasty during an acute episode of Chest Pain. Infarction is Single best evidence for Mortality benefit with Angioplasty. If PCI is Inaccessible in 90 Minutes, Give Thrombolytics (if chest pain is within 12 hours). Remember CA TABS (1 Clopidogrel, 2 ACEI or ARB only in LV or Systolic Dysfunction, 3 Thrombolytics, 4 Aspirin, Angionplasty or PCI, 5 Beta Blocker (Metoprolol), 6 Statins (if LDL not at Goal). BAS not urgent to give (Not time dependent) - 1 Beta Blocker, 2 ACEI or ARB, 3 Statins (Atorvostatin) - for all ACS (Unstable Angina, NSTEMI, STEMI).
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Lower mortality in STEMI and Time Independent?
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Lower mortality in STEMI - 1 Thrombolytics (within 12 Hours), 2 Primary Angioplasty - PCI (within 90 Minutes) - PCI. They are Dependent on Time (Benefit diminishes with delay). Primary Angioplasty means Angioplasty during an acute episode of Chest Pain. Infarction is Single best evidence for Mortality benefit with Angioplasty. If PCI is Inaccessible in 90 Minutes, Give Thrombolytics (if chest pain is within 12 hours). Remember CA TABS (1 Clopidogrel, 2 ACEI or ARB only in LV or Systolic Dysfunction, 3 Thrombolytics, 4 Aspirin, Angionplasty or PCI, 5 Beta Blocker (Metoprolol), 6 Statins (if LDL not at Goal). BAS not urgent to give (Not time dependent) - 1 Beta Blocker, 2 ACEI or ARB, 3 Statins (Atorvostatin) - for all ACS (Unstable Angina, NSTEMI, STEMI).
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What is Metoprolol?
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Metoprolol is Beta Blocker. Given in STEMI.
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What is Atorvostatin?
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Atorvostatin is Statins given to all pt with ACS, regardless of EKG or Troponin or CK-MB levels.
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Lower mortality in STEMI - general?
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Lower mortality in STEMI - General - Remember CA TABS (1 Clopidogrel, 2 ACEI or ARB only in LV or Systolic Dysfunction, 3 Thrombolytics, 4 Aspirin, Angionplasty or PCI, 5 Beta Blocker (Metoprolol), 6 Statins (if LDL not at Goal). BAS not urgent to give (Not time dependent) - 1 Beta Blocker, 2 ACEI or ARB, 3 Statins (Atorvostatin) - for all ACS (Unstable Angina, NSTEMI, STEMI).
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Clopidogrel function? When to give?
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Clopidogrel is Platelet Antagonist. ACS pt with 1 Allergic to Aspirin, or 2 Angioplasty.
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In ACS, when is Calcium Channel Blockers given?
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In ACS, when is Calcium Channel Blockers given? CCB (Verapamil, Diltiazem) given - 1 Intolerance to Beta Blocker (Severe Reactive Airway Disease - Asthma), 2 Cocaine-Induced Chest Pain, 3 Coronary Vasospasm (Prinzmetal Angina).
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What medications is Calcium Channel Blockers given ACS?
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What medications are Calcium Channel Blockers given ACS? CCB (Verapamil, Diltiazem) given - 1 Intolerance to Beta Blocker (Severe Reactive Airway Disease - Asthma), 2 Cocaine-Induced Chest Pain, 3 Coronary Vasospasm (Prinzmetal Angina).
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What is Verapamil? Tx?
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What medications are Calcium Channel Blockers given ACS? CCB (Verapamil, Diltiazem) given - 1 Intolerance to Beta Blocker (Severe Reactive Airway Disease - Asthma), 2 Cocaine-Induced Chest Pain, 3 Coronary Vasospasm (Prinzmetal Angina).
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What is Diltiazem? Tx?
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What medications are Calcium Channel Blockers given ACS? CCB (Verapamil, Diltiazem) given - 1 Intolerance to Beta Blocker (Severe Reactive Airway Disease - Asthma), 2 Cocaine-Induced Chest Pain, 3 Coronary Vasospasm (Prinzmetal Angina).
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What is Prinzmetal Angina? Tx?
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What medications are Calcium Channel Blockers given ACS? CCB (Verapamil, Diltiazem) given - 1 Intolerance to Beta Blocker (Severe Reactive Airway Disease - Asthma), 2 Cocaine-Induced Chest Pain, 3 Coronary Vasospasm (Prinzmetal Angina).
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When is Pacemaker Tx for Acute MI?
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When is Pacemaker Tx for Acute MI? 1 Third-Degree AV Block, 2 Mobitz II, Second-Degree AV Block, 3 Bifascicular Block, 4 New Left Bundle Branch Block, 5 Symptomatic Bradycardia. Remember 11223. 1 LBBB, 1 Bradycardia, 2 Second-degree AV block, 2 Bifascicular Block, 3 Third-degree AV Block
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When is Lidocaine Tx for Acute MI?
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When is Lidocaine or Amiodarone Tx for Acute MI? 1 Ventricular Tachycardia or Ventricular Fibrillation, 2 No Prophylaxis Anti-Arrhythmic med to prevent Ventricular Arrhythmia.
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When is Amiodarone Tx for Acute MI?
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When is Lidocaine or Amiodarone Tx for Acute MI? 1 Ventricular Tachycardia or Ventricular Fibrillation, 2 No Prophylaxis Anti-Arrhythmic med to prevent Ventricular Arrhythmia.
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What do all complications of MI result?
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What do all complications of MI result? Hypotension.
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What are complications of MI - general?
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Complications of MI - 1 Cardiogenic Shock, 2 Valve Rupture, 3 Septal Rupture, 4 Myocardial Wall Rupture, 5 Sinus Bradycardia, 6 Third-Degree (Complete) Heart Block, 7 Right Ventricular Infarction.
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What are complications of MI? Dx? Tx?
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Complications of MI - 1 Cardiogenic Shock (Dx - Echo, Swan-Ganz or RiGht Heart Catheter. Tx - ACEI, Urgent Revascularization), 2 Valve Rupture (Dx - Echo. Tx - ACEI, Nitroprusside, Intra-Aortic Ballon Pump as a Bridge to Surgery), 3 Septal Rupture (Dx - Echo, Right Heart Catheter Showing a Step Up in Saturation from Right Atrium to Right Ventricle. Tx - ACEI, Nitroprusside, and Urgent Surgery), 4 Myocardial Wall Rupture (Dx - Echo. Tx - Pericardiocentesis, Urgent Cardiac Repair), 5 Sinus Bradycardia (Dx - EKG. Tx - Atropine, Followed by Pacemaker if Symptoms still present), 6 Third-Degree (Complete) Heart Block (Dx - EKG, Canon A Wave. Tx - Atropine and a Pacemaker even if Symptoms Resolve), 7 Right Ventricular Infarction (Dx - Right Ventricular Leads on EKG. Tx - Fluid Loading).
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Complications of MI - Cardiogenic Shock. Dx? Tx?
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Complications of MI - 1 Cardiogenic Shock (Dx - Echo, Swan-Ganz or RiGht Heart Catheter. Tx - ACEI, Urgent Revascularization), 2 Valve Rupture (Dx - Echo. Tx - ACEI, Nitroprusside, Intra-Aortic Ballon Pump as a Bridge to Surgery), 3 Septal Rupture (Dx - Echo, Right Heart Catheter Showing a Step Up in Saturation from Right Atrium to Right Ventricle. Tx - ACEI, Nitroprusside, and Urgent Surgery), 4 Myocardial Wall Rupture (Dx - Echo. Tx - Pericardiocentesis, Urgent Cardiac Repair), 5 Sinus Bradycardia (Dx - EKG. Tx - Atropine, Followed by Pacemaker if Symptoms still present), 6 Third-Degree (Complete) Heart Block (Dx - EKG, Canon A Wave. Tx - Atropine and a Pacemaker even if Symptoms Resolve), 7 Right Ventricular Infarction (Dx - Right Ventricular Leads on EKG. Tx - Fluid Loading).
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Complications of MI - Valve Rupture. Dx? Tx?
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Complications of MI - 1 Cardiogenic Shock (Dx - Echo, Swan-Ganz or RiGht Heart Catheter. Tx - ACEI, Urgent Revascularization), 2 Valve Rupture (Dx - Echo. Tx - ACEI, Nitroprusside, Intra-Aortic Ballon Pump as a Bridge to Surgery), 3 Septal Rupture (Dx - Echo, Right Heart Catheter Showing a Step Up in Saturation from Right Atrium to Right Ventricle. Tx - ACEI, Nitroprusside, and Urgent Surgery), 4 Myocardial Wall Rupture (Dx - Echo. Tx - Pericardiocentesis, Urgent Cardiac Repair), 5 Sinus Bradycardia (Dx - EKG. Tx - Atropine, Followed by Pacemaker if Symptoms still present), 6 Third-Degree (Complete) Heart Block (Dx - EKG, Canon A Wave. Tx - Atropine and a Pacemaker even if Symptoms Resolve), 7 Right Ventricular Infarction (Dx - Right Ventricular Leads on EKG. Tx - Fluid Loading).
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Complications of MI - Septal Rupture. Dx? Tx?
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Complications of MI - 1 Cardiogenic Shock (Dx - Echo, Swan-Ganz or RiGht Heart Catheter. Tx - ACEI, Urgent Revascularization), 2 Valve Rupture (Dx - Echo. Tx - ACEI, Nitroprusside, Intra-Aortic Ballon Pump as a Bridge to Surgery), 3 Septal Rupture (Dx - Echo, Right Heart Catheter Showing a Step Up in Saturation from Right Atrium to Right Ventricle. Tx - ACEI, Nitroprusside, and Urgent Surgery), 4 Myocardial Wall Rupture (Dx - Echo. Tx - Pericardiocentesis, Urgent Cardiac Repair), 5 Sinus Bradycardia (Dx - EKG. Tx - Atropine, Followed by Pacemaker if Symptoms still present), 6 Third-Degree (Complete) Heart Block (Dx - EKG, Canon A Wave. Tx - Atropine and a Pacemaker even if Symptoms Resolve), 7 Right Ventricular Infarction (Dx - Right Ventricular Leads on EKG. Tx - Fluid Loading).
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Complications of MI - Myocardial Wall Rupture. Dx? Tx?
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Complications of MI - 1 Cardiogenic Shock (Dx - Echo, Swan-Ganz or RiGht Heart Catheter. Tx - ACEI, Urgent Revascularization), 2 Valve Rupture (Dx - Echo. Tx - ACEI, Nitroprusside, Intra-Aortic Ballon Pump as a Bridge to Surgery), 3 Septal Rupture (Dx - Echo, Right Heart Catheter Showing a Step Up in Saturation from Right Atrium to Right Ventricle. Tx - ACEI, Nitroprusside, and Urgent Surgery), 4 Myocardial Wall Rupture (Dx - Echo. Tx - Pericardiocentesis, Urgent Cardiac Repair), 5 Sinus Bradycardia (Dx - EKG. Tx - Atropine, Followed by Pacemaker if Symptoms still present), 6 Third-Degree (Complete) Heart Block (Dx - EKG, Canon A Wave. Tx - Atropine and a Pacemaker even if Symptoms Resolve), 7 Right Ventricular Infarction (Dx - Right Ventricular Leads on EKG. Tx - Fluid Loading).
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Complications of MI - Sinus Bradycardia. Dx? Tx?
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Complications of MI - 1 Cardiogenic Shock (Dx - Echo, Swan-Ganz or RiGht Heart Catheter. Tx - ACEI, Urgent Revascularization), 2 Valve Rupture (Dx - Echo. Tx - ACEI, Nitroprusside, Intra-Aortic Ballon Pump as a Bridge to Surgery), 3 Septal Rupture (Dx - Echo, Right Heart Catheter Showing a Step Up in Saturation from Right Atrium to Right Ventricle. Tx - ACEI, Nitroprusside, and Urgent Surgery), 4 Myocardial Wall Rupture (Dx - Echo. Tx - Pericardiocentesis, Urgent Cardiac Repair), 5 Sinus Bradycardia (Dx - EKG. Tx - Atropine, Followed by Pacemaker if Symptoms still present), 6 Third-Degree (Complete) Heart Block (Dx - EKG, Canon A Wave. Tx - Atropine and a Pacemaker even if Symptoms Resolve), 7 Right Ventricular Infarction (Dx - Right Ventricular Leads on EKG. Tx - Fluid Loading).
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Complications of MI - Third-Degree (Complete) Heart Block. Dx? Tx?
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Complications of MI - 1 Cardiogenic Shock (Dx - Echo, Swan-Ganz or RiGht Heart Catheter. Tx - ACEI, Urgent Revascularization), 2 Valve Rupture (Dx - Echo. Tx - ACEI, Nitroprusside, Intra-Aortic Ballon Pump as a Bridge to Surgery), 3 Septal Rupture (Dx - Echo, Right Heart Catheter Showing a Step Up in Saturation from Right Atrium to Right Ventricle. Tx - ACEI, Nitroprusside, and Urgent Surgery), 4 Myocardial Wall Rupture (Dx - Echo. Tx - Pericardiocentesis, Urgent Cardiac Repair), 5 Sinus Bradycardia (Dx - EKG. Tx - Atropine, Followed by Pacemaker if Symptoms still present), 6 Third-Degree (Complete) Heart Block (Dx - EKG, Canon A Wave. Tx - Atropine and a Pacemaker even if Symptoms Resolve), 7 Right Ventricular Infarction (Dx - Right Ventricular Leads on EKG. Tx - Fluid Loading).
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Complications of MI - Right Ventricular Infarction. Dx? Tx?
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Complications of MI - 1 Cardiogenic Shock (Dx - Echo, Swan-Ganz or RiGht Heart Catheter. Tx - ACEI, Urgent Revascularization), 2 Valve Rupture (Dx - Echo. Tx - ACEI, Nitroprusside, Intra-Aortic Ballon Pump as a Bridge to Surgery), 3 Septal Rupture (Dx - Echo, Right Heart Catheter Showing a Step Up in Saturation from Right Atrium to Right Ventricle. Tx - ACEI, Nitroprusside, and Urgent Surgery), 4 Myocardial Wall Rupture (Dx - Echo. Tx - Pericardiocentesis, Urgent Cardiac Repair), 5 Sinus Bradycardia (Dx - EKG. Tx - Atropine, Followed by Pacemaker if Symptoms still present), 6 Third-Degree (Complete) Heart Block (Dx - EKG, Canon A Wave. Tx - Atropine and a Pacemaker even if Symptoms Resolve), 7 Right Ventricular Infarction (Dx - Right Ventricular Leads on EKG. Tx - Fluid Loading).
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What is Swan-Ganz? Dx for?
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Cardiogenic Shock - Dx - Echo, Swan-Ganz or RiGht Heart Catheter. Tx - ACEI, Urgent Revascularization
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What is right heart cather name? Dx for?
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Cardiogenic Shock - Dx - Echo, Swan-Ganz or RiGht Heart Catheter. Tx - ACEI, Urgent Revascularization
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Right Heart Catheter Showing a Step Up in Saturation from Right Atrium to Right Ventricle. Dx? Tx?
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Complications of MI - Septal Rupture (Dx - Echo, Right Heart Catheter Showing a Step Up in Saturation from Right Atrium to Right Ventricle. Tx - ACEI, Nitroprusside, and Urgent Surgery)
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Canon A Wave. Dx? Tx?
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Complications of MI - Third-Degree (Complete) Heart Block (Dx - EKG, Canon A Wave. Tx - Atropine and a Pacemaker even if Symptoms Resolve)
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