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42 Cards in this Set
- Front
- Back
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What is the range of normal axis on an EKG?
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-30 to +90
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What are the criteria for Left Anterior Fascicular Block?
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LAD
qR in aVL QRS<120 w/ no other cause of LAD |
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What are the criteria for left posterior fascicular block?
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RAD
rS in I and aVL qR in III and aVF QRS<120 w/ no other cause of RAD |
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How do you calculate the corrected QT interval?
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Bazett's formula
QT/sqrt(RR) RR=60/HR |
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Describe the Sokolow-Lyon criteria for LVH-
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S in V1 and R in V5 or V6 >35mm
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What are common etiologies of LVH?
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HTN
AS/AI HCMP Coarctation of aorta |
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What are common etiologies of RVH?
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cor pulmonale
congenital (tetralogy, ASD, VSD) MS TR |
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What is the criteria for defining pathologic Q waves on EKG?
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>30msec or >25% of R wave in that complex
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What is the DD of ST elevation?
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Acute MI
Coronary spasm Myopericarditis LBBB HCMP PE |
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Name pulmonary causes of chest pain-
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Pneumonia
Pleuritis Pneumothorax PE Pulmonary hypertension |
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Name GI causes of chest pain-
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Esophageal reflux
Esophageal spasm Mallory-Weiss Boerhaave syndrome PUD Biliary disease Pancreatitis |
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How long after AMI is troponin detectable?
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3-6hrs
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Name some reasons for a false positive troponin-
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Myocarditis
CMP Severe CHF PE Sepsis HTN crisis |
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What is the essential diagnostic difference between Unstable Angina and NSTEMI?
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UA - troponin negative
NSTEMI - troponin positive |
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What are non-atherosclerotic causes of CAD?
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Prinzmetal's variant
Dissection Embolism from endocarditis, myoxoma etc Vasculitis - Kawasaki, Takayasu Myocarditis |
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What are some typical associated symptoms of MI besides chest pain?
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dyspnea
diaphoresis nausea/vomiting palpitations lightheadedness |
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What might you hear on cardiac auscultation w/ AMI?
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S3
new MR murmur due to papillary muscle dysfunction |
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What anatomical area of the heart is infarcted when you see ST elevation in V1-V2?
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Septal infarct
Infarct of Proximal LAD |
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What anatomical area of the heart is infarcted when you see ST elevation in V3-V4?
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Anterior wall MI
Infarct of LAD |
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What anatomical area of the heart is infarcted when you see ST elevation in V5-V6?
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Apical infarct
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What anatomical area of the heart is infarcted when you see ST elevation in I and aVL?
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Lateral wall MI
Infarct of LCx |
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What anatomical area of the heart is infarcted when you see ST elevation in II, III, aVF?
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Inferior wall MI
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What anatomical area of the heart is infarcted when you see ST depression in V1-V3?
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Posterior wall MI
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What are medications used for treating Prinzmetal's angina?
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CCBs
nitrates |
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Which drug should cocaine users avoid to prevent cocaine-induced vasospasm?
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Beta blockers since unopposed alpha stimulation can worsen spasm
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What are the seven factors for calculating TIMI risk score?
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Age >65
>3 risk factors for CAD Known CAD ASA use in last 7 days Severe angina ST elevation >0.5mm Troponin or CKMB |
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What is the time goal for reperfusion primary PCI after first contact in a patient with STEMI?
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<90 minutes from first medical contact
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What are absolute contraindications for Fibrinolysis?
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Prior ICH
Intracranial neoplasm, AVM Stroke w/in 3mo Active internal bleeding Suspected aortic dissection |
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What are post-MI complications to look out for?
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Cardiogenic shock
Heart block Free wall rupture VSD Papillary muscle rupture Arrhythmias (AF, VT) |
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How do you treat Dressler's syndrome post-MI?
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aspirin, NSAIDs
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What medications should be used on discharge post-STEMI barring contraindications?
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Aspirin
Clopidogrel Beta blocker ACEI |
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Name some causes of high output heart failure-
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AV fistula
Sepsis Beriberi Anemia Thyrotoxicosis |
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What are some precipitants of acute heart failure?
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MI
Renal failure (increases preload) hypertensive crisis worsening AS Dietary indiscretion or medical nonadherence Drugs or toxins Arrhythmias |
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What are standard treatments for chronic heart failure?
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Diet/exercise
ACEI/ARB Beta blocker Diuretics ~spironolactone ICD |
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What are clinical manifestations of Dilated Cardiomyopathy?
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Heart failure - lateral displaced PMI, S3, MR or TR
Chest pain |
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What are the clinical manifestations of Hypertrophic cardiomyopathy?
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Dyspnea
Angina Arrhythmias, including sudden death |
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What are the physical exam findings for Hypertrophic cardiomyopathy?
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Sustained PMI
Paradoxical S2 splitting S4 Systolic murmur increased w/ valsalva |
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What are the common etiologies for Aortic Stenosis?
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Calcific >70yrs
Congenital bucuspid Rheumatic heart disease |
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What type of murmur is heart with aortic stenosis?
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Midsystolic crescendo decrescendo at RUSB. High pitched radiating to carotids
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How should asymptomatic AS be treated?
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It shouldn't be treated
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What type of murmur is heard in patients with Aortic insufficiency?
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Early diastolic decrescendo murmur at LUSB
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What medical therapies may be used in patients with Aortic insufficiency?
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Vasodilators like Nifedipine, ACEIs, hydralazine
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