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39 Cards in this Set
- Front
- Back
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How common is it for a patient that uses cocaine and complains of chest pain to rule in for an acute MI?
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6%
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What is the most common cause of death in the United States?
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Ischemic Heart Disease
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What type of ST segments would you expect to see in a patient suffering from Printzmetal's Angina?
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ST Elevation
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What is the cause of Printzmetal's Angina?
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Coronary Artery Vasospas,/
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What is the prognosis for a Non-Q Wave MI vs STEMI
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Initially prognosis is better for Non Q Wave MI but long term, there is no difference
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What are the three EKG criteria for emergency reperfusion of an acute MI?
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1 mm ST elevation in 2 contiguous leads, or New LBBB, or Old LBBB with +Sgarbossa Criteria
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What are Sgarbossa Criteria?
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ST segment elevation concordant with QRS in any lead, or ST depression in any of V1 - V3, or > 5mm ST elevation discordant in any lead
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What should you consider to be an early marker of reperfusion in AMI?
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1. The Early Development of T wave inversion,
2. Normalization of ST elevation 3. Development of accelerated idioventricular rhythm |
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Describe the EKG findings in a right ventricular MI
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ST elevation in V1, II,III, avF
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Describe the concerns of post MI bradycardia vs post MI conduction abnormalities.
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Conduction abnormalities indicated dead tissue in the conducting system. This is more dangerous that arrhythmias.
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What are the indications for Thrombolytics?
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1. 1/2 - 12 hr CP not relieved by nitro
2. 1 mm ST elevation in 2 contiguous lead 3. New LBBB or Sgarbossa Criteria 4. PCI delay of > 90 minutes Note: RBBB does not obscure the dx of AMI |
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List the seven absolute contraindications to thrombolytics.
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1. PCI is available
2. Active Bleeding 3. CVA in past 6 months 4. H/O hemorrhagic CVA 5. Brain/Spinal Surgery in past 2 months 6. Tumor in brain/cord 7. Suspected dissection |
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What are the clinical findings in a RV infarct?
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1. Hypotension
2. Distended Neck Veins 3. Clear Lungs |
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What is Dressler's Syndrome?
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Post MI pericarditis
2 - 8 weeks post MI + Fever Treat with NSAIDS |
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When should you expect to see the late complications of AMI?
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1 - 7 days Post MI when ventricles, papillary muscles, and septa that are ischemic rupture.
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What are the 5 causes of high output failure?
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1. BeriBeri
2. Anemia 3. A-V fistula 4. Thyrotoxicosis 5. Paget's Disease of the Bone |
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Which valves are most commonly infected with endocarditis?
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M > A > T > P
Tricuspid = IVDA |
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What is the most common pathogen seen in IVDA endocarditis?
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Staph Aureus
Tricuspid Valve |
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What type of endocarditis do older people get?
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Strep Viridans
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What is the most common cause of death in patients with left sided endocarditis?
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Heart Failure
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When are infections most common in patients with a new prosthetic heart valve?
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First 2 months postop
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Which bacteria are most commonly associated with bacterial endocarditis?
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1. Native valve: Strep
2. IVDU: Staph 3. Prosthetic Valve: Staph epi and aureus |
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Differentiate Osler nodes, Janeway lesions, Roth Spots
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All are seen with endocarditis.
Osler Nodes are tender nodules tips of fingers and toes Janeway are painless hemorrhage fingers and toes Roth Spots: Retinal hemorrhages with central clearing |
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When should you prophylax against endocarditis?
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Major dental and invasive respiratory procedures.
Do not prophylax GU/GI procedures |
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What is the most common cause of valvular disease?
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Degenerative changes to the valve.
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How is Rheumatic Heart Disease diagnosed?
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Jones criteria (2 major or 1 major and 2 minor)
Major: Carditis, Arthritis, Sydenham's chorea, Erythema marginatus, Subcutaneous Nodules. Minor: H/X of RF, arthralgia, Elevated ESR, Prolonger PR, Fever |
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A patient presents with exertional dyspnea. What is at the top of the differential?
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Aortic stenosis
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Which medications are contraindicated in Aortic Stenosis?
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Nitrates
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Describe the heart murmur of aortic stenosis?
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SEM radiates to the neck
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What is the most common cause of Mitral Stenosis?
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Rheumatic Heart Disease
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What is the most common cause of Mitral Stenosis?
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Rheumatic Heart Disease
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Which agent is used to reverse Heparin overdose?
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Protamine
1 mg neutralizes 100u of Heparin |
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Is Thrombocytopenia a common or rare side effect of IV Heparin administration
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Generic Thrombocytopenia is a common side effect
Anti-platelet induced Thrombocytopenia is a rare side effect. |
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What is the most common hematologic complication of HIV?
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TTP
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Do factor VIII inhibitors prolong PTT or PT?
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PTT (intrinsic cascade)
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How quickly with DDAVP reverse Hemophilia A?
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Less than an hour
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A patient presents to the ER with Acute Chest Syndrome secondary to Sickle Cell Disease. What is the cause?
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It is usually an infected pulmonary infarct.
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A patient on Bactrim presents with dark urine and urobilinogen in the UA. What disorder should you be thinking of?
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Hemolysis from G6PD deficiency
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Differentiate ITP and TTP
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ITP: Autoimmune
TTP: Microangiopathic Hemolytic Anemia. Treat with Plasma Exchange transfusion, FFP and steroids |
