What 2 EKG findings suggest STEMI?
- ST segment elevation
- new LBBB
If patient can’t walk for stress test, what 2 meds can administer for pharmocologic stress?
- dobutamine
- adenosine
What is acute treatment for ACS?
- Morphine (prn)
- O2 (prn)
- Nitrate
- ASA
- BB
- ACEI
- Statin
- Heparin/Clopidogrel
What is purpose of administering BB for ACS?
- reduce myocardial work
- prevent ventricular arrthythmia
What are the indications for thrombolysis in ACS?
- can’t catheterization (PCI facility is >60min away)
- in acute disease (STEMI)
- within 12hr of onset
STEMI –> within how long need cath?
90min
valsalva does what?
decrease venous return (decrease preload)
when use synchronized cardioversion?
unstable Afib/flutter/SVT
when use unsynchronized cardioversion?
no coordinated cardiac electrical activity –> V tach/fib
arrhythmia –> QRS fast & wide –> what drug for tx?
amiodarone
arrhythmia –> QRS fast & narrow –> what drug for tx?
adenosine
arrhythmia –> QRS slow –> what drug for tx?
atropine
Afib/flutter –> what drug for tx?
- BB
- CCB: verapamil, diltiazem
no pulse –> ACLS –> what rhythms do you shock, and which rhythms don’t shock?
VT/VF: shock
PEA/asystole: no shock
VT/VF –> ACLS –> what drugs for tx?
epi
amio
epi
PEA/asystole –> ACLS –> what drugs for tx?
epi
0
epi
Afib –> >48hr –> want to cardiovert –> need to be on warfarin for how long before cardioversion?
3-4 wks
Afib –> >48hr –> why need to be on warfarin for 3-4wks before cardioversion?
to prevent embolization of mural thrombus
Afib –> <48hr –> want to cardiovert –> when can cardiovert?
right away if necessary
aortic regurg –> murmur?
blowing diastolic murmur at L sternal border +/- mid-diastolic rumble (Austin-Flint murmur)
acute pericarditis –> possible etiologies (6)
- viral infection
- TB
- SLE
- uremia
- drugs
- neoplasm
acute pericarditis –> first line tx
NSAID and ASA
PE –> EKG finding
S1Q3T3 (right heart strain)
HOCM –> murmur decreases or increases with valsalva?
increases
HOCM –> what tx decreases intensity of murmur?
BB –> increase preload
what is Eisenmenger’s synd?
ASD/VSD/PDA –> reverse from LtoR shunt to RtoL shunt –> cyanosis
b/l renal artery stenosis –> what med is contraindicated? why?
ACEI –> decrease renal perfusion and GFR –> accelerate renal failure
16M –> no PMHx, no meds –> no complaints –> routine EKG shows short PR, slurred QRS
what condition?
wolff-parkinson-white synd
wolff-parkinson-white synd –> pathophys
anomalous embryonic development of myocardial tissue –> fibrous tissue bridge bw atria & ventricle –> accessory pathway
WPW synd –> EKG findings
- shortened PR
- delta wave
- wide, slurred QRS
WPW synd –> COD
rapid conduction thru accessory pathway –> unstable ventricular rate –> cardiac output decrease –> sudden cardiac death
BB toxicity –> tx
glucagon –> increase cardiac contractility, HR, conduction
who gets AAA screening?
65-75M who have ever smoked
alcohol abuse –> dilated cardiomyopathy –> tx? why?
stop alcohol use –> almost completely reversible
differentiate: dressler’s synd vs post-infarction pericarditis
dressler’s (postpericardiotomy synd):
- onset 2-4wk after MI
- also constitutional ssx
postinfarct pericarditis:
- onset 12hr-10days after MI
acute stable angina –> tx
SL nitroglycerin
exertional stable angina –> tx
isosorbide mononitrate: long-acting nitrate –> improve exercise tolerance
septic shock:
- cardiac output
- pulm capillary wedge pressure
- peripheral vascular resistance
- cardiac output: increased
- pulm capillary wedge pressure: decreased
- peripheral vascular resistance: decreased
> 60yo without DM –> BP goal
<150/90
> 60yo with DM –> BP goal
<140/90
Vtach –> when synchronized vs unsynchronized cardioversion?
Vtach w pulse –> synchronized
Vtach without pulse –> unsynchronized
ABI –> normal?
> 1
ABI –> claudication?
0.5-0.8