cardio step 3

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  1. Chest pain that does not change with body position or respiration
  2. Plueritic pain ddx
    PE, Pneumo, Pleuritis, Pericarditis, Pneumothorax
  3. Positional Pain ddx
  4. S3 Gallop suggests
    dilated left ventricle
  5. S4 Gallop suggests
    left ventricle hypertrophy
  6. Rales suggests
  7. best test for ischemic chest pain
  8. Time frame that CK-MB and Troponin
     rises3-6 hrs after start of CP
  9. Main diff btw CK-MB and TroponinCK-MB
    only stays elevated 1-2 days while troponin stays elevated 1-2 wks
  10. Time frame that Myoglobin rises
    1-4 hrs after start of CP
  11. When do you do a stress test
    when CP isnt acute and intial EKG & cardiac enzymes don't establish dx
  12. When do I answer dipyridamole or adenosine thallium stress test or dobutamine echo
    pt who cannot exercise to target HR of >85% of max: COPD, Amputation, Deconditioning, weakness/prev stroke, lower-extremity ulcer, dementia, obesity
  13. When do I answer exercise thallium testing or stress echo
    EKG is unreadable for ischemia: LBBB, digoxin use, pacemaker in place, Left ventricular hypertrophy, any baseline abnorm of ST segment of the EKG
  14. What do you use to stress test in obese and large breasted pts
    Sestamibi nuclear stress test
  15. Best initial tx for Acute coronary syndrome
  16. % mortality reduced when using aspirin for MI and in unstable angina
    25% MI and 50% UA
  17. Other tx giving in ACS but does not lower mortality
    O2, nitrates, morphine
  18. Tx that will lower mortality in STEMI
    thrombolytics and primary angioplasty (both dependent on time)
  19. PCI must be performed c/in what time frame
    90mins of arrival at the ED for STEMI
  20. Angioplasty or med tx (aspirin, BB, statins) is better at decreasing mortality in stable angina
    medical tx (aspirin, BB, statins)
  21. If PCI cannot be performed c/in the set time frame then what should be done
  22. when are thrombolytics indicated
    CP for <12 hrs and has ST elevation in 2 or more leads; new LBBB
  23. what is the time frame for thrombolytics
    given c/in 30mins of pts arrival to ED c/pain
  24. what has the single greatest efficacy in lowering mortality in STEMI
  25. What should be given to ACS pts in addition to O2, aspirin, angioplasty or thrombolytics
    BB & ARB or ACEI
  26. What drug is given to pts c ACS, lowers mortality but isn't time dependent
  27. ACEI and ARBs lower mortality in which ACS pts
    pts c left vent dysfunction or systolic dysfunction
  28. What med should always be given to all pts c ACS
    statin medications (atorvostatin)
  29. ACS tx that always lower mortality
    aspirin, thrombolytics, angioplasty, metoprolol, statins (atorvostatin), clopidogrel
  30. ACS tx that lowers mortality in certain conditions
    ACEI (if EF is low); ARBs (if EF is low)
  31. CS tx that do not lower mortality
    O2, morphine, nitrates, CCB, Lidocaine, Amiodarone
  32. When is clopidogrel the answer in ACS
    when pt has ACS and is allergic to aspirin or pt is undergoing angioplasty
  33. When is CCB the answer in ACS
    when pt has intolerance to BB (eg asthma), cocaine induced CP, coronary vasospasm (prinzmetal angina)
  34. When is pacemaker the answer in ACS
    3rd degree block, Mobitz type II, Bifasicular block, new LBBB, symptomatic bradyc
  35. When is lidocaine or amiodarone the answer in ACS
    ONLY in vent fib or vent tachyc (DO NOT give to prevent vent arrythmias
  36. all complications of MI can lead to
  37. Complication of MI: Cardiogenic shock dx tx
    dx: echo, swan ganz tx: ACEI, urgent revasc
  38. Complication of MI: Valve rupture dx tx
    dx: echo tx: ACEI, nitroprusside, intra-aortic balloon pump as bridge to sx
  39. Complication of MI: Septal rupture dx tx
    Complication of MI: Septal rupture dx txdx: echo, rt heart catheter showing a step up in sat from rt atr to rt vent tx: ACEI, nitroprusside, urgent sx
  40. Complication of MI: Myocardial wall rupture dx tx
    dx: echo; tx: pericardiocentesis, urgent cardio repair
  41. Complication of MI: Sinus bradyc dx tx
    dx: EKG; tx: Atropine followed by pacemaker if there are still symptoms
  42. Complication of MI: 3rd degree block dx tx
    dx: EKG, canon "a" waves; tx: atropine and pacemaker
  43. Complication of MI: Rt vent infarction dx tx
    dx: Rt ventricular leads on EKG; tx: fluid loading
  44. All pts post MI should go home on what meds
    aspirin, BB, statin, ACEI
  45. Predominant diff in mgmt of NSTEMI vs STEMINSTEMI: no thrombolyic use, heaparin used routinely, glycoprotein IIb/III inhib lower mort (esp in pts undergoing angioplasty)
    NSTEMI: no thrombolyic use, heaparin used routinely, glycoprotein IIb/III inhib lower mort (esp in pts undergoing angioplasty)
  46. Both ARBs and ACEI have what SE
  47. Meds used routinely in SA mgmt
    aspirin, metoprolol
  48. Med used in anginal pain but do not reduce mortality
  49. When should ARBs and ACEI be used in SA mgmt
    in pts c CHF, Systolic dysfunction, low EF
  50. Why is an angiography done?
    to determine who is a candidate for CABG
  51. What are the indications for CABG
    3 coronary vessels c > 70% stenosis, left main coronary art stenosis >70%
  52. When is a statin recommended
    in ACS pt c LDL > 130
  53. Goal of statin tx
    in CAD pt LDL <100; in diabetic pt c CAD LDL <70
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