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when to use thallium v stress treadmill to assess angina when can't see ST changes well, incl abnl baseline EKG, LVH, MVP, WPW, LBB, pacemaker, young women (high false +), quinidine, procainamide, dig
contraindications to stress testing USA, AoS, severe COPD, acute isch changes on ECG, severe uncontrolled HTN (and Ao dissection)
what's syndrome X exertional angina, incl exercise testing and nuclear imaging showing myo isch, but no stenosis on cath
name non selective b blocker propanolol, nadolol timolol, pindolol
name cardiac selective b blockers esmolol (ultra fast), metoprolol, atenolol
2 alternatives to ASA ticlopidine (watch for neutropenia)and clopidogrel
s/p PTCA what meds ASA + ticlopidine/clopidogrel + GIIb/IIIa (abciximab, tirofiban, eptifibatide)
pathoophysiol and 5 elements of metabolic syn X insulin resistance due to obesity; incrsd Chol&TG, impaired glu tol, DM, HTN, incrsd uric
contraindications to full dose heparin in AMI HEAPS=HTN (>190/110), Endocarditis, Activ bleeding or hemorrhagic diathesis, Purpura, Surgery (recent neuro or ocular)
what parts of the heart do ea cor artery supply RCA=P LV, RV and RA, SA and AV node; LCA=A LV, A 2/3 of interventricular septum; LCx=L LV
EKG of PE S in I, Q in III, inverted T in III [think SQT in I,II, III]
MC cause in hospital mortality s/p MI, overall mortality s/p MI CHF, arrhythmia
how tx 2nd degree type II block s/p MI if anterior MI emergent temp pacemaker, if inferior MI IV atropine (if unsuccessful then pacemaker)
which are more likely to rupture, ventricular psudoaneur or aneur pseudoaneur
how tx angina after tPA angioplasty or bypass
what is amiloride? Triamterene? Bumetanide? Metolazone? Indapamide? amiloride and triamterene are both K+ sparing like spironolactone, but don't cause gynecomastia; bumetanide is a loop; metolazone and indapamide are thiazide
what is the CHADS2 score risk of stroke w non rheum A Fib: CHF, HTN, 75yo, h/o stroke/TIA (counts as 2, rest count as 1)
what are 2 common dig related conduction problems paroxysmal atrial tachy w 2:1 block, A Fib w PVC and slow ventricular rate
2 congenital QT syndromes, genetics, tx AR Jervell-Lange-Nielsen w congenital deafness, AD=Romano Ward; symptomatic tx w b blocker (QT will remain long)
which infarct area assoc w AV block diaphragmatic
Lenerge dz MC cause of 3rd degree block, senile fibrosis of conduction system
when see large v wave on JVP TR (and MR)
when see incrsd a waves pulHTN and RHF
when see cannon a waves in JVP arrhythmias ie 3rd degree block when atria pushing ag closed TV, also V Tach or A Flutter
rapid y descent can be seen in 3 dz constrictive pericarditis, restrictive CM, TR
describe how/why S2 splits when inspire more blood in RV and PV stays open longer (AV then PV)
what leads to wide split S2 R vol overload, pulHTN, also MR
what leads reverse splitting S2 AS, HOCM (AV stays open longer)--maybe also pul HTN--not sure
3 CAD risk equivalents DM, PVD, AAA
how tell when to put on 1 HTN med, 2 med HTNI gets 1 med, HTNII needs 2 (both w lifestyle changes)
which BP med use in AA diuretic (they are usu salt sensitive)
what causes an anterior infarct? Posterior? Lateral? Inferior? LAD, PDA, LAD or LCx, RCA
which artery and infarct do you need to watch for RV failure RCA and inferior
which are anterior leads? Lateral? Inferior? Septal? anterior=I, V1-6; inferior=II, III, aVF, lateral=I, aVL, V5, V6; septal=V1,V2
definition of BBB QRS>0.12
nml axis positive I and aVF
LAD by I and aVF I=+, aVF=-
RAD by I and aVF leads I=-, aVF=- or +
in considering arrhythmias, when is a pt considered unstable SBP <90, AMS, CP, SOB
LBBB v RBB on ECG *W*i*LL*ia*M* *Ma*RR*o*W* W in QRS in V1-2 and M in V3-V6=LBBB; M in QRS in V1-2 and W in V3-V6=RBBB;
dx of LVH amplititude of R in aVL + S in V3>24males or 20females
dx of RVH RAD + R wave in V1>7
dx RAE P in II>2.5
dx LAE biphasic P in V1
3 features of WPW on ECG short PR, delta wave, wide QRS
list of CAD risks used to calculate when to treat lipids CAD equiv=DM, PVD, AAA; CAD risks: current smoking, HTN, DM, HDL <35 (>60 is negative), age m>45, f<55; male (don't count if already counting age), fam hx of MI in m<55 in f<65
what ECG change is specific for RV infarct ST elevation in R sided V4 RV4
MC presenting sympt for HOCM, AS, MVP, long QT, myocarditis HOCM=dyspnea, AS=dyspnea, MVP=CP, long QT=syncope, myocarditis=dyspnea& fatigue
MC arrhythmia s/p MI V Fib
MC cause cardiogenic shock s/p AMI
MC cause of death s/p endocarditis CHF
general tx for regurg L heart lesions decrs afterload w ACEI
pt h/o MI and MR, what Rx take them off b blocker (incrses preload)
Created by: ehstephns
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