CVS2 USMLE
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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
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contraindications to stress testing | USA, AoS, severe COPD, acute isch changes on ECG, severe uncontrolled HTN (and Ao dissection)
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what's syndrome X | exertional angina, incl exercise testing and nuclear imaging showing myo isch, but no stenosis on cath
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name non selective b blocker | propanolol, nadolol timolol, pindolol
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name cardiac selective b blockers | esmolol (ultra fast), metoprolol, atenolol
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2 alternatives to ASA | ticlopidine (watch for neutropenia)and clopidogrel
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s/p PTCA what meds | ASA + ticlopidine/clopidogrel + GIIb/IIIa (abciximab, tirofiban, eptifibatide)
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pathoophysiol and 5 elements of metabolic syn X | insulin resistance due to obesity; incrsd Chol&TG, impaired glu tol, DM, HTN, incrsd uric
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contraindications to full dose heparin in AMI | HEAPS=HTN (>190/110), Endocarditis, Activ bleeding or hemorrhagic diathesis, Purpura, Surgery (recent neuro or ocular)
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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
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EKG of PE | S in I, Q in III, inverted T in III [think SQT in I,II, III]
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MC cause in hospital mortality s/p MI, overall mortality s/p MI | CHF, arrhythmia
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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)
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which are more likely to rupture, ventricular psudoaneur or aneur | pseudoaneur
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how tx angina after tPA | angioplasty or bypass
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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
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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)
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what are 2 common dig related conduction problems | paroxysmal atrial tachy w 2:1 block, A Fib w PVC and slow ventricular rate
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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)
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which infarct area assoc w AV block | diaphragmatic
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Lenerge dz | MC cause of 3rd degree block, senile fibrosis of conduction system
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when see large v wave on JVP | TR (and MR)
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when see incrsd a waves | pulHTN and RHF
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when see cannon a waves in JVP | arrhythmias ie 3rd degree block when atria pushing ag closed TV, also V Tach or A Flutter
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rapid y descent can be seen in 3 dz | constrictive pericarditis, restrictive CM, TR
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describe how/why S2 splits | when inspire more blood in RV and PV stays open longer (AV then PV)
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what leads to wide split S2 | R vol overload, pulHTN, also MR
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what leads reverse splitting S2 | AS, HOCM (AV stays open longer)--maybe also pul HTN--not sure
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3 CAD risk equivalents | DM, PVD, AAA
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how tell when to put on 1 HTN med, 2 med | HTNI gets 1 med, HTNII needs 2 (both w lifestyle changes)
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which BP med use in AA | diuretic (they are usu salt sensitive)
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what causes an anterior infarct? Posterior? Lateral? Inferior? | LAD, PDA, LAD or LCx, RCA
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which artery and infarct do you need to watch for RV failure | RCA and inferior
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which are anterior leads? Lateral? Inferior? Septal? | anterior=I, V1-6; inferior=II, III, aVF, lateral=I, aVL, V5, V6; septal=V1,V2
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definition of BBB | QRS>0.12
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nml axis | positive I and aVF
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LAD by I and aVF | I=+, aVF=-
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RAD by I and aVF leads | I=-, aVF=- or +
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in considering arrhythmias, when is a pt considered unstable | SBP <90, AMS, CP, SOB
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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;
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dx of LVH | amplititude of R in aVL + S in V3>24males or 20females
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dx of RVH | RAD + R wave in V1>7
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dx RAE | P in II>2.5
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dx LAE | biphasic P in V1
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3 features of WPW on ECG | short PR, delta wave, wide QRS
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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
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what ECG change is specific for RV infarct | ST elevation in R sided V4 RV4
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MC presenting sympt for HOCM, AS, MVP, long QT, myocarditis | HOCM=dyspnea, AS=dyspnea, MVP=CP, long QT=syncope, myocarditis=dyspnea& fatigue
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MC arrhythmia s/p MI | V Fib
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MC cause cardiogenic shock | s/p AMI
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MC cause of death s/p endocarditis | CHF
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general tx for regurg L heart lesions | decrs afterload w ACEI
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pt h/o MI and MR, what Rx take them off | b blocker (incrses preload)
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