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when do you do thallium echo or thallium with adenosine?
- under 5 conditions
- ST segment abnormality
- Digoxin use
When do ACE inhibitors lower mortality in MI?
- in LV dysfunction
- decreased EF
- systolic dysfunction
When do you give prasugrel or clopidogrel?
if you will do angioplasty and stent
when does the classical treatment for stemi not apply?
- posterior wall MI
- MI causing pulmonary edema
- MI with bradycardia
Sokolow-Lyon criteria for LVH?
S in V1 + R in V5-V6 > 35mm
When do you give CCB for MI?
- 3 conditions
- prinzmetals angina
- Cocained induced ischemia
Most accurate test for STEMI?
What are the first cardiac biomarkers present post MI?
in an unequivical case of STEMI, EKG or treatment?
- ace inhibitors
Risk factors for CAD
- FH of CAD <55 for males <65 for females
- Age >45 for males > 55 females
- HTN/HDL low
When do you do CABG vs stenting
- 3 vessel dz
- 2 vessel dz + DM
- Left main coronary
TIMI score for UA/NSTEMI
- Age >65
- Markers--troponins or ckmb +ve
- EKG--st changes of 0.5 mm
- Risk factors for Cad >3
- Ischemia-2 episodes in 24 hours
- Cad >50% stenosis
- Aspirin use in past 7 days
When do you use PM in acute MI management?
- new LBBB
- Bifascicular block
- 3 degree heart block
- 2 degree type 2 morbitz
- symptomatic bradycardia
When do you give intra-aortic balloon pump?
Difference in management of NSTEMi from STEMI?
- no thrombolytics
- G2B inhbitors--abxicimab
How far should you move a clock in the ICU or ED?
What is the initial mngt of Pulmonary Edema
what are the + ionotropes used for CHF?
When do you give an ICD for a pts with CHF?
When do you use biventricular pacemaker vs ICD?
- biventricular PM--QRS >120 msec
- ICD- EF <35%
Bicuspid aortic valve is most commonly seen with what two conditions?
- turners syndrome
- coarctation of aorta
which murmurs are best heard at LSB?
- aortic regurg
- Tricuspid regurg
best initial test for valvular lesions?
How do you treat murmurs which are decreased by valsalva?
decrased by amyl nitrate?
what tests need to be ordered for valvular disorders?
when do you dilate aortic stenosis ?
if can't do surgery
difference between metallic valves vs bioprostehtic valve like bovine or procine?
metal require warfarin but last forever
bioprostethic--- no warfarin , last 10 years
when is sx indicated for aortic stenosis
- pressure of >40
- area <1 cm^2
when do you do sx for aortic regurg?
Mitral regurg sx?
For wall valvular lesions, what tests are ordered initially?
For valvular lesions, surgical repair/replacement is the best treatement except for what valvular lesion?
ankylosing spondylitis and reiters syndrome can cause what type of valvular lesion?
what happens to opening snap with worsening MS?
moves closer to S2
at what nyha stage, do bb and aceI lower mortality?
at all stages
when suspecting valvular disease, what exams shoudl be done?
most accurate way to dx restrictive cardiomyopathy
what ekg findings are seen with paricarditis?
- diffuse st segment elevation
- pr depression
constrictive pericarditis presents how?
- like right heart failure
treatment for constrictive pericarditis vs cardiac tamponade?
- cardiac tamponade- pericardiocentesis
management of dissection of aorta?
- bp controle--ekg, chest xray
- then further bp control + ct angiography or tee or mra
which murmur is not affected by either handgrip or amyl nitrate?
stenotic lesions are best treated how?
how are asd repaired?
percutaneous or catheter
what is the strongest indication for asd repair?
shunt ratio exceeds 1.5:1
catheterization of heart in cardiac tamponade will show what?
equalization of pressure in all chambers
most dangerous therapy in cardiac tamponade?
difference in presentation between acute pericarditis and constrictive pericarditis?
acute pericarditis--- kaussmal sign, sob
constricitve --chronic heart heart failure--hepatomegaly, edema, jvd
best initial therapy for constrictive pericarditis?
most effective therapy
best initial therapy for pad?
- bp controll
- smoking cessation
- exercise as tolerate
how do you diagnose afib in the hospital if the initial ekg doesnt show it>
what tests are ordered once afib is found?
- cardiac enzymes
- Thyroid function tests
rx for unstable afib?
after how many days do you anticoagulate afib?
if the questions doesnt state how long afib has been, do you anticoagulate?
when do you give digoxin for afib or a flutter?
with borderline hypotension
what are the 3 rhythms originating from the atria that can be irregularly irregular?
under what circumstances should you order echo?
in all cases of arrhythmias
when do you give ionotropes for chf exacerbtion?
if it fails to respond to the initial treatment and you have pulmonary edema
Best SVT treatment
catheter ablation of aberrant foci
best long term rx for wpw
what drugs can throw svt into wpw?
- any drug that delays the av node
2 causes for sudden loss of consciesness?
regaining of consciesness from syncopy?
most important to do during a syncopal episode?
exclude cardiac cause
if after intial work up the cause of syncopy is not clear, next step?
- urine tox
- telemetry/holter monitoring
- tilt table testing
- EP testing
what do you not order during a syncopal workup