0- no need for treatment
1- consider anti platelet or anticoagulation
>2- anticoagulation necessary
What is the INR range for patients taking warfarin for atrial fibrillation? - 2-3 !
What presents with intermittent claudication (pain in a muscle group induced by
exercise and relieved with rest), decreased distal pedal pulses, cool, shiny extremity
with decreased hair?
Dx and Tx? - Peripheral Arterial Disease!
Dx:
ABI- Ankle-Brachial Index (measure BP in arm vs leg) <.9% indicates stenosis , <.4%
indicates ischemia --> Simple, quick, noninvasive most useful screening tool
Arteriography--> Gold standard (visualizes atherosclerosis inducing ischemia)
Peripheral arterial disease most commonly affects which vessels? - Superficial femoral
artery (calf pain)
Aortoiliac system (thigh/buttock pain).
Which of the following features can differentiate myocardial infarction from pericarditis?
- Reciprocal changes in EKG!
Meaning... ST depression in the leads opposing ST elevation!--> ONLY occurs in MI,
will never occur in pericarditis
Ex:
Anterior vs Inferior are reciprocal leads, so if anterior has elevations, inferior would have
depressions
What is Dressler's syndrome? - Post-myocardial infarction pericarditis.
What presents with pleuritic chest pain radiating to back, worse when laying back,
improved when leaning forward, with tachycardia and pericardial friction rub?
Dx and Tx? - Pericarditis!
Dx:
EKG:
Diffuse ST elevations(concave)
May also show PR depression/elevation
Tx:
NSAIDs (Indomethacin)
What is the most common cause of Pericarditis? - Idiopathic!!
2nd most commonly cause by
Viral--> Cocksackie!
What cardiac biomarker occurs first?
Which one is most specific?
Timeline of each? - 1st occurring:
Myoglobin
,Most Specific:
Troponin I or T
Timeline:
Myoglobin--> 1-2 hours onset, peaks 8-10 hours, gone by 1-2 days
Troponin --> 3-12 hour onset, peak 24-48 hours, lasts up to 5-14 days
What is the role of beta-adrenergic blocking agents in acute myocardial infarction? -
Within 24 hours of presentation reduce the risk of developing ventricular dysrhythmias!
Which cardiac biomarker is useful for assessing a re-infarction during the hospital stay?
- CK-MB , because troponin will last for up to 14 days and therefore would not be good
indicator of whether another heart attack occurred !
What is the earliest ECG sign of MI? - hyperacute T waves
What cardiac biomarker has the highest sensitivity and specificity? - Troponin I!
What is the #1 cause of death in the US? - Ischemic Heart Disease!
What is the most common symptom of cardiac ischemia in patients older than 85 years?
- Dyspnea!
Which of the following is the most predictive risk factor for cardiac ischemia? - PMH of
CAD!
Tobacco smoking, family history of CAD, and DM are also risk factors, but not as strong
as having personal history of CAD
What is the most common cause of cardiac related syncope? - Cardiac Dysrhythmias
What is the scaling used for assessing syncope? - San Francisco Syncope Scale:
CHESS
C-CHF
H-Hematocrit <30%
E-EKG abnormal
S- SOB
S- Systolic <90
What presents with Adolescent athlete + syncope?
, Dx and Tx? - HOCM (Hypertrophic Cardiomyopathy)
Autosomal DOMINANT pattern!!!
Dx:
EKG
Echo
Tx:
ICD
What presents with young woman with abdominal pain and syncope? - Ectopic
Pregnancy
What presents with elderly male, abdominal/flank pain and syncope? - AAA (Abdominal
Aortic Aneurysm)
infrarenal aortic diameter ≥ 3 cm
What presents with sudden onset HA and syncope? - Subarachnoid Hemorrhage!
(SAH)
What presents with female with prodrome of nausea, sweating warmth and syncope? -
Vasovagal
What presents with history of malignancy with sudden onset of SOB and syncope? -
Pulmonary Embolism!
What is the most common cause for syncope in a patient with a non-specific history,
normal physical exam and normal EKG? - Unknown!
What presents with a low intensity, low pitch extra heart sound which occurs in early
diastole?
TX? - S3 heart sound!
Dilated Cardiomyopathy! --> abnormal variant in elderly population (>40) indicates
ventricular dysfunction ( volume overload )
Usually heard at the apex in the left lateral decubitus position
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