cardiology

chest pain=ekg
st changes or new onset lbbb(wide flattended qrs>120ms)
best thing pci cathlab
1.if no cath lab in 90mins thrombolytics
2.contra to thrombo recent ischemic infarct or closed head trauma,hemorrhagic
stroke any time in the past,bleeding
inferior wall mi=jvd but lungs clear,hypotension,shock.Rx no nitrates,RV isnt
pumping,send more preload

chest pain=normal ekg

do biomarkers,do 3 sets,every 6-8 hrs
re in farction ckmb vs myoglobin see time frame
schedule angiography
indication of cabg=left main.2 vessel in diabetic,>70%,3 vessel,very sick

unstable angina=no marker no ecg

bb and ccb hold before stress test
no use of stress tes:old lbbb,digoxin,do echo
dobutamine /adesonine chemical stress test
maga nuclear medicine
stress testst-depression,bp drops,go to cathlab

MI complication
cod=v fib,
5-7 days new systolic murmur=acute mr from papillary muscle rupture
murmur+hypotension=free wall rupture
O2 up between RA and RV=septal rupture
murmur+persistant st elevation=v aneurysm
canon a wave=3rd degree heart block
5-10weeks=pleuritic chest pain+low grade fever rx aspirin+nsaids

young man diffuse st elevation= pericarditis,rx nsaids

palpable=costochondritis
viral vague myocarditis
rest worst at night lady with migraine =prinzmental angina,ergonamine stimulation
test,rx=ccb and nitrates

ecg

mobitz 1
3rd degree heart block,regular pp and regular rr,no p with qrs
mat=3 p wave morphology in same lead,varying pr,poor prognosis.
wide vs narrow complex tachy
v tach=unstable=shock,stable lidocaine or amiodarone
wpw delta,short pr,wide qrs,doc=procainamide,dont give av slower bb ccb digoxin
a flutter 2 to 1 ratio atrial vs ventricular
torsades=low k low mg tca overdose
svt=rhythm regular,1st line=carotid massage,ice water,then adenosine
tall t wave,qrs wide,short qt,pr long,ckd,crush,burn=hyperkalemia
low vol,undulating,becks triad=tamponade electrical alterans
a fib:causes,rate is better=bb ccb dig

murmur
as=old,bicuspid young,softer with valsalva,rx=replace
hocm louder with valsalva
mvp younger louder with valsalva softer with squatting
holo mr axilla
holo vsd
machine pda
split fixed asd
os rumbling ms afib
blowing dia ar