HIGH YIELDS INTERNAL MEDICINE
SHELF EXAM REVIEW
EMMA HOLLIDAY RAMAHI
LATEST 2022
2mm ST elevation STEMI on ECG?
- STE immediately
- T wave inversion 6hrs-yrs
- Q waves last forever
new LBBB (wide, flat QRS)
Anterior: LAD - V1-4 Localized infarcts on ECG?
Lateral: Circumflex - I, aVL, V4- [Anterior, Lateral, Inferior,
6 RV]
Inferior: RCA - II, III, aVF
RV: RCA - V4 on R side ECG!
Cath lab Emergency reperfusion options? Contraindications?
...
Thrombolytics w/in 6hrs
Contra: bleeding, hx
hemorrhagic stroke, recent
closed head trauma
Sx: HoTN, tachycardia, clear RV infarct Sx? Tx?
lungs, JVD, and NO pulsus
paradoxus.
Txt: vigorous fluid resuscitation,
increase preload. DON'T give
Internal Medicine - Emma Holliday Ramahi
nitro, will worsen sx
, ECG CP workup?
Cardiac enzymes
NSTEMI Normal ECG, elevated cardiac enzymes. Dx?
Check enzymes q8h x 3 to look Workup?
for trend
Myoglobin Cardiac enzymes? (3)
Rises 1st, peak 2h, nml by 24h
(detect NEW infarct)
CKMB
Rise 4-8, peak 24h , nml by 72h
Troponin I
Rise 3-5h, peak 24-48h, nml by
7-10d
Morphine NSTEMI acute txt? Immediate workup?
O2
Nitrates
ASA/clopidogrel
Beta-blocker
Coronary angiography w/in
48h
,PCI w/ stenting CABG NSTEMI interventions and discharge Rx?
if:
- L main dx
- 3 vessel dx
- 2 vessel dx in DM
- >70% occlusion
- pain despite txt
- post-MI angina
DC on:
Beta-blocker (Metoprolol,
Labetalol)
ACEI if CHF or LV dysfxn
Statin
Heparin (while in hospital)
+Nitrates
Exercise ECG Unstable angina workup? What meds do you dc?
- dc Beta-blockers and CCB before
If + -> Coronary angio graphy
Contra: Contraindications to exercise stress test and
- old LBBB alternatives?
- bilat STE
- on Digoxin
Exercise ECHO
Chemical stress test w/
Dobutamine or Adenosine
MUGA
, Multi Gated Acquisition Scan MUGA
nuclear medicine test
shows perfusion areas of heart
DC caffeine or Theophyline
before
Arrhythmia s Post-MI complications:
(most Vfib) Most common cause of death?
Post-MI complications:
Papillary muscle rupture
New systolic murmur 5-7d s/p?
Post-MI complications:
Ventricular free wall rupture
Acute severe hypotension?
Post-MI complications:
Ventricular septal rupture
"step up" in [O2] from RA->R V?
Post-MI complications:
Ventricular wall aneurysm
Persistent STE ~1mo later + systolic MR murmur?
Post-MI complications:
AV-dissociation
"Cannon A-waves"?
Valve not opening properly ->
blood bounds back to neck
Either V-fib or 3rd degree
heart block
SHELF EXAM REVIEW
EMMA HOLLIDAY RAMAHI
LATEST 2022
2mm ST elevation STEMI on ECG?
- STE immediately
- T wave inversion 6hrs-yrs
- Q waves last forever
new LBBB (wide, flat QRS)
Anterior: LAD - V1-4 Localized infarcts on ECG?
Lateral: Circumflex - I, aVL, V4- [Anterior, Lateral, Inferior,
6 RV]
Inferior: RCA - II, III, aVF
RV: RCA - V4 on R side ECG!
Cath lab Emergency reperfusion options? Contraindications?
...
Thrombolytics w/in 6hrs
Contra: bleeding, hx
hemorrhagic stroke, recent
closed head trauma
Sx: HoTN, tachycardia, clear RV infarct Sx? Tx?
lungs, JVD, and NO pulsus
paradoxus.
Txt: vigorous fluid resuscitation,
increase preload. DON'T give
Internal Medicine - Emma Holliday Ramahi
nitro, will worsen sx
, ECG CP workup?
Cardiac enzymes
NSTEMI Normal ECG, elevated cardiac enzymes. Dx?
Check enzymes q8h x 3 to look Workup?
for trend
Myoglobin Cardiac enzymes? (3)
Rises 1st, peak 2h, nml by 24h
(detect NEW infarct)
CKMB
Rise 4-8, peak 24h , nml by 72h
Troponin I
Rise 3-5h, peak 24-48h, nml by
7-10d
Morphine NSTEMI acute txt? Immediate workup?
O2
Nitrates
ASA/clopidogrel
Beta-blocker
Coronary angiography w/in
48h
,PCI w/ stenting CABG NSTEMI interventions and discharge Rx?
if:
- L main dx
- 3 vessel dx
- 2 vessel dx in DM
- >70% occlusion
- pain despite txt
- post-MI angina
DC on:
Beta-blocker (Metoprolol,
Labetalol)
ACEI if CHF or LV dysfxn
Statin
Heparin (while in hospital)
+Nitrates
Exercise ECG Unstable angina workup? What meds do you dc?
- dc Beta-blockers and CCB before
If + -> Coronary angio graphy
Contra: Contraindications to exercise stress test and
- old LBBB alternatives?
- bilat STE
- on Digoxin
Exercise ECHO
Chemical stress test w/
Dobutamine or Adenosine
MUGA
, Multi Gated Acquisition Scan MUGA
nuclear medicine test
shows perfusion areas of heart
DC caffeine or Theophyline
before
Arrhythmia s Post-MI complications:
(most Vfib) Most common cause of death?
Post-MI complications:
Papillary muscle rupture
New systolic murmur 5-7d s/p?
Post-MI complications:
Ventricular free wall rupture
Acute severe hypotension?
Post-MI complications:
Ventricular septal rupture
"step up" in [O2] from RA->R V?
Post-MI complications:
Ventricular wall aneurysm
Persistent STE ~1mo later + systolic MR murmur?
Post-MI complications:
AV-dissociation
"Cannon A-waves"?
Valve not opening properly ->
blood bounds back to neck
Either V-fib or 3rd degree
heart block
