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Emma Holliday Ramahi - Internal Medicine

Terms in this set (556)

Risks for PE?
after surgery
long car ride
hyper coagulable state (cancer, nephrotic)
STEMI on ECG? (2)
when does T wave invert?
what lasts forever?
2mm ST elevation
- ST elevation immediately
- then T wave inversion 6hrs-yrs
- Q waves last forever
new LBBB (wide, flat QRS)
Localized infarcts on ECG? what leads and what artery?
[Anterior, Lateral, Inferior, RV]
Anterior: LAD - V1-4
Lateral: Circumflex - I, aVL, V4-6
Inferior: RCA - II, III, aVF
RV: RCA - V4 on R side ECG!
Emergency reperfusion options (2)?
Contraindications (2)?
*Cath lab*
*Thrombolytics* w/ in 6hrs
Contra: bleeding, hx hemorrhagic stroke, recent closed head trauma
RV infarct BP, pulse, Sx (2) no what? Tx?
Low BP, tachycardia
clear lungs, JVD
No pulsus paradoxus

Txt: vigorous fluid resuscitation, increase preload. DON'T give nitro, will worsen sx
STEMI work up after EKG? then what?
cardiac enzyme
Normal ECG, elevated cardiac enzymes. Dx? Workup?
NSTEMI
Check enzymes q8h x 3 to look for trend
3 Cardiac enzymes? (3)
*Myoglobin*
Rises 1st, peak 2h, nml by 24h (detect NEW infarct)
*CK-MB*
Rise 4-8, peak 24h , nml by 72h
*Troponin I*
Rise 3-5h, peak 24-48h, nml by 7-10d
NSTEMI acute txt (8)? Immediate workup?
*M*orphine
*O*2
*N*itrates
*A*SA/clopidogrel
Coronary angiography w/in 48h
For STEMI & NSTEMI
1st tx option; when to do a CABG? (6)
PCI w/ stenting
CABG if:
- L main dx
- 3 vessel dx
- 2 vessel dx in DM
- >70% occlusion
- pain despite txt
- post-MI angina
NSTEMI discharge Rx?
DC on:
*B*eta-blocker (Metoprolol, Labetalol)
*A*CEI if CHF or LV dysfxn
*S*tatin
*H*eparin (while in hospital)
+Nitrates
CP w/out ST elevation & normal cardiac enzyme (how many repeats)?
normal cardiac enzyme x 3
if both negative, then unstable angina
Unstable angina workup (4)? what if the result is positive?
1. Exercise EKG
2. if EKG not possible, exercise echo
3. if pt cannot exercise, do chemical stress test (Adenosine/Dobutamine; Thallium-Dipyridamole)
4. multiple gated acquisition scan MUGA is nuclear medicine test that shows perfusion of the heart
If +, coronary angiography
What to avoid b/f exercise EKG (2)?
beta-blocker, CCB
Exercise ECG
Contraindications to exercise stress test (3)
- old LBBB
- baseline STE
- on Digoxin
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