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Cardiology ITE/Board Review Part 1
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Cardiology ITE/Board Review Part 1

A Case of Chest Pain

A 70-year-old male with a history of hypertension, diabetes mellitus, and TIA presents with intermittent, sharp left-sided chest pain occurring at rest and during exertion for the past day. Vital signs are within normal limits.

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Source ECG 856
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Q1: Troponin negative. Pain-free. What is the next best step?
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Q2: What are the components of the Heart score?
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Q3: What are risk factors for ACS as defined by the Heart score?

While in observation, a repeat ECG is performed.

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Source ECG 646
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Q4: A repeat troponin is 0. What is the best next step?
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Q5: What are the ECG and clinical features of Wellens Syndrome?
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Q6: What is the difference between Type A and Type B Wellens pattern?
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Q6: What coronary lesion does Wellens Syndrome signify?

Cath is scheduled next day….but chest pain recurs and you record another ECG

9-1 The ECG in the Acute MI
9-1 The ECG in the Acute MI
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Q7: The third troponin is 0. What is the best next step?

While waiting for cath, the chest pain continues and the ECG now looks like this:

Fig 3-1 The ECG in the Acute MI
Fig 3-1 The ECG in the Acute MI
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Q8: What type of MI is this?
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Q9: Which ECG leads correlate to anterior, septal, inferior, right and posterior MI?
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Q10: What are the classic STEMI Criteria?
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Q11: Which of the following treatments has a proven mortality benefit in AMI?
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Q12: The cath lab is down. What are the indications for fibrinolytics?
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Q13: What are the absolute contraindications for fibrinolytics in acute MI?

The patient receives fibrinolytic and his chest pain resolves. He feels great but his monitor alarms go off and you get another ECG….

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ECG 612
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Q14: What is the next best step?

5 days laters, the patient develops chest pain and sob. You get another ECG.

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ECG 82
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Q15: What test should be performed next?
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Q16: What is the diagnosis / post MI complication?

2 weeks after discharge, the patient returns to the hospital with chest pain once again.

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ECG 766
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Q17: Which of the following physical exam findings may have been identified by your med student but missed by you and the attending on their initial eval?
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Q18: What is the diagnosis / post MI complication?

Patient returns to the ER 3 months after discharge now with left sided weakness for 2 days. Denies any chest pain.

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ECG 149
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Q19: Which of the following can explain both symptoms and ECG?

What type of MI does the following ECG show?

Fig 13-1 The ECG in the Acute MI
Fig 13-1 The ECG in the Acute MI
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Q20: What type of MI?
Fig 13-2 The ECG in the Acute MI
Fig 13-2 The ECG in the Acute MI
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Q21: What type of MI?
Fig 16-7 The ECG in the Acute MI
Fig 16-7 The ECG in the Acute MI
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Q22: What type of MI?
Fig 12-2 The ECG in the Acute MI
Fig 12-2 The ECG in the Acute MI
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Q23: What type of MI?

A second case of chest pain

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Q24: A patient presents with chest pain. Their blood pressure in triage is 65/45...which of the following is most appropriate initial treatment?
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Q25: What is the rhythm? What is the treatment?
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Q26: Patient is awaiting catheterization. You’ve given 4L of IVF and are transcutaneously pacing the patient. HR is now 70s, blood pressure remains 70s systolic. Cap refill 3.5s. What’s the next step?
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Q27: After cath, the patient develops sudden shortness of breath. Crackles & a harsh blowing holosystolic murmur can be heard exam. What is the etiology / diagnosis?

Heart Murmur Review

Q28: Are the following valve disorders associated with systolic or diastolic murmurs?

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Answer

Q29: Identify the valve disorder by murmur.

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Answer

Q30: Identify the valve disorder by buzz word.

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Answer

This post is for education and not medical advice.

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