High Yield IM CARDIOVASCULAR Review for Step 2 CK & Shelf Exam

Summary

This script offers an in-depth look at diagnosing and treating cardiovascular diseases, focusing on stable and unstable angina, stress tests, and pharmacological interventions. It covers various diagnostic methods like EKG, echo, and nuclear perfusion studies, and treatments including nitrates, aspirin, and beta blockers. The script also addresses acute coronary syndrome, differentiating unstable angina from STEMI, and outlines treatments for each. Additionally, it touches on Dressler syndrome, restrictive cardiomyopathy, and the management of hypertensive emergencies and peripheral vascular disease.

Takeaways

• 🏥 Stable angina is characterized by chest pain during exertion that improves with rest, and is assessed with stress tests like EKG, echo, or nuclear perfusion study.
• 💓 A positive stress test indicates ST depression, hypotension, pain, abnormal wall motion, or decreased nuclear isotope uptake.
• 🚑 Pharmacologic stress tests are used for those unable to exercise, utilizing drugs like adenosine to induce cardiac stress.
• 🩺 Angiography is the definitive diagnostic method for coronary artery disease but is invasive, hence stress tests are conducted first.
• 💊 First-line treatments for stable angina include nitrates, aspirin, and beta blockers, while unstable angina is treated with a broader regimen including morphine and heparin.
• 🆘 Acute coronary syndrome encompasses unstable angina, NSTEMI, and STEMI, and is initially assessed with EKG and cardiac enzymes.
• 🩹 In STEMI, cardiac enzymes aren't necessary for diagnosis if there's ST elevation or new left bundle branch block with chest pain.
• 🩩 Unstable angina is differentiated from stable by rest pain and worsening symptoms, without troponin elevations.
• 🌡️ Stress tests are indicated for chest pain assessment, with exercise tests preferred unless contraindicated by abnormal EKG or physical limitations.
• 🛑 Cardiac tamponade presents with Beck's triad (hypotension, JVD, muffled heart sounds) and is treated by draining the pericardial fluid.
• 🩸 Peripheral artery disease is diagnosed with ankle-brachial index, with treatment ranging from exercise to interventional procedures based on severity.

Q & A

What is stable angina and how is it typically managed?

Stable angina is a condition where substernal chest pain occurs with exercise or exertion and is relieved by rest. It is managed by stress tests such as EKG, echo, or nuclear perfusion study, and pharmacological stress tests if the patient is unable to exercise.

What are the three types of stress tests mentioned in the script?

The three types of stress tests mentioned are EKG stress test, echo stress test, and nuclear perfusion study.

How is a positive stress test indicated in the script?

A positive stress test is indicated by ST depression, hypotension, pain, abnormal wall motion in an echo, or decreased uptake of nuclear isotope in a nuclear perfusion study.

What is the first-line treatment for stable angina according to the script?

The first-line treatment for stable angina is nitrates, aspirin, and beta blockers.

What is the difference between stable and unstable angina as described in the script?

Stable angina occurs with exertion and is relieved by rest, while unstable angina is worsening, evolving, or occurs at rest without troponin elevations. Unstable angina with troponin elevations is considered NSTEMI.

What are the three types of acute coronary syndrome mentioned in the script?

The three types of acute coronary syndrome mentioned are unstable angina, STEMI, and NSTEMI.

How is STEMI diagnosed in the script?

STEMI is diagnosed with one millimeter ST elevations in two continuous leads or a new left bundle branch block with chest pain on an EKG.

What is the treatment for Dressler syndrome as per the script?

Dressler syndrome is treated with aspirin, which is an NSAID used specifically for this autoimmune pericarditis that occurs after an MI.

What are the conditions associated with restrictive cardiomyopathy according to the script?

The conditions associated with restrictive cardiomyopathy are hemochromatosis, amyloidosis, and sarcoidosis, which cause deposits in the myocardium leading to diastolic heart failure.

What is the first-line treatment for hypertensive emergency as mentioned in the script?

The first-line treatments for hypertensive emergency are IV hydralazine, nitroprusside, or labetalol, with the necessity of end organ damage for it to be considered an emergency.

How is aortic dissection differentiated into Type A and Type B in the script?

Aortic dissection is differentiated into Type A, which is anything proximal to the left subclavian, and Type B, which is distal to the left subclavian. Type A requires immediate surgery, while Type B is treated with beta blockers.