Florida International University BSC MISC IM EOR Study Guide

Internal Medicine EOR Review Cardiology (20%) Angina Pectoris Stable Unstable Prinzmetal Predictable pattern* Aggravated c exertion; alleviated c rest or NTG; Caused by FIXED* plaque EKG: STd ONLY* Outpatient Setting Unpredictable pattern* New onset while RESTING*; NOT alleviated c rest EKG: STd or TWi* MUST ADMIT* Unpredictable/EPISODIC pattern* Triggered by COCAINE*, alcohol or triptans* EKG: STe +/- reciprocal changes MUST ADMIT* S/Sx & PE SUBSTERNAL CP usually brought on by EXERTION (due to low supply & high demand) WITHOUT necrosis*. Described as “pressure/burning/tightness”, usually NOT SHARP or altered by breathing or positioning. POORLY* localized; radiation to ARM*, LOWER JAW*, back, epigastrium, shoulders. By definition lasts < 30 minutes but usually only lasts 1-5 minutes; (+) Levine’s Sign (clenched fist on chest) Associated sx: SOB/DOE, DIAPHORESIS*, cool/clammy skin; ATYPICAL* presenters: Female, Diabetics, Elderly Dx F/L: EKG* - STd classic* (especially horizontal/downsloping STds) ● Resting EKG is normal in half of pts (therefore not definitive) ● May also have TWi, nonspecific ST changes, poor RWP & pseudonormalization of T waves* ● WILL NOT HAVE PATHOLOGIC Qs or STe* S/L: Stress Testing - Most useful NONinvasive SCREENING tool* ● Stress EKG ○ (+) if STd, hypo/hypertension, arrhythmias or cardiac sx develop ● Myocardial Perfusion Imaging Stress c Thallium-201 or 99m-technetium sestamibi ○ Used when baseline EKG has abnormalities* ○ Exercise if able to tolerate exercise (C/I in asthmatics) ○ Pharmacologic: Dobutamine, Adenosine or Dipyridamole if unable to exercise (C/I in asthmatics) ● Stress Echocardiogram or cardiac MRI can also be used for further evaluation (esp. Valvular etiologies) Gold Standard: Coronary Angiography* Cardiac Enzymes (CEs): ALL NEGATIVE* Pharmacologic Definitive (Revascularization) > NTG (Vasodilator) ● Decreases preload & afterload; SL route most effective* ● Used in acute setting; max dose 0.4mg x3 SL (Total of 1.2mg) ● S/E: HA (MC*), flushing, hypotension (keep out of light) ● C/I: SBP < 90mmHg; RVMI; use of PDE-5 inhibitors (Sildenafil aka Viagra, Cialis, etc.) > Beta blockers ● Increase diastolic timing by prolong