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Internal Medicine Board Review – Cardiology II July 17 th , 2014

Internal Medicine Board Review – Cardiology II July 17 th , 2014. Topics. EKG’s and arrhythmias/conduction abnormalities Myocardial Disease and Cardiomyopathies Pulmonary artery catheters and hemodynamic data interpretation Syncope Valvular heart disease. HOLD ON!!!.

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Internal Medicine Board Review – Cardiology II July 17 th , 2014

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  1. Internal Medicine Board Review – Cardiology II July 17th, 2014

  2. Topics • EKG’s and arrhythmias/conduction abnormalities • Myocardial Disease and Cardiomyopathies • Pulmonary artery catheters and hemodynamic data interpretation • Syncope • Valvular heart disease

  3. HOLD ON!!!

  4. Approach to EKG’s • Always read the question stem first to know what you are looking for • Think about the clinical context; may not even need the tracing • Look for patterns that fit the clinical situation • Dissect the EKG in your usual systematic way

  5. EKG interpretation • Use your system, whatever it is • ie. Mechanism, Structure, Function • If the question includes multiple tracings, it is usually looking for a pattern; beware that two are likely very similar. ie. Mitral stenosis • Don’t forget you can use paper/pencil as “poor man’s calipers”

  6. EKG interpretation • May include 12 lead, 6 lead, 3 lead or rhythm strips • Pay attention to which leads you are given (and the order/arrangement) • Look for standardization if voltage is relevant (ie. LVH, tamponade) • Count big blocks for heart rate (300, 150, 100, 75, 60…) • Remember, each small block is 0.04 seconds

  7. Frequently Seen Tracings On Boards • Conduction Abnormalities • AV block, LBBB, RBBB • Bradyarrhythmias • Sinus brady, A-fib with junctional escape • Atrial Tachyarrhythmias • Sinus tach, A-fib, A-flutter, AVNRT, MAT • Ventricular Arrhythmias • VT, AIVR, torsades • Acute Infarction (Identify the vascular distribution) • Pericarditis • Tamponade • WPW (ventricular pre-excitation) • Long QT syndrome • Electrolyte Disturbances • Hyperkalemia, hypo/hypercalcemia

  8. Normal

  9. 1st degree AV block

  10. 2nd degree - Mobitz I(Wenckebach)

  11. 2nd degree (Mobitz II) AV Block

  12. 2:1 AV Block

  13. 3rd degree AV block

  14. Left Bundle Branch Block

  15. Right Bundle Branch Block

  16. Sinus Bradycardia

  17. Sick Sinus Syndrome

  18. Atrial Fibrillation with Heart Block and Junctional Escape

  19. Premature Atrial Contractions

  20. Premature Ventricular Contractions

  21. Sinus Tachycardia

  22. Atrial Fibrillation

  23. Atrial Flutter (2:1 conduction)

  24. Atrial Flutter (4:1 conduction)

  25. Multifocal Atrial Tachycardia

  26. AV Node Reentrant Tachycardia

  27. Ventricular Tachycardia

  28. Frequent PVC’s and Nonsustained Ventricular Tachycardia

  29. Ventricular Tachycardia

  30. Torsades de Pointes

  31. Torsades de Pointes

  32. AIVR (Accelerated Idioventricular Rhythm)

  33. AIVR (Accelerated Idioventricular Rhythm)

  34. LVH with Repolarization Abnormalities or Hypertrophic Cardiomyopathy

  35. Tamponade (low voltage with electrical alternans)

  36. Low voltage (amyloid)

  37. Anterior Acute Infarction (LAD)

  38. Inferior Acute Infarction (RCA)

  39. Posterolateral Acute Infarction (Circumflex)

  40. Pericarditis

  41. Ventricular Pre-excitation (WPW)

  42. Atrial Fibrillation with WPW

  43. Long QT syndrome

  44. Brugada Syndrome

  45. S1Q3T3 (Pulm embolus)

  46. Ventricular Pacemaker

  47. Pacemaker Failure to Capture

  48. Hyperkalemia

  49. Hyperkalemia

  50. Hypo/hypercalcemia

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