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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 17th, 2014
Topics • EKG’s and arrhythmias/conduction abnormalities • Myocardial Disease and Cardiomyopathies • Pulmonary artery catheters and hemodynamic data interpretation • Syncope • Valvular heart disease
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
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”
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
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
Atrial Fibrillation with Heart Block and Junctional Escape
LVH with Repolarization Abnormalities or Hypertrophic Cardiomyopathy
Tamponade (low voltage with electrical alternans)