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

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