Master the board step 3

Cardiology
Diagnosis Diagnostic Test Treatment
Cardiogenic shock
Echo, Swan-Ganz (right heart)
catheter
ACEI, urgent revascularization
Valve rupture Echo ACEI, nitroprusside, intra-aortic
balloon pump as a bridge to
surgery
Septal rupture
Echo, right heart catheter showing
a step up in saturation from the
right atrium to right ventricle
ACEI, nitroprusside, and urgent
surgery
Myocardial wall rupture Echo Pericardiocentesis, urgent cardiac
repair
Sinus bradycardia EKG Atropine, followed by pacemaker if
there are still symptoms
Third-degree (complete) heart block EKG, canon “a” waves Atropine and a pacemaker even if
symptoms resolve
Right ventricular infarction EKG showing right ventricular leads Fluid loading
Basic Science Correlate
Mechanism of Septal Rupture Systolic Murmur
Left ventricular pressure is greater than right ventricular pressure. This causes
left-to-right shunt of oxygenated blood. Oxygen saturation in the right
ventricle is markedly increased compared with the right atrium.
Post-MI Discharge Instructions
All patients post-MI should go home on aspirin, clopidogrel (or prasugrel),
a beta blocker, a statin, and an ACE inhibitor.
A patient’s wife comes to take her husband home after an MI and asks how long
they should wait before they have sex. What do you tell her?
a. No waiting necessary
b. 2–6 weeks
c. After echocardiography
d. They should wait for a normal angiography.
Answer: B. Some waiting is necessary to have sex after an infarction. Sex minimally
increases the risk of infarction. The duration and the intensity of exertion are sufficient
to provoke ischemia in some cases.
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