Category: Cardiology

NBME Shelf Review Part 6


Complications of MI

When patient’s come in with MI or shortly after having an MI, you need to think beyond “Is this another heart attack?”. There is a whole list of complications from heart attacks that you need to remember, and that is what we’re covering this week.


EM physicians are the masters of EKG interpretation. We will cover an organized EKG interpretation system today with an emphasis on identifying life threats, and this will act as the foundation for your EKG interpretation skills for the rest of your career.


The approach to bradycardia is very simple and straightforward. The most important thing is to remember you differential diagnosis. After that, it’s a simple algorithm that you’ll never forget.


EM doctors specifically look for two things every time they see an EKG. Ischemic changes (STEMI, ST depressions, inverted T waves), and dysrhythmias (bradycardia and tachycardias). In this episode, we cover the 5 categories of tachycardias and a basic approach to each one.

Low Risk Chest Pain

Not all patients with chest pain are having a STEMI, or massive PE, or aortic dissection. In fact, most patients with chest pain will have a set of normal labs, feel better, and we then have to decide what to do next. Admit or Discharge? What if we send this low risk patient, complaining of chest pain, home? What if they get home and die of a massive MI, and you had seen them the day before for chest pain? That’s why this is a huge topic that your attendings will want you to understand. In this episode we will talk low risk chest pain, and specifically, the HEART score.


The key to understanding syncope is understanding who is at high risk and who can go home. Over the years, numerous different studies have been done looking at this topic. The easy way to remember the approach to syncope is 6-6-6. There are 6 high risk EKG findings. 6 important risk factors, and 6 deadly syncope mimics (aka the “Rule of 15s”). Patients with these are at high risk for sudden death and typically need to be admitted, even if they sound like a “simple” case of “orthostatic” syncope.

STEMI (Critical Diagnosis)

We get hundreds of EKGs every day looking for ST elevation myocardial infarction. And when you finally see it, you have to know what to do. In 2013, the American Heart Association updated their STEMI management guidelines, and that is what we are learning about today. Make sure you understand the material in this episode, because you will only have 90 minutes to run through the algorithm when this EKG gets handed to you during your clerkship.

Chest Pain

Today I would like to teach you about the biggest, awesomest, most stereotypical chief complaint that there is in all of Emergency Medicine: chest pain. This is a huge topic on your shelf exam, and you really need to have an in-depth understanding of it to do well on your clerkship. HOWEVER, you have to start with the basic approach, and that is what this episode covers.


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