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310 Cards in this Set
- Front
- Back
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What are the big three questions you should ask about the heart during every review of systems?
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Have you had chest pain, SOB, or syncope?
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Severe constricting pain in the chest, often radiating from the precordium to the shoulder and down the arm due to ischemia of the heart muscle usually caused by coronary disease
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Angina Pectoris
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Episodic nighttime SOB requiring person to get out of bed for relief.
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Paroxysmal Nocturnal Dyspnea
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Discomfort in breathing aggravated by laying flat.
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Orthopnea
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What question(s) would you ask to assess if patient has orthopnea?
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How many pillows a patient sleeps on and if that number has changed recently.
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What murmurs are best heard using the diaphragm?
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Aortic Stenosis, Aortic regurgitation, mitral regurgitation.
Also pericardial rubs and ventricular septal defects |
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What murmurs are best heard with the bell?
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Mitral Stenosis, Tricuspid Stenosis, and AR.
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Which heart sounds are heard best with the bell?
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S3 & S4
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AV node is supplied by which artery?
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Mainly RCA
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What are the 4 known causative factors of congenital heart disease?
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1) rubella in 1st trimester
2) uncontrolled maternal diabetes 3) drugs (accutane, ETOH, Lithium) 4) heredity |
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What are the 4 T's of blue baby?
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Tetralogy > transposition > truncus arteriosis > tricuspid atresia
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What are the 4 characteristic features of Tetralogy of Fallot?
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Pulmonary stenosis, VSD, RVH, over riding aorta
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On X-ray a cyanotic small baby with clubbing has a boot shaped heart. What is the likely diagnosis?
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Tetralogy of Fallot
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In a patient with transposition of the great vessels, what is used to keep the PDA open?
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prostaglandins
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What EKG changes are you likely to see in an infant with transposition of the great vessels?
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RVH
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A cyanotic baby with no heart murmurs and a loud single S2 may have been born with what congenital abnormality?
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transposition of the great vessels
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A cyanotic infant with bounding pulses and a large heart on x-ray may have been born with what congenital abnormality?
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truncus arteriosis
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Cyanotic infant, that hasn't been feeding well, presents with shortness of breath and a holosystolic VSD murmur. EKG reveals left axis deviation and LVH. x-ray = normal
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tricuspid atresia
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Hypertensive infant with radial femoral delay and rib notching
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coarctation
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Systole starts at____?
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S1
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Which valve closes first aortic or pulmonic?
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Aortic valve closes slightly before the pulmonic valve.
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The SA node is located where?
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In the wall of the right atrium
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The AV node is located where?
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In the atrial septum.
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Where is the cardiac impulse delayed?
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AV node
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Where is ventricular contraction initiated?
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At the apex and proceeds toward the base of the heart.
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On the EKG what wave signifies the spread of the stimulus through the atria?
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P-wave
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The time from the initial stimulation of the atria to initial stimulation of the ventricles is usually how long? What part of the EKG is it?
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.12-.2 PR interval
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How long should the QRS complex be?
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.10 seconds
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How does fetal circulation leaving the right ventricle differ from that of a child?
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The right ventricle pumps blood through the patent ductus arteriosus rather than into the lungs.
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PDA typically closes how long after birth?
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24 - 48 hrs
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When is the adult heart position reached in a child?
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age 7
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In infants and young children the heart lies more ____ than in the adult.
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horizontally
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When do the relative sizes of the left and right ventricles approximate the adult ratio of 2:1?
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by 1 year of age.
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During pregnancy a woman's blood volume increases ____ % over the pre-pregnancy level.
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40-50%
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How long does it take for blood volume to return to pre-pregnancy levels post partum?
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3-4 weeks
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What are the 5 major manifestations of Rheumatic Fever?
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Chorea, carditis, polyarthritis, erythema marginatum, subcutaneous nodules
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When does cardiac output in a pregnant woman reach its highest level?
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From weeks 25-32
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Cardiac output returns to pre-pregnancy levels about _____ weeks post partum?
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2 weeks
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Unless there is enlargement associated with hypertension or heart disease, heart size is likely to ____ with age
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decrease
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Why is myocardial contractility delayed in older adults?
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myocardium becomes less elastic and more rigid.
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Common EKG changes in the older adult?
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1st degree av block, bundle branch blocks, st-t wave abnormaities, premature systole, left anterior hemiblock, LVH and a-fib
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Substernal; provoked by effort emotion, eating; relieved by rest and/or nitroglycerin; often accompanied by diaphoresis, occasionally by nausea
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Angina
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Precipitated by breathing or coughing; usually described as sharp; present during respiration; absent when breath held
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Pleural
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Burning, substernal, occasional radiation to the shoulder; nocturnal occurrence, usually when lying flat; relief with food, antacids, sometimes nitroglycerin
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Esophageal
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Infradiaphragmatic and epigastric; nocturnal occurence and daytime attacks relieved by food; unrelated to activity
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From a peptic ulcer
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Usually under right scapula, prolonged in duration; often occurring after eating; will trigger angina more often than mimic it
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Biliary
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Usually lasts for hours; local tenderness and/or pain with movement
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Arthritis/bursitis
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Associated with injury; provoked by activity, persists after activity; painful on palpation and/or movement
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Cervical
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Intensified or provoked by movement, particularly twisting or costochondral bending; long lasting; often associated with focal tenderness
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Musculoskeletal chest pain
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associated with/after anxiety; poorly described; located in intramammary region
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Psychoneurotic
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How do you calculate pack years?
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number of years smoking x number of packs smoked per day
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In most adults the apical impulse should be visible where?
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MCL in the fifth intercostal space
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Absence of an apical impulse in addition to faint heart sounds when the patient is left lateral recumbent suggests?
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pleural or pericardial fluid
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How wide is the PMI usually?
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not more than 1 cm
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An apical impulse that is forceful, widely distributed, fills systole, or is displaced laterally and downward may indicate?
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Increased cardiac output or LVH.
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A lift along the left sternal border may be caused by ?
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RVH
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Displacement of PMI to the right without a loss or gain of thrust suggest what abnormalities? (hint:4 of them)
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dextrocardia, diaphragmatic hernia, distended stomach, or pulmonary abnormality.
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A fine palpable rushing vibration is referred to as a ____
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thrill
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A thrill indicates what?
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disruption of expected blood flow related to some defect in the closure of a semilunar valve, pulmonary hypertension, or ASD.
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Where is the carotid pulse located?
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just medial to and below the angle of the jaw
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The carotid pulse is practically synchronous with which heart sound?
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S1
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Systolic thrill palpated at the suprasternal notch and/or second & third right intercostal spaces
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Aortic stenosis
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Systolic thrill palpated at the suprasternal notch and/or second & third left intercostal spaces
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Pulmonic stenosis
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Systolic thrill palpated in the fourth left intercostal space
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VSD
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Systolic thrill palpated at the apex
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Mitral regurgitation
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Systolic thrill palpated at the left lower sternal border: in a newborn baby.
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Tetrology of Fallot
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Systolic thrill felt in the left upper sternal border, with radiation
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PDA
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Diastolic thrill felt at the right sternal border
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Aortic regurgitation or aneurysm of ascending aorta
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Diastolic thrill felt at the apex
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Mitral stenosis
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What method is the most useful for defining the heart borders?
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x-ray
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Best position to hear the low-pitched filling sounds in diastole with the stethoscope bell?
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left lateral recumbent
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Best postion to hear relatively high-pitched murmurs with the stethoscope diaphragm?
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patient sitting up leaning slightly forward
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Aortic valve listening area
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2nd right intercostal space @ right sternal border
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Pulmonic valve listening area
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2nd left intercostal space at the left sternal border
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Tricuspid valve listening area
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4th left intercostal space along lower left sternal border
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Mitral valve listening area
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5th left intercostal space at MCL
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Second Pulmonic listening area
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3rd left intercostal space @ left sternal border
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What marks the beginning of systole?
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S1
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What marks the beginning of diastole?
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S2
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To better appreciated splitting of S2 have the patient do what?
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hold breath in inhalation.
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Where is split S2 best appreciated?
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pulmonic auscultatory area
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S1 results from the closure of the __
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AV valves
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S1 is best heard where?
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At the apex
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A loud S1 may indicate what pathologies?
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Blood velocity is increased: anemia, fever, hyperthryoidism, anxiety and during exercise or a stenotic mitral valve
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What happens to S1 when fibrosis and calcification of a diseased mitral valve occurs?
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S1 intensity decreases
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An intense S2 occurs under what conditions?
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systemic hypertension, syphilis of aortic valve, exercise or excitement.
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P2 may be accentuated in what conditions?
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pulmonary hypertension, mitral stenosis, and congestive heart failure
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The intensity of S2 decreases in what conditions?
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shock, immobile valves, AS, PS, overlying tissue fat or fluid.
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During inspiration P2 occurs slightly ____ than A2
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later
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Splitting of S2 is which of the following?
Abnormal? Expected? |
Expected
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What is S3?
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passive phase of early diastole when the ventricular walls distend causing vibration
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What is S4?
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the second phase of ventricular filling where vibration of valves, papillae and ventricular walls produce sound
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What is fixed splitting?
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splitting that is unaffected by respiration
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Under what conditions is fixed splitting appreciated?
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Large atrial septal defects, ventricular septal defect with left to right shunting, or right ventricular failure
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Paradoxic splitting occurs when the closure of which valve is delayed?
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aortic
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What causes paradoxic splitting?
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Left bundle branch block.
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What are causes of wide splitting?
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Right bundle branch block, pulmonary hypertension, mitral regurgitation (induces early closure of aortic valve)
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What condition causes splitting of both S1 and S2
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right bundle branch block
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To better appreciated S3 and S4 you may ask your patient to do what?
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1. ask patient to raise a leg increasing venous return
2. ask patient to grip your hand vigorously increasing arterial pressure. |
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When is S3 abnormally loud?
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If filling pressure is increased or ventricular compliance is low
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An opening snap is often heard with what valvular abnormality?
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mitral stenosis
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Pericardial friction rubs are best appreciated by auscultating what area?
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Apex
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Which part(s) of the cardiac cycle will a friction rub occupy?
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systole and diastole
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Placement of a prosthetic mitral valve may produce what abnormal heart sound?
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distinct click early in diastole loudest at the apex
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An infant with large firm liver, with inferior edge as much as 5cm below the right costal margin may have?
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right sided heart failure
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Infant with a purplish plethora may indicate what?
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polycythemia
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An ashy white color in an infant may indicate what?
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shock
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Acrocyanosis?
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cyanosis of hands and feet without central cyanosis. usually disappears within a few days
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What causes cyanosis at birth?
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Tetralogy of fallot, tricuspid atresia, severe septal defect, severe pulmonic stenosis,
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What causes cyanosis after the neonatal period?
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pure pulmonic stenosis, esienmenger complex, tetralogy of Fallot, large septal defects
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A pneumothorax shifts the apical impulse ____ the area of the pneumothorax
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away from
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A diaphragmatic hernia found on the left would shift the heart in what direction?
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to the right
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Pushing up on the liver will cause the murmur of a left to right shunt through a septal opening or PDA to ____
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disappear briefly
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Pushing up on the liver will cause the murmur of a right to left shunt to ____
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intensify
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This murmur is best heard with the bell at the apex with the patient in the left lateral decubitus postion
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mitral stenosis
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This murmur is best heard at the apex and along the left sternal border. The murmur fills systole, is diamond shaped medium pitched and coarse.
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subaortic stenosis
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A vigorous sustained lift during ventricular systole. Displacement of apical impulse lateral to MCL and downward
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LVH
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Causes a lift along the left sternal border in the 3rd & 4th intercostal spaces accompanied by occasional systolic retraction at the apex.
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RVH
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Dysrhythmias leading to fainting, transient dizzy spells, light-headedness, seizures, palpitations, and symptoms of angina or CHF
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sick sinus syndrome
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Patient with small erythematous or hemorrhagic macules appearing on palms and soles and Osler nodes
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Bacterial endocarditis.
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Narrowed pulse pressure associated with _____ heart failure
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systolic congestive heart failure
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Widened pulse pressure associated with _____ heart failure
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diastolic congestive heart failure
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Dyspnea, orthopnea, tachycardia, decreased pulse pressure, S3, abdominojugular reflux
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left-sided heart failure
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Triphasic friction rub that comprises ventricular systole, ealy diastolic ventricular filling, and late atrial systole. Best heard just left of sternum in 3rd & 4th interspaces.
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Pericarditis
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Muffled heart sounds, with a drop in blood pressure, a rapid weak pulse.
The paradoxic pulse becomes exaggerated |
Cardiac Tamponade secondary to pericarditis, aortic dissection or trauma
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Left parasternal systolic lift and a loud S2 exaggerated in the pulmonic region.
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Cor Pulmonale
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Deep substernal chest pain that radiates to the jaw. Present S4.
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MI
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Loud, coarse, high-pitched murmur best heard along left sternal border in 3rd to 5th interspaces. murmur does not radiate into neck.
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VSD
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Harsh, loud, continous murmur hear at the 1st to 3rd interspaces. Machine-like quality.
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PDA
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This creates a systolic ejection murmur that is diamond shaped, loud, high in pitch and harsh. It is heard best over the pulmonic area. Accompanied by brief, rumbling, early diastolic murmur. S2 is split fairly widely.
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ASD
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Normal duration of the P wave?
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.08 - .11 seconds
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Normal Axis of P wave?
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0 - 75 degrees
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If the P wave is greater than .12 seconds in limb leads I and II and notched it is known as?
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P-mitrale
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P-mitrale is associated with _______ atrial enlargement
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Left
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The width of the notch in a P wave must be at least ________ seconds to be considered P-mitrale
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.04
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The notching of the P wave in P-mitrale is due to slower conduction through the _______ ?
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left atrium
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If a premature atrial impulse causes the SA node to depolarize, there is a _______ pause and the interval is _____?
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non-compensatory pause and the interval is < 2X
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On the EKG you see an inverted P wave in leads II, III, and AVF. What does this tell you?
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The pacemaker is low atrial or AV nodal and there has been retrograde conduction in the atria
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What is the most common cause of P-mitrale?
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mitral valve disease
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P-pulmonale is a sign of _____?
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right atrial enlargement
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You see a P wave that is peaked and more than 2.5 mm high, in the limb leads. What is your diagnosis?
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P-pulmonale --> severe right atrial enlargement
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What are causes of right atrial enlargement?
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COPD, PE, pulmonary hypertension, pulmonic, tricuspid, or mitral valvular disease, secondary to left sided disease
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What are causes of left atrial enlargement?
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severe hypertension, aortic or mitral valve disease, cardiomyopathy.
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When the first half of the P wave in V1 is taller than the first half of the p in V6 you may have what?
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right atrial enlargement (per Heibel's notes)
intraatrial conduction delay (per our ekg book) Note that RAE may cause IACD. |
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When the second half of a biphasic P wave in V1 is wider and deeper than 1 small block you may have what?
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left atrial enlargement.
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Hypothermia may lead to what EKG changes?
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Osborn waves
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When the first half of a biphasic P wave is taller in V1 than the first half of the P wave in V6 what diagnosis is likely?
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Right atrial enlargement.
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When the second half of a biphasic P wave in V1 is wider and deeper than one small block what diagnosis is likely?
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Left atrial enlargement
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Normal duration of PR interval?
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.11 - .20 seconds
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What constitutes the PR interval?
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beginning of the P wave to the beginning of the QRS
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True or false, Purkinje stimulation is included in the PR interval
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True
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What are two things that may cause PR segment elevation?
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atrial infarction (also causes depression) and trauma
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What can cause a normal variant PR segment depression (less than .8 mm below baseline)?
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atrial repolarization
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Pericarditis may cause what EKG changes concerning the PR segment?
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PR segment depression
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What are the 4 EKG signs of Pericarditis?
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1. Tachycardia
2. PR depression 3. Diffuse ST segment elevation (concave up) 4. Notching of the terminal portion of the QRS. |
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Normal PR interval in seconds?
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.12 - .20
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Which PR interval should be measured?
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The interval measuring the beginning of the widest P wave to the beginning of the widest QRS wave.
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If all PR intervals are long on an individuals EKG what might your diagnosis be?
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metabolic problem e.g. hyperkalemia
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What are 3 causes of short PR intervals?
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1. Junctional P-waves
2. Premature atrial contractions 3. Some other means of atrial to ventricular connection exists (e.g. Lown-Ganong_Levine Syndrome or Wolff-Parkinson-White Syndrome) |
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What syndrome includes a benign bypass around the AV node? What is this bypass called?
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Lown Ganong Levine Syndrome
Bypass = James Fiber |
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What are the 5 criteria for defining Wolff-Parkinson-White Syndrome (WPW)?
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1. short PR interval
2. wide QRS 3. delta wave 4. ST-T wave changes 5. Association w/ paroxysmal tachycaridas |
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What is a Kent bundle, in which syndrome is this a feature?
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Kent bundle is a bypass from the atrium to the ventricular myocardium. It is a feature of WPW.
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What does the WPW delta wave represent?
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The initial ventricular myocardium depolarized by the impulse from the Kent bundle.
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If a patient has all the WPW findings except tachycardia this is referred to as what?
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WPW pattern
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What are some causes of First Degree block?
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drugs, increased calcium, hypothermia, inferior MI
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Which block features constant PR intervals until a beat is dropped suddenly?
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Mobitz II Block
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Which block features PR intervals that continually lengthen until a beat is dropped?
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Mobitz I Block, or Wenkebach
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What is a significant Q wave?
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if the Q wave is .03 sec or wider or if the height is equal to or greater than 1/3 of the R wave
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normal duration of the QRS wave?
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.06 - .11 seconds
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normal axis of QRS wave?
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-30 to 105
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Which leads usually constitute the QRS transition zone?
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V3 or V4
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What can cause lower voltages on an EKG?
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MI's, obesity, left pleural effusion, pericardial effusion
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As a pericardial effusion gets larger the QRS amplitude gets?
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smaller
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Limb leads less than 5 mm in voltage and Precordial leads less than 10 mm in voltage are associated with?
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pericardial effusions
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LVH maybe secondary to what two things?
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1. outflow obstruction
2. volume overload |
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What are the EKG criteria for LVH?
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1. Any precordial lead ≥ 45mm
2. S in V1 or V 2 added to R of V5 or V6 > 34mm 3. R wave in aVL is >10mm 4 R wave in lead I is > 11mm 5. R wave in aVF is > 19 mm |
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Which leads will you use to diagnose RVH?
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V1 and V2
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If the R:S ≥ 1 in leads V1 or V2 what may be a diagnosis if no RBBB exist?
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RVH, posterior wall MI and WPW type A.
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On EKG a patient has QRS complexes wider than .12 seconds until proven other wise you think this patient has?
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V-tach
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A patient asks you what you mean when you say she has an insignificant Q wave. Physiologically the Q wave represents?
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septal depolarization
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RBBB, WPW A, and Posterior wall MI may mimic which of the following?
A)RAE B)LAE C)LVH D)RVH |
RVH
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A patient has tachycardia of > 100 bpm with a wide QRS. What should be your first thought?
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V-tach
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What makes a significant Q wave?
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1. more than 1/3 total height of QRS
2. Wider than 0.03 seconds |
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Biphasic P wave with a deep second half in V1 is indicative of what pathology?
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Left atrial enlargement
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Lead one is Positive, lead AVF is negative: which quadrant would this axis fall into?
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Left of Normal
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If Lead I and Lead AVF are positive which quadrant does this axis fall into?
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normal
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If Lead I and Lead AVF are negative, which quadrant does this axis fall into?
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extreme right
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If lead I is negative and Lead AVF is positive, which quadrant does this axis fall into?
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right
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In reality the "normal" quadrant extends between what two values?
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-20 to + 100
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On an EKG you see QRS complex greater than .12 seconds and an RSR' pattern in V1. What pathology is likely?
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Right bundle branch block
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A slurred S wave in leads I and V6 may indicate what pathology?
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right bundle branch block
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In lead V1 you see a significant Q wave followed by an R wave. Leads I and V6 show slurred S waves. What pathology/pathologies are present?
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Anteroseptal MI with RBBB
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Can you make a diagnosis of LVH in a patient with RBBB based off of EKG findings?
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Yes you can! p 252 in Garcia-Holtz
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What are the criteria for Left Bundle Branch Block?
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1. QRS longer than .12 sec
2. broad, monomorphic R waves in I and V6 with no Q's 3. broad, monomorphic S in V1, small R wave possible |
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Notching of the R wave in lead V6 may indicate what pathology?
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LBBB
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How does ventricular depolarization occur in LBBB?
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Depolarization proceeds from right to left by direct cell to cell transmission
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Common causes of LBBB?
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Hypertension, CAD, Cardiomyopathy, Rheumatic, Infiltrative, Idiopathic
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With what concurrent pathology are RVH & LVH impossible to call on an EKG?
A)LAE B)RAE C)RBBB D)LBBB |
LBBB
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Until proven otherwise Dr. Heibel thinks IVCD is caused by?
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Kidney failure
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The QRS complex of LVH is typically _____ than .12 seconds
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less than
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A localized IVCD is usually has QRS complexes ____ than .12 seconds wide?
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less than
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A generalized IVCD is usually _____ than .12 seconds wide?
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greater than or equal to
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What electrolyte abnormality is common in patients that show IVCD on EKG's?
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hyperkalemia
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Which of the following is true of hemiblocks:
A) no p waves B) hemiblocks may occur on the right side of the heart C) hemiblocks only occur only on the left side of the heart D) Occurs only in children |
hemiblocks only occur on the left side of the heart
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What portions of the heart are innervated by the left anterior fascicle?
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anterolateral walls of left ventricle
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What portions of the heart are innervated by the left posterior fascicle?
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inferior and posterior walls of the left ventricle
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What are the criteria for diagnosing LAH?
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1. left axis deviation with the axis at -30 to - 90
2. either a qR complex or an R wave in lead I 3. an rS complex in lead III and probably also in II and aVF |
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On EKG lead aVF and II are negative. Lead I is positive. Which of the following is your most likely diagnosis?
A)RBBB B)LAH C)LBBB D)RVH |
LAH
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When diagnosing hemi blocks a negative in lead II is a huge clue for which diagnosis?
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LAH
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What are the criteria for LPH?
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1. Axis 100 - 180 (right)
2. S in I, q in III 3. Exclusion of RAE and RVH |
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In the presence of RAE and/or RVH what type of block can you not call using an EKG?
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LPH
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Most common cause of right axis deviation is____.
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RVH
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Most common cause of RAE is _____?
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RVH
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If you have right axis deviation you should ask yourself about what three pathologies?
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RVH, RAE and LPH
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S1Q3T3 refers to?
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S1 = S wave in lead I
Q3 = Q or q wave in III T3 = flipped T wave in III |
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The ekg you see rabbit ear pattern in V1 with wide QRS complex. You also see left axis deviation with rS waves in lead III what is your DX?
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RBBB + LAH
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What can cause a RBBB + LAH to become unstable?
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Acute MI
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Where is the J point located?
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end of the QRS and beginning of the ST segment
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ST segment depression and T waves in the opposite direction from what is normal are signs of _____?
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ischemia
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ST elevation, with or without T wave changes is a sign of _____?
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myocardial injury.
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On EKG you see ST depression and T wave in opposition to the QRS, what is your diagnosis?
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ischemia
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What physiological event does the ST segment signify?
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ventricles between depolarization and repolarization.
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Electrically the J-point should be:
A)positive B)negative C)neutral |
neutral
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Baseline is measured from _____ segment to ______ segment?
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TP segment to TP segment
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ST segment that is concave up could signify _____ or _____?
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early repolarization or pericarditis
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A ST segment that is concave down indicates ______?
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strain pattern
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A flat then depressed ST segment may indicate _____?
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subendocardial ischemia
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A flat elevated ST segment may indicate what pattern?
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injury
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A tombstone pattern ST segment indicates ______?
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infarction or ventricular aneurysm
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Why is the T wave the same direction as the QRS?
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Purkinje system is endocardial, so depolarization goes from endocardium to the epicardium. The epicardium repolarizes before the endocardium.
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A symmetrical T-wave is _____?
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abnormal
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If the first half of a biphasic T wave is negative it is considered _____
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pathological
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If the first half of a biphasic T wave is positive it is considered _____
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normal
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If the T wave is more than ______ the height of the R wave it is definitely abnormal.
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2/3
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Normal T wave height in limb leads is ___ in precordial leads is ____
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6mm in limb leads 12 mm in precordial leads
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Tall symmetrical T waves could be a sign of what electrolyte abnormality?
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hyperkalemia
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QT interval prolongation puts an individual at risk for developing ____?
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dysrhytmia
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QTC = ?
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QT + 1.75X (ventricular rate-60)
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During which electrolyte abnormality can you see a U wave?
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hypokalemia
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If you see a positive T wave and a negative U wave what is your diagnosis?
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ischemia till proven otherwise
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U waves are commonly seen during failure of what organ(s)?
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kidneys
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CNS, atheroscelrotic disease, and electrolyte imbalance cause _____ T waves on EKG
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symmetrical
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How does an infarct usually change the ST segment on EKG?
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ST elevation
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How does ischemia or subendocardial MI typically affect the ST segment on EKG?
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ST depression
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A flat or downsloping j-point indicates _____ rather than infarct
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ischemia
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Criteria for RVH?
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1. P-pulmonale (RAE)
2. Right axis deviation 3. Increased R:S ratio in V1 and V2 4. RVH strain pattern 5. S1Q3T3 pattern |
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An increased R:S ratio in V1 or V2 may indicate RVH and what 4 other things?
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1. RBBB
2. Posterior wall AMI 3. WPW type A 4. Young kids and adolescents |
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On an EKG strain pattern is usually the greatest in which lead?
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The lead with the tallest and deepest QRS pattern.
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RVH strain is characterized by concave downward ST portion in what lead?
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V1
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LVH strain we see a pattern of ST depression with downward concavity and flipped asymmetric T wave in what leads?
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V4 - V6
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ST elevation with upward concavity and an upright asymmetric T wave in V1 V2 or V3 may be associated with?
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LVH with strain
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A person has chest pain that worsens when she lies back and eases when sitting up. She may have _____?
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pericarditis
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EKG on a patient with chest pain worse while laying back shows: PR depression, diffuse ST elevation, upwardly concave ST segments, and notching at the end of the QRS
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pericarditis
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In BBBs the T wave is ______ to the QRS
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discordant!
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Very broad, symmetrical T waves are classic for:
A) MI B) Ischemia C) Hypokalemia D) Hyperkalemia E) CNS events |
CNS events
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ST segment depression is classically found in what 2 pathologies?
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ischemia and non-q-wave AMI
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True or false: strain pattern is the greatest in the lead with the tallest or deepest QRS complexes
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true
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On an EKG strain pattern is usually the greatest in which lead?
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The lead with the tallest and deepest QRS pattern.
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RVH strain is characterized by concave downward ST portion in what lead?
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V1
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LVH strain we see a pattern of ST depression with downward concavity and flipped asymmetric T wave in what leads?
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V4 - V6
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ST elevation with upward concavity and an upright asymmetric T wave in V1 V2 or V3 may be associated with?
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LVH with strain
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A person has chest pain that worsens when she lies back and eases when sitting up. She may have _____?
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pericarditis
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EKG on a patient with chest pain worse while laying back shows: PR depression, diffuse ST elevation, upwardly concave ST segments, and notching at the end of the QRS
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pericarditis
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In BBBs the T wave is ______ to the QRS
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discordant!
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Very broad, symmetrical T waves are classic for:
A) MI B) Ischemia C) Hypokalemia D) Hyperkalemia E) CNS events |
CNS events
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ST segment depression is classically found in what 2 pathologies?
|
ischemia and non-q-wave AMI
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True or false: strain pattern is the greatest in the lead with the tallest or deepest QRS complexes
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true
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True or False: ST segment elevation or depression that is ischemic in nature is usually flat and is associated with symmetrical T waves
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true
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During heart ischemia, the ST segment is _____ and the T wave is _____
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ST segment depressed and the T wave is inverted.
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Ischemia affects a wedge-shaped section of the heart with the wedge ____ in the epicardium and ______ along the endocardium
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wider in the epicardium and thinner along the endocardium
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What changes does myocardial Injury elicit on EKG?
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ST segment elevation and a flipped T wave
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Most common Non-Q MI?
|
subendocardial infarction
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Reciprocal leads (to that of the lead directly over the MI) should gain ____ wave height
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R wave
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Inferior portion of the heart may be perfused by ____ or ____?
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Right coronary artery or Left circumflex artery
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Portion of the heart supplied by the proximal RCA
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inferior-RV
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Inferoposterior part of the heart is supplied by ____ or _____
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RCA, LCx
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Isolated RV supplied by
|
LCx
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Isolated posterior supplied by ___ or ____
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RCA or LCx
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LAD supplies the ?
|
anterior and anteroseptal portion of the heart
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The anteroseptal-lateral portion of the heart is supplied by ?
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proximal LAD
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anterolateral, inferolateral, posterolateral may be perfused by what artery?
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LCx
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An anterior wall infarct produces EKG changes consistent with MI in what leads?
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V3 and V4
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An inferior wall infarct produces EKG changes consistent with MI in what leads?
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II, III, AVF
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Lateral wall infarcts produce EKG changes consistent with MI in what leads?
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I, AVL, V5 and V6
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Septal infarcts produce EKG changes consistent with MI in what leads?
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V1 and V2
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An anterior wall (septal and lateral) infarction commonly involves what vessel(s)?
|
Left Main Coronary (slide 67 in the ischemia lecture) or LAD
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During a lateral wall MI reciprocal ST depression may be visible on EKG in what leads?
|
II, III, and aVF
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During an inferior wall MI reciprocal ST depression may be visible on EKG in what leads?
|
I and aVL
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Inferior wall MIs show ST segment elevation in which leads?
|
II, III, aVF
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Inferolateral MI may involve which arteries?
|
RCA or LCx
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ST segement depression in leads V1 and V2 may indicate an MI where?
|
posteriorly
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|
What are the 4 known causative factors of congenital heart disease?
|
Rubella in 1st trimester
Diabetic control Drugs: accutane, ETOH, Lithium Heredity |
|
|
What are the 4 T's of blue baby?
|
Tetralogy > transposition > truncus arteriosis > tricuspid atresia
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Mothers with diabetes are more likely to have children with what congenital heart defect?
|
transposition of the great vessels
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Murmur heard loudest at 2nd interspace during late systole that radiates to the carotid and is harsh and high pitched. Patient complains of "big 3" cardiac symptoms. What is your DX?
|
aortic stenosis
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You hear a murmur in the 3rd left interspace. While the patient grips your hand the murmur increases in intensity. Patient has a wide pulse pressure. What is your DX?
|
aortic regurgitation
|
|
|
A woman presents with SOB, fatigue, and a bluish mottled appearance of her face. She relates a history of rheumatic heart disease. What is your likely DX?
|
mitral stenosis
|
|
|
In order to best hear the murmur of mitral stenosis, place the patient in what position?
|
left lateral decubitus, listen with the bell
|
|
|
Over time mitral stenosis may cause what type of changes to the heart that may be prominent on chest xray?
|
enlarged left atrium, prominent right ventricle.
|
|
|
A holosystolic, high pitched murmur loudest at the apex in a patient with SOB is most likely?
|
Mitral regurgitation
|
|
|
What molecule is responsible for the "second wind phenomenon"?
|
ADP --> vasodilation
|
|
|
Chest pain and back pain that is worse in the first second of onset
|
aortic dissection
|
|
|
Which type of angina occurs at rest or nocturnally during REM sleep and is associated with ST elevation with pain?
|
Prinzmetal's Angina
|
|
|
What changes during REM sleep that may contribute to Prinzmetal's Angina?
|
Sympathetic discharge
|
|
|
How long after an MI will a VSD typically present?
|
2 - 14 days
|
|
|
Sudden onset of severe CHF or pulmonary edema 2 - 14 days post MI may be related to rupture of what muscle?
|
posterior medial papillary muscle
|
|
|
JVD, hepatomegaly, ascites, and edema are commonly seen with _____ sided heart failure?
|
right
|
|
|
SOB, PND, Orthopnea, Tachypnea, Rales, S3, S4, and PMI changes are commonly seen with ______ sided heart failure?
|
left
|
|
|
NYHA classification of heart failure
Class I: Class II: Class III: Class IV: |
1) normal
2) sx on ordinary exertion 3) sx on less than ordinary exertion 4) symptoms @ rest |
|
|
Virchow's triad?
|
1) stasis
2) hypercoaguability 3) intimal injury |
