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63 Cards in this Set

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  • Back
What is an acceptable range for axis on a child's EKG?
about +10 to +180.
Where are T wave inversions a normal variant in a child's EKG?
V1-V4. Once a T wave is upright, all Ts lateral to it should also be upright.
What are the EKG findings for pericarditis?
PR depression, diffuse ST elevations, ST normalization, and T wave depression.
Which viruses classically cause pericarditis and myocarditis?
coxackie, flu, and enteroviruses.
Which is the most common cause of cyanosis after the first month of life?
Tetralogy of Fallot.
What is the most common cause of cyanosis in the first week of life?
Transposition of the great vessels.
How do you treat Tet spells?
Fluid bolus, knee-to-chest positioning, oxygen, morphine. consider beta blockade and phenylephrine. If younger than 1 month, consider PGE1.
How does congenital heart disease present?
Irritability, poor feeding, poor weight gain, sweating while feeding.
What percentage of patients with myocardial infarction have a normal EKG, and where is the lesion usually located in these cases?
Circumflex lesion
What EKG findings are suggestive of infarction in patients with pacers or pre-existing LBBB?
Concordant ST changes of 1 mm or more, discordant ST changes of 5 mm or more, or any ST depressions in V1, V2, or V3
What are absolute contraindications to lysis of an ST elevation MI?
Persistent hypertension despite treatment (>180/110), any previous hemorrhagic stroke, recent trauma, recent major surgery, ischemic CVA in previous 3 months, active bleeding excluding menses
In the setting of symptomatic bradycardia in a heart transplant patient, which ACLS medication should not be routinely given?
atropine. transplanted hearts are denervated and will therefore not respond to atropine.
What are common medical causes of atrial fibrillation?
Mitral valve disease, hyperthyroidism, alcoholism, ischemic heart disease
What is the most common presenting complaint in women with MI?
Fatigue. Chest pain is the 4th most common complaint.
What is the most common presenting complaint in the elderly with MI?
Altered mental status.
An 18 year old male presents with chest pain and syncope during soccer practice. On exam you hear a murmur which is made louder when the patient performs the Valsalva maneuver. How should his pain be treated?
fluid hydration and beta blockade. the patient has IHSS and should no longer perform vigorous exercise.
A patient presents with syncope while at an aerobics class. You hear a late-peaking crescendo-decrescendo murmur in the second intercostal space on the right. This patient should not have a stress test. True or false.
The patient has critical aortic stenosis and should absolutely not have a stress test. he should have an echocardiogram and be referred for valve replacement.
What are 4 causes of systolic murmurs?
anemia, fever, aortic stenosis, mitral regurgitation
What are causes of diastolic murmurs?
mitral stenosis, aortic insufficiency
A patient has an EKG with ST elevations in II, III, and aVF, and a tall R wave and ST depression in V1 and V2. His heart rate is 90 and his systolic blood pressure is 90. What is your first line of treatment for his hypotension?
fluids. the patient has evidence of a right sided infarct and should be volume resuscitated. You should avoid beta blockade acutely in this patient.
ST segment elevations of 1mm in 2 consecutive leads precordially meets cath lab criteria, true or false.
false. it's 2 mm precordially, 1 mm in the limb leads.
A new left bundle branch block in the presence of chest pressure radiating into the left arm meets cath lab criteria, true or false.
Is most valvular disease acute or chronic?
90% of valvular disease is chronic.
What type of chronic adaptation is made to preserve cardiac function in valvular disease?
Dilatation or hypertrophy
Which heart valves have 2 cusps?
Only the mitral valve has two cusps. The tricuspid, pulmonary, and aortic valves have three cusps
Describe the murmur of hypertrophic cardiomyopathy.
Murmur in fifth intercostal space mid left thorax radiating to left sternal border, increases from squatting to standing
Describe the murmur of aortic stenosis and aortic regurgitation.
AS – harsh systolic ejection murmur in second intercostal space radiating to right carotid artery
AR – high-pitched blowing diastolic murmur after S2 at right 2nd-3rd IC parasternal area
Describe the murmur of mitral regurgitation.
High-pitched holosystolic murmur in fifth intercostal space mid left thorax radiating to left axilla
Describe the murmur of tricuspid regurgitation.
Soft blowing holosystolic murmur in lower left sternal border radiating to lower right sternal border
Describe the murmur of mitral valve prolapse and mitral stenosis.
* MVP – midsystolic click
* MS – mid-diastolic rumbling with crescendo to S2
What is the most common presenting symptom in valvular disease?
Exertional dyspnea
What is the most common cause of mitral stenosis?
Rheumatic heart disease, despite its declining frequency
How does rheumatic fever result in mitral stenosis?
Rheumatic endocarditis causes fusion of the commissures and matting of the chordae tendinae with calcification of the valve over time
What are the potential complications of mitral stenosis?
Pulmonary hypertension leading to pulmonary and tricuspid valve incompetence
* Progressive atrial dilatation leading to atrial fibrillation
What ECG findings are typical of mitral stenosis?
Notched or biphasic P waves and right-axis deviation
What is the diagnostic study of choice for all valve disease?
TEE, though TTE is usually done first.
What is the goal INR in patients with mitral stenosis and concomitant atrial fibrillation?
2 - 3
Appetite-suppressant drugs (fenfluramine, phentermine, dexfenfluramine) are most commonly associated with which valvular disease?
Aortic regurgitation
What are the causes of acute mitral regurgitation?
MI, trauma, infective endocarditis
How does the clinical presentation of acute mitral incompetence differ from the chronic state?
* Acute mitral regurgitation into a noncompliant left atrium quickly increases pressures, leading to pulmonary edema, cardiogenic shock, MI
* Chronic MR causes a dilated left atrium, which often maintains effective forward flow into aorta despite significant regurgitant flow. Patients can be asymptomatic for yrs-decades, with only exertional dyspnea +/- atrial fibrillation
What is the most common valvular disease in industrialized countries? What causes it?
MVP or click-murmur syndrome (affects ~2.4% of population). Etiology unknown, may be congenital.
Which valvular disease may be associated with skeletal abnormalities?
MVP patients may have thoracic cage abnormalities (pectus excavatum, a straight thoracic spine, or scoliosis)
How is MVP generally treated?
Reassurance, beta-blockers, avoidance of EtOH/caffeine/tobacco
What is the most common cause of aortic stenosis?
* U.S. - congenital heart disease (young adults, 50% bc of bicuspid valve), calcific AS (elderly)
* Worldwide – rheumatic heart disease
Is atrial fibrillation more common in mitral or aortic disease?
What is the classic triad of aortic stenosis?
Dyspnea, chest pain, syncope
What are the signs of aortic stenosis?
* Pulsus parvus et tardus (small amplitude with brachioradial delay)
* Harsh systolic ejection murmur
* Narrow pulse pressure
* Sudden death from dysrhythmias (25% of patients)
What are the ECG findings in aortic stenosis?
LVH and in 10% of patients RBBB or LBBB
Which valvular disease is characterized by narrow pulse pressure? Which is characterized by wide pulse pressure?
AS = narrow, AR = wide
what are the most common causes of acute aortic regurgitation?
Infective endocarditis, aortic root dissection, trauma
What is the treatment for acute or chronic aortic regurgitation?
* Acute – oxygen, intubation (if needed), nitrate/inotrope drip
* Chronic – ACEI and nifedipine
What is the most common cause of tricuspid regurgitation ?
IVDU with endocarditis (Staph aureus)
What is the most common cause of pulmonary valve stenosis?
Congenital Tetralogy of Fallot
What is the goal INR for patients with mechanical valves?
2 - 3.5, depending on the type of valve
What percentage of patients with CHF are rehospitalized within 6 months of discharge?
Which of the following decrease contractility?
c--B blockers
d--Intracellular Ca++
c. beta blockers
Heart failure classification is based on ejection fraction. Systolic heart failure has an abnormal EF? True or false?
Which type of heart failure is more sensitive to preload?
*Diastolic, impaired relaxation means impaired LV compliance leading to higher atrial pressures. These patients are dependant on their preload.
In general, BNP may be increased in all of the following conditions except:
a--Renal failure
b. carcinoma
40mg of Lasix is equivalent to ____mg of Bumetanide (Bumex)?
a. 1mg
Which antiarrhythmic works for both atrial and ventricular arrhythmias?
a. adenosine
b. lidocaine
c. amiodorone
e. quinidine
c. amiodorone
In tetralogy of fallot, which component of the lesion is most predicitive of prognosis?
a. VSD
b. subpulmonic stenosis
c. overriding aorta
b. subpulmonic stenosis
Acutely, how do you treat symptomatic Eisenmenger's syndrome?
IV fluids to reduce right to left shunting. You can also use vasopressors.