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116 Cards in this Set

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upright QRS in lead I and downward in aVF
left-axis deviation
downward QRS in lead I and upright in aVF
right-axis deviation
treatment for sinus brady?
none necessary if asymptomatic; atropine may be used; pacemaker definitive
RBBB may result from what conditions?
COPD, valvular disease, chronic CAD; may follow surgical repair of VSD
treatment for RBBB?
none necessary
EKG findings of RBBB?
QRS > 120 ms; RSR' complex with wide R in V1; wide S in V6
signs/symptoms of sinus brady?
may be associated with light-headedness, syncope, or hypotension
what is LBBB usually a sign of?
organic heart disease (HTN, valvular disease, cardiomyopathy, CAD)
EKG findings in LBBB?
QRS>120ms; wide, negative QS in V1; wide, tall R with no Q in V6
definitive therapy in post-MI LBBB patients with conduction defects?
ventricular pacemaker
with what drugs is first-degree AV block associated?
beta-blockers, calcium channel blockers
EKG findings in first degree AV block?
PR > 200 ms
treatment for first-degree AV block?
none necessary
second-degree AV block (Mobitz I) is usually caused by what?
drug effect - digoxin, B blockers, or Ca2+ blockers
EKG findings in second-degree AV block (Mobitz I)?
increased PR interval until dropped beat occurs; PR then resets
treatment for second-degree AV block (Mobitz type I)?
stop the offending drug
etiology of second-degree AV block (Mobitz type II)?
fibrotic disease of the conduction system or from a previous septal MI
EKG findings in second-degree AV block (II)
unexpected dropped beat without a change in the PR interval
treatment for second-degree AV block (Mobitz II)?
pacemaker
etiology of third degree AV block?
no electrical communication between the atria and ventricles
signs/symptoms of third degree block?
syncope, dizziness, acute heart failure, hypotension, cannon A waves
EKG findings in third degree block?
no relationship between P waves and QRS complexes
treatment for third degree block?
pacemaker
etiologies of afib
PIRATES:
Pulmonary disease
Ischemia
Rheumatic heart disease
Anemia/atrial myxoma
Thyrotoxicosis
Ethanol
Sepsis
cardioversion criteria for afib?
only if new onset (<48 hours), if TEE shows no clot in LA, or after 6 weeks of coumadin
treatment for afib & aflutter?
anticoagulation, rate control (Ca2+ channel blockers, beta blockers, dig)
etiology of atrial flutter
circular movement of electrical activity around the atrium at a rate of 300x/minute
etiology of multifocal atrial tacycardia
multiple atrial pacemakers of reentrant pathways, COPD, hypoxemia
EKG findings of multifocal atrial tachycardia
three or more unique P wave morphologies; rate >100
treatment for multifocal atrial tachycardia?
treat underlying disorder; verapamil or B blockers fo rate control and suppression of atrial pacemakers
etiology of atrioventricular nodal reentry tachycardia
reentry circuit in the AV node depolarizes the atrium and ventricle simultaneously
sx of AVNRT
palpitations, SOB, angina, syncope
EKG findings in AVNRT
rate 150-200; P wave often buried in QRS or shortly after
treatment of AVNRT
carotid massage, valsalva, or adenosine can stop the arrhythmia; cardioversion if hemodynamically stable
what happens in atrioventricular reciprocating tachycardia?
circular movement of an impulse down the AV node and back up to the atrium through a bypass tract
in what syndrome is atrioventricular reciprocating tachycardia seen?
Wolff-Parkinson-White
EKG findings in atrioventricular reciprocating tachycardia?
retrograde P wave often seen after normal QRS
what is the cause of paroxysmal atrial tachycardia?
rapid ectopic pacemaker in the atrium
what drug can be used to diagnose paroxysmal atrial tachycardia?
adenosine - turns off ventricular response for seconds so that underlyinig atrial activity can be seen
EKG findings in paroxysmal atrial tachycardia?
rate >100; P wave with an unusual axis before each normal QRS
with what are PVCs associated?
hypoxia, electrolyte abnormalities, hyperthyroidism
treatment of ventricular tachycardia?
cardioversion and antiarrhythmics (amiodarone, lidocaine, procainamide)
syncope, hypotension, pulselessness
vfib
symptoms of vtach
palpitations, hypotension, angina, syncope; can progress to vfib
Cornell criteria for LVH
R wave in aVL + amplitude of S in V3 is >= to 24 in males/20 in females
Cornell criteria for RVH
RAD and R wave in V1>7mm
right atrial enlargement?
P wave amplitude in lead II > 2.5 mm
left atrial enlargement?
biphasic P wave in V1
what must be present for diagnosis of dilated cardiomyopathy?
left ventricular dilatation and systolic dysfunction
two most common causes of secondary dilated cardiomopathy?
ischemia and long-standing HTN
known causes of dilated cardiomopathy
ABCD:
Alcohol
Beriberi
Coxsackie B, Chagas, Cocaine
Doxorubicin
end of rapid ventricular filling; associaed with dilated cardiomyopathy
S3
high atrial pressure/stiff ventricle; atrial kick associated with a hypertrophic ventricle
S4
poor prognostic signs in hypertrophic cardiomyopathy?
arrhythmias and increased LA pressure
mitral regurgitation, sustained apical impulse, S4, systolic ejection murmur
fingings in hypertrophic cardiomyopathy
what happens in hypertrophic cardiomyopathy
LVH -> impaired LV relaxation and filling (diastolic dysfunction); LVOT obstruction from thickened interventricular septum
treatment of hypertrophic cardiomyopathy
beta-blockers initially, calcium channel blockers second line
surgical options for IHSS?
dual-chamber pacing, partial exision of septum, ICD
what should patients with IHSS avoid?
intense athletic competition and training
what is the difference between restrictive cardiomyopathy and hypertrophic cardiomyopathy?
restrictive - myocardium has impaired elasticity; hypertrophic - myocardium is slow to relax
what causes restrictive cardiomyopathy?
infiltrative disease (sarcoid, hemochromatosis, amyloidosis) or scarring and fibrosis (XRT or doxorubicin)
how do you diagnose restrictive cardiomyopathy?
cardiac biopsy
treatment for restrictive cardiomyopathy?
correct underlying cause and improve CHF sx
risk factors for CHF?
CAD ,HTN, valvular heart disease, pericardial disease, cardiomyopathy, pulmonary HTN
definition of systolic dysfunction
EF < 50%
left-sided CHF symptoms
bilateral basilar rales, S3 gallop, pleural effusions, pulmonary edema
right-sided CHF symptoms
JVD, hepatomegaly, hepatojugular reflux, bipedal edema
acute CHF management?
LMNOP-
Lasix,
Morphine,
Nitrates,
O2
Pulmonary ventilation
when has low-dose spironolactone been shown to decrease mortality risk?
when given with ACEIs and loop diuretics in pts with LV systlic dysfunction and NYHA class III-IV heart failure
wat what point do you consider coumadin in patients with dilated cardiomyopathy? an ICD?
EF<25%
EF<35%
in what patients is digoxin not useful?
patients with diastolic dysfunction
what are xanthelasmas?
yellow fatty deposits in skin around eyes
what is lipemia retinalis
creamy appearance of retinal vessels
target LDL for patients with 0-1 risk factor for CAD
<160
target LDL for patients with >/= 2 risk factors
<130
target LDL for patients with CAD
<70
acute treatment for stable angina?
morphine, O2, SL nitroglycerin, ASA, IV beta blockers
acute treatment for unstable angina?
same as for stable; consider glycoprotein IIB-IIIA inhibitors (eptifibatide, tirofiban, abciximab); also heparinize, angiograpy, possible revascularization
new mitral regurgitation in setting of MI signifies what?
ruptured papillary muscle
sequence of EKG changes in MI
peaked T, ST elevation, Q waves, TWI, ST normalization, T wave normalisation
ST elevation in II, III, aVF
inferior wall MI
ST elevation in V1-V4
anterior wall MI
ST elevation in I, aVL, V5-V6
lateral MI
which cardiac enzyme appears first and is most sensitive and specific?
troponin I
indicatons for CABG
DUST
Depressed ventricular function
Unable to perform PTCA (diffuse disease)
Stenosis of left main
Triple-vessel disease
most common cause of death following MI
lethal arrhythmia
Dressler's syndrome
autoimmune process with fever, pericarditis, pleural effusion, leukocytosis, and increased ESR 2-4 weeks post-MI
safe reduction in BP for hypertensive emergency/urgency
decrease in mean arterial pressure of only 25% over first 2 hours to prevent cerebral hypoperfusion or coronary insufficiency
defnition of malignant hypertension
progressive renal failure and/or encephalopathy with papilledema
causes of pericarditis
viral infection, TB, SLE, uremia, drugs, neoplasms; most commonly idiopathic
exam in pericarditis?
pericardial friction rub, elevated JVP, pulsus paradoxus (fall in systolic BP >10 on inspiration)
describe chest pain in pericarditis
often positional - worsens in the supine position & with inspiration; improves with shallow breathing or leaning forward
EKG findings in pericarditis
PR segement depression, low voltage, diffuse ST-segment elevation
risk factors for cardiac tamponade
pericarditis, malignancy, SLE, TB, trauma (stab wound medial to left nipple)
decrease in cardiac output in cardiac tamponade is related to what?
rate of fluid formation (more so than size of effusion)
how does cardiac tamponade present?
fatigue, dyspnea, tachycardia, tachypnea
Beck's triad?
hypotension, distant heart sounds, distended neck veins (cardiac tamponade)
what may EKG show in cardiac tamponade?
decreased amplitude and/or electrical alternans (electrical axis changes with each beat)
treatment of cardiac tamponade?
aggressive voulme expansion with IV fluids; urgent pericardiocentesis
what will you aspirate with pericardiocentesis in setting of cardiac tamponade?
nonclotting blood
common ages for renal artery stenosis
<25 and >50
eitologies of renal artery stenosis
fibromuscular dysplasia (younger pts) and atherosclerosis (older)
treatment of renal artery stenosis
angioplasty and stenting; consider ACEIs as adjunctive or temporary therapy in unilateral disease
why should you avoid using ACEIs in bilateral renal artery stenosis
because they can accelerate kidney failure by preferential vasodilation of the efferent arteriole
Conn's syndrome
hyperaldosteronism - most often due to aldosterone-producing adrenal adenoma
triad of Conn's syndrome
hypertension, unexplained hypokalemia, metabolic alkalosis
classic triad associated with aortic stenosis
exertional dyspnea, angina, syncope
physical exam in AS
pulsus parvus et tardus (weak, delayed carotid upstroke), sustained apical beat; paradoxically split S2
aortic aneurysms are associated with what?
atherosclerosis
where do >90% of aortic aneurysms originate?
below the renal arteries
when is surgical repair indicated for abdominal aneurysms?
when lesion is >5.5 cm (abdominal) or >6 cm (thoracic) or is enlarging rapidly
most common sites of origin of aortic dissection?
above aortic valve and distal to left subclavian
in whom does aortic dissection most occur
due to HTN; in people 40-60 years of age, more common in men
when is aortic dissection a surgical emergency?
when it involves the ascending aorta
Trousseau's syndrome
hypercoagulability due to malignancy
what can lidocaine increase the risk of?
asystole