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