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66 Cards in this Set

  • Front
  • Back
What is the most common organism causing subacute bacterial endocarditis on the right and left side?
• Right Side - Staphlococcus Aureus
• Left Side - Strep Virudens
What is the most common cause of ascending aortic aneurysm?
Cystic Medical Necrosis
What is the Metabolic Syndrome?
• Central Obesity
• Insulin resistance
• High triglycerides
• Also Low HDL
• High catecholamines
• inflammatory markers; C-reactive protein
What are varicose veins?
• Dilated, tortuous superficial veins (usually greater and lesser saphenous)
• Incompetent valves
What is thrombophlebitis?
inflammation of a vessel due to a clot
How often are classic DVT symptoms seen?
50% of the time
What are risk factors for DVT?
• venous stasis
• abnormal vessel wall
• altered coagulation
• leg trauma
• prolonged bed rest
• cancer
• obesity
• surgery
• central lines
• venous insufficiency
What are some complications of DVT?
pulmonary embolism
What is the treatment of DVT?
• Classic therapy is continuous intravenous infusion of unfractionated heparin (UFH) for 5-10 days
• Coumadin is begun a few days before UFH is discontinued (when INR therapeutic) and used for 3 months
• Newer therapy is Low Molecular Weight Heparin (LMWH) instead of UFH
What is Cor Pulmonale?
right ventricular hypertrophy due to a lung disorder
What are secondary causes of hypertension?
• Adrenal - Primary hyperaldosteronism, Cushing’s syndrome, pheochromocytoma
• Renal - Chronic renal disease, renal artery stenosis, (atherosclerotic or fibromuscular dysplasia)
• Other - Oral contraceptives, alcohol, NSAID’s drugs, pregnancy associated, hypercalcemia, hyperthyroidism, obstructive sleep apnea, obesity, coarctaction of the aorta, acromegaly, increased intracranial pressure
What is the pathophysiologic basis behind mitral stenosis/
• Antibodies form in response to the strep antigen
• These antibodies mistakenly attack host tissues
What is the drug and dosage for subacute endocarditis prophylaxis?
Amoxicillin 2gms orally 1 hour prior to procedure
What are EKG criteria for acute MI?
• ST segment elevation
• T wave inversion
• Development of Q waves
• Reciprocal ST segment depression
What are the 3 categories of cardiomyopathy?
• Dilated
• Restricted
• Hypertrophic
Name the valves the are affected by rheumatic heart disease (from most common to least common)
Mitral>aortic>tricuspid (almost never involves pulmonic)
What are EKG findings of hyperkalemia?
Progressive pattern
• Diffuse ‘Peaked’ T waves
• Prolonged PR interval with flattening of P wave
• QRS widens with merging into T wave forming a ‘Sine wave’ pattern
• V-Fib
What are EKG findings of hypokalemia?
Progressive Pattern
• Diffuse Flattening of the T wave (c possible diffuse ST segment depression or T wave inversion)
• Appearance of the U wave
• Torsades de Pontes
What are EKG findings of hypercalcemia?
Shortened QT interval
What are EKG findings of hypocalcemia?
• Prolonged QT interval
• Torsades de Pontes
When is cardioversion unsafe with PSVT? with AFib?
• unsafe with PSVT if the patient has dig toxicity
• unsafe with Afib if it been more than 48 hours (due to clot formation)
What are EKG findings with Dig Toxicity?
• SA & AV blocks
• PAC’s & PVC’s
•- Atrial and ventricular tachycardia (arrhythmias)
• V-tach
• V-fib
What is the difference between Wolf-Parkinson-White and Long-Ganong-Levine Syndrome?
• WPW has shortened PR interval and widened QRS c fusion of Delta wave
• LGL has shortened PR interval, QRS not widened, and no delta wave
How do you determine left ventricular hypertrophy by voltage criteria?
(R in V5 or V6) + (S in V1 or V2) > 35 mm
What are EKG findings for a Ventricular Aneurysm? Brugata Syndrome? Pericarditis?
• Ventricular aneurysm has ST greater than 4 weeks post-MI; most common in anterior leads
• Brugata Syndrome is characterized by RBBB c ST elevation in leads V1-V3. The elevated ST segments have a peculiar, peaked down sloping shape, particularly in V1, V2.
• Pericarditis is characterized by an ST segment that is elevated throughout almost all leads and usually flat or concave. The entire Twave may be elevated off the baseline, which resolves with time.
What is the earliest detectible sign of cardiac involvement of hypertension?
left ventricular hypertrophy
Describe the murmur of aortic stenosis upon auscultation
• "diamond-shaped" murmur (crescendo-decrescendo) at the 2nd intercostal space at the left sternal border
• low pitch murmur at the base radiating to the carotids
• paradoxically S2 split from constant late A2 (P2-A2 instead of normal A2-P2)
What are some findings upon physical exam of a patient with aortic regurgitation?
• wide pulse pressure
• physical findings of Marfan's
• displaced PMI (due to left ventricular hypertrophy) with palpable S3 and S4
• possible pulmonary congestion
• diastolic "blowing" murmur along left sternal border
• high pitched decrescendo diastolic murmur heard best by sitting up and leaning forward
Describe the murmur of mitral regurg
holosystolic (or pansystolic) murmur at apex radiating to the axillae
Describe the murmur of mitral stenosis
Diastolic “thrill” left apex in left lateral decubitus position
What does the P wave represent?
atrial depolarization
What is normal axis?
ORS is upright in leads I and aVF (between 0-90º)
What is the duration of a normal QRS?
< .12 sec
When is a Q wave pathologic?
Q wave >0.04 sec in duration, depth 1/3 the height of the R wave in the same QRS complex
What are characteristics of a junctional rhythm on EKG?
• negative P wave in lead II that occur immediately before the QRS, immediately after the QRS, or hidden within the QRS.
• Short PR interval <0.10 sec
• A QRS complex that is identical or very similar to normally conducted beats
Which leads form Eithoven's Triangle?
limb leads (I, II, III)
What are causes of right ventricular hypertrophy?
• Right ventricular hypertrophy is a consequence of right ventricular overload.
• This is caused by pulmonary valve stenosis, tricuspid insufficiency, or pulmonary hypertension.
• Also many congenital cardiac abnormalities, such as a ventricular septal defect, may cause right ventricular overload
What are causes of right atrial enlargement?
• Right atrial hypertrophy is a consequence of right atrial overload.
• This may be a result of tricuspid valve disease (stenosis or insufficiency), pulmonary valve disease, or pulmonary hypertension (increased pulmonary blood pressure).
• The latter is most commonly a consequence of chronic obstructive pulmonary disease or pulmonary emboli
What are EKG findings of left ventricular hypertrophy?
• Voltage criteria
• R in aVL > 13 mm
What lead is best to evaluate for atrial enlargement?
• V1: in LAE, Biphasic P wave in V1 c terminal (negative) component increased in amplitude (>1mm) and duration (>1mm)
• in RAE, Biphasic P wave in V1 with increased amplitude and duration of initial component.
Describe a normal P-wave in V1?
equally biphasic wave
What is P mitrale?
aka left atrial enlargement becuase mitral valve disease is a common cause of left atrial enlargement
What are the values of the boxes on an EKG going horizontally? going vertically?
• Horizontally measures time (each little box is 0.04 sec, each big box is 0.20 sec)
• Vertically measures voltage or mV (each little box is 0.1 mV, each big box is 0.5 mV)
What is the standard calibration on EKG?
one box wide (0.20 sec) and two boxes high (1 mV)
What are some causes of a widened QRS?
• idioventricular rhythm
• Wolf-Parkinson-White
• Bundle Branch Block
What is differences between RBBB and LBBB on EKG?
• RBBB has bunny ears in leads V1 and V2
• LBBB has bunny ears in leads V5 and V6
What is the PMI and where is it?
• PMI is the point of maximal impulse where the apex of the left ventricle hits the chest wall
• occurs at the 5 intercostal space and the midclavicular line
Low voltage on an EKG will occur in all of the following except:
a. obesity
c. pericardial effusion
d. pneumonia
Answer is C: pneumonia
• low voltage occurs by increasing the distance between the leads and the electrical activity of the heart
What is inotrope?
contractility of the heart
What is afterload?
Load against which the contracting myocardium exerts its force (Aortic pressure).
Leads II, III, and aVF look at what side of the heart? what artery is that?
the inferior side of the heart which corresponds to the right coronary artery (RCA)
What are the rates of an idioventricular rhythm? accelerated ventricular rhythm? ventricular tachycardia?
• idioventricular: 20-40 bpm
• accelerated ventricular: 40-100 bpm
• ventricular tachycardia: 140-250 bpm
What are factors that determine stroke volume?
preload, afterload, contractility
What is the treatment for SVT?
• vagal maneuvers (carotid massage)
• Adenosine IV
• Ca channel blockers (cardizem, procainamide)
What are characteristics of left anterior hemiblock on EKG (LAHB)?
• Q1S3
• LAD occlusion
RR' in leads V1 and V2 is likely attributed to what?
right bundle branch block due to a delay in right ventricular depolarization
What is the greatest complication of MI?
arrhythmia (?)
Why use beta blockers in heart failure?
create renewed responsiveness to the positive inotropic effects of the NE circulating
Why use ACE inhibitors in heart failure?
ACE inhibitors interfere with progression of LV dysfunction and decrease mortality
Alcoholics are at increase risk for what type of cardiomyopathy?
dilated cardiomyopathy
What drug class should be used with diabetics with hypertension?
What are the drugs used to treat hypertensive emergency?
• Nitroprusside (directly dilates peripheral vessels)
• Labetolol (ß-blocker)
• Nitroglycerin (Nitrate)
What is the Jones Criteria for Rheumatic fever?
• migratory arthritis
• carditis
• sub-cutaneous nodules
• erythema marginatum (redness with a margin)
• Sydenham's chorea (shakes)
What are the 4 features of Tetralogy of Fallot?
• Ventricular septal defect
• Pulmonary stenosis
• Right ventricular hypertrophy
• Overriding aorta
What are characteristics of Superior Vena Cava Syndrome?
• 75% secondary to bronchogenic carcinoma
• Remainder mostly lymphoma generated
• Superior vena cava syndrome creates emergency need for decompression (one of the rare emergency uses of radiation therapy)
• Patient presents with collateral vein dilatation of neck and thorax, plethora and edema face and neck, conjunctival edema, headache
What is tricuspid atresia?
• there is no flow between the right atrium and ventricle
• the entire systemic venous return enters the left heart via the foramen ovale.