Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
36 Cards in this Set
- Front
- Back
Describe determination of ECG axis.
|
normal (-30 to +105): positive QRS in leads I, II
left-axis deviation (<-30): positive QRS in I, negative QRS in II right-axis deviation (>+105): negative QRS in I, positive QRS in II |
|
Distinguish ECG characteristics of AV block, LBBB, RBBB.
|
AV block: PR >200 msec, or P with no QRS
LBBB: QRS >120 msec, no R wave in V1, wide and tall R waves in I, V5, V6 RBBB: QRS >120 msec, RSR' complex (rabbit ears), wide S in I, V5, V6 |
|
ECG changes with ischemia
ECG changes with infarction (transmural) |
ischemia: inverted T waves, poor pre-cordial R-wave progression, ST-segment elev/depr
infarction (transmural): Q wave higher/longer, ST elevation, T-wave inversion |
|
What is an elevated JVD?
What leads to elevated JVD? |
>7 cm above sternal angle
R heart failure pulmonary HTN volume overload tricuspid regurgitation pericardial disease |
|
What is Kussmaul's sign?
|
increased JVP with inspiration
signifies RV infarction, postoperative cardiac tamponade, tricuspid regurg, constrictive pericarditis |
|
What is signified by hepatojugular reflux?
|
fluid overload
impaire RV compliance |
|
Describe the following systolic murmurs:
1. aortic stenosis 2. mitral regurgitation 3. mitral valve prolapse 4. flow murmur |
1. harsh systolic ejection murmur, radiation to carotids
2. holosystolic murmur, radiation to axillae or carotids 3. midsystolic or late-systolic click 4. does not imply cardiac disease |
|
Describe the following diastolic murmurs:
1. aortic regurgitation 2. mitral stenosis |
1. early decrescendo
2. mid to late, low-pitched murmur |
|
causes of peripheral edema (10)
|
R heart failure
bi-ventricular failure peripheral venous disease constrictive pericarditis tricuspid regurgitation hepatic disease lymphedema nephrotic syndrome hypoalbuminemia drugs |
|
increased peripheral pulses in what conditions?
|
compensated aortic regurg
coarcation (arms > legs) PDA |
|
Define pulsus paradoxus.
What is the DDx for pulsus paradoxus? |
decreased systolic BP with inspiration
pericardial tamponade asthma or COPD tension pneumothorax foreign body in airway |
|
What is the DDx for pulsus alternans (alternating weak and strong pulse)?
|
cardiac tamponade
impaired LV systolic function (poor prognosis) |
|
What condition is implied by pulsus parvus et tardus (weak and late)?
|
aortic stenosis
|
|
What is the management of atrial fibrillation?
|
"A, B, C, D"
Anticoagulate Beta-blockers to control rate Cardiovert/Ca2+-channel blockers Digoxin |
|
Give the ECG findings for each type of bradyarrythmia/conduction abnormality:
1. sinus brady 2. 1st degree AV block 3. 2nd degree, Mobitz I 4. 2nd degree, Mobitz II 5. 3rd degree (complete) 6. sick sinus syndrome/tachy-brady |
1. rate <60, normal P before every QRS
2. PR >200 msec 3. progressive PR lengthening until dropped beat 4. unexpected dropped beats without change in interval 5. no relationship between P waves and QRS complexes 6. intermittent SV tachy and brady |
|
Give the Tx for each type of bradyarrythmia/conduction abnormality:
1. sinus brady 2. 1st degree AV block 3. 2nd degree, Mobitz I 4. 2nd degree, Mobitz II 5. 3rd degree (complete) 6. sick sinus syndrome/tachy-brady |
1. none if no Sx (atropine or pacemaker if Sx)
2. none 3. stop drug (atropine or pacemaker as indicated) 4. pacemaker 5. pacemaker 6. pacemaker (most common indication) |
|
Give the ECG findings for each type of atrial tachyarrhythmia:
1. sinus tachy 2. atrial fib 3. atrial flutter 4. multifocal atrial tachycardia |
1. >100, normal P waves before every QRS
2. no discernible P waves, variable QRS response 3. sawtooth P waves 4. three or more P wave morphologies; rate >100 |
|
Give the Tx for each type of atrial tachyarrhythmia:
1. sinus tachy 2. atrial fib 3. atrial flutter 4. multifocal atrial tachycardia |
1. treat underlying cause
2. anticoagulate if old, cardiovert if new i.e. <48 hours (use CHAD2 to estimate stroke score) 3. anticoagulation and rate control, cardiovert accordingly 4. treat underlying disorder; verapamil or beta-blockers for rate |
|
Give the ECG findings for each type of AV junction tachyarrhythmia:
1. AV nodal re-entry tachycardia 2. AV reciprocating tachy (WPW syndrome) 3. Paroxysmal atrial tachy 4. PVC 5. V tach 6. V fib 7. torsades de pointes |
1. 150-250; P waves buried in QRS
2. retrograde P wave after QRS 3. rate >100; P wave with unusual axis before each normal QRS 4. early, wide QRS not preceded by P wave 5. three or more consecutive PVS, wide, regular, rapid QRS 6. totally erratic, wide complex 7. polymorphous QRS; VT @ 150-250 |
|
Give the Tx for each type of AV junction tachyarrhythmia:
1. AV nodal re-entry tachycardia 2. AV reciprocating tachy (WPW syndrome) 3. Paroxysmal atrial tachy 4. PVC 5. V tach 6. V fib 7. torsades de pointes |
1. carotid massage, Valsalva, adenosine (cardiovert if unstable)
2. same as #1 3. adenosine for temporary AV block helps unmask underlying atrial activity 4. treat underlying cause; beta-blockers for Sx 5. cardioversion + amiodarone, lidocaine, or procainamide 6. immediate cardioversion and ACLS protocol 7. correct hypokalemia/withdraw offending drug; give Mg initially and cardiovert if unstable |
|
features of L-sided heart failure
|
Left-sided CHF: dyspnea predominates!
L S3/S4 bilateral basilar rales pleural effusions pulmonary edema orthopnea paroxysmal nocturnal dyspnear |
|
features of R-sided heart failure
|
Right-sided CHF: fluid retention predominates!
R S3/S4 JVD hepatojugular reflex peripheral edema hepatomegaly, ascites |
|
What is the treatment for different stages of heart failure?
|
Stage A. manage risk factors (HTN, smoking, lipids, obesity, exercise, alcohol); ACE-Is for vascular disease, DM, or HTN
Stage B: ACE-Is, beta-blockers Stage C: diuretics, ACE-Is, beta-blockers, digitalis, dietary Na+ restriction Stage D: assist devices, xplant, continuous IV inotropes, hospice |
|
What is the Tx for acute pulmonary congestion due to CHF?
|
"LMNOP"
Lasix Morphine Nitrates Oxygen Position (upright) |
|
For each class of diuretic, give mechanism of action:
1. loop 2. thiazide 3. K+-sparing 4. carbonic anhydrase inhibitors 5. osmotic agents |
1. decrease Na/K/2Cl cotransporter in loop of Henle; decrease urine concentration; increase Ca2+ excretion
2. decrease NaCl absorption in early distal tubule leading to decreased dilution 3. spironolactone: aldosterone antagonist; triamterene and amiloride block Na channels 4. bicarbonate diuresis decreases total body bicarb 5. increases tubular osmolarity, leading to increased urine flow |
|
For each class of diuretic, give side effects:
1. loop 2. thiazide 3. K+-sparing 4. carbonic anhydrase inhibitors 5. osmotic agents |
1. ototoxicity, hypo-K+, hypo-Ca2+, dehydration, gout
2. hypo-K+ metabol acidosis, hypo-Na+, hyper-(glucose, lipids, urea, Ca2+) 3. hyper-K+, gynecomastia, hirsutism, sexual dysfunction 4. hyperchloremic metabolic acidosis, neuropathy, NH3 toxicity, sulfa allergy 5. pulmonary edema, dehydration (contraindicated in anuria and CHF) |
|
dilated cardiomyopathy: causes
|
idiopathic
ischemia long-standing HTN alcohol myocarditis postpartum status drugs (doxorubicin, AZT, cocaine) endocrinopathies infection wet beriberi |
|
dilated cardiomyopathy: Dx
|
echo
CXR shows enlarged heart and pulmonary congestion |
|
dilated cardiomyopathy: Tx
|
treat underlying cause
ACE-Is, beta-blockers, aldosterone antagonist (spironolactone) consider ICD if EF <35% treat CHF Sx with diuretics |
|
hypertrophic cardiomyopathy: causes
|
50% AD inheritance in congenital form
HTN aortic stenosis |
|
hypertrophic cardiomyopathy: Dx
|
echo shows asymmetrically thickened LV wall and dynamic blood flow obstruction
|
|
hypertrophic cardiomyopathy: Tx
|
beta-blockers initially
then CCBs |
|
restrictive cardiomyopathy: causes
|
decreased elasticity of myocardium due to:
infiltrative diseases (amyloidosis, sarcoidosis, hemochromatosis) scarring/fibrosis (secondary to radiation or doxorubicin) |
|
restrictive cardiomyopathy: Dx
|
echo shows rapid early filling with normal or near-normal EF
|
|
restrictive cardiomyopathy: Tx
|
limited, palliatve (vasodilators and anticoagulation if not contraindicated)
|
|
Describe Prinzmetal's (variant) angina
|
mimics angina pectoris, but caused by vasospasm of coronary vessels
clasically affects young women at rest in the early morning; associated with ST-elevation with NO cardiac enzyme elevation |