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111 Cards in this Set
- Front
- Back
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U waves...
Upright -> Inverted-> |
U- hypokalemia, hypercalcemia, digitalis, phenothiazines, quinidine, epi, thyrotoxicosis
I- ACS, strain, hypertension, increased ICP |
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Temperature at which hypothermia starts?
EKG findings? |
35 C (95 F); J wave, prolongation of PR, QRS and QT, sinus brady, slow a-fib
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CPR in hypothermia?
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CPR in all monitored with v-fib, pulseless v-tach, or asystole; if no monitor, check pulse x 45 seconds before begining CPR
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V-fib in hypothermia...
cardiovert? |
yes, but may not work; rewarm and will prob convert on own; can use mag as antidysrhythmic
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EKG in hypo-k
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u wave, flat then inverted t, QT and PR prolongation, ectopy, st depression
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EKG in hyper k
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peaked T, prolongation of PR, loss of P, QRS widening, sine wave
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EKG in hypocalcemia
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prolonged QT, T-wave inversion, torsades; treat with mag
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EKG in hypercalcemia
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QT shortening, QRS widening
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EKG in hypomag
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QT and PR prolongation, T wave inversion, ectopy
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Digitalis effect on EKG
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sagging ST seg, QT shortening, PR prolongation
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2 mechanisms of digitalis' toxicity
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poisons Na/K/Mg ATPase -> K eggress, Ca builds up in cell -> irritability; Increases vagal tone -> brady and blocks
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Factors that increase dig toxicity
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hypo-K, hypo-Mag, hyper-Ca, hyper-K, hypoxia, alkalosis, age, sick heart; drugs- quinidine, CCB, e-mycin, captopril, amiodarone, ibuprofen
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EKG in dig tox; most common; pathognomonic; other common
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most common - PVCs, either multiform or bigeminy/trigeminy; pathognomonic- atrial tach with block; regular/slow a-fib, bidirectional v-tach
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Clincial symptoms of dig toxicity
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flu-like with N/V, diarrhea, malaise, yellow-green color abberrancies, halos, AMS
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Prognosis of dig tox in acute ingestion is dependant on what?
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degree of hyper-k, not dig level
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Treat dysrhythmias in dig tox (other than fab frag); what to avoid
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phenytoin or lidocaine #1; mag can work too
cardioversion, calcium, procainamide, beta-blockers |
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Treatment of bradycardia in dig toxicity
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#1- atropine (remembter increased vagal tone)
#2- trans-q pacing (not invasive pacing) |
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EKG of WPW
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short PR (< .12), delta wave, wideish QRS, kent bundle bypass
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EKG of LGL
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short PR, no delta wave, normal QRS, James bundle bypass
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Treatment of bradycardia...
when not to use atropine |
atropine, trans-q pacing, epi gtt (2-10 mcg/min), dopamine 5-20 mcg/kg/min, transvenous pacing
NO- acute iscemia, mobitz II or third degree AVB |
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Dobutaimine
action, dose |
B1 agonist -> inotrope with mild chronotropy
2.5-40 mcg/kg/min |
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Dopamine
action, dose |
dopamine receptor, plus beta and/or alpha
0.5-2 mcg/kg/min - vasodilation; 2-10 mcg/kg/min- beta; 10-20 mcg/kg/min alpha |
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Epi gtt
action, dose |
inotrope, chronotrope > vasoconstrictor
1-20 mcg/min |
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Norepi gtt
action, dose |
inotrope, chronotrope < vasoconstrictor
8-30 mccg/min |
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Phenylephrine
action, dose |
pure alpha-agonist
40-180 mcg/min; push dose 50 mcg q 2 min 10 mg into 100 ml bag of saline -> 100 mcg/ml, push 0.5 ml at a time |
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vassopressin
dose |
40 units is code dose
0.01 - 0.04 units/min |
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Tx to consider in PSVT
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valsalva, adenosine, diltiazem, esmolol, amiodarone, procainamide
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Drug that potentiates adenosine?
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carbamazepine
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Esmolol
bolus and gtt |
500 mcg/kg bolus/ 1 min
50-200 mcg/kg/min |
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Propranolol
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crosses brb; use in thyrotoxicosis
1 mg IV q min to 0.3 mg/kg |
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Digoxin loading dose
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0.5 mg IVP then 0.25 mg IVP q 30 min up to effect or 0.02 mg/kg
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Diltiazem
bolus and gtt |
0.25 mg/kg IV over 2 min then 0.35mg/kg IV over 2 min 15 min later; gtt at
80-250 mcg min |
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How much Ca to give before dilt?
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5-10 cc of CaGluconate
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Phenytoin
dose |
20 mg/kg IVPB in NS and run at 50 mg/min or less
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Rx to control rate in A-fib
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diltiazem, esmolol, metoprolol, digoxin
*magnesium is an adjunt for all of the above |
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Rx to control rate in A-fib with low EF
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diltiazem, digoxin
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Causes of MAT?
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COPD, CHF, sepsis, theophyline toxicity
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Tx of MAT? What is inneffective?
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correct hypoxia, magnesium, CCB, BB;
don't - cardiovert, digoxin |
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Causes of PVCs?
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hypo-k,mg; hypoxia, MI, ETOH, cocaine, meethyxanthines, dig, tobacco, hyperthyroid, chf, cardiomyopathy, contusion
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Procainamide
dose? |
17 mg/kg at 35 mg/min to qrs widening or hypotension
gtt of 1-4 mg/min |
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Lidocaine
dose? |
1.5 mg/kg IVP; re[eat .5 mg/kg q 5 min to 4mg/kg
gtt 2-4 mg/min |
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Algorhithm for stable v-tach
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lidocaine followed by amio or procain followed by mag, followed by cardioversion
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Magnesium dose?
precaution? |
2 g slow IVP followed by .5-2 g/hr
renal failure |
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H's and T's?
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hypovolemia, hypoxia, hydrogen ion, hyper/hypo-k, hypothermia; thrombosis (mi, pe), tension pneumo, tamponade, tablets (drugs)
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Amiodarone
Dose? |
code - 300 mg IVP then repeat 150 mg IVP
non-code- 150 mg over 10 min then 1mg/min x 6 hr then .5 mg/min x 18 hrs |
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First degree AVB
causes? Danger? |
normal or high vagal tone, dig, myocarditis; not dangerous
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Mobitz I
cause? Dangerous? |
typically transient and intranodal; inferior MI, dig, vagal tone, myocarditis
No tx needed unless symptomatic -> atropine |
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Mobitz II
Cause? Dangerous? |
often permanent and infranodal; anteroseptal MI -> complete block; pacer placement; no atropine
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Complete block?
Cause? Dangerous? |
narrow- typically inferior MI or drugs and transient
wide- typically anterior MI and permanent -> pacer |
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Tx of WPW with narrow or wide SVT?
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narrow- orthodromic; tx same as regular SVT
wide- antidromic; tx with amio (EF <40%) or procaine |
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Tx of WPW in A-fib or flutter?
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unstable -> defib
stable -> amio (EF < 40%) or procaine |
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First two letters of pacer code?
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chamber paced, chamber sensed
V, A, D (dual) or O (none) |
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Major risk factors for CAD/AMI?
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cigarettes, HTN, DM, hypercholesterolemia, 1st degree relative < 55, other vascular occlusion
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Order of EKG changes in AMI?
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large T -> ST elevation +/- reciprocal, q waves, T-wave inversion
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isolated t wave without ST changes or Q waves?
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ischemia not infarction
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Inferior MI association?
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RCA lesion; bradydysrhythmias, vagal tone, AV blocks
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Right ventricular MI association?
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shock, hypotension
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Definition of pathologic q?
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greater than 0.04 sec long and > 25% of r wave
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CK-MB peak and duration?
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peak at 4 hours, lasts 24 hours
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Troponin peak and duration? I v. T?
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peak in 6 hours, lasts weeks; I is very specific, T is less so but more than CK-MB
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Heparin dosing?
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60 U/kg up to 4,000 units and 12U/Kg/hr (max 1000 U/hr) to PTT of 50-70 sec
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contraindication for lovenox?
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HIT, obesity, renal failure, planned CABG
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Contraindication for NTG?
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use of viagra etc in last 24 hours, SBP < 100 or inferior/RV infarct
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Metoprolol dose?
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5 mg IV q 5 min to 15 mg total
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Reperfusion rhythms post lytic? Tx?
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PVCs, accelerated idioventricular, V-tach, V-fib
tx v-vib always; others if unstable only |
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nicardapine
action? dose? |
peripheral CCB
80 - 250 mcg/hr IV |
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Slovis' PEA
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1. oxygenate/ventilate
2. IV fluids 3. think hyper-k, hypothermia 4. epi q 3 min 5. h's and t's |
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Slovis' v-fib
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200J -> O2/tube -> epi -> CPR -> 200J -> amio 300 -> cpr -> 200 J -> ? mag -> cpr -> amio 150/lido
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Slovis' V-tach
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lido -> amio or procaine -> mag -> 200 J
if convert -> load with amio post conversion |
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Contraindications to ACE-I?
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renal artery stenosis, creatinine > 2.5
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Which side is CHF effusion most often on (if unilateral)?
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right
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Tx cardiogenic pulmonary edema?
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ntg, O2, bipapa, lasix, morphine; if shock then dopamine or norepi (better)
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Order of sx in HCM?
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D.O.E. -> CP with exertion -> syncope -> cardiac death
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Exam for HCM?
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systolic murmur increases with decreased preload (valsalva) and decreases with knee to chest/squatting
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Tx HCM? Avoid in HCM?
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beta blockers, avoid sports
avoid- dig, inotropes, vasodilators |
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Phlegmasia cerulea dolens?
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massive dvt -> ischemia; tense blue leg with petechiae and bullae
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Phlegmasia alba dolens
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massive dvt with arterial spasm -> not tense, white, petechiae -> progresses to cerulea dolens
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O2 sat/paO2 rule?
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60 -> 90%
50 -> 80% 40 -> 70% |
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A-a gradient calculation
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150 - (pO2 + (pCO2/.8))
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Normal A-a grad?
normal pOs? |
age/4 + 4
100 - age/4 |
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P pulmonale?
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sharply peaked p wave, seen best in V2 = COPD or chronic pulm dz; also PE
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D-dimer in PE?
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low pretest prob = dd (-) and done; mod/high = just get a doppler or ct
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heparin or lovenox in pregnancy?
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yep; doesn't cross the placenta
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Work up for pt with (+) PE?
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troponin, echo; if shock or (+) troponin/echo then lytic or thrombectomy
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2 most common causes of pericarditis?
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idiopathic and viral
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History in pericarditis?
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sharp CP, pleuritic, positional and worse with swallowing; dyspnea, fever
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ECG in pericarditis?
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diffuse ST seg elevation with PR depression except aVR, V1; diffuse T-wave inversion (late)
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Steroids in pericarditis?
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not first line since 25% will have rebound sx after course is finished
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Out patient v. in for pericarditis?
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Idiopathic/viral in the young can go home on NSAID
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Beck's triad for tamponade?
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distant sounds, JVD, hypotension
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Risks for endocarditis?
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valve dz(fake), IVD use, Ca degeneration, catheters, dialysis, card surg, HIV, burns
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Most common bacteria in native-valve endocarditis?
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non-viridans strep -> staph -> strep viridans -> enterococci
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Most common bacteria in prosthetic-valve endocarditis?
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coag neg staph -> staph -> strep viridans -> enterococci
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Most common bacteria in IVD use endocarditis?
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staph ->. strep -> gram (-)
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Most common left-sided valve affected by endocarditis? Right-sided?
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mitral; tricuspid
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New guidlines for abx prophylaxis against IE?
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prosthetic valve, hx of congenital heart disease, hx of IE or heart tx with valve dz
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Risks for dissection?
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HTN, connective tissue d/o, 3rd trimester, coarc, bicus AV, Turner's, trauma, cocaine/meth, syphilis, tobacco
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Connective tissue d/o that increase risk for dissection?
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Ehlers-Danlos, Marfan, Lupus, Ciant cell arteritis, Cystic medial necrosis
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Classification of dissection?
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DeBakey 1- ascending + distal, 2- a only 3- d only
Stanford A- includes a B- d only |
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Tx of dissection?
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esmolol to HR of 60 and nitroprusside to systolic of 100 or single agent labetalol
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Dx of thrombosis of prosthetic valve?
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acute CHF, muffling of prosthetic heart sound, hypotension, embolic phenomenon
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Symptoms of mitral stenosis?
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D.O.E., hemoptysis, orthopnea, PND, fatigue, emboli, arrhythmias
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Most common cause of AS?
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bicuspid (<65), calcium (>65), rheumatic dz
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The most common reason for failure to pace?
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oversensing
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Findings of CHF in order of appearance?
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cephalization -> hilar congestion, kerley-B, frank edema
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Most common type of dissection?
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proximal (Stanford A or DeBakey I or II)
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Treatment of chest pain from mitral valve prolapse?
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beta blocker
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Adult blood volume?
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70 ml/kg
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Successful placement of transvenous pacer on EKG is?
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ST elevation
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Janeway? Oslers?
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J- nontender macules on fingers, palms, soles
O- tender nodules on volar aspect of fingers |
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Most common complication of mitral stenosis?
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a-fib
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