03a: PCI and EKG Flashcards
Cardiac cath may be beneficial in Angina Class I/II patients under which circumstances?
- Intolerant to anti-angina meds
2. Occupation high risk (ex: pilot)
List the general categories of diseases in which diagnostic cardiac catheterization is indicated.
- Coronary a disease
- Valvular disease
- Cardiomyopathy
- Congenital disease
List the complications/risks of cardiac cath related to contrast agents.
- Anaphylaxis
2. Nephrotoxicity
T/F: Death, MI, stroke are all risks of cardiac cath procedure.
True
The limitation of balloon angioplasty is:
high rate of restenosis
Exposed (bare-metal) stent struts are a nidus for (X) until (Y) of the stent occurs. For this reason, patients are treated (Z) therapy for about a month after procedure.
X = clot formation Y = endothelialization Z = antiplatelet
The main late complication of bare-metal stents is:
In-stent stenosis (due to SM hyperplasia)
Drug-eluding stents are embedded with paclitaxel. What does this drug do?
Chemotherapy agent that interferes with MT function (reduces SM hyperplasia)
Drug-eluding stents are embedded with sirolimus. What does this drug do?
Immunosuppressant (reduces SM hyperplasia)
Main limitation of drug-eluding stents:
Time to endothelialization is prolonged (1 year instead of 1 month); extends the time during which the stent is prone
to thrombosis
In which patients has CABG been proven more efficacious than PCI?
- Left main stenosis over 50%
- 3-vessel disease (RCA, LAD, LCX)
- 2-vessel disease (LAD and another) with reduced EF
- Diabetes with multi-vessel disease
What are the risk factors associated with acute renal failure during cardiac cath procedure?
- Dehydration
- Hypotension
- Renal insufficiency
- High contrast dose
- Diabetes Mellitus
T/F: Balloon angioplasty has higher rates of repeat revascularization than CABG.
True
What are the criteria for a Q wave to be pathological?
- Width greater than 1 small box
- Height greater than 25% of QRS
- Seen in 2 contiguous leads
Which are the Limb Leads?
I, II, III
Which are the Augmented Leads?
aVF, aVR, aVL
Which are the precordial Leads?
V1-V6
The “High Lateral” Leads are (X) and these regions supplied by (Y) artery.
X = I, aVL Y = Circumflex
The “Inferior” Leads are (X) and these regions supplied by (Y) artery.
X = II, III, aVF Y = RCA
The “Septal” Leads are (X) and these regions supplied by (Y) artery.
X = V1, V2 Y = LAD
The “Anterior” Leads are (X) and these regions supplied by (Y) artery.
X = V3, V4 Y = LAD
The “Lateral” precordial Leads are (X) and these regions supplied by (Y) artery.
X = V5, V6 Y = Distal LAD, RCA or Lateral Circumflex
Normal PR interval
3-5 small boxes (120-200 ms)
Normal QRS interval
Under 2.5 small boxes (90 ms)
Normal QT interval
Under 11.5 small boxes (460 ms)
MEASURE TO END OF T-WAVE
Criteria for LBBB
- Wide QRS
- V1: absent R, prominent S
- V6: broad, notched R
RBBB criteria
- Wide QRS
- V1: rabbit ears
- V6: wide, slurred S wave
LVH Voltage criteria
- aVL: R over 11 mm
- Lead I: R over 15 mm
- S in V1 + R in V5/6 equal 35 mm
LVH Cornell criteria
S in V3 + R in aVL over 24 mm (men) or 20 mm (women)
Sick Sinus Syndrome (SSS) is also known as (X). List three examples of manifestations of this disorder.
X = SND (Sinus Node Dysfunction)
- Inappropriate rest bradycardia
- Chronotropic incompetence
- Tachy-Brady syndrome (ex: a-fib overrides SA Node)
SA node is diseased and exhibits chronotropic incompetence. What does that mean?
Node fails to increase impulse frequency when stimulated by X or SNS
Patient with A-fib experiences periods of syncope when tachyarrhythmia suddenly stops due to prolonged period of (X). What is the culprit of this phenomenon?
X = asystole
Diseases SA Node results in prolonged recovery period after A-fib stops
List the most common intrinsic etiologies that cause SA Node dysfunction
- Fibrosis (age-related)
- Ischemia (CAD)
- Surgical trauma
- Infiltration (sarcoidosis, amyloidosis)
List the most common extrinsic etiologies that cause SA Node dysfunction
- Drugs that suppress pacemaker (b-blockers, CCB)
2. Metabolic
2o Mobitz Type I: block occurs in (X) part of conduction system. Treat with (Y).
X = AV Node Y = exercise or Atropine
2o Mobitz Type II: block occurs in (X) part of conduction system. Treat with (Y).
X = His-Purkinje Y = permanent pacemaker
Junctions escape rhythm presents as (narrow/wide) QRS. And ventricular escape rhythm?
Narrow;
Wide
