1) Cardio Flashcards
Area of infarct/Artery if Changes in: II, III, AVF
Inferior Infarct/Right Coronary Artery
Area of infarct/Artery if Changes in: V1-V3
Anteroseptal Infarct/Left Anterior Descending
Area of infarct/Artery if Changes in: V2-V4
Anterior Infarct/Left Anterior Descending
Area of infarct/Artery if Changes in: I, AVL, V4, V5, V6
Lateral Infarct/ Left Circumflex Artery
Area of infarct/Artery if Changes in: V1, V2
Posterior/Right Posterior descending artery
Dx of AMI =
ST elevations of at least `1mm in 2 contiguous leads
Tx of chest pain =
Oxygen, Aspirin, Nitroglycerin unless systolic BP <90 and IV morphine if not relieved by 3 sublingual nitros
Tx of unstable angina, NSTEMI and STEMI should recieve
- Beta-blockers IV (metoprolol, atenolol = selective beta1)
- Heparin IV
- Nitroglycerin IV drip (caution if inferior or posterior MI because may precipitate hypotension)
Goals for PCI
It is superior to primary thrombolysis
- thrombolytics should begin w/in 30 minutes of arrival to arrival
- if PCI is unavailable to patients within 60 minutes of arrival to ED then treatment should begin with thrombollytic agents such as tissue plasminogen activator and streptokinase
BNP levels
<100 in a patient w/ acute dyspnea makes the diagnosis of CHF unlikely
Tx of CHF
1) Oxygen (high flow/CPAP/intubation)
2) Nitroglycerin
3) loop diuretics (IV q 30 min, double dose each time if no response)
4) Morphine (IV q5-10min)
5) Pressors (dopamine IV if systolic 100 and in need of inotropic support)
What is a hypertensive emergency?
Elevated BP w/ signs of end organ damage (brain, heart, kidney, eyes)
-typically occurs when Diastolic is >115-130
Tx of hypertensive emergency
Don’t lower too quickly, want to lower by 25%
-diastolic to 100-115 over hours
(if you lower it too quickly = cerebral or coronary insufficiency)
-Nitroprusside is usually the drug of choice (contraindicated in pregnancy)
-Labetolol (alpha and beta effects)
Others:
-Phentolamine (excess catecholamine states/cocaine, MAOI) etc
-Hydralazine (for eclampsia)
-Nitroglycerine (for ischemia or CHF)
Stanford Classification for Aortic Dissection
A: Involves the ascending Aorta
B: involves the descending aorta
(TEE: can be performed quickly at the bedside, determines type and valvular involvement; Aortography = gold standard)
Tx of Aortic Dissection
IV fluids, blood transfusions
-if unstable = vascular surgery consult
-goal is to maintain systolic BP 100-120mmHg to limit progression of dissection in hypertensive pts
(nitroprusside and beta-blockers or alternatively = labetolol)
AAA dx
Ultrasound
-but to as sensitive in determining if it has ruptured, for this abdominal Ct is better
Tx of AAA
If unstable = immediate surgery and fluid resuscitation
Tx of Occlusive arterial disease
This is a true emergency
- Emergency vascular surgery consult
- IV heparin to prevent further clot extension/further emboli
Treatment of choice is thrombolectomy; alternative = intra-arterial thrombolysis: streptokinase, urokinase, tissue plasminogen activator
Cardiac Tamponade signs=
(Beck’s Triad)
- Muffled heart sounds
- Jugular venous distention
- Hypotension
-Pulsus Paradoxus (fall in SBP >10mmHg w/ inspiration) may be present w/ large pericardial infusion or tamponade
Tx of Cardiac Tamponade
US guided pericardiocentesis
Tx of Pericarditis
- NSAIDS (if viral, idiopathic, rheumatologic, post traumatic)
- IV abx & drainage (if bacterial)
Most common cause of infective endocarditis
HIV and IV drug use now > rheumatic fever
Roth spots =
small white spots on the retina surrounded by hemorrhage
infective endocarditis
Osler nodes=
small tender lesions that form on the fat pads of the finger or toes and represent immune complex deposition
(infective endocarditis)
Janeway lesions=
painless, reddish, macular lesions on the hands or feet
infective endocarditis
Criteria for Dx of Infective Endocarditis
=Duke Criter
Major:
-Persistently + blood cultures
-Positive blood cultures for microorganism known to cause endocarditis
-Positive echogram for endocarditis
-New heart Murmur
Minor:
-Predisposing condition (IVD use, heart valve ban)
-Fever >38.0 on 2 occasions
-Vascular phenomena: stroke, janeway lesions, splinter hemorrhages, myocotic aneurysms, major arterial emboli
-Immunologic phenomena: roth spots, osier nodes, +RF, glomerulonephritis
Microorganims known to cause endocarditis
- strep viridians
- strep bovis
- HACEK group: haemophilus, actinobacillus, cardiobacterium, eikenella, kingella)
- s. aureus or enterococci
Tx of Infective endocarditis
Stabilize hemodynamic status & empiric abx
-Nafcillin and genatmicin = 1st line
(further tx depends on culture results and should go on for at least 4 weeks)
What are the steps to reading an EKG
1) Rate
2) Rhythm
3) Axis
4) Hypertrophy/Morphology
5) Ischemia/Infarction
How to determine rate?
If regular rhythm = 300, 150, 100, 75,60,50
If irregular = Count QRS per 6 sec (30big boxes) x 10
How to determine axis?
Lead I if positive = right side of graph
Lead AVF if positive = bottom of graph
(or find isoelectric lead and know that axis is perpendicular to this)
What are the designations of axis?
Normal = -30 to 90
RAD = 90 to 180
marked RAD = 180 to -90
LAD = -90 to -30
R Atrial Hypertrophy =
Biphasic P wave with front part more positive than the second part is negative
(also has peaked p-waves in lead 2 (>2.5mm))
L Atrial hypertrophy =
Biphasic p wave w/ front part less positive than the second part is negative
(also P wave is notched)
R ventricular hypertrophy
Large R wave in V1
progressively smaller v1-v4
L ventricular hypertrophy
Large S wave in V1
and
Large R in V5
If the sum of S in V1 or V2 + large R in V5 or V6 is >35
