Cardiac Flashcards
Sinus tachycardiaSinus tachycardia
> 100 bpm
Can occur in normal individuals with exercise, emotions, pregnancy, caffeine***
There’s probably going to be a question like “Tina has a high HR after drinking coffee. What’s the deal?” And the answer is Sinus tachycardia
Paroxysmal supraventricular tachycardia
an episode that begins and ends abruptly during which there are very rapid and regular heartbeats that originate in the atrium or in the AV node
Atrial flutter
irregular beating of the atria
Atrial rate 250-350 bpm
Atrial fibrillation
occurs when the normal rhythmic contractions of the atria are replaced by rapid irregular twitching of the muscular heart wall
Increases with age
No P waves (little blip before QRS complex)
CHADS2 Score (5)
risk of stroke in patients with non-rheumatic atrial fibrillation (AF), since AF can cause stasis of blood in the upper heart chambers, leading to the formation of a mural thrombus that can dislodge into the blood flow, reach the brain, cut off supply to the brain, and cause a stroke.
CHF HTN >140/90 Age >75 Diabetes Stroke (2 pts)
0 = aspirin/or nothing 1 = aspirin or warfarin >2 = warfarin
Wolff-Parkinson-White Syndrome
congenital abnormal (extra) conducting fibres which accelerate the transmission of impulse from the atria to ventricles
Bundle of kent
Premature ventricular contraction
a ventricular contraction preceding the normal impulse initiated by the SA node
-associated with hypoxia, electrolyte abnormalities, and hyperthryoidism
Ventricular tachycardia
A rapid heart rhythm in which the electrical impulse begins in the ventricle (instead of the atrium), which may result in inadequate blood flow and eventually deteriorate into cardiac arrest.
SUDDEN DEATH
Torsades de Pointes
“Twisting of points”: your ECG looks like that one Arctic Monkey’s album cover
Basically, your ECG is a mess because the electrical conduction in the heart is **y
most frequent cause of sudden death
Ventricular fibrillation
Ischemic heart disease
poor blood supply to the heart via the coronary arteries
MC cause of cardiovascular comobidity and mortality
2M : 1F
Fam hx, hyperlipidemia, HTN, DM, cigarette smoking
Patient has chest pain that does not change with body position or respiration. What’s the deal
Coronary artery disease
Chronic stable angina
Ischemic heart disease due to an imbalance between oxygen supply and demand in myocardium
Decreased myocardial supply causes: atherosclerosis, vasospasm, tachycardia, anemia
Increased myocardial demand causes: hyperthryoidism, aortic stenosis
Retrosterna chest pain, tightness, left arm/jaw/neck pain
3 e’s: exertion, emotion, eating
Acute coronary syndrome
Ischemic heart disease with exercise or at rest
Acute coronary syndrome shows ST segment [ Or ], while chronic stable angina shows ST segment [ ]
Elevation or depression; depression
T or F: hypertension symptoms are not usually present
True–the “silent killer”
Congestive heart failure
Clinical syndrome caused by inability of the heart to pump enough blood
- left- or right-sided
- systolic or diastolic
Caused by ischemic hd, htn, alcohol, idiopathic
Exertional dysnpea is the earliest symptom of [ ]
Heart failure
Systolic heart failure
Recall: systolic is when blood is emptying from ventricle
SHF: heart relaxes but can’t contract–mm strength loss so ventricles can fill but can’t eject properly
Diastolic heart failure
Recall: diastolic is when blood fills ventricle
DHF: contract but can’t relax–> ventricles can’t fill with enough blood but can contract and eject blood
Acute pericarditis: most common etiology
Idiopathic
Followed by infectious, post-myocardial infarction, post-surgical
Acute pericarditis clinical triad
Chest pain + pericardial friction rub + ECG changes
Dilate cardiomyopathy and major risk factors
Dilation and impaired systolic function of one or both ventricles
Rf
- family history (60%)
- alcohol (20-30%)
- cocaine
Best initial test for dilated cardiomyopathy
Echocardiogram–shows chamber enlargment
Most common cause of sudden cardiac death in young athletes
Hypertrophic cardiomyopathy–genetic variant (1/500 to 1/100 in general population)
***usually asymptomatic
Management: avoid ALL COMPETITIVE SPORTS 😬
Restrictive cardiomyopathy
Impaired ventricular filling in a non-dilated, non-hypertrophies ventricle due to factors that decrease myocardial compliance (e.g., fibrosis)
In what condition would you hear a “crescendo-decrescendo systolic ejection murmur radiating to carotid”?
Aortic stenosis
In what condition would you hear an “early decresendo diastolic murmur at left lower sternal border or right lower sternal border” best heard when sitting or leaning forward
Aortic regurgitation
In what condition would you hear a “mid-diastolic rumble at the heart’s apex” best heard in left lateral decubitus position?
Mitral stenosis
In what condition would you hear a “holosystolic murmur at apex, radiating to axilla/mid-diastolic rumble”?
Mitral regurgitation
In what condition would you hear a “diastolic rumble at the 4th intercostal space”?
Tricuspid stenosis
In what condition would you hear a “holosystolic murmur at the left lwoer sternal border accentuated by inspiration”?
Tricupsid regurgitation
In what condition would you hear a “systolic murmur at 2nd left intercostal space accentuation by inspiration, pulmonary ejection click”?
Pulmonary stenosis
In what condition would you hear a “early diastolic murmur at left lower sternal border” AND “diastolic murmus at the 2nd and 3rd left intercostal space increasing with inspuration”
Pulmonary regurgitation
In what condition would you hear a “mid-systolic click, mid to late systolic murmus at apex accentuated by valsalva or squat-to-stand”?
Mitral valve prolapse
Sudden onset tearing chest pain that radiates to bacK + difference in blood pressure between r and l arms
aortic dissection
True vs false aortic aneurysm
TA: involves all vessel wall layers (intima, media, adventitia)
FA: not all layers, but blood can collect between media and adventitia
Best diagnostic test for aortic aneurysm
Abdominal ultrasound
Classic triad of ruptured AAA
Back/abdomen pain + hypotension +pulsatile abdominal mass
What is an acute arterial isshemia (how long before med management)
Acute occlusion of a peripheral aa w/o history of claudication
Urgent management required (skeletal mm can tolerate 6hr of ischemia before irrevesabilie damage occurs)
Where is acute arterial ischemia mc
lower e> upper e.
risk factors of acute arterial ischemia
arrhythmia endocarditis arterial aneurysms chronic Pad Previous grafts hypercoagulatble states
triad for suspected arterial occlusion
Pain
Pallor
Pulseless
main risk factors of chronic arterial occlusion/insufficiency
- Atherosclerosis
- smoking
- DM
- old age
Chronical arterial occlusion clinical fx
- Claudication (pain w exersion, usually calfs, relieved by rest, reproducible)
- Critical limb ishemia (rest pain, night pain, tissue loss, ABI
