Cardiac Flashcards
Causes of 1st degree heart block
normal variant increased vagal tone inferior MI myocarditis hypokaelmia AV nodal blocking drugs: b blockers; ca channel blockers; digoxinl amiodarone
Causes of long QT
Idiopathic Acquired including Drugs: antiarrhythmics (incl. amiodarone; sotalol); TCA; Antipsychotics (risperidone); antibiotics (macrolides); antifungals (traizoles); antihistamines MI Hypokalemia myocarditis cardiopmyopathy hypothermia
Causes of mobitz type 2
Anterior MI Idiopathic fibrosis of conduction system cardiac surgery inflammatroy conditions (myocarditis, rheumatic fver) Autoimmunie (SLE, SS) Hyperkalemia Drugs: beta blockers, calcium channel blockers, digoxin, amiodarone
Causes of mobitz type I
drugs: beta blcoekrs; ca channle blockers; digoxin increased vagal tone inferior MI myocardtitis Post cardiac sugery
Causes of non-cardiogenic pulmonary oedema
ARDS high altitude plumonary eedema neurogenic pulmonary edema (narcotic OD; PE;Eclampsia; TRALI) in no-cardiogenic pulmonary oedema its factoris other than high pulmonary capillary pressure that are responsiblt for protein and fluid accumulation in alveoli
Causes of VF
- Structural Myocardial disease: infraction/ischemia; cardiomyopathy; HOCM; myocarditis; myocardial trauma 2. Metabolic/Electrlyte derangements: hypoxemia of any cause; hypo/hyper K; hypo Ca; hypo Mg; severe acidosis 3. Conduction abnormalities: prolonged WT; WPW and AF together; channelopathies 4. Drugs/Toxins; digoxin OD; TCA OD; 5. Environmental : electrocution; severe hypothermia
Complications of ECMO
hemmorraghe; vascular damage; thromboembolism; infection; thrombocytopenia (HITS); VA ECMO - cardiac thrombus VA ECMO: inadeqaue upper body/coronary/ brain perfusion VA ECMO: pulm hemmorhage
Complications of IABP
infection hemorhage vascular damage- arotic perforation thromboembolic phenomena renal failure failure to assist cardiac function balloon rupture
Contraindicatins to ECMO
irresivble cardiac or respiratroy failure anticoagulation contra-indicated likley futility (MOF; GVHD; Age; prolonged CPR; advanced malignancy)
Contraindications to IABP
significant Aoritc regurgitation Aortic aneurysm/ dissection significant PVD tortuous aorta uncontrolled sepsis uncontrolled bleeding
Contraindications to thrombolysis in PE
intracrania neoplasm; intracranial surgery/trauma < 2mths; internal bleedgin last 6/12, Hx of hemmorhagic stroke, sever HTN; surgery last 10 days;bleeding diathesis; thrombocytopenia; non-hemm stroke last2/12;
Diagnosis of infective endocarditis
2 major or 1 major +3 minor, or 5 minor criteria major criteria: positive BC for infective endocarditis with typical organisms positive echo for IE (oscialting mass on vlalve or adjacent structure; abscess; new dehiscence of prosthetic valve) New valvular regurg Minor crtiera: predisposition (heart condtion; IVDU); Fever>38; vascular phenomena (i.e.emboli); immunologic phenomena (glomerulonephritis; osler nodes; roths spots); microbiological evidence (BC positve not typical for IE); echo findings consitent with IE but does not meet major criteria
ECG features of LVH
left axis deviation left atrial enlargement Swave in v1 + R wave in V5/V6 >35 mm
ECg features of RVH
right axis deviation V1- dominant R wave V5/V6 dominant S wave
Features of left atrial enlargement on ECG
bifid p wave in lead II (2 peaks) bipahsic p wave in V1
Features of right atrial enlargement
peaked p wave in inferior leads (>2.5mm) andV1/V2 (>1.5mm)
Indications for ECMO
VV ECMO: respiratroy failure PaO2/FiO2 <7.2 VA ECMO: refarctory cardiogenic shock ;cardiac arrest; failure to wean from bypass; bridge to cardiac transplant
indications for surgery in infective endocarditis
hemodynamic instability abscess recurrent emoboli fungal or Qfever (coxiella burnetti)
List investigations that help distinguish between cardiogenc and non-cardiogenic pulmonary edema
PCWP and CI- in cardiogenic pulmonary edema PCWP>18 mmH Serum BNP Echo PICo and EVLW (raised in both types) - can use pulmonary vascular permeability index to distinguish (raised in non cardiogenic; essentially te ratio of EVLW to Pulm blood voulme)
List techniques/measurements available to assess the circulation status of a patient
Physical examiation- warm hands, UO, mentation Vital signs ABG- oxygenaion and lactate blood pressure repsonse to fluid challenge or leg raise Invasive monitoring: PICCO; LIDCO; FloTrac/Vigileo PAC Echocardiography -TTE; TOE Other methods: Impedance cardiography; gastric tonometry; trasncutatneous doppler
mechanical strategies for supporting myocardial function
PEEP
IABP
Pacemaker
ECMO
VAD
Potential indications for IABP
cardiogenic shock - although negative recent RCT intractable angina low CO post bypass (failure to wean post bypass) Cardiac surgery wth 2 of: left main>70%, LVEF<40%, unstable angina, reop bridge to heart transplant high risk PCI
Prognosication following OOH arrest
Type of rhythm time to ROSC time to start CPR no sedation or NMBD required After 72 hours: GCS33 at 3 days) (EEG evidence of poor prognosis: burst surpresion; genealised seizures- less useful)
Risks of cardioversion
failure need for sedation hypotension myocardial damage (usually transient) conduction abnormalities embolic phenomena burns damage to pacemaker
Signs of severe Aoti stenosis
plateau pulse aortic thrill S4 splitting of S2 LVH- displaced apex beat LVF- late sign
What is mobitz type 1
2nd degree heart block where PR interval lengthens and then drop every nth beat Treatment rarely needed
What is mobitz type 2
2ns degree hear block where PR length is normla, but fail to conduct every nth PR interval Lesions is in bundle of His- always pathological
