Cardiac 2024 Flashcards
MI, AV blocks, congenital abnormalities, BBB, percarditis, ...
Afib and Aflutter med tx
BB, CCB(diltiazem, verapamil).
Also for Afib- digoxin for allergy to BB and CCB
EKG for afib and aflutter
sawtooth for flutter. smaller sawtooth in afib.
1,2,3 degree heart blocks
1st: prolonged PR interval(>200), every p has a qrs
2nd: dropped qrs
Mobitz 1: prog lengthening PR w/ dropped qrs
Mobitz 2: same length PR w/ occ dropped qrs
3rd: AV dissociation
Causes can be from fibrosis, increased vagal tone, drugs, CAD, nml variant, mitral valve surgeries,
* delay in conduction thru AV node
*poss electrolyte imbalance causes are what
1st degree AV block
hypokalemia and hypomagnesiumia
1st degree AV block symptoms? What is a big risk of having this? tx?
Asymptomatic usually. 3 x risk for Afib, pacemaker if over 300 PR interval and symptomatic
Wenkebach tx
Mobitz 1; usually no tx. Atropine for bradycardia and hypotension, maybe pacing.
Causes can be from increased vagal tone, drugs, nml variant, mitral valve surgeries, MI, HYPERkalemia
mobitz 1, wenkeabach
4 types of afib
- Paroxysmal: self terminating in 7 days, usually 24 hrs, +/- recurrent
- Persistent: fails to self terminate, lasts > 7 days. Requires termination.
- Permanent: persistent AF > 1 year- refractory to cardioversion.
- Lone: Paroxysmal, persistent, or permanent w/out evidence of heart disease.
symptoms in unstable afib
due to hypoperfusion: HYPOtension, altered mental status, refractory CP
tx for unstable afib and aflutter
direct synchronized cardioversion
AV nodal blocking agents
BB, digoxin, CCB
bradycardia related decreased perfusion symptoms
fatigue, dizziness, CP, syncope
-think second degree heart block, mobitz type 1 Wenckebach
TX for symptomatic wenckebach, what if it is persistent?
tx for mobitz type 2
atropine; pacemaker;
type 2: atropine or temp pacing. Progression to type 3 is common so permanent pacemaker is definitive.
AV block commonly at bundle of HIS
mobitz type 2
AV block rarely seen in patients w/out structural heart disease: myocardial ischemia, myocardial fibrosis, myocarditits(LYME), endocarditis
mobitz type 2
avoid atropine in what heart block
it can precipitate 3rd degree heart block
No atrial impulses reach ventricles leading to escape rhythm. More P waves then QRS complexes
3rd degree heart block
causes of 3rd degree heart block
INFERIOR wall infarction, AV node blocking agents, degeneration of conduction system
which AV block often symptomatic? symptoms?
3rd degree. syncope, fatigue, CP, death
tx of 3rd degree heart block
maybe dopamine or adrenaline.
For sure pacemaker
Valves most affected in endocarditis
M>A>T>P
except IV drug use: tricuspid
describe acute bacterial endocarditis
infection of normal valves with virulent organism (eg S. aureus)
describe subacute bacterial endocarditis
indolent infection of abnormal valves with less virulent organism (eg s viridans)
organisms with IV drug related endocarditis
most commonly s aureus(especially MRSA), pseudomonas, candida
describe prosthetic valve endocarditis
early(within 60 days): staph epidermis most common.
late: resembles native valve endocarditis.
PE of endocarditis around body
- Persistent fever
- new onset murmur or worsening of an existing murmur
S: splinter hemmorhages
O: Osler nodes (hands/feet) painful
R: roth spots (eye)
J: Janeway lesions (hands/feet/ashtray)
3 biggest causes of endocarditis
IV drugs/needles, valve replacement surg, dental visits
6 organisms of endocarditis
staph aureus
strep viridans
staph epidermis
enterococcus
HACEK
strep bovis
describe staph aureus in endocarditis
most common cause of acute endocarditis, rapidly progressive, affects NORMAL valves. also common in pts with IV drug use (esp MRSA)
describe strept viridans in endocarditis
most common cause of subacute infective endocarditis; affects DAMAGED valves. part of oral flora(dental procedures)
describe staph epidermis in endocarditis
most common in early prostetic valve endocarditis, especially within 60 days of the procedure
describe enterococcus in endocarditis
seen especially in men over 50 years old with recent history of GI or genitourinary procedure
describe HACEK in endocarditis
Haemophilus, Aggregatibacter, Cardiobacterium, Eikenella, Kingella, Enterococci; all gram neg and hard to culture. Suspect these in endocarditis and neg blood cultures
describe strep bovis in endocarditis
especially in patients with colon cancer or UC
endocarditis blood cultures
3 sets at least 1 hour apart;
labs: leukocytosis, anemia(microchromic, normocytic), increased ESR/rheumatoid factor
left vs right sided emboli from heart
left to other organs(brain, kidney, spleen, heart)
right to lungs
imaging for endocarditis
Get TTE first (transesophageal echocardiogram more sensitive than TTE)
endocarditis, DUKE criteria
2 major OR 1 major with 3 minor, OR 5 minor
describe major criteria (DUKE)
- sustained bacteremia with 2 pos blood cultures by organism known to cause endocarditis
- endocardial involvement: + echo and new valvular regurgitation(AR or MR)
describe minor criteria (DUKE)
- predisposing condition
- fevers>38 degrees or 100.4
- vascular and embolic phenomena(janeway, septic arterial or pulmonary emboli, ICH)
- immunologic phenomena: oslers nodes, roth spots, +RF, acute glomerulonephritis
- blood culture not meeting major criteria
- echo not meeting major criteria (worsening existing murmur)
refractory CHF, persisent or refractory infection, invasive infection, prostetic valve, recurrent systemic emboli, fungal infections
indications for surgery for endocarditis
empiric endocarditis tx: native valve
- anti staph PCN: (nafcillin, oxacillin) plus ceftriaxone 4-6 weeks or gentamycin (aminoglycocides only 2 weeks)
- vanco if needed due to allergy
empiric endocarditis tx: prosthetic valve
vanco plus gentamicin plus rifampin
empiric endocarditis tx: fungal
amphotericin B for 6-8 weeks, often will need surgery
great gram positive coverage
PCN and Vanco
great gram neg coverage
gentamicin, ceftriaxone
Prophylaxis for which procedures to prevent endocarditis
dental, respiratory, and procedures involving infected skin/musculoskeletal tissues
Prophylaxis medications to prevent endocarditis
amox 2 gms 30-60 min before procedure
clinda 600 mg if PCN allergic
Macrolides or cephalexin are other options
4 things to ask if bradycardic pulse
Hypotension, AMS, refractory CP, acute heart failure
bradycardic med tx and exception
atropine 1st line; next is epi infusion or dopamine infusion, pacing
**exception is 3rd heart block- must pace then permanent pacemaker
When left side of the heart malfunctions, what happens?
blood will get backed up in the lungs, you get SOB, body does not get O2 rich blood to the body(fatigue), kidneys getting too little blood(doesn’t make enough urine causing fluid build up in the body[legs]
When right side of the heart malfunctions, what happens?
blood gets backed up from tissues in the body[swelling in feet/LL], sluggish flow of blood and heart failure can lead to blood clots forming in heart, leading to clots in brain to cause a stroke OR clots in legs can travel to lungs
what is a cardiac arrest?
Heart has stopped pumping blood effectively due to an electrical issue, brain not getting enough O2, person unconscious, may not be breathing or breathing abnormally
Beck’s triad
B E C
B: big jugular vein distention
E: extreme low BP (hypotension) C: can’t hear heart sounds, distant muffled heart sounds
**Cardiac tamponade
5 initial symptoms of hypoxemia
restless & confusion, dizziness (syncope), fatigue, SOB, tachycardia