Cardiac Flashcards
Types of stress testing:
ECG
Echo
Nuclear medicine
Unit of measure for exercise stress testing:
Metabolic equivalents (METS)
What is 1 MET?
Eat, dress, use toilet, walk around the house
What is 4 METs?
Do light work around the house like dusting or washing dishes.
What is greater than 10 METs?
Participate in strenuous sports.
Labs for CAD?
CBC- to detect anemia, infection, platelet function
CMP- renal/liver disease (for use when prescribing medications)
Lipids- baseline risk
Creatine kinase (CK)- used to measure muscle enzymes- baseline for the use of statins
TSH- presence of arrhythmias or other causes of ischemia
High-sensitivity CRP and homocysteine- risk but evidence suggests these are not helpful
This is angioplasty with possible stenting?
Percutaneous coronary intervention
This is reconfiguring the patients blood flow with the patients arteries or vein grafts?
Bypass surgery
Risk factors for metabolic syndrome (presence of 3 or more):
Waist circ: greater than 40inches males and 35 inches female Triglycerides greater than 150 Low HDL level BP over 130/85 FBG over 200
Large box in ECG strip =
O.20 s
Each small box in ECH strip =
0.04s
Five large boxes in ECG strip =
1s
The PR interval is:
From the beginning of the p wave to the beginning of the QRS complex
A normal PR interval =
0.12-0.2 s
The QRS interval starts with:
Deflection away from the PR interval, continues to end of QRS complex
What does the QRS interval respresent?
The time taken for an impulse to spread down the bundle branches and purkinje fibers through the ventricles
Usual length of QRS complex is:
0.04-0.12
This represents the entire time taken for electrical depolarization and repolarization of the ventricles.
QT interval
Normal QTc is less than
0.44
What are the inferior leads?
II, III, AvF - look from bottom up
What are the septal leads?
V1, V2 - look at ventricular septum
What leads are lateral?
V4, V6 - look at axillary line
What are anterior leads?
V3, V 4
Sinus rhythm with a rate greater than 100 bpm and less then 160-180 bpm.
Sinus tach
This is present when there is a sinus rhythm with variability in the cycle lengths between successive p waves.
Sinus arrhythmia
Complete stopping of p wave firing that results in a long pause and a complete skipped beat.
Sinus arrest
P waves originate in various locations (3 or more), rhythm may be irregular but with p waves before each QRS
Multi focal atrial tachycardia
Complete loss of normal atrial function. Rhythm is irregularly irregular.
A fib
P wave is circulating through the atrial with predictable pattern of flutter waves and regular falling QRS complexes.
Atrial flitter
AV node fires independently, absence of p wave ( or inverted p wave)
Premature junctional contraction
Complete loss of p wave functioning, av node is back-up pacemaker, narrow qrs with absence of p waves
Junctional dysthymia
3 or more PVCs
Vtach
Mag deficiency implicated so often associated with alcoholism
Tosades
Every impulse is conducted to the ventricles, but duration of AV conduct is prolonged greater than 0.2.
1st degree AV block
Progressive lengthening of PR interval with loss of QRS.
2nd degree AV type 1, Mobitz 1, wenckebach
Blocked p waves varying degrees, without progressive lengthening.
2nd degree AV block, type 2
P waves completely dissociated from QRS, requires pacemaker
3rd degree AV heart block
ST elevation in leads 2, 3, and aVF indicate:
An acute inferior infarct
ST elevation in leads 1 and aVL is characteristic of:
An acute lateral wall infarct
St elevation in leads v3 and v4 is present in:
An anteroapical infarct
St elevation in leads 1, aVL, v5, and v6 is indicative of:
An acute anterolateral infarct
St segment elevation in v1 and v2 is characteristic of:
An acute anteroseptal infarct
St segment elevation in some of all of the precordial leads is characteristic of:
An acute anterior wall infarct
This is defined as a complex clinical syndrome that can result from any structural or functional cardiac disorder that impairs the ability of the ventricles to full or eject blood.
Heart failure
This again is defined as a clinical syndrome that is characterized by specific symptoms (dyspnea and fatigue) in the medical history and signs (edema, takes) on the physical exam.
HF
This is a problem with contraction; EF decreased ( less than 50)
Systolic heart failure
This is a problem with relaxation; EF is preserved.
Diastolic heart failure
Symptoms and signs of right-sided heart failure?
Symptoms: SOB/DOE, fatigue, GI, epistaxis
Signs: weight gain, edema, ascites, hepatomegaly, elevated JVP, plus HJR
Signs symptoms of left-sided heart failure:
Signs: SOB/DOE, fatigue, PND, orthopnea, cough
Signs: rales/crackles, tachycardia, s3/s4 gallop, displaced PMI, cool extremities
Aha/acc stages of heart failure:
At risk:
A- high risk for developing HF
B- asymptomatic LV dysfunction
Heart failure
C- past or current symptoms of HF
D- end-stage HF
These are indicated for all patients with current or prior symptoms of HF and reduced LVEF who have evidence of fluid retention.
Diuretics and salt restrictions
Addition if these is recommended in selected patient with moderately severe to severe symptoms of HF and reduced LVEF who can be carefully monitored for preserved kidney function and normal potassium concentration.
Aldosterone antagonist i.e. spironolactone
These are recommended for all stable patients with current or prior symptoms of HF and reduced LVEF unless contraindicated.
Beta-blockers bisoprolol, carvedilol, and SR metoprolol succinate
The addition of a combo of these is reasonable for patients with a reduced LVEF who are already taking an ACEI and BB for symptomatic HF and have persistent symptoms.
Hydralazine and a nitrate
What is the most common cause of systolic heart failure?
Coronary artery disease
What medication has not shown survival benefit in patients with systolic heart failure?
Digoxin
Which antihypertensives are not good for HF?
CCB
What 12 lead changes occur with acute myocardial ischemic event?
Ischemia will be st depression and t wave inversion. It will ultimately become st elevation
