Cardio Flashcards
What are the classic ECG findings during an anginal episode? (2)
ST-segment DEPRESSION
T-wave inversion
What is the gold standard for the diagnosis of CAD?
Coronary arteriography
What are the key steps in the medical management of a patient with unstable angina?
β-blocker ASA/anti-coagulate (heparin/warfarin) nitroglycerin O2 (if hypoxic) morphine
(BANO)
Describe how nitrates reduce angina:
- Venodilation causes venous pooling →↓preload →↓myocardial O2 consumption (demand)
- Coronary vasodilation →↑O2 delivery to the myocardium
Describe how each of the following drugs reduces angina:
- β-Blockers
- Nifedipine
- Verapamil
- ↓ Myocardial O2 use, ↓ afterload, ↑ coronary filling during diastole
(↓ O2 demand) (↑ O2 supply) - Coronary arteriolar vasodilation
(↑ O2 supply) - Slows cardiac conduction
(↓ O2 demand)
What intervention is reserved for patients whose angina cannot be controlled medically?
Percutaneous transluminal coronary angioplasty (PTCA)
What is the common presentation of MI?
Crushing retrosternal chest pressure occurring at rest and radiating to left arm, neck, or jaw; diaphoresis;
nausea/vomiting; dyspnea; and anxiety
What is a common physical examination finding during an MI?
S4 gallop
Which are the six life-threatening causes of chest pain that must be ruled out in all patients?
- MI
- Cardiac tamponade
- Pulmonary embolism (PE)
- Pneumothorax (PTX)
- Aortic dissection
- Esophageal rupture
(My Chest Pain Panics All EDs)
What are the classic ECG abnormalities in an acute MI?
3
ST elevation/depressions
Q waves
T wave inversions (past/active)
Which ECG finding is very sensitive and specific for right ventricular infarction?
ST elevation in lead V4
Which coronary artery is likely to be occluded with these ECG abnormalities?
Large R and ST-segment depression in V1, V2
Right coronary (posterior infarction)
Which coronary artery is likely to be occluded with these ECG abnormalities?
Q waves and ST-segment elevation in leads V1-V4
Left anterior descending (anterior infarction)
Which coronary artery is likely to be occluded with these ECG abnormalities?
Q wave in leads I, aVL, V5, V6
Circumflex (lateral infarction)
Which coronary artery is likely to be occluded with these ECG abnormalities?
Q waves and ST elevation in leads II, III, aVF
Right coronary (inferior infarction)
Which serologic markers are typically used to diagnose and follow an MI? (3)
Troponin I
Repeat: Myoglobin > CK-MB
What are the clinical manifestations of right ventricular MI?
ECG inf. changes: Q waves and ST elevation in leads II, III, aVF (RCA) hypotension CLEAR LUNGS + JVD jugular venous distension (JVD) Tricuspid regurgitation
Which medical therapy should be avoided in a patient with a right ventricular infarction?
Nitroglycerin
initial therapy should involve IV fluids to ↑ preload
What arrhythmia has
PR interval >0.2 s prolongation,
often due to increased vagal tone?
Primary (1°) heart block
What arrhythmia has
PR interval gradually increases to the point at which a QRS complex is dropped?
2° Mobitz type I heart block (Wenkebach)
What arrhythmia has
PR interval >0.2 s with occasional dropping of the QRS complex at a fixed interval (ie, 2:1 or 3:1)
2° Mobitz type II heart block
What arrhythmia has
Irregularly irregular pulses and QRS complexes
Atrial fibrillation
What arrhythmia has
Sawtooth appearance of P waves
Atrial flutter
What arrhythmia has
Usually caused by conduction block within the bundle of His
2° Mobitz type II heart block
What arrhythmia has
Complete dissociation between P waves and QRS complexes
3° or complete heart block
What arrhythmia has treatment which includes anticoagulation, rate control, and/or cardioversion.
Atrial fibrillation
What arrhythmia has
Wide QRS complexes not preceded by a P wave
Premature ventricular contraction (PVC)
What arrhythmia has
Normal QRS morphology with a rate of 150-200 beats/min
Paroxsymal SVT
Treatment of hemodynamically UNSTABLE
1. Pulseless V-Tach:
V-Tach with pulse
- Polymorphic VT:
- Monomorphic VT:
- CPR & Defibrillate
- Defibrillate
- Synchronized Cardioversion
Treatment of hemodynamically STABLE patients
in V-tach:
If Refractory Vtach then treat with:
Long term tx of pts with VTach:
pharmacological cardioversion with
antiarrhythmics (amiodarone, procainamide, or sotalol)
Refractory → cardioversion
Long term = Beta blockers first line
Which arrhythmia may be treated with carotid massage or Valsalva maneuver
Paroxsymal SVT
Arrhythmia commonly caused by MI that may lead to hemodynamic instability
V-Tach
practice code with Dr. Meinke
Arrhythmia where treatment with pacemaker is necessary.
Symptomatic 2° Mobitz type II heart block
3° heart block
Sick sinus node syndrome
ECG finding: Short PR interval delta wave Widened QRS P-waves follow QRS
Wolff-Parkinson-White
bypass AV node via Bundle of Kent
Tx: Unstable = cardioversion.
Stable = IV Procainamide
Name four common chest x-ray (CXR) abnormalities in CHF:
- Cardiomegaly
- Cephalization of pulmonary vessels (↑ vascularity in lung fields)
- Kerley B lines (indicating pleural fluid in fissures)
- Pleural effusions
What is the common presentation of pericarditis?
Pleuritic retrosternal chest pain (↑ when supine, ↓ when sitting up and leaning forward), dyspnea, cough, and fever
What serologic test is elevated in rheumatic heart disease? (2)
Antistreptolysin antibodies (ASO) DNAse B
Name the five major J♡NES criteria for rheumatic heart disease:
aside from constitutional symptoms
- Joint pain (migratory polyarthritis)
- ♡ Pancarditis (endo/myo & pericarditis +/- murmurs)
- Nodules (painless, firm on extensors)
- Erythema marginatum (annular, faintly red, non-itchy)
- Sydenham chorea
Acute severe, tearing substernal pain radiating to the interscapular region of the back
aortic dissection
Which examination findings are characteristic of an aortic dissection? (3)
Unequal BP in the extremities
New diastolic decrescendo murmur (aortic regurg)
Widened Mediastinum on CXR
Pain in buttocks and thighs with walking
Aortoiliac occlusive disease
Pain in calves with walking
Femoral-popliteal occlusive disease
Abdominal angina
Chronic mesenteric arterial occlusive disease
Pericarditis presents with
Pleuritic chest pain, fever, leukocytosis
Chest x-ray: pleural effusion ± enlarged cardiac silhouette
Echocardiography: pericardial effusion
pericardial friction rub
List 4 causes of pericarditis
Myocardial infarction (Dressler syndrome) CABG or Percutaneous coronary intervention trauma
pericardial friction rub described as a
scratchy sound between S1 and S2
only heard in ACUTE episodes
Pericarditis improved when ___ and worsens when ___
leaning forward
Laying back
Pericarditis 2/2 SLE treated with
NSAIDs
If you suspect pericarditis what imaging would you get?
Echocardiogram
Dx of Cor Pulmonale
echocardiographic findings:
RV hypertrophy, TR w/ RA enlargement
Definitive dx via:
Right heart catheterization
showing elevated
pulmonary artery systolic pressure (>25 mm Hg)
Lyme disease with cardiac involvement (Lyme carditis) usually presents with ___ on ECG
conduction abnormalities (atrioventricular block)
Cardiac tamponade can occur as a catastrophic complication of acute
aortic dissection
Echocardiography typically shows biventricular enlargement with diffuse ventricular wall hypokinesis.
Viral Myocarditis
___ cardiomyopathy is a diagnosis of exclusion in patients with dilated cardiomyopathy and history of alcohol abuse in whom no other potential causes of cardiomyopathy (coronary artery disease, valvular heart disease) are suspected or identified.
Alcoholic
