Cardio Flashcards
Following ECG changes represent:
ST elevation, T wave inversion, Q waves
ischemic changes (Myocardial Infarction)
_____ is a common cause of atrial fibrillation resulting from left atrial dilation.
Mitral stenosis
✽ Px with acute dyspnea & Pulm Edema on CXR
Distant heart sounds, hypotension, and JVD
Pulsus paradoxus (>10 mm Hg decrease in systemic BP with inspiration).
Diagnosis?
Cardiac Tamponade
2 signs of right-heart congestion
pedal edema
hepatomegaly
2 signs of left-heart congestion
Crackles (pulmonary edema)
Laterally displaced PMI (LV enlargement)
RV infarction
Presents with acute chest pain and hypotension.
Lungs CTAB + Pedal Edema
Ischemic changes on ECG
Diagnosis?
RV infarct
↓ CVP (R sided preload)
↓ PCWP (L sided preload)
are expected in ___ shock.
Septic shock
↑ CVP (R sided preload)
↑ PCWP (L sided preload)
are expected in ___ shock.
Cardiogenic shock
✽ Acute MI → LV Failure → Cardiogenic Shock
✽ Acute MR s/t MI → Cardiogenic Shock
↑ CVP (R sided preload)
↓/– PCWP (L sided preload)
are expected in ___ shock.
Prepulmonary obstructive shock
–Pulmonary Embolism
–TPX
–RV Failure
Pt with new-onset JVD and RBBB are indicative of ___ strain, which is commonly seen in association with __
Right heart strain
Pulmonary Embolism
Cardiovascular changes in the setting of SEPSIS include:
Hypotension
↓ SVR
_ Cardiac Output
_ PCWP (L sided preload)
↑ Cardiac Output
↓ PCWP (L sided preload)
Bradycardia
Hypotension
↑ JVD
Diagnosis?
Complete heart block
- New Right bundle branch block suggests:
- New Left bundle branch block suggests:
- Acute massive PE
- Acute MI
Septic embolization of the lungs is usually associated with right-sided ____
endocarditis
(Px: febrile + tricuspid or pulmonic valve diastolic heart murmur)
Multifocal Atrial Tachycardia (MAT) is often confused with Atrial Fibrillation.
On ECG, both show irregular RR intervals:
1. MAT demonstrates [P-waves]
2. A-Fib demonstrates [P-waves]
- distinct P waves with varying morphology (MAT)
- No P waves (A-Fib)
___ is an SVT usually triggered by acute respiratory illness in patients with underlying lung disease like COPD.
Multifocal atrial tachycardia
✽ Tx: correct the inciting disturbance like managing COPD exacerbation to resolve MAT
___ is the most common cause of cor pulmonale (RHF w/o LHF)
COPD
➣ Other causes: ILD (idiopathic pulmonary fibrosis), OSA, thromboembolic pulmonary vascular disease,
Restrictive Lung Disease (kyphoscoliosis, Obesity).
Mitral stenosis usually occurs s/t rheumatic heart disease and presents with dyspnea, cough, and orthopnea.
Elevation of the left main stem bronchus on CXR indicates [what heart structure change?]
____ is a common CX of MS & can trigger acute decompensated HF
Left Atrail dilation
Atrial fibrillation
Congestive heart failure commonly causes bilateral ____ effusions.
Transudative effusions
↳increased hydrostatic pressure or hypoalbuminemia
↳Pleural pH: 7.40–7.55
➣Normal pleural fluid pH: 7.60
Diffuse ST-segment elevation is consistent with acute
pericarditis
brachial-femoral pulse delay
seen in what vasculature deformity?
Aortic coarctation
↳increased blood flow to the BUE and decreased blood flow to the BLE
- An S3 heard at the apex on end-expiration is consistent with:
- An S3 heard at the left lower sternal border on end-inspiration is consistent with:
- Left ventricular failure
- Right ventricular failure
↳ b/c inspiration increases the volume of blood in the right side of the heart
Wide and fixed splitting of S2 occurs in an atrial septal defect (ASD) which can eventually lead to ___ in adults.
Right-sided heart failure
List 1º & 2º GDMT for Heart Failure
Diuretics
ACE-I/ ARB/ or ARNI (Sacubitril/Valsartan – Entresto)
& Beta Blocker
——-
Spironolactone (MRA)
Dapagliflozin – Farxiga (SGLT2 Inhibitor)
In patients with refractory HF despite optimum pharmacologic GDMT, what is the next step in management?
Device therapy:
Implantable cardioverter-defibrillator (ICD) for 1º or 2º prevention of Sudden Cardiac Death
[in HFrEF or Cardiomyopathy]
Cardiac resynchronization therapy (CRT-D) with Biventricular pacing (aka Biventricular ICD)
[in HFrEF + prolonged QRS]
Advanced heart failure therapies for pts with refractory HF despite optimum therapy may include:
1. Palliative care
2. IV vasodilators
3.
4.
or a Heart transplant.
- IV Inotropes (Milrinone)
- Mechanical circulatory support
–Left Ventricular Assist Device (LVAD)
– Impella Ventricular Support Device
Uncontrolled diabetes with history of CKD = ↑ Cr and ↑BUN results in chronic pericardial effusion s/t
uremia
hemodynamically unstable pt with Beck triad ( ___), pulsus paradoxus (___ during inspiration), and chest pain, all of which indicate cardiac tamponade.
hypotension, distant heart sounds, & JVD
absent pulse during inspiration
Ang II increases GFR by what mechanism?
Constricting Efferent Arteriole
(ACE: Ang II Constricts Efferent)
→ ACE–Inhibitors block this constriction resulting in ↓ GFR
Prostaglandin (made from COX/Cholesterol) increase GFR via what mechanism?
Dialating Afferent Arteriole
(PDA: Prostaglandin Dilates Afferent)
→NSAIDs lower prostaglandin resulting in ↓ GFR
atrial fibrillation can be triggered by ectopic conduction foci, most frequently from the
pulmonary veins
Patients with an accessory atrioventricular bypass tract, as seen in Wolff-Parkinson-White syndrome, may develop a reentrant loop, causing what arrhythmia?
atrioventricular reentrant tachycardia (AVRT)
(Procainamide)
What arrhythmia results from a reentrant circuit formed by 2 separate conducting pathways within the atrioventricular node?
ECG shows regular R-R intervals with P waves typically buried within the QRS complexes (ie, retrograde P wave conduction occurs).
Atrioventricular nodal reentry tachycardia (AVNRT)
The most common cause of atrial flutter is a reentrant circuit around what structure?
Rapid “sawtooth” flutter waves are seen on ECG, and the rhythm may appear regular or irregular.
tricuspid annulus
(Cavotricuspid Isthmus)
Atrial tachycardia + AV block is the most specific arrhythmia for what med toxicity?
digoxin
(from increased automaticity of myocardial conduction and/or increased vagal tone.)
