Cardio 2 Flashcards
What is pericardiectomy?
“Pericardial stripping” most effect surgical procedure for managing large pericardial effusions.
Pulsus paradoxus is defined as a decline of greater than _______ in (sys/dias)_________pressure during inspiration.
10-12 mmHg
systolic pressure
Weak pulse during inspiration
What causes secondary myocarditis?
Non viral pathogens, meds, chemicals,
SYSTEMIC LUPUS
What is the BPM for sinus bradycardia?
<60 bpm.
A patient presents with an ABI of 0.4 and is symptomatic of PAD, what should you do?
REFER ASAP!! Emergent.
A patient present with Ventricular Tachycardia, but is determined to be chronic and sustained, what would you do next?
Treat cause.
Consider chemical or electrical cardioversion
Three main steps for treating rheumatic fever.
Bed rest
Penicillin
Anti-inflammatory agents
Pharm treatment of LONG QT?
Beta Blockers.
Mexilitine
Disorder of ventricular depolarization resulting in a LONG QT interval
LONG QT SYNDROME
What does a high dose of dopamine do?
Peripheral vasoconstriction. >10 mcg/kg/min
True or False: electrical cardioversion restores sinus rhythm in 75-90% of patients
True.
It is an initial shock of 100-200 Joules in synchrony with the R wave. If unsuccessful, juice it up to 360 Joules
What is the most common cause of Acute Endocarditis?
Staph aureus
Atrial flutter is commonly associated with________
COPD!
What is the vasopressor of choice for anaphylaxis?
Epinephrine
Patients with PVD usually have coexisting _____________disease.
Coronary Artery
Acute inflammatory pericarditis is usually _____________in duration.
Less than 2 weeks
Are statins helpful in HF?
No benefit has been shown.
What is a bacterial or fungal infection of the valvular or endocardial surface of the heart?
Acute/Subacute Endocarditis
What is obstructive shock?
Obstruction to the outflow due to impaired cardiac filling and excessive afterload.
Antiarrhytmics maintain sinus rhythm in about ________% of patients.
50
Nerves and Lange-Nielsen Syndrome is associated with ________ syndrome.
LONG QT
What might you see on a chest x-ray with dilated cardiomyopathy?
Enlarged LEFT VENTRICULAR shadow
For a patient with PAD, pain in the calf, and reduced popliteal and pedal pulses, where might the level of obstruction be?
Femoral or popliteal
What happens to mitral valves during dilated cardiomyopathy?
Regurgitation.
Will hear holosystolic murmur.
What might you see on an ECG with Wolf-Parkinson-White? (Antidromic)
Abnormally long QRS.
DELTA wave
Short PR
200-300 bpm
What is the treatment for ACUTE Ventricular tachycardia?
THIS IS A CODE!!
Cardioversion/ VT algorithm meds
More than 3 consecutive PVCs (WIDE QRS!)
Ventricular Tachycardia
The junctional rhythm rate is usually______________bpm
35-60
What are common symptoms of pericardial effusion?
Chest pain.
Syncope and light-headed
Palpitations
Cough
What is happening to the heart in hypertrophic cardiomyopathy?
Myocardium concentrically hypertrophied leading to:
THICKENED and STIFF ventricle.
Can’t FILL-DIASTOLIC HEART FAILURE.
What is the definitive therapy for cardiac tamponade?
Removal of pericardial fluid.
What are the two main key points for diagnosing heart failure?
History and Physical Examination
________is an anti-arrhythmic used to treat atrial______ and atrial________ in patients with heart failure.
Digoxin
Flutter
Fibrillation
What might you see on a chest x-ray with heart failure?
“Kerley B lines” (fluid in lungs)
Enlarged heart
What is the Venturi effect?
Building muscle in inner septum in LV pushes up against valve walls and increases afterload. (Blood forced through small opening).
CRESCENDO-DECRESCENDO murmur.
Many patients with Multifocal Atrial Tachycardia have ________ _________.
Severe COPD.
We know A fib causes a 5 fold increase in stroke risk, but what other conditions are we concerned about?
Heart failure, dementia, increased risk of death
Also precipitates hypotension, myocardial ischemia, or other myocardial dysfunction
What causes dilated cardiomyopathy?
Generally Idiopathic.
Genetic Mutation
Infection
Alcohol Abuse-STRONGLY RELATED!
What is the ejection fraction of heart failure with “reduced ejection fraction” (or systolic heart failure)?
< or = to 40%
Second line meds for AVNRT.
Diltiazem
Beta Blockers
*slow down the AV node
What are extrinsic causes of sinus node dysfunction?
Drugs, hypothyroidism, electrolyte abnormalities, autonomic dysfunction.
Ischemic ulceration of toes, secondary to local trauma that does not heal, is suggestive of _________disease.
Peripheral Vascular
In which kind of heart failure have effective therapies been identified?
Reduced Ejection Fraction (Systolic HF)
What is restrictive cardiomyopathy?
Muscles in heart are stiff and less compliant. Can’t stretch.
Less blood can fill into ventricle-less can pump out.
HEART FAILURE. (Diastolic)
ECG of Supraventricular Tachycardia
NARROW QRS
Regular
P wave embedded
NOT atrial fib.
What are some symptoms of PVCs?
Skipped beat
Dizziness
More frequent AT REST
Go away with EXERTION
What is the traditional definition of systolic BP in hypotension?
90 or less
What drug might cause bradycardia?
Digoxin
CCBs and BBs
What tests should you do if PVCs are frequent and/ or hemodynamically symptomatic?
Evaluate with:
ECHO
STRESS TESTING
+/- Electrophysiology evaluation
Trigger of AVNRT
Caffeine
In diagnosing shock you may see elevated __________concentrations of higher than _____mmol/L
Lactic Acid (b/c of inadequate 02 delivery)
2
Examples of WIDE REGULAR TACHYCARDIA.
Ventricular Tachycardia
SVT with aberrant conduction
AVRT with antidromic conduction
__________is the most effective diuretic in the treatment of heart failure.
Furosemide
What is the most commonly infected valve in endocarditis?
Mitral
Tricuspid in IV drug users
PVC’s usually go away during__________.
Exertion
___________is the cytokines that mediates septic shock.
TNF-alpha
This type of shock occurs when the intramuscular volume is depleted relative to the vascular capacity as a result of blood loss or dehydration.
Hypovolemic Shock.
How does long standing hypertension lead to heart failure?
Arterial pressure makes it harder to pump blood into systolic circulation, to compensate the left ventricle hypertrophies (to contract with more force), which increases muscle mass leading to greater 02 demand.
The coronaries are squeezed, which reduces 02 saturation of ventricles. More Demand and Less Supply!
Muscles have weaker contractions. Leading to heart failure.
Pitting edema can be a sign of________sided heart failure.
Right
What are Class III antiarrhythmics?
Potassium channel blockers
What happens to walls of myocardium in dilated cardiomyopathy?
Get thin and weak.
Weak contractions-lower stroke volume
Biventricular congestive heart failure.
What is the accessory pathway in WOLF-Parkinson-White Syndrome?
Bundle of KENT
Is hypertrophic cardiomyopathy a systolic or diastolic heart failure?
Diastolic
____________heart failure is abnormal cardiac relaxation, stiffness, or filling.
Diastolic
Ventricular rupture can cause ________________shock.
Cardiogenic
What might you find on the feet of patients with endocarditis?
Osler nodes: tender subcutaneous nodules found on the distal pads of the digits.
What is the most common type of cardiomyopathy?
Dilated
Two major signs of pericardial effusion.
Pericardial friction rub
Pulses paradoxes
What causes Rheumatic Fever?
Autoimmune inflammatory response that develops 2-3 weeks after a PHARYNGEAL group A beta-hemolytic streptococcal infection.
What are the minor jones criteria for diagnosis of rheumatic fever?
Fever.
Polyarthralgias (inflammation of joints, morning stiffness)
Reversible prolonged PR interval
Elevated ESR or CRP (erthryocyte sedimentation and C-reaction protein)-detect inflammation in the body
What is the accumulation of too much fluid in the double-layered, sac like structure around the heart?
Pericardial Effusion
What is the targeting resting heart rate for Afib?
<80bpm
What happens to the pulse pressure in cardiogenic shock?
Decreases.
Management of SIck Sinus Syndrome
ATROPINE
Bicuspid aortic valves, rheumatic fever, IV drug use, and sclerotic aortic valves are risk factors for___________.
Endocarditis
Long PR interval, LONGER, EVEN LOOOONGER…dropped.
Second Degree AV Block Mobitz Type I (Wenckebach)
Rhythm arising from the AV junction.
Junctional Rhythms
Bradycardia with P wave ALWAYS followed by QRS. (multiple options)
Sinus brady
First degree AV
Sinus pause/arrest
What is the cornerstone of therapy for PAD?
Lifestyle Management!
Smoking
Diabetes
Walking program
What happens during squatting with hypertrophic cardiomyopathy?
Systemic Vascular Resistance Increases-Making it harder to eject blood (inc. afterload).
This INCREASES BLOOD IN VENTRICLE, making it LESS obstructed.
Murmur LESS INTENSE.
What should all patients with cardiac tamponade receive?
O2
Volume expansion with blood plasma.
Bed Rest with leg elevation (increase venous return).
What is the criterion standard for confirming group A streptococcal infection?
Positive Throat Culture.
Can also have a Rapid Strep or ASO
How do you treat all hemodynamically unstable AV blocks?
ATROPINE! (increases firing of SA node)
Treat cause
What happens to the PR interval in rheumatic fever?
Prolonged
A reduced ejection fraction, increased end diastolic volume, and decreased contractility are signs of ________cardiac dysfunction.
Systolic
Anaphylactic shock is a type of __________shock.
Distributive
What is the ejection fraction of “Diastolic heart failure” or Preserved Ejection Fraction?
> or = to 50%
What are AV nodal blocking agents used to manage Afib?
Beta Blockers
CCBs
Digoxin-when combined with above.
What is exercise testing used for?
Detection of ischemic heart disease.
Risk stratification.
An abnormal pattern of breathing, deeper and faster followed by decrease and a temporary stop.
Cheyne Stokes
Diastolic heart failure is more common in (men/women)________
Women
Diltiazem is what kind of drug? What is used to treat?
CCB
High BP and angina
*relaxes blood vessels in the heart, so it doesn’t have to work as hard
What category of AFib terminates spontaneously or for a duration of time after intervention that happen with variable frequency?
Paroxysmal
Symptoms of acute pericarditis.
Palpitations
Low-grade intermittent fever
Shortness of breath.
Cough
Dysphasia
____________shock is characterized by loss of vascular tone.
Distributive
What is third spacing?
When too much fluid moves from the blood vessels in the interstitial space-the nonfunctional area between cells. Can cause edema, reduced cardiac output, and hypotension.
What’s a major difference in neurogenic claudication and intermittent vascular claudication?
Pain triggered by unsupported standing;relieved by leaning on something “shopping cart sign” (neurogenic claudication)
_______sided heart failure is associated with paroxysmal nocturnal dyspnea.
Left
What is the goal of rate control treatment of A fib?
Symptom management and prevention of tachycardia-mediated cardiomyopathy
What are the causes of sinus bradycardia?
Increased vagal influence on the normal pacemaker.
Physical fitness.
Meds: Beta Blockers
The rate of ventricular tachycardia is _________bpm
> 120 (Typically 160-240). RAPID!
Pre-excitation syndromes involves a ________accessory pathway.
Congenital
In Left sided heart failure blood gets backed up in the________
Lungs
What is the main goal in management of hypovolemic shock?
Restore volume lost.
Hemorrhagic shock>blood substitutes
Non hemorrhagic shock>isotonic crystalloid in IL increments.
This medication may improve pain and walking distance in patients with PAD
Cilostazol
In term of the CHADS VASc score, what is >2 mean?
High risk, anticoagulation.
What is the initial test of choice for acute pericarditis?
ECHO (but shows limited view of pericardium)
What should be performed on all patients with suspected purple tissue pericarditis?
Pericardiocentesis (fluid analysis and culture)
What is the most common chronic arrhythmia?
Afib
Ventricular tachycardia is ______ or more consecutive ventricular beats
3
Anaphylaxis is caused by type I, _________mediated hypersensitivity response.
IgE
What might you find in a blood test in myocarditis?
Elevated Troponin and Creatine Kinase levels.
How does percutaneous balloon pericardiotomy work?
Creates a pleura-pericardial direct communication, allowing for drainage of fluid into the pleural space.
The most common viral cause of myocarditis is________.
Coxsackie B.
1 in 4 people over ____ years old can expect to develop Afib in their lifetime
40
What are causes of nontraumatic hemorrhagic hypovolemic shock?
GI bleed
AAA rupture
Ectopic pregnancy rupture
In septic shock, the primary insult is due to systemic vasodilation and therefore an (inc/dec) ______in afterload.
Decrease
What is the NORMAL vertical height of the external jugular vein pulsation?
<3cm above the sternal angle.
Upon physical exam you notice a JVD and peripheral edema, with an irregular and rapid pulse.
Afib.
How do you treat PVCs?
Not much you can do.
HEALTHY LIFESTYLE CHANGES.
MAYBE use Beta-blockers or Calcium Channel Ablation
Ventricular tachycardia has a ________QRS complex
Wide
What is a normal hearts ejection fraction?
Around 55-65%
In terms of CHADS VASc score, what does 1 mean?
moderate risk, anticoagulant, ASA or no therapy.
What is the HR for SIRS?
> 90
Afib causes a ______fold increase risk of stroke.
5
Why do you do a CT or MRI for acute pericarditis?
Rule out any extra cardiac disease.
How do you treat NONSUSTAINED CHRONIC VT?
CORRECT UNDERLYING CAUSE
CONTROL RATE AND DECREASE RECURRENCE W/ Beta Blockers and Calcium Channel Blockers
Radio frequency ablation if refractory
Pacemaker
Not a true block, more of a delayed or slowed AV conduction.
First Degree AV Block
What med could use to manage bradycardia?
Atropine
Ejection fraction is usually (is/is not)________preserved in diastolic heart failure. Why?
IS
ABNORMAL CARDIAC FILLING (not contractility) Less blood overall getting pumped into body, but not less % that is actually in the heart.
Someone suddenly dies waking up to a new alarm clock. What causes this?
Long QT syndrome
______ and _______diuretics both decrease preload on the heart but are not associated with improved survival in patients with congestive heart failure.
Loop and Thiazides
Common symptom of AVNRT.
Faint-lose adequate BP to perfuse to brain. SOB and chest pain.
What are Class I antiarrhythmics?
Fast Sodium Channel Blockers
What is something really important to not miss in sinus tachycardia?
BLOOD CLOTS IN LUNGS!!
Thought to be either an ESCAPE RHYTHM b/c other pacemakers aren’t working OR due to INCREASED AUTOMATICITY.
Accelerated idioventricular rhythm
What kind of heart sound does pericarditis make?
Leather rubbing on leather. Scratching or grating.
Most common cause of palpitations in patients with structurally normal heart beats.
AVNRT
EKG of ventricular tachycardia has ________QRS and BPM of ______
WIDE QRS (more than 3 PVC)
>
Can’t ID a P wave
What is an inflammation of the heart muscle caused by an acute viral infection or a post viral immune response?
Myocarditis
What does atropine do?
Increases the firing of the SA node and conduction through the AV.
Opposes actions of vagus nerves
What meds do you use to treat CONGENITAL long QT syndrome?
Beta Blockers
Mexiletine (sodium channel blocker)
What is hypertrophic cardiomyopathy?
Asymmetric thickening of walls of bottom 1/2 of heart with disorganization.
What do you do if there is an escape rhythm in accelerated idioventricular rhythm?
Treatment contraindicated since it’s the ONLY THING KEEPING THE HEART GOING.
Is hypertrophic cardiomyopathy autosomal dominant or recessive?
Dominant
What is the main genetic mutation causes LQTS?
LQT1 (40 to 55%)
If Wenckebach is symptomatic and hemodynamically unstable, what might you do?
ATROPINE!
Temporary Cardiac pacing.
(If stable, just monitor with pads)
Signs of hypovolemic shock.
Tachycardia.
Hypo
Oliguria
Pale Skin
What is the target ambulatory rate for Afib?
<100 bpm
For a patient with PAD, if pain is found in the calf, thigh or hip, where might the level of obstruction be?
Aorta or Iliac
What is the pathophysiology of ventricular tachycardia?
REENTRANT DYSRHYTHMIA
SECONDARY TO OR A COMPLICATION OF SOMETHING ELSE.
- ischemia
- dilated cardiomyopathy
- chronic coronary disease
- many more.
What is the best treatment for long term control of a recurrent or very symptomatic PVC?
Electrophysiological studies and catheter ablation.
Anaphylactic shock is a type of ____________shock.
Distributive
How does increased pulmonary blood pressure effect the right side of the heart?
Right Side has to pump harder, which can lead to hypertrophy and ultimately failure.
(I.e. Chronic lung diseases)
Patients with ________disease can present with continuous rest pain that is prominent at night (relieved by standing).
Peripheral vascular
What is the most common pathophysiology of a PVC?
Reentrant circuit, which is typically secondary to a healed MI.
________________heart failure is a dysfunction resulting in cardiac contractile function.
Systolic
What are the 3 categories of Afib and their defining characteristics?
Paroxysmal-terminates spontaneously
Persistent >7 days
Chronic-no treatment to restore.
What are important pieces of patient history with AV block?
Lyme disease
History of heart disease
Cardiac procedures
Level of fitness
What is the most common cause of left sided heart failure?
RIGHT SIDED HF. (Wants you to realize that they are both connected, and both back up systems in the body. )
Beta-blockers are recommended in all stages of (acute/chronic)______heart failure.
Chronic
Incidence of PVC increase with:
AGE
CV disease
Electrolyte abnormalities (K+, Mg++, Ca++)
Pharmacological Rx options for ACQUIRED LONG QT syndrome.
Magnesium Sulfate
Isoproterenol
Lidocaine
Phenytoin
Sodium bicarbonate
HR of Junctional Tachycardia
100-120