Cardio Flashcards
when do you treat bradycardia?
treat bradycardia when there are not syx, then use atropine and follow with Epi or Dopa and if not response then you pace them
whend oyou treat first degree AV block
first degre AV block is just an icnreased PR interval and is treated when QRS is long
what is it called when PR is lon
long PR is a first degree heart block and is only treated wth QRS is long as this indicates slow conduction elow the AV node
What heart block (1,2 (I or II)) do you treat
Only treat type 2 degree 2 heart block as it progresses to third degree heart block
what is type II, mobitz ii herat block
no change of PR with dropped beats, it progresses to third degree so oyu treat it with pacemaker
What is diff between type I and type II mobitz physio
Type I is due to transient delay in AV node versus type II which is due to conduction delay below the AV node and therefore progress to third degree you only treat type II mobtiz second degree block as it is not a conduction isse in the AV node
What is SSS
tachy and brady arrhtymia which is MCC for pacemaker placement
How is stable sinus tachy treated?
With observation or vagal maneurvers or IV adenosine
when is IV adenosine and vagal maneuvers used in sinus tachy?
Use IV adenosine or vagal maneuvers in stable tachycardia, versus DC conversion in unstable tachy
drug of choice for supraventricular stable tachycarrhtymia?
IV adenosine
Unstable supraventricularly sinus tachy
DC convert.
Who gets anticoag in afib
do CHA2DS2VASc and 1-2 get warfarin in afib
what does Afib cause?
Afib causes dilated cardiomyopathy
how is dilated cardiomyopathy of afib prevented
rate control reverses afib cardiomyopathy with RVR
How is wafarin necrosis treated
warfarin necrosis is treated with d/c warfarin and adding vitK then bridging with heparin until the necrotic lesions heal
what causes atrial flutter
atrial flutter is due to a reentrant circut around the tricuspid annulus with saw tooth appearance
how is atrial flutter treated
treat atrial flutter same as afib, rate and rhythm control and cardiovert if unstable
common rate control drug?
diltizaem and verapamil are common rate control blockers
what do you suspect retroperitoneal hematoma
in MVA with vague backpain and some weakness
what do preatrial complexes look like?
Look different than normal P waves and also cause irregular rhtyhm, but P waves are seen. Reduce alcohol and cigarettes and only treat if symptomatic
What does AV-node tachy look like
it is increased conduction throught he node so there is normal conduciton below the AV node which means it is narrow complex and the P wave is often burried
how is AVNRT traeted?
Rapid WRS with P wave buried is IV adneosine or bagal maneuvers with cardioversion if unsable
what drugs are AV blockers
BB, diltiaezem, verapamil, adenosine
how is WPW treated?
WPW is due to conduciton outside AV node so ther proainadme and ibulitilide are sued
How is VT treated
stable is adenosine, unstable is cardiovert
What does VT look like
VT is wide complex tachycardia
What is a common use of amiodarone
amiodarone and lidocaine are commonly used in VT
When do you do Defrib
Pulseless VT and VF you defrib
Why is hyponatremia a bad sign in CFH
hyponatremia means there is excessive activation of RAA by the kidney due to malperfusion and is a bad prognostic sign as this can also worsen remodels
what is a normal EF > 55%
EF >55%
How is constrictive percarditis treated?
Due to fibrosis of the pericardial sac, you just remove the sac with pericardiectomy if refractory to diuresis
Prolonged tacharrythmia like AF.RVR leads to what?
Prolonged tachyarrhytmia causes cardiomyopathy and you treat by controlling valve
What type of effect does chronic inflammation have on the heart
chronic inflammation leads to AL (MM) or AA (RA/IBD/TB) restrictive cardiomyoapthy wiht normal chamber size but thickened wall.
What liver disease causes heart dysfunction
Remember that hemochromatosis often causes iron deposition in the myocardium
+ stress test what common med used
Aspirin/anti-plt NOT anticoag (protect against plaque rupture)
What does variant (prinzmetal) show on EKG
it shows ST depressions
Dual effects of dypradimole?
Antiplatelets and coronary vasodilator causing coronary steal syndrome
Best enzyme for reinfarct
CKMB is the best enzyme for reinfarct
best and msot senstiive enzyme
troponin I
In suspected MI and no dissection, what is give immediately
Give ASA right away as this decreases mortality in MI and stabilizes the plaque and prevents more formation
Why does acute limb ischemia happen post-MI
it commonly happen in LAD MI due to emboli that are ARTERIAL and cause PPPPP – treat with heparin and get echo to see where thrombi in the heart is coming from (YOU NEED ECHO TO EVAL THROMBUS)
Acute pericarditis post MI causes what?
Acute pericarditis causes pleuritic chest pain post-MI
Why does ventricular anerysm occur months after infarct
ventricular aneurysm occurs month after infarct due to cardiac remodeling of thin, fibrotic tissue and presents with Q waves and acute STEMI on EG
What complication of MI (that isn’t Dressler) Commonly happens months later?
Ventricular aneurysm happen smotnhs later
What type of nephritis does analgesics cause
Papillary calcificatin/damage and tubulointerstitial nephritis is secondary to chronic analgesic use
Long term analgesics, WBC casts, papillary necrosis due to?
Tubulointerstitial nephritis from analgesic use
Classic signs of interstitial nephritis
a person who just started a drug and gets rash/eosioniphilia in their urine and s/s of nephritis with WBC casts
When do you see a waterbottle heart and hard to palpate PMI
pericardial effusion
when do you go right to pericardiocentesis in pericardial effusion
if patient is unstable
Common complication of RHD
atrial fibrillation
What other murmus improves with preload beside HOCM?
MVP improves with more preload as it causes the myocardium to stretch and approx the leaflets better
HOw can a young person have angina who is female
bicuspid aortic valves acuse angina in young people
when is there pulsus parvus et tardus
pulsus parvus et tardus ia d elaye dand weak carodtid upstraoke and a split S2 commonly in aortic stenosis
when do you see parvus et tardus
AS
How is aortic stenosis treated
AS is aortic replacement (calcification)
when do you see water hammer pulse and head bob
water hammer pulse and head bob in aortic regurg
why water hammer pulse and head bob in aurtoci regurg
regurg causes increased stroke volume then the regurg sucks it out
what is a common cause of aortic regurg
a common cause of aortic regurg is bicuspid aortic valve
mitral stenosis common complication
atrial fibrillation is a common complicaiton of mitral stenosis
foreigner with hemoptysis and afib consider?
mitral stesnosis
how is mitral stenosis treate
balloon valvotomy
Holosytolic murmur increasing during inspiration?
100% sensitive for tricuspid regurgitation
Aortic dissection dx
Bedside TEE then CT with contrast if no C/I to it (good renal fucntion)
Other than volume, why do elderly get orthostatics commonly
elderly have an imparied baroreceptor sensitivity and are often volume depleted (BUn Cr ratio)
What does fibromuscular dysplasia affect?
Fibromuscular dysplasia affects NOT just renal arterires, but carotids, vasculature or arteries anywhere it is systemic, not just renal
Is FMD inflammatory or atherosclerotic?
FMD is NON inflammatory NON athersclerotic that affects any vasuclautre in the body not just kidney and so syx can vary
Diffuse ST elevation everywhere and a PR depression with pleuritis pain?
Acute pericarditis
Diastolic heart disease go
EF normal (50-55%) with a history of HTN/infiltrative disease, radiation
Syncope with a h/o recent MI or heart disease/valve disease with no prodrome or seizre/postictal confusino
In recent heart disease with syncope or valve disease that causes cardiac manifestations first thought in a syncopal episode is cardiogenic due to arrhythmia
What CHADSVASC score needs Warfarin
4 or higher
Odd signs of cholesterol embolism (other than skin mottling) in labs after cath/vasc surgery?
Eosinophilia, hypocomplementemia with CNS/ocular and kidney invovlement in s/s
When do you defibrillarte?
In VF or pulseless VT
Risks for PAC?
Smoking and tobacco
Tx for PAC
stop smoking and tobacco
cause of PAC
different foci in atria with odd/dipped P waves and some feelings of palps due to smoking and tobacco rarely preceding afib
Diff between PAC and afib
P waves in PAC and none in afib, both can cause rythm irregularity
When is S4 heard acutely
S4 is often heard acutely during MI
when is S4 heard chronically
S4 is heard chronically due to stiff ventricles
WHy do you stop statins with muscle pain and high CPK
avoid renal rhabdomyolysis
why does CCB amlodipine cause edema
dilation of precapillary arterioles
how is CCB edema prevented
prevent CCB edema with ACEi/ARB which dilated the post venou capillary and reduce the hydrostatic pressure responsible for it
What does prolonged QRS indicate in heart block
Prolonged QRS (not just long PR without drop in first degree block) suggests a block in conduction below the AV node needs more evaluation
