Cardio Flashcards
CHF findings on CXR
Kerley B-lines Vascular redistribution Cardiomegaly Peribronchial cuffing Perihilar infiltrates Pleural effusion
Galactin-3-mediated heart failure
Galectin-3 instigates fibrosis after cardiac ischemia or MI –> a/w heart remodelling, increased stiffening of heart which reduces cardiac output = heart failure
Pulmonary capillary wedge pressure in cardiogenic pulmonary edema
> 25mmHg
Pulmonary capillary wedge pressure in ARDS-induced pulmonary edema
<18mmHg
Cheyne-Stokes respirations
Triggered by hyperventilation and hypocapnia
Form of periodic breathing in which central apneas and hypopnea alternate with periods of hyperventilation –> waxing and waning of tidal volume
PE on ECG
Sinus tachy New RAD Complete or incomplete RBBB Dominant R wave in V1 (RV dilatation) S1Q3T3 pattern Deep S in lead I Q wave in lead III Inverted T wave in lead III
Tx for MI
B-MONAA + PCI/thrombolysis
Betablocker
Morphine
O2
Nitro (beware in RH infarction ie. inferior or posterior)
Antiplt (ASA 320mg + Clopidogrel for PCI or Ticagrelor if more invasive)
Anticoag (UFH if PCI, LMWH if thrombolysis)
PCI if door to balloon time <90 min and within 12h of symptom onset
Thrombolysis (Alteplase) if no C/I and within 12h of symptom onset
Septal MI
V1, V2
LAD
Anterior MI
V3, V4
LAD
Anterolateral MI
V5, V6
LAD
Inferior MI
II, III, aVF
RCA (Lead III ST elevation > Lead II, ST depression in I and AVL)
LCx (ST elevation in II is equal to that in III + ST segment depression in V1-V3)
Lateral MI
I, aVL
LCx
Posterolateral MI
V7, V8, V9
RCA
Normal QTc length in men and women
Men: <450
Women <460
Hypertrophic cardiomyopathy P/E
Double apical pulse (forceful LA contraction against highly noncompliant LV)
Carotid bifid pulse (rises quickly b/c increased velocity of blood through LV outflow tract into aorta, then declines in mid-systole as gradient develops)
Increased murmur on Valsalva
HOCM tx
Main goal is symptomatic relief
Beta blockers = reduce ventricular contractility, increased ventricular volume, compliance and reduce pressure gdt across LV outflow tract
AVOID drugs that REDUCE preload (ie. ACEi, diuretics, nitrates)
HOCM mostly affects ___ side of heart
Left
Left sided murmurs increase by conditions that increase _____ and decrease by conditions that decrease ______
Increase by increased preload
Decrease by deccreased preload
Ie. Aortic stenosis murmur is increased by rapid leg raising/squatting, but is decreased by valsalva/standing
3 characteristics of WPW syndrome on ECG
Shortened PR interval (<0.12s) Slurred upstroke of R-wave Broadened QRS (>100ms)
HOCM characteristics on ECG
T wave inversion ST segment depression Pathological Q waves Conduction delay LAD LAE
Debakey aortic dissection classifcation
BAD
I = both ascending and descending
II = ascending only
III = descending only
Stanford aortic dissection classification
A = ascending +/- descending B = descending only
Stanford A aortic dissection tx
Medical preferred (HTN mgmt) unless ruptured
Stanford B aortic dissection tx
Surgery
CHADS score
Stroke risk assessment in AFib pt CHF (1) HTN (1) Age >/=75 (1) Diabetes mellitus (1) Stroke/TIA (2)
1 : OAC needed depends
>/=2 : OAC
If CHADS 0 and NO CAD OR arterial vascular dz, NO ASA needed
Meds used in cardiac arrest algorithm
Epi 1mg IV q3-5min
Amiodarone 300mg IV (for VT/VF that’s unresponsive to shock, CPR and vasopressor)
1st degree AV block
PR interval >200ms
CONSTANT
No tx required
2nd degree AV block: Mobitz Type 1 (Wenkebach)
PR interval progressively increases until failed conduction
Usually A/W AV node disease
2nd degree AV block: Mobitz Type 2
Constant PR, either normal or prolonged with RANDOM failures
Usually A/W His Bundle disease
Worse than Type I
3rd degree AV block
Complete AV dissociation