Cardio Block Two "Not" From JJ's Doc Flashcards
What is the Canadian CV classification criteria
1- only strenuous/prolonged activity causes angina
2- angina from +2 blocks of walking/emotional stress
3- angina from 2 or less blocks
4- inability to do activity, possible angina at rest
What is the NYHA classification of CV Dz
1- normal PT doesn’t cause Sxs
2- comfortable at rest, activity causes Sxs
3- limited activity, less than ordinary PT causes Sxs
4- inability to do activities w/out Sxs, possibly at rest
What are the 4 Sxs the NYHA criteria looks for in Class 1?
Define Osler’s Sign
Dyspnea, Fatigue, Angina, Palpitations
Calcification of radial artery causing fictitiously elevated BP in elderly PTs
What are the criteria for OHOTN?
What part of this criteria is most sensitive?
> 20mm SBP
10mm DBP
HR inc 30 BPM
HR most specific, implies low volume
Pulse Pressure Equation
What does a wide/narrow PP mean?
PP= SBP-DBP
Wide- inc CO, dec peripheral resistance
Narrow- dec CO, inc peripheral resistance
Define Pulsus Paradoxus
What can cause it?
Inspiration causes SBP to drop 10mmHg or more
Tamponade, Constrictive pericarditis, obstructed airway, SVC obstruction, COPD
Define Pulsus Alternans
Beat to beat alteration in PP amplitude w/ dip in SBP due to alternating LV contraction force/severe dysfunction
Define Pulsus Parvus et Tardus
Slow uprising of carotid upstroke from severe AS
Define Pulsus Bisferiens
Double wave form from AS and AR combining
Define Spike and Dome Pulse
Double carotid impulse from HOCM
Characteristics of Osler Nodes
Characteristics of Jane Way lesions?
Osler- painful nodes
Jane- painless
What type of skin finding on PE indicated PT may have hemachromatosis
What are Roth Spots associated with?
Browning of the skin
Infective endocarditis
What are copper wires lesions(A/V nicking) associated with?
What else may be seen in the eyes?
Chronic HTN
Soft and hard exudates
What are the causes of a wide pulse pressure?
What are the causes of a narrow pulse pressure?
Inc CO from AR, HTN, Fever, Anxiety, Thyrotoxicosis (High output HF)
Dec CO from CHF, Shock, Hypovolemia, MI, Cardiomyopathy, Hypothryoid (Isolated Diastolic Hypetension)
What causes a pulse beating predominantly in LE but absent in UE is caused by ?
What is the normal location and size of PMI?
Aortic dissection
5ICS at mid-clavicular line 10cm or less from midline, 2-3cm in diameter
What causes a quiet S2?
What causes a loud S2?
A/P stenosis
PHTN (P2) or Systemic HTN
What causes a loud S1?
What causes a quiet S1?
High LA pressure from early MS
1* Block Calcified MV/Late MS, CHF Severe AR, Occasional MR
Wide fixed spit S2 is associated w/ ?
What are 4 causes of soft heart sounds?
ASD
Low CO
Obesity
Emphysema
Pericadial effusion (muffled= tamponade)
What are the only two things that cause opening snaps?
What causes ejection clicks?
MS or TS
AS or PS
What causes mid-systolic click?
What two things cause friction rubs?
MVP or TVP
Pericarditis or Ventricular Systole
How would an atrial myxoma present on PE?
Inspiration augments all R sided murmurs except ?
Expiration augments ?
Opening snap ONLY when PT bends over
Pulmonary ejection click
AR- best heard on full exhalation while leaning Fwd
What are the 3 pansystolic murmurs?
What are the continuous murmurs?
VSD, MR, and TR
Venous Hum and PDA
What are the four systolic ejection murmurs?
AS, PS, HOCM, ASD
What are the different waves of JVP mean?
A: atrial contraction, precedes carotid pulse
X: atrial relaxation
C: bulging TV during RV systole; can be felt on carotid in neck
X prime: descent of base of heart during ventricular systole
V: passive atrial filling against closed AV valve
Y: rapid atrial emptying following opening of AV valve after carotid pulse is felt
Loss of the “a wave” is due to ?
What causes absent venous pulses?
A-Fib, Atrial stand still
RHF/CHF, SVC obstruction, Tamponade
What causes Giant A Waves?
What causes Cannon A Waves?
Contraction of atrium against inc resistance (RVH, PS, TS, PHTN)
Contraction of atria against closed TV due to AV dissociation (3* Block)
What causes Systolic Venous Pulsations (C-V Waves)?
What causes a Sharp Y Descent
Regurgitation of blood into venous system w/ ventricular contraction in TR, causes rapid Y
Increased venous pressure, Constrictive Pericarditis
Define Y > X Phenomenon
How is rate measured on an EKG?
Sharp Y descent from increased venous pressure in constrictive pericarditis
Each small box= 0.04 sec
Each large box= 0.2 sec
If an EKG rhythm is normal, how is the rate obtained?
How is it obtained if the rate is irregular?
Dividing 300 by number of large squares between two R waves
Average ventricular rate over 10sec
RVH criteria on EKG
QRS < 0.12sec R/S ration >1 in V1 R/S ration <1 in V5, V6 R >7mm in V1 RAD >90* Asymmetric ST segment depression and T wave inversions in V1 and V2 (RV strain pattern)
LVH criteria on EKG
S in V1/2 + R in V5/6 >35mm S in V1/2 or R in V5/6 >25mm R in aVL >11mm R in I+S in III>25mm LAD >-30* w/ slightly wide QRS LV strain in I, aVL, V4-6 LAE
How do you ID P Pulmonale on an EKG?
How is P Mitrale ID’d?
RAE
P wave >2.5mm in leads 2, 3 or aVF
P wave >0.11s in 1,2,aVL, V4-6
Large biphasic P-wave in V1 w/ deep terminal part that’s one square wide and deep
Notched P wave w/ inter peak interval >0.04sec in 1, 2 or aVL
DDx of tall R waves in V1 include ?
RVH HCM, septal Post-MI WPW Duchenne Dextrocardia
What are the DDx for ST segment elevation changes?
Early repol= normal variant Acute/Post MI Prinzmetal's angina Acute pericarditis Ventricular aneurysm LBBB
What are the DDx for ST segment depression changes?
Ischemic angina Non-Q wave MI Acute posterior MI (V1 and 2) L/RVH w/ strain Digitalis effect Hypo K or Mg L/RBBB, WPW
What is the progression of the T waves during an MI on EKG?
Hyper acute T waves
ST depression
ST elevation
Q wave
An MI of the anteroseptal, anterior lateral or extensive anterior area involves ? vessel
and seen in ? leads
LAD
V1, V2
V3, V4
1, aVL, V1/3-6
An inferior MI involves ? vessel
A lateral MI involves ? vessel and is seen on ? leads
RCA
2, 3, aVF
Circumflex
1, aVL, V5-6
A posterior MI involves ? vessel and seen in ? leads?
An infarct in the R Ventricle involves ? vessels and seen in ? leads
RCA- inf MI
CFLX- post MI
V6, Mirrored in V1-2
RCA
V4-6R on R sided EKG
What EKG changes doe hypo/hyper Ca cause?
Being hyperCa makes PT more likely to have ?
Hyp= Prolonged QT interval Hyper= Shortened QT interval
Hypercoagulation to PE
What are the EKG changes of hyperkalemia
Peaked T waves Flat P Wide QRS Long PR Elevated ST
What are the EKG changes of hypokalemia?
Flat T
U Waves
ST depression
Prolonged QT interval
What EKG changes does hypothermia cause?
Sinus brady
Slow A-Fib
Muscle tremor artifacts
Osbone/J-wave deflections
What is the definition/criteria for low voltage on EKG?
What issues can cause low voltage findings to be seen on EKG?
QRS less than 10mm in precordial lead, <5mm in limb
Pericardial effusion COPD barrel chest Hyothyroidism Dilated cardiomyopathy Myocarditis- 2wks post illness, PT present ill, fatigues and cyanotic
What effect does Digoxin have on EKGs?
Na, K, Ace Inhibitor
Causes Sign Wave
Toxic levels= AV blocks
What 3 drug classes can cause prolonged QT intervals and U waves?
Quinidine
Phenothiazines
TCAs
When are Holter Monitors used?
What if these Sxs aren’t occurring often enough?
Sxs occurring daily or hourly
Event monitoring- good for picking up arrhythmia or palpitations
Echos can be usd to determine ? 6 facts of the heart?
LVEF Chamber size/thickness Valve morphology Pericardial effusion Wall motion abnormalities Complications of acute MIs
What is the Gold Standard test for detecting and quantifying CADz?
How is this info obtained?
Dx: Coronary Angiography
Prognosis: Post-MI
Injection of radiopaque dye into arteries from percutaneous femoral catheter
What stress tests have the highest to lowest sensitivities?
Stress Echo, Nuclear perfusion/Nuclide angiography, Treadmill (90, 80-85, 65-70%)
What are the 3 types of arrhythmias?
Brady: <60; sinus brady, sinus arrest, escape rhythm (junction, ventricle)
Conduction delay: 1-3*, Fascicular block, BBB
Tachy: >100;
Irregular= A-Fib (MAT, flutter, A/VPBs)
Regular= Narrow (SVT, Flutter, AVNRT, WPW)
Wide= SVT w/ aberrancy/BBB, V-Tach
1* Block Criteria
Constant PR interval elongation >0.2sec, all beats conducted through ventricles
2* Block Criteria
Type 1 W= AV blockage, progressive PR elongation until QRS dropped, Sx= atropine Tx
Type 2 M= His/Purkinje blockage, QRS’ dropped at irregular intervals
3* Block Criteria
No P-wave produces QRS response from complete AV dissociation; P-waves march through
Define Stokes-Adams attacks
Syncope w/ brief cardiac arrest
Narrow complex tachycardias are at ? rates
150bpm during A-flutter
140= A-Fib
110= MAT
How is A-Fib treated?
+100bpm= rate control w/ BB, Verapamil, Digoxin
Anti-Coag w/ Warfarin
What are the steps for PSVT Tx?
Carotid massage
Valsalva
Adenosine if stable
Electricity if unstable
If V-Tach originates from LBBB then what is the site?
If it’s a RBBB pattern, where is the site?
RV
LV
How is V-Tach w/ Sx palpitations treated?
What are the indications for pacemakers?
BBs
SA node dysfunction Sx bradycardia Mobitz Type 2 3* complete block Sx carotid sinus hypersensitivity
How is WPW w/ A-fib Tx?
What is the #1 drug give to PTs w/ chronic ischemic heart dz to decrease morbidity and mortality?
IV Procainamide
BBs to decrease O2 demand
What drug is first line therapy in ischemic heart Dz?
What drug needs to be avoided
BBs- decrease mortality, HR/afterload and increase coronary perfusion
Acebutolol- increase demand
When are Nitrates used in ischemic heart Dz?
Sxs control but not impact on survival
Dec heart work and O2 requirements
Venous dilation= dec pre/after loads
Why are CCBs used in ischemic heart Dz?
Dec after load
Dec HR
Dec contractility
Coronary dilation
What do all ischemic heart dz PTs need to be on?
What drugs are used for dyslipidemia?
Statins
Fibrinates
When do PTs need to have a PTCA?
Vessel occluded by 70% or more:
Angina, MI, Post-MI or presenting w/ bypass graft stenosis
NOT in left main Dzs
Spectrum of ACS encompasses what 3 Dzs?
Unstable angina
Acute MI
Sudden death
How are PTs w/ ischemic heart Dz managed?
O2
Hospital/monitor
Bed red
Anti-anginal meds: Nitro, BBs, CCBs if BB c/i or refractory Sxs, ECASA, Heparin/Plavix, Angiography, IABP
Who is more likely to have silent MIs?
When do we use thrombolytic therapies?
DM, Elderly, HTN PTs, post-heart transplants
STEMI PT and can’t get/do PCI
Stopped at
1:27:00 Review Lect
