Cardio Block Two "Not" From JJ's Doc Flashcards by brandon lovin

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

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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

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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

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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

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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

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Define Pulsus Paradoxus

What can cause it?

Inspiration causes SBP to drop 10mmHg or more

Tamponade, Constrictive pericarditis, obstructed airway, SVC obstruction, COPD

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Define Pulsus Alternans

Beat to beat alteration in PP amplitude w/ dip in SBP due to alternating LV contraction force/severe dysfunction

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Define Pulsus Parvus et Tardus

Slow uprising of carotid upstroke from severe AS

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Define Pulsus Bisferiens

Double wave form from AS and AR combining

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Define Spike and Dome Pulse

Double carotid impulse from HOCM

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Characteristics of Osler Nodes

Characteristics of Jane Way lesions?

Osler- painful nodes

Jane- painless

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What type of skin finding on PE indicated PT may have hemachromatosis

What are Roth Spots associated with?

Browning of the skin

Infective endocarditis

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What are copper wires lesions(A/V nicking) associated with?

What else may be seen in the eyes?

Chronic HTN

Soft and hard exudates

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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)

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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

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What causes a quiet S2?

What causes a loud S2?

A/P stenosis

PHTN (P2) or Systemic HTN

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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

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Wide fixed spit S2 is associated w/ ?

What are 4 causes of soft heart sounds?

ASD

Low CO
Obesity
Emphysema
Pericadial effusion (muffled= tamponade)

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What are the only two things that cause opening snaps?

What causes ejection clicks?

MS or TS

AS or PS

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What causes mid-systolic click?

What two things cause friction rubs?

MVP or TVP

Pericarditis or Ventricular Systole

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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

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What are the 3 pansystolic murmurs?

What are the continuous murmurs?

VSD, MR, and TR

Venous Hum and PDA

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What are the four systolic ejection murmurs?

AS, PS, HOCM, ASD

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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

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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