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IPAP > Cardio Block Two "Not" From JJ's Doc > Flashcards

Cardio Block Two "Not" From JJ's Doc Flashcards

1
Q

What is the Canadian CV classification criteria

A

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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2
Q

What is the NYHA classification of CV Dz

A

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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3
Q

What are the 4 Sxs the NYHA criteria looks for in Class 1?

Define Osler’s Sign

A

Dyspnea, Fatigue, Angina, Palpitations

Calcification of radial artery causing fictitiously elevated BP in elderly PTs

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4
Q

What are the criteria for OHOTN?

What part of this criteria is most sensitive?

A

> 20mm SBP
10mm DBP
HR inc 30 BPM

HR most specific, implies low volume

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5
Q

Pulse Pressure Equation

What does a wide/narrow PP mean?

A

PP= SBP-DBP

Wide- inc CO, dec peripheral resistance
Narrow- dec CO, inc peripheral resistance

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6
Q

Define Pulsus Paradoxus

What can cause it?

A

Inspiration causes SBP to drop 10mmHg or more

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

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7
Q

Define Pulsus Alternans

A

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

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8
Q

Define Pulsus Parvus et Tardus

A

Slow uprising of carotid upstroke from severe AS

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9
Q

Define Pulsus Bisferiens

A

Double wave form from AS and AR combining

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10
Q

Define Spike and Dome Pulse

A

Double carotid impulse from HOCM

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11
Q

Characteristics of Osler Nodes

Characteristics of Jane Way lesions?

A

Osler- painful nodes

Jane- painless

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12
Q

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

What are Roth Spots associated with?

A

Browning of the skin

Infective endocarditis

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13
Q

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

What else may be seen in the eyes?

A

Chronic HTN

Soft and hard exudates

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14
Q

What are the causes of a wide pulse pressure?

What are the causes of a narrow pulse pressure?

A

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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15
Q

What causes a pulse beating predominantly in LE but absent in UE is caused by ?

What is the normal location and size of PMI?

A

Aortic dissection

5ICS at mid-clavicular line 10cm or less from midline, 2-3cm in diameter

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16
Q

What causes a quiet S2?

What causes a loud S2?

A

A/P stenosis

PHTN (P2) or Systemic HTN

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17
Q

What causes a loud S1?

What causes a quiet S1?

A

High LA pressure from early MS

1* Block 
Calcified MV/Late MS, 
CHF 
Severe AR, 
Occasional MR
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18
Q

Wide fixed spit S2 is associated w/ ?

What are 4 causes of soft heart sounds?

A

ASD

Low CO
Obesity
Emphysema
Pericadial effusion (muffled= tamponade)

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19
Q

What are the only two things that cause opening snaps?

What causes ejection clicks?

A

MS or TS

AS or PS

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20
Q

What causes mid-systolic click?

What two things cause friction rubs?

A

MVP or TVP

Pericarditis or Ventricular Systole

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21
Q

How would an atrial myxoma present on PE?

Inspiration augments all R sided murmurs except ?

Expiration augments ?

A

Opening snap ONLY when PT bends over

Pulmonary ejection click

AR- best heard on full exhalation while leaning Fwd

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22
Q

What are the 3 pansystolic murmurs?

What are the continuous murmurs?

A

VSD, MR, and TR

Venous Hum and PDA

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23
Q

What are the four systolic ejection murmurs?

A

AS, PS, HOCM, ASD

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24
Q

What are the different waves of JVP mean?

A

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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25
Q

Loss of the “a wave” is due to ?

What causes absent venous pulses?

A

A-Fib, Atrial stand still

RHF/CHF, SVC obstruction, Tamponade

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26
Q

What causes Giant A Waves?

What causes Cannon A Waves?

A

Contraction of atrium against inc resistance (RVH, PS, TS, PHTN)

Contraction of atria against closed TV due to AV dissociation (3* Block)

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27
Q

What causes Systolic Venous Pulsations (C-V Waves)?

What causes a Sharp Y Descent

A

Regurgitation of blood into venous system w/ ventricular contraction in TR, causes rapid Y

Increased venous pressure, Constrictive Pericarditis

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28
Q

Define Y > X Phenomenon

How is rate measured on an EKG?

A

Sharp Y descent from increased venous pressure in constrictive pericarditis

Each small box= 0.04 sec
Each large box= 0.2 sec

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29
Q

If an EKG rhythm is normal, how is the rate obtained?

How is it obtained if the rate is irregular?

A

Dividing 300 by number of large squares between two R waves

Average ventricular rate over 10sec

30
Q

RVH criteria on EKG

A 
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)
31
Q

LVH criteria on EKG

A 
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
32
Q

How do you ID P Pulmonale on an EKG?

How is P Mitrale ID’d?

A

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

33
Q

DDx of tall R waves in V1 include ?

A 
RVH
HCM, septal 
Post-MI
WPW
Duchenne 
Dextrocardia
34
Q

What are the DDx for ST segment elevation changes?

A 
Early repol= normal variant
Acute/Post MI
Prinzmetal's angina
Acute pericarditis
Ventricular aneurysm
LBBB
35
Q

What are the DDx for ST segment depression changes?

A 
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
36
Q

What is the progression of the T waves during an MI on EKG?

A

Hyper acute T waves
ST depression
ST elevation
Q wave

37
Q

An MI of the anteroseptal, anterior lateral or extensive anterior area involves ? vessel
and seen in ? leads

A

LAD
V1, V2
V3, V4
1, aVL, V1/3-6

38
Q

An inferior MI involves ? vessel

A lateral MI involves ? vessel and is seen on ? leads

A

RCA
2, 3, aVF

Circumflex
1, aVL, V5-6

39
Q

A posterior MI involves ? vessel and seen in ? leads?

An infarct in the R Ventricle involves ? vessels and seen in ? leads

A

RCA- inf MI
CFLX- post MI
V6, Mirrored in V1-2

RCA
V4-6R on R sided EKG

40
Q

What EKG changes doe hypo/hyper Ca cause?

Being hyperCa makes PT more likely to have ?

A 
Hyp= Prolonged QT interval
Hyper= Shortened QT interval

Hypercoagulation to PE

41
Q

What are the EKG changes of hyperkalemia

A 
Peaked T waves
Flat P
Wide QRS
Long PR
Elevated ST
42
Q

What are the EKG changes of hypokalemia?

A

Flat T
U Waves
ST depression
Prolonged QT interval

43
Q

What EKG changes does hypothermia cause?

A

Sinus brady
Slow A-Fib
Muscle tremor artifacts
Osbone/J-wave deflections

44
Q

What is the definition/criteria for low voltage on EKG?

What issues can cause low voltage findings to be seen on EKG?

A

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
45
Q

What effect does Digoxin have on EKGs?

A

Na, K, Ace Inhibitor
Causes Sign Wave

Toxic levels= AV blocks

46
Q

What 3 drug classes can cause prolonged QT intervals and U waves?

A

Quinidine
Phenothiazines
TCAs

47
Q

When are Holter Monitors used?

What if these Sxs aren’t occurring often enough?

A

Sxs occurring daily or hourly

Event monitoring- good for picking up arrhythmia or palpitations

48
Q

Echos can be usd to determine ? 6 facts of the heart?

A 
LVEF
Chamber size/thickness
Valve morphology
Pericardial effusion
Wall motion abnormalities
Complications of acute MIs
49
Q

What is the Gold Standard test for detecting and quantifying CADz?

How is this info obtained?

A

Dx: Coronary Angiography
Prognosis: Post-MI

Injection of radiopaque dye into arteries from percutaneous femoral catheter

50
Q

What stress tests have the highest to lowest sensitivities?

A

Stress Echo, Nuclear perfusion/Nuclide angiography, Treadmill (90, 80-85, 65-70%)

51
Q

What are the 3 types of arrhythmias?

A

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

52
Q

1* Block Criteria

A

Constant PR interval elongation >0.2sec, all beats conducted through ventricles

53
Q

2* Block Criteria

A

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

54
Q

3* Block Criteria

A

No P-wave produces QRS response from complete AV dissociation; P-waves march through

55
Q

Define Stokes-Adams attacks

A

Syncope w/ brief cardiac arrest

56
Q

Narrow complex tachycardias are at ? rates

A

150bpm during A-flutter

140= A-Fib

110= MAT

57
Q

How is A-Fib treated?

A

+100bpm= rate control w/ BB, Verapamil, Digoxin

Anti-Coag w/ Warfarin

58
Q

What are the steps for PSVT Tx?

A

Carotid massage
Valsalva
Adenosine if stable
Electricity if unstable

59
Q

If V-Tach originates from LBBB then what is the site?

If it’s a RBBB pattern, where is the site?

A

RV

LV

60
Q

How is V-Tach w/ Sx palpitations treated?

What are the indications for pacemakers?

A

BBs

SA node dysfunction
Sx bradycardia
Mobitz Type 2
3* complete block
Sx carotid sinus hypersensitivity
61
Q

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?

A

IV Procainamide

BBs to decrease O2 demand

62
Q

What drug is first line therapy in ischemic heart Dz?

What drug needs to be avoided

A

BBs- decrease mortality, HR/afterload and increase coronary perfusion

Acebutolol- increase demand

63
Q

When are Nitrates used in ischemic heart Dz?

A

Sxs control but not impact on survival
Dec heart work and O2 requirements
Venous dilation= dec pre/after loads

64
Q

Why are CCBs used in ischemic heart Dz?

A

Dec after load
Dec HR
Dec contractility
Coronary dilation

65
Q

What do all ischemic heart dz PTs need to be on?

What drugs are used for dyslipidemia?

A

Statins

Fibrinates

66
Q

When do PTs need to have a PTCA?

A

Vessel occluded by 70% or more:
Angina, MI, Post-MI or presenting w/ bypass graft stenosis
NOT in left main Dzs

67
Q

Spectrum of ACS encompasses what 3 Dzs?

A

Unstable angina
Acute MI
Sudden death

68
Q

How are PTs w/ ischemic heart Dz managed?

A

O2
Hospital/monitor
Bed red
Anti-anginal meds: Nitro, BBs, CCBs if BB c/i or refractory Sxs, ECASA, Heparin/Plavix, Angiography, IABP

69
Q

Who is more likely to have silent MIs?

When do we use thrombolytic therapies?

A

DM, Elderly, HTN PTs, post-heart transplants

STEMI PT and can’t get/do PCI

70
Q

Stopped at

A

1:27:00 Review Lect

IPAP (212 decks)

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