Cardio exam 3 Flashcards
% blockage with angina and unstable angina
UA-90%
A-75%
Post MI 4-12hr
mottling/necrosis/hemorrhage
Post MI 12-24hr
Red/blue mottling
pyknosis
Post MI 1-3 days
Yellow/tan center
neutrophils
loss of striations/nuclei
Post MI 3-7 days
Phyagocytosis (macrophages), decreasing neutrophils
myofiber disintegration
hyperemic border
Post MI 7-10 days
Red/tan margin with yellow center
early granulation tissue
Post MI 10-14 days
Red/gray border
granulation tissue
neovascularization + collagen
Post MI 2-8 wks
scar
collagen
Ankle/brachial index
Ankle systolic (higher of the two)/brachial (higher of two)
For peripheral arterial disease
When to tx carotid stenosis
symptomatic and over 50% occluded or
asymptomatic and over 80% occluded
3 Criteria for MI dx on EKG
acute ST elevation
significant Q waves
deep, symmetrical inverted T waves
1st sign of STEMI on EKG
T waves>10mm in precordials
T waves>5mm in limb leads
Most common MI cause
spontaneous thrombus
Criteria to use thrombolytics
<6hr since onset (most beneficial)
ST elevation over 1mm
new LBBB
ST depression on V1/V2 with prominent R waves
Contraindications for thrombolytics
Anything with stroke/ICP
Aortic dissection
Cause of ischemia in UA and NSTEMI
vasospasm (not a full occlusion)
Use of CPK cardiac marker
detectable for 2-4 days
good to detect reinfarct
Absolute contraindications for thrombolytics
UA and NSTEMI and aortic dissection
Long term med tx to avoid with MI
NSAIDS
Risks of percutaneous intervention and what would help each
hematoma-stop anticoagulants
pseudoaneurysm- thrombin
acute renal failure-decrease contrast use
embolization- decrease cath manipulation
Emergency tx for ruptured AAA
avoid over fluid resucitation
surgery ASAP
Aortic dissection vs AAA tx
AAA do not need confirmation on radiograph
AD needs confirmation before surgery
Emergency tx for ACS
MONA B
morphine, O2, nitrates, aspirin, Beta blockers
Use of fibrinolytic therapy
Less than 30 minutes since onset
less than 75 y/o
PCI therapy timeframe
<90 min from onset
1st manifestion of thrombophlebitis
pulmonary embolism
Lymphangitis sx
painful cutaneous red streaks
Lymphedema types
I-hereditary (milroy disease)
II-obstructive
Cavernous hemangioma assc and risk
von Hippel Lindau disease
risk of rupture (stroke)
Cystic hygroma/cavernous lymphangioma
on neck/axilla of children
can cause deformities
Glomus tumor
very painful under the nails
Port Wine Stain feature and assc
CN V distribution
Sturg-Weber syndrome
Hereditary hemorrhagic telangiectasia sx and assc
multiple aneurysmal telangiectasias
assc with Osler Weber Rendu disease
Bacillary angiomatosis description and assc
red papules with nodules
assc with Bartonella (gram - rod)
Types of Kaposi sarcoma
Chronic- older men, distal LE involvment
Lymphadenopathic-African distribution/aggresive lymphadenopathy
Transplant assc-from long term immunosuppresion
AIDS assc-LN and viscera
Stages of Kaposi sarcoma
Patch-distal LE
Plaque-violaceous raised lesions
Nodule-neoplastic, slit spaces
Cause of hepatic angiosarcoma
carcinogen exposures: arsenical pesticides/thorotrast/polyvinyl chloride
Hemangiopericytoma location
common LE and retroperitoneum
around capillaries/venules
SA node depolarization spike cause
Ca2+ entering cell (not Na like in myocytes)
Cause of spontaneous depolarization in SA node
funny channels that allow Na to enter cell slowly
more (-) hyperpolarization, the more open and the faster the depolarizationAV Need -60mV to open at minimum
Sx of supraventricular tachycardia
syncope
AV nodal reciprocating tachycardia types
typical- slow is antegrade (short RP interval)
atypical-slow is retrograde (no P wave)
AVNRT on EKG
delta wave (pre-excitation)
Orthodromic v Antidromic AVRT
Ortho-retrograde up accessory
Anti-ant down the accessory (AAA)
Tx for AVRT
ibutilide
procainamide
flecaninide
COPD associated arrhythmia
multifocal atrial tachycardia
Cause of idiopathic VT
increased cAMP/Ca2+
Arrhymogenic RV dysplasia on EKG
epislon wave
Brugada’s Sign
R to S length is 0.10sec
Josephson’s sign
notch near low point of S wave
Condition assc with Brugada’s and Josephson’s sign
ventricular tachycardia
Early afterpolarization result
prolonged QT inteval
can cause Torsades
Cause of delayed afterpolarization
increased intracellular Ca2+
EKG changes for Class I antiarrhythmics
1A-prolonged repolarization (long phase 2)
1B-shortened repolarization (short phase 2)
1C-decreased slope of phase 0
Impact of class I antiarrhythmics
block fast Na channels of phase 0
Class 1A antiarrhythmics
quinidine
procainamide
disopyramide
Quinidine
class 1A antiarrhythmic
strong antimuscarinic
can cause cinchonism (tinnitus/vertigo)
Procainamide
calss 1A antiarrhythmic
weak antimuscarinic
less QT prolongation (less Torsades)
Disopyramide
class 1A antiarrhythmic negative inotropic effect
Class 1B antiarrhythmics
lidocain
mexiletine
phenytoin
Phenytoin
tx digoxin induced arrhythmias
Class 1C antiarrhythmics
flecainide
propafanone
for A fib/SV in healthy pts
Class II antiarrhythmics
beta blockers
decrease mortality
Class III antiarrhythmics
block K+ current amiodarone sotalol bretylium tosylate dofetilide
Amiodarone
1st line for emergency VT less proarrhythmic blocks K+ rectifier current and some Na+ channels causes peripheral vasodilation long t1/2
Side effects of amiodarone
pulmonary fibrosis
hyper/hypothyroidism
corneal deposits
Sotalol
inhibits K+ currents
can cause Torsades
inhibits conduction of bypass tracts
Bretylium tosylate
IV for emergency VT/V fib
decreases NE release
Dofetilide
selective K+ blocker
for A fib/A flutter
can cause Torsades
Class IV antiarrhythmics
verapamil
diltiazem
block Ca2+ currents
Adenosine
short t1/2
hyperpolarizes with K+ rectifier activation
for PSVT
Digoxin
for CHF with A fib
decreases AV conduction
prolongs PR interval
MgSO4
prevents current Torsades
Indications for ICD (internal defibrillator)
sx bradycardia HR 3sec (asystole)
Pacing codes for ICD
I-chamber placed
II-chamber sensed
III-mode of response
When is asynchronus pacing used?
surgery
Demand pacing for ICD
inhibited by intrinsic P or R waves
Telangiectasias v reticular v.
Telangiectasias- red
Reticular-blue
Virchow’s triad
stasis of blood
hypercoagulability
vascular damage
Side effect of hydralazine + IDN
Lupus like syndrome
