Cardiologia Flashcards
Blocco di branca SINISTRA e DESTRA
SINISTRA
- QRS>0,12 sec
- no R, ma S ampie in V1,
- R alte e ampie in D1, V5, V6
DESTRA
- QRS>0,12 sec, RSR’ (rabbit ears)
- qR o ampie R in V1
- ampie S in D1, V5, V6
Q waves in trasmural infarct
Onda Q>0,40 sec o di ampiezza >1/3 del complesso QRS
Wolff-Parkinson-White syndrome
- DELTA wave with widened QRS complex and shortened PR interval on ECG.
- Reentry circuit
- Supraventricular tachycardia
Brugada syndrome
- Autosomal dominant
- ECG: pseudo blocco di branca destra e sopraST in V1-V3
- Prevent SCD with implantable cardioverter-defibrillator (ICD)
Congenital long QT syndrome
- Romano-Ward syndrome—autosomal dominant, pure cardiac phenotype .
- Jervell and Lange-Nielsen syndrome— autosomal recessive, sensorineural deafness.
Drug-induced long QT
[ABCDE]
AntiArrhythmics (class IA, III) AntiBiotics (eg, macrolides) Anti“C”ychotics (eg, haloperidol) AntiDepressants (eg, TCAs) AntiEmetics (eg, ondansetron)
Onde e intervalli ecg
-Onda P (depolarizzazione atri) 0,05-0,12 sec
-QRS (depolarizzazione ventricoli) <0,12 sec
-Onda T: (ripolarizzazione ventricoli) 0,18-0,20 sec
-Onda U: prominent in hypokalemia (think
hyp“U”kalemia), bradycardia.
- Inter. PR: 0,16-0,20 sec
- Inter. ST: 0,27 – 0,33 sec
- Inter. QT: <0,44 sec (QTc>0,44 QT lungo)
-Inter RR: 0,8-0,9 sec
Doppia aggregazione profilattica post intervento di angioplastica coronarica con BMS (bare metal stent) e con stent medicato
BMS: 1 mese
Stent medicato: 1 anno
Jugular venous pulse
A WAVE—Atrial contraction (absent in atrial
fibrillation).
C WAVE—right ventricol Contraction (closed tricuspid valve bulging into atrium).
X DESCEND—downward displacement of closed
tricuspid valve during rapid ventricular ejection phase (reduced or absent in tricuspid regurgitation and right heart failure)
V WAVE—increasing right atrial pressure due to filling
(“Villing”) against closed tricuspid valve.
Y DESCEND—right atrial emptYing into right ventricole. (prominent in constrictive pericarditis, absent in cardiac
tamponade)
Cardiac sounds features
S1—mitral and tricuspid valve closure.
S2—aortic and pulmonary valve closure.
S3—in early diastole during rapid ventricular
filling phase. Associated with increased filling
pressures (eg, mitral regurgitation, HF) and
more common in dilated ventricles (but can
be normal in children, young adults, and
pregnant women).
S4—in late diastole (“atrial kick”). (Best heard
at apex with patient in left lateral decubitus
position). High atrial pressure. Associated with
ventricular noncompliance (eg, hypertrophy).
Left atrium must push against stiff LV wall.
Consider abnormal, regardless of patient age.
Frazione di eiezione
EF = gittata sistolica/EDV(end diastolic volume)
= (EDV-ESV)/EDV
Cardiac Contractility when does increase and decrease? What is the best contractility index?
Contractility INCREASES
- Catecholamine stimulation via β1 receptor:
- intracellular Ca2+
- LESS extracellular Na+
- Digitalis
Contractility DECREASES
- β1-blockade
- HF with systolic dysfunction
- Acidosis
- Hypoxia/hypercapnia ( Po2/ Pco2)
- Non-dihydropyridine Ca2+ channel blockers
FE is the best index contractility
Pulse pressure
sistolic pressure-diastolic pressure
Pulse pressure is proportional to SV (gittata sistolica), inversely proportional to arterial compliance
PP increases:
- hyperthyroidism,
- aortic regurgitation,
- aortic stiffening (systolic hypertension in elderly),
- obstructive sleep apnea
- anemia,
- exercise (transient).
PP decreases
- aortic stenosis,
- cardiogenic shock,
- advanced heart failure (HF).
- cardiac tamponade,
Aumento di dimensione degli atri all’ECG
ATRIO SINISTRO
-onda P in D2 > 120msec (or M shaped P)
ATRIO DESTRO
-onda P in D2 > 2,5mm
[P polmonare Peaked waves, P Mitrale M shaped]
Aumento dimensione ventricoli ECG
VENTRICOLO SINISTRO
onda S in V1 + onda R in V5 o V6 > 35mm
VENTRICOLO DESTRO
deviazione asse a destra + onda R in V1 > 7mm
Score per rischio di stroke nella FA. Che punteggio è necessario per iniziare terapia con warfarin?
[CHA2 DS2 VASc]
- CHF (congestive heart failure)
- HTN (hypertension)
- Age >75aa (2 pt)
- Diabetes
- Stroke or TIA history (2pt)
- Vasculare disease
- Age 65-74aa
- Sex category (female 1 pt)
> =2 pt start warfarin
Terapia FA cronica e FA acuta
FA CRONICA
- Controllo ritmo (beta blocc, ca antag, digossina)
- Anticoag se CHA2DS2VASc >=2
FA ACUTA o UNSTABLE
- <48h cardiovert
- > 48 h o unclear duration TEE (transesophageal ecocardio) to rule out trombo atriale
Più comune causa di impianto pacemaker
Sick sinus syndrome
Terapia flutter atriale
Come FA
Possibili clinical findings nelle tachiaritmie sopraventricolari
Palpitazioni Shortness of breath Angina Sincope Lightheadedness
tranne FA, flutter e multifocal atrial tachycardia
Terapia tachicardia ventricolare
Cardiovert if unstable
Antiaritmici (amiodarone, lidocaina, procainamide)
Terapia trosades de pointes
Magnesio
Cardiovert if unstable
Correggere ipokaliemia
Diagnosi Scompenso cardiaco congestizio CHF
CLINICA RX -Cardiomegalia -Cephalization of pulm vassels -pleural effusion -vascular congestion -edema -ili prominenti ECOCARDIO LAB -bnp > 500pg/ml -creatinina + (a volte) -Na - later
Terapia CHF acuto e cronico
CHF ACUTO Farmacologico -Diuretici dell'ansa -Ace inib/sartani -Beta blocc NO in pz instabile, appena euvolemico Coreggere cause Trattare edema polmonare con [LMNOP] -Loop diuretics -Morphine -Nitrates -Oxygen -Position (upright)
CHF CRONICO Lifestyle Farmacologico -Diuretici dell'ansa -Ace inib/sartani -Beta blocc -Spironolattone -ASA e Statine se il CHF è dato da precedente IMA Terapie Avanzate -ICD (pz FE <35%) -LVAD e trapianto (pz non response)