Cardiology Flashcards
What are the 4 stages of ECG changes in cardiac tamponnade?
1 - no change apart from sinus tachycardia
2 – depressed voltages
3 – electrical alternans
4 – diffuse ST elevation
For what arrhythmias is amiodarone used?
VTach- with or without pulse
SVT with pulse
Pulseless vfib
Causes of benign cardiac murmurs
Flow murmur
Peripheral pulmonary stenosis (0-6mo)
Stills murmur (2-6y)
Venous hum (3-8y)
Pulmonary flow murmur
Supraclavicular or brachiocephalic systolic murmur - older
Aortic systolic murmur - older
Mammary artery - older
Features concerning for a pathologic murmur
History concerning for cardiac disease
Systolic murmur that intensifies with standing
Holosystolic murmur
Diastolic murmur
Grade 3+
Abnormal S2 or audible click
Signs on X-ray of thoracic aortic injury
Widened mediastinum
Irregular aortic notch
Apical cap
L sided pleural effusion
L main stem bronchus depressed
R main stem bronchus elevated
Deviation of NG or ETT
Leading cause of sudden cardiac death in peds
hypertrophic cardiomyopathy
Causes of sudden cardiac death
Congenital coronary artery anomalies - anomalous left coronary artery from the pulmonary artery (ALCAPA)
dilated cardiomyopathy
myocarditis
ARVD
aortic rupture
arrhythmia - WPW (afib - VF), Long QT syndrome. CPVT, Brugada syndrome, heart block
What is Bland White Garland Syndrome?
ALCAPA in 10 week infant - PVR drops - anomalous LCA not perfused - ischemia
- crying with feeds, cardiac wheeze, resp distress, CHF, sudden cardiac death
What is brugada syndrome?
ECG abnormality putting young ppl at high risk of sudden death
Brugada sign = coved ST segment elevation > 2mm in > 1 of V1-V3 followed by negative T wave
What electrolyte abnormalities cause prolonged QT?
Low Ca, K and Mg
What drugs cause prolonged QT?
Amiodarone
TCAs
Fluconazole
Metoclopramide
Haloperidol
Methadone
Ondansetron
SSRIs
Erythromycin
Antihypertensives used in hypertensive emergency
Labetolol (beta blocker)
Nicardipine (calcium blocker)
Nitroprusside (vasodilator)
Hydralazine (vasodilator)
Secondary effects/contraindications to:
Labetolol (beta blocker)
Nicardipine (calcium blocker)
Nitroprusside (vasodilator)
Hydralazine (vasodilator)
Labetolol (beta blocker) - contraindicated in asthma, can mask hypoglycemia
Nicardipine (calcium blocker) - reflex tachycardia, intracranial hypertenision, phlebitis at infusion site
Nitroprusside (vasodilator) - cyanide toxicity, transitory hypotension
Hydralazine (vasodilator) - headache, tachycardia, fluid retention, Increased ICP
Causes of secondary hypertension in infants
renal artery thrombosis
renal artery stenosis
congenital renal malformations
coarctation of the aorta
BPD
Renal parenchymal diseases
Classic ECG findings in myocarditis
sinus tachycardia, low-voltage QRS complexes, and inverted or low-voltage T waves
What is the minimum age for use of an AED?
1 year old
What ages are pediatric paddles/stickers used on AED?
1-8y/o
ECG changes in beta blocker and calcium channel blocker toxicity
sinus bradycardia
AV block (all degrees)
Junctional bradycardia
Ventricular bradycardia
ECG changes in propranolol toxicity
QRS widening
positive R’ wave in avR
ECG changes in Sotalol poisoning
QT prolongation - torsades de pointes
ECG findings in carbamazepine toxicity
QRS widening
1st degree AV block
(sodium channel blockade)
ECG findings in Wolff-Parkinson-White syndrome
short PR interval
widened QRS
delta wave (slurred upstroke to QRS complex)
ECG changes in digoxin toxicity
SVT (increased intracellular calcium)
slow ventricular response (increased vagal effects at AV node)
frequent PVCs* (most common)
sinus bradycardia
slow atria fibrillation
any type of AV block
ventricular tachycardia
ECG changes in hypercalcemia
shortened QT interval
severe - osborn/J waves
ECG changes in hyperkalemia
peaked T waves
P wave flattening/widening
PR prolongation
Bradyarrhythmias
Conduction blocks
QRS widening
ECG changes in hypokalemia
T wave inversion
ST depression
Prominent U wave
ECG findings in thyrotoxicosis
Sinus tachycardia
Afib
apparent LVH
ECG changes in hypocalcemia
QT prolongation (prolongation of ST segment)
ECG changes in hypomagnesemia
Prolonged PR
Prolonged QT with risk of TdP
Atrial and ventricular ectopy
ECG changes in hypothermia
Bradyarrhythmia
Osborne waves (J waves)
Prolonged PR, QRS, QT
ventricular ectopics
ECG changes in hypothyroidism
bradycardia
low QRS voltage
widespread t-wave inversions
ECG changes in intracranial hypertension
Widespread giant T-wave inversions
QT prolongation
Bradycardia
ECG changes in pericarditis
widespread concave ST elevation and PR depression
Reciprocal ST depression and PR elevation in aVR + V1
Sinus tachycardia
4 stages of ECG changes in pericarditis
Stage 1 – widespread STE and PR depression with reciprocal changes in aVR (occurs during the first two weeks)
Stage 2 – normalisation of ST changes; generalised T wave flattening (1 to 3 weeks)
Stage 3 – flattened T waves become inverted (3 to several weeks)
Stage 4 – ECG returns to normal (several weeks onwards)
ECG changes in pulmonary embolism
Sinus tachycardia *
R ventricular strain - T wave inversion in V1-4 and II, III, aVF
ECG changes in quetiapine toxicity
HR > 120 (sinus)
prolonged QTc
ECG changes in TCA overdose
wide QRS
terminal R wave > 3mm in aVR
sinus tachycardia
ECG findings in WPW syndrome
shortened PR interval
delta wave
widened QRS
ECG findings in Brugada syndrome
coved ST segment elevation > 2mm in >1 of V1-V3 followed by negative Twave
Diagnostic criteria for Brugada Syndrome
ECG findings (coved ST elevation + neg T wave in 2 leads) PLUS 1 of:
Documented VF or VT
Family history of sudden cardiac death at <45 years old
Coved-type ECGs in family members.
Inducibility of VT with programmed electrical stimulation
Syncope
Nocturnal agonal respiration
What are cardiac problems associated with/caused by anorexia nervosa?
Hypotension
Bradycardia
Long QT
Dilated Cardiomyopathy
What systemic conditions can cause pericarditis?
SLE
Periarteritis nodosa
peptic ulcer
uremia
Medications that act on the following in CHF managment:
preload
pump
afterload
i. Preload – nitroprusside (reduces preload and improves cardiac output), furosemide
ii. Pump – epinephrine, norepinephrine
iii. Afterload – milrinone, ace-inhibitors, ARBS, nitrates
