Cardiology Flashcards by Zoe Lazaris-Brunner

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

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For what arrhythmias is amiodarone used?

VTach- with or without pulse
SVT with pulse
Pulseless vfib

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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

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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

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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

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Leading cause of sudden cardiac death in peds

hypertrophic cardiomyopathy

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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

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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

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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

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What electrolyte abnormalities cause prolonged QT?

Low Ca, K and Mg

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What drugs cause prolonged QT?

Amiodarone
TCAs
Fluconazole
Metoclopramide
Haloperidol
Methadone
Ondansetron
SSRIs
Erythromycin

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Antihypertensives used in hypertensive emergency

Labetolol (beta blocker)
Nicardipine (calcium blocker)
Nitroprusside (vasodilator)
Hydralazine (vasodilator)

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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

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Causes of secondary hypertension in infants

renal artery thrombosis
renal artery stenosis
congenital renal malformations
coarctation of the aorta
BPD
Renal parenchymal diseases

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Classic ECG findings in myocarditis

sinus tachycardia, low-voltage QRS complexes, and inverted or low-voltage T waves

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What is the minimum age for use of an AED?

1 year old

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What ages are pediatric paddles/stickers used on AED?

1-8y/o

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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