Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

int med exam 0828 > cardiology 3: valvular heart disease and arrhythmias > Flashcards

cardiology 3: valvular heart disease and arrhythmias Flashcards

1
Q

what are the 3 usual mechanisms of abnormal rhythms?

A

reentry, triggered activity and automaticity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what is sick sinus syndrome?

A

anything that causes sinoatrial syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what are the 2 indications for treatment for sick sinus syndrome?

A
  • a symptomatic patient
  • tachy-brady syndrome where tx of tachyarrhythmias might precipitate or worsen bradycardia.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what is a first-degree heart block and general causes/tx?

A
  • PR interval >200 ms
  • can be caused by medications
  • no tx
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

describe 2nd degree wenckebach?

A
  • gradual prolongation of PR interval until QRS drops.
  • Occurs during periods of high vagal tone during sleep (OSA) or in endurance athletes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what is a mobitz 2?

A

abrupt loss of p wave conduction to ventricle with no evidence of gradual prolongation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what is a 3rd degree heart block?

A

p waves not conducted to the ventricle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

how can you tell a counterclockwise rotation atrial flutter?

A

this is a counterclockwise rotation around the right atrium.

see negative sawtooth flutter waves in 2,3,AvF (with positive deflection in V1)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

how can you tell a clockwise rotation atrial flutter?

A

positive flutter waves in 2,3,Avf with a negative deflection in V1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what are the types of categories of afib?

A
  • first detected (only 1 diagnosed episode)
  • paroxysmal (more than 2 episodes, self terminating <7 days, most <24 hours)
  • persistent (more than 2 episodes, each last > 7 days)
  • permanent (>6-12 months)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

in what circumstance is immediate DC cardioversion indicated for afib?

A
  • hemodynamic instability
  • onigoing MI
  • symptomatic hypotension
  • angina
  • heart failure
  • WPW with rapid ventricular rate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

in patients that you want to DC cardioversion with slow afib, considerations?

A

consider inserting a temporary pacemaker before DC cardioversion because the patient could have sinus nodal disease and may have asystole after cardioversion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what would you use for pharmacologic cardioversion for Afib >7 days?

A
  • 1st line: dofetilide
  • 2nd line: amiodarone or ibutilide
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what would you use for pharmacologic conversion for Afib <7 days?

A
  • 1st line: flecainide, ibutilide, dofetilide, propafenone
  • 2nd line: amiodarone
  • Exception: if <48 hours and poor cardiac function, amiodarone is 1st line.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

in what scenarios would you not shock a hemodynamically stable patient with abnormal tachycardiac atrial rhythm?

A
  • dig intoxication
  • hypokalemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what is a acceptible resting heart rate for Afib patients?

A
  • <110 if LVEF>40% and no symptoms related to arrhythmias.
  • The strict control of heart rate is considered 80bpm at rest or 110 bpm during a 6-minute walk.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what medications can you use for Afib rate control w/o HF?

A
  • beta blockers (atenolol or metoprolol)
  • CCB (verapamil diltiazem)
  • Digoxin can be synergistic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

in the acute setting, what cna you use for tx of Afib with HF and no preexcitation?

A
  • IV beta blockers (esmolol, metoprolol, or propanolol) to slow ventricular rate
  • Amniodraone to slow ventricular rate and possibly restore sinus rhythm
  • CCB with caution (verapamil/diltiazem) to slow ventricular response cautiously with hypotension or heart failure because of negative inotropic effects
  • Digoxin/amiodarone provided no accessory pathway
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what afib rhythm control medications require hospital monitoring to initiate therapy?

A

dofetilide and sotalol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what do you need to keep in mind if you’re going to use a class Ic agent for Afib?

A

with propafeone and flecainide, unopposed use can organize Afib into Aflutter which can degenerate into VF/VT. You need to use an AV nodal blocking agent like CCB, BB, or digoxin.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what is used for medication refractory Afib?

A
  • RF ablation of the pulmonary veins.
  • provides definitive rate control but does not cure the underlying cause.
  • You still need to be on anticoagulation.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

when can you cardiovert a stable patient?

A

If<48 hours, cardiovert.

If>48 hours, anticoagulate for 3 weeks or do TEE cardioversion.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

for patients undergoing cardiac surgery, what medication should be used to prevent post-operative Afib?

A

give oral beta blocker unless contraindicated.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

which patient group does not need antithrombotic therapy for Afib?

A

Lone afib (age<60 w/o heart disease and w/o risk factors)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

which patient group is at highest risk for thromboembolism in Afib?

A

rheumatic mitral stenosis and prior thromboembolism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

define non-valvular afib?

A

not having rheumatic mitral stenosis or posthetic valves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

define MAT? how do you treat it?

A
  • atrial rate>100 beats with p waves of at least 3 distinct morphologies
  • treat the underlying condition
  • CCB and amiodarone might help
  • Digoxin can worsen it.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

what conditions do you see MAT?

A
  • pulmonary disease
  • theophylline use
  • low K or low magnesium
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

what EKG finding suggests AVNRT?

A

if no p wave is seen (buried in QRS) or is seen at the end of QRS (very short R-P interval)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

what EKG findings suggest AVRT?

A

P wave is somewhere in the ST segment (short R-P interval)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

what suggests atrial tachycardia? tx?

A
  • P wave seen after a T wave (long R-P interval)
  • BB, CCB, adenosine, carotid sinus massage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

basics of WPW?

A
  • preexcitation syndrome with PR<0.12 due to delta wave and symptoms of tachycardia.
  • Total QRS >0.12.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

what medications can you use and not use to treat Afib with WPW?

A
  • never use: digoxin, verapamil, or beta blockers as they can increase the refractory period in the AV node, enhancing conduction down the accessory pathway and precipitate VF.
  • Use procainamide, ibutilide, or amiodarone.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

when do you shock for WPW tachyarrhythmia? Preferred long term option?

A
  • shock if any signs of hemodynamic deterioration
  • watch if VR>285 BPM
  • RF ablation if preferred long term option
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

why do PVCs have a compensatory pause?

A

do not reset the sinoatrial node and the time between the sinus beats that are on either side of the PCV = 2basic RR intervals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

define the basics of VT?

A

3 or more sequential QRS complexes of ventricular origin of 100 bpm or faster.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

what is the ECG criteria for VT?

A
  • AV dissociation
  • fusion and capture beats
  • NW axis
  • positive or negative concordance in precordial leads
  • absence of rS complex in all precordial leads
  • QRS width of >140 ms with a RBBB
  • QRS width>160ms with a LBBB
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

sustained monomorphic VT treatment: stable:

A

amiodarone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

sustained monomorphic VT treatment: unstable

A

shock

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

sustained monomorphic VT treatment: unstable and refractory to shock

A

amiodarone/procainamide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

sustained monomorphic VT treatment: with acute mI?

A

amiodarone first lidocaine can be useful

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

what cardiac medication should you never use with any wide complex tachycardias in the emergency setting?

A

verapamil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

which patients qualify for class I indications for ICD?

A
  • survivors of cardiac arrest due to VF or who are unstable after VT without any reversible causes
  • structural heart disease and spontaneous SVT stable or unstable
  • syncope of undetermined origin with hemodynamically sustained VT/VF induced at EPS
  • LVEF<35% due to prior MI 40 days out with NYHA 2/3
  • LVEF<30% in NYHA Class I
  • nonischemic DCM LVEF<35% and NYHA 2/3
  • nonsustained VT due to prior MI with LVEF<40% and inducible VT/VF at EPS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

which drugs prolong QT interval?

A
  • Class Ia antiarrhythmic drugs (quinidine, procainamide, disopyramide)
  • Class 3 antiarrhythmics (sotalol, dofetilide, and amiodarone)
  • haloperidol and TCA
  • antibiotics (macrolides)
  • antihistamines
  • Antifungal agents
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

how do you treat TDP?

A
  • DC cardioversion for sustained episode
  • magnesium 2-4 grams
  • correction of hypokalemia
  • correction of bradycardia
  • never treat with class Ia or class 3 antiarrhythmics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

how do you prevent recurrence of TDP?

A
  • discontinue offending medications
  • prevent bradycardia with isoproterenol or overdrive pacing
  • supplement potassium and magnesium
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

what ekg rhtyhm do you see TDP?

A

polymorphic VT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

define NSVT?

A

asymptomatic VT >3 sequential PCVs with HR>100bpm) lasting <30 seconds.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

when are NSVT are at risk for sustaining VT and sudden death? tx?

A

ischemic cardiomyopathy (LVEF<40%) or sustained VT can be induced at EPT.

Treat with ICD implantation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

under what conditions is permanent pacing recommended?

A
  • symptomatic bradycardia
  • sinus node dysfunction (sick sinus syndrome)
  • AV conduction syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

what is the most common pacemaker and what does it stand for?

A
  • DDD
  • Dual chamber paced
  • Dual chamber sensed
  • dual response to sensing: triggered and inhibited
  • this is the most physiologic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

what is pacemaker syndrome?

A
  • associated lightheadness/syncope
  • can occur with single chamber ventricular pacing
  • commonly cured by DDD which restores atrial kick
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

how long do you need to wait to determine if an antiarrhytmic drug is effective?

A

4-5 half lives

54
Q

what does the 5 letters of pacers indicate?

A
  • 1st letter - chamber paced (V/A/D (V+A)
  • 2nd letter - chamber sensed (V/A/D (V+A)/O (none)
  • 3rd letter - mode of response (Triggered (T), Inhibited (I), dual (T+I), None (O)
  • 4th letter - programmability (P/M/C/R/O - programmable, multi programmable, communicating, rate-modulated, none)
  • 5th letter - arrhythmia control - Pacing (P), shock (s), dual (P+S), none (O)
55
Q

when do you avoid verapamil?

A
  • Afib/flutter with WPW
  • wide complex tachycardias
  • beta blocker co-administration (both CCB and BB negative chronotropies/inotropes)
  • asymptomatic HCM
  • obstructive HCM with symptoms
56
Q

what conditions is it okay to use verapamil?

A
  • control ventricular response in healthy heart for Afib/flutter
  • MAT
  • SVT (2nd choice after adenosine)
  • symptomatic treatment in HCM that is non-obstructive
  • severe concentric LVH
  • hypertension
57
Q

major side effects of quinidine?

A
  • prolongs QRS complex and QT interval, occasionally leading to TDP
  • autoimmune Thrombocytopenia purpura
  • cinchonism: hearing loss, tinnitus, and psychosis
58
Q

major side effects of procainamide?

A
  • prolongs QT and QRS
  • pancytopenia
  • drug induced lupus
  • used in caution with HF patients due to mild myocardial depressive effect
59
Q

major side effect of disopyramide?

A
  • prolong QT, QRS and TDP
  • anticholinergic so urinary retention etc
60
Q

major side effect of lidocaine?

A

seizures

61
Q

beta blockers major side effect?

A
  • decreased libido and impotence.
  • must taper slowly as beta blocker abrupt stop can precipitate angina
62
Q

major side effects of amniodarone?

A
  • corneal deposits
  • pulmonary fibrosis
  • hepatic toxicity
  • hypo/hyperthyroidism
  • grey skin
63
Q

what determines a toxic level of digoxin?

A
  • determine by ECG changes not blood levels.
  • you would see bradycardia and prolonged PR interval
64
Q

which patients are likely to suffer dig toxicity?

A
  • elderly
  • low potassium
  • low magnesium
  • low PO2
  • impaired renal function
65
Q

when do you use RF ablation?

A
  • WPW
  • and if not responsive to medications or preference (AVNRT, Atrial tachycardia, atrial flutter, idiopathic VT)
66
Q

what is aortic stenosis generally due to? when does it present?

A
  • age-related calcific valve degeneration
  • congenital bicuspid AV - age 40 to70
  • normal trileaflet AV stenotic at age>75
67
Q

bedside physical exam findings for AS?

A
  • diamond-shaped SEM at RUSBP radiating to the neck
  • S4 gallop
  • decreased or absent S2
  • paradoxical S2 split with severe AS
68
Q

Name 2 chronic conditions/mechanisms that cause CHRONIC AR?

A
  • valve deformity (BAV, RF, endocarditis, degenerative valve disease)
  • abnormal aortic root (marfan, senile aortic disease GCA, relapsing polychondirits, syphilis)
69
Q

what does chronic AR cause?

A

LV volume overload, causing LV dilatation and drop in LV systolic function

70
Q

what murmur do you see with chronic AR?

A
  • descrendo diastolic high pitched blowing murmur.
  • Loudest at LSB if due to aortic leaflet
  • loudest at RSB if due to aortic root disease
71
Q

what does CXR show for chronic AR?

A

enlarged LV which may show dilation of the ascending aorta

72
Q

what is the gold standard to diagnose AR?

A

aortic angiography though more frequently diagnosed with echo

73
Q

what is the medical treatment for chronic and severe AR?

A
  • routine use of vasodilator therapy no longer recommended for non-severe AR
  • ACE/ARBs + diuretics to treat symptoms
74
Q

when is valve surgery indicated for chronic and severe AR?

A
  • patient is symptomatic
  • LVEF <55%
  • LV end-systolic dimension >55mm
  • LV end-diastolic dimension>75mm
75
Q

what surgery is contraindicated in AR?

A

IABP

76
Q

what is native acute AR caused by what conditions?

A

flail leaflet due to:

  • Endocarditis
  • type A aortic dissection
  • trauma
77
Q

what is prosthetic valve AR caused by?

A
  • tissue valve leaflet rupture
  • mechanical valve closure problems (thrombosis)
  • paravalvular regurgitation due to infection
78
Q

what do patients with acute AR present with?

A

severe pulmonary edema and low cardiac output

79
Q

what is the treatment for severe AR and heart failure?

A

if no reversible cause, likely need immediate surgery

80
Q

what are the top causes of mitral stenosis?

A
  • rheumatic fever
  • SLE
  • rheumatoid arthritis
  • severe valve calcification
81
Q

what are typical comorbid conditions with MS?

A
  • atrial fibrillation
  • heart failure
  • secondary pulmonary HTN
82
Q

what murmur do you see with MS?

A

diastolic murmur with diastolic opening snap caused by tensing of chordae tendinae and stenotic leaflets.

S1 is accentuated and can have snapping quality.

83
Q

what suggests more severe mitral stenosis?

A

shorter time of S2-OS interval as more severe the MS, the higher the left atrial pressure, earlier the MV is forced to open in diastole.

84
Q

what is the triad seen on CXR with MS?

A
  • prominent pulmonary artery revascularization
  • enlarged left atrium
  • normal sized LV
85
Q

why do you see hemoptysis in MS?

A

due to rupture of pulmonary bronchial vessels distended by pulmonary venous hypertension

86
Q

what is the initial presentation of MS in pregnancy? TX?

A
  • new onset AF and pulmonary edema
  • heart rate and volume control with BB and diuretics
  • heparin instead of anticoagulation if 1st trimester
87
Q

what surgical treatment do you do for MS?

A

percutaneous valvotomy with:

  • Symptomatic MS
  • asymptomatic patient with PAH >50 a rest, >60 with exercise
88
Q

what conditions predispose to chronic MR?

A
  • rheumatic heart disease
  • MVP
  • annulus dilation from LV dilation
  • prior episode of endocarditis
  • ischemic effects of the papillary muscle from CAD/MI
89
Q

how does chronic MR differ from acute MR?

A
  • heart has enlarged LA in chronic form thus less back pressure to the flow across incompetent MV resulting in a constant intensity holosystolic murmur instead of descrescendo (as in acute MR).
  • Both see soft/absent S1
  • wide split S2
  • S3 in severe MR
90
Q

what is the medical treatment for severe MR?

A

diuretics and afterload reducing agents (ACE/ARB).

91
Q

what is the surgical treatment of chronic MR? indication?

A

percutaneous valve repair or valve replacement.

  • if symptomatic
  • asymptomatic if LVEF<65% and /or LV enlargement with LV end-systolic diatmeter>40mm
  • pulmonary HTN
92
Q

what is the normal variant anatomic description of MVP?

A

chordae tendinae are weakened causing billowing of the otherwise normal MV leaflet.

93
Q

what murmur do you see with MVP?

A

mid systolic click followed by a mid to late systolic murmur if there is associated MR

94
Q

what is the most common symptom of acute mitral regurgitation?

A

acute onset pulmonary edema

95
Q

what are the causes of native valve AMR?

A
  • flail leaflet (endocarditis, MVP or trauma)
  • papillary muscle ischemia or fupture (MI, trauma)
  • chordae tendineae rupture (endocarditis, Acute rheumatic fever, spontaneous)
96
Q

what are the causes of prosthetic valve acute MR?

A
  • tissue valve leaflet rupture
  • MV closure problem (thrombosis)
  • paravalvular regurgitation due to infection
97
Q

what murmur do you hear with acute MR?

A

decrescendo systolic murmur at the apex

98
Q

what is the medical and surgical treatment for acute MR?

A
  • afterload reduction and diuresis
  • IABP can help.
99
Q

what are the causes of TS?

A
  • rheumatic fever
  • carcinoid
  • endocarditis
100
Q

carcinoid usually results in what type of murmur?

A

TS with TR especially if hepatic tumor.

101
Q

what waveforms are seen with TS?

A

giant a wave caused by backflow during atrial contraction against a stenotic TV.

102
Q

what do you see on EKG with TS?

A
  • tall peaked waves in II and V1 (evidence of right atrial hypertrophy)
  • no indications of RVH
103
Q

what do you see on waveform of TR?

A

large jugular V waves representing backflow through TV during ventricular contraction

104
Q

what is ebstein anomaly?

A
  • the tricuspid septal leaflet is positioned lower in the ventricle than normal (apically displaced) so the RA appears huge and the RV is small.
  • TR murmur common
  • seen with ASD and with WPW.
105
Q

basics of bioprosthetic valve?

A
  • less durable but do not require anticoagulation
  • indicated in patients with life expectancy <5-10 years
  • women of childbearing age so no anticoagulation
106
Q

balloon valvuloplasty procedure of choice for which conditions?

A

pulmonic valve stenosis and frequently mitral stenosis

107
Q

what are the major determinants in prognosis after valve surgery?

A
  • EF
  • degree of symptoms
  • type of valve surgery.
108
Q

what is the INR targets for mechanical valves?

A
  • aortic - 2-3
  • mitral 2.5-3.5
109
Q

Valsalva does what to murmurs?

A
  • decrease murmur of AS
  • increases HCM murmur
  • increases murmur of MVP
110
Q

what does a R wave in V1 tell you?

A
111
Q

what are the two morphologies of a QRS complex?

A
112
Q

what does poor R wave progresion indicate?

A
113
Q

what does the following indicate?

Peaked t wave

focal flipped inverted t wave

Diffuse, flipped T waves

A
114
Q

what is a U wave? what does a prominent vs inverted U wave show?

A
115
Q

what is early repolarization? criteria?

A
116
Q

what are the 3 distinct morphologies for ST-segment depression?

A
117
Q

Define ST segment elevation/depression associated with MI?

A
118
Q

what are the 3 main causes of ST segment elevation?

A
119
Q

what are the causes of ST-segment depression?

A
120
Q

describe the normal vs LVH vs RVH QRS complex?

A
121
Q

what is the LVH ECG criteria?

A
122
Q

ECG criteria for RVH?

A
123
Q

describe normal, RBBB and LBB patterns?

A
124
Q

how to diagnose LBB?

A
125
Q

criteria for RBBB?

A
126
Q

what causes a bifasicular block?

A
127
Q

what are the criteria for Afib?

A
128
Q

what are the ECG changes associated with STEMI (timing)?

A
129
Q

Common locations of STEMI?

A
130
Q

ECG locations on heart

A
131
Q

what are the 3 main dx for wide QRS complex tachycardia?

A
132
Q
A

int med exam 0828 (24 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions