Cardiology Flashcards
NYHA Classification of Heart Failure
- Class I: no symptoms
- Class II: symptoms with mod activity, slight limits
- Class III: symptoms with minimal activity, mod limits
- Class IV: symptoms at rest, severe limits
Management if statin induced myalgias
- CK
- normal: hold, resume when asymptomatic, repeat CK in 6-12 weeks after restarting
- >10x ULN: stop, Cr, urine myoglobin, consider rehydration, trend to normal
- Consider changing to different stating/lowering dose depending on severity
Wells PE Score
SSx DVT: 3 points
PE is most likely diagnosis: 3 points
Tachycardia > 100 BPM: 1.5 points
Immobilization > 3d/Surgery within 4 wks: 1.5 points
Hx of VTE: 1.5 points
Malignancy (within 6 mo.): 1 point
Hemoptysis: 1 point
6 points = 60%
4: Imaging
HOCM (ECG)
LVH
Dagger Q’s in Inferolateral leads
Tall R waves V1-V2
ARVD
Epsilon Waves, V1-V3
TWI’s, V1-V3
Slight prolongation QRS
LBBB type VT/PVC’s
ECG signs of tamponade
Low Voltage: I+II+III
V1 + V2 + V3
Tachycardia
Electrical Alternans
ECG Signs of LMCA Stenosis
STE aVR + V1/V2
STE aVR > 1.5 mm = 75% mortality
ECG signs Posterior MI
R waves V1-V2
STD V1-V3 with upright T waves
Brugada Syndrome (ECG)
Incomplete RBBB with STE in V1-V3
Type 1: Convex STE
Type 2: Saddleback STE
ECG Signs RV infarct
STD in V2 whith normal ST or STE in V1
STE III>II
Amal Mattu’s ECG Approach to Pericarditis
- Is there any STD?
- Is there any convex/horizontal STE?
3) Is STE III>II?
if YES, then AMI, if NO then
look for PR depression +-friction rub
look for checkmark sign (STEMI)
look for Spodick’s sign (downsloping TP, pericarditis)
Left Atrial Enlargement
- Large bifid P-wave lead II (p mitrale): >40 ms between peaks, >110 ms total duration
- V1: biphasic p-wave, terminal portion > 1mm deep and >40 ms duration
Right Atrial Enlargement
II, III, aVF: p-wave > 2.5 mm (p pulmonale)
V1-V2: p-wave > 1.5 mm (p pulmonale)
Usually peaked p-wave
STEMI criteria
1) Use J-point, two contiguous leads
2) Men 3) Men >= 40: 2 mm in V2-V3 and 1 mm in all other leads
4) Women: 1.5 mm in V2-V3 and 1 mm in all other leads
V7-V9 use 0.5 mm cutoff except for men
Wellen’s Syndrome
Biphasic or deeply inverted T-Waves in precordial +-lateral leads
Often in the absence/after resolution of symptoms
Sign of proximal LAD disease
AHA FMC-to-balloon time for patients presenting to primary PCI centre
90 minutes
AHA Door-in-to-door out time for STEMI at non-PCI hospital
30 minutes
AHA TTT times for STEMI at non-PCI hospital
To primary PCI FMC-balloon = 120 minutes
If anticipated >120 minutes then lytic within 30 min
then
Transfer to PCI if failed reperfusion
or within 3-24h if successful
RVH Criteria
RAD (90-180) + R>Q in V1 or S>R in V6
LVH Criteria
Precordial:
S in V1 or V2 + R in V5 or V6 >35 mm
R in V5 >26 mm
R in V6 > 18 mm
R in V6 > R in V5
Limb:
R aVL > 13 mm
R aVF > 21 mm
R I > 14 mm
R I + S III > 25 mm
LAFB
Can be normal
LAD
+
No QRS prolongation
+
qR I, aVL
rS II, III, aVF
LPFB
Always abnormal
RAD
+
rS I, aVL
qR II, III, aVF
Bifascicular Block
RBBB
+
LAFB/LPFB
Trifascicular Block
RBBB
+
LAFB/LPFB
+
AV Block
or LBBB + 1st deg AVB
Causes of prolonged QTc
hypo-K
hypo-Ca
hypo-Mg
hypothermia
Na Ch Blockers (TCA, Quinidine, antidepressants)
MI
IICP
Congenital
ECG signs of TCA overdose
Tachycardia
RAD
R wave aVR >= 3 mm
IVCD
RBBB + LAFB + CP
- call cath lab
- high chance LAD occlusion (Smith ECG blog)
When to worry about STEMI in RBBB
- V1, V2 should have some STD
- isoelectric or STE is always abnormal
- There shouldn’t be STD/STE anywhere else
- RBBB + LAFB (Dr. Smith’s ECG blog) = cath
Approach to Narrow Complex, Regular Tachycardia
-
Sinus tach
- max is 220-age
- SVT
-
Aflutter with 2:1 conduction
- 150 +- 20 BPM
- flip ECG upside down, check for sawtooth pattern (P-waves often inverted so hard to see on upright ECG)
- Bix rule
- if T wave is halfway between QRS complexes, look for a buried P wave in it, and the other buried P in the QRS complex
Bidirectional Vtach
QRS Axis changes 180 deg with each alternating beat
Sign of severe digoxin toxicity
Also sometimes in familial CPVT
Sustained vs. Non-sustained Vtach
-
sustained
- HR >120/130
- lasts >30s or HD unstable
- shock or amio/procainamide
-
non-sustained
- HR >120/130
- <30 s and stable
- don’t use antiarrhythmics
- Mg if low
- search for reversible causes
- beta blockers OK
STEMI Activation Criteria
- STEMI
- ischemic pain + ECG changes despite aggressive medical therapy (cath or transfer, no lytics)
- ischemic CP + new acute heart failure
- AMI + vtach (sustained or unsustained)
- AMI + HD instability
- Wellen’s Syndrome
- Diffuse ST depression + elevation in aVR
- deWinter T waves
- ROSC after Vfib/pulseless Vtach arrest
- ROSC after some PEA arrests
Approach to Vtach
see Evernote
