Cardiology Flashcards
Osborn waves
J point elevation in the precordial leads seen in hypothermia
arrythmias seen in hypothermia
bradyarrythmia, afib, osborn waves
staging of hypothermia
swiss stage I -IV
why do you warm the trunk before the limbs in hypothermia?
warming the limbs cause cold acidemic blood to go to heart and can cause arrythmias
passive leg raise, threshold for SV
> 10% increase in SV with passive leg raise has a high positive and negative predictive value for volume responsiveness
MOA of milrinone
phosphodiesterase-3 inhibitor. predominantly is a vasodilator but does have ionotopic effects.
Nitric oxide MOA
a potent vasodilator but does not have any inotropic effects
phrenic nerve injury during CABG?
20% unilateral, 1 % bilateral. Can be from direct trauma, ishcemic injury from lack of flow to the vaso nervorum, cold induced injry
AV dissociation in complete heart block?
regular atrial and ventricular rhythms at different rates
CHB in anterior MI, what does it mean?
usually indicated more myocardium is involved and is distal to AV node. This correlates with a higher mortality.
CHB in inferior MI, what does it mean?
often a result of inc vagal tone and will be transient
- if the block is above the His then the escape rythym is typically stable and will be narrow QRS
- if below the bundle then they may become HD unstable
pregnancy SCAD treatment
usually supportive with single AP therapy. PCI not ideal because could worsen dissection
pregnancy SCAD
likely 2/2 hormonal changes of the arterial media and changes in CO during pregnancy
MOA of BB in afib?
blocking sympathetic input
MOA of CCB in afib?
block L type calcium channels and block block calcium influx thereby slowing AV nodal conduction by reducing the action potential
when do you not use CCB in afib?
patients with LV dysfunction and decompensated HF because of the negative ionotropic effects
definition of Peripartum CM?
- incidence?
- Risk factors?
- development of heart failure in the latter weeks of pregnancy, after 36, or 1-6 months postpartum
- approximately 1:3000
- gestational HTN, preeclampsia, african, advanced maternal age, obesity, lower socioeconomic class
Atrial Fibrillation
paroxysmal?
persistent?
- <1 week
- >1week
how would you shock someone out of acute unstable afib?
- synchronized cardioversion
120-200J
controlling afib in heart failure?
amiodarone, digoxin
if there is an accessory pathway how to control afib?
no AV nodal blocking agent
pharmacologic cardioversion for afib?
ibutilide
(concern for torsades), amiodarone, procainamide
afib >48 hours, elective CV?
rate control, AC for 3 weeks, then elective DC CV followed by 4 weeks AC
afib>48 hrs, emergent?
TEE, bolus AC then DC CV followed by oral AC for 3 weeks
Multifocal Tachycardia?
tx?
cardiovert?
irregularly irregular, differing p waves
- treat underlying etiology
- can control rate with BB, CCB
- WILL not respond to cardioversion
AV node reentry tachycardia?
respond to adenosine?
tx?
regular tachycardia, development of a slow pathyway in the AV node, causing a circle through both fast and slow pathways
- yes because blocks through AV node
- BB, CCB, dig, amio, vagal, DC cardioversion, pacing
WPW?
reason for sudden death?
- accessory pathway
- reentry circuit, AV-> Vent and then back up the accessory pathway and back down
- slurred, widened QRS, delta wave
- afib with rapid vent conduction with conduction over accessory pathway, can lead to vfib
tx for WPW?
- don’t use AV nodal agent alone
- use with slowing the accessory pathway
- procainamide plus BB
- DC cardioversion
atrial flutter pathophys
tx?
- sawtooth pattern in inferior leads
- due to reentry circuit spinning around tricuspid valve
- DC CV at 50-100J
- atrial pacing
what is a fusion beat?
- see during VT
- every once in a while a sinus conduction happens in the other bundle opposite of the side of the ventricular focus where the VT is occuring
SVT with Abberancy?
- wide complex tachycardia
- conducts to ventricle, when it hits the right and left bundle it gets delayed through one of the bundles and becomes a wide complex
Ventricular tachycardia features?
- fusion/capture beats
- QRS concordance in the precordial leads
- AV dissociation
features that support SVT with abberancy in WCT?
- stops with vagal tone
- rate dependent, narrow complex that speeds up and becomes widened
- alternating bundle branch blocks
Ashman phenomenon?
afib and then wide complex beats start occurring
VT with pulse unstable?
- if wide regular syn DC 100J
- wide irregular: defib 200J
VT with pulse and stable?
- can use adenosine at first to see if its SVT with aberrancy
prolonged QT and torsades, what is the tx?
- Mag first
- can use isuprel
