Cardiology Flashcards
How to calculate rate on ECG (regular)?
300/large squares
OR
1500/small squares
How to calculate rate on ECG (irregular)?
6 x R-R intervals on 10 sec (50 large squares)
Hyperkalemia on ECG?
Peaked T waves
Hypokalemia on ECG?
ST depression
U waves
Hypercalcemia on ECG?
Shortened QT interval
Hypocalcemia on ECG?
Prolonged QT interval
Heart block 1st degree?
Prolonged P-R in every complex, but every QRS has its own P
Heart block 2nd degree?
Mobitz I: gradual prolongation until one P is alone
Mobitz II: fixed P-R with a ratio of P dropped (e.g., 3:1, 4:1)
Heart block 3rd degree?
P-P and R-R are constant but independent
Enzyme to diagnose new MI?
Troponins
Enzyme to diagnose old MI?
CK-mb
Medical acute treatment of MI?
MONA (morphine, O2, nitrates, ASA) BASH (beta blockers, ACE inhibitors, statins, heparin) and copidogrel (if the probability of CAD is high).
Out-patient medical treatment of MI?
ABAS (ASA, betablockers, ACE inhibitors, statins)
Contraindication of Nitrates (MI context)?
Right side STEMI
Chest pain + normal ECG + negative troponins. Next step?
Stress test:
The goal is to get the patient to target heart rate (85% of their maximum)
Diamond classification?
(1) Substernal chest pain, (2) Worse with Exertion, and
(3) Better with Nitroglycerin. 3/3 is called typical, 2/3 is called
atypical, and 0-1 is called non-anginal.
Indications CABG
3 vessel disease or left mainstream disease
Indications angioplasty (PCI)
1, 2 vessel disease
Treatment SVT (stable)
Vagal maneuvers. If that doesn’t work Adenosine (6-12-12), if doesn’t work, BB/CCB
Causes torsade des pointes
Hypokalemia or hypomagnesemia
Prolonged QT
Treatment torsade des pointes
Magnesium
Treatment VTach
Amiodarone
Treatment A Fib (unstable)
Cardiovert
Treatment Afib, stable, new (<48h)
Rate control (BB/CCB) Cardioversion
Treatment Afib, stable, old (>48h)
Anticoagulate -> TEE -> CArdioversion -> Anticoagulate
A Fib, valvular clot
Tx?
Warfarin
A Fib, non-valvular clot.
Anticoagulation treatment?
NOACs (e.g., dabigatran, apixaban and rivaroxaban)
Treatment AFib
RACE (rate control, anticoagulation, cardioversion, etiology)
Anticoagulation AFib
CHA2DS2 VASC
o Chronic heart failure: 1 pt
o Hypertension: 1 pt
o Age 65-74: 1 pt
o Age > 75: 2 pt
o Diabetes: 1 pt
o Stroke: 2 pt
o Vascular disease: 1 pt
o Femaie: 1 pt
Results 0: ASA; 1: ASA or anticoagulation; >2: anticoagulation (warfarin aiming for INR of 2-3) or NOAC
Door needle time (MI)
60 mins to give tPA
Time door balloon (MI)
90 mins
Farmaco Tx for 1º AV block
Generally none, but Atropine if Sx
Farmaco Tx for 2º AV block type I
Generally none, Atropine if Sx.
Review patient’s meds
Tx for 2º AV block type II
Peace, even if asx
Tx for 3º AV block
Peace
Tx Idioventricular rhythym
Peace
Defribilable rhythms
VT/VF
Farma TX unstable VT/VF
Epinephrine-Amiodarone-Epinephrine-Amiodarone
Farma TX PEA/Asystolia
Epinephrine-nothing-Epinephrine-nothing
Definition of Hypertensive urgency
> 210/120 NO target-organ damage
Hypertensive emergency
dBP > 120 + target-organ damage
HTN + CHF/CAD. Ideal tx for HTN?
BB (metropolol, carvedilol) + ACEI
HTN + stroke. Ideal tx for HTN?
ACEI + HCTZ
HTN + CKD. Ideal tx for HTN?
ACEI
HTN + DM. Ideal tx for HTN?
ACEI
Secondary effects of dCCB (e.g., amlodipine)
Peripheral edema
Secondary effects of ACEI
↑ Cr, ↑ K
Dry cough, angioedema
Secondary effects of ARB
↑ Cr, ↑ K
Secondary effects of HCTZ
↓ K, ↓ urinary calcium (used for Kidney stones)
HyperGLUC
Secondary effects of BB
↓ HR
Secondary effects of Aldosterone antagonists (e.g., spironolactone)
Gynecomastia, ↑ K
Secondary effects of Hydralazine
Drug-induced lupus
Reflex tachycardia
Secondary effects of Alpha-antagonists (Doxazosin, Prazosin, Terazosin)
Orthotastisc hypotension
Secondary effects of Central (clonidine)
Rebound hypertension
Emergency hypertension initial goal of BP reduction
↓MAP 25% in 4-6 hrs then to normal in 24 hours
Which anti-hypertensive shouldn’t be used with afroamerican patients?
ACEI unless there is a comorbility
Most common cause of secondary hypertension
CKD/End-state renal disease (ESRD)
Treatment of CHF exacerbation
If STEMI/NSTEMI: MONA BASH and cath Not STEMI/NSTEMI • L= Lasix (Furosemide) 40-500 mg IV • M= Morphine 2-4 mg IV • N= Nitrates • O= Oxygen • P= Position • P= Positive airway pressure (CPAD, BiPAP) IMPORTANT: Never start or increase a Beta-Blocker during an exacerbation.
Tx CHF class I
No limitations of activity; no sx with normal activty
(BB+ACEI)
Tx CHF class II
Slight limitation with activity. Comfortable with rest or mild excertion
(BB+ACEI) + Furosemide
Tx CHF class III
Marked limitation of activty. Comforable only at rest
(BB+ACEI) + Furosemide+ [BiDil (isosorbide /hydralazine)+ Spironolactone]
Tx CHF class IV
Any physicial activity brings disconfort; Sx at rest
(BB+ACEI) + Furosemide + [BiDil (isosorbide /hydralazine) + Spironolactone] + Inotrops (e.g., dobutamine)
Causes of CHF
CAD, HTN, valvular, alcohol
Dressler syndrome
Pericaditis post MI (2-8 wk)
Acute pericarditis triad
Chest pain, friction rub, ECG changes (↓PR, diffuse ↑ST)
Causes of pericardial diseases
infectious, autoimmune, trauma, and proximate cancers (breast, lungs, esophagus, lymphoma)
Etiology of pericarditis
Viral (coxsackie) or uremia
Diagnosis of pericarditis
ECG: ↓ P-R (Pathognomonic); Diffuse ↑ S-T
Echo is not used!!!!!
Treatment of pericarditis
NSAIDS + Colchicine*
- secondary effect: diarrhea
Contraindication of NSAIDs
CKD, thrombocytopenia or peptic ulcer disease (PUD)
Treatment of Pericardial effusion
NSAIDS + Colchicine (Tx of pericarditis) but if it doesn’t work, pericardial window is the next step
Diagnosis of Pericardial effusion
Echo
Sx/sg’s of Pericardial tamponade
Beck’s triad
* JVD
* Hypotension
* ↓ heart sounds
Clear lungs
Pulsus paradoxus > 10 mmHg
Tx of Pericardial tamponade
pericardiocentesis and bolus of IV fluids
Etiology of Constrictive pericarditis
recurrent pericarditis
Dyspnea, fatigue
Mimic right CHF (edema, ascites, splenomegaly)
Pericardial knock
Dx and next step?
Constrictive pericarditis
Best step:
- CxR: shows calcifications
- Echo
Tx of Constrictive pericarditis
Diuretics and salt retention. If this doesn’t work, pericardiotomy
Causes of Dilated cardiomyopathy
Viral
Ischemia
Valvular disease
Infectious
Metabolic
Alcoholic (wet beriberi)
Autoinmune
Treatment of Dilated cardiomyopathy
Same as CHF (BB, ACEI, diuretics)
Etiology of Hypertrophic cardiomyopathy (HCM)
Autosomal dominant mutation
Pathofisology of Hypertrophic cardiomyopathy (HCM)
Obstructs the aortic outlet
Differences between Hypertrophic cardiomyopathy (HCM) and Aortic Stenosis
Hypertrophic cardiomyopathy is found in young people
Improves with preload
Hypertrophic cardiomyopathy (HCM) is known for…
Sudden death of athletes
Treatment of Hypertrophic cardiomyopathy (HCM)
Avoid dehydration (AKA no sports), BB/CCB, myectomy, implantable defibrillator, transplant
Causes of Restrictive cardiomyopathy
Sarcoid
Amyloid
Hemochromatosis
Cancer
Fibrosis
Cardiomyopathy of wet beriberi
Dilated cardiomyopathy