Cardiology I Flashcards
What is the heart rate with a Normal Sinus Rhythm?
60-100 bpm
Describe the P-waves with Normal Sinus Rhythm.
P-waves present with each QRS
Describe the PR interval with a Normal Sinus Rhythm.
normal and the same (0.12-0.2)
Describe the QRS in a Normal Sinus Rhythm.
regular
What is the Rate with Sinus Bradycardia?
rate is < 60 with Sinus Bradycardia
Describe P-waves with sinus bradycardia.
p-waves are present with each QRS
Describe the PR interval with sinus bradycardia.
PR interval is normal and the same (0.12-0.2) in sinus bradycardia
Describe the QRS with sinus bradycardia.
regular QRS with sinus bradycardia
What is the Rate with sinus tachycardia?
Rate is > 100 bpm with sinus tachycardia
Describe the P-waves in sinus tachycardia.
P-waves are present with each QRS with sinus tachycardia
Describe the PR interval with sinus tachycardia.
PR interval is normal and the same (0.12-0.2) in sinus tachycardia
Describe the QRS with sinus tachycardia.
the QRS in sinus tachycardia is regular
What is another term for Supraventricular Tachycardia?
Paroxysmal SVT
What is the heart rate with SVT/PSVT?
the rate in SVT/PSVT is 140-220 bpm
Describe the P-waves of SVT/PSVT.
P-waves are present with each QRS but may not be visible when rate is fast with SVT/PSVT
Describe the PR interval with SVT/PSVT.
the PR interval is consistent but may be hidden in the QRS with SVT/PSVT
Describe the QRS with SVT/PSVT.
the QRS with SVT/PSVT is regular but fast
What are Premature Atrial contractions?
extra atrial contractions (p waves) can occur at any time and rate,
these p waves usually look different than normal p waves
What are Premature Ventricular contractions?
- can occur at any time & rate
- different QRS morphology
- T waves in the opposite direction
- these are followed by compensatory pause
What is Atrial Fibrillation?
Irregularly Irregular arrhythmia caused by
firing of multiple foci in the arorta
What is the most common sustained arrhythmia and a leading cause of thrombosis with possible emolization?
atrial fib
What is the Etiology of A. fib?
stress, fever, Alcohol, volume depletion, pericarditis, CAD, MI, PE, mitral valve disease, thryotoxicosis, and idiopathathic lone A. fib
If your cardiac patient is Hemodynamically Unstable how do you Tx this patient’s Atrial Fibrillation?
-DC cardioversion
If your cardiac patient is Hemodynamically Stable when do you treat this patient’s Atrial Fibrillation with Electrocarioversion?
-after 4 weeks of anticoagulation with coumadin
When Tx Atrial Fibrillation and the patient is Hemodynamically Stable what drugs are you going to prescribe to lower the heart rate?
- Beta blockers
- calcium channel blockers
- digoxin
When Tx Atrial Fibrillation and the patient is Hemodynamically Stable what drugs might you prescribe for Anitcoagulation?
- Heparin
- Aspirin
- Coumadin
When Tx Atrial Fibrillation and the patient is Hemodynamically Stable what drugs may be used for Chemical Cardioversion?
- Amiodarone
- Ibutalide
What electrolytes might need to be replaces when Tx Atrial Fibrillation and the patient is Hemodynamically Stable?
-K and Mg
When Tx Atrial Fibrillation and the patient is Hemodynamically stable lab hormone test should you run and correct abnormalities?
-Check TSH and correct abnormalities
Describe the EKG caused by an Atrial Ectopic focus (Atrial Flutter) ?
-atrial flutter produces a classic sawtooth pattern on EKG
What are the possible etiology for Atrial Flutter?
- CAD
- pericarditis
- valvular heart disease
- cardiomyopathy
What are the possible Tx for Atrial Flutter?
- Rate controlling meds
- Cardioverting meds
- Anticoagulation
- Electrical Cardioversion
What are the possible Tx options for Atrial Fibrillation?
- DC cardioversion
- Rate lowering meds
- Chemical cardioversion
- Electrical cardioversion
- Replace electrolytes
- Check TSH and correct abnormalities
What are the Rate Controlling meds for Tx of Atrial Flutter?
- Beta blockers
- calcium channel blockers
- digoxin
What are the Cardioverting meds for Tx of Atrial Flutter?
- Amiodarone
- Ibutilide
What are the anticoagulation med used to Tx Atrial Flutter?
- Heparin
- Aspirin
- Coumadin
When is Electrical Cardioversion used to Tx Atrial Flutter?
-if unstable or after 4 weeks of anticoagulation
What is the most significant finding on EKG for First Degree Heart Block?
*** PR interval : > 0.20 ***
In Tx of hypertension, what is the DASH diet?
-diet high in K+ and Ca++
What is the significance of the DASH diet?
-1600 cal DASH diet is as effective as the effects of drug monotherapy
When do you use 2 drugs to tx hypertension?
-use to 2 drugs when BP is > 20/10 mmHg above goal
How do Loop, thiazide and potassium sparring drugs work?
-reduce volume and preload
What are the side effects of diuretics?
- Loop/thiazide–decrease K+
- Thiazide–increase uric acid and lipids
- Spirolonactone–conserves K+
How do beta blockers work?
-slow HR and reduce peripheral resistance
Other than HTN when else are beta blockers used?
- thyrotoxicosis
- essential tremor
- post MI
- migraine HA
- tachyarrhythmias
What HTN medication can mask hypoglycemia is diabetics?
-beta blockers
What are the side effects of beta blockers?
- impotence
- fatigue
- bradycardia
- Bronchial constriction (Nonselctive BB)
ACE-I end in what four letters?
-pril
How do ACE-I work?
-work by reducing peripheral vascular resistance
How effective are ACE-I in monotherapy?
-40% effective in monotherapy and 80% effective in combination theraphy
What other positive effect do ACI-I have?
-preserve renal function
Do you use ACI-I in pregnancy?
-category X
What are the side effects of ACE-I?
- cough (chronic and nonproductive)
- Angioedema
What’s a good way to remember which HTN meds are Angiotension Receptor Blockers (ARB) ?
-end in –sartan
How do ARB’s (angiotensin receptor blockers) work?
-vasodilate similar to ACE-I
Which two HTN meds have renal protective effects?
-ACE-I and ARB’s
What are the side effects of ARB’s ?
- less cough than ACE-I
- less angioedema than ACE-I
How do Alpha Blockers work?
- produce arterial and venous dilation
- they do not reduce cardiac outpur
What’s a good way to remember Alpah Blockers?
-end in – zosin
What are the side effects of alpha blockers?
- postural hypertension
- improves BPH and urine stream
- positive effects on HDL and LDL
How do calcium channel blockers work?
- vasodilate
- slow HR
- have negative inotropic effects
What other medical conditons are CCB’s used?
- Raynauds
- cardiomyopathy
- migraines
- cluster headaches
What are the side effects of CCB’s ?
- heart block
- constipation
- peripheral edema
What are the Direct arterial dilators used in HTN?
-hydralazinde & minoxidil
What are the side effects of the direct arterial dilators (hydralazine & minoxidil) ?
- reflex tachycardia
- fluid retension
What are the Central acting agents used to tx HTN ?
- methyldopa
- clonidine
What are the side effects of the central acting agents (methlyldopa and clonidine?
- sedation
- dry mouth
- postural hypotension
Name HTM meds for Heart Failure?
- ACE-I
- BB
- ARB’s
- aldosterone blockers
- Loop diuretics
HTN meds to use for diabetics?
- ACE-I
- ARB’s
- thiazide diuretics
- BB
- CCB’s
What is the BP numbers goal for HTN in diabetics?
- <130/100
HTN meds to use for patients with Cerebral Vascular Disease?
-ACE-L and Thiazide diuretic
What is the goal HTN with Cerebral Vasc Disease?
- 160/100
Etiology for kids with HTN?
- kidney disease
- coarctation of the aorta
You don’t use ACE-I or ARBs on who?
- pregnancy
- sexually active females
What is HTN Urgency?
-BP >220/120 without SXs
What is HTN Emergency?
-Sx's are present: HA confusion dissection nephropathy pulm edema
How drugs are used with HTN Emergency?
-IV nitroprusside (nipride) or labetolol
How does nitroglycerin work?
- decreases arteriolar and venous tone
- reduces preload and afterload
- lowers O2 demand of the heart
- 0.4 mg SL or spray q 5 min x3
How do you tx a patient with stable angina in order to prevent further attacks ?
- Beta blockers
- Aspirin 81-325mg q day
- long acting nitrates
- CCB’s 3rd line tx, and only amlodipine and norvasc
Who gets Prinzmetal (variant) angina?
-usually women >50
What are the keys to Dx of Prinzmetal angina?
- CP without usual precipitating factors
- ST-segment elevation*rather than depression
- Sx usually in occur in the morning**
- cardiac cath in N
What meds do you put your 53 y.o. female on for her Prinzmetal angina?
- nitrates*
* CCBs*
What HTN medication will exacerbate coronary vasospasm in Prinzmetal Angina?
-Beta Blockers
What do gals with Prinzmetal Angina need to avoid?
- smoking
- cocaine
- beta blockers
