Cardiovascular Flashcards

To Know The CardioVascular System In the First Aid Book.

1
Q

Normal Heart Rate

A

60 - 100 bpm

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2
Q

Heart Rate < 60 bpm is?

A

Bradycardia

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3
Q

Heart Rate > 100 bpm is?

A

Tachycardia

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4
Q

Rhythm, look for what on tracing?

A

P before every QRS and QRS after every P

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5
Q

Axis: Normal

A

Upright (positive) QRS in leads I and II

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6
Q

Left Axis Deviation

A

Upright (positive) QRS in lead I
&
Downward (negative) QRS in Lead II

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7
Q

Right Axis Deviation

A

Downward QRS in lead I
&
Upright QRS in lead II

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8
Q

What is “unstable” in a patient?

A

Chest Pain
SOB
Hypotension
Confusion (brain not perfusing)

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9
Q

Characteristics of “Stable Angina”

A
Tightness
Heaviness
Pressure
Sore
Dull
Squeeze
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10
Q

Inferior Wall Ischemia presents?

A

Presents with Vagal Reflexes

Bradycardia
Hypotension
Dizzy
Faint
Sweating
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11
Q

Less Likely to be Ischemic or Infarct with characteristics like?

A

Sharp / knife like pain, easily pinpointed

Pain reproduced on palpation
Or
Change in position

Tender

Respiratory changes

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12
Q

True Infarct has a time that lasts longer than?

A

Pain lasts > 20 - 30 min

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13
Q

Transient Ischemia

Or

Esophageal Spasms

A

Relieved by Nitro

GERD (Worse with Nitro)

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14
Q

To Distinguish between LBBB and RBBB

A

WiLLiaM MaRRoW:

W patter: of QRS in V1-V2 and M pattern of QRS in V3-V6 for LBBB

M pattern: of QRS in V1-V2 and W pattern of QRS in V3-V6 for RBBB

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15
Q

Infarction

ST is elevated or depressed?
T-wave is?

A

ST Elevation

T wave inversion

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16
Q

Systolic Murmurs:

Aortic Stenosis
Mitral Regurgitation
Mitral Valve Prolapse
Flow Murmur

A

AS- Harsh Systolic ejection murmur
- radiation to carotids

MR- Holosystolic murmur
- radiation to axillae or carotids

MVP- Midsystolic Click or Late Systolic Click

Flow Murmur- Common, no disease

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17
Q

Diastolic Murmurs:

Aortic Regurgitation
Mitral Stenosis

A

AR- Early decrescendo murmur

MS- Mid to late, low pitched murmur

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18
Q

Difference of 20 mmHg in Arms with B.P. suggests what?

A

Aortic Disection

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19
Q

Gallops:

S3

S4

A

S3- Volume Issue

- Dilated cardiomyopathy (Floppy ventricle)
- Mitral Valve Disease
- Estrogen effect in early females (normal)

S4- Stiff Ventricle

- HTN
- Diastolic dysfunction (stiff ventricle)
- Aortic Stenosis
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20
Q

Edema, what are causes?

Pulmonary

Peripheral

A

Pulmonary: Left heart Failure

Peripheral: Right heart failure
: Hypoalbuminemia and drugs
: Hepatic Disease

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21
Q

Pulsus Paradoxus

A

(decreased systolic B.P. with inspiration)

Pericardial tamponade
Asthma
COPD
Tension Pneumothorax
Foreign body in airway
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22
Q

Pulsus Alternans

A

(alternating weak and strong pulse)

Cardiac tamponade
impaired left ventricular systolic function
Poor prognosis

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23
Q

Pulsus Parvus et Tardus

A

(weak and delayed pulse)

Aortic Stenosis

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24
Q

Management of Atrial Fibrillation

A

ABCD

Anti-Coagulate
Beta Blockers to control rate
Cardiovert / Calcium Channel Blockers
Digoxin

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25
Definition of CHF
Inability of the heart to pump enough blood to maintain luid and metabolic homeostasis
26
CHF Drugs that Increase Mortality
``` ACE-I / ARBS ACE-I + Diuretic Beta Blocker Vasodilator Spironolactone ```
27
Acute Atrial Fibrillation Causes (7) Chronic Atrial Fibrillation Causes (2)
PIRATES: - Pulmonary Disease - Ischemia - Rheumatic Heart Disease - Anemia / Atrial Myxoma - Thyrotoxicosis - Ethanol - Sepsis Chronic: - HTN - CHF
28
Atrial Flutter has what type of EKG Appearance?
Sawtooth
29
Atrial Flutter has a bpm rate of how much?
240 - 320 bpm
30
Treatment of Atrial Flutter?
Anticoagulation and rate Control Cardiovert according to AF criteria
31
CHAD2 Score CHAD2 VASc
``` C- CHF (1) H- HTN (1) A- Age (1) D- DM (1) S2- Stroke or TIA (2) ------------------------- Total = 6 ``` ``` V- Vascular (1) A- Age (1) Sc- Sex (1) ---------------- CHAD2 VASc = 9 ```
32
Atrial Fibrillation use the CHAD2 score to estimate risk of Stroke then treat accordingly What is the treatments?
- Anticoagulate if >48 hours (prevent CVA) - Rate Control (CCB, BB, Digoxin, Amiodarone) or - Initiate Cardioversion if <48 hours - Cardiovert if Transesophageal echo (TEE) shows no Left Atrial Clot - Cardiovert after 3 - 6 weeks of warfarin treatment with INR 2 -3
33
Ventricular Tachycardia (VT) Treatment
Cardioversion and Antiarrhythmics (Amiodarone, Lidocaine, Procainamide)
34
Ventricular Fibrillation (VF) Treatment | Syncope, absence of blood pressure, pulselessness
Immediate electrial cardioversion and ACLS protocol
35
Torsades De Pointes Treatment
- Correct HypoKalemia - Withdrawl offending drugs - Give Magnesium Initally - Cardiovert if unstable
36
New York Heart Association Classificaiton of CHF (NYHA Classifcation of CHF) 4 classes
1- No limit on activity; no symptoms with normal activity 2- Slight limitation of activity, comfortable at rest or with mild exertion 3. Marked limitation of activity, comfortable only at rest 4- Confined to complete bed rest or chair, physical activity brings on discomfort, symptoms present at rest
37
Left Sided CHF Symptoms (5)
``` Left sided S3/S4 gallop Bilateral Basilar Rales Pleural Effusions Pulmonary Edema Orthopnea, Paroxysmal Nocturnal dyspnea ```
38
Right Sided CHF Symptoms (5)
``` Right-sided S3/S4 gallop JVD Hepatojugular reflex Peripheral Edema Hepatomegaly, Ascites ```
39
Stage Classification and Treatment of CHF (4)
A- Patients at high risk of developing CHF Treatment- Manage risk factors (HTN, Smoking, Hyperlipidemia, obesity, exercise, alcohol) - ACE-I B- Structural Heart Disease (MI, Valve Disease), with no symptoms of CHF Treat- ACE-I, BB C- Structural Heart Disease with symtoms of CHF (SOB, fatigue, decrease exercise) Treat- Diuretics, ACE-I, BB, Digitalis, Salt Restrict D- Marked symtoms of CHF at rest Treat- Mechanical assist, Heart Transplant, IV inotropic drugs, Hospice
40
Systolic Dysfunction is defined at what?
Ejection Fraction <50% and Increased Left Ventricular End-Diastolic Volumes
41
CHF Diagnosis
CHF is Clinical Syndrome CXR: Cardiomegaly Pleural Effusions Vascular Plumpness Prominent Hila Echo- Decrease Ejection Fraction Ventricular dilation Lab Abnor- BNP >500 Increase Cr Decrease Sodium
42
Acute CHF Managment
LMNOP ``` Lasix Morphine Nitrates Oxygen Position (Upright) ```
43
Acute Treatment of CHF
- Correct underlying cause (MI, Drugs, Alcohol, Thyroid and Valvular Disease) - Diurese aggressively with loop and thiazide - Give ACE-I Do the LMNOP
44
Chronic CHF Treatment
Control Comorbid Conditions (DM, HTNm Obesity) limit sodium and fluid - Long term BB + ACE-I - Daily ASA and Statin - Chronic diuretic - Low Dose Spironolactone - Anticoagulate with history of AF
45
Hypertrophic Cardiomyopathy What is it?
LVH results in Impaireded left ventricular relaxation and filling involves the interventricular septum, leading to left ventricular outflow tract obstruction and impaired ejection of blood Congenital Form (Hypertropic Obstructive Cardiomyopathy: HOCM) in Autosomal Dominant) Most common cause of sudden death in children
46
Diagnosis of HOCM
Echo- shows asymmetrically thickened left ventricular wall and dynamic obstuction of blood flow ECG- may show LVH CXR- may reveal left atrial enlargement
47
Treatment of HOCM
Initial- BB for symptom relief | 2nd line- CCB
48
Restrictive Cardiomyopathy
Defined as Decreased Elastic of myocardium Leads to impaired diastolic filling but has normal EF Caused- Infiltrative disease (Amyloidosis, Sarcoidosis, Hemochromatosis) or by scarring
49
History or Restrictive Cardiomyopathy
Left sided and right side heart failure Symtoms of Right sided heart failure predominate (JVD, Peripheral edema)
50
Diagnosis and Treatment of Restrictive Cardiomyopathy
Echo- Key test reveals rapid early filling with normal EF ECG- frequently shows LBBB Treatment- Limited and Pallative - Diuretics for fluid overload - Vasodilators to decease filling pressure
51
Dilated Cardiomyopathy
Most common ``` Left ventricular dilation Systolic Dysfunction (Low EF) ``` both must be present Most cases idiopathic 2nd cause- Alcohol, myocarditis, Drugs, Endocrinopathies, Infections (Coxsackie, Chags), nutrition (Beriberi) and most common are HTN and Ischemia
52
History of Dilated Cardiomyopathy
Gradual symtoms of CHF Exam shows: - displacement of Left Venticular impulse - JVD - S3/S4 gallop - Mitral / Tricuspid Regurg
53
Diagnosis of Dilated Cardiomyopathy
Echo- Diagnostic EKG- non-specific St-T changes - Low volte QRS - LBBB CXR- Enlarged balloon-like heart - Pulmonary congestion
54
Treatment of Dilated Cardiomyopathy
Address underlying issues (Alcohol, endocrine) - Treat CHF symptoms: - Diuretics Prevent disease pregression: - ACE-I - BB - Aldosterone Antagonists Consider ICD if EF <35%
55
Coronary Artery Disease (CAD) Manifestations
``` Stable and Unstable Angina SOB Dyspnea on Exertion Arrhythmias MI Heart Failure Sudden Death ```
56
Angina Pectoris Prinzmetal's (Variant)
Substernal Chest Pain secondary to Myocardial Ischemia (O2 supply and demand mismatch) Prinzmetal's- mimics Angina Pectoris but is caused by vasospasms of coronary vessels. Affects young women at rest in early morning - ST-Elevation in absence of Cardiac Enzyme elevation
57
Angina Pectoris: Diagnosis
- Rule out: Pulmonary, GI and Cardiac causes - Women and diabetic classically experience "silent" ischemic events. Keep Suspicous high - St segment change with stress test is diagnostic of CAD
58
Angina Pectoris: Treatment Acute Chronic
Acute Symptoms: (MONA) - ASA - 02 - Nitro IV - IV Morphine - Consider IV BB Chronic: - Nitrates - ASA - BB (CCB are second line) Initiate risk reduction: - Smoking - Cholesterol - HTN
59
Unstable Angina / Non-Elevation MI (NSTEMI) Unstable Angina Description
Unstable Angina- chest pain that is - New Onset - Accelerating - Occurs at rest NSTEMI - Elevation of: - Troponin I - Troponin T - CK-MB
60
Unstable Angina / NSTEMI Diagnosis
Pt should be risk stratified by TIMI (Thrombosis in Myocardial Infarction Study) - Unstable Angina doesn't have elevated cardiac Markers, but ST changes seen on EKG - NSTEMI- serial cardiac enzymes and EKG
61
Unstable Angina / NSTEMI
Tx same as for Stable Angina - Clopidogrel - Unfractionated Heparin or Enoxaparin - Glycoprotein IIB/IIIA TIMI >3 - Troponin elevation or St changed >1mm - Given Heparin - Angiography - Revascularization
62
TIMI
- AGE (>65)- 1 - >3 CAD risk factors (Family, DM, Smoke, HTN)- 1 - Known CAD (stenosis >50%) - 1 - ASA use in past 7 days- 1 Presentation - Severe Angina >2 episodes in 24hr- 1 - St deviation >0.5mm - 1 - + Cardiac Marker - 1 Risk Score = 0-7 Score >3 = Enoxaparin and Angiography
63
ST-Elevation MI (STEMI) Definition
St- Elevation and Cardiac Enzyme release secondary to prolonged cardiac ischemia and necosis
64
STEMI Hx
Acute onset substernal chest pain Described as: - pressure or tightness - radiates to left arm, next, jaw Associated symptoms - Diaphoresis - SOB - Lightheaded - Anxiety - N/V - Syncope Physical - Arrhythmias - Mitral Regurg (rupture papillary muscle - Hypotension - CHF new (rales, S3 gallop) Best predictor of survival - left ventricular EF
65
STEMI Diagnosis
ST Elevation New LBBB ST Depression in leads V1-V2 means infarction of posterior wall T wave inversions peak T waves Cardiac Enzymes - Troponin I (most sensitive) - CK-MB (specific)
66
STEMI Tx
Six Meds Consider: - ASA - BB - Clopidorgrel - Morphine - Nitrates - O2 Emergent Angiography and PCI
67
Indications for CABA
DUST Depressed ventricular Function Unable to do PCI Stenosis of left main coronary artery Triple vessel disease
68
Complications of STEMI
Arrhythmia most common Dressler's happen 2-10 weeks Post MI ``` Timeline of complications: 1st day- Heart failure 2-4- arrhythmias 5-10- left ventricular wall rupture Weeks-Months- Ventricular aneurysms ```
69
HyperCholesterolemia
Total Cholesterol >200 mg/dL LDL >130 mg/dL Triglycerides >500 mg/dL HDL <40 mg/dL Risk factors for CAD
70
Hypercholesterolemia Hx
Most have no signs or symptoms Extremely high triglycerides or LDL levels may have - Xanthomas (nodules in skin over the tendons - Xanthelasmas (yellow fatty deposits in the skin around the eyes) - Lipemia Retinalis (creamy appearance of retinal vessels)
71
Hypercholesterolemia Dx
Fasting lipid profile >20 years old Repeat every 5 years Total Serum Cholesterol >200 mg/dL on 2 occasions is diagnostic
72
Dyslipidemia
LDL >130 | HDL <200 is diagnostic of dyslipidemia
73
Hypercholesterolemia Tx
1st intervention- Diet / Exercise for 12 weeks Then do Statins
74
HTN Definition
Systolic >140 Diastolic >90 based on 3 measurements separated in time
75
Diabetic HTN range
<130/80
76
Essental HTN Dx
Conduct: - Cardio - Neuro - Ophthalmologic - Abdominal exams Obtain: - UA - BUN/CR - Electrolytes To assess organ problems
77
HTN Tx
ABCD ACE-I / ARBS BB CCB Diuretics
78
Causes of 2 HTN
CHAPS ``` Cushings Hyperaldosteronism (Conns) Aortic Coarctation Pheochromocytoma Stenosis of Renal Arteries ```
79
HTN Emergencies >200
IV Meds: - Labetalol - Nitroprusside - Nicardipine Goal is to lower no more than 25% over first 2 hours to prevent cerebral hypoperfusion
80
Pericarditis
Pain sharper and worse when lying down (due to stretch on pericardium) Pain worsens with inspiration Relieved when sitting up
81
Pericarditis Looks on EKG and Tx
PR Depression Treat- Start NSAIDS then give steroids if no better in 2 days
82
Pericarditis Diagnosis
CXR, EKG and Echo to rule out MI EKG changes include ST segment Elevation PR depressions T wave inversion
83
Cardiac Tamponade
Excess fluid in the pericardial sac compromises ventricular filling and decrease cardiac output
84
Risk factors for Cardiac Tamponade
``` Pericarditis Malignancy SLE TB Trauma (Stab wound medial to the left nipple) ```
85
Cardiac Tamponade What is Becks Triad
JVD Hypotension Distant Heart Sounds
86
What Causes Pericarditis
CARDIAC RIND ``` Collagen Disease Aortic Disection Radiation Drugs Infections Acute Renal Failure Cardiac (MI) Rheumatic Fever Injury Neoplasms Dressler Syndrome ```
87
Treatment of Tamponade
Aggressive Volume Expansion with IV fluid Pericardiocentesis (aspirate will be non clotting blood) Decomprensation may warrent balloon pericardiotomy and pericardial window
88
Aortic Aneurysms
Associated wit Atherosclerosis Most Abdominal >90% originate below renal arteries
89
Aortic Aneurysm HX Risk factors? Look for?
Usually asymptomatic Risks- HTN - Hypercholesterolimia - Males > Females Exam- Pulsitile abdominal mass or abdominal bruits
90
Diagnosis Aortic Aneurysms
Abdominal Ultrasound
91
Treatment of Aortic Aneurysms
Asymptomatic- Monitor lesions 5.5 cm Abdominal >6cm thoracic Surgery if ruptured
92
Aortic Dissection
Most commonly 2nd to HTN Creates false Lumen (intima and adeventia) are affected not true rupture Occurs at 40-60 M>F
93
Aortic Dissection HX
Sudden tearing / ripping pain in anterior chest in ascending dissection Interscapular back pain in descending disection Pt is typically HTN Asymmetric pulses and B.P. measurments (20 mmHg difference between arms)
94
Aortic Dissection Dx
EKG CXR- widening of the mediastinum, cardiomegaly or new left pleural effusion. CT angiography is gold standard of imaging TEE- provide details of thoracic aorta
95
Aortic Dissection Tx
Monitor and medically manage B.P. and HR necessary Don't give Thrombolytics Dissection of Ascending Aorta- MEDICAL EMERGENCY Dissection of DECENDING AORTA- Manage with B.P. and HR control
96
Deep Venous Thrombosis (DVT) what is the Virchow's Triad
Clot formation in the large veins of the extremities or pelvis Virchow's- Hemostasis, trauma, hypercoagulability
97
DVT Hx
Unilateral lower extremity pain, erythema and swelling Homan's Sign- Calf tenderness with passive foor dorsiflexion
98
DVT Dx
Doppler ultrasound Spiral CT or V/Q scan- evaluate for pulmonary embolism
99
DVT Tx
IV unfractionated heparin or SQ low molecular weight heparin followed by warfarin for 3-6 months CONSIDER IVC Filter for contraindications to anticoagulation
100
Lymphedema
Disruption of lymphatic circulation results in peripheral edema and chronic infection of extremities Complication of surgery or node dissection
101
Lymphedema Hx
PostMasectomy has upper extremity Immigrants present with progressive swelling of lower extremities bilateraly Children present progressive, bilateral swelling
102
Lymphedema Dx
Diagnosis is clinical Rule out other causes of edema- Cardiac and Metabolic disorders
103
Lymphedema Tx
NO CURATIVE TX Exists Diuretics are ineffective Exercise, massage and pressure garments to mobilize and limit fluid may help
104
Peripheral Artery Disease
Occulsion of blood supply to the extremities by atherosclerotic plaque Lower extremities are most commonly affected
105
PID Hx
Intermittent claudication (reproducible leg pain that occurs with walking and ALAYS relieved by rest) Disease preogresses, pain occurs at rest and affect distal extremities Foot ulcerations develop due to poor perfusion FEMOROPOPLITEAL DISEASE- Calf Claudication, pulses below femoral artery absent
106
PID Dx
Measure Ankle and Brachial Systolic BP (Ankle-brachial index ((ABI))) Normal ABI >1 Pain at rest occcurs with ABI<0.4
107
PID Tx
Control underlying conditions (smoke, dm) Exercise best Drugs: ASA, cilostazol, thromboxane inhibits may improve symptoms Angioplasty / stents have variable success rate Amputation if conservation tx fails Avoid BB in PID due to B2 mediated peripheral vasoconstriction
108
Syncope
Sudden temporary less of consciousness and postural tone secondary to cerebral hypoperfusion Etiologies are either Cardiac or Non-Cardiac
109
Syncope Cardiac reasons
``` Valvular lesions Arrhythmias Pulmonary Embolisms Cardiac Tamponade Aortic Dissection ```
110
Syncope Non-Cardiac
``` Orthostatic / Hypovolemic Hyptotension Neurologic (TIA / Stroke) Metabolic Abnormalities Neurocardigenci syndromes (Vasovagal) Psychiatric ```
111
Syncope Dx
Depends on suspected etiology Holter Monitor Echocardiogram Stress Test
112
Syncope Tx
Tailored to the etiology
113
Stable Angina And Unstable Angina
``` Stable --------- EKG Negative Stress test + - ST depression Increase 02 demand Releaved by rest ``` ``` Unstable ---------- New Worse pattern Pain @ rest ```