Cardiovascular Flashcards
Determine axis of EKG:
normal?
LAD?
RAD?
Normal = +QRS in leads 1 and avF (0-90*) LAD = +QRS in lead 1, and -QRS in avF RAD = -QRS in lead 1, and +QRS in avF
What does a LBBB look like?
a QRS >120msec, no R wave in V1, tall R waves in 1, V5, and V6
What does a RBBB look like?
QRS >120msec, RSR complex with a wide R wave in V1, wide S wave in 1, V5, and V6
What is Kussmauls sign?
Increased JVP with inspiration. Could mean: ventricular infarction postoperative cardiac tamponade tricuspid regurg constrictive pericarditis
I.E. = something is pushing the blood out of the RA up into the neck!
What does a mitral valve prolapse murmur sound like?
A midsystolic or late systolic murmur with a preceding click
Diastolic murmurs are always abnormal.
They include aortic regurg or mitral stenosis.
A college age male “passes out” while playing basketball w/ no prodromal symptoms or seizure activity. His cardiac exam is normal. EKG shows slurred upstroke of the QRS. What do you do?
This is WPW.
Advise against exercise and tx the arrhythmia with procainamide and refer for electrophysiology study.
What does an S3 mean?
S4?
S3: dilated cardiomyopathy, mitral valve disease or a floppy ventricle (Slosh-ing in.) Can be normal in pregnancy or high flow state.
S4: caused by HTN, stiff ventricle (A-stiff heart), or aortic stenosis. Often normal in young patients and athletes
What causes pulsus paradoxis? What does it indicate?
Caused by a decreased systolic BP when inspiration. Due to pericardial tamponade, asthma, COPD, tension PNX, or FOB in airway
What causes pulsus alternans?
=alternating weak and strong pulses.
Due to cardiac tamponade, LVHF
What causes pulsus parvus et tardus?
=weak or delayed pulses
Due to Aortic Stenosis
A man with CHF is taking lasix and metoprolol, what else should he be on?
an ACE-I
They have a +mortality benefit when used with BB’s in class 2-4 CHF patients
Describe Second degree heart blocks?
Type 1 (wenckebach) = progressive PR lengthening until beat is dropped
Type 2 = unexpected drops in beat w/o PR lengthening. more dangerous type, can lead to type 3 block. NEEDS PACEMAKER
What are cannon A waves seen with?
Type 3 block (complete dissociation between P and QRS)
NEEDS PACEMAKER
What is the most common indication for a pacemaker?
SSS (sick sinus syndrome)
This is a combo of SVT and bradyarrythmias. Can present as syncope, palpitations, TIA, stroke…
When do you anticoagulate a patient with Afib?
Use the CHADS2 score and anticoagulate if they are >2 or if it has been >48h since afib
If cardiovert them (If TEE shows no clot, or else you have to have 3-6 warfarin therapy with INR of 2-3)
What is the atrial and ventricular rates in aflutter?
atrial rate = 240-320
ventricular rate = 150
What type of arrhythmia occurs when the “P wave is buried in the QRS.”
Atrioventricular Nodal Reentry Tachycardia (AVNRT)
Occurs when a reentry circuit in the AV node depolarizes the atrium and ventricle simultaneously.
What type of arrhythmia occurs when there is a “retrograde P wave after a normal QRS”
Atrioventricular Reciprocating Tachycardia (AVRT)
WPW is a particular form of these that will have a DELTA WAVE