Cardiovascular Flashcards
Elevation and equalization of RA, RV, and PCWP after cardiac surgery
Cardiac tamponade
Causes of pulseless electrical activity?
5 H’s and T’s, + Anaphylaxis
Hypovolemia, Hypoxia, Hydrogen ions (acidosis), Hypo/hyperkalemia, Hypothermia
Tension pneumo, Tamponade, Trauma, Thrombosis (MI or PE), Toxins (narcotics, benzos)
Immunologic (immune complex) phenomena in endocarditis
- Osler nodes (painful fingertip nodules)
- Rosh spots (retinal hemorrhages with pale centers)
- Glomerulonephritis
- Positive rheumatoid factor
Embolic phenomena in endocarditis
- Janeway lesions (painless)
- Splinter hemorrhages
- Conjunctival hemorrhages
- Infarcts: stroke, renal infarct, splenic infarcts, digital gangrene
Endocarditis with nosocomial UTI
Endocarditis
Endocarditis with new AV block
Perivalvular abscess
Medications to hold prior to cardiac stress testing
Beta-blockers, CCBs, nitrates for 48 hours prior (caffeine for 12 hours prior)
(Continue ACEIs/ARBs, diuretics, statins, digoxin)
Persistent ST elevation well after an MI
LV Aneurysm (late complication, seen 5 days - 3 months after)
Type of cause of cardiac arrest in the first 10 minutes after an MI?
10-60 minutes after?
First 10: Re-entry
10-60: Abnormal automaticity
Location of MI with ST elevation in precordial leads? Vessel?
Anterior MI due to LAD occlusion
Location of MI with ST elevation in I, aVL, V5, and V6? Vessel?
Lateral MI due to circumflex or diagonal artery (off LAD)
May also see ST depression in inferior leads (II, III, aVF
Location of MI with ST depression in V1-V3? Vessel?
Posterior MI, usually due to RCA (right dominant, 70%), less commonly circumflex (left-dominant, 20%)
Posterior MI with ST depression in V1-V3. How can you tell whether it is RCA or circumflex occlusion?
RCA: ST depression in left lateral limb leads (I and aVL)
Circumflex: ST elevation in left lateral limb leads (I and aVL)
Location of MI with ST elevation in II, III, and aVF? Vessel?
Inferior MI, usually due to RCA (80%), sometimes circumflex
Signs of right ventricle MI on regular 12-lead EKG? Vessel?
ST elevation in V1 > V2 (or elevation in V1 and depression in V2) and elevation in III > II. (Confirm with ST elevation in V3R-V6R)
Vessel obstructed for MI with SA node block?
Either RCA (60%) or LCX (40%)
Vessel obstructed for MI with AV node block?
Usually RCA (80%), sometimes LCX (20%)
Malignant HTN
Severe HTN with retinal hemorrhage, exudates, or papilledema
What can prevent flushing and pruritis due to niacin?
Low-dose aspirin beforehand
Initial treatment for symptomatic sinus bradycardia
IV atropine (if fails, can externally pace or use dopamine or epi)
Electrophysiological cause of a-fib? Atrial flutter?
A-fib: Ectopic foci around pulmonary veins
Flutter: Reentry around tricuspid valve
Treatment for AVNRT
Try vagal maneuvers, then go to adenosine (Gi/Go, leads to transient AV node block)
Regular rhythm at 180-200 with retrograde P waves buried in the QRS complex
AVNRT
Treatment for sustained v-tac in a hemodynamically stable patient?
IV Amiodarone
But TdP is treated with magnesium sulfate
Treatment for Torsades de Pointes in a hemodynamically stable patient?
Hemodynamically unstable?
Stable: Magnesium sulfate
Unstable: Defibrillation (not cardioversion, even if have pulse)
Treatment for hereditary long QT syndrome
Beta-blocker, plus pacemaker or AICD if symptomatic or history of syncope
Medication that can lead to acquired angioedema
ACEIs (ACE breaks down bradykinin)
Antihypertensives that can lead to hyperglycemia and hyperlipidemia
Thiazides
Diuretics leading to hypercalcemia? Hypocalcemia?
HyperCa: Thiazides
HypoCa: Loop diuretics
Amiloride
Potassium-sparing diuretic that blocks ENaC
Atrial tachycardia with AV block
Digoxin toxicity (atrial tachycardia due to ectopic activity, AV block due to vagal tone). (Also look for N/V/D and vision changes. Can be triggered by other cardiac drugs like amiodarone and verapamil)
Treatment for beta blocker overdose
First IV fluids and atropine. If still hypotensive, give IV glucagon (also Gs)
What is the big side effect of amiodarone you have to monitor for?
Chronic interstitial pnuemonitis (get CXR and PFTs before starting)
(Others: bradycardia, heart block, thyroid disease, liver toxicity, neurologic symptoms, visual disturbances, blue-gray skin discoloration).
Fleicanide and propafenone
Class 1C antiarrythmics (use-dependent K+ block) sometimes used for rhythm control for paroxysmal a-fib
Hypertension control in aortic dissection
Beta-blockers, goal is systolic 100-120.
(Nitroprusside can be added if beta-blockers not enough, but don’t give it alone as it can lead to reflex beta stimulation)
