Cardiovascular Flashcards
ACS
Diagnosis criteria for STEMI
Diagnosis criteria for NSTEMI
STEMI
- 2 or more contiguous leads with >1mm elevation at J-point
- (V2-V3 must be 2mm)
- New LBBB
- Elevated Troponin
NSTEMI
- ST depression and/or T-wave inversion
- Elevated Troponin
MI localization based on ECG
Septal: V1-V2: Proximal LAD
Anterior: V3-V4: LAD
Apical: V5-V6: Distal LAD, LCx, RCA
Lateral: I, aVL: LCx
Inferior: II, III, aVF: RCA (85%), LCx (15%)
RV: V1-V2 and V4: Proximal RCA
Posterior: ST depression V1-V3: RCA, LCx
STEMI treatment
- Time is Muscle
- Once at hospital: PCI within 90mins or Fibrinolytic within 30 mins
- Transfer for PCI if door to balloon <120mins, or patient has high risk factors (cardiogenic shock, >3h since symptoms, high risk for cerebral hemorrhage)
- Fibrinolysis = TpA (activates plasmin)
Percutaneous Coronary Intervention
Immediate medical adjuncts for Untable Angina/NSTEMI/STEMI
- Morphine: venodilation to decrease preload which decreases pulm effusion. Also treats pain/anxiety
- Oxygen: maintain SpO2 >90%
- Nitrates: relief symptoms (contraindications: hypovolemia, RV infarcts, Sildenafil)
- ASA: Chew 325mg
Unstable Angina/NSTEMI treatment
- Beta blocker: CI’s bronchospasm, HF, 2/3 degree block, shock, brady/hypoten
- CCB: Only if Bb contraindicated for bronchospasm
- ACE inhibitor: Esp for HF, EF <40%
- Morphine: venodilation to decrease preload which decreases pulm edema. Also treats pain/anxiety
- Oxygen: maintain SpO2 >90%
- Nitrates: relief symptoms (contraindications: hypovolemia, RV infarcts, Sildenafil)
- Antiplatelet
- Anticoag
Effectiveness of Bb in decreasing progression of UA/NSTEMI to STEMI
13%
CHF
- Systolic HF (can’t expel blood): EF, murmur, left ventricle
- Diastolic HF (can’t relax and fill): EF, murmur, left ventricle
Systolic:
- Reduced EF <40%
- S3 murmur
- Dilated LV
Diastolic
- Preserved EF >50%
- S4 murmur
- Hypertrophoic LV
CHF stage and treatment
A: risk of HF
B: Asymptomatic but structural abnormalities
C: HF symptoms + structural abnormalities
D: HF symptoms at rest. (4yr mortality >50%)
A: Treat underlying condition
B: ACE inhibitor, Bb
C: ACE-I, Bb, diuretic, salt restriction
D: Above + mechanical support (VAD, transplant, end of life)
Valve sounds:
Crescendo-decrescendo systolic murmur
Aortic stenosis
Angina, syncope, HF
AVR if symptomatic
Valve sounds:
Decrescendo blowing diastolic murmur
Aortic regurg
Dyspnea on exertion, signs of HF
Decrease afterload with systemic vasodilatros and diuretics
Valve sounds:
Opening snap
Mitral stenosis
Gradual onset dyspnea on exertion, R HF, Pulm HTN
Rx, valvuloplasty, MVR
Holosystolic blowing murmur
Mitral regurg
Asymptomatic progressing to dyspnea on exertion and HF
EF <30% MVR
EF>30 Rx or left vent assist device
Midsystolic click
MVP
Asymptomatic
No treatment if asymptomatic
Midsystolic click
MVP syndrome
SVT, autonomic nerve dysfunction, CP, palpitations, sycope
Reassurance, stress reduction
Difference between Esmolol and Labetalol
- receptors
- rate of onset
- duration
Receptors
- Esmolol selective-beta-1 blocker
- Labetalol non-selective beta blocker: beta-1, beta-2, alpha
Rate of onset
- Esmolol 2 mins
- Labetalol 5 mins
Duration
- Esmolol 30 mins
- Labetalol 8 hours
Why is ACE inhib + diuretic 1st line for CHF
Why is ACE inhib + diuretic 1st line for CHF
- Decrease afterload (ACE) and preload (Diuretic)
Heart Sounds
- S1
- S2
- Split S2: which valve is delayed in closing and why?
- Which heart sounds are pathologic if present?
Heart Sounds
- S1 = End of diastole (TcV and MtV closed)
- S2 = End of systole (PmV and AoV closed)
- Split S2 = PmV delayed closing bc inspiration brings extra blood into R ventricle. More blood to push out of ventricle means valve stays open a little longer
- Pathologic = fixed S2, S3 (gallop volume overload or CHF), S4 (stiff ventricle in HTN, Aortic Stenosis, Cardiomyopathy)
Renin-Aldosterone System
- Sympathetic or Parasympathetic mediated
- What organ releases Renin?
- What organ converts Angiotensin I into Angiotensin II?
- What structure releases ADH (Vasopressin)
- What structure releases Aldosterone
- Action of ADH
- Action of Aldosterone
- Action of Angiotensin II
Renin-Aldosterone System
- Sympathetic mediated
- Kidney releases Renin if perfussion/serum Na low
- Lung converts Angiotensin I into Angiotensin II?
- Pituitary releases ADH (Vasopressin)
- Adrenal gland Aldosterone
- Action of ADH - renal retention of sodium leading to fluid retention
- Action of Aldosterone - retention of sodium in kidney, colon, sweat glands
- Action of Angiotensin II - see photo
RCA occlusion manifests how clinically?
LCA/LAD occlusion manifests how clinically?
RCA supplies SA node, AV node, R ventricle
- Occlusion causes arrythmias, heart block
LCA/LAD supplies septum, L ventricle
- Occlusion causes decreased myocardial function
Which ECG lead is most sensitive to ischemia?
Which ECG lead monitors RCA and conduction disturbances?
Lead V5 most sensitive to ischemia
Lead II monitors RCA and conduction disturbances
List 3 calcium channel blockers
- Uses
- Mechanism
- Side effects
List 3 calcium channel blockers
- Verapamil, Diltiazem, Amlodipine
- Uses: Vasodilation, angina
- Mechanism: Smooth muscle relaxation in vessels, decreased contractility of myocardium (negative ionotrope)
- Side effects: Reflex tachycardia, HA, flushing
Does aldosterone waste or retain K+?
Side effects of ACE-I
Aldosterone wastes K+
Side effects of ACE-I
- Hyperkalemia, cough, angioedema from increased bradykynin, teratogen
Infective Endocarditis
Organism(s) for each:
- IV drug use
- Native valve
- Prothestic valve
- Culture negative
IV drug use
- Staph aureus
Native valve
- Staph aureus, Strep virridans, enterococci
Prothestic valve
- Staph epidermidis, aureus
Culture negative
- HACEK (Haemophilus, Aggregatibacter, Cardiobacterium, Eikenella corrodens, Kingella),
- Candida, Aspergillus
WPW
- EKG signs
- Pathophys
- Treatment
- Medications to avoid
WPW
- Delta wave = slurred P wave + QRS
- Atrial contraction + Ventricle contraction almost simeoutaneously because of an accessory pathway
- Tx = Procainamid (Na channel blocker anti-arrhythmic )
- Don’t use = Adenosine, Amiodarone. Will cause V-fib
