Cardiovascular Flashcards
Elevated Trops?
0.014 - normal
0.014- 0.1 - micro MI, myocarditis, heart failure, CKD, sepsis, hypertensive crisis, stroke, and SAH
0.1-1 - small to moderate MI, myocarditis, heart failure, OE, CKD, sepsis
1-10 - large MI, myocarditis, PE, critical illness
>10 - very large MI, myocarditis
Causes of ST elevation
MI, Pericarditis, Benign Early Depolarization, Aortic Dissection, PE, electrolyte abnormalities
Types of narrow complex tachycardia?
Narrow complex tachycardia = SVTs trigged above the ventricle and is using the septum to depolarize the ventricles so this is FAST conduction.
Sinus - lots of causes - nodal system intact, something making heart rate fast, vagus or circulation of sympathetic hormones
A.fib/Aflutter - nodal system intact but activated from other spots in the atria, SA signal doesn’t get through
AV N/RT - problem is with the AV node itself or accessory pathway causing a loop, but still going in the right direction
Types of wide complex tachycardia?
Depolarization occurring outside of the septum in the ventricle itself - slow = wide complex.
Ventricular tachycardia - usually monomorphic
Torsades de Pointes - polymorphic
Things that slow down the conducting system = BBB (either left or right) wide is because half is fast and slow. This is a SVT but looks wide.
Rule for LBBB vs RBBB
William
Morrow
V1 to V6
Thinking about the direction of travel of the vector to the V1 and V6 leads.
Classes of anti-arrhythmics
Class 1: Na+ channel blocker - levels (A,B,C) Quinidine, Lidocaine, Propafenone
Class 2: metoprolol, propranolol - Beta blocker
Class 3: K+ channel blocker - amioderone
Class 4: Verapamil/ Diltazem - Ca++ blocker (nondipyramide)
Anti-arrhythmics that act on the AV/SA nodes and should be avoided in wide complex?
CCBs and Beta-blockers, also avoid digitalis and adenosine
When to follow up on an aortic aneurysm?
Follow up starting at 4.5cm, need to refer to specialist at 5cm
Bradycardia, no P waves, double peaked Ts?
Junctional rhythm - rhythm not generated from the SA node but from AV
Q waves, inverted Ts?
Both signs of previous MI/ myocardial ischemic changes
What bleeds in trauma?
Spleen, kidney - floppy structures.
What holds your blood in a trauma?
Abdomen (check Morrison pouch) Thigh (up to a litre) Pelvis (pouch of Douglas) Thorax (hemothorax) Retroperitoneal (back pain)
Initial management of a shock?
Rule out trauma - every hole and tube or a finger (rectal, catheter, ETT, or sweep)
Try to get a GCS
Give saline, morphine for pain and Ancef
(Consider IVIG if strong tetanus concern, can give shot over the next few weeks)
SAMPLE
Check for subcutaneous emphysema
Flail chest, bowel sounds, Hbg, type and cross (if you know you are giving blood)
X-ray - cross table lateral to clear C-Spine (usually C1/2 and C6/7 fractured)
GET A URINE
Measure output
(Fill the tank, squeeze the tank, flog the heart)
Fluids, pressers, ionotropes)
Most common sign of right heart failure?
Left heart failure
Cor pulmonale
RH failure due most commonly to pulmonary HTN
Low platelets - when do we need to anticoagulate?
Can start DVT prophylaxis around >100 platelets
How much should you down with daily in CHF weights
1kg/day
Wellen’s criteria?
Deep inverted T’s -sign of high grade t-wave inversion
Duke’s criteria
For risk of endocarditis
DDX for atypical heart failure
Vascular - ischemic, HTN, tachycardia induced cardiomyopathy (a.fib)
Infectious - post-viral/myocarditis, HIV, Chagas, TB (constrictive pericarditis)
Neoplastic - not so much
Drugs - alcohol, chemo (Doxyrubicin, herceptin), radiation can cause constrictive pericarditis, cocaine
Iatrogenic/ infiltrate/ idiopathic - amyloid/sarcoid, hemochromatosis,
Congenital - HOCM, peds stuff
Autoimmune - Giant cell myocarditis
Trauma - takotsubo (apical ballooning, stress related HF)
Endocrine/metabolic - thyroid dysfunction/ pheo/ Cushing’s/acromegaly
*VALVULAR
Investigations for atypical HF
Viral serology, HIV, HX, SPEP, total protein, CXR, calcium, ECG (low voltage, bradycardia, iron studies - ferritin/saturation/ genetic test for hemochromatosis, cardiac MRI, Cardiac PET, hormone levels (TSH, ACTH)
Always: Trops, TSH, echo, Iron studies (ferritin)
Triad of critical AS?
Dyspnea, syncope, angina
The 4 Ds of vertebrobasilar TIA/ stroke
Dysphagia, Diplopia, Dysarthria, Drop attacks (dizziness)
DDX for bradycardia
Meds, athletes, ACS (inferior), OSA, hyperK+, increased ICP (Cushing’s triad),
No P waves, narrow QRS complex
From AV node (junctional rhythm)
Causes of hyperkalemia
Insulin deficiency, decreasing kidney function, ARBS/ACE/Spironolactone, diet, constipation.
Tx of HyperK+
Ca+ gluc (1-2g), Insulin (IV - regular, 10 units, with D50 - one amp), to stabilize the membrane and shift the potassium. Can give ++ ventolin, and give bicarbonate (if acidosis). Give fluids, and lasix at the same time (can work)
Don’t give CaCl - unless pt is coding. Causes soft tissue burns if IV goes interstitial.
Kayexalate. Longer term management.
