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Amb Care > Case Files > Flashcards

Case Files Flashcards

1
Q

When is direct current cardioversion indicated post-MI?

A

When ventricular contraction is not coordinate w/ the SA node, such as in sustained VT (over 30 sec) and VF

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2
Q

Amiodarone

A

Antiarrhythmic

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3
Q

What is an inferior MI?

A

Inferior MI = ST segment elevation in the inferior leads (II. III. aVF) = RCA territory

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4
Q

Complications of an inferior MI that may required atropine

A

Inferior MI is MI involving the RCA (leads II, III, aVF are the inferior leads), RCA Is what supplies the SA node => inferior MI can cause bradycardia
-usually this bradycardia doesn’t require tx, but if HR falls low enough for CO and BP to fall, give IV atropine (ACh receptor blocker)

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5
Q

Mobitz I vs. Mobitz II second-degree AV Block

A

Mobitz I = Gradual prolongation of the PR interval before a nonconducted P wave (dropped beat)

Mobitz II = nonconducted P waves (dropped beat) NOT preceded by PR prolongation

-AV nodal dysfunction (ex: nodal ischemia from inferior MI)

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6
Q

Criteria for cardiogenic shock

A

Hypotension w/ systolic BP under 80 mmHg

  • markedly reduced cardiac index less than 1.8 L/min/m2
  • elevated LV filling pressure
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7
Q

Clinical appearance of pt in cardiogenic shock

A
  • hypotensive
  • cold extremities due to peripheral vasoconstriction
  • pulmonary edema (due to high left sided filling pressures)
  • elevated jugular venous pressure (due to high right sided filling pressures)
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8
Q

Development of acute heart failure w/ new holosystolic murmur after MI

A

Complication of MI = ventricular septal rupture => holosystolic murmur
-stabilize w/ afterload reduction (IV nitroglycerin)

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9
Q

Most catastrophic and lethal complication of MI

A

Rupture of the ventricular free wall

  • as blood fills the pericardium, cardiac tamponade develops => sudden pulselessness, hypotension, LOC
  • nearly always fatal
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10
Q

Dressler syndrome

(a) Tx

A

Dressler syndrome = post-MI immune phenomenon characterized by pericarditis, pleuritis, and fever

(a) Tx = anti-inflammatory, mainly NSAIDs and sometimes prednisone

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11
Q

Most important risk factor to prevent cardiac events

A

Smoking cessation

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12
Q

Medicines for secondary prevention of ischemic heart disease

A
  1. aspirin
  2. clopidogrel
  3. beta-blocker
  4. statin
  5. ACEi
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13
Q

59 yo diabetic F had acute anterior wall MI 5 days ago, is complaining of CP

  • current EKG shows no ischemic changes
  • troponin levels are mildly elevated

Next best step?

A

Next best step = serial EKGs and obtain CK-MB
(not PCI)

  • tropnonins remain elevated 5-14 days after event => shouldn’t be used to diagnose reinfarction
  • new EKG findings or rising CK-MB can be used to dx reinfarction
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14
Q

EKG leads

(a) Anterior
(b) Lateral
(b) Inferior

A

EKG leads

(a) Anterior leads = LAD territory = V2,3,4
(b) Lateral leads = Left circ territory = I, aVL, V5, V6
(c) Inferior leads = RCA territory = II, III, aVF

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15
Q

How to ACEi reduce mortality in heart failure?

A

ACEi reduce preload and afterload => decreasing atrial, pulmonary arterial, pulmonary capillary wedge pressures and systemic vascular resistance => prevents remodeling

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16
Q

Use of diuretics in HF

A

To reduce preload

17
Q

Most probable cause of aortic stenosis in

(a) Pts under 30
(b) Pts 30-70 yoa
(c) Pts over 70 yoa

A

Aortic stenosis cause in

(a) Pts under 30 = congenital bicuspid aortic valve
(b) 30-70 yoa: congenital bicuspid aortic valve or acquired rheumatic disease
(c) Over 70 yoa: degenerative calcific stenosis

18
Q

Gives examples in each of the categories for causes of CHF

(a) Myocardial injury
(b) Chronic pressure overload
(c) Chronic volume overload
(d) Infiltrative Diseases

A

Causes of CHF

(a) Myocardial injury
- acute rheumatic fever
- ischemic cardiomypathy from atherosclerotic CAD
- alcohol and cocaine use
- viral myocarditis
- chemo drug: adriamycin

(b) Chronic pressure overload from HTN (high SVR) and aortic stenosis
(c) Chronic volume overload from mitral regurg

(d) Infiltrative disease
- amyloidosis
- hemochromatosis

19
Q

55 yo M w/ CHF and DOE
-EF 47%

Diastolic or systolic dysfunction?

A

W/ EF over 40%- more likely to be diastolic dysfunction (stiff ventricles that do not readily accept blood)

20
Q

Signs of aortic stenosis

(a) pulse pressure
(b) type of murmur
- best heard where?

A

Aortic stenosis

(a) Narrow pulse pressure
- narrow reading btwn systolic and diastolic
(b) harsh, late-peaking systolic murmur
- late-peaking crescendo-decrescendo ejection systolic murmur
- heard best at right 2nd intercostal space, radiates up to carotids

21
Q

Pulsus parvus et tardus

A

Delayed slow-rising carotid upstroke- indicative of aortic stenosis

Parvus = weak/small b/c upon palpation pulse is weak
Tardus = late b/c upon palpation pulse is late
22
Q

What is the most common cause of CHF in the US?

A

Myocardial injury due to ischemic cardiomyopathy (atherosclerotic coronary artery disease)
-so basically CAD so basically HTN/HLD

23
Q

How to distinguish HF from systolic vs. diastolic dysfunction

A

Ejection fraction

HF due to impaired systolic fraction has EF under 40%
HF due to diastolic dysfunction will have preserved EF

24
Q

What determines CHF functional class?

A

Exercise tolerance

-best predictor of mortality and often guides therapy

25
Q

AFib

(a) atrial depolarization rate
(b) ventricular depolarization rate
(c) resultant rate and rhythm

A

Afib

(a) Atrial rate of 300-400 bpm
(b) Ventricular rate depends on the number of impulses that get thru the AV node => irregular
(c) Irregularly irregular rhythm

26
Q

Diastolic rumble and ruddy cheeks

A

Diastolic rumble and ‘ruddy cheeks’ = buzzwords for mitral stenosis

27
Q

Why do we care about AFib?

A

We care about AFib b/c a fibrillating atria is just a sess-pool for blood to thrombose and shoot right up to the brain => stroke

28
Q

I SMART CHAP mneumonic for causes of AFib

A

Inflammatory disease (pericarditis, myocarditis)

Surgery (postbypass, postvalvular)
Meds 
Atherosclerotic CAD
Rheumatic heart disease (esp. w/ mitral stenosis)
Thyrotoxicosis

Congenital: Ebstein’s anomaly, ASD

29
Q

Contraindications to cardioversion for pt in AFib

(a) How to treat this pt

A

After a pt is in AFib for over 48 hrs there is too high of a chance of LA thrombosis (aka stroke) for cardioversion to be safe =>

(a) pts in AFib for over 48 hrs: first anticoagulate for 3-4 weeks, then cardiovert

30
Q

Two important factors affecting cardioversion outcome in AFib pts

A

AFib prognostic factors

  • left atrial dilation: >4.5 cm predicts failure of cardioversion
  • duration of AFib: longer the pt is in fibrillation, more likely they are to stay there
31
Q

Efficacy of warfarin anticoagulation in AFib pts

A

Warfarin anticoagulation reduces the risk of stroke in pts w/ chronic AF by two-thirds

32
Q

Goal INR for AFib pt on warfarin

A

Wafarin goal INR 2-3

33
Q

Are all AFib pts on aspirin?

A

No! If pt is young and

Amb Care (13 decks)

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