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Clin Med II > conduction blocks, aortic diseases > Flashcards

conduction blocks, aortic diseases Flashcards

1
Q

first degree AVB

A
  • prolonged PR
  • 1:1 P to QRS
  • not likely to degrade to second degree
  • usu benign and asymptomatic
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2
Q

treatment for first degree AVB

A
  • if PR interval < 300 msec and narrow complex, no treatment
  • if wide QRS refer to EP and possible pacemaker
  • need to treat underlying causes
  • avoid AV nodal blocking meds
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3
Q

work up for second and third degree AVB

A
  • check electrolytes
  • check digoxin levels
  • cycle cardiac biomarkers if suspect MI
  • lyme titers
  • echo
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4
Q

Wenckebach

A
  • aka mobitz type I
  • PR interval gets longer and longer until dropped beat
  • usually asymptomatic
  • can happen in normal or sick hearts
  • rarely progresses to complete heart block
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5
Q

treatment of wenckebach

A
  • treat underlying cause
  • avoid AV nodal blocking meds
  • no specific tx for asymptomatic pts
  • monitor EKG for progression
  • if syncope or other sx refer to EP
  • if marked PR prolongation consider pacemaker
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6
Q

Mobitz type II

A
  • normal PR but random dropped beats
  • indicates underlying disease of his- purkinje system
  • sx range based on rate and frequency of dropped beats
  • frequently progresses to complete heart block
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7
Q

treatment for mobitz type II

A
  • pacemaker in all pts
  • treat underlying cause
  • avoid AV nodal blocking meds
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8
Q

third degree AVB

A
  • complete AV dissociation

- disease of AV node or his- purkinje system

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9
Q

clinical manifestations of third degree AVB

A
  • chest pain if in setting of MI
  • lightheadedness
  • fatigue, weakness, exertional dyspnea
  • bradycardia
  • v tach or v fib
  • asystole/ sudden death
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10
Q

treatment for third degree AVB

A
  • temporary pacer and refer to EP
  • treat underlying cause
  • avoid AV nodal blocking meds
  • permanent pacemaker placement in all pts
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11
Q

LBBB

A
  • widened QRS > 0.12 sec
  • broad S waves in V1-V3, AVR
  • broad R waves in I, V5 V6
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12
Q

treatment for LBBB

A
  • if young and asymptomatic without CAD no treatment
  • treat underlying cause
  • manage and reduce risk in CAD
  • if STEMI equivalent -> cath lab
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13
Q

when is LBBB considered a STEMI equivalent

A
  • new LBBB In setting of MI
  • associated with increased short and long term mortality
  • usually assoc with CAD
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14
Q

aneurysm

A
  • all three artery walls weaken -> abnormal bulge
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15
Q

fusiform aneurysm

A
  • entire circumference of segment of vessel
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16
Q

saccular aneurysm

A
  • portion of circumference -> out pouching of wall like a pocket
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17
Q

pseudoaneurysm

A
  • intimal and medial layers disruptued
  • dilated segment lined by adventitia only
  • doesnt involve all three layers
18
Q

etiology of aneurysm

A
  • degenerative diseases
  • atherosclerosis
  • marfans
  • ehlers- danlos
  • family hx
  • infections- tertiary syphilis
  • vasculitis
  • trauma
19
Q

thoracic aortic aneurysms

A
  • most are in ascending aorta, next is descending
  • assoc with atherosclerosis
  • less common than AAA
  • usually male with HTN in 50s or 60s
20
Q

diagnosis of TAA

A
  • gold std= chest CT
  • CXR
  • echo
21
Q

sx of TAA

A
  • often asymptomatic with normal PE
  • if sx it is because aneurysm is very large
  • chest, back, flank, or abd pain
  • rarely HF sx
  • hoarseness, wheezing, cough, hemoptysis, dysphagia
  • rupture -> tachycardia and hypotension
22
Q

treatment of TAA

A
  • BB, esp in Marfan
  • HTN control, usually ACEI/ ARB
  • operative repair / replacement when sx, ascending > 5.5 cm or descending > 6.5 cm
  • may need endovasc repair
23
Q

AAA

A
  • > 3 cm
  • usu asymptomatic when > 5 cm
  • rupture is catastrophic
  • more common in men over 60
24
Q

at what point is AAA a concern for rupture

A
  • > 5 cm
25
Q

where do most AAA occur

A
  • 90% originate below renal arteries
26
Q

risk factors for AAA

A
  • age > 60
  • male
  • cigarette smoking**
  • HTN, hyperlipidemia
  • caucasian, family hx
  • other aneurysms
  • atherosclerosis
27
Q

sx of AAA

A
  • mostly asymptomatic
  • abdominal, back, flank, or groin pain
  • sudden cold or blue extremities
  • any sx= rupture risk
  • pulsatile abdominal mass
  • eccchymosis if AAA ruptured
28
Q

screening for AAA

A
  • abd US best
  • men 65-74 with hx of cigarette smoking**
  • first degree relative with hx of AAA
  • pts with throacic or peripheral aneurysms
  • pts with hypermobile syndromes like marfan’s or ehlers danlos
29
Q

treatment for AAA

A
  • surveillance until > 5.5 cm
  • open vs endovascular repair
  • endovasc repair preferred- lower short term morbidity
  • high mortality rate
30
Q

aortic dissection

A
  • disruption of intima, blood pools between -> false lumen
  • “intima dissects out from media”
  • may lead to embolic phenomenon
  • 90% occur in 1st 10 cm of aorta, most are 2.2 cm above aortic root
31
Q

risk factors for dissection

A
  • HTN**
  • atherosclerosis
  • aortic aneurysm
  • vasculitis
  • marfan’s, ehlers- danlos
  • bicuspid aortic valve, aortic coarctation
  • previous cardiac surgery
  • turner syndrome
  • high intensity weight lifting
  • crack, cocaine
32
Q

sx of dissection

A
  • severe tearing back pain (intrascapular)
  • pain may radiate to anterior chest or neck
  • HTN
  • wide pulse pressure
  • unequal or diminished peripheral pulses
  • chest pain + neuro sx
  • acute aortic regurg
33
Q

diagnosis of dissection

A
  • CXR and echo esp if pt is in acute distress

- CTA gold std

34
Q

findings on CXR for dissection

A
  • widened mediastinum
  • loss or aortic knob
  • deviated trachea if dissection is large
35
Q

findings of CXR for AAA

A
  • widened mediastinum

- tracheal deviation

36
Q

classification for dissection

A
  • stanford type A- ascending aorta
  • stanford type B- distal to left subclavian
  • also the debakey classification
37
Q

treatment for dissection

A
  • ascending- surgical emergency
  • descending- medically managed
  • operate if progression with end organ damage, continued hemorrhage, or tamponade
38
Q

surgical options for dissection

A
  • endovascular repair or open surgical repair

- reoperation if extensive or recurrent dissection, aneurysm, or leakage at anastamoses or stent site

39
Q

medical therapy for dissection

A
  • life long BB
  • avoid strenuous activity
  • keep BP < 120/80
40
Q

mortality rate for dissection

A
  • 1% per hour for 72 hours if untreated

- over 90% at 3 months

Clin Med II (16 decks)

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