CV Flashcards
Heart rate on ecg
300/# of large boxes between two consecutive qrs complexes
Thumb rule for axis on ekg
If both leads I and II are positive (qrs up), axis is normal
If lead I is up and lead II is down, they have LEFT each other (left axis deviation)
If lead I is down and lead II is up, they are heading RIGHT for each other (right axis deviation)
Each large box on ecg represents ___ seconds and ms
0.2seconds
200ms
Each small box on ekg represents how many Seconds/milliseconds
0.04 s
40 ms
Pr interval is usually between how many msec
120 and 200 (3-5 little boxes)
Pr interval is how long in av block
> 200ms
Qrs interval is usually how many ms? Which two patterns have a wider qrs
Normally <12ms
Lbbb and rbbb
Normal qtc interval
<440 ms
In normal ekg, r waves ___ in size compared to S waves between leads __ and __
Increase
V1 and v5
Poor r wave progression in precordial leads is a nonspecific sign of
Ischemia
How to detect right atrial enlargement on ekg?
P wave in lead II > 2.5mm
How to detect left atrial enlargement on ekg?
P wave width in lead II is >120ms, or terminal negative deflection in v1 is >1mm in amplitude and >40msec in duration
Lv hypertrophy on ekg
Amplitude of s in v1 + r in v5 or v6 is >35mm
Rv hypertrophy on ekg
Right axis deviation and r wave in v1>7mm
One big box on ekg is how many mm
Five
What is hepatojugular reflux
Distention of neck veins upon applying pressure to liver
Hepatojugular reflux is seen in what conditions
Heart failure or pulmonary htn
What is kussmaul sign
Increase in jugular venous pressure with inspiration
Kussmaul sign is seen in what two conditions
Cardiac tamponade and constrictive pericarditis
Systolic murmurs
A dashing cis (sys) mister
Aortic stenosis
Mitral regurg
Also mvp and flow murmurs
Describe mitral regurg
Holosystolic murmur that radiates to the axilla
Describe mitral valve prolapse
Midsystolic click and then systolic murmur
Diastolic murmur types
Aortic regurg
Mitral stenosis
A daring missus, a disreputable diastolic damsel
Are diastolic murmurs normal or abnormal
Always abnormal
What is pulsus paradoxus
Decrease in systolic bp with inspiration
What is pulsus alternans? What is it seen in
Alternating weak and strong pulses
Seen in cardiac tamponade
What is pulsus parvus Et tardus? What is it seen in
Weak and delayed pulse
Seen in aortic stenosis
Management options for atrial fibrillation
Anticoagulate
B blockers
Cardiovert/ca channel blocker
Digoxin (refractory)
Chads vasc score estimates
Stroke risk in afib pts
Anticoagulate for a Chad’s vasc score of __ or above
2
What does Chad’s vasc stand for
Chf Htn Age >75 Diabetes Stroke or tia hx Vasc diseAse Age 65-74 Sex category (female)
Sinus bradycardia Is under how many bpm
60
In first degree av block, pr interval is >
200ms
Second degree av block is also called
Mobitz type I/wenckebach
Or
Mobitz type II
Define 2nd deg av block mobitz I
Progressive pr lengthening until a drppped beat occurs
Drugs that can cause second deg av block mobitz I
Digoxin
B blockers
Ccbs
Define mobitz II
Unexpected dropped beats without change in pr interval
Cause of mobitz II
Fibrotic dz of conduction system or MI
Tx of mobitz II
Pacemaker
Tx of mobitz I
Atropine as needed
Define third deg av block. Tx?
No electrical communication between Atria and ventricles
Tx-pacemaker
Define sick sinus/yacht Brady syndrome
Intermittent supraventricular tachy and Bradyarrhythmias
Most common indication for pacemaker
Sick sinus/tachy Brady syndrome
Sinus tachy is above
100 bpm
For chronic afib, rate control with
B blockers
Ccbs
Digoxin
For chronic afib, anticoagulate with
Warfarin
For unstable/chronic afib,
Cardiovert if onset <2 days
If >2 days or unclear duration,get a tee to rule out atrial clot
Etiology of aflutter
Circular movement of electrical activity around the atrium at rate of 300X per minute
Etiology of avnrt
Reentry circuit in av node that depolarizes atrium and ventricle nearly simultaneously
Rate in avnrt
150-200
P wave in avnrt
Often buried in qrs or shortly after
Etiology of avrt
Ectopic connection between Atria and ventricle that causes a reentry circuit
Example: wpw
Etiology of paroxysmal atrial tachy
Rapid ectopic pacemaker in atrium (not sinus node)
How to unmask underlying atrial activity in paroxysmal atrial tachy
Adenosine
Define systolic dysfunction
Ef <50% and increased lv end diastolic volumes
Systolic dysfunction is caused by
Inadequate lv contractility it increased afterload
Bnp levels in chf
> 500pg/ml
Creatinine in chf
Sometimes high
Sodium levels in chf
Low in later stages
Class III chf
Limitation of activity. Comfort only at rest.
Class IV chf
Symptoms present at rest
Class I chf
No limitation of activity
Acute chf pulmonary congestion management
Lmnop Lasix Morphine Nitrates Oxygen Position (upright)
B blockers should be ___ during decompensated chf
Avoided
Why avoid ccbs in chf
Can worsen edema
B Blockers and arbs in chf help
Help prevent remodeling of heart and decrease mortality
Low dose spironolactone does what for chf pts
Decrease mortality risk
Loops ___ calcium, thiazides ___
Loose
Take in
In nonsystolic dysfunction, ventricle has either
Impaired active relaxation or impaired passive filling
If you send a guy out after chf exacerbation on lasix and bblocker, what else should you add
Acei
Potassium levels with loops
Cause hypokalemia
Thiazides cause hyper__
Gluc Glycemia Lipidemia Uricemia Calcemia
Side effects of spironolactone
Hyperkalemia
Gynecomastia
Sex dysfunction
S3 signifies
Rapid ventricular filling in setting of fluid overload
S4 gallop signifies
Stiff non compliant ventricle and increased atrial kick
S4 May be associated with
Hypertrophic cardiomyopathy
Key pe finding in hocm
Systolic ejection crescendo-decrescendo murmur that increased with decreased preload (valsalva, standing) and decreases with increased preload (passive leg raise)
Tx of hocm
B blockers for symptomatic relief, ccbs second line
What is angina pectoris
Substernal chest pain secondary to ischemia
Prinzmetal angina is caused by
Vasospasm of coronary vessels
Prinzmetal angina classically affects
Young women at rest in early morning
St elevation in absence of cardiac enzyme elevation
Prinzmetal angina
Tx of stable angina
Asa
B blockers
Nitroglycerin
Ck comes down _ days after mi, tropinin comes down after _ days
Two
4-5
Inferior mi involves what coronary vessels
Rca/pda
Anterior mi involves what coronary vessels
Lad
Lateral mi involves what coronary vessels
Lca
Ecg changes in inferior mi
St elevation in leads II, III, aVF
Ekg changes in anterior mi
St elevation in leads v1-v4
Ekg changes in lateral mi
St elevation in leads I, aVL, and v5-v6
In ___ Wall mis, avoid nitrates due to
Inferior
Risk of severe hypotension
Post mi complications: first day
Heart failure
Post mi complications: 2-4 days
Arrhythmia, pericarditis
Post mi complications: 5-10 days
Lv Wall rupture, papillary muscles rupture
Post mi complications: weeks to months
Ventricular aneurysm
What is dressler syndrome
Autoimmune process 2-10 weeks post mi, presents with fever, pericarditis, pleural effusion, leykocytosis, elevated esr
Start getting lipid levels at age
35
Effect on lipid profile:
Gemfibrozil
Low triglycerides
High hdl
Effect on lipid profile:
Ezetimibe
Lowers ldl
Effect on lipid profile:
Niacin
Elevated hdl
Lowers ldl