Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

IPAP > EKG Block 2: The Possible Algorithm Thunder Dome > Flashcards

EKG Block 2: The Possible Algorithm Thunder Dome Flashcards

1
Q

What are the cardinal Sxs of CVDz?

A 
CDC PFCS 
Chest pain/discomfort
Dyspnea
Cough
Palpiatation
Fatigue/Weakness
Claudication
Syncope/Dizzy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the cardinal manifestation of myocardial ischemia from CAD?

A

Chest pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Define Dyspnea

A

Uncomfortable awareness of breathing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are parts of the blood testing used for standard evaluation?

A

CBC
Thyroid indices
Lipid levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Other than troponin, what other lab/blood result is useful in evaluating PTs for potential HF?

A

Pro- B type natriuretic peptide level

BMP <300 nearly excludes Dx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

In the setting of acute chest pain, what imaging modality if effective in diagnosing coronary artery disease?

A

Multi-slice CT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

When are stress tests/pharmacologic stress testing useful?

A

Ischemia
Abnormal perfusion- radionuclide studies
Abnormal transient wall motion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Radionuclide studies can be used to assess what types of heart function issues?

A

Left ventricle function
Myocardial ischemia
Determine if ischemic myocardium is variable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What can cardiac catherterization be used to measure?

A

Gradients across stenotic cardiac valves
Severity of intracardiac shunts
Intracardiac pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What can coronary angiography be used to provide diagnostically?

A

Definitive Dx of coronary artery disease

Necessary to prelude coronary revascularization with percutaneous interventions or coronary artery bypass grafts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Define Palpitations

A

Sensation of irregular/abnormal heart beats most commonly from ectopic premature atrial beats, ventricular contractions and tachyarrythmias

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the next clinical step when a PT complains of palpitations?

A

Hx can lead to Dx

Pt taps out rhythm with fingers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Pre/Syncopes can be manifestations of what four things?

A

Tachy/brady arrhythmias
Neurocardiogenic syncopes
Unrelated to arrhythmias

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What can cause neurocardiogenic syncope?

A 
Vasovagal/reflex- most common
Situational micturition- defecate, swallow, cough
Carotid sinus syncope
Neuralgia
Psych d/o
Meds
Exercise
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What can cause arrythmogenic syncope?

A

Bradys: sinus node dz, 2/3 AV blocks, pacemaker malfunction, drug induced
Tachys: V-tach, Torsades, SVT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the “other” causes of syncopes?

A 
Neurologic/psych dz- migraine, TIAs
OHOTN
Dec CO
Neuralgias
Psych D/os
Meds
Exercise
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Diagnostic considerations that need to be taken for neurocardiogenic syncope?

A

Sxs after prolonged motionless standing
Well trained athlete after exertion w/out heart dz
Situational syncope after micturition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Diagnostic considerations that need to be taken for organic heart disease syncope?

A

No prodrome, brief LOC
Syncope w/ exertion
FamHx of sudden death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Diagnostic considerations that need to be taken for neurological syncope?

A

Confusion >5min post-seizure
TIA
Migraine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Diagnostic considerations that need to be taken for other vascular reasons of syncope

A

Carotid sinus
OHOTN
Subclavian steal
Aortic dissection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the 3 class categories for PTs with heart palpitations?

A

1- palpitations, syncope, dizziness
2- SoB, chest pain, fatigue,
3- Sxs not reasonably expected to be caused by arrhythmias

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

When is long term monitoring suggested for PTs?

When is exercise testing used?

A

Holter, Loop, Telementry or Loop Recorders

Assess arrhythmia and chronotorpic incompetence in bradyarrhythmias

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

When can formal invasive electrophysiologic testing useful diagnostically?

When/why is electrophysiologic testing used?

A

Supra/Ventricular wide-complex tachy

Mechanisms of tachyarrhythmias and prior to ablations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the three Classes of electrophysiology studies?

A

1- PT w/ palpitations and tachy arrhythmias and ECG fail to document cause of palpitations or palpitations after a syncope
2- clinically significant palpitations, sporadics/unrecordable Sxs
Studies used to determine mechanism of arrhythmia, direct/provide therapy or assess prognosis
3- PTs w/ palpitations and have extracardiac causes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

WHat are the three classes of use for an ECG?

A

1- arrhythmic w/ evidence of heart dz
2- arrhythmias associated with but w/out evidence of heart dz
3- palpoatations w/out evidence of arrhythmias or minor arrhythmia w/out evidence of heart dz

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is the most useful test for analyzing valve and ventricular functions and can quantify stenotic/regurgitated lesions?

A

ECG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

When are handheld US performed by generalists?

A

Assess left ventricular function, cardiomegaly and pericardial effusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is the preferred test/image modality to evaluate probable aortic dissection and idntify clots in cardiac chambers?

A

Transesophageal echocardiography

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is the most common form of angina?

What S/Sxs does it present with?

A

Stable agina pectoris- classic angina

Short lasting burning, heavy, squeezing feeling in chest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Describe Unstable Angina

A

Chest pain occurring with increased frequency, duration and intensity that can be precipitated by progressive less effort

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What are the parts of gatering an angina history?

A 
S/Sx- in PTs own words
Allergies
Meds- SHOP
Past MedHx
Last PO intake
Events- what were you doing when this event started?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What acronym are we using for gathering an aninga history?

A

OPQRST

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What are the anginal equivalents that PTs can present with that are not EXACTLY angina?

A

Dyspnea, Fatigue, Lightheaded, Dizzy, Belching

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What position preference do angina PTs prefer?

What makes the feel better?

A

Rest, sit, or stop walking when angina occurs

Resolves w/in minutes of rest or taking Nitro

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What does typical chest pain quality have?

What are the atypical quality traits of angina that are more common in women, elder, DM, CVD PTs?

A

Levine Sign

Mild epigastric burning
Numbness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Where does angina radiation commonly present?

A 
L side of neck/jaw
L shoulder
Ulnar surface of L arm
R arm is less common
Epigastric w/ or w/out chest pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

When does angina pain start to become concerning?

A

Angina pectoris is brief-mi

Concerning for ACS when more than 15-20min and especially at rest or nocturnal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Describe what non-cardiac etiologies of chest pain can present as?

A

Pleuritic- reproduced w/ movement/palpitations of chest wall
Sharp/constant x many hrs
Localized pain w/ tip of finger

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What is the preferred test for PTs with suspected angina or moderate probablitlity of CAD?

A

Treadmill ECG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Q waves are a specific indicator for ?

A

Previous MI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

When are Nuclear Cardiology imaging used?

A

Single Photon Emission on PTs who have an abnormal ECG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

When is a Stress Echo done on PTs?

A

ID new wall motion abnormalities and structure of the heart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Define Prinzmetal Angina?

A

Caused by occlusive spasm on a coronary artery that would not otherwise obstruct blood flow

44
Q

Prinzmetal Angina is associated with what 3 things?

A

Raynauds phenomenon
Migraine HA
Smoking

45
Q

When do PTs with variant angina have pain?

How does the pain present?

A

Rest, possibly w/ exercise

Cyclic or recurring

46
Q

How is Variant Angina diagnosed and managed?

A

Documented Transient ST elevation during chest pain w/out corresponding CAD

CCBs

47
Q

Define Wellens Syndrome

A

Syndrome indicating critical high-grade occlusion of the proximal LAD or L main

48
Q

What is the pathophysiology behind Wellens Syndrome

A

Unstable angina or unstable thrombus that may cause intermittent Sxs, nonspecific ECG findings, and little/no cardiac marker elevations

49
Q

What is the end results of Wellens Syndrome that is not identified and properly treated?

A

Mean time from onset to extensive anterior wall MI is 8.5days

50
Q

Difference between Type A and B Wellens Syndrome

A

A= 25%, biphasic T waves in anterior leads
Pseudo normal ST segment w/ pain
Causes AMI in 9 days if no PCI/CABG is done

B- 75%, V3 deeper than V2, 1mm ST elevation in chest leads

51
Q

ECG characteristics of Wellends Syndrome Type A

A

Biphasic T waves in V2 and V3 that are symmetrical
No Q waves in precordial leads
Precordial R waves remain unchanged

52
Q

ECG characteristics of Wellens Syndrome Type B

A

Deep symmetrical T waves

53
Q

Characteristics of LMCA occlusion

A

70% risk of cardiogenic shock or dying
ONLY Tx- rapid PCI or emergent CABG
Not only in STEMI PTs, any ACS w/ LMCA occlusion

54
Q

What ECG changes occur in aVR during a Left Main Occlusion?

A

ST elevation in aVR during ACS highly indicative

ST elevation in aVR greater than V1, elevation in aVL and aVR >1.5mm

55
Q

What’s the dilema with Dx MI w/ LBBB?

A

1/2 of PTs don’t have chest pain and thus less likely to receive appropriate care (aspririn, BBs)

56
Q

How to ID a posterior wall STEMI?

A

ST elevation in aVR in presence of ischemia- highly specific for acute occlusion on LMCA

57
Q

Where to look to try and locate a Posterior Wall STEMI?

A

V1-3 reciprocal marks

58
Q

Posterior Wall MIs are suggested by what ECG changes?

A

Horizontal ST depressions
Tall, broad R waves
Upright T waves
Dominant R waves in V2

59
Q

PT presenting w/ ischemic Sxs, horizontal ST depression in V1-3 raises suspicion for ?

A

Post MI

60
Q

Posterior wall STEMIs use leads V7-9 to locate, where are they placed?

A

7- posterior axillary line
8- tip of L scapula
9- left paraspinal region

61
Q

What effect does cocaine cause on the heart?

A 
Inhibits NorEpi, Sympathomimetic effect
Tachy
HTN
Vasospasm
Chest pain
ACS
62
Q

What can cocaine cause in the heart and what may be seen?

A

Cause: MI/ischemia, Myocarditis, arrhythmia, stroke, dissection

See- widened QRS, QT prolongation

63
Q

What does amphetamine toxicity cause?

A

Peripheral and central smypathomimetic effects
HTN
Tachy

64
Q

How is cocaine arrhythmia treated?

A

Sodium bicarbonate

65
Q

How is the horizontal axis determines?

A

R wave progression
Towards hypertrophy
Away from infarcts
V1-neg, V6-pos

66
Q

What are four causes of poor R wave progression?

A

Prior anterior infarct
L/RVH
Dilated cardiomyopathy
LBBB

67
Q

Where do you look on an ECG for suspected right atrial enlargement?

A

Tall peaked P wave over 2.5mm
Most evident in II, III, aVF
Biphasic P wave in V1

68
Q

Where do you look on an ECG for suspected left atrial enlargement?

A

Notched P wave in III

Biphasic P wave in V1

69
Q

What are the criteria for RVH?

A

R wave reversal
V1, V2 strain pattern
RAD

70
Q

What are the criteria for LVH?

A

Deepest S in V1 or V2 + tallest R in V5 or V6= 35mm

R wave in aVL >11mm

71
Q

Where are strain patterns sen during hypertrophy?

A

I, aVL, V5, V6

Classically w/ ST depression

72
Q

Define Early Repolarization

A

Greater than or equal to 0.1mV J-point elevation in 2 or more adjacent leads with slurred/notched morphology

73
Q

What type of PT usually presents w/ early repolarization?

A

ASx young and athletic PT

74
Q

Define Athletic Heart

A

Extenxive PT leading to structural and physiologic adaptations that can appear as abnormal EKGs
Hypervagotonia
Early repolarization
Inc chamber size

75
Q

What are the benign findings usually seen with Athletic Heart?

A 
Sinus arrhythmia
Bradycardia
Wandering atrial/junctional rhythm
1* AV block
Mobitz 1 Wenkebach 2* block
Isolated LVH voltage criteria
Early repolarization pattern
Mild RAD in young/thin PTs
76
Q

ECGs are not recommended/seen as controversial for what PTs?

When are ECGs used for pre-op?

A

ASx
Athletes
Prior to low risk procedures in ASx PTs

High risk procedures/suspected medical problems

77
Q

Most HCM PTs are ASx but they can present with what issues?

A 
Typically in young athletes
Dyspnea on exertion
Chest pain
Syncope
Sudden death
78
Q

How is HCM detected and how is the Dx confirmed?

A

Harsh creshendo-decrescendo systolic murmur that inc w/ valsalva and dec w/ squatting
Echo confirms

79
Q

How does HCM present on ECG?

A

Significan Qs almost everywhere

LVH

80
Q

How is HCM managed?

A 
Echo
Holter or Event monitor
Refrain from vigorous activity
Rx= Verapamil or BBs
Consider implanting pacemaker
81
Q

Characteristics of Long QT syndrome

A

Ventricular arrhythmia from dysfunctional ion channel

QT interval is longer than 1/2 of cardiac cycle

82
Q

What meds can cause Long QT Syndrome

A 
Levaquine
Amiodarone
Zoran
Azithromycin
Fluconazole
Anti- histamine, psychotic, depreeseant
ABX
83
Q

How is Long QT Syndrome treated?

A

BB and ICD

84
Q

How is Short QT Syndrome Dx?

A

QTc under 360

SIDS, Sudden arrest, Syncope, A-Fib, Polymorphic VT or VF

85
Q

Acquired Short QT Syndrome can be caused by what 4 outlying issues?

How are these PTs treated?

A

Hyper K
Hyper Ca
Digitalis
Acidosis

Implant ICD

86
Q

Define Brugada Syndrome

A

Genetic Dz characterized by abnormal ECG
Dx depends on:
EKG criteria
Clinical- syncope, agonal respirations, dizzy, palpitations
FamHx of sudden death under 45y/o
Death from Ventricular arhhythmias

87
Q

What does Brugada Syndrome look like on ECG?

How are these PTs treated?

A

Sail sign in V1-V3

Tx w/ ICD and Genetic Studies

88
Q

Define Arrhythmogenic RVCardiomyopathy

A

Genetic cardiomyopathy causing fibrous RV

seen as ventricular arrhythmia w/ LBBB

89
Q

How does Arrhythmogenic RVC look on ECG?

A

Prolonged S wave
Inverted T waves V1-V3
Epsilon wave- R ventricle post excitation and is most characteristic finding

90
Q

What is the best first tool for distinguishing VT and SVT?

A

12 lead ECG

91
Q

What can be done to treat/manage VT vs SVT with Aberrancy?

What needs to be avoided?

A

Vagal maneuver or Adenosine can help Dx or terminate SVT

CCBs are avoided, may negatively impact structural heart Dz or WPW

92
Q

What are the typical characteristics of Wide Complex Tachycardia typical w/ SVT?

A

Young w/ no CAD

QRS

93
Q

What are the typical characteristics of Wide Complex Tachycardia typical w/ V-Tach?

A 
Older w/ CAD
QRS >.14
Capture/Fusion beats
P wave dissociation
Pos/Neg concordance
Extreme RAD
Cannon A waves on JVP
94
Q

Define Fusion Beat

A

Combo of beats that fuse together as result of two impulses activating the same area

95
Q

Define Takotsubo Cardiomyopathy

A

Broke Heart Syndrome
Transient apical L ventricular dysfunction that mimics MI
90% in women

96
Q

How does Takotsubo Cardiomyopathy present?

A

Chest pain
ST elevation
Inc troponins
Normal vessels on coronary arteriography

97
Q

How is Takotsubo Cardiomyopathy treated?

A

Removing stressor rapidly improves Sxs

98
Q

What are the common causes of hyperkalemia?

A 
CKDz
Uncontrolled diabetes
Dehydration
Excess K in diet
ACEIs
ARBs
NSAIDs
K sparing diuretics
Bactrim
99
Q

What is the function of K in the heart?

A

Repolarization of the ventricular myocyte action potential

Inc K= inc conductance

100
Q

Inc K causes what changes seen on ECGs?

A 
Shortened repolarization
ST depression
Peaked T wave
QT shortening
QRS widening
Wide to flat to no P wave
101
Q

High levels of K lead to what abnormal HR?

A

V-Fib

102
Q

How is hyperkalemia managed?

A

IV Calcium gluconate
Redistribute K w/ IV Dextrose, insulin and Beta agonists
Lower K w/ diuretic, dialysis and gastro binder

103
Q

What are the common causes of Hypokalemia?

A 
Diuretic
Diarrhea- lax overuse/vomit
Eating d/o
Hyperaldosteronism
CKDz
Low Mg
Sweat
104
Q

How does Hypokalemia look on an ECG?

A

Flat/inverted T wave
U waves
Arrhythmia
Torsades, Polymorphic VT and VT

105
Q

How is Hypokalemia treated/managed?

A

IV K
Oral K
Nutrition consult

106
Q

Stopped on

A

Chart on Slide 16

IPAP (212 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions