EKG Block 2: The Possible Algorithm Thunder Dome Flashcards
What are the cardinal Sxs of CVDz?
CDC PFCS Chest pain/discomfort Dyspnea Cough Palpiatation Fatigue/Weakness Claudication Syncope/Dizzy
What is the cardinal manifestation of myocardial ischemia from CAD?
Chest pain
Define Dyspnea
Uncomfortable awareness of breathing
What are parts of the blood testing used for standard evaluation?
CBC
Thyroid indices
Lipid levels
Other than troponin, what other lab/blood result is useful in evaluating PTs for potential HF?
Pro- B type natriuretic peptide level
BMP <300 nearly excludes Dx
In the setting of acute chest pain, what imaging modality if effective in diagnosing coronary artery disease?
Multi-slice CT
When are stress tests/pharmacologic stress testing useful?
Ischemia
Abnormal perfusion- radionuclide studies
Abnormal transient wall motion
Radionuclide studies can be used to assess what types of heart function issues?
Left ventricle function
Myocardial ischemia
Determine if ischemic myocardium is variable
What can cardiac catherterization be used to measure?
Gradients across stenotic cardiac valves
Severity of intracardiac shunts
Intracardiac pressure
What can coronary angiography be used to provide diagnostically?
Definitive Dx of coronary artery disease
Necessary to prelude coronary revascularization with percutaneous interventions or coronary artery bypass grafts
Define Palpitations
Sensation of irregular/abnormal heart beats most commonly from ectopic premature atrial beats, ventricular contractions and tachyarrythmias
What is the next clinical step when a PT complains of palpitations?
Hx can lead to Dx
Pt taps out rhythm with fingers
Pre/Syncopes can be manifestations of what four things?
Tachy/brady arrhythmias
Neurocardiogenic syncopes
Unrelated to arrhythmias
What can cause neurocardiogenic syncope?
Vasovagal/reflex- most common Situational micturition- defecate, swallow, cough Carotid sinus syncope Neuralgia Psych d/o Meds Exercise
What can cause arrythmogenic syncope?
Bradys: sinus node dz, 2/3 AV blocks, pacemaker malfunction, drug induced
Tachys: V-tach, Torsades, SVT
What are the “other” causes of syncopes?
Neurologic/psych dz- migraine, TIAs OHOTN Dec CO Neuralgias Psych D/os Meds Exercise
Diagnostic considerations that need to be taken for neurocardiogenic syncope?
Sxs after prolonged motionless standing
Well trained athlete after exertion w/out heart dz
Situational syncope after micturition
Diagnostic considerations that need to be taken for organic heart disease syncope?
No prodrome, brief LOC
Syncope w/ exertion
FamHx of sudden death
Diagnostic considerations that need to be taken for neurological syncope?
Confusion >5min post-seizure
TIA
Migraine
Diagnostic considerations that need to be taken for other vascular reasons of syncope
Carotid sinus
OHOTN
Subclavian steal
Aortic dissection
What are the 3 class categories for PTs with heart palpitations?
1- palpitations, syncope, dizziness
2- SoB, chest pain, fatigue,
3- Sxs not reasonably expected to be caused by arrhythmias
When is long term monitoring suggested for PTs?
When is exercise testing used?
Holter, Loop, Telementry or Loop Recorders
Assess arrhythmia and chronotorpic incompetence in bradyarrhythmias
When can formal invasive electrophysiologic testing useful diagnostically?
When/why is electrophysiologic testing used?
Supra/Ventricular wide-complex tachy
Mechanisms of tachyarrhythmias and prior to ablations
What are the three Classes of electrophysiology studies?
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