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EKG Cumulative Final Flashcards

1
Q

What are the indications for getting an EKG?

A

Unexplained syncope
Unexplained palpitations
Episodic Pain, Dizzy, Fatigue, SoB
Neuro events w/ transient A-Fib/Flutter

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2
Q

Sequence/Pathway of signals through the heart?

A

SA, AV Node, AV Bundle, Septum, Purkinje Fibers

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3
Q

What part of the pathway connects the atria to the ventricles and conducts impulses through the interventricular septum?

A

AV Bundle

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4
Q

What part of the conduction pathway stimulate the contractile cells of both ventricles, starting at the apex?

A

Purkinje Fibers

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5
Q

What are the intrinsic conduction speeds of the heart?

What can change these speeds?

A

SA and AV- 0.01 - 0.02m/s
Atria and Ventricle- 1 m/s
Purkinje Fibers- 2 m/s
Altered by medication

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6
Q

What are the BPMs of the different areas of the heart?

What alters these numbers?

A 
SA Node- 60-100
Atrial cell- 55-60
AV Node- 45-50
Juntion- 40-60
His  bundle- 40-45
Branch- 40-45
Purkinje- 35-40
Myocardial- 30-35
Ventricles- 20-40
Autonomic stimulus
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7
Q 
Define Automaticity
Define Excitability
Define Chronotrophy
Define Inotropy
Define Dromotropy
A 
Discharge spontaneously w/out stimulus
Ability to be depolarized by stimulus
Affecting HR
Affecting contractility
Affecting conductivity
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8
Q

Parasympathetic NS only affects ? part of heart?

Sympathetic NS affects ? parts?

A

Atria- Ach, decreases SA node pacing, dilates arteries

Atria and ventricles- Epi/NorEpi, Inc rate and force of contraction, constricts arteries

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9
Q

What are two factors that can alter general/diffuse amplitude?

A

Increases w/ hypertrophy

Decreases w/ COPD

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10
Q

Characteristics of a normal P wave?

A 
Impulses through atria
Upright in I, II, aVF and V2-6
Inverted in aVR
Amplitude= up to 2.5mm
Duration= <0.12 seconds
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11
Q

Characteristics of Q waves?

A

.04 sec or 1/4 the R wave

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12
Q

What does the QRS complex represent?

A

Depolarization through the ventricles

Normal is >.10 seconds

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13
Q

What does the T wave represent?

A

Repolarization of the ventricles
Upright in I, II, III, aVF, V3-6
Inverted in aVR

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14
Q

What two waves usually show concordance?

A

Normal T wave and QRS complex

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15
Q

What does the U wave represent?

A

Repolarization of Purkinje Fibers

Abnormally long in hypo Mg, Ca, K

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16
Q

What does the PR interval measure?

A

Time for signal to travel from SA to ventricular muscles

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17
Q

What does the QT interval measure?

A

Total time of duration of ventricular systole

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18
Q

How does a normal pediatric ECG appear?

A

HR +100
Longer QTc
Dominant R, inverted T in V1-3
Sinus arrhythmia

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19
Q

How do you test for premature atrial contractions?

How are they treated?

A

Holter/Event monitor
Echo
Labs w/ E+

Treat underlying cause, not the HR

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20
Q

What are the criteria for WAP?

A

HR below 100bpm
Multi focal rhythm originating from atria
3 different P wave morphologies
Pace maker shifts between SA node, AV node and Atria

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21
Q

What are the etiological causes of WAP?

How is it treated?

A

Idiopathic, Vagal tone, Dig toxicity, Inflamed atria, VHD

Treat underlying cause, usually ASx

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22
Q

What are the characteristics of MAT?

A

SA node doesn’t pace the heart, several groups of cells in atria do
3 or more morphologically different P waves
HR +100bpm
Irregular P-R, R-R and P-P intervals

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23
Q

What are the etiological reasons that cause MAT?

A

COPD- common finding
Pneumonia
Hypoxia
CHF

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24
Q

How do PTs with MAT present?

How is it treated?

A

Palipitations, SoB, Chest pain, Light headed, Syncope

O2
Treat underlying cause
Rate control- CCBs

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25
Q

How can you tell if a impulse originated from the SA node, Junction or Ventricle?

A 
Atria= upright P wave
Junction= inverted/absent wave
Ventricle= widened QRS
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26
Q

When are Atrial Escape Beats usually seen and what causes them?

A

Healthy PTs from sinus node depression from meds, ischemia or respiratory failure

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27
Q

What can cause Junctional Escape Beats?

A

Stimulants, Nicotine Caffeine, Low E+ or Hypoxia

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28
Q

The occurrence of bigeminy beats is associated w/ what underlying issue?

A

Hypoxia

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29
Q

What is the first key to diagnosing SVTs?

A

12 lead

Electrophysiologic tests is definitive way to distinguish SVT from V-Tach

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30
Q

What are the criteria for an unstable tachcardic PT?

A

HOTN
AMS
Chest pain
HF (dyspnea)

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31
Q

Sinus tachycardia criteria= ?bpm?

A

Rarely exceeds 180bpm

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32
Q

What leads need to be examined when considering junctional tachycardia?

A

No P waves

Negative deflections in II, III, aVF can be retrograde P waves

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33
Q

Criteria for AVNRT

A

120-220
Buried/inverted P waves
Narrow QRS unless BBB is present

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34
Q

What is the most common SVT in all age groups?

What type of PT is it normally seen in?

A

AVNRT

Young adults and women exacerbated by pregnancy or menstrual cycle

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35
Q

What is the definitive treatment for AVNRT?

A

EP study and ablation

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36
Q

What type of defect is AVNRT?

What type of defect is AVRT?

A

Accessory pathway in/near AV node

Anatomic bypass bundle between atria and ventricles

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37
Q

What is the difference between Orthodromic AVRT and Antidromic AVRT?

A

Ortho- impulse travels down AV node but return to atria through Kent bundle causing narrow tachycardia

Anti- impulse travels down Kent bundle and up to AV node causing wide complex tachycardia

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38
Q

WPW Type A pattern is seen ? and mimics?

WPW Type B pattern is seen ? and mimics?

A

L sided pathway w/ tall R in V1-3 mimicing RVH

R sided path w/ tall R and inverted T in inferior leads that mimics LVH

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39
Q

Orthodromic WPW look like ? so it’s treated as such

Antidromic WPW looks like ? so it’s treated as such

A

SVT

VT

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40
Q

When/where do we not use ABCD medications in order to prevent blocking AV node and speeding the heart up?

A

AVRT- WPW Antidromic

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41
Q

What are the characteristics of LGL Syndrome?

A

PR interval is <0.12sec
Normal QRS
No delta wave
Paroxysmal tachycardia

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42
Q

Characteristics of A-Fib?

A

No P wave

Irregularly irregular

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43
Q

What are the causes of A-Fib?

A 
PIRATES
Pulmonary
Ischmia
Rheumatic HDz
Alcohol/Anemia
Thyroid/Toxins
E+/Endocarditis
Sepsis/SSS
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44
Q

Time frame for paroxysmal, persistent and permanent A-Fib?

A

Paroxysmal- less than 7 days
Persistent- more than 7 days
Permanent- always there even when medications are used

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45
Q

All A-Fib PTs must be ?

A

Anticoagulated

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46
Q

How is A-Fib managed?

A

Acute and no HOTN= rate control w/ DMV ED
New onset and good conversion candidates= DARE
Transesophageal echo prior to conversion or anti-coag for 4wks before and after

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47
Q

What are the BPMs for A-Flutter?

A

250-300

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48
Q

What leads are examined when considering A-Flutter?

How is A-Flutter diagnosed?

A

Counterclockwise- II, III, aVF

ECG

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49
Q

How is A-Flutter treated?

A

Control ventricular rate w/ BB/CCB
Ablation is primary definitive Tx due to reoccurrence
Can treat w/ cardioversion, rate control, antiarrhythmics

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50
Q

How is A-Flutter treated?

A

IV Ibutilide- 65% effective

Cardioversion- 95% effective

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51
Q

Prior to converting A-Flutter, PTs INR must be below ? on what drugs?

A

INR between 2-3 w/ Warfarin or,

DARE 4wks prior to conversion

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52
Q

What are the criteria/characteristics for V-Tach?

A

150-250bpm
Dissociated P waves
Wide complexes

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53
Q

Define R on T Phenomenon

A

PVC hits a T wave and causes V-Tach (shark fin appearance)

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54
Q

How is V-Tach managed?

A 
Unstable= Synchronized conversion @ 200J
Stable= Procainamide, Amiodarone, Lidocaine
Pulseless= defibrillation
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55
Q

How is Torsades de Pointes treated?

A

Unsynchronized conversion if unstable

IV Magnesium sulfate

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56
Q

What are the characteristics of V-Fib?

A

Variable wide complex rhythm over 300bpm and no P waves

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57
Q

What are the 5 Hs and 5Ts of PEA?

A

Hypovolemia, Hypoxia, H+ excess, HypoK, Hypotemp

Tamponade, Toxins, Tension Pneumo, Thrombosis

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58
Q

Define SSS

A

Dropped P wave and/or QRS complex with escape contraction that manifests as sinus brady w/out normal escape mechanisms

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59
Q

What is the etiology, presentaiton, Dx and Tx for SSS?

A

Etiology: CAD
Presents: palpitations, light headed, syncope
Dx: holter monitor
Tx: pacemaker

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60
Q

What are the two types of 2* AV blocks?

A

Mobitz Type 1- Wenckebach (going, going, gone)

Mobitz Type 2 (duck duck goose)

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61
Q

Wenkebach Blocks can be caused if what vessel is occluded?

A

RCA

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62
Q

3* blocks are rarely caused by ?

They can present with what unique characteristic?

A

Medications

Cannon A Waves

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63
Q

How is Bradycardia treated?

A

Unstable- Atropine 1mg or Isoproterenol infusion, temp pace maker

Stable- remove medications, consider implant pacemaker especially if brady is caused by Mobtiz 2 or 3* Block

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64
Q

A BBB is defined by what finding on EKG?

What if it’s between 0.10-0.12?

A

QRS longer than 0.12 seconds

QRS that is 0.10-0.12- defined as intraventricular conduction delay

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65
Q

What are the causes of RBBB?

A

RANCID PE

RVH ASD Normal variant Cardiomyopathy Ischemia Degeneration Massive PE

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66
Q

What leads are examined when investigating RBBBs?

A

Wide “slurred” S in I, V4-6

Depressed ST, Inverted T, or RSR’ V1 or V2 (R’ taller than R)

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67
Q

What can cause LBBBs?

A

INLAND HH

Ischemia Normal LVH Aortic stenosis New LBBB c/w STEMI Degeneration HTN HyperK

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68
Q

What are the criteria for LBBBs?

A 
QRS > 0.12sec in any lead
High S in V1 or 2
Tall r in V5 or 6, I and aVL
ST depression in V5, V6 1 and aVL
Inverted T in V5, V6 1 and aVL
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69
Q

What does the RCA supply?

What does the LCA supply?

A

Posterior LBB and AV node

RBB and anterior LBB

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70
Q

What leads are examined for an anterior fascicular block?

A

Q1S3 also II and aVF

Normal to slightly wide QRS

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71
Q

What leads are examined for a posterior fascicular block?

Why are these rare?

A

S1Q3 and RAD
Deep/wide S in I
Q in III

Dual blood supply

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72
Q

What types of occlusions can result in a bifasicular block?

A

RBBB + anterior fasicular block

RBBB = posterior hemi block

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73
Q

What types of occlusions can result in an anterior or 3* block?

A

Anterior hemi + posterior hemi= LBBB

RBBB + AFB + PFB= 3* block

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74
Q

What can cause LAD?

A 
LVH
Inferior MI
LAFB
LBBB
WPW
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75
Q

What can cause RAD?

A 
RVH
Lateral MI
LPFB
Acute lung Dz (PE)
COPD
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76
Q

What are the two things that can cause extreme RAD?

A

V-Tach

Hyperkalemia

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77
Q

Define Horizontal Zone of Transition

A

How deflection moves across precordial leads

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78
Q

What four things can cause poor R wave progression?

A

Anterior infarction
RVH
Chronic Lung Dz
Obesity

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79
Q

What can cause Left Atrial Enlargement

A

CHF
HTN
MS or MR/AS or AR

80
Q

What can cause Right Atrial Enlargement?

A

Cor Pulmonale (Pulm HTN and RVH)
Tricuspid Dz
Congenital Dz

81
Q

What leads are best assessed for Right Atrial Enlargement?

What leads are best assessed for Left Atrial Enlargement?

A

II, III, aVF

Any lead but II is best

82
Q

What are the criteria for RVH?

A

RAD
Normal QRS without BBB
Reverse R wave progression
V1 or V2 strain pattern

83
Q

Define Scott Criteria

A

Deepest S in V1 or V2
Tallest R in V5 or V6
>35mm= hypertrophy

84
Q

What leads are best examined for strain patterns?

A

Lateral leads- I, aVL, V5, V6 w/ prominent R waves

Classically w/ ST depression and asymmetric negative T waves

85
Q

Why do PTs die from HOCM?

A

Arrhythmia outflow obstruction

86
Q

What are the ST elevation criteria for men and women?

A

> 2mm for men
1.5mm for women
Or >1mm in two or more contiguous leads

87
Q

What are the 3 Phases of MI changes in an ECG?

A

Hyper/Early Acute
Evolved
Chronic- stabilized

88
Q

What events are occurring during the hyperacute phase of MI changes?

A

Heightened and widened T waves over injury
ST segment shift from concave to convex
Sxs
Not generalized

89
Q

What events are occurring during the evolved acute phase of MI changes?

A

ST segments regress
T waves invert
Q waves

90
Q

What events are occurring during the chronic phase of MI changes?

A

ST segment return to baseline

Q waves remain

91
Q

Anterior MI involves ? leads and which vessel?

A

V3 and V4

LAD

92
Q

Septal MI involves ? leads and which vessel?

A

V1 and V2

LAD

93
Q

Anterior septal MI is commonly associated with what two issues?

A

Cardiogenic shock

Hemodynamic compromise

94
Q

Lateral MIs involve ? leads and ? vessel?

A

I, aVL, V5, V6

Proximal LAD

95
Q

Inferior MIs involve ? leads and ? vessel?

A

II, III, aVF

RCA, LCX

96
Q

Inferior lateral MIs involve ? leads and ? vessel?

A

II, III, aVF, V5 and V6

LCX

97
Q

Apical MIs involve ? leads and ? vessel?

A

I II III aVF aVL V2-6

RCA

98
Q

What ECG changes will be seen in an inferior Mi with right extension?

A

Lead III will be taller than lead II

99
Q

What is the way to remember elevation and location of reciprocal changes?

A

Elevation: PAILS
Depression: AILSP

100
Q

How is coronary artery disease diagnosed?

A

Multi-slice CT

101
Q

Why are stress tests performed?

A

Precipitate ischemia for ECG to detect
Abnormal perfusion on radionuclide studies
Transient wall motion abnormalities

102
Q

What test is performed to assess left ventricle function, ischemia and assess viable myocardium?

A

Radionuclide studies

103
Q

What info do cardiac catheterizations measure?

A

Gradients across stenotic valves
Severity of shunts
Measure intracardiac pressure

104
Q

What value do coronary angiography provide?

A

Definitive Dx of CAD

Necessary prelude to PCI or coronary bypass graft surgery

105
Q

What are the three classes for Ambulatory Electrocardiography?

A

I- palpitation, syncope, dizzy
II- SoB, pain, fatigue
III- Sxs not expected to come from arrhythmias

106
Q

All PTs with known or suspected cardiac disease get what two things?

A

ECG

Chest x-ray

107
Q

What are the 4 types of ECG monitoring their timeframes?

A

Holter- 24-48hrs and ST segment analysis
Event/Loop- one month and activated by PT
Mobile OPT Telemetry- one month
Implantable loop- 3yrs

108
Q

Exercise tests are performed to asses what two things?

A

Exercise induced arrhythmia

Chronotropic incompetence in bradyarrhythmias

109
Q

When is formal invasive electrophysiological studies useful?

A

Dx of V/SVT wide complexes

110
Q

What are the 3 classes for electrophysiological studies?

A

I- ECGs fail to document palpitations
II- sporadic Sxs and can’t be documented
III- palipitations from extracardiac causes (hyper thyroid)

111
Q

What are the 3 classes of echo studies?

A

I- arrhythmias from heart Dz, FamHx of arrhythmias
II- arrhythmia commonly from but not associated w/ heart Dz, A-Fib, A-Flutter
III- palpitations w/out evidence of arrhythmias or minor arrhythmias w/out evidence of heart dz

112
Q

An echo is the most useful test to analyze what parts of the heart?

Echos are always done on PTs w/ ? presentation?

A

Valve/ventricle function
Stenotic and regurgitant lesions

Syncope and no obvious neurocardiac cause

113
Q

When/why are transesophageal studies preferred?

A

Evaluate possible aortic dissections

ID clot in cardiac chambers

114
Q

How do you get a PTs angina history?

A

SAMPLE w/ CC in PTs own words
Meds- SHOP (stree, herbal, OTC, Rxf

OPQRST

115
Q

Define Levine Sign

A

Hand over heart/chest to describe chest/ischemic pain

116
Q

What are the four anginal equivalents?

A

Dyspnea
Fatigue
Lightheaded/dizzy
Belching

117
Q

What are the atypical qualities of chest pain and when are they more commonly seen?

A

Women, Elderly, DM, CVD

Mild epigastric burning or numbness

118
Q

What are the five non-invasive heart studies and when are they performed?

A

Treadmill- angina or moderate chance for CADz
SPECT- abnormal EKG
Stress Echo- new wall motion abnormalities and heart structure
MRI
PET Scan

119
Q

Prinzmetal angina is associated with what three risk factors?

A

Raynauds
Smoking
Migraine HA

120
Q

How is Prinzmetal angina diagnosed?

How is it managed?

A

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

CCBs and Nitrates

121
Q

Define Wellens Sydrome

Why is this so critical to ID?

A

Indicates occlusion of proximal LAD or Left Main

Will lead to extensive anterior MI in 8.5 days from Sx onset

122
Q

Define Type A Wellens Syndrome

Define Tpe B Wellens Sydrome

A

Biphasic T wave in anterior leads

Deep T wave inversions in V2 and V3

123
Q

How are Left Main occlusions treated?

A

Rapid PCI

Emergent CABG

124
Q

What lead is examined to assess for Left Main occlusions?

What patterns can be seen?

A

aVR- 77% sensitive and 82% specific

STE in aVR >1.5mm
STE in aVL

125
Q

Define Sgarbossa Criteria

A

ST elevation 1mm or more concordant w/ QRS- 5pts
ST depression in V1-V3- 3pts
ST elevation 5mm or more discordant w/ QRS- 2pts
Score >2= 90% specificity for MI w/ LBBB

126
Q

What leads are examined for posterior wall STEMIs?

A 
ST depression in V1-3 for:
Horizontal ST depression
Tall broad R waves
Upright T waves
Dominant R wave in V2
127
Q

What ECG changes does cocaine cause?

What ECG changes does meth cause?

A

Wide QRS, QT prolongation

QT prolongation

128
Q

How is cocaine toxicity treated?

A

Sodium Bicarbonate

129
Q

Define Early Repolarization

What type of PT is it normally seen in?

A

0.1mV or greater J-point elevation in two or more adjacent leads that are either slurred or notched

ASx young athletic PT

130
Q

What are the 6 benign ECG findings found with athletic heart?

A 
Abnormal beat/rhythm
1* block
Mobitz Type 1
Isolated voltage criteria for LVH
Early repolarization
Mild RAD in young PTs
131
Q

Characteristics of hypertrophic cardiomyopathy

A

Autosomal dominant defect
Dyspnea on exertion, chest pain, syncope or death
Creshendo/Decrescendo systolic murmur inc w/ valsalva and dec w/ squatting

132
Q

How is hypertrophic cardiomyopathy diagnosed?

Why is this so important to detect?

A

Echo

Most common cause of sudden cardiac death in young athletes

133
Q

What is looked for on an ECG for hypertrophic cardiomyopathy?

A

Large amplitude QRS’
Significant Qs in inferior/lateral leads
Tall R waves in V1-V2
LVH

134
Q

How is HCM managed?

A

Echo for Dx
Ambulatory ECG w/ no vigorous activities
Verapamil or BB
Consider implanting defibrillator

135
Q

Criteria for Long QTc Syndrome?

A

QTc is more than 1/2 longer than cardiac cycle

136
Q

What medications can cause long QT Syndrome?

A

LAZAF Anti-DAPH
Levaquine, Amiodarone, Zofran, Azithromycin, Fluconazole
Anti depressant, ABX, histamine, psychotic

137
Q

How is Long QT Syndrome treated?

138
Q

Define Short QT Syndrome?

A

QTc under 360

139
Q

How can Short QT Syndrome present?

A

SIDS
Sudden arrest
A-fib
Polymorphic VT/VF

140
Q

What can cause acquired short QT syndrome?

A

Hyper K, Ca
Digitalis
Acidosis

141
Q

What treatment option is considered for Short QT Syndrome?

142
Q

How is Brugada Syndrome managed?

A

ICD

Genetic Studies

143
Q

Define Arrhythmogenic Right Ventricle Cardiomyopathy

A

Genetic defect causing fibrosis of R ventricle

Presents w/ PVCs, arrhythmias, sudden death

144
Q

What are the evaluation studies for Arrhythmogenic Right Ventricle Cardiomyopathy?

A 
ECG- usually shows ventricular arrythmia w/ LBBB
Holter
Exercise ECG
Echo
MRI
145
Q

What are the 3 signs of Arrhythmogenic Right Ventricle Cardiomyopathy

A

Prolonged S wave upstroke
T wave inversion in V1-3
Epsilon wave- most characteristic

146
Q

What is the best and first tool used to distinguish between VT or SVT?

147
Q

What can be done/used to help reduce the severity of VT vs SVT?

What needs to be avoided?

A

Vagal or Adenosine

CCBs- may impact structural diseases or WPW

148
Q

What are the typical traits of SVT?

A 
Young PT w/ no CAD
QRS < .14
No capture/fusion beats
Normal axis
BBB/SVT supports Dx
149
Q

What are the typical traits of V-Tach?

A 
Older PT w/ CAD
QRS > .14
Capture/Fusion beats present
P wave dissociation
Pos/Neg concordance
Extreme RAD
Cannon A waves w/ JVP
150
Q

Define Cannon A waves

A

Simultaneous contraction of atria and ventricle seen at JVP

151
Q

Define Takotsubo Cardiomyopathy

A

Apical left ventricular dysfunction that mimics MIs

152
Q

What are the causes of hyperkalemia?

A

K SAT BAN BUD

CKDz, DM, Dehydrate, Excess K diet, ACEI, ARB, NSAID, Spirinolactone, Trimamterine, Bactrim

153
Q

What are the ECG changes of hyperkalemia?

A 
ST depression
Peaked T waves
QRS widening
QT shortening
Widened P waves
154
Q

How is hyperkalemia treated?

A

IV Calcium gluconate
K redistribution w/ IV Dextrose, insulin, Beta agonists
Lower K w/ diuretics, dialysis and GI binder

155
Q

What are the common causes of hypokalemia?

A

CD MEALS

CKDz, Diuretics, Mg, Eating d/o, Aldosteronims, Laxative, Sweating

156
Q

What are the ECG findings of hypokalemia?

A

Flat/inverted T wave

U waves

157
Q

ECG effects of hypokalemia have been shown to be due to ?

A

Suppression of K channels

Low K activates Na and Ca channels

158
Q

What are the ECG findings of K levels less than 2/5, >6.0, >7.5, >9.0

A 
<2.5= depressed ST, diphasic T, U waves
>6= tall T wave
>7.5= long PR, wide QRS, tall T
>9= no P wave, sinusoidal wave
159
Q

What are the causes of hypercalcemia?

What are the ECG changes?

A

T CHIK
TZD, CA, Hyperthyroid, Immobile, Kidney failure

Short QT

160
Q

How is hypercalcemia treated?

A

IV hydration

Antiresorptives- biphosphonates, calcitonin

161
Q

What are the common causes of hypocalcemia?

What are the ECG changes seen?

A

Parathyroid hypo
D deficiency
Failure, renal

Prolonged QT interval

162
Q

How is hypocalcemia treated?

A

IV calcium gluconate

Chronic= oral Ca and Vit D

163
Q

What ECG changes are seen with pericarditis?

Pericarditis is most commonly caused by ?

A

Widespread concave ST elevation/PR depression
Sinus tachy is common due to pain or pericardial effusion

Coxsackie virus

164
Q

Define Dressler’s Syndrome

A

Pericarditis from MI weeks prior

165
Q

What are the treatment options for pericarditis?

A 
ASA
NSAIDs
Colchicine
Steroids- if refractory
Surgery
166
Q

What is the most common cause of electrical alterans?

A

Pericardial effusion

167
Q

How is cardiac tamponade diagnosed?

How is it treated?

A

Echo

Emergent- pericardiocentesis
Stable- eval and catheter drainage w/ Echo guide

168
Q

What is the key indicator of PE on an ECG?

A

S1Q3T3 from acute pressure and volume overload of the right ventricle

169
Q

What is the acute treatment for PEs?

A

Anticoag w/ LMWH or Fondaparinux
Fibrinolytics if shock/HOTN, RV dysfunction, clot burden or right atrial thrombus
Catheter/surgical embolectomy

170
Q

Define Low Voltage Echocardiogram

A

QRS amplitude:
<5mm in limb leads
<10mm in chest leads

171
Q

What is the temp criteria for hypothermia?

A

Less than 95*

172
Q

Define Osborn Waves

A

Positive deflection of the J point most prominent in precordial leads and proportional to the degree of hypothermia

173
Q

How is dilated cardiomyopathy managed?

What must not be given to these PTs?

A

BB/CCBs

Positive inotropes and nitrates

174
Q

What are the most common causes of restrictive cardiomyopathy?

A

Amyloidosis

Hemochromatosis

175
Q

How do PTs w/ restrictive cardiomyopathy present?

A

Peripheral edema
Dyspnea
Fatigue
Signs of heart failure

176
Q

What are the diagnostic studies used for restrictive cardiomyopathy?

A

Echo shows impaired diastolic filling and preserved systolic function
ECG shows low voltage

177
Q

What is the most common sustained dysrhythmia?

178
Q

Electrical impulses of A-Fib are ? compared to A-Flutter which are ?

A

Fib- disorganized

Flutter- organized

179
Q

What is the difference between Mobitz Type I and II?

A

I- Progressive PR elongation until QRS is dropped, block is in AV node
II- Fixed and constant PR interval, block is below AV node in Purkinje system

180
Q

How are 3* heart blocks managed?

A

If Sxs- atropine or isoproterenol

Definitive Tx= permanent pacemaker

181
Q

WPW is a ? syndrome

What are the three parts of the WPW triad?

A

Pre-excitation

Delta
Wide QRS
Short PR interval

182
Q

How is WPW managed?

A

Unstable- cardioversion
Procainamide
Definitive= ablation

183
Q

How do PTs with PSVTs present?

How are they treated?

A

Palpitations, anxiety and heart rate of 120-200bpm

Vagal and Adenosine
Unstable= cardioversion

184
Q

How is SSS managed?

A

Pacemaker

Medication rate control

185
Q

Criteria for Sinus Bradycardia

A

HR less than 60 but above 45

186
Q

How is V-Fib managed?

A

Defib at biphasic 200J

187
Q

What two medication classes can cause Torsades de Points?

A

Antipsychotics

Methadone

188
Q

When is aorta coarctation considered and how is id diagnosed?

A

BP in arms higher than legs

Echo for Dx

189
Q

Anterior and Septal leads are ? and are supplied by ?

190
Q

Inferior leads include ? and are supplied by ?

A

II III aVF

RCA more commonly than by LCx

191
Q

Lateral leads include ? and are supplied by ?

A

I aVL V5-6

LCs

192
Q

What biomarker is the first to arrive during an MI?

What use does CK-MB have for MIs?

A

Myoglobin

Reinfarction Dx

193
Q

What are the triad ECG indications of pericarditis?

A

PR elevation in aVR- Thumb print sign
PR depression
Concave ST elevation

194
Q

What leads are investigated for suspected Dressler’s Syndrome?

How is it managed?

A

PR depressions
PR elevation in aVR
Diffuse ST concaved elevation

Colchicine, steroid, NSAID

195
Q

How does cardiac tamponade present on ECG?

A

Low voltage QRS
Electrical alterans
Diastolic collapse of right ventricle

IPAP (212 decks)

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