Emma H review Flashcards
*** scary new ekg changes that say STEMI
2mm ST elevation or new LBBB
wide flat QRS
LBBB
anterior infarct
LAD; V1-V4
lateral infarct
Circumflex; I, avL, V4-V6
Inferior infarct
RCA; II, III and aVF
R ventricular infarct
RCA; V4 on right sided ekg is 100% specific
*** V1-V4 lead changes
Anterior and LAD
*** II, III and avF changes
Inferior, RCA
thrombolytic window
6 hrs
CI to thrombolytics
active bleed, anticoagulated, recent ischemic stroke, hemorrhagic stroke, recent closed head trauma
hypotension, tachycardia, JVD but lungs are clear
R ventricular infarct - Don’t give nitro b/c risk of hypotension, give fluid with NS bolus!
patient with chest pain but normal EKG, what next?
cardiac enzymes, at least 3 sets q8hr
*** when does troponin rise and when normal by
rise 3-5 hrs, nl by 7-10 days
labs for repeat infarct
CKMB or myoglobin*
MI cocktail
morphine, oxygen, nitrates, aspirin/clopidogrel, bb
you find a lesion on coronary angiography, what to do?
PCI or CABG
when to CABG?
L main disease 3 vessel disease or 2 vessel disease PLUS DM >70% occlusion pain despite maximal medical tx post-infarction angina
*** medication after MI
aspirin + clopidogrel if stent bb ACEi in CHF of LV dysfunction Statin SA nitrates
*** pt with chest pain but normal EKG and cardiac enzymes, what to do?
stress test for suspect angina
*** when can’t you do a stress test
abnormal baseline EKG (LBB or baseline ST elevation)
on digoxin
findings of a + stress test
chest pain reproduced, ST depression, hypotension
Cause of death post-MI
arrhythmias, namely V-fib
New systolic murmur 5-7 days following MI
papillary muscle rupture with MR
acute severe hypotension following MI
ventricular free wall rupture
“step up” in O2 concentration from RA to RV following MI
ventricular septal rupture
*** persistent ST elevation ~ 1 mo later + systolic MR murmur post MI
ventricular wall aneurysm
cannon-A waves
bounding pulsations of jugular vein - AV dissociation, either v-fib or 3rd degree heart block (AV node ischemia)
5-10 weeks following MI. pleuritic CP
Dressler’s syndrome - thought to be autoimmune, treat with NSAIDs or aspirin
CP, murmur, vague history of viral illness
myocarditis
*** CP at rest, worse at night, also migraine HA and EKG shows transient ST elevation with episodes
Prinzmetal angina, dx with ergonovine stim tests
*** pt is diagnosed with Prinzmetal angina following ergonovine stim test, what is tx?
CCB or nitrates
progressive prolongation of PR interval followed by dropped beat
Mobitz type 1
regular p-p and r-r intervals but no pattern between p and qrs
3rd degree heart block - would see cannon-a wave
multifocal atrial tachycardia
rapid, irregular atrial rhythm arising from multiple foci in atria; severely sick pt with lung/heart path; poor prognosis
normal QRS
< 0.12 sec = 3 small squares
normal PR
< 0.2 sec = typically 3-5 small squares
vtach tx
unstable = shock; stable = medical tx (lidocaine, amiodarone)
delta wave
gradual up-sloping of QRS complex
*** QRS > 120 ms with slurred initial deflection representing early ventricular activation via the bundle of Kent
WPW; tx with procainamide
*** rx CI in WPW
anything that slows the AV node - bb, digoxin, verapamil, diltiazem
regular rhythm with ventricular rate 125-150 and atrial rate 250-300
atrial flutter
*** OD of ___ or ____ can lead to torsades
Lithium or TCA
girl in her 20s with sudden palpitations found to have EKG with regular rhythm and rate 200, what is it and what to do?
SVT, tx is NON-rx first -> carotid massage or face in ice
causes of hyperkalemia
burn victim, renal failure, crush injury
EKG with undulating baseline, low-voltage; pt has pulsus paradoxus, hypotension, distant heart sounds, JVD
electrical alternans in cardiac tamponade
why low voltage with EKG of tamponade
blood buffering voltage
first line of afib tx
rate control
causes of AS
age with calcific degeneration, congenital anomaly (bicuspid like Turners)
*** systolic cresc/decresc murmur that is louder with squatting + parvus et tardus on palpation of pulse
AS
*** late systolic murmur with click that is louder with valsalva and handgrip
MV prolapse
*** holo-systolic murmur loudest at apex and radiates to axilla
MR
continuous machine like murmur
PDA
wide fixed split S2
ASD
rumbling diastolic murmur with an opening snap
MS
*** blowing diastolic murmur with widened pulse pressure
AR
two diastolic murmurs especially important in the aging population
MS + AR
how does squatting, inspiration, and handgrip affect blood flow?
INCREASES blood flow return to the heart
how does standing and valsalva affect blood flow?
DECREASES blood flow return to the heart
what maneuvers can you do to increase preload?
squatting, handgrip, inspiration
what maneuvers decrease preload?
valsalva
*** which murmurs are worsened by increased preload?
stenotic and regurgitant valves - AS, MS, AR, MR
*** these two murmurs are made LOUDER by DECREASED preload
HCOM and MV prolapse
why is HCOM worse with valsalva (decreased preload)
without blood to push thing open, the hypertrophied septum covers the aortic opening
D\does less preload mean LOUDER floppy valves of MV prolapse?
YES
what to do for pt with SOB + murmur + hx of CHF
get an echo
acute pulmonary edema tx
nitrates, lasix, morphine
young pt who has sx of CHF and recent hx of viral illness
myocarditis, most likely coxsackie
*** what test can help you differentiate CHF from pulmonary HTN?
right heart cath
