Exam 4 Flashcards
1
Q
ischemia
A
- deprivation of oxygen and nutrients to myocardium
- heart needs more oxygen than arteries can deliver
- causes- exs, tachycardia, hypotension, anemia
2
Q
angina
A
- chest pain resulting from diminished BF to a region of the heart
- due to CAD or coronary spasm
- stable or unstable
3
Q
stable angina
A
- exs induced
- predictable
4
Q
unstable angina
A
- pain at rest
- if exertional angina is getting worse considered unstable
5
Q
acute coronary syndrome (ACS)
A
- unstable CAD or evolving infacrtion
- STEMI
- nSTEMI
- unstable angina
6
Q
classic presentation of MI
A
- prolonged ( >20 min) crushing sub-sternal chest pain
- pain radiates to L arm, jaw, or shoulder
- associated with nausea, diaphoresis, SOB
7
Q
EKG during MI
A
- initial EKG may not always be diagnostic
- evolution of EKG varies person to person
- impt to obtain serial EKGs
8
Q
stages of STEMI
A
- transient T wave changes happen immediately (T wave peaking and inversion)
- ST segment elevation 0-24 hours
- pathologic Q waves within hours to days (permanent)
- T wave inversion- within hours to days and often normalize
9
Q
pseudonormalization vs normalization of T waves
A
- pseduo- pt has chronic T wave inversions which normalize in setting of chronic ischemia
- normalization- T waves invert due to ischemia eventually return
10
Q
ST elevation
A
- myocardial injury beyond ischemia
- potentially reversible if perfusion occurs soon enough
11
Q
reciprocal changes during MI
A
- a distant lead from infarct may record ST segment depression
12
Q
Inferior infarction
A
- RAD
- Leads II, III, and aVF
13
Q
Lateral infarction
A
- left circumflex a
- in leads I, aVL, V5 and V6
14
Q
anterior infarction
A
- LAD
- “widow maker”
- leads V1-V4
15
Q
posterior infarction
A
- occlusion of RCA
- reciprocal changes in anterior leads
- often missed because you do not see the ST elevation only depressions
16
Q
treatment for STEMI
A
- urgent reperfusion therapy
- door to balloon time <90 min
- aspirin
- oxygen only when hypoxic
- sublingual nitroglycerin to treat chest pain
- morphine to treat chest pain
- beta blockers within 24 hours
17
Q
hyperkalemia
A
- due to renal disease, adrenal insufficiency, and meds
- meds: ACEI, angiotensin receptor blockers, K sparing diuretics
- EKG finding- peaked T waves, may develop sine wave
- can lead to v fib
18
Q
hypokalemia
A
- dietary deficiency
- alkalosis
- excess mineralocorticoids
- meds- diuretics
- presents with T wave flattening and sometimes U wave
19
Q
hypocalcemia
A
- malabsorption
- vit D def
- hypoparathyroidism
- EKG findings- T wave flattening, prolonged QT, shortened PR
- increased risk of torsades
20
Q
R on T phenomenon
A
- occurs due to hypocalcemia
- R wave forms at same time as T is forming
21
Q
hypercalemia
A
- malignancy
- granulomatous disease
- medication induced
- primary hyperparathyroidism
- EKG findings- shorted QT interval
22
Q
hypothermia
A
- metabolism slows
- sinus bradycardia
- segments and intervals prolong
- distinct ST elevation called osborne wave
- arrhythmias develop, usually slow a fib
23
Q
digitalis effect
A
- slows down AV node conduction
- occurs at therapeutic levels
- ST depression with gradual downslope
- T wave flattening or inversion
- expected and does not necessitate d/c of drug
24
Q
digitalis toxicity
A
- occurs at supratherapeutic levels
- sinus node suppression -> sinus exit block
- AV conduction blocks 1-3rd degree
- tachyarrhythmias
- most common= paroxysmal atrial tachycardia
25
Q
paroxysmal atrial tachycardia (PAT)
A
- from ectopic focus or reentrant circuit
- usually cannot distinguish from SVT
- have P waves hiding behind T waves
- rate usually 100-200
26
Q
acute pericarditis
A
- often post viral infection
- pt presents with sharp chest pain
- EKG shows diffuse ST elevation, T wave changes, and PR depressions in multiple leads
- usually self limited
- associated with pericardial effusions
- tx- NSAIDs
27
Q
pericardial effusions
A
- low voltage because harder for electrical energy to make through fluid
- heart rotates freely within fluid filled sac -> varied amplitude of waveforms called electrical alternans
28
Q
COPD
A
- low voltage
- R axis deviation
- poor R wave progression
- R atrial enlargement
29
Q
acute PE
A
- right ventricular hypertrophy or dilation
- RBBB
- S1, Q3, T3
- tachycardia (sinus or a fib)
30
Q
S1, Q3, T3
A
- occurs in acute PE
- large S in I
- Q wave in III
- inverted T wave in III
31
Q
brugada syndrome
A
- rare
- inherited autosomal dominant train
- most common in men in 20s and 30s
- pt presents with syncope
- EKG shows RBBB and ST elevation in V1 V2 and V3
- risk of V tach -> sudden death
