Focus cardiology Flashcards
What is the crista terminalis
is a ridge of myocardium within the right atrium that extends along the posterolateral wall of the right atrium between the orifice of the superior vena cava to the orifice of the inferior vena cava
What is the ligamentum arteriosum aka** Botallo’s ligament **aka Harvery’s ligaement aka Botallo’s duct?
is a small ligament attaching the aorta to the pulmonary artery. It serves no function in adults but is the** remnant of the ductus arteriosus** formed within three weeks after birth
What is the eustachian valve
an embryologic remnant that lies at the junction of the inferior vena cava (IVC) and inferior right atrium (RA).
In fetal development, the valve directs incoming oxygenated blood towards the foramen ovale and away from the right atrium
What anatomical structure prevents blood from going back up the coronary veins when the right atria contracts?
the thesbian valve aka the coronary sinus
What is the triangle of Koch and what are the 3 deliminations?
Found in the Right atrium. Helps us find the AVN
Tendon of Todaro
Septal side of Tricuspid
Valve of tebesio
If you want to ablate the AVN (in case of pacemake implantation in A fib patients) you go into this triangle
Why is the auricle/appendage in the left atrium important?
90% of intracavitary thrombi form here
Virchow triad determines the likelihood of thrombi development. It includes
statis
hypercoagulability
endothelial damage
What is transposition of the greater vessels
is a congenital heart defect in which the position of the two major vessels that carry blood away from the heart, the aorta and the pulmonary artery, is switched
MUST OPERATE!!
What happens to the coronary circulation for the RV in systoli?
maintenence of circualtion (but note that the refilling of the vessel occurs in the diastolic phase)
What happens to the coronary circulation of the LV in systole?
decrease the circulation bc the muscle of the LV squishes the vessel
Where is the pulmonary trunk located with respect to the aorta?
infront of the aorta
What are the first and second most common valvulopathies?
1st: aortic stenosis
2nd: mitral insufficiency
another name for semilunar valves is (aortic/pulmonary)
sigmoid valves
which heart valve pathology has the highest risk of getting bacterial endocarditis?
bicuspid aortic valve
which condition has a higher likelihood of a person having a bicuspid aortic valve?
marfan syndrome
arteria coronaria sinistra gives the segno of valsalva sinistra
arteria coronaria destra gives the segno of valsalva destra
both signs of the valsalva are on the aortic valve
Which coronary artery is dominant
IVP - interventriculare posteriore aka discendente posteriore
which has an origin in the coronaria destra
whats the origin of the anterior interventricular artery? heart?
coronary sinistra
what is an absolute contradiction for coronagrophy
Nothing
If pt is allergic to iodinated contrast give cortisone and proceed
if pt has iper or ipothyroidism, schedule dialysis after proceedure but proceed
Coronary right
gives off the Interventricular posteriores (descenging postereior) which is for dominance
coronary left
has atrunoc commune then w2 branches. one with the interventrular anterior and the other is the circomflex artery
veins of the heart
coronary sinus (seno coronarico) - with valve names Tebesio
- vene cardiache anteriore o magna e parva
- vene minime di tebesio
Conduction system of the heart
sinoatrial node - 2 interatrial branches - join back at AVNode- split into bundle of Hiss then split into brnaca destra and sinistra (sinistra is bigger so it divides furhter into fascicolo anteriore and fascicolo posteriore)
do pacemaker cells have a fase di riposo?
no
WPW has what
a bundle of kent which is an additional point of conduction apart from the AVN
What are the 4 manuovers to reduce the AV conduction?
valsalva
carotid massage
compressione dei globi
Adenosino
BB
C antagonista
Digitale
(note you use them in that order!)
what is post load (post carico)
l’insieme della resistenza che il ventricolo deve vincere per espellere il sangue ed equivale allo stress di parete
what is preload
volume of blood in the ventricles at the end of diastole (end diastoli pressure)
cardiac tropisms
inotropismo
chronotropismo
batmotropismo (excitability)
dromotropismo (conduction velocity)
polso paradosso is always with what pathology
cardiac tamponade
S1 (First heart sound) is due to closure of which heart valves?
closure of atrioventricular valves (LUB)
At the beginning of systole
The first heart sound coincides with the QRS complex.
What is S2 the sound of
aortic and pulmonary valves close
DUB
end of systole/beginning of diastole
Austin flint mumur is
is a rumbling diastolic murmur best heard at the apex of the heart that is associated with severe aortic insufficiency and is usually heard best in the fifth intercostal space at the midclavicular line.
De Musset’s sign
head bob with each systolic pulsation
Corrigans pulse
bounding pulse
traube’s sign
booming systolic and diastolic sounds over the femoral arteries
Mullers sign
systolis pulsation of uvula
Quinckes sign
capillary pulsations noted in the nail beds or fingertips with each cardiac cycle
Rivero carvalho sign
increase in systolic murmur of tricuspid regurgitation during inspiration. As venous return increases during inspiration, blood volumes in the right side of the heart and TR increase
Graham steel mumur
(GDP- Gross Domestic Product. Graham Diastolic Pulmonary)
the early blowing diastolic murmur heard along the left border of the sternum due to functional regurgitation through the pulmonic valve. The pulmonic valve itself is not diseased; its ring of attachment is stretched as a result of chronic pulmonary hypertension from marked mitral stenosis.
Homans sign
Homan’s sign test also called dorsiflexon sign test is a physical examination procedure that is used to test for Deep Vein Thrombosis (DVT).
A positive Homans’s sign (calf pain at dorsiflexion of the foot) is thought to be associated with the presence of thrombosis.
Baur sign
pain when you compress the polpaccio
When do you hear s3
during systole
when there is a sovracarico di volume
insuff aortica, insuff mitralic, scompenso cardiaco
When do you hear S4
in diastole
when the ventricle has a reduced compliance (and the atria is very efficiently emptying - not applicable in case of A fib/A flutter)
Erb point
for aortic valve insufficiency
left, sternal border, 3rd intercostal space
what does polso parvo mean
means a pulse with small amplitude
what is the most common cause of tachicardia parossistica sopraventricolare?
tachicardia da rientro nodale
flutter atrial on ECG
saw tooth pattern
flutter atriale tipico or atipio
tipico is comune - 90% - saw tooth pattern: percorso in type of anti- orario
IBUTILIDE is for?
Is a class 3 anti arrythmic.
Atrial flutter emergency tx if not responding to vagal manuvers or ABCD drugs
WPW
Delta wave, attached to the wide QRS
What pathology lends a high risk of recurrence of arythmia after ablation?
severe dilation of the left atrium
What is the most common cause of long QRS tachycardia?
tachycardia ventriculare monomorfa sostenuta
if you have QRS complexes what can it not be
ventricular fibrillation
most common cause of bradycardia
sinus bradycardia
AV block of mobitz 2 tx
pacemaker
Ideal LDL levels are calculated based on risk of cardiovascular events using SCORE 2 or SCORE 2-OP
LDL <55 - for pts at risk
LDL<40 - pts at high risk
Pro atherogenic lipoproteins examples
VLDL, IDL, LDL, and Lp (a) are all pro-atherogenic while HDL is anti-atherogenic
progression of atherosclerosis
fatty streak
atheroma
fibrous plaque (stable or unstable)
complicated lesion/rupture
VCAM 1 is found on
endothelial cells
Two types of plaques in atherosclerosis
Plaques with elevated lipid content: even if they are smaller, they have a higher risk of rupturing
Plaques with fibre/calcification: even if bigger have lower risk of rupture
What is a complicated plaque?
when an atherosclerotic plaque ruptures
What is myocardio stordito
is myocardium affected by transient reversible myocardial contractile dysfunction induced by acute ischemia.
What is miocardio ibernato
is ischemic myocardium supplied by a narrowed coronary artery in which ischemic cells remain viable but contraction is chronically depressed.
Tx for stable angina
aspirin, statin, anti-angina (sublingual nitrates, if chronic BB, CCB. then ivabraidine (acts on funny current, reduces HR)) are first line
contraindications to a stress test
left bundle branch block
pace maker
WPW syndrome
takes digitalis
ST>=o.1
What is MINOCA
MI with non-obstructive coronary arteries
Can be: Type 2 MI; plaque disruption, epicardial spasm, coronary TE, dissection, takosubo
prinzmetal angina
(vasospastic angina or variant angina) is a known clinical condition characterized by chest discomfort or pain at rest with transient electrocardiographic changes in the ST segment, and with a prompt response to nitrates. These symptoms occur due to abnormal coronary artery spasm
– in young smokers
Microvascular angina
a type of angina (chest pain) that happens because of problems in the small blood vessels bringing oxygenated blood to the heart.
– in diabetics
How do you do double anti aggregant therapy
with cardioaspirin + clopidogrel/prasugrel
If acute MI: for 12 months min and max 36m if at high risk of thormbosis (can also use cardioasp with rivaroxaban instead of antiaggregant in some pts)
IF pt has high risk of hemorrrhage (PRECISE-DAPT >=25) do it for atleast one month
what is nitroprussiato di sodio used for
to manage pulmonary edema due to hypertension
Dressler syndrome is
pericarditis as a complication after acute MI
systolic murmur at the apex with a click is a sign of
mitral prolapse
what is a controindication to do a TAVI in a pz with a severe aortic stenosis
suspected endocarditis
first line therapy for mild to moderate aortic insufficiency
farmaci: CCB, ACEi, ARBS, BB
What is the rivero carvalho sign
shows increase in systolic murmur of TR during inspiration. As venous return increases during inspiration, blood volumes in the right side of the heart and TR increase.
AORTIC INSUFFICIENCY
what is carcinoid syndrome
occurs when a rare cancerous tumor called a carcinoid tumor secretes certain chemicals into your bloodstream (eg. serotin)
this damages the tricuspid valve (cuore destro)
when to use a mechanical valve vs a biological valve replacement
mechanical valve for young (unlimited life span) - use warfarin not NAO (NOT IN PREGNANT)
biologic valve lasts only 10-15 years (use in old) and don’t need to use anti-coagulant for long time so also good for pregnant women
What happens to the RAAS in heart failure (activated or inhibited?)
activated
pro BNP does what
released from heart, to decrease vasconstriction (too much adrenergic and RAAS activity)
must be over 100 to think of HF
normal ejection fraction
50-70%
reduced EF: <=40%
how to operate on a pt on warfarin
suspend 5 days before operation
In acute scompenso what do you not use
BB
cardiotoxic chemotherapeutic drug
anthracycline
When do you have cyanosis in congential cardiopathy
> 5g/dl concentration of deocyHb
In non cyanotic congential HF, what are signs
scompenso cardiaco
retarted growth
reduced sucking (Scala di Ross)
dyspnea
edemi
cyanosis occurs when
theres an obstruction of right heart circulation
non cyanotic cardiopathies (LETTERS D and A)
Intratrial defect
intraventricular defect
previo ductus arteriosis
canale atrio-ventricular
aortic coartation
aortic stenosis
cyanotic cardiomyopathies (LETTER T)
Tetralogy of fallot
tranposizion of great vessels
tronco arterioros persistente
ritorno venosos anomolo
what is the most common form of interatrial defect
of osteum secondum / fossa ovale (80%)
treatment of DIA
kids: resolution of increased incidence of respiratory infections
adults: diuretics and digitalis
percutaneous closure if an osteom secondum <38mm
surgery (dacron patch)
what is the most common acyanotic congential cardiomyopathy
Interventricular defect.
can be
peri membranous - most common
in ducto aortico (muscular)
double committed (both of above)
the most frequent cyanotic congenital cardiomyopathy is
tetrology of fallot
- IV septum defect
- hypertrophy of the RV
- overriding aorta ( a cavaliere)
- pulmonary stenosis
the degree of cyanosis in tetralogy of fallot depends on
the grade of stenosis of the polmonary arteries
what is the blalock taussig intervention
palliative intervention for all cyanotic congenital cardiomyopathies.
Connect to subclavian artery and the polmonary artery - therefore correcting the DX-SX shunt
how do you operate to cure tetralogy of fallot and what are the complications
close DIV, dilate the polmonary valve (stenotic)
complications:
- pulmonary insufficiency
- stenosis of polmonary artery
- dilation of RV
- residual shunts
intervention for transposition of great vessels
intervention of mustard senning
What is coarctation of the aorta
congential cardiopathy with part of aorta narrower (in the Duct of botallo area)
can be associated to:
bicuspid aorta
subaortic stenosis
hypoplastic aortic arch
DIV
mitral valve anomaly
NON CYANOTIC
main cause of hypertension in pediatrics?
coarctation of the aorta
What is roesler sign
is the name given to the inferior rib notching seen in coarctation of the aorta
Sign of three for coarctation of the aorta is
focal indentation of the distal aortic arch
in which phase can you diagnose bicuspid aorta
in systole
aLcapa syndrome
when the LEFT coronary artery originates from the pulmonary artery
aRcapa syndrome
when the RIGHT coronary artery originated from the pulmonary artery
what is the most common cause of hypertension?
essential hypertension (95%)
when it hypertension resistant
after pt has tried a combination of 3 drugs
a diuretic
two anti hypertensives
IN THIS CASE YOU CAN ADD AN ANTI-ALDOSTERONIC DRUGS
do you start hypertension treatment with two drugs?
yes
An ACEi or ARB
with
CCB or diuretic
what antihypertensive drug has an anti-protenuric effect?
ACE i
ARB’s (are more)
hypertensive emergency vs hypertensive urgency
urgency does not have organ damage
how to manage hypertensive emergency
call 118
IV drugs
hypertension in pregnancy can be categorised into 3 sections. The drugs used to treat it are? Which anti-hypertensives can you not use in pregnancy?
- pre existing HTN that developed before 20 weeks of gestation
- gestational hypertension: starts after 20 wks of festation and resolved 42 days post partum
- pre-eclampsia: gestational HTN with proteinuria (>0.3g/24h)
DRUG: methyl dopa, labetolol, CCB
NOT ACEI, ARBS, Renin inhibitors
gold standard for myocarditis diagnosis
endomyocardial biopsy followed by a histological exam via Dallas criteria
- you will see inflammed infiltrate and necrosis of adjacent myocites
!! only done in cases where it doesnt respond to antibiotics bc you can do a CARIO RM now
clinical signs of myocarditis
new MI signs on ECG
new arythmia
cardiogenic shock
a week bf pt had a respiratory infection
what is a prognositic factor for sudden death in hypertrophic cardiomyopathy
family history of sudden cardiac death and episodes of unexplained fainting
HCM score for hypertrophic cardiomyopathy cannot be used for
<16 y/o
athletes
patients with metabolic malattie/infiltrative diseases
What is anderson fabry disease? ON ECG? TX?
is a lysosomal storage disorder caused by mutations in the α-galactosidase A gene (GLA) located on X chromosome (Xq22) – hypertrophic cardiomyopathy
ECG: sinus bradycaridia/BAV, IVS
TX: substitute enzymes, BB, amiodarone
in restrictive cardiomyopathy is the systolic function reduced?
it can be normal or reduced
T/F amyloidosis can cause restrictive cardiomyopathy
T
how does amyloidosis appear on echocardiography?
Hyperechogenic or granular sparkling
Amyloidosis on ECG
bassi voltage periferici
segni di pseudonecrosi
retarda della conduzione atrio-interventriculare
What is arrythmogenic cardiomyopathy? Whats on ECG?
a genetic cardiomyopathy (desmosomes) where the heart muscle (myocardium) is replaced by both scar (fibrosis) and FAT.
ON ECG: EPSILON WAVE on the end of QRS
treatment of acute pericarditis
ASA or ibruprofen (to decrease inflammation)
Colchicina - inhibits collagen formation (prophylaxis for 6 months after recurrence)
corticosteroids (2 line)
pericardiocentesis
4 things needed for pericarditis diagnosis
- pleuritic thoracic pain (changes with breathing)
- sfregamenti pericardici (pericardial rub)
- change ST (all elevated)
- versamento pericardico
do you give diuretics in cardiac tamponade?
NO NO NO it reduces circulating volume
when do you have a real aneurysm vs a pseudoaneurysm?
real: all three layers (intima, media, avventizia) are involted
pseudo: only one or two
most common places for pseudoaneurysm formation
1- abdomenal aorta below kidneys
2- toracic aorta ascending
3- thoracis aorta descending
>6 or >7 mm - high risk of rupture
When to operate for thoracic/abdominal aortic aneurym
if >55mm in all pts
BUT if >50 mm in pts with bicuspid valve
>45 in marfan syndrome
OR: anuryms grows 10mm/year of more
what sugeries for preventing rupture of thoracic aneyrysm
david technique (conserve aortic valve)
bentall-bono technique (substitute aortic valve)
aortic abdominal aneuryms above what diameter
> 30 mm
gold standard diagnosis: CT
dissection of the aorta pathophysiology and diagnostic imaging
formation of a true lumen and a false lumen (behind tunica intima)
Echo cardio TT/TE seeing the intimal flap
RX torace with increases mediastinal space, TC with mdc, rmn
L’ankle brachial index (ABI or WINDSOR index) indicative of arteriopatia obliterante periferica?
<1
TX for occlusione arteriosa cronica
pentossifilina, cilostazolo, anti aggre, anti coag, (not chronic!) pro angiogenosis
IF STAGE 2B: short lesions (angioplasty), long lesions (bypass)
with 40% block of cornocary artery what TX (anti agg or anti coag)
anti agg - cardioASA, plavix
most frequent places for DVT
deep veins of the calf (sura)
thigh veins
ileo femoral axis
USE HOMANS SIGN
after DVT how do you use anti coags?
both oral and injections for 48 hours
what is a polso bigemino?
Bigeminy is a heart rhythm that has an extra heartbeat between every normal one.
What therapy can you give to a pt with complete AVB just while you’re waiting for a PM implant?
isoprenaline (B agonist)
dopamine
dobutamine
atropine
(increases the heart rate and improves the atrioventricular conduction by blocking the parasympathetic influences on the heart.)
Brugada syndrome is associated to
La sindrme di Brugada si manifesta prevalentemente nel sonno, quando aumenta il drive vagale.
Si manifesta soprattutto nelle ore notturne
E’ una patologia dovuta a delle alterazioni genetiche del canale del sodio, trasmesse per via AD
Può manifestarsi con morte cardiaca improvvisa
I farmaci cardine per il trattamento dello scompenso cardiaco a ridotta frazione di eiezione sono
I farmaci cardine per il trattamento dello scompenso cardiaco a ridotta frazione di eiezione sono 4: beta bloccanti, ACE inibitori o sacubitril-valsartan, glifozine e antialdosteronici.
Quando viene effettuato il test alla flecainide?
Il test alla flecainide viene effettuato nei tipi II e III della sindrome di Brugada, in quanto la sindrome è caratterizzata da una alterazione dei canali del sodio. Utilizzando la flecainide (che blocca i canali del Na e quindi slatentizza un eventuale problema) si può far virare i tipi II e III nel tipo I (fenotipo diagnostico della Sindrome di Brugada).
fast and slow fibers
La via rapida sebbene presenti una velocità di conduzione più veloce, presenta anche un periodo refrattario più lungo
What is one of the most fearful side effects of immune checkpoint inhibitors?
myocarditis
What is TAPSE?
an echocardiographic index used to evaluate right ventricular function.
(tricuspid annular plane systolic excursion).
TAPSE has a normal value > 15, if lower, right ventricular dysfunction can be diagnosed.
An 80-year-old hypertensive and dyslipidemic patient is hospitalized for heart failure. He has a creatinine level of 3.6 mg/dl. What medication would you give the patient? Bisoprolol, valsartan, enalapril, losartan, spironolattone
Bisoprolol
the patient has renal failure (see creatinine value) so the only drug that can actually be used is bisoprolol which has bronchospasm, AV blocks and symptomatic bradycardias as contraindications. ACEi, ARBs, as well as spironolactone are contraindicated due to possible hyperkalemia.
In regards to A fib
The risk of emboligenic cerebrovascular accident is similar in cases of paroxysmal AF and chronic AF
C) Amiodarone is more effective for preventing relapses in cases of AF and for maintaining sinus rhythm compared to IA and IC drugs
D) In chronic treatment, digoxin is usually insufficient for rate control during exercise
E) None of the above
Il modello Erasmus per cosa è utilizzato?
Il modello Erasmus incrementa la specificità dell’indice di Lee nel quantificare il rischio perioperatorio CV. Inserisce la variabile età e divide il rischio in basso, medio-basso, medio-alto e alto.
Il nodulo di Morgagni è:
La valvola polmonare, situata in corrispondenza dell’orifizio arterioso, presenta la caratteristica organizzazione delle valvole semilunari ed è quindi costituita da tre tasche di uguali dimensioni disposte una anteriormente (semiluna anteriore) e due posteriormente (semilune destra e sinistra); ciascuna semiluna nel punto di mezzo del margine libero mostra un piccolo rigonfiamento denominato nodulo di Morgagni. Le semilune destra e sinistra si interfacciano con le omonime semilune della valvola aortica essendo da queste separate solo dagli anelli fibrosi che circondano gli orifizi arteriosi.
Morgagni in pulmonary
Aarantini in aortic
arrythmogenic dysplasia of the right ventricle is
V tachy, sudden cardiac death
loose myocardial tissue becomes fatty fibrous tissue
ECG: t wave inversion in V1-V4, Epsilon eave at end of QRS
TX: ICD, BB, cardioablation
Quinidine therapy is one of the most common causes of the acquired long QT syndrome and torsade de pointes.
T
LBBB on ECG
WILLIAM
W in V1
M in V6
Complicanze di angiplastic coronarica
rottura del vaso
embolus distale o trombosi della coronaria trattata
dissection del parete dell’arteria coronaria
What is most used to repair the anterior limb of the mitral valve
impianto di loop di corde tendinee
How does an IMPELLA support heart pumping function
the IMPELLA is a coaxial pump.
A systemic support of the circolo.
Si tratta di una pompa coassiale, posizionata per via retrograda in posizione transvalvolare aortica, che aspira il sangue dal ventricolo sinistro per immetterlo in aorta ascendente.
Bentall operation
consiste in una sostituzione in blocco in un unico tempo di valvola aortica e aorta ascendente con una protesi costituita da un tubo di dacron all’estremità del quale viene fissata una valvola artificiale
RIGHT BORDER of heart in X RAY has 2 ARCS which are
the upper one: superior vena cava and ascending aorta. Is straight.
the inferior one: is the right atrium
Left has 3 arches:
Superior: arch of the aorta
Middle: trunk of the pulmonary artery and part of the LA
Lower: left ventricle
most serious complications with mitral stenosis?
60%: atrial firbillation
Systemic emoblisms
when is surgical bypass indicated
Surgical bypass is indicated in cases of left main disease with lesions > 50% and in cases of three-vessel disease, with left ventricular dysfunction, diabetes, or complex coronary lesions.
What is the ERASMUS model used for?
To improve the accuracy of the evaluation of post-operative CV risk/mortality
Enoximone is a
selective PDE inhibitor - positive inotropic effect
used in congestive heart failure refracotry to first line therapy, or acute post surgical decompensation
What is aliskirin
renin inhibitor(the job of renin is to form angiotensin 1∴ vasocontrictor)
what is vernakalanet
an anti arrythmic used in AFIB
what is levosimendan
a sensitizing calcium positive inotrope with partial PDE inhibitory activity
What is the incidence of congenital heart diesease
4-10 cases per 1000
VSD is 25% of the above
cardiogenic shock TX
infusoin of IV fluids
positive inotropic drugs (dopamine, dobutamine, milrinone, amrinone, levosimendan, digitalis)
when the microscopic changes of acute MI first become visible?
12-24 hours after the infarct
The patient has chronic rheumatic heart disease (RHD) due to untreated group A beta-haemolytic streptococcal pharyngitis, likely leading to acute rheumatic fever during childhood. Diagnosing acute rheumatic fever requires evidence of previous streptococcal infection and two or more major ‘Jones’ criteria, such as migratory polyarthritis, carditis, subcutaneous nodules, chorea, or erythema marginatum. Alternatively, a diagnosis can be made with one major criterion and two minor criteria, such as fever, arthralgia, or elevated acute phase reactants. RHD can cause dysfunction of the heart valves, most commonly the mitral valve, leading to mitral stenosis in approximately 60% of cases. The characteristic murmur of mitral stenosis is a mid-diastolic rumbling murmur following an opening snap after the second heart sound. Aortic stenosis can also occur but is less common, occurring in about 30% of RHD cases.
t
I f you have an ST elevation, is there a transmural lesion or subendocardial lesion?
The presence of ST elevation translates into a transanmural lesion, due to complete occlusion of a coronary artery; a sub endocardial lesion, on the other hand, is due to a sub occlusion of the coronary arteries, where there is a variation in cardiac enzymes, but on the ECG there is no ST elevation
Takusobo facts
The therapy is based on the treatment of decompensation
B) It has no significant choranographic alterations
C) It causes acute segmental systolic dysfunction of the left ventricle which is generally reversible
D) The symptoms are clinically indistinguishable from an ACS
What pathological condition are QS complexes a sign of?
previous MI
Which test should be performed before starting and during anthracycline therapy?
echocardiogram bc the drug is extremely cardiotoxic causing
dilated myocardiopathy
What is the digoxinemia limit that must not be exceeded to avoid the onset of symptoms of digitalis intoxication?
It has a very narrow therapeutic range, ranging from 0.5 to 2 ng/ml.
In case of chronic intoxication, the patient may present cachexia, gynecomastia, confusion and yellow vision.
If the ECG shows: electrical axis deviated to the left, with a qR appearance in D1-aVL and rS in D2-D3-aVF, and slightly widened QRS, which pathological condition should be suspected?
Normally the depolarization wave runs uniformly along the two fascicles into which the left branch is schematically divided. If conduction is blocked in either fascicle, the ventricular activation sequence is characteristically altered. In the left anterior hemiblock, the excitation wave travels along the right branch and the left posterior fasciculus and only spreads forward and upwards later, through the contractile myocardium. It follows that the terminal vector of the QRS is directed to the left and upwards; on the ECG the electrical axis is therefore deviated to the left, giving a qR appearance in D1-aVL and rS in D2-D3-aVF; the QRS may be slightly widened.
