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High Yield Cardiology Flashcards

1
Q

How to determine Sinus rhythm

A
  • positive P in I, II, aVF

- negative P in aVR

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2
Q

How to determine LAE

A
  • “M” p wave in II, <0.12 sec

- biphasic p wave in V1 with large terminal

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3
Q

How to determine RAE

A
  • tall p wave in II, greater or equal 3mm

- biphasic p wave in V1 with large initial

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4
Q

Normal intervals?

  1. PR
  2. QRS
  3. QT
A
  1. PR: 0.12-0.20 sec (3-5 small boxes)
  2. QRS: less than 0.12 sec
  3. QT: 440-460ms
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5
Q

How to determine RBBB?

A
  • wide QRS
  • RsR’ in V1-V2
  • Wide s wave in V6
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6
Q

How to determine LBBB?

A
  • wide QRS
  • Broad, slurred R in V5-V6
  • deep s wave in V6
  • ST elevation in V1-V3
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7
Q

How to determine RVH?

A
  • R>S in V1

- R >7mm in V1

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8
Q

How to determine LVH?

A

S in V1 + R in V5 or V6
Men: >35mm
Women: >30mm

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9
Q

What leads and artery are involved with

-Anterior infarction

A

V1-V4

LAD

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10
Q

What leads and artery are involved with

-Septal infarction

A

V1-V2

prox. LAD

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11
Q

What leads and artery are involved with

-Lateral infarction

A

I, aVL, V5, V6

LCX

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12
Q

What leads and artery are involved with

-Anterolateral infarction

A

I, aVL, V4, V5, V6

mid LAD or LCX

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13
Q

What leads and artery are involved with

-Inferior infarction

A

II, III, aVF

RCA

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14
Q

What leads and artery are involved with

-Posterior infarction

A

ST depression in V1-V2

RCA or LCX

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15
Q

Causes of Afib

A
  1. Cardiac disease- ischemia, CAD, cardiomyopathies
  2. Pulmonary disease
  3. Infection
  4. Electrolyte imbalances
  5. Endocrine (thyroid)
  6. Increasing age, genetics, idiopathic
  7. Medications
  8. Drugs or alcohol
  9. Men>Female, Whites>blacks
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16
Q

Describe the CHADSVASc scoring

A 
CHF +1
HTN +1
Age 75 or older +2
DM +1
Stroke +2
Vasc dz +1
Age 65-75 +1
Sex female +1
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17
Q

What are the NOACs

A

Non-Vitamin K oral anticoags.

  1. Direct thrombin inhibitiors (Dabigatran/Pradaxa- 150mg BID)
  2. Factor Xa inhibitors (selectively binds to antithrombin III)
    - Rivaroxaban/Xarelto 20mg QD
    - Apixiban/Eliquis 5mg BID
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18
Q

Describe the intrinsic and extrinsic clotting pathways

A

Intrinsic: 8, 9, 11, 12 –> 1, 2, 5
-Measure PTT (heparin)

Extrinisic: 7, 10 –> 1, 2, 5
-Measure PT (warfarin)

II= prothrombin
IIa= thrombin
I= fibrinogen
Ia= fibrin
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19
Q

MOA of warfarin

A

inhibits vitamin K dependent clotting factors (2, 7, 9, 10)

2= prothrombin

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20
Q

Types of SVT

A
  1. AVNRT (AV nodal reentry tachycardia)- 2 pathways within the AV node
    *MC
  2. AVRT (AV reciprocating tachycardia)- 1 pathway w/in AV node and 1 accessory pathway outside AV node
    ex- WPW and LGL
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21
Q

Tx of stable SVT

A

Narrow–> vagal maneuvers, adenosine, BB or CCB

Wide–> amiodarone or procainamide if WPW

22
Q

EKG changes with WPW

A
  1. Delta wave (slurred QRS upstroke)
  2. wide QRS >0.12 sec (AVRT)
  3. short PR interval
23
Q

what is the definition of VT and sustained VT

A

VT: 3 or more consecutive PVCs at rate >100

Sustained VT: VT for 30 or more seconds

24
Q

why do you need to use caution with IV nitro and morphine with right sided and inferior MIs

A

Right side is more dependent on preload and stroke volume to maintain CO
-Nitro and morphine decrease preload

25
Q

Outpatient treatment for stable chronic angina

A
  1. BB (metoprolol or atenolol 50mg BID –> 100mg BID)
  2. ASA
  3. Nitro PRN
  4. Statin

+/- CCB (diltiazem or verapamil) w/ or w/o BB

26
Q

When does troponin I appear, peak and return to baseline

A

Appear: 4-6hrs
Peaks: 12-24hrs
Returns: 7-10 days

27
Q

treatment of pericarditis

A

ibuprofen 600-800mg TID x 7-14 days then taper
+/- colchicine x 3 months

Dressler: ASA or cochicine

28
Q

What does the EKG suggest:

  1. low voltage and electric alternans
  2. Diffuse ST segment elevation and PR segement depressions
A
  1. pericardial effusion

2. pericarditis

29
Q

What is Beck’s triad?

A
  • pericardial tamponade
    1. distant (muffled) heart sounds
    2. Increased JVP
    3. HYPOtension

-pulsus paradoxus

30
Q

What is pulsus paradoxus

A

exaggerated >10mmHg decrease in systolic blood pressure with inspiration –> pulses decrease with inspiration

31
Q

MC cause of

  1. myocarditits
  2. dilated cardiomyopathy
  3. restrictive cardiomyopathy
A
  1. enteroviruses (esp. coxsackie)
  2. idiopathic, viral, alcohol, doxorubicin
  3. amyloidosis, sarcoidosis
32
Q

treatment of myocarditis

A

supportive mainstay of tx, standard systolic HF tx: diuretics, ACEI (reduce afterload), inotropic drugs if severe (dopamine, dobutamine)

33
Q

What is Takotsubo cardiomyopathy

A

apical left ventricular ballooning following an event that causes a catecholamine surge (ex. emotional stress, “broken heart syndrome,” surgery, postmenopausal)

*EKG: ST elevation, + cardiac enzymes, no thrombosis on cath

34
Q

Increased SAM (systolic anterior motion) is seen with:

A
  1. increased contractility (ex. digoxin, beta agonists, exercise)
  2. Decreased LV volume (ex. decreased venous return, dehydration, valsalva maneuver)
  3. hypertrophic cardiomyopathy
35
Q

HCMP murmur is described as

A

harsh systolic crescendo-decrescendo best heard LLSB
-decreases w/: increased venous return- handgrip, squatting, lying supine ((increase d LV volume preserves outflow))

-increases w/: decreased venous return- valsalva, standing

36
Q

What type of dysfunction does the following cardiomyopathies result in?

  1. Dilated
  2. Restrictive
  3. Hypertrophic
A
  1. Systolic– ventricular dilation, regional or global LV hypokinesis
  2. Diastolic- ventricular rigidity impedes ventricular filling- marked dilation of both atria
  3. Diastolic- impaired ventricular relaxation and filling
37
Q

What valves are most affected by rheumatic heart disease?

A

Mitral 75-80%
aortic 30%
TV and PV 5%

38
Q

What is Jones Criteria

A

*Criteria for rheumatic fever (2 Major or 1 Major + 2 minor)

Major:
Joint- migratory polyarthritis 2+ (MC large/medium joints)
Oh my heart- active carditis
Nodules
Erythema marginatum
Sydenham's chorea
Minor:
Fever 101.3 or greater
Arthralgia
Increased ESR, CRP, leukocytosis
EKG: prolonged PR interval

PLUS
evidence of recent GAS infection (rapid strep or ASO titers)

39
Q

Treatment for rheumatic fever

A
  1. ASA 2-6 weeks w/ taper +/- steroids

2. Penicillin G (or erythromycin in PCN allergy)

40
Q

What causes the following heart sounds:

  1. S1
  2. S2
  3. physiological split S2
  4. fixed split S2
  5. paradoxical split S2
  6. S3
  7. S4
A
  1. MV and TV closure
  2. AV and PV closure
  3. AV closure followed by PV closure on inspiration
  4. L to R shunts, ASD, VSD, PHTN, MR
  5. PV closure followed by AV closure on max expiration, LBBB, severe AS
  6. rapid passive ventricular filling, normal if less than 30yo, LVSF
  7. atrial contraction against stiff ventricles, HTN, LVH, AS
41
Q

Describe when AS becomes symptomatic and why

also Tx for AS

A

Sx when AoV <1cm (nl 3-4cm)– dyspnea, angina, syncope, CHF
-due to LV outflow obstruction and increased LV pressure

TX:
Monitor until symptomatic then valve replacement
-avoid physical exertion/venodilators (nitrates), negative inotropes (BB, CCB) with severe
-Mechanical: long durability by thrombogenic need anticoag
-Bioprosthetic: less durable but minimally thrombogenic

42
Q

Describe AR and TX

A

regurg from Ao to LV–> LV volume overload–> LV dilation–> CHF

TX:

  • decreased afterload w/ venodilators (ACEI, ARBs, nifedipine, hydralazine)
  • surgery
43
Q

MC cause of mitral stenosis

A

rheumatic heart disease by far

44
Q

Describe MS and TX

A

obstruction from LA to LV–> increased LA pressure and volume overload–> Pulm congestion and HTN–> CHF

TX:
*meds don't alter hx or need for surgery
-loop diuretics, BB, digoxin (Afib)
Percutaneous ballon valvuloplasty/valvuotomy
MR replacement
45
Q

SE of loop diuretics

A
  1. hyponatremia
  2. hypokalemia
  3. hypocalcemia
  4. hyperglycemia
  5. hyperuricemia
  6. ototoxicity
  7. sulfa allergy
  8. metabolic alkalosis
46
Q

What valves are most commonly affected with endocardititis

A

MV* M>A>T>P

IVDU= TV

47
Q

MC cause of:

  1. ABE
  2. SBE
  3. endocarditis in IVDU
  4. Prosthetic valve endocarditis
A
  1. S. aureus
  2. S. viridans
  3. MRSA (pseudomonas, candida)
  4. S. epidermis
48
Q

What is Dukes Criteria

A

2 Major, 1 Major + 3 minor, 5 minor

Major:

    • BC x2
    • echo for vegetation, abscess, valve perforation or dehiscence
  3. New valvular regurg

Minor:

  1. Fever
  2. Predisposing condition- abnl. valve, IVDU, indwelling cath
  3. Vascular phenomena- janeway lesions, PE
  4. Immunologic phenomena- roth spots, osler nodes, + RF, AGN
    • BC
  6. Worsening echo- regurg, murmur
49
Q

Indications for endocarditis prophylaxis

A
  1. Prosthetic valve
  2. Heart repairs with prosthetic material
  3. PMH endocarditis
  4. congenital heart dz
  5. cardiac valvulopathy in transplanted heart
50
Q

What procedures need prophylaxis for endocarditis

A
  1. Dental: cleaning, manipulation of gums, roots, mucosal perforation
  2. Resp: rigid bronchoscopy, on resp. mucosa
  3. Infected skin/MSK tissue- abscess I&D
51
Q

Regimens for endocarditis prophylaxis

A

Amoxicillin 2g (4- 500mg) 30-60min before procedure
or
Clindamycin 600mg if PCN allergy

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