High Yield Cardiology Flashcards
1
Q
How to determine Sinus rhythm
A
- positive P in I, II, aVF
- negative P in aVR
2
Q
How to determine LAE
A
- “M” p wave in II, <0.12 sec
- biphasic p wave in V1 with large terminal
3
Q
How to determine RAE
A
- tall p wave in II, greater or equal 3mm
- biphasic p wave in V1 with large initial
4
Q
Normal intervals?
- PR
- QRS
- QT
A
- PR: 0.12-0.20 sec (3-5 small boxes)
- QRS: less than 0.12 sec
- QT: 440-460ms
5
Q
How to determine RBBB?
A
- wide QRS
- RsR’ in V1-V2
- Wide s wave in V6
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
7
Q
How to determine RVH?
A
- R>S in V1
- R >7mm in V1
8
Q
How to determine LVH?
A
S in V1 + R in V5 or V6
Men: >35mm
Women: >30mm
9
Q
What leads and artery are involved with
-Anterior infarction
A
V1-V4
LAD
10
Q
What leads and artery are involved with
-Septal infarction
A
V1-V2
prox. LAD
11
Q
What leads and artery are involved with
-Lateral infarction
A
I, aVL, V5, V6
LCX
12
Q
What leads and artery are involved with
-Anterolateral infarction
A
I, aVL, V4, V5, V6
mid LAD or LCX
13
Q
What leads and artery are involved with
-Inferior infarction
A
II, III, aVF
RCA
14
Q
What leads and artery are involved with
-Posterior infarction
A
ST depression in V1-V2
RCA or LCX
15
Q
Causes of Afib
A
- Cardiac disease- ischemia, CAD, cardiomyopathies
- Pulmonary disease
- Infection
- Electrolyte imbalances
- Endocrine (thyroid)
- Increasing age, genetics, idiopathic
- Medications
- Drugs or alcohol
- Men>Female, Whites>blacks
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
17
Q
What are the NOACs
A
Non-Vitamin K oral anticoags.
- Direct thrombin inhibitiors (Dabigatran/Pradaxa- 150mg BID)
- Factor Xa inhibitors (selectively binds to antithrombin III)
- Rivaroxaban/Xarelto 20mg QD
- Apixiban/Eliquis 5mg BID
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
19
Q
MOA of warfarin
A
inhibits vitamin K dependent clotting factors (2, 7, 9, 10)
2= prothrombin
20
Q
Types of SVT
A
- AVNRT (AV nodal reentry tachycardia)- 2 pathways within the AV node
*MC - AVRT (AV reciprocating tachycardia)- 1 pathway w/in AV node and 1 accessory pathway outside AV node
ex- WPW and LGL
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
- Delta wave (slurred QRS upstroke)
- wide QRS >0.12 sec (AVRT)
- 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
Outpatient treatment for stable chronic angina
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
When does troponin I appear, peak and return to baseline
Appear: 4-6hrs
Peaks: 12-24hrs
Returns: 7-10 days
27
treatment of pericarditis
ibuprofen 600-800mg TID x 7-14 days then taper
+/- colchicine x 3 months
Dressler: ASA or cochicine
28
What does the EKG suggest:
1. low voltage and electric alternans
2. Diffuse ST segment elevation and PR segement depressions
1. pericardial effusion
| 2. pericarditis
29
What is Beck's triad?
* pericardial tamponade
1. distant (muffled) heart sounds
2. Increased JVP
3. HYPOtension
-pulsus paradoxus
30
What is pulsus paradoxus
exaggerated >10mmHg decrease in systolic blood pressure with inspiration --> pulses decrease with inspiration
31
MC cause of
1. myocarditits
2. dilated cardiomyopathy
3. restrictive cardiomyopathy
1. enteroviruses (esp. coxsackie)
2. idiopathic, viral, alcohol, doxorubicin
3. amyloidosis, sarcoidosis
32
treatment of myocarditis
supportive mainstay of tx, standard systolic HF tx: diuretics, ACEI (reduce afterload), inotropic drugs if severe (dopamine, dobutamine)
33
What is Takotsubo cardiomyopathy
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
Increased SAM (systolic anterior motion) is seen with:
1. increased contractility (ex. digoxin, beta agonists, exercise)
2. Decreased LV volume (ex. decreased venous return, dehydration, valsalva maneuver)
3. hypertrophic cardiomyopathy
35
HCMP murmur is described as
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
What type of dysfunction does the following cardiomyopathies result in?
1. Dilated
2. Restrictive
3. Hypertrophic
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
What valves are most affected by rheumatic heart disease?
Mitral 75-80%
aortic 30%
TV and PV 5%
38
What is Jones Criteria
*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
Treatment for rheumatic fever
1. ASA 2-6 weeks w/ taper +/- steroids
| 2. Penicillin G (or erythromycin in PCN allergy)
40
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
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
Describe when AS becomes symptomatic and why
also Tx for AS
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
Describe AR and TX
regurg from Ao to LV--> LV volume overload--> LV dilation--> CHF
TX:
- decreased afterload w/ venodilators (ACEI, ARBs, nifedipine, hydralazine)
- surgery
43
MC cause of mitral stenosis
rheumatic heart disease by far
44
Describe MS and TX
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
SE of loop diuretics
1. hyponatremia
2. hypokalemia
3. hypocalcemia
4. hyperglycemia
5. hyperuricemia
6. ototoxicity
7. sulfa allergy
8. metabolic alkalosis
46
What valves are most commonly affected with endocardititis
MV* M>A>T>P
IVDU= TV
47
MC cause of:
1. ABE
2. SBE
3. endocarditis in IVDU
4. Prosthetic valve endocarditis
1. S. aureus
2. S. viridans
3. MRSA (pseudomonas, candida)
4. S. epidermis
48
What is Dukes Criteria
2 Major, 1 Major + 3 minor, 5 minor
Major:
1. + BC x2
2. + 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
5. + BC
6. Worsening echo- regurg, murmur
49
Indications for endocarditis prophylaxis
1. Prosthetic valve
2. Heart repairs with prosthetic material
3. PMH endocarditis
4. congenital heart dz
5. cardiac valvulopathy in transplanted heart
50
What procedures need prophylaxis for endocarditis
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
Regimens for endocarditis prophylaxis
Amoxicillin 2g (4- 500mg) 30-60min before procedure
or
Clindamycin 600mg if PCN allergy
