LA cardiac pt 1 Flashcards
dilated CM
-vent wall
-dysfunction
-etio
-EF
-murmur
-vent wall: thin, decreased contractility
-dysfunction: systolic
-etio: A B C C D (alcohol, beriberi(thiamine), cocaine, chagas, coxsackie B(enterovirus), doxorubicin
idiopathic most common
-EF: under 40%
-S3 gallop, MR or TR
avoid CCB
kussmaul sign
lack of inspiratory decline or increase in JVP.
restrictive CM, pericarditis
HOCM
-vent wall
-dysfunction
Most common sx
-EF
-murmur
-vent wall: thick, small ventricle
-dysfunction: diastolic
-most common symptom: dyspnea
-EF: preserved
-murmur: S4 loud, MR, S3, pulsus bisferens
increase LV volume how
squatting, leg raise
decrease LV volume how
valsalva, standing
what movement will accenuated HOCM
standing
3rd degree heart block first line tx
transcutaneous pacing
sinus rhythm with inspiration and expiration
rhythm increases with inspiration
1st degree AV block
PR interval prolonged (>0.20).
wenkebach
mobitz 1
mobitz 1 vs 2
1: wenkebach: progressive PR lengthening then dropped qrs
2: constant prolonged PR interval then dropped qrs
which av block seen in pts with structural hrt disease
mobitz 2
sawtooth pattern on ekg
atrial flutter
a flutter
-rate
- ecg picture
300 beats/min
sawtooth
most common chronic arrhythmia
a fib
afib vs aflutter
aflutter has one irritable atrial foci, afib has multiple
4 types of a fib
paroxysmal, persistant, permanent, lone
ashman’s phenomenon
occasional abberrantly conducted beats (wide QRS) after short R-R cycles
Afib tx
stable: rate control with BB or CCD(D/V)
digoxin is BB/CCB contraindicated
unstable: direct current synchronized CV
anticoagulation and cardioversion
AF > 48 hours: anticoagulation at least 3 weeks before CV
AF < 48 hours: anticoagulation for 4 weeks after CV
CHA2DS2-VASc
chronic oral anticoagulation for score of or higher
CHF, HTN, Age>75(2), DM, Stroke/TIA/Thrombus(2), Vascular disease(prior MI, aortic plaque, PAD), age 65-74, sex(female)
dabigatran
direct thrombin inhibitor(binds and inhibits thrombin)
non vitamin K antagonist oral anticoagulant
rivaroxaban, apixaban, edoxaban
factor 10a inhibitors
non vitamin K antagonist oral anticoagulant
pts for warfarin
severe CKD, contraindicated to use carbamazepine, phenytoin, cost issue
PSVT most common type
AV node re-entrant tachycardia
PSVT common finding on ECG
orthodromic: regular narrow complex tachycardia.
PSVT tx
-stable(narrow and wide)
-unstable
-definitive
stable, narrow: adenosine and vagal manuevers
stable, wide: amiodarone. Procainimide if WPW suspected.
unstable: direct current synchonized CV
definitive: radiofrequency catheter ablation
multifocal atrial tachycardia classically associated with what.
ECG
tx
COPD
heart rate >100, 3 or more P wave morphologies
verapamil or BB
WPW
what pathway
tx
avoid what
bundle of kent
procainimide preferred. amiodarone
lupus like syndrome
avoid AV nodal blocking agents
Etiologies of myocarditis
Infectious, viral most common, especially in tarot, viruses and coxsackievirus b and toxoplasmosis, Lyme disease
Auto immune think of Lupus and rheumatoid arthritis, polymyositis
Clozapine
Myocarditis symptoms
Fever, myalgia, malaise for a few days, followed by symptoms of systolic dysfunction, ( dilated cardiomyopathy)
S3 gallop
Megacolon, pericarditis
Myocarditis gold standard diagnostic test, and other tests
Gold standard is the endomyocardial biopsy
Echo; vent systolic dysfunction
Saddle shaped ST elevation
Myocarditis
Vent tachycardia is usually due to what
Underlying heart disease, ischemic heart disease
V tachycardia treatment
Stable
Unstable with pulse
No pulse
Stable: amio, lido, procainimide
Pulse: synchronized cv
No pulse: defib, unsynchronized cv + cpr
What electrolyte abnormalities can cause VTEC and torsades
Low magnesium, low, potassium, and low calcium
V fib, patient presentation and management
Unresponsive, pulse, syncope
Un synchronized cardioversion (defib) + cpr
Brugada
Rt bbb
Prostaglandins
PDA and ductus arteriosis
They keep ductus open and close pda
Most common innocent murmur
Still murmur
Most common innocent murmur
Still murmur
Systolic and diastolic pediatric murmurs, which are innocent and concerning
Systolic or innocent and diastolic are pathological
Murmur that may develop paradoxical emboli
Asd
Describe murmur for ASD
Systolic ejection crescendo de crescendo at pulmonic area
Wide, fixed S2 split that does not vary with respirations
Systolic ejection crescendo de crescendo at pulmonic area
Wide, fixed S2 split that does not vary with respirations
Asd
Systolic ejection crescendo de crescendo at pulmonic area
Wide, fixed S2 split that does not vary with respirations
Asd
Describe the PDA murmur
Continuous machine like murmur loudest at the pulmonic area
Wide pulse pressure/bounding, peripheral pulses, S2
Continuous machine like murmur loudest at the pulmonic area
Wide pulse pressure/bounding, peripheral pulses, S2
Pda
pathophys of pda
continued prostanglandin E1 production and low arterial oxygen content promotes patency
congenital heart defect often associated with bicuspid aortic valve
coa
narrowing occurs where in coa in adult and infants
adult: occurs distal to the ductus arteriosum
infants: occurs proximal to ductus arteriosum
s/s coa
claudification bilateral, DOE, syncope
neonatal presentation of coa
failure to thrive, poor feeding 1-2 weeks after birth
describe murmur of coa
systolic murmur radiating to the back, scapula, or chest
coa cxr
posterior rib notching; 3 sign
failure to thrive, poor feeding 1-2 weeks after birth
coa
coa confirmatory test and gold standard
confirmatory test: echo(narrowing of aorta)
gold standard: angiography
CXR: posterior rib notching; 3 sign
coa
systolic murmur radiating to the back, scapula, or chest
coa
tetrology of fallot constellation
- overiding aorta
- rv outflow obstruction
- RVH
- large unrestrictive VSD
associated with chromosome 22 deletion
tet of fallot
most common cyanotic congenital heart disease
tet of fallot
blue baby syndrome
tet of fallot
squatting with tet spells do what
decreases the right to left shunting, improving oxygenation
tet of fallot murmur
harsh systolic murmur at left mid to upper sternal border, rt ventricular heave.
harsh systolic murmur at left mid to upper sternal border, rt ventricular heave.
tet of fallot
CXR: boot shaped heart
tet of fallot, prominent rt ventricle
tet of fallot test of choice
echo.
what to do prior to tet of fallot surgery
prophylaxis for what
prostaglandin infusion
bacterial endocarditis
most common cyanotic heart d/s presenting in neonatal period
TOGA, dextro
difference between dextro and levo TOGA
dextro: parallel circuits, most common
levo: acyanotic
egg on a string CXR
toga
TOGA primary means of diagnosis
gold standard
echo
cardiac cath
most common type of congenital heart disease in childhood
vsd
congenital heart defect that eisenmenger can occur
vsd
most common type of vsd
perimembraneous 80%; hole in the outflow tract near tricuspid valve
swiss cheese pattern
vsd
s/s of moderate vsd
excessive sweating or fatigue, especially during feeds, lack of adequate growth, frequent respiratory infections
excessive sweating or fatigue, especially during feeds, lack of adequate growth, frequent respiratory infections
s/s of moderate vsd
large vsd pressure in ventricles
no differences
vsd murmur
high pitched harsh holosystolic murmur best heard at the LLSB
vsd testing
echo finds location and size
echo usually preferred over cath
congenital cyanotic heart diseases
5 Ts
truncus arteriosus
TOGA
tricuspid atresia
tet of fallot
total anomalous pulm venous return
hypoplastic left heart syndrome is often associated with what
mitral valve and/or aortic valve atresia
pulm atresia def
complete obstruction to rt ventricular outflow; blood if unable to flow from the rt ventricle into pulm artery and lungs
pulm atresia s/s
improved survival …
cyanosis
improve survival if there is a PDA
single heart sound(due to semilunar valve-aortic valve)
systolic murmur of TR
tricuspid atresia
incidence
leads to what
s/s
2%
leads to hypoplastic rt ventricle.
single heart sound S2
tricuspid atresia CXR and ECG
nml or enlarged cardiac silhouette with DECREASED pulm flow
LVH ECG
single heart sound(due to semilunar valve-aortic valve)
systolic murmur of TR
pulm atresia
nml or enlarged cardiac silhouette with DECREASED pulm flow
LVH ECG
tricuspid atresia
what is hypoplastic left heart syndrome
incidence
failure of the development of the mitral valve, aortic valve, or aortic arch then small ventricle unable to supply the nml systemic circulation requirements.
1% of all congenital heart diseases
failure of the development of the mitral valve, aortic valve, or aortic arch then small ventricle unable to supply the nml systemic circulation requirements.
hypoplastic left heart syndrome
CAD and angina def
inadequate tissue perfusion due to imbalance between increased demand and decreased coronary artery blood supply
CAD major risk factors
DM worst, smoking modifiable.
classic EKG for angina
ST depression
angina initial test of choice
most important non-invasive testing
definitive diagnostic test
angina initial test of choice: EKG
most important non-invasive testing: stress testing
definitive diagnostic test: coronary angiography
angina tx
4 drugs: asa qd, bb, nitro, qd statin
ccb if bb contraindicated
4 classes of angina
- angina only with strenuous activity. no limitations.
- angina with more prolonged or rigorous activity. s.ight limitations with activity.
- angina with usual daily activity. marked limitation of physical activity.
- angina at rest. often unable to carry out any physical activity.
most useful non-invasive test in CAD
stress testing
definitive diagnosis/gold standard in CAD
coronary angiography
ACS silent MI pt population
atypical S/s
women, elderly, DM, obese
abd pain, jaw pain, dyspnea without CP
what artery supplies the AV node
RCA
triad of rt ventricular infarction (ACS)
increased JVP, clear lungs, positive kussmaul sign
CK/CK-MB marker
appears 4-6 hours
peaks 12-24 hours
baseline 3-4 days
troponin 1 and T
appears 4-8 hours
peaks 12-24 hours
baseline 7-10 days
Myoglobin
appears 2-4 hours
peaks 4-6 hours
baseline 1 day
quickest cardiac enzyme
myoglobin
most sensitive and specific cardiac enzyme
troponin
STEMI tx
BB, nito, asa, heparin, ACE, reperfusion
avoid what in cocaine induced MI
BB
do CCB, MONA, heparin
O2 in NSTEMI and STEMI
NSTEMI: low O2
STEMI: no O2
proximal LAD
V1 and V2 anterior and septal wall
LAD
V1 -V4 anterior wall
circumflex artery
lateral wall
RCA
inferior wall
leads in anterior wall/septal wall
V1-V4
leads in lateral wall
1, avL, V5, V6
leads in anterolateral wall
1, avL, V4-V6
leads in inferior wall
11, 111, avF
posterior wall leads
ST depressions in V1-V2
avoid what in inferior/posterior MI
nitro and morphine
dressler syndrome
post MI pericarditis + fever + pulm infiltrates
to form a clot, factor __
factor Xa converts prothrombin II to thrombin(IIa).
Thrombin activates fibrinogens to fibrin clot.
cheap and least chance of intracranial bleeding:
streptokinase
MOA of rTPA
dissolves clot by activating tissue plasminogen to plasmin
initial tests of choice for suspected CHF
CXR, BNP
Kerley B lines
linear lucencies in the peripheral lung fields
most common cause of pleural effusions
CHF
BNP in CHF
over 100
cheyne stokes breathing
deeper, faster breathing in gradual decrease and periods of apnea, cyanosis
cephalization
increased vascular flow to the apices as a result of increased pulmonary venous pressure. occurs with PCWP of 12-18.
bat wings
PCWP over 25
HTN urgency tx medications
clonidine, captopril, furosemide, labetalol, nicardipine
avoid cerebral hypoperfusion if ischemic
list bps
> 220/120 (not a thrombotic candidate)
> 185/110 ok
avoid what in acute HF
hydralazine and BB
when to not use nitro
if suspected right ventricular infarction
orthostatic hypoTN
workup
tx
avoid what
tilt table test: BP reduction at a 60 degree angle
fludrocortisone
avoid flat position, sleeping with the head of the bed raised to 30-45 degrees
left BBB EKG
WILLIAM
wide qrs
rsr in V5,6
deep S wave in V1
ST elevations in V1-V3
Extra cranial branches of carotid artery
Temporal, occipital, opthalmic, posterior ciliary artery
Temporal arteritis
R/F
Triad symptoms
Women, >50 yo, NE Europeans
Ha, jaw clarification with mastication, visual changes . Poss scalp tenderness
Right BBB
MARROW
wide qrs
rsr in V1, 2
wide S wave in V6
