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RCE Guidelines Studying > Laflamme- Chapter 1 (Cardiac Diagnostic Assessment) > Flashcards

Laflamme- Chapter 1 (Cardiac Diagnostic Assessment) Flashcards

1
Q

What are three physical exam findings of FH?

A
  • Arcus Senilus
  • Tendinous Xanthomas (extensor tendons, MCP, Achilles)
  • Xanthelasma
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2
Q

What are 2 physical exam findings of Familial Hypertriglyceridemia?

A
  • Eruptive Xanthomas

- Lipemia Retinalis

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3
Q

What are two characteristic physical exam findings of Dysbetalipoproteinemia?

A
  • Tuberous Xanthomas (elbow, knees)

- Palmar Xanthomas

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4
Q

Name 10 causes of wide pulse pressure?

A
  • Age
  • HTN
  • AR
  • PDA
  • Fever
  • Anemia
  • Pregnancy
  • AV fistula
  • Paget’s disease
  • Hyperthyroidism
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5
Q

Name 6 causes of SPB difference of 10mmhg between both arms

A
  • Normal variant
  • PAD
  • Inflammatory Vascular disease
  • Supravalvular aortic stenosis
  • Aortic coarctation
  • Aortic dissection
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6
Q

Name three caused of BP difference between the arms and legs > 20mmhg

A
  • Aortic regurgitation
  • Aortic coarctation
  • PAD
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7
Q

What are the 4 phases of the Valsalva response?

A
  • Increased BP from increased intrathoracic pressure
  • Decreased venous return -> decreased BP -> Increased SVR and reflex tachycardia
  • Release: Decreased BP
  • Overshoot: Increased venous return, increased BP -> decreased SVR and reflex bradycardia
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8
Q

What do you see in JVP with Constriction?

A

Predominant y descent (W or M pattern)
Normal x descent
Distended
Kussmaul sign

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9
Q

What are 6 causes for Kussmauls?

A
  • Constriction
  • RCM
  • RV infarct
  • RV failure
  • PE
  • Tricuspid stenosis
  • RA tumor
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10
Q

What is a positive AJR?

A

-Sustained increase in JVP > 3 cm over 15 seconds with 25mmhg compression; this reflects RHF and wedge pressure > 15mmhg

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11
Q

What would be the cause of a pulsation in the 2nd right ICS?

A

Ascending Aortic Aneurysm

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12
Q

What would be the cause of a pulsation in the left second ICS?

A

PA dilatation

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13
Q

What are two causes of increased intensity of S1?

A
  • Any Hyperdynamic state

- Early Rheumatic RS

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14
Q

What are three causes of Variable intensity S1?

A
  • Atrial Fibrillation
  • AV dissociation
  • Cardiac Tamponade
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15
Q

What are 3 causes of a split S1?

A
  • RBBB
  • ASD
  • Ebsteins
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16
Q

What are 4 causes of widened split s2?

A
  • RBBB
  • Severe MR
  • VSD
  • RVOT obstruction
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17
Q

What are 6 causes of paradoxical splitting?

A
  • LBBB
  • RV PPM
  • AS
  • HCM
  • LV systolic dysfunction
  • Aortic Regurgitation
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18
Q

What are three causes of singular S2?

A
  • Aortic Stenosis
  • Pulmonic Stenosis
  • TGA
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19
Q

How do you tell that P2 is loud?

A

-It’s louder than A2 in left ICS

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20
Q

What are three causes of holosystolic murmur?

A
  • MR
  • TR
  • Restrictive VSD
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21
Q

Name 12 causes of continuous murmur

A
  • PDA
  • Aortopulmonary window
  • Coronary AV fistula
  • Ruptured aneursym of the sinus of Valsalva
  • Neck venous hum
  • Mammary murmur of Pregnancy
  • Stenosis of Peripheral branch of PA
  • Lutembacher’s syndrome: MS + ASD
  • Coarctation with intercosta collateral vessels
  • Pulmonary or systemic AV fistula
  • Bronchial collateral vessels
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22
Q

What is characteristic for Arm lead reversal?

A

-P and QRS and T wave inverted in 1 and aVL but not in V6

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23
Q

What is Lown-Ganong-Levine syndrome?

A

-Atrio-His accessory pathway that short ciscuits the AV node, narrow QRS

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24
Q

What are 6 causes of RAD?

A
  • RVH
  • LPFB
  • Secundum ASD
  • COPD
  • PE
  • Lateral Infarct
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25
Q

What are 6 causes of LAD?

A
  • LVH
  • Primum ASD
  • LAFB
  • Pregnancy
  • Ascites
  • Inferior Infarct
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26
Q

What are the 5 criteria for LAHB?

A 
LAD -45 to -90 msec 
qR in 1 and aVL 
rS in III and aVF 
QRS < 120msec 
R wave peak time in aVL > 45msec 
(not valid in LVH, COPD or inferior infarct)
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27
Q

What are 4 criteria for LPFB?

A

RAD
rS in 1, aVL
qR in inferior leads
QRS < 120 msec

(not valid in lateral infarct, RVH, COPD, Dextrocardia, Limb lead reversal)

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28
Q

What are the 5 criteria for LBBB?

A
  • QRS > 120msec
  • Wide monophasic R wave in lateral precordial leads, aVL, 1
  • Absence of septal Q waves
  • R wave peak time >60 msec
  • ST and T wave in opposite directions
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29
Q

What is Sgarbossa criteria?

A
  • ST Elevation >1mm in leads with positive QRS
  • ST depression >1mm in V1-V3
  • ST elevation >5mm in leads with negative QRS (extreme discordance)
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30
Q

Two ways to tell old infarct in LBBB?

A
  • Cabrera’s: Notch of the upslope of the S wave in V2-V4

- Chapmans: Notch of the upslope of the R wave in V5, V6, 1, aVL

31
Q

What are three criteria for RBBB?

A
  1. QRS > 120 msec
  2. rsr in V1
  3. S > 40 msec in 1 and V6
32
Q

What are 4 causes of electrical alternans?

A
  • Pericardial effusion
  • SVT
  • Aortic regurgitation
  • Severe cardiomyopathy
33
Q

What are the three criteria for LVH?

A
  • Sokolow Lyon: S V1 and R (5 or 6) >35mm
  • Cornell: S V3 and aVL >28 in men, >20 women
  • R aVL > 11mm
34
Q

What are the 5 other considerations for LVH using the Romhilt Estes criteria?

A
  • R wave peak time
  • QRS durction > 90msec
  • LAD
  • LA abnormality
  • ST abnormalities
35
Q

What is criteria for LVH in LBBB?

A
  • LA abnormality
  • QRS > 155 msec
  • Precordial Voltage criteria
36
Q

What is criteria for LVH with RBBB?

A
  • LA abnormality
  • LAD
  • S V1 > 2mm
  • R V5 or V6 < 15mm
  • LAD and Precordial SR max > 29mm
  • R in 1 > 1mm
37
Q

What are 3 criteria for RVH? and how about if RBBB present?

A
  • R V1 + S V5/V6 > 10.5mm
  • R/S V1 > 1
  • R V1 > 5mm
  • with RBBB: If R wave in V1 > 15mm and RAD
38
Q

4 causes of Giant T wave inversion?

A
  • Apical HCM
  • Wellens
  • CNS Lesion
  • Post Stemi (Aneurysm)
39
Q

4 causes of Short QT interval

A
  • Hypercalcemia
  • Hyperkalemia
  • Digoxin
  • Congenital short QT syndrome
40
Q

What are 7 causes of a Prominent U wave?

A
  • Long QT syndrome
  • Class 1c
  • Hypercalcemia
  • Hypokalemia
  • Thyrotoxicity
  • ICH
  • Digoxin effect
41
Q

What are Q wave criteria for V2-V3? V1-V2? All other leads?

A
  • > 20 msec (V2-V3)
  • > 40 msec (V1-V2)
  • > 30 msec (All other)
42
Q

Name 6 ECG findings in PE?

A
  • Sinus Tachy
  • RAD
  • RBBB or Incomplete RBBB
  • STD and TWI in anterior precordial leads (RV strain)
  • R/S > 1 in V1
  • S1/Q3/T3
43
Q

What is Dig effect on ECG? (5 findings)

A
  • Scooped ST
  • Flattened T wave
  • QT decrease
  • PR interval increase
  • U wave
44
Q

What are 5 presentations of Digoxin Toxicity?

A
  • Sinus brady/Brady arrhythmia
  • EAT
  • Regularized Afib
  • Junctional Tachycardia
  • VT (Bidirectional)
45
Q

How does progressive Hyper Kalemia present on ECG?

A

Symmetrically peaked T wave -> decreased QT interval and increased QRS duration -> Conduction disorders -> Flattened P wave -> ST elevation -> VT -> Asystole

46
Q

What are the ECG findings of Hypothermia? (6)

A
  • Bradycardia
  • Increased PR
  • Osborne waves
  • Increased QRS
  • Increased QT
  • VT or Asystole
47
Q

What are 8 absolute containdications for EST?

A
  • ACS 48h
  • High risk UA
  • PE
  • Aortic Dissection
  • Symptomatic AS
  • Unstable Arrhythmias (VT)
  • Myopericarditis
  • Decompensated HF
48
Q

What is the modified BRUCE Protocol?

A

-Addition of 2 initial stages if necessary

49
Q

What is the Cornell Protocol?

A

-More gradual increase of exertion (each BRUCE stage is subdivided into 2 stages)

50
Q

What is the Naughton Protocol?

A

2 minute stages with increase of 1 MET per stage, used during evaluation of VO2 max

51
Q

What is a submaximal stress test and when would you do it post infarct?

A

-3 days post infarct, stop at 70% of HR max or 5 METS

52
Q

What are 6 reasons to stop a submaximal stress test?

A
  • HR 70% of max
  • 5 METS
  • 3 PVC
  • Chest Pain or Dyspnea
  • STD 2mm
  • Decreased BP
53
Q

When can you do a normal EST after submaximal?

A

3 weeks post MI

54
Q

Name 8 reasons to stop and EST?

A
  • VT
  • STE
  • Mod-severe angina
  • Cyanosis
  • Ataxia/CNS
  • Patient request
  • Cannot monitor
  • BP > 10mmhg drop with ischemia
55
Q

What is the Chronotropic Index?

A
  • (Maximum HR on stress test - HR at rest) / (Predicted HR max for age - HR at rest )
  • Incompetent if < 80%
56
Q

What is significance of LBBB on exertion?

A
  • Increase mortality risk

- Increased probability of CAD

57
Q

What is abnormal HR recovery?

A
  • Less than 12 beats less in the first minute of recovery
58
Q

What are complications of Dobutamine during DSE?

A
  • Angina
  • Hypotension
  • VT
  • SVT
  • MI (1/2000)
59
Q

What are 6 indications to stop a DSE?

A
  • HR target hit
  • New WMA or worsening
  • Hypotension
  • Significant Arrythmia
  • Severe HT
  • Intolerable symptoms
60
Q

What are 3 ways to minimize risk of CIN? 1 way that doesnt work? What type of contrast agent is preferred?

A
  • Ways that work: minimize contrast, hydrate before had (1ml/kg/hr 3-12h before and 6-24h after), and avoid nephrotoxins
  • NAC doesnt work
  • Preferred contrast agent is non-ionic
61
Q

How to manage contrast allergy in patients undergoing Cath?

A
  • Prednisone 50mg 12h and 1h before angio
  • Benadryl and Ranitidine PO 1h before cath
  • If urgent: Methylpred 125mg and Benadryl 50mg
62
Q

DDx for Prominent Y descent?

A
  • CP
  • TR
  • RCM
63
Q

What are 5 relevant cardiac signs seen in the eye?

A
  • AV knicking/Cotton wool spots/Papilledema (HTN retinopathy)
  • Roth spots
  • Lipemia Retinalis
  • Corneal Arcus
  • Diabetic retinopathy
64
Q

3 causes for mid systolic murmurs?

A
  • MVP
  • TVP
  • Ischemic MR
65
Q

4 causes of mid diastolic murmur?

A
  • MS
  • TS
  • Atrial Myxoma
  • Austin Flint
66
Q

Give 4 causes of alternans?

A
  • Tamponade
  • SVT
  • Cardiomyopathy
  • Severe AR
67
Q

What are three causes of pulsus bisferiens/bifid pulse?

A
  • HoCM
  • AR
  • PDA
68
Q

What are three causes of pulsus alternans?

A
  • Severe HF
  • Bigeminy
  • Tamponade
69
Q

What are 5 causes of artifacts or false positives on MIBI?

A
  • DCM
  • Septal HCM
  • Breast Artifact
  • Take up of radioisotope by visceral organ
  • Attenuation artifact
  • LBBB
70
Q

What is prognosis of patients with negative MIBI at 1 y?

A

< 1% of MI/Death

71
Q

What are 3 causes of pulsus alternans?

A
  • Severe CMO
  • Tamponade
  • Ventricular Bigeminy
72
Q

3 causes of Pulsus Bisferiens?

A
  • HCM
  • AR/Mixed Aortic Valve disease
  • PDA
73
Q

In context of LVH what are three clues that there is concomitant RVH?

A
  • Predominant S wave in V6
  • RAD
  • RAE
74
Q

What is the Romhilt Estes score?

A
  • Frontal leads R or S > 20mm: 3 pts
  • ST-T abnormality: 3 pts
  • LA abnormality: 3 pts
  • Left Axis: 2 pts
  • QRS widening (> 90 msec): 1 pt

> 4 = Definite LVH

4 points = LVH

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