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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
What are 6 causes of LAD?
- LVH - Primum ASD - LAFB - Pregnancy - Ascites - Inferior Infarct
26
What are the 5 criteria for LAHB?
``` 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) ```
27
What are 4 criteria for LPFB?
RAD rS in 1, aVL qR in inferior leads QRS < 120 msec (not valid in lateral infarct, RVH, COPD, Dextrocardia, Limb lead reversal)
28
What are the 5 criteria for LBBB?
- 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
29
What is Sgarbossa criteria?
- ST Elevation >1mm in leads with positive QRS - ST depression >1mm in V1-V3 - ST elevation >5mm in leads with negative QRS (extreme discordance)
30
Two ways to tell old infarct in LBBB?
- 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
What are three criteria for RBBB?
1. QRS > 120 msec 2. rsr in V1 3. S > 40 msec in 1 and V6
32
What are 4 causes of electrical alternans?
- Pericardial effusion - SVT - Aortic regurgitation - Severe cardiomyopathy
33
What are the three criteria for LVH?
- Sokolow Lyon: S V1 and R (5 or 6) >35mm - Cornell: S V3 and aVL >28 in men, >20 women - R aVL > 11mm
34
What are the 5 other considerations for LVH using the Romhilt Estes criteria?
- R wave peak time - QRS durction > 90msec - LAD - LA abnormality - ST abnormalities
35
What is criteria for LVH in LBBB?
- LA abnormality - QRS > 155 msec - Precordial Voltage criteria
36
What is criteria for LVH with RBBB?
- LA abnormality - LAD - S V1 > 2mm - R V5 or V6 < 15mm - LAD and Precordial SR max > 29mm - R in 1 > 1mm
37
What are 3 criteria for RVH? and how about if RBBB present?
- 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
4 causes of Giant T wave inversion?
- Apical HCM - Wellens - CNS Lesion - Post Stemi (Aneurysm)
39
4 causes of Short QT interval
- Hypercalcemia - Hyperkalemia - Digoxin - Congenital short QT syndrome
40
What are 7 causes of a Prominent U wave?
- Long QT syndrome - Class 1c - Hypercalcemia - Hypokalemia - Thyrotoxicity - ICH - Digoxin effect
41
What are Q wave criteria for V2-V3? V1-V2? All other leads?
- >20 msec (V2-V3) - >40 msec (V1-V2) - >30 msec (All other)
42
Name 6 ECG findings in PE?
- 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
What is Dig effect on ECG? (5 findings)
- Scooped ST - Flattened T wave - QT decrease - PR interval increase - U wave
44
What are 5 presentations of Digoxin Toxicity?
- Sinus brady/Brady arrhythmia - EAT - Regularized Afib - Junctional Tachycardia - VT (Bidirectional)
45
How does progressive Hyper Kalemia present on ECG?
Symmetrically peaked T wave -> decreased QT interval and increased QRS duration -> Conduction disorders -> Flattened P wave -> ST elevation -> VT -> Asystole
46
What are the ECG findings of Hypothermia? (6)
- Bradycardia - Increased PR - Osborne waves - Increased QRS - Increased QT - VT or Asystole
47
What are 8 absolute containdications for EST?
- ACS 48h - High risk UA - PE - Aortic Dissection - Symptomatic AS - Unstable Arrhythmias (VT) - Myopericarditis - Decompensated HF
48
What is the modified BRUCE Protocol?
-Addition of 2 initial stages if necessary
49
What is the Cornell Protocol?
-More gradual increase of exertion (each BRUCE stage is subdivided into 2 stages)
50
What is the Naughton Protocol?
2 minute stages with increase of 1 MET per stage, used during evaluation of VO2 max
51
What is a submaximal stress test and when would you do it post infarct?
-3 days post infarct, stop at 70% of HR max or 5 METS
52
What are 6 reasons to stop a submaximal stress test?
- HR 70% of max - 5 METS - 3 PVC - Chest Pain or Dyspnea - STD 2mm - Decreased BP
53
When can you do a normal EST after submaximal?
3 weeks post MI
54
Name 8 reasons to stop and EST?
- VT - STE - Mod-severe angina - Cyanosis - Ataxia/CNS - Patient request - Cannot monitor - BP > 10mmhg drop with ischemia
55
What is the Chronotropic Index?
- (Maximum HR on stress test - HR at rest) / (Predicted HR max for age - HR at rest ) - Incompetent if < 80%
56
What is significance of LBBB on exertion?
- Increase mortality risk | - Increased probability of CAD
57
What is abnormal HR recovery?
- Less than 12 beats less in the first minute of recovery
58
What are complications of Dobutamine during DSE?
- Angina - Hypotension - VT - SVT - MI (1/2000)
59
What are 6 indications to stop a DSE?
- HR target hit - New WMA or worsening - Hypotension - Significant Arrythmia - Severe HT - Intolerable symptoms
60
What are 3 ways to minimize risk of CIN? 1 way that doesnt work? What type of contrast agent is preferred?
- 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
How to manage contrast allergy in patients undergoing Cath?
- Prednisone 50mg 12h and 1h before angio - Benadryl and Ranitidine PO 1h before cath - If urgent: Methylpred 125mg and Benadryl 50mg
62
DDx for Prominent Y descent?
- CP - TR - RCM
63
What are 5 relevant cardiac signs seen in the eye?
- AV knicking/Cotton wool spots/Papilledema (HTN retinopathy) - Roth spots - Lipemia Retinalis - Corneal Arcus - Diabetic retinopathy
64
3 causes for mid systolic murmurs?
- MVP - TVP - Ischemic MR
65
4 causes of mid diastolic murmur?
- MS - TS - Atrial Myxoma - Austin Flint
66
Give 4 causes of alternans?
- Tamponade - SVT - Cardiomyopathy - Severe AR
67
What are three causes of pulsus bisferiens/bifid pulse?
- HoCM - AR - PDA
68
What are three causes of pulsus alternans?
- Severe HF - Bigeminy - Tamponade
69
What are 5 causes of artifacts or false positives on MIBI?
- DCM - Septal HCM - Breast Artifact - Take up of radioisotope by visceral organ - Attenuation artifact - LBBB
70
What is prognosis of patients with negative MIBI at 1 y?
< 1% of MI/Death
71
What are 3 causes of pulsus alternans?
- Severe CMO - Tamponade - Ventricular Bigeminy
72
3 causes of Pulsus Bisferiens?
- HCM - AR/Mixed Aortic Valve disease - PDA
73
In context of LVH what are three clues that there is concomitant RVH?
- Predominant S wave in V6 - RAD - RAE
74
What is the Romhilt Estes score?
- 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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