M2 Cardiology Formatives Key Points Flashcards
Point on ECG Corresponding to Ventricle Ca+ Rise
QRS
Week 1
Soft S1 Causes (4)
Leaflets Close Together
1) Long PR (1st Degree AV Block)
2) Severe Mitral Stenosis
3) Mitral Regurgitation
4) HTN (LVH)
Week 1
Loud S1 Causes (3)
Leaflets Far Apart
1) Mild Mitral Stenosis
2) Short PR (Junctional Escape Rhythm)
3) High CO (Tachycardia for anemia/exercise)
Week 1
Causes of Pathological S2 Splitting (3)
Fixed = ASD Widened = RBBB + Pulmonic Stenosis Paraxodical = LBBB + Aortic Stenosis
Week 1
S3 vs. S4 in CHF
S3 = Systolic Heart Failure S4 = Diastolic Heart Failure
Week 1
Long QT - Key Points (3)
1) Not Hypercalemia (Hypo)
2) Long Duration AP
3) Increase HR = Decrease Long QT
Week 1
Isoprotenenol Keys (3)
1) Increase Chronotropy + Inotropy without Increase BP (decreases peripheral resistance
2) Not good for shock (no increase in BP)
3) Beta Selective
Week 1
Alpha Blockers - Uses (4)
Resistant HTN
Pheochromocytoma
BPH
HTN Crisis
Week 1
Phenylephrine Keys (2)
A1 Agonist - Used in Neurogenic Shock + Nasal De-congestion
Will Increase HTN/MI/Stroke
Week 1
AE of Beta Blocker (4) vs. Alpha Blocker (2)
Alpha - Increased Ocular Pressure + Arrythmias
Beta - Bronchoconstriction + AV Block + HF + Sleep Issues
Week 1
Elderly HTN (3) vs. Young HTN (3)
Elderly - Systolic with high pulse pressure + loss of vessel compliance
Young - Diastolic with low pulse pressure + increased risk of secondary cause
Week 1
Hypovolemic Shock vs. Cardiogenic Shock vs. Septic - Swanz Ganz Changes
Hypovolumic - All Decrease (RA/RV + PA + Wedge)
Cardiogenic - All Increase (RA/RV + PA + Wedge)
Septic - No Change
Week 1
Hydralazine - Key Points (3)
1) Vasodilator (NO Release)
2) Secondary/Resistant HTN in Africans
3) Pregnancy HTN with A-Methyldopa
4) SE = Headache + Symp Stim (Palpitation + High HR)
Week 1
Adenosine - Key Points - Uses + Toxicity (4) + Contraindications (3)
1) First line for Supraventricular Tachycardia (Reentry + AVNRT + AVRT (Orthodontic) + Atrail Tachy)
2) Used with Vagal Massage + Valsalva
Toxicity = Chest Pain + Nausea + Flushing (Short-Lived) + Bronchspasm (Severe)
Contraindicated in Heart Transplant + Wide QRS + COPD
Week 2
Steps for Supraventricular Tachycardia Treatment (4)
1) Vagal Massage + Valsalva
2) Adenosine
3) Class IV (Ca-Block) - Recurrent
4) Class II (B-Block) - Recurrent - AVNRT more than AVRT
Treatment of Afib - #1 Option
1C - Flex
Treatment of Post MI V-Tach - #1 Option
1B - Lidocaine - Reduced Abnormal Automaticity
Treatment of Post MI V-Tach - 2/3/4 Option
1 = Lidocaine 4 = Amilodine (III) + B-Block - Get Defibilator in!
Torsades Drugs (3)
Levofloxan + IA + III (Less with Amilodine)
Monomorphic V-Tach - Cause + 2 ECG Features
Reentry = #1 Cause
Normal Similar QRS with Regular Rate vs. Polymorphic (Caning QRS with Irregular Rate)
Week 2
Reentry - V-Tach - Associated ECG + 3 Main Criteria + Result
ECG = Monomorphic with Regular Rate/QRS 3 Main Causes Criteria for Reentry 1) Multiple Parallel Pathways 2) Unidirection Conduction Block 3) Conduction time (CT) > Effective Refractory Period (ERP)
Result = Unidirection block through a branch point with delay conduction that allows reentry formation
Week 2
<24 Hours Post MI - Histopathology
Wavy fibers with edema - Then Coagulative Necrosis
Week 2
Hypertrophic Cardiomyopathy - Histopathology
Myofiber Disarray (not in series)
Week 3
Myocardial Demand Factors
Increase (3) + 4 Pathologies
Decrease (1) + 1 Pathology
Increase O2 Demand
Increase Ventricular Wall Stress + HR + Contracility
Pathology
Aortic Stenosis + HTN (High Pressure)
Mitral + Aortic Regurg (Increase LV FIlling + Radius)
All Decreased by Nitrates (Left Wall Stress + Volume Decreased by vasodilation)
Decrease O2 Demand
Increased Wall thinkness = Dereased O2 Demand
LVH = Less O2 Consumption
Week 2
Nitrates - Specific Mechanism (3)
Decrease LV Wall Stress
Decease LV Volume
Increase Systemic Venous Reserve/Capacitance (Preload)
Week 2
Mitral and Aortic Stenosis - Most Common Causes
Mitral - Rhemuatic Fever
Aortic - Age > 65 = Calcium
Aortic - Age - 65-40 Bicuspid AV (or Rheumatic with fusion of the commisure)
Week 2
SLE Causes Drugs (2)
Procaimide + A-Methyldopa
Toursades des Pointes - Pathophysiolgoy + Causes (4)
Triggered Activity - Early Afterdepolarizations
Long QT
Congential Long QT
Hypokalemia
Hypomagnesium
Anti-Arrhythmia Drugs - IA + IC + III
Week 2
Infectious Endocarditis - Key Signs/Sympomts (8)
1) Murmur (Mitral or Aortic)
2) Patechiae
3) Nail BEd Hemorrhage
4) Rential Hemorrhage (Roth Spot)
5) Immune Mediated Vasculitis
6) Painless Palm Lesion - Janeway
7) Painful Finger Tip Nodes - Osler
Hypoplastic Left Heart Syndrome - Key Points (5)
1) Slit Like Left Ventricle with Atretic Valves
2) PFO + ASD
3) Ventricular Septum Intact
4) PDA Keeps the patient alive (PFO brings blood back + PDA gets it to circulation)
5) Early Cyanosis
Sudden Death - Think MI - 4-24 Hour Pathology
1) Contraction Band Coagulative Necrosis
Nuclei Out + “blurry” myocytes with internal white lines
Acute Rhematic Fever - Presentation (2)
Aschoff Body = Big Circle with waves in middle of myocardium
Strep. Pydrimidans or Staph Aureus
Acute Rheumatic Fever - Long Term Implications
1) Carditis - Long Term = Mitral Valve Most Likely
2) Aortic Valve = 2nd
3) Tricuspid in Staph
Heart Failure - Always Look for Side - Left Alone vs. Right Alone vs. Both Chambers
DO IT
Low EF Cardiomyopathy - Key Points
1) Dilated Cardiomyopathy - Look for S3
2) Both Chambers of the Heart
3) Most Common Lymphocyte Rich Inflitrate Dilated Cardiomyopathy = Coxsackie A/B
4) South America Carditis - Trypanzsoma = Protazoa
5) Alcohol and Pregancny can cause Dilated Cardiomyopathy
Transposition of Great Arteries - Keys
1) Worses as PDA Closes (Cyanosis)
2) Don’t give imosaide - need to keep it open not close - Want to Elevate PGE
Hypertrophic Cardiomyopathy - Murmur
Murmur results from obstruction of the ventricular outflow tract by the valve leaflet - Aortic Stenosis
Pressure Volume - Systolic Failure
1) Increased Afterload/Decreased Contractility
2) Move Up and Right
Decrease in ESPVR Curve
Increase ESV and EDV
Decrease EF and SV
Pressure Volume - Diasolic Failure
Increased Preload Move Left and Smaller Increased EDPVR Decreased EDV Increased EDP
Hypertropic Cardiomyopathy - Keys
1) Younger + cause of sudden death
2) Mitral Valve Prolapse - Less with less volume - Left Sternal Border Systolic Murmur
3) Young Patient with septal enlargement
4) Mutate Sarcomere proteins
