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Z - M2 Cardiology > M2 Cardiology Key Facts - Week 2 > Flashcards

M2 Cardiology Key Facts - Week 2 Flashcards

1
Q

Determining ECG Axis - 3 Options

A 
Normal = Lead I + II = Positive
LAD = Lead I Positive and Lead II Negative
RAD = Lead II Positive and Lead I Negative/Positive Depending on Degree of RAD
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2
Q

Left Axis Deviation - ECG Findings + Causes (3)

A

ECG = Lead I Positive + Lead II Negative

Causes - LVH + LAFB + Inferior Wall MI

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3
Q

Right Axis Deviation - ECG Findings + Causes (2)

A

ECG = Lead II Positive + Lead II Negative

Causes - RVH + LPFB

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4
Q

Normal Ventricle Depolarization Pathway

A

Start in Left Septum -
Travel to RV (Up in Lead V1/Down in V6) -
Travel to Left Lateral (Up in V5/6 Down in V1)
Travel to Posterior Left

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5
Q

LBBB - ECG Features

A

WiLLiaM - Big S (W in V1) + Notched R (M in V6)

Wide QRS

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6
Q

RBBB - ECG Features

A

MaRRoW - Rabbit Ears in V1 vs. Big S (W) In V6

Wide QRS

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7
Q

Left Anterior Fascicle Block

A

Superior Left Knocked Out - LAD

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8
Q

Left Posterior Fascicle Block

A

Inferior Right Knocked Out - RAD

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9
Q

Inferior MI - Leads with Q Waves + Artery

A

Leads - II, III, aVF

Artery - RCA

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10
Q

Anteroseptal MI - Leads with Q Waves + Artery

A

Leads - V1-2

Artery - LAD

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11
Q

Anteroapical MI - Leads with Q Waves + Artery

A

Leads - V3-4

Artery - LAD

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12
Q

Anterolateral MI - Leads with Q Waves + Artery

A

Leads - V5-6

Artery - Circumflex

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13
Q

Posterior MI - Leads with Q Waves + Artery

A

Leads - V1-2 with Tall R

Artery - RCA

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14
Q

Short PR Causes (2) + Long PR Causes (1)

A

Short PR - Preexcitaiton Syndrome + Junctional Rhythm

Long - 1st Degree AV Block

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15
Q

Long QRS Interval Causes (4)

A

1) BBB
2) Ventricular Ectopy
3) Drugs
4) Hyperkalemia (Tented T-Wave with Short PR)

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16
Q

Long QT Causes (5)

A

1) Hypokalemia (with U Wave after T)
2) Hypocalcemia
3) MI
4) Long QT Syndrome
5) Drugs - Class IA + III

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17
Q

Short QT Causes (2)

A

1) Hypercalemia

2) Tachycardia

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18
Q

Leads for Atrial Enlargement (2)

A

Leads II and V1

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19
Q

Right Atrial Enlargement ECG

A

Lead II - Big Increase in R Component

V1 - Bigger Bump Up (vs. Down for L)

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20
Q

Left Atrial Enlargement ECG

A

Lead 2 - Notched (Volcano)

V1 - Bigger Down (L Deflection)

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21
Q

Escape Rhythm - Define + 2 Types

A

Something other than the SA Node Sets the Pacemaker Potential
Types - Junctional + Ventricular

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22
Q

Junctional Escape Rhythm

A

Normal QRS with a beat of 40-60 (AV Node takes over pacemaker function + sometimes the P wave is burred in QRS)

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23
Q

Ventricular Escape Rhythm

A

Wide QRS with a beat of 30-40 - Has BBB on side opposite to the one setting the pace (E.g. Left Pace Rhythm = RBBB)

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24
Q

Early Afterdepolarization Causes (4)

A

Long QT - Genetic + Hypokalemia + Class Ia/III Anti-Arrhythmia Meds
Can develop into V-Tachy + Torsades

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25
Q

Delayed Afterdepolarization Causes (2)

A

High Intracellular Ca (Digitalis Poisoning) +_ Massive Catecholamine Surge

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26
Q

Causes of Conduction Blocks (4)

A

Fibrosis + Hyperkalemia + MI + Gap Junction Abnormalities

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27
Q

Arrhythmias caused by Reentry (4) + 2 Major Parts of Reentry

A

Monomorphic V-Tach (s/p MI)
AV Reentry Tachy.
AV Node Reentry Tachy.
Atrial Flutter/Fib

Slowed conduction velocity + unidirectional block

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28
Q

AVRTs (3) + Associated Pathology

A

WPW - Conduction down the Accessory pathway (leads to delta waves as right depolarizes first)
Orthodromic - Anterograde down the AV Node and retrograde up the accessory pathway
Antidronic - Anterograde down the accessory pathway and retrograde up the AV Node

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29
Q

Monomorphic vs. Polymorphic V-Tach

A

Monomorphic = Regular Rate/QRS - Typically Structural Abnormality leading to reentry (E.g. MI Scar)

Polymorphic = Irregularily Irregular = Multiple Ectopic Foci causing changing reentry circuits - Torsades de Pointes

30
Q

Typical AV Node Block Causes (4)

A

1) Age
2) Fibrosis
3) STEMI
4) Cardiomyopathy

31
Q

Mobitz Type 1 Causes (3)

A

Inferior MI + Digitalis + High Vagal Tone

32
Q

Mobitz Type II Causes (3)

A

Extensive Anterior MI + Degenerative Disease + More Serious

33
Q

Supraventricular Arrhythmias - 3 Groups + 2 Major Treatment Classes

A

1) Sinus Node
2) Atrial - APCs + Atrial Tachy + Afib
3) AV Node Reentry - Junctional Complexes + AVNRT + AVRT

34
Q

Atrial Fibrilation Presentations (5)

A

Palpitations + CVA + HF + HTN + Hyperthyroid

35
Q

AVNRT vs. AVRT

A

AVNRT - Narrow QRS with hidden P-Wave + Tachy - Based on Slow AV Pathway
AVRT - Wider QRS with Delta Wave
Based on Accesory Pathway

36
Q

AVNRT Termination (3)

A

Adenosine + Valsalva + Carotid Massage

37
Q

V-Fib Causes (3)

A

1) Acute MI
2) Cardiomyopathy
3) Degeneration of V-Tach/Torsades

38
Q

Congenital Long QT Genes (3)

A 
1 = Activity (swimming)
2 = Noise (Alarm)
3 = Sleeping
39
Q

Stunned Myocardium - Description

A

Decreased contractile without necrosis + bounce back after a short episode of transient ischemia

KEY : Prolonged systolic function without necrosis after

40
Q

Hibernating Myocardium - Description

A

Chronic contractile dysfunction due to reduced blood supply without necrosis

41
Q

Variant Angina

A

Vasospasm leads to random ST elevation due to transmural ischemia

42
Q

Silent Ischemia

A

ECG Ischemia without symptoms

43
Q

Syndrome X

A

Ischemia signs/symptoms without coronary flow pathology

44
Q

Myocardial ISCHEMIA Signs/Symptoms (6)

A

Rales + S4 + Mitral Regurgitation + Diaphoresis + Increase HR + Increase BP

45
Q

Signs/Symptoms - ACS (2) vs. Pericarditis (4) vs. Aortic Dissection (3)

A

ACS
Retrosternal pressure pain + radiates left
ECG with ST Elevation/Depression

Pericardits
Sharp pleuritic pain (worsens on inspirtaion) + Relieved by sitting forward + Friction Rub + Diffust ST Elevation

Aortic Dissection
Tearing/Ripping Pain (10/10 Acute Onset) + Widening of Mediastinum on CXR

46
Q

Signs/Symptoms ACS (2) vs. Esophageal Spasm (3)

A

ACS
Retrosternal pressure pain + radiates left
ECG with ST Elevation/Depression

Esophogeal Spasm
Retrostrenal but worse with swallowing + dysphagia + antiacid relief

47
Q

Acute MI Complications (2)

A

0-4 Hours - Cardiogenic Shock

4-24 Hours - Arrhythmias due to lack of conduction + decreased membrane potentials (treat with lidocaine)

48
Q

Inflammatory MI Complications (4)

A

1-3 Days - Neutrophils (Yellow)
1) Acute Fibrinous Pericarditis - Chest Pain + Friction Rub
4-7 Days - Marcophages (Yellow)
1) Septal Rupture - Shunt Forms
2) Papillary Muscle Rupture - Mitral Regurgitation
3) Ventricle Fee Wall Rupture - Tamponade

49
Q

Fibrinous MI Complications (2)

A

1) Aneurysm of weakened wall or thrombus

2) Dressier Syndrome - Autoimmune Antibody Pericardia - Inflammation of the Pericardium

50
Q

Aortic Stenosis - Physical Exam Findings - Murmur (3) + Signs (2)

A

Murmur - Systolic Coarse Crescendo-Decrescendo Murmur with Ejection Click + Possible S4 (from Stiff LV)

Pulsus Parvus - Weak/Delay Carotid Pulse
Paradoxical S2 Splitting

51
Q

Aortic Regurgitation - Physical Exam Findings - Murmur (2) + Signs (2)

A

Murmur - Decrescendo Diastolic Murmur - Best heard at the end of expiration with the patient leaning forward

Findings - Bounding Pulses + Wide Pulse Pressures

52
Q

Aortic Stenosis Causes (2)

A

1) Normal Wear and Tear

2) Chronic Rheumatic Fever (along with mitral valve issues) - Key pathology is fusion of the commisures

53
Q

Aortic Stenosis Symptoms (5)

A

1) LV Hypertrophy
2) Angina
3) CHF
4) Exertion Syncope
5) A-Fib (LA Dilation)

54
Q

Aortic Regurgitation Causes (2)

A

1) Congentital/Bicuspid Leaflet

2) Aortic Root Dilation (E.g. Dissection or Aneurysm)

55
Q

Acute Aortic Regurgitation

A

LV is normal and non-compliant - Transfers the pressure increase back to the LA and Pulm Circuit
Causes Pulm Edema + Dyspnea

56
Q

Chronic Aortic Regurgitation

A

Long term the LV becomes compliant via hypertrophy and dilation - CHF due to inability to maintain CO

57
Q

Austin-Flint Murmur

A

Occurs in Aortic Regurgitation - Low frequency diastolic rumble
High LV Pressure (from Aortic Regurgitation) creates a change in the LA-LV pressure gradient during diastole
New gradient causes murmur while blood crosses the mitral valve

58
Q

Acute Rheumatic Fever - Cause + Pathophysiolgy

A

Caused by Group A Beta Hemolytic Streptococci (Pharyngitis) - 2-3 Weeks After

Bacterial M-Protein triggers Auto-Immune Response via molecular mimicry

59
Q

Acute Rheumatic Fever - JONES

A

J - Joints - Poly-arthritis
O = Heart = Acute Pancardits + Chronic Endocarditis
N = Nodules = Subcutanus Nodules
E = Erythemia Marginatum = Skin rash with spreadiny red edge
S = Sydenham Chorea = Longest Lasting 1=2 Years

60
Q

Acute Rheumatic Fever - Histopathology (3)

A

Aschoff Bodies = Foci of Chronic Inflammation with Reactive Histiocytes
Histiocyes = Slender Wavy Nuclei = Antischkow Cells
Giant Cells

61
Q

Chronic Rheumatic Fever - Cardiac Sequel

A

Almost Always Mitral Valve - Then Aortic - Then Tricuspid (won’t get tricuspid without mitral)
Thickening of the chordae tendinae + cusps
Fusion of the aortic valve commisures

62
Q

Mitral Stenosis - Physical Exam Findings - Murmur (3)

A 
Opening snap followed be decrescendo diastolic murmur
Accentuated S1 (Atrial Contraction = Late Accentuation Murmur)
The closer the opening snap is to S2 = Increased Murmur Severity
63
Q

Mitral Regurgitation - Physical Exam Findings - Murmur (2)

A

Holosystolic Blowing Murmur

Accentuated with clenched fists + squatting + expiration

64
Q

Mitral Prolapse - Physical Exam Findings - Murmur (1) + Risk Factors (2)

A

Mid-Systolic Click accentuated by valsava + decreased by squatting
Risk Factors - Marfan + Ehler-Danlos

65
Q

Mitral Prolapse - Increases Risk Of (4)

A

Infective Endocarditis
Arrhythmia
Emboli
Progressive Mitral Regurgitation

66
Q

Mitral Stenosis Symptoms - Early (1) + Late (4) + End Stage (3)

A

Early - Dyspnea on Exerction
Late - Left HF - Severe Pulm. Congestion + Dyspnea at Rest + Orthopnea + PND
End Stage - Right HF - Ascities + Hepatomegaly + Peripheral Edema

67
Q

Mitral Regurgitation - Acute Causes (3) + Symptoms (2)

A

Causes - Papillary Muscle Rupture (MI) + Endocardities + Ruptured Chordae Tendonae

Symptoms - Acute = Pulm Overload = Pulm Edema + Congestion

68
Q

Mitral Regurgitation - Chronic Cause (4) + Symptoms (1)

A

Causes - DIlated Cardiomyopathy + Rheumatic Fever + Mitral Prolapse + Calcified annulus

Symptoms - More Dilated Heart Spares the LA/Pulm but eventually mimics Left HF

69
Q

Pulmonic Stenosis - Key Points (2)

A

1) Rare In Adults + Okay to treat with valvuloplasty

2) Linked with RBBB to Widened S2 Splitting

70
Q

Pulmonic Regurgitation - Key Points (2)

A

1) Functional (Pulm. HTN)

2) Left Sternal Border - High Pitched Decrecendo Murmur

71
Q

Tricuspid Stenosis - Key Points (3)

A

1) Opening Snap + Decrescendo Diastolic Murmur
2) Large Alpha Wave on JVD (Atria Contracts Hard)
3) Similar Symptoms to MS with Right Heart

72
Q

Tricuspid Regurgitation - Key Points

A

1) Usually a functional issue (not a problem with the valve
2) Holosystolic Murmur that increases on inspiration
3) Typical Causes = High RV Pressure + Rheumatic Valve Disease (will see Mitral disease too)
4) Elevated P wave on JVD Tracing (due to increased atrial filling volume during systole)

Z - M2 Cardiology (5 decks)

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