M2 Cardiology Key Facts - Week 2 Flashcards
Determining ECG Axis - 3 Options
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
Left Axis Deviation - ECG Findings + Causes (3)
ECG = Lead I Positive + Lead II Negative
Causes - LVH + LAFB + Inferior Wall MI
Right Axis Deviation - ECG Findings + Causes (2)
ECG = Lead II Positive + Lead II Negative
Causes - RVH + LPFB
Normal Ventricle Depolarization Pathway
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
LBBB - ECG Features
WiLLiaM - Big S (W in V1) + Notched R (M in V6)
Wide QRS
RBBB - ECG Features
MaRRoW - Rabbit Ears in V1 vs. Big S (W) In V6
Wide QRS
Left Anterior Fascicle Block
Superior Left Knocked Out - LAD
Left Posterior Fascicle Block
Inferior Right Knocked Out - RAD
Inferior MI - Leads with Q Waves + Artery
Leads - II, III, aVF
Artery - RCA
Anteroseptal MI - Leads with Q Waves + Artery
Leads - V1-2
Artery - LAD
Anteroapical MI - Leads with Q Waves + Artery
Leads - V3-4
Artery - LAD
Anterolateral MI - Leads with Q Waves + Artery
Leads - V5-6
Artery - Circumflex
Posterior MI - Leads with Q Waves + Artery
Leads - V1-2 with Tall R
Artery - RCA
Short PR Causes (2) + Long PR Causes (1)
Short PR - Preexcitaiton Syndrome + Junctional Rhythm
Long - 1st Degree AV Block
Long QRS Interval Causes (4)
1) BBB
2) Ventricular Ectopy
3) Drugs
4) Hyperkalemia (Tented T-Wave with Short PR)
Long QT Causes (5)
1) Hypokalemia (with U Wave after T)
2) Hypocalcemia
3) MI
4) Long QT Syndrome
5) Drugs - Class IA + III
Short QT Causes (2)
1) Hypercalemia
2) Tachycardia
Leads for Atrial Enlargement (2)
Leads II and V1
Right Atrial Enlargement ECG
Lead II - Big Increase in R Component
V1 - Bigger Bump Up (vs. Down for L)
Left Atrial Enlargement ECG
Lead 2 - Notched (Volcano)
V1 - Bigger Down (L Deflection)
Escape Rhythm - Define + 2 Types
Something other than the SA Node Sets the Pacemaker Potential
Types - Junctional + Ventricular
Junctional Escape Rhythm
Normal QRS with a beat of 40-60 (AV Node takes over pacemaker function + sometimes the P wave is burred in QRS)
Ventricular Escape Rhythm
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)
Early Afterdepolarization Causes (4)
Long QT - Genetic + Hypokalemia + Class Ia/III Anti-Arrhythmia Meds
Can develop into V-Tachy + Torsades
Delayed Afterdepolarization Causes (2)
High Intracellular Ca (Digitalis Poisoning) +_ Massive Catecholamine Surge
Causes of Conduction Blocks (4)
Fibrosis + Hyperkalemia + MI + Gap Junction Abnormalities
Arrhythmias caused by Reentry (4) + 2 Major Parts of Reentry
Monomorphic V-Tach (s/p MI)
AV Reentry Tachy.
AV Node Reentry Tachy.
Atrial Flutter/Fib
Slowed conduction velocity + unidirectional block
AVRTs (3) + Associated Pathology
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
Monomorphic vs. Polymorphic V-Tach
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
Typical AV Node Block Causes (4)
1) Age
2) Fibrosis
3) STEMI
4) Cardiomyopathy
Mobitz Type 1 Causes (3)
Inferior MI + Digitalis + High Vagal Tone
Mobitz Type II Causes (3)
Extensive Anterior MI + Degenerative Disease + More Serious
Supraventricular Arrhythmias - 3 Groups + 2 Major Treatment Classes
1) Sinus Node
2) Atrial - APCs + Atrial Tachy + Afib
3) AV Node Reentry - Junctional Complexes + AVNRT + AVRT
Atrial Fibrilation Presentations (5)
Palpitations + CVA + HF + HTN + Hyperthyroid
AVNRT vs. AVRT
AVNRT - Narrow QRS with hidden P-Wave + Tachy - Based on Slow AV Pathway
AVRT - Wider QRS with Delta Wave
Based on Accesory Pathway
AVNRT Termination (3)
Adenosine + Valsalva + Carotid Massage
V-Fib Causes (3)
1) Acute MI
2) Cardiomyopathy
3) Degeneration of V-Tach/Torsades
Congenital Long QT Genes (3)
1 = Activity (swimming) 2 = Noise (Alarm) 3 = Sleeping
Stunned Myocardium - Description
Decreased contractile without necrosis + bounce back after a short episode of transient ischemia
KEY : Prolonged systolic function without necrosis after
Hibernating Myocardium - Description
Chronic contractile dysfunction due to reduced blood supply without necrosis
Variant Angina
Vasospasm leads to random ST elevation due to transmural ischemia
Silent Ischemia
ECG Ischemia without symptoms
Syndrome X
Ischemia signs/symptoms without coronary flow pathology
Myocardial ISCHEMIA Signs/Symptoms (6)
Rales + S4 + Mitral Regurgitation + Diaphoresis + Increase HR + Increase BP
Signs/Symptoms - ACS (2) vs. Pericarditis (4) vs. Aortic Dissection (3)
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
Signs/Symptoms ACS (2) vs. Esophageal Spasm (3)
ACS
Retrosternal pressure pain + radiates left
ECG with ST Elevation/Depression
Esophogeal Spasm
Retrostrenal but worse with swallowing + dysphagia + antiacid relief
Acute MI Complications (2)
0-4 Hours - Cardiogenic Shock
4-24 Hours - Arrhythmias due to lack of conduction + decreased membrane potentials (treat with lidocaine)
Inflammatory MI Complications (4)
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
Fibrinous MI Complications (2)
1) Aneurysm of weakened wall or thrombus
2) Dressier Syndrome - Autoimmune Antibody Pericardia - Inflammation of the Pericardium
Aortic Stenosis - Physical Exam Findings - Murmur (3) + Signs (2)
Murmur - Systolic Coarse Crescendo-Decrescendo Murmur with Ejection Click + Possible S4 (from Stiff LV)
Pulsus Parvus - Weak/Delay Carotid Pulse
Paradoxical S2 Splitting
Aortic Regurgitation - Physical Exam Findings - Murmur (2) + Signs (2)
Murmur - Decrescendo Diastolic Murmur - Best heard at the end of expiration with the patient leaning forward
Findings - Bounding Pulses + Wide Pulse Pressures
Aortic Stenosis Causes (2)
1) Normal Wear and Tear
2) Chronic Rheumatic Fever (along with mitral valve issues) - Key pathology is fusion of the commisures
Aortic Stenosis Symptoms (5)
1) LV Hypertrophy
2) Angina
3) CHF
4) Exertion Syncope
5) A-Fib (LA Dilation)
Aortic Regurgitation Causes (2)
1) Congentital/Bicuspid Leaflet
2) Aortic Root Dilation (E.g. Dissection or Aneurysm)
Acute Aortic Regurgitation
LV is normal and non-compliant - Transfers the pressure increase back to the LA and Pulm Circuit
Causes Pulm Edema + Dyspnea
Chronic Aortic Regurgitation
Long term the LV becomes compliant via hypertrophy and dilation - CHF due to inability to maintain CO
Austin-Flint Murmur
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
Acute Rheumatic Fever - Cause + Pathophysiolgy
Caused by Group A Beta Hemolytic Streptococci (Pharyngitis) - 2-3 Weeks After
Bacterial M-Protein triggers Auto-Immune Response via molecular mimicry
Acute Rheumatic Fever - JONES
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
Acute Rheumatic Fever - Histopathology (3)
Aschoff Bodies = Foci of Chronic Inflammation with Reactive Histiocytes
Histiocyes = Slender Wavy Nuclei = Antischkow Cells
Giant Cells
Chronic Rheumatic Fever - Cardiac Sequel
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
Mitral Stenosis - Physical Exam Findings - Murmur (3)
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
Mitral Regurgitation - Physical Exam Findings - Murmur (2)
Holosystolic Blowing Murmur
Accentuated with clenched fists + squatting + expiration
Mitral Prolapse - Physical Exam Findings - Murmur (1) + Risk Factors (2)
Mid-Systolic Click accentuated by valsava + decreased by squatting
Risk Factors - Marfan + Ehler-Danlos
Mitral Prolapse - Increases Risk Of (4)
Infective Endocarditis
Arrhythmia
Emboli
Progressive Mitral Regurgitation
Mitral Stenosis Symptoms - Early (1) + Late (4) + End Stage (3)
Early - Dyspnea on Exerction
Late - Left HF - Severe Pulm. Congestion + Dyspnea at Rest + Orthopnea + PND
End Stage - Right HF - Ascities + Hepatomegaly + Peripheral Edema
Mitral Regurgitation - Acute Causes (3) + Symptoms (2)
Causes - Papillary Muscle Rupture (MI) + Endocardities + Ruptured Chordae Tendonae
Symptoms - Acute = Pulm Overload = Pulm Edema + Congestion
Mitral Regurgitation - Chronic Cause (4) + Symptoms (1)
Causes - DIlated Cardiomyopathy + Rheumatic Fever + Mitral Prolapse + Calcified annulus
Symptoms - More Dilated Heart Spares the LA/Pulm but eventually mimics Left HF
Pulmonic Stenosis - Key Points (2)
1) Rare In Adults + Okay to treat with valvuloplasty
2) Linked with RBBB to Widened S2 Splitting
Pulmonic Regurgitation - Key Points (2)
1) Functional (Pulm. HTN)
2) Left Sternal Border - High Pitched Decrecendo Murmur
Tricuspid Stenosis - Key Points (3)
1) Opening Snap + Decrescendo Diastolic Murmur
2) Large Alpha Wave on JVD (Atria Contracts Hard)
3) Similar Symptoms to MS with Right Heart
Tricuspid Regurgitation - Key Points
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)
