PANCE Flashcards
Area of infarction–> EKG leads–> artery involved
anterior–> V1-V4–> LAD
septal–> V1 and V2–> prox LAD
lateral–> I, aVL, V5, V6–> circ
anterolateral–> I, aVL, V4, V5, V6–> mid LAD or circ
inferior–> II, III, aVF–> RCA
posterior–> depression is V1 and V2–> RCA or circ
Coronary Artery Disease
ischemia d/t imbalance of blood supply and demand
MC atherosclerosis
Angina Pectoris
substernal CP brought on by exertion
Class I: usually strenuous activity
Class II: prolonged activity
Class III: daily activity
Class IV: at rest
poorly localized, non pleuritic exertional CP w/ radiation to arm, teeth or lower jaw
relieved with rest or nitro
Anginal Equivalent
dyspnea, epigastric or shoulder pain
Classic outpatient angina regimen
ASA, nitro PRN, beta blocker, statin
Acute coronary syndrome
sx’s of acute mycardial ischemia 2ry to occlusion
anginal pain lasting longer then 30mins not relieved by rest or nitro
get EKG and cardiac markers
1) Unstable angina and 2) NSTEMI
antithrombotic therapy (ASA, plavix,integrellin, heparin) + adjunctive (beta blocker, morphine, nitro)
3) STEMI
reprofusion (PCI, thrombolytic) + antithrombotic +adjunctive (beta blocker, ACE-I, nitrate, morphine)
Coronary Vasospasm Disorders
1) Prinzmetal: coronary spasm–>transient ST elevation w/o MI
-non exertional CP
-EKG–> transient ST changes resolved w/ nitro or CCB
TREAT W/ CCB
2)Cocaine induced: sympathetic and alpha 1 activation
-EKG–> transient ST elevation
- CCB +/- nitro
NO BETA BLOCKER
Dilated Cardiomyopathy
systolic dysfunction–>ventricular dilatation-> dilated, weakened heart
MC–> idiopathic
systolic HF symptoms (left and right sided)
pulmonary congestion, peripheral edema, increased JVP, hepatic congestion
echo–> LV dilation, deceased EF, LV hypokenesis
CXR–> cardiomegaly, pulmonary edema, pleural effusion
standard systolic HF tx–> ACEI, diuretic, beta blocker
Restrictive Cardiomyopathy
diastolic dysfunction, ventricular rigidity impedes ventricular filling–> decr compliance
MC–> infiltrative diseases (amyloid)
right sided failure sx’s more than left
peripheral edema, increased JVP, hepatic congestion
echo–>non dilated ventricles with normal thickness, DILATION OF ATRIA, diastolic dysfunction with normal systolic
treat underlying cause
Hypertrophic Cardiomyopathy
diastolic dysfunction d/t impaired ventricular relaxation/filling
PLUS
subaortic outflow obstruction d/t hypertrophic septum
PLUS
systolic anterior motion of mitral valve
inherited genetic disorder
often asx but can have dyspnea, angina, syncope, arrhythmia, sudden cardiac death
harsh systolic cres-decresc murmur @ LLSB
incres by standing and valsalva
echo–> asymm wall thickness
ekg–> LVH
use beta blocker
myomectomy, ETOH ablation
Atrial Fibrililation
irregularly irregular rhythm w/ narrow QRS and no P waves
rate control with beta blocker, CCB or digoxin
rhythm control with DCC–> afib <48hr or after anticoagulation and TEE
or ibutilide, flecainide, amiodarone, sotalol
or radiofrequency ablation
Unstable–> DCC
anticoagulation if indicated (CHA2DS-2VASc)
Atrioventricular Blocks
First degree–> constant prolonged PR
Second Degree type I–> Wenckeback
progressive PRI prolongation leads to dropped QRS
tx w/ atropine if sx
Second degree type II–> constant prolonged PR followed by dropped QRS
tx w/ atropine or temporary pacing
pacemaker definitive tx
Third degree–> AV dissociation
acutely tc with temporary pacing then PPM
Atrial Flutter
regular rhythm w/ flutter waves and no p waves
stable–> vagal maneuvers, beta blocker or CCB
unstable–> DCC
definitive tx–> ablation
Left Bundle Branch Block
- wide QRS
- broad slurred R in V5 and V6
- deep S wave in V1
- ST elevation V1-V3
MI UNTIL PROVEN OTHERWISE
Right Bundle Branch Block
- wide QRS
- RsR’ in V1 and V2
- wide S wave in V6
