PANCE Review Flashcards
MCC of Dilated Myopathy
MC infectious cause
? metabolic issue can cause this
Idiopathic
Enterovirus: Coxsackie
B1- Thiamine
? is the hallmark PE finding of Dilated Cardiomyopathy
? is the Dx test of choice
How is this condition managed
S3 gallop
Echo- LV dilation w/ EF <50% (systolic failure)
Loop ACEI BB; Inc contractility w/ Digitalis
When is an ICD indicated for Dilated Cardiomyopathy
MCC of Restrictive Cardiomopathy
MC c/c
EF <35%
Sarcoidosis
Dyspnea
What will be seen on PE of Restrictive Cardiomyopathy
What is the Dx test of choice
What is the definitive Dx test
Kussmaul Sign- inc JVP w/ inspiration
Echo: non-dilated ventricles w/ diastolic dysfunction
MRI if Dx still uncertain
Endomyocardial biopsy- amyloidosis appears apple-green birefringence w/ Congo-red stain
How is Restrictive Cardiomyopathy managed
What causes HOCM
What creates the obstruction
Chelation- hemochromatosis, GCCS- sarcoidosis
Autosomal dominant d/o of inappropriate hypertrophy
Sub-aortic outflow d/t septal hypertrophy and anterior motion of MV during systole
What makes HOCM murmur louder
What do Pts w/ HOCM die from
What may be found on PE
Inc contractility, Dec LV volume
V-Fib
S4, MR, Pulse bisferiens
How is HOCM managed
How is HOCM Tx
What is an alternative Tx
BB > CCBs
Momectomy- young Pt refractory to medical therapy
Septal ablation w/ alcohol
Define Myocarditis
What non-cardiac issue can Pts present w/
Classic Dx study finding
Inflammation of muscle d/t viral infection (Coxsackie) leading to systolic dysfunction/pericarditis
Toxic megacolon
Cardiomegaly on CXR
Sinus tach on EKG
Ventricular dysfunction on Echo
Gold standard to Dx Myocarditis
How are Pts Tx
LA/RA enlargement on EKG
Biopsy- lymphocyte infiltration and myocardial necrosis
Loop ACEI BBs
L: M-shape P-wave in Lead 2, Biphasic P-wave in V1 w/ large terminal part
R: tall Lead 2 P-wave, Biphasic P-wave in V1 w/ larger initial component
RVH criteria on EKG
LVH criteria on EKG
Normal QRS axis
V1 w/ R >7mm or is R>S
Sokolow-Lyon: V1-S + V5-R= >35mm/30mm (m/w)
Cornell: aVL-R + V3-S= >28/20mm (m/w)
-30 - 90
How is Sinus Tach Tx during AMIs
How is Sinus Brady Tx
How is SSS Tx if Sxs
Metoprolol
Atropine then Epi/Pacing
Atropine then Dopamine, Epi, Pacine
Pacemaker= definitive
Most helpful part of EKG to determine if AV block exists
All heart blocks are Tx first line w/ ? if Sxs exist
When is ICD indicated for Type 1 Block
PR interval
Atropine
Persistent Sxs/PRI >0.30sec
Adverse outcome from surviving inferior wall MI
What causes the ‘saw-tooth’ pattern of A-Flutter
How is AFlutter Tx
Wenckebach block
One irritable atrial site
Stable: Vagal Rate (BB>CCBs)
Unstable: conversion
Ablation- definitive
What are the 4 types of Afib
Define Ashermann Phenomenon
Paroxysmal: self terminates <7d
Persistent: fails to self terminate, lasts >7d
Permanent: >12mon or refractory to conversion
Lone: exists outside of heart dz
Short RR cycle followed by aberrant beat seen in Afib
How is Afib Tx in stable Pts
What is the name of the definitive Tx procedure
How long is anticoagulation needed
Rate: BB or Non-DHPs (Digoxin if BB/CCB c/i d/t CHF/HOTN)
Maze
3wks prior, 4wks after
Direct thrombin inhibitor
Factor Xa inhibitors
What are the two types of PSVTs
Dabigatran- binds/inhibits thrombin
Edo/Apix/Riva-roxaban
AVNRT- two paths w/in AV node (MC type)
AVRT- two paths outside of AV node
How is stable, Narrow PSVT Tx
How is stable, Wide PSVT Tx
Define MAT/WAP
Vagal, Adenosine then CCB/BB/Digoxin
Amiodarone, Procainamide
MAT: >100 in COPD Pt (Tx: Verapamil/BB if LV preserved)
WAP: <100bpm
Pathophysiology behind WPW
What are the 3 EKG components of this condition
How is Wide Complex WPW Tx and what is avoided
Accessory pathway through Bundle of Kent connect atria to ventricles, bypassing AV node= D-wave
Wave-delta PR-short Wide-QRS
Procainamide > Amiodarone; Avoid Adenosine, BB, CCB, Digoxin
EKG finding for AV junctional rhythms
Define PVC
What other EKG abnormality will be seen
Inverted P-wave 1, 2, aVF
Premature beat from ventricle causing T-wave to travel opposite of QRS complex
Compensatory pause
MCC of V-Tach
How is this Tx in order
How are refractory Torsades Tx
Ischemic heart dz
Amiodarone, Lidocaine, Procainamide
Isoproterenol, Transvenous overdrive pacing
Anti-Arrhythmics
Na blockers, dec automaticity and stabilize membrane:
1A: Double Quarter Pounder; Dispyramide Quinidine Procainamide
1B: Lettuce Tomatoes; Lidocaine Tocainide
1C: Pickles Extra Fries; Propafenone Encainide Flecainide
2: BB, dec AV conduction
3: K blocker, Amiodarone Ibutilide Dofetilide Sotalol
4: Ca blocker
5: Digoxin
? antiarrhythmic possesses Class 1-4 properties
Classes ? are more for rhythm while Classes ? are used for rate
MC innocent murmur and MC continuous murmur
Amiodarone
Rhythm: 1,3 Rate: 2,4
Innocent: Still- dec w/ stand/valsalva; inc w/ supine
Continuous: Venous- dec w/ supine, rotation; inc w/ sitting upright
MC type of ASD
What does this sound like
What EKG sign may be seen
What size needs surgical correction
Ostium secundum
Wide, fixed split S2 w/out varying during respiration
Crochetage- notched peak of R-wave in inferior lead
> 1cm or Sxs
Define PDA
What does this sound like on PE
How is this Tx
Connected Pulm Artery and descending aorta
Continuous, machinery murmur w/ bounding peripheral pulses and wide pulse pressures (BMW)
Indomethacin- dec prostaglandin production
MC location for aortic coarctations
What are the two types
What do Pts need pre-op
Ductus arteriorsus insertion site distal to left subclavian vein
Post-duct: adults, Pre-ductal: infants
Alprostadil
MC congenital heart dz of childhood
What phenomenon can develop w/ this MC
When is surgical closure needed and why
VSD- MC type being perimembranous near TV
Katz Wachtel- RVH+LVH
Recurrent infection, Delayed growth, CHF, Sx; Prevent P-HTN
What is the worse and what is the most important RF for CADz
Anginal equivalents are more common in ? Pts
What two meds dec mortality of CADz
Worse: DM, Important: smoking
Obese Women Elderly DM
ASA+BBs
PCI vs CABG determinations
Meds used for myocardial perfusion imaging
Meds used for Stress Echo
PCI: 1-2 vessel w/out L-main involvement and normal EF
CABG: L-main stenosis, 3 vessel dz (2 vessel diabetic) or EF <40%
Adenosine, Dipyridamole
Dopamine, Dobutamine
Pentad for Inferior MI
EKG progression during STEMI
AMI time protocols
S4, Inc JVP, Clear lungs, Kussmaul
Hyper-acute T-waves, ST elevation, Q-waves
EKG: 10min, Thrombolytics: 30min, PCI: 90min
Cocaine induced MIs are Tx w/ ? med of choice
CCBs
