Part 15 Flashcards
AV nodal re-entry tachycardia treatment (3)
- mammalian diving reflex, vagal maneuvers of carotid, valsalva
- adenosine 6mg rapid IV bolus (stops heart with a chemically short half life drug to allow for full refractory period to return)
- Electrophysiologist (EP) lab referral***
Mammalian diving reflex
When water fills the nostrils, the autonomic nervous system redirects blood flow thru peripheral vasoconstriction from the limbs and viscera to the heart and brain to conserve oxygen, causes slowing of the heart rate
AV reentrant tachycardia (AVRT) nick name
Wolf parkinson white syndrome
Atrial flutter
Involves circus movement (conduction around same loop in atrium) generally 250-350 bpm, saw tooth pattern, often with picket fence P waves seen in leads 2, 3, and AVF
atrial flutter treatment (4)
- Digoxin
- B blockers or Ca2+ blockers
- pacemaker
- ablation
Atrial fibrillation
Occurs when atrial rate is 350-700 bpm, ventricular rate may be normal or rapid, involves a complete lack of P waves, irregularly irregular rhythm, at risk for stroke and hypotension
Common causes of atrial fib (4)
- thyroid abnormalities
- alcohol
- COPD
- underlying heart disease
Afib treatment (3)
- rate control (B blockers, Ca2+ channel blockers, digoxin
- anticoagulation before and after cardioversion
- rhythm control
Defibrillation will not work on a heart that has reached what stage of arrest?
Asystole
Ventricular arrhythmias occur from the…
….AV node down
ventricular tachycardia
3 or more successive PVC’s, nonsustained is less than 30 sec and sustained is more, rate >100bpm usually regular rhythm, may or may not see P waves
Torsades de pointes
Form of polymorphic ventricular tachycardia assoc with prolonged QT interval >500ms, changes in amplitude and morehphology of QRS around isoelectric line, causes of prolonged QT interval can be congenital or acquired
Ventricular fib requires…
…electric shock
Brugada syndrome
Congenital channelopathy caused by mutation of cardiac Na+, K+ or Ca2+ , ST segment elevation in one of the right precordial leads (V1-V3) at baseline or after use of Na+ blockers, 3 subtypes
Commotio cordis
Ventricular fib caused by blunt, non-penetrating blow to chest during vulnerable portion of ventricular repolarization, more common in children and adolescents, more common with moderate to high velocity strike usually projectile right during a T wave
Ventricular flutter
Ventricular tachyarrhythmia 250-350 bpm, rapidly deteriorates into ventricular fib
Ischemia will manifest on an EKG as…
…ST depression
ST elevation indicates…
Acute injury within past 24-48 hrs
T wave inversion or ST elevation or depression across all leads is pathonomonic of what condition?
Pericarditis
Punumbra
Direct death of tissue from blocked artery that is not perfused, surrounded by ischemic and injured tissue in a circular area around the source
Lesions that occlude LAD represent ___% of MI’s, RCA represents ___%, and circumflex represents ___%
50, 30, 20
Inferior wall MI is represented in leads…
II, III, and AVF
Lateral wall MI is represented in leads…
I, AVL, V5, V6
Septal/anterior wall MI is represented in leads…
Septum: V1,2,
Anterior: V3,4
Posterior wall MI findings on EKG
ST DEPRESSION in V1 ,2, 3,
Early treatment of MI (3)
Coronary angioplasty with balloon angiogram Stent placement (bare metal or drug eluding) -Coronary artery bypass graft either by harvesting saphenous vein, radial artery, or left internal thoracic artery
Lateral wall MI occludes what artery?
Circumflex
Posterior and inferior MI occludes what artery?
Posterior descending artery
S1 heart sound occurs during what phase of the heart cycle? What about S2?
- At the end of diastole/start of systole
- At the end of systole/start of diastole
Pulse pressure definition
Difference between systolic and diastolic blood pressure
End systolic volume
Volume of blood remaining in LV following cardiac contraction and ejection of blood
Ejection fraction and avg value
Stroke volue/end diastolic volume, should be about 55%
Aortic area Pulmonic area Erb's point Tricuspid area Mitral area Locations
- 2nd intercostal space right sternal border
- 2nd intercostal space, left sternal border
- third intercostal space, left sternal border
- 4th intercostal space, left sternal border
- 5th intercostal space, mid clavicular line
S3 gallop
Early diastolic sound following S2 with new blood entering a dilated ventricle, may be normal in children or indicative of CHF, CAD, or aortic/mitral insufficiency
S4 gallop
Late diastolic sound right before S1 due to ejection of blood from atria during atrial contraction hitting a stiff noncompliant wall, long standing hypertension causing LV hypertrophy is key, may be normal but almost always pathologic
Cardiac friction rub
Creaking, grating, or scratching sound heard with pericardial inflammation, classically has 2 systolic and one diastolic component, heard best at the left sternal border (increased when leaning forward) when patient is not breathing
Erythema nodosum
An idiopathic inflammatory disease affecting primarily the skin in the front of the legs below the knees causing very painful macules
Wegener’s granulomatosis
Autoimmune inflammatory disease of the blood vessels that has a distinct saddle nose appearance
Xanthelasma (hyperlipoproteinemia)
Sharp demarcated deposits of cholesterol underneath the skin, usually near the eyelids, usually not painful or problematic
Kawasaki’s disease
Inflammation of blood vessels often seen in children less than 5 years old, presents with a week of high fever, bilateral conjunctivitis, strawberry tongue, cervical lymphadenopathy and plaque-like rash on trunk and proximal extremities.
Acanthosis nigricans
Characterized by dark discoloration of body folds and creases seen in obese or diabetic patients
Cowden’s disease
Sees development of multiple noncancerous growths called hamartomas that are associated with development of breast and thyroid cancer
Peutz Jegher’s syndrome
Genetic disorder causing benign hyperpigmented macules on lips and mucosa
Infective endocarditis
From infection of the endocardium, can see janeway lesions (spots on palms and soles), oslers nodes (painful red lesions on hands and feet), and splinter hemorrhages (tiny blood spots under nails)
Steven johnson syndrome
An emergency reaction to medication or disease that causes red/purple purpura rash to spread systemically
Neurofibromatosis
A genetic condition that causes tumors to form on nervous tissue, skin can see pigmentation and freckling
Pityriasis rosacea
hAn unknown triggered rash that begins as a large oval patch herald patch before a fawn colored generalized rash appears, spontaneously resolves in 6 weeks, common and harmless
Schleroderma
Hardening and tightening of skin often seen in women 30-50, co-occurs with raynauds often
Cautions against iodinated contrast (3)
- Iodine allergy
- Shellfish allergy
- Renal insufficiency (relative contraindication depending on severity)
Gadolinium
Used in MRI and MRA but highly contraindicated in renal failure because it cannot dialysize out and thus ends up depositing into soft tissue resulting in possible nephrogenic systemic fibrosis (stiffening of all tissue similar to scleroderma but caused by gadolinium)
CT is better for ___ visualization, MRI is better for ___ or ___, MRA is best for ___
Bone, soft tissue, nerve, vascular
Generalized pruritis all over can be a sign requiring further evaluation as it may be due to…
….lymphoma
FEES
Fiberoptic endoscopic evaluation of swallowing, passing a scope thru the nose and down into the back of the throat then having a patient eat and drink, a non radiation alternative to X ray to visualize food bits left in piriform sinus (posteriolateral on either side of laryngeal opening)