Random lists Flashcards by Bree Henry

Etiology of incompetent heart valves

Carditis (rheumatic fever)
Valvular stenosis (previous endocarditis or calcium deposits)

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Myocardial disorders that may cause cardiogenic syncope

HOCM
Myxoma

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Bradyarrhythmias that may cause cardiogenic syncope

Sick-sinus syndrome
Sinus bradycardia
High grade AV block
Pacemaker malfunction

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Supraventricular tachyarrhythmias that may cause cardiogenic syncope

supraventricular tachycardia
atrial fibrillation w/ rapid response

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ECG findings with supraventricular tachyarrhythmias

Wolff-Parkinson-White syndrome
Brugada syndrome
Long QT syndrome

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Ventricular arrhythmias that may cause cardiogenic syncope

V-tach
Torsades de pointes

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Valvular disorders that may cause cardiogenic syncope

Mitral stenosis
Aortic stenosis

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Vascular disease that may cause cardiogenic syncope

Myocardial infarction
Aortic dissection
Pulmonary hypotension
Pulmonary embolism

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“low flow” states that may cause cardiogenic syncope due to hypotension

Advanced cardiomyopathy
CHF
Valvular insufficiency
Meds that decrease afterload

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What types of heart issues can cause cardiac syncope? (Broad categories)

vascular disease
Valvular dysfunction
Arrhythmias
Myocardial disorders

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What effect on the heart does HYPERKALEMIA cause

reduced myocardial excitability with depression of both pacemaking and conducting tissues

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EKG findings with HYPERKALEMIA

Peaked T waves
Prolonged PR segment
Broad P waves and QRS complexes
Loss of P waves
Bradycardia
spreads everything out

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What is the effect of HYPOKALEMIA on the heart

myocardial hyper excitability with the potential to develop re-entrant arrhythmias

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ECG findings of HYPOKALEMIA

T wave inversion & prominent U wave
Long QT interval

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Effect of HYPERCALCEMIA on the heart

block the conduction pathways of electrical impulse

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ECG findings of HYPERCALCEMIA

Shortened QT interval

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Effect of HYPOCALCEMIA on the heart

decreased myocardial contraction

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ECG findings of HYPOCALCEMIA

Prolong QT interval

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Effect of HYPERMAGNESEMIA on the heart

delayed conduction of electrical impulse

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ECG findings of HYPERMAGNESEMIA

Prolonged PR interval
Wide QRS complex

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Effect of HYPOMAGNESEMIA on the heart

irregular contraction of ventricles leading to arrhythmias

ECG findings of HYPOMAGNESEMIA

Depressed ST segment
Tall T waves
Torsades de pointes

Pt with palpitation feels pulse, rhythm is normal but rate is tachycardic. Possible causes?

SVT or ventricular tachyarrhythmia

Pt with palpitation feels pulse, rhythm is abnormal. Thoughts?

“extrasystole” - premature contractions and post-premature contractions often described as floppy

“ectopic beats” - end suddenly - beat that resumes sinus rhythm can be strong

Patient can be acutely aware of the onset and end of arrhythmias - often made treatable with “vagal maneuvers”

Labs for patients with palpitations

CBC - anemia and infection TSH Electrolytes

What should be checked for on physical exam for patients with palpitations

Evidence of valvular heart disease Thyroid disease Pulmonary disease

Examples of palpitations due to cardiac arrhythmias and info about them

Tachyarrhythmias - can be assoc. with dizziness, near syncope or syncope; potentially lethal PVC - "pounding" or "jumping" in heart when in quiet space or lying down Heart valve abnormalities - 40% with MVP have palpitations

What is not associated with palpitations

A fib, persistent tachy, anything constant and not acute change

What are the sources of chest pain

1. chest wall 2. Back 3. Lung 4. Heart 5. Aorta 6. Esophagus 7. Diaphragm 8. Abdominal cavity 9. Anxiety/psychological

What are essential things to determine in the presence of chest pain complaint?

1. Chest discomfort duration, onset, character, location, periodicity, and exacerbations 2. SOB history 3. Vital signs 4. Chest and cardiac exam 5. ECG 6. Biomarkers of myocardial necrosis

Serious causes of chest discomfort

Anxiety PUD GERD Pneumonia Pericarditis Mallory Weis tear

Lethal causes of chest discomfort

ACS Aortic dissection PE Esophageal perforation Tension pneumothorax

Conditions that pose strong risk for CAD

SLE RA HIV

What types of loud, rumbling murmurs may cause thrills

AS PDA VSD

What sounds are best heard with the diaphragm?

S1 S2 AR/MR PFR OS and AS

What sounds are best heard with the bell?

S3 S4 MS

What heart sounds are paradoxically heard best with valsalva and wose with squatting/leg lifting

MVP HOCM

What should be ruled out if S3 if heard in a patient >40

CHF MR

What can cause the stiffening of the ventricle leading to S4?

Long-standing HTN CAD AS Cardiomyopathy more

When is a pericardial friction rub heard/etiology

pericarditis S/P MI

Where is PFR best heard and what position

3rd ICS, LSB with diaphragm and patient leaning forward then to right and left

Describe the ejection sound

early systolic sound as disease aortic valve opens (AS) - high-pitches, sharp, clicking quality

Describe opening snap

diastolic sound as mitral valve opens (MS) - stenotic mitral valve

Describe what determines venous jugular pressure

blood volume and the capacity of the right heart to eject blood into the pulmonary arteries

What causes elevated JVP?

Heart failure Restrictive pericarditis Cardiac tamponade Fluid overload - impaired renal function

What are the causes of >10mm Hg difference in upper limb BPs

Coarctation of the aorta Subclavian steal syndrome Aneurysm of subclavian or innominate artery Thrombosis of innominate or subclavian artery

What are the causes of >20mm Hg difference between upper limb and lower limb

Coarctation of the aorta Aortic dissection Severe chronic aortic regurgitation Inappropriate cuff size for thigh

What are the causes of pulsus alterans

Large pericardial effusion Left ventricular failure Asthma

What is the cause of paradoxical pulse and some conditions that cause it?

decreased blood flow to the left heart by lung hyperinflation causing increased pre-load to the right heart Exacerbations of asthma and COPD Pericardial tamponade Tension pneumothorax