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Step 1 - Quick Decks > Heart Murmurs, EKG, MI complications > Flashcards

Heart Murmurs, EKG, MI complications Flashcards

1
Q

aortic stenosis

A

crescendo-decrescendo ejection murmur at right upper sternal border

soft S2 +/- ejection click

“pulsus parvus et tardus” (weak pulses with delayed peak)

in older patients, most commonly due to age-related calcification; in younger patients, most commonly due to early-onset calcification of a bicuspid aortic valve

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2
Q

mitral regurgitation

A

holosystolic, high-pitched “blowing” murmur loudest at apex, radiates toward axilla

often due to ischemic heart disease, mitral valve prolapse, LV dilation, rheumatic fever, or infective endocarditis

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3
Q

mitral valve prolapse

A

Midsystolic click followed by late systolic murmur

can predispose to infective endocarditis; can be caused by rheumatic fever, chordae rupture, or myxomatous degeneration

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4
Q

ventricular septal defect

A

holosystolic, harsh-sounding murmur, loudest at tricuspid area

larger VSDs have lower intensity murmur than VSDs

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5
Q

aortic regurgitation

A

early diastolic, decrescendo, high-pitched “blowing” murmur heard at the base (aortic root dilation) or left sternal border (valvular disease)

caused by bicuspid aortic valve, endocarditis, aortic root dilation, rheumatic fever

wide pulse pressure, pistol shot femoral pulse, pulsing nail bed (Quincke pulse); hyperdynamic pulse and head bobbing when severe

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6
Q

mitral stenosis

A

follows opening snap (OS); delayed rumbling mid-to-late diastolic murmur (decreased interval between S1 and OS correlates with increased severity)

late and highly specific sequalae of rheumatic fever; chronic MS can => LA dilation and pulmonary congestion, atrial fibrillation, Ortner syndrome, hemoptysis, right HF

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7
Q

patent ductus arteriosus

A

continuous machine-like murmur, best heart at left infraclavicular area, loudest at S2

often caused by congenital rubella or prematurity

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8
Q

crescendo-decrescendo ejection murmur, loudest at heart base, radiates to carotids

A

aortic stenosis

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9
Q

holosystolic, high-pitched “blowing” murmur loudest at the apex, radiates toward axilla

A

mitral regurgitation

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10
Q

holosystolic, high-pitched “blowing” murmur loudest at tricuspid area

A

tricuspid regurgitation

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11
Q

late crescendo murmur with midsystolic click that occurs after carotid pulse

A

mitral valve prolapse

best heart over apex, loudest just before S1

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12
Q

holosystolic, harsh-sounding murmur loudest at tricuspid area

A

ventricular septal defect

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13
Q

early diastolic, decrescendo, high-pitched “blowing” murmur best heart at base or left sternal border

A

aortic regurgitation

hyperdynamic pulse and head bobbing when severe and chronic

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14
Q

opening snap followed by delayed rumbling mid-to-late murmur

A

mitral stenosis

late and highly specific sequelae of rheumatic fever

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15
Q

continuous machine-like murmur, best heart at left infraclavicular area, loudest at S2

A

patent ductus arteriosus

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16
Q

leads with ST-segment elevations or Q waves: V1-V2

A

anteroseptal (LAD)

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17
Q

leads with ST-segment elevations or Q waves: V3-V4

A

anteroapical (distal LAD)

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18
Q

leads with ST-segment elevations or Q waves: V5-V6

A

anterolateral (LAD or LCX)

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19
Q

leads with ST-segment elevations or Q waves: I, aVL

A

lateral (LCX)

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20
Q

leads with ST-segment elevations or Q waves: II, III, aVF

A

inferior (RCA)

21
Q

leads with ST-segment elevations or Q waves: V7-V9

A

posterior (PDA)

22
Q
A

atrial fibrillation: irregularly irregular rate and rhythm with no discrete P waves

risk factors = HTN and CAD; may predispose to thromboembolic events, particularly stroke

management: rate and rhythm control, cardioversion; ablation of pulmonary vein ostia or left atrial appendage; coagulation based on stroke risk

23
Q

multifocal atrial tachycardia

A

irregularly irregular rate and rhythm with at least 3 distinct P wave morphologies due to multiple ectopic foci in atria

associated with COPD, pneumonia, HF

24
Q
A

atrial flutter: rapid succession of identical, consecutive atrial depolarization waves => “sawtooth” appearance of P waves

treat like atrial fibrillation +/- catheter ablation of region between tricuspid annulus and IVC

25
Q

paroxysmal supraventricular tachycardia

A

due to reentrant tract between atrium and ventricle, most commonly in AV node

sudden onset palpitations, lightheadedness, diaphoresis

treatment: terminate reentry rhythm by slowing AV node conduction, electrical conversion if hemodynamically unstable; catheter ablation of reentry tract

26
Q
A

Wolff-Parkinson-White syndrome: abnormal fast accessory conduction pathway from atria to ventricle (bundle of Kent) bypasses rate-slowing AV node => ventricles partially depolarize earlier => characteristic delta wave with widened QRS complex and shortened PR interval

may result in reentry circuit => supraventricular tachycardia

treatment: procainamide; avoid AV nodal blocking drugs

27
Q
A

ventricular tachycardia: regular rhythm, rate >100, QRS > 120 ms

due to structural heart disease (cardiomyopathy, scarring after myocardial infarction)

high risk of sudden cardiac death

28
Q
A

torsades de pointes: polymorphic ventricular tachycardia; shifting sinusoidal waveforms; may progress to ventricular fibrillation

long QT interval predisposes to torsades de pointes; caused by drugs that decreased K+, Mg++, and Ca++

treatment: magnesium sulfate

drugs that induce long QT: Ia and III antiarrhythmics, arsenic, macrolides, fluoroquinolones, haloperidol, chloroquine, TCAs, thiazides, ondansetron, fluconazole, protease inhibitors, methadone

29
Q
A

ventricular fibrillation: disorganized rhythm with no identifiable waves

fatal without immediate CPR and defibrillation

30
Q
A

first-degree heart block: prolonged PR interval (>200 ms)

benign and asymptomatic

31
Q
A

second degree heart block type I: progressive lengthening of PR interval until a beat is “dropped” (P wave not followed by QRS complex); variable RR interval with a pattern (regularly irregular)

usually asymptomatic

32
Q
A

second degree heart block type II: dropped beats that are not preceded by a change in PR interval; may progress to 3rd degree block

usually indicates a structural abnormality (ischemia, fibrosis, sclerosis)

treatment: pacemaker

33
Q
A

third degree heart block: P waves and QRS complexes rhythmically dissociated; atria and ventricles beat independently of each other; atrial rate > ventricular rate

may be caused by Lyme disease

treatment: pacemaker

34
Q

bundle branch block

A

interruption of conduction of normal left or right bundle branches; affected ventricle depolarizes via slower myocyte-to-myocyte conduction from the unaffected ventricle, which depolarizes via faster His-Purkinje system

commonly due to ischemic or degenerative changes

35
Q

premature atrial contraction

A

extra beats arising from ectopic foci in atria instead of the SA node; often secondary to increased adrenergic drive (caffeine consumption); narrow QRS complex with preceding P wave

benign, but may increase risk for atrial fibrillation and flutter

36
Q

premature ventricular contraction

A

ectopic beats arising from ventricle instead of SA node; shortened diastolic filling time => decreased SV; wide QRS complex with no preceding P wave

37
Q

Brugada syndrome

A

AD loss of function mutation of Na+ channels => pseudo-right bundle branch block and ST segment elevations in leads V1-V2

treatment: prevent sudden death with ICD

38
Q

congenital long QT syndrome

A

mutations of KCNQ1 => loss of function of K+ channels => affects repolarization

Romano-Ward syndrome (AD, pure cardiac phenotype), Jervell and Lange-Nielsen syndrome (AR, sensorineural deafness)

39
Q

sick sinus syndrome

A

age-related degeneration of SA node => ECG shows bradycardia, sinus pauses, sinus arrest, junctional escape beats

40
Q

MI complications: cardiac arrhythmia

A

first few days to several weeks

supraventricular arrhythmias, ventricular arrhythmias, or conduction blocks

due to myocardial death and scarring; important cause of death before reaching the hospital and within the first 48 hours post MI

41
Q

MI complications: peri-infarction pericarditis

A

1-3 days

pleuritic chest pain, pericardial friction rub, ECG changes, and/or small pericardial effusion

usually self-limited

42
Q

MI complications: papillary muscle rupture

A

2-7 days

can result in acute mitral regurgitation => cardiogenic shock, severe pulmonary edema

posteromedial&raquo_space; anteromedial papillary muscle rupture (posteromedial has single blood supply (PDA), anterolateral has dual (LAD, LCX)

43
Q

MI complications: interventricular septal rupture

A

3-5 days

mild to severe sxs with cardiogenic shock and pulmonary edema

macrophage-mediated degradation => VSD => increased O2 saturation and increased pressure in RV

44
Q

MI complications: ventricular pseudo-aneurysm

A

3-14 days

asymptomatic or chest pain, murmur, arrhythmia, syncope, HF, embolus from mural thrombus; rupture => tamponade

more likely to rupture than true aneurysm because it does not contain endocardium or myocardium

45
Q

MI complications: ventricular free wall rupture

A

5-14 days

free wall rupture => cardiac tamponade; acute forms usually leads to sudden death

LV hypertrophy and previous MI protein against free wall rupture

46
Q

MI complications: true ventricular aneurysm

A

2 weeks to several months

similar to pseudoaneurysm: chest pain, murmur, arrhythmia, syncope, HF, embolus from mural thrombus; rupture => cardiac tamponade

outward bulge with contraction (“dyskinesia”); associated with fibrosis

47
Q

MI complications: postcardiac injury syndrome

A

weeks to several months

fibrinous pericarditis dye to autoimmune reaction

aka Dressler syndrome; cardiac antigens released after injury => deposition of immune complexes in pericardium => inflammation

48
Q

Aortic regurgitation

A

High-pitched “blowing”, diastolic, decrescendo murmur at left upper sternal border (valvular) or right upper sternal border (aortic root)

Due to Marfan syndrome (aortic root dilation) or bicuspid aortic valve, rheumatic heart disease (valvular)

Step 1 - Quick Decks (18 decks)

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