Cardio Flashcards
(138 cards)
1
Q
Infection of normal valves with a virulent organism (S. aureus)
A
Acute bacterial endocarditis
2
Q
Difference in acute vs subacute bacterial endocarditis
A
Acute = Normal valves (S.Aureus)
Subacute = Abnormal valves with less virulent organism like (S. Viridans)
3
Q
Duke Major criteria for endocarditis
A
Blood cx (x2 ; 12 hrs apart)
Echo = Vegetations seen
New regurg murmur
4
Q
Dukes Minor criteria for endocarditis
A
Risk factors
Fever 100.5
Osler nodes
Janeway lesions
Roth Spots
Splinter hemorrhages
Clubbing
5
Q
Tx of endocarditis normal valve + prosthetic valve
A
Normal valve = IV Vanc or Amp/Sulbactam PLUS aminoglycoside
Prosthetic valve = Rifampin
6
Q
Which bacteria is seen in acute vs subacute vs IV drug user vs prosthetics
A
Acute + IV drugs = Staph aureus
Subacute = Sub → Not as bad = Staph Viridans
Prosthetic = S. Epidermidis
7
Q
MC bug of endocarditis
A
Strep viridans = Late complication of valve replacement and presents as small vegetations and emoblic events
8
Q
Gold standard dx for endocarditis?
A
TEE
9
Q
Chest pain or discomfort, heaviness, pressure, squeezing, tightness that is increased with exertion or emotion
A
Stable angina
10
Q
Chest pain or substernal pressure <10-15 min that is relieved with rest or w/ NTG
A
Stable angina
11
Q
What is levine sign?
A
Clenched fist over sternum + teeth clenched = Stable angina
12
Q
Workup for stable angina includes?
A
EKG = Normal (q waves before MI)
Cardiac stress test = reversible wall motion abnormalities
Coronary angio = DEFINITIVE diagnosis
13
Q
Tx of table angina
A
NTG sublingual then IV nitro
Betablockers = make heart work less
Severe = angioplasty + by;pass
14
Q
Main vessel involved in stable angina
A
Left main
15
Q
Previously stable and predictable symptoms of angina that are now more frequent, increasing or present at rest
A
Unstable angina
16
Q
Tx of unstable angina
A
Admit with continous monitoring, establish IV, O2
Pain control = NTG + morphine
ASA +/- Clopidogrel - Used together these reduce rate of MI compared to ASA alone
LMWH for 2 days
Bblockers
Revascularization if symptoms PERSIST WITH MEDS
Ace + statins go home with
17
Q
What type of angina awakes pts from sleep and isn ot associated with clot?
A
Prinzmetal variant
18
Q
Coronary artery vasospams causing transient ST segment elevation
A
Printzmetal angina
19
Q
Known triggers of printzmetal angina
A
Hyperventilation, COCAINE, tobacco use, acteycholine, ergonivine, histamine, serotonin
20
Q
Which type of angina is associated with nitric oxide deficiency?
A
Printzmetal - Lack of nitric oxide → Increases activity of potent vasoconstrictors + stimulators of smooth muscles
21
Q
Is prinzmetal angina pain cyclical or noncylical?
A
Cyclical = Occurs most often in morning hours, no correlation to cardiac workload
22
Q
What does Prinzmetal angina look like on EKG?
A
Inverted U waves; ST segment or T wave abnormalities
23
Q
Tx of Prinzmetal angina
A
Stress test + Myocardial perfusion imaging or coronary angio
Once dx made = CCB + Long acting nitrates used for long term ppx like Amlodipine
24
Q
Sawtooth pattern on EKG
A
Aflutter
25
Heart rate is [**irregularly irregular**](https://youtu.be/wDRr7EgGk_c). **An absence of P waves.** Narrow QRS complex
A. Fib
26
Which type of pt is a.fib most commonly seen in?
Elderly, excessive alcohol use patients
27
What is the atrial rate of a. fluttler
250-350 BPM
28
What type of pt does a.fluttler most likely occur in?
COPD, CHF, ASD, coronary artery disease
29
What is the biggest concern in a pt with afib? What score assesses for this?
Clot/Stroke/DVT
CHADS2/VASc
30
How many points does a pt need to score on CHA2DS2 to qualify for anticoag regimen?
0 = Aspirin
1 = Aspirin or anticoag
2 = Anticoag
31
Which anticoag is used for pts with mechanical heart valves
Warfarin
32
1st degree AV block on EKG
PR interval is longer than 0.20 seconds
Rhythm is regular
33
What medication is contraindicated in any of the heart blocks/heart failure?
**CCB because of the possibility of causing bradycardia and worsening cardiac output**.
34
2nd degree AV block type 1
Wenckebach
PR interval progressively lengthens until beat is dropped
PR gets longer
35
2nd degree AV block mobitz 2
P waves without QRS
36
Tx of 2nd degree Mobitz 2 block
Pacemaker
37
3rd degree AV block
P-P = Constant and the R-R is constant; Relationship between PR is erratic
38
3rd degree AV block tx
Pacemaker
39
**You see regular P waves and regular QRS complexes, but they do not seem to have any correlation to each other. What is the diagnosis?**
3rd degree block
40
Sx of AV block
Depends on severity; MC = As the electrical signal that controls one's heartbeat is partially or completely blocked the **heart beats slowly** or **skip beats** and can't pump blood effectively. Symptoms include **dizziness**, **fainting**, **fatigue**, and **shortness of breath**
41
MCC of AV blocks
* Idiopathic fibrosis and sclerosis of the conduction system (about 50% of patients)
* Ischemic heart disease (40%)
42
Stable vs unstable patient, what is the tx of AV block
Stable = Most likely benign; no tx
Unstable = Pacemaker
43
A 12-lead ECG showed sinus rhythm, rate 60, with an **R and R’ (upward bunny ears) in V4-V6**
Left bundle branch block
44
**QRS looks like W in V1 and M in V6 it is LBBB (WiLLiaM)**
**Left BBB -**
45
New LBBB + Chest Pain =
MI until proven otherwise
46
**R and R’ (upward bunny ears) in V1-V3**
Right bundle branch block
47
MCC of bundle branch blocks
In most cases, bundle branch block is caused by **fibrosis** or scarring, that either occurs **acutely** or **chronically**
* **Acute causes** can be things like **ischemia**, **heart attack**, or **myocarditis**
* **Chronic conditions** include **hypertension**, **coronary artery disease**, and **cardiomyopathies**
48
**An RSR prime in leads V5 or V6 should make you think of what diagnosis?**
Left bundle
49
**Which finding requires immediate attention: left bundle branch block or right bundle branch block?**
New left bundle branch block is a STEMI equivalent. Right bundle branch block is usually not a problem.
50
Tx of bundle branch blocks
**No specific treatment is indicated**
* If there's an underlying condition, such as heart disease, that condition needs treatment
* In patients with heart failure, a pacemaker also can relieve symptoms as well as prevent death
51
bnormal heart rhythm that occurs when a short circuit rhythm develops in the upper chamber of the heart **in patients who have no other types of structural heart disease**
**Paroxysmal supraventricular tachycardia (PSVT)**
52
What are the 3 causes of SVT?
AVNRT = AV nodal reentrant tachy
Wolff-Parkinson White
Atrial tachy
53
Hallmark sx of PSVT
* A regular but **racing heartbeat** of 120 to 230 beats per minute that starts and stops abruptly
* Palpitations, dizziness or lightheadedness, syncope, chest pain, weakness of fatigue
54
MC type of SVT
**Atrioventricular nodal reentrant tachycardia (AVNRT)** is the most common type of supraventricular tachycardia and occurs when a [**small extra pathway exists in or near the AV node**](http://washingtonhra.com/wp-content/uploads/2015/05/AVNRT-animation.gif)
55
MCC of Wolff-parkinson white
1. **Wolff-Parkinson-White (WPW) syndrome** is caused by the presence of an abnormal [**accessory electrical conduction pathway between the atria and the ventricles**](https://healthjade.net/wp-content/uploads/2018/02/Wolff-Parkinson-White-syndrome-1.jpg) (Bundle of Kent fibers). Hallmarks on EKG include a shortened PR interval, **widened QRS, and delta waves**
56
Atrial tachycardia is a type of SVT, but only occurs in 5%, why does this happen
1. is responsible for about 5 percent of PSVTs. It occurs when an electrical impulse fires rapidly [**from a site outside the sinus node**](https://www.unm.edu/~lkravitz/Extras7/AtrialTachycardia.gif) and circles the atria, often due to a short circuit.
57
Hallmarks of Wolff-parkinson white on EKG
hallmarks on EKG include a shortened PR interval, **widened QRS, and delta waves.**
58
How are PSVT most likely diagnosed?
Holter monitor to “catch” episodes while pt is symptomatic
59
Tx of PSVT
**Try vagal maneuvers: carotid massage** and Valsalva for stable patients
* **Adenosine** for symptomatic patients
* beta-blocker/calcium channel blocker (if regular)
* Definitive treatment: **Radiofrequency ablation**
* **WPW** - **do not** administer **adenosine** or **calcium channel blockers**
60
How is Adenosine dosed for psvt?
The initial dose of adenosine in treating acute PSVT is **6 mg given by rapid i.v. bolus injection, followed in one to two minutes by up to two additional 12-mg boluses if necessary**.
Adenosine has been found to be effective in terminating PSVT and thus offers an alternative to verapamil
61
How does Adenosine work for PSVT?
**It acts on receptors in the cardiac AV node, significantly slowing conduction time**
62
What are the 3 types of premature beats?
Three types: Premature atrial (PACs), ventricular (PVCs), and junctional (PJCs) contractions
63
What type of premature beat is this: **Early wide “bizarre” QRS, no p wave seen**
PVC= Premature ventricular contraciton
64
What type of permature beat is this: **Early, abnormally shaped P wave**
Premature atrial contraction
65
What type of premature beat is this:**Early, narrow QRS complex, usually measured at 0.10 sec or less, no p wave or inverted p wave**
Premature junctional contraction
These arise from the region of the AV node, so the ventricles are usually activated normally.
66
Which premature beat is MC in pts with COPD
PAC
67
Dx of premature beats
EKG, holter monitor testing, exercise stress testing, echo
68
Tx of premature beats
None or **beta-blockers**/**calcium channel blockers** if symptomatic
* **PAC:** Usually benign, provide reassurance if symptomatic treat with beta-blockers or calcium channel blockers
* **PVC:** If symptomatic, look for cause and treat with calcium channel blockers/beta-blockers first then consider radiofrequency catheter ablation
* **PJC:** Treatment only if greater than ten per minute or they are multifocal – can use lidocaine or an antiarrhythmic
69
What causes torsades?
* Etiology: QT prolongation may occur secondary to multiple drug effects, electrolyte abnormalities and medical conditions; these may combine to produce TdP
* Drug-induced long QT can be remembered by the mnemonic (ABCDE):
* Anti**A**rrhythmics (class IA, III)
* Anti**B**iotics (e.g., macrolides)
* Anti"**C**"ychotics (e.g., haloperidol)
* Anti**D**epressants (e.g., TCAs)
* Anti**E**metics (e.g., ondansetron)
70
Torsades may cease spontaneously or
* This arrhythmia may cease spontaneously or degenerate into [**ventricular fibrillation**](https://smartypance.com/lessons/conduction-disorders/ventricular-fibrillation/)
71
Tx of torsades
* Treatment is with **IV magnesium** and measures to shorten the QT interval
72
Hemodynamically unstable pt with torsades, what is the tx
Unsynchronized cardioversion
73
**uncoordinated quivering of the ventricle with no useful contractions**
Ventricular fibriation
74
* Presentation: Unstable patient
* EKG: No discernible heart contractions
Vfib
75
What is the tx of V.Fib
Treat with **unsynchronized** **cardioversion**
* **Unsynchronized cardioversion** - start CPR
* **Give 3 sequential shocks** (120, 150, 180); assess rhythm
* If VF persists --\> **do CPR and intubate**
* **Administer two doses amiodarone 2-4 min.** Administer 1 mg IV bolus epi every 3-5 minutes (will ↑ myocardial blood flow and ↓ cerebral blood flow and ↓ defib threshold)
Implantable cardioverter-defibrillator may be necessary
76
**three or more consecutive ventricular premature beats**
V. tachycardiac
77
VT is frequently a complication of
Acute MI or Dilated cardiomyopathy
78
**Unstable patients with monomorphic VT** should be immediately treated with
**synchronized direct current (DC) cardioversion**, usually at a starting energy dose of 100 J (compare this to ventricular fibrillation which is treated with non-synchronized cardioversion)
79
Tx of V. tach
**Stable:** Stable patients have adequate vital end-organ perfusion and thus do not experience signs or symptoms of hemodynamic compromise
* Treat with **amiodarone** → lidocaine → procainamide (in this order)
* **Unstable:** Unstable patients have signs or symptoms of **insufficient oxygen delivery** to vital organs because of the tachycardia. Such manifestations may include **chest pain, dyspnea, hypotension,** and **altered level of consciousness**
* Unstable patients with monomorphic VT should be immediately treated with **synchronized direct current (DC) cardioversion,** usually at a starting energy **dose of 100 J**
* **Unstable polymorphic VT** is treated with **immediate defibrillation.** The defibrillator may have difficulty recognizing the varying QRS complexes; therefore, synchronization of shocks may not occur.
80
A buildup of **fluid between** the **pericardial sac** and the **heart;** constricts the heart
Cardiac tamponade
81
Pathophys behind cardiac tamponade
* Heart unable to pump normally → blood flow through chambers obstructed → cardiac output decreases → hypotension → lower tissue perfusion → heart rate increases
82
MCC of cardiac tamponade
* **Acute onset:** trauma, myocardial infarction, aortic dissection, pericardial effusion
* **Slow onset:** cancer, chronic inflammation, uremic pericarditis, hypothyroidism, connective tissue disease
83
Becks triad
**The 3 D's: D** istant heart sounds**, D** istended jugular veins**,** and **D** ecreased arterial pressure
**Beck’s triad:**
1. Hypotension
2. muffled heart sounds
3. elevated neck veins (JVD)
84
What is pulsus pardoxus
(drop 10 mmHg in systolic pressure on inspiration), narrow pulse pressure) Commonly seen in → Cardiac tamponade
85
consecutive, normally-conducted QRS complexes alternate in height) and **low voltage QRS complex**
Electrical alternans → Seen in cardiac tamponade
Also pulsus paradoxus
86
What is the CXR finding in cardiac tamponade
Water bottle heart = Huge enlarged water filled heart
87
Tx of cardiac tamponade
Pericardiocentesis
88
5 causes of acute chest pain in ED
* [**Pericarditis**](https://smartypance.com/lessons/forms-heart-disease/acute-pericarditis/): chest pain that is **relieved by sitting and/or leaning forward**
* **ACS:** chest pain with shortness of breath, with possible radiation to the neck, jaw, arms, shoulders, and back
* [**Pulmonary embolism**](https://smartypance.com/lessons/pulmonary-circulation/pulmonary-embolism/): dyspnea (most common) and **pleuritic chest pain**. Spiral CT is the best initial test
* [**Pneumothorax**](https://smartypance.com/lessons/pleural-diseases/pneumothorax-reeldx/)**:** ipsilateral chest pain and dyspnea with decreased tactile fremitus, **deviated trachea, hyperresonance, diminished breath sounds**
* [**Thoracic aneurysm/dissection**](https://smartypance.com/lessons/vascular-disease/aortic-aneurysmdissection/)**:** severe, **tearing** (ripping, knife-like) chest pain **radiating to the back**
89
myocardial necrosis (evidenced by cardiac markers in the blood; **troponin I** or **troponin T** and **CK** will be elevated) **WITHOUT** acute **ST-segment elevation** or **Q waves**
NSTEMI
90
Tx of NSTEMI
TX: Beta Blockers + NTG + aspirin and clopidogrel + heparin + ACEI + statins + reperfusion
* **Reperfusion** via percutaneous coronary intervention (not thrombolysis)
* Less time-sensitive than in STEMI
91
STEMI =COMPLETE BLOCK OF
**St-segment elevated M**I is myocardial necrosis (evidenced by cardiac markers in the blood; **troponin I** or **troponin T** and **CK** will be elevated) **WITH** acute **ST-segment elevation** or **Q waves**
* **Coronary artery completely blocked; full thickness of myocardial wall involved**
92
I, AVL, and V2 to V6 in EKG STEMI =
Anterior wall
93
ST elevation in the lateral leads (I, aVL, V5-6). Reciprocal ST depression in the inferior leads (III and aVF).
Lateral wall MI
94
ST depressions in V1 to V3
Posterior wall MI
95
Tx of STEMI
TX: Beta Blockers + NTG + aspirin and clopidogrel + heparin + ACEI + statins + reperfusion
* **Aspirin** and **Clopidogrel** are given at once
* Very time sensitive - Immediate **(within 90 minutes)** coronary angiography and primary PCI
* **Thrombolytic therapy** within the **first 3 hours** if **PCI not available**
96
**Absolute contraindications for fibrinolytic use in STEMI include the following:**
* Prior intracranial hemorrhage (ICH)
* Known structural cerebral vascular lesion.
* Known malignant intracranial neoplasm.
* Ischemic stroke within 3 months.
* Suspected aortic dissection.
* Active bleeding or bleeding diathesis (excluding menses)
97
Dyspnea on exertion in the ER should make you think of two areas ⇒ the **cardiac** and **pulmonary systems**
**Cardiac system:**
* Coronary heart disease
* Heart failure
* Myocarditis
* Pericarditis
* MI
* ACS
**Pulmonary system:**
* Asthma
* COPD
* Pneumonia
* Pulmonary Hypertension
* Obesity, kyphosis, scoliosis (restrictive lung disease)
* Interstitial lung disease
* Drugs (e.g., methotrexate, amiodarone) or radiation therapy, cancer
* Psychogenic causes
98
What is the pathophysiology behind dyspnea on exertion for Heart, lungs, Blood
HEART → **not pumping blood out to the lungs during exertion causing shortness of breath**
LUNGS → **not functioning properly and dyspnea on exertion is because the lungs cant exchange oxygen**
Blood → **Anemia is also another cause of shortness of breath usually a chronic problem and can be easily worked up with routine blood work (CBC)**
99
Main causes of edema seen in ED
* **In other words, when patients in the ER have edema either the heart is failing as a pump (CHF) or the fluid is backing up such as with kidney or liver disease**
* Always remember medications such as calcium channel blockers and Alpha-1 blockers vasodilate the vessels making the fluid come out and will go down to the feet due to gravity
100
Main sx of heart failure
* **Exertional dyspnea (SOB)**, then with **rest**
* Chronic nonproductive cough, worse in a recumbent position
* Fatigue
* **Orthopnea (late)**, night cough, relieved by sitting up or sleeping with additional pillows
* Paroxysmal nocturnal dyspnea
* Nocturia
101
Physical exam findings of heart failure
* Cheyne-Stokes breathing - periodic, cyclic respiration
* **Edema**: ankles, pretibial (cardinal)
* Rales (crackles)
* **S4** = diastolic HF (**ejection fraction is usually normal**)
* **S3** = Systolic HF (reduced EF) with volume overload - tachycardia, tachypnea. **(Rapid ventricular filling during early diastole is the mechanism responsible for the S3)**
* Jugular venous pressure: \>8 cm
* Cold extremities, cyanosis
* Hepatomegaly Ascites, jaundice, peripheral edema
102
CXR finding in heart failure
Kerley B lines
103
Best test for dx heart failure
**Echocardiogram (BEST TEST):** diagnose, evaluate, manage Most useful, differentiates HF ± preserved LV diastolic function
104
New York Heart failure Classification
* **Class I** (\< 5%) **without any limitation** of physical activity
* **Class II** (10-15%): Patients with **slight limitation** of physical activity, they are **comfortable at rest**
* **Class III** (20-25%): Patients with **marked limitation** of physical activity they are **comfortable at rest**
* **Class IV** (35 - 40 %): Patients who are not only **unable to carry on any physical activity** without discomfort but who also have symptoms of heart failure or **anginal syndrome even at rest**
105
Tx of systolic vs diastolic heart failure
**Systolic left heart failure:** Ace Inhibitor + β-blocker + **Loop Diuretic**
**Diastolic heart failure:** Ace inhibitor + β-blocker or CCB (do not use diuretics in stable chronic diastolic failure)
* **Lasix**—for diuresis
* Morphine—reduces preload
* Nitrates (NTG)—reduce preload O2
* **ACE inhibitor** + diuretic (unless contraindicated)
* CCB in diastolic HF
* Poor prognosis factors: chronic kidney disease, diabetes, lower LVEF, severe symptoms, old age
* 5-y mortality: 50%
106
* BP usually **\>180/120 WITH** impending or progressing **end-organ damage**
HTN Emergency
107
HTN Urgency
* BP usually **\> 180/120** **WITHOUT** signs of **end-organ damage**
108
Tx of HTN urgency vs emergency
* Hypertensive emergency = **sodium nitroprusside (drug of choice)**
* Hypertensive urgency **= clonidine (drug of choice)**
109
MCC of cardiogenic shock
Common causes: [**acute MI**](https://smartypance.com/lessons/coronary-heart-disease/acute-myocardial-infarction/), [**heart failure**](https://smartypance.com/lessons/heart-failure-reeldx408/), [**cardiac tamponade**](https://smartypance.com/lessons/forms-heart-disease/cardiac-tamponade/)
110
Tx of cardiogenic shock
* Treatment: Fluid resuscitation, pressors (dopamine), and treat the underlying cause
111
**Drop of \> 20 mm Hg systolic, 10 mmHg diastolic, 15 BPM increase in pulse** 2-5 minutes after a **change** from **supine** to **standing**
Orthostatic hypotension
112
Cardiac vs pulmonary causes of orthopnea
Cardiac causes:
* [**CHF**](https://smartypance.com/lessons/heart-failure-reeldx408/)
* [**MI**](https://smartypance.com/lessons/coronary-heart-disease/acute-myocardial-infarction/)
* [**Arrhythmias (atrial fibrillation)**](https://smartypance.com/lessons/conduction-disorders/)
Pulmonary causes
* [**COPD**](https://smartypance.com/lessons/obstructive-pulmonary-diesase/chronic-bronchitis-reeldx264/) and [**cor pulmonale**](https://smartypance.com/lessons/pulmonary-circulation/cor-pulmonale/)
* [**Pulmonary hypertension**](https://smartypance.com/lessons/pulmonary-circulation/pulmonary-hypertension/)
* Indirect causes such as [**kidney failure**](https://smartypance.com/lessons/renal-diseases/) and [**liver failure**](https://smartypance.com/lessons/liver-disorders/cirrhosis-reeldx516/) (will cause fluid back up into the lungs)
113
Pathophys behind pulmonary vs cardiac causes of orthopnea
Heart = **fluid is in the pulmonary space either by the heart not pumping or failing as a pump (CHF) or the heart is injured (MI).**
Lungs **= Pulmonary causes mean the lungs are failing to move the blood so the fluid leaks out. Causes like pulmonary hypertension and COPD (secondary cause of pulmonary hypertension)**
114
**Same symptoms as acute pericarditis** except patient will now have signs of fluid buildup around the heart which include **low voltage QRS complexes, electrical alternans, distant heart sounds** and an echocardiogram showing a collection of pericardial fluid
Pericardial effusion
115
**Intermittent claudication, Ankle-brachial-index (ABI) \< 0.9**
Peripheral vascular dz
116
Sx of Peripheral vascular dz
* **Lower extremity loss of hair**, brittle nails, pallor, cyanosis, claudication, hypothermia
* Ulcers are pale to black, well-circumscribed and painful, located laterally and distally
117
Gold std for dx of peripheral vascular dz
Ateriography
118
Tx of peripheral vascular dz
* Definitive treatment: Arterial bypass
* Medical treatment: Antiplatelets, anti lipids, manage risk factors, cilostazol Aspirin, and Plavix
119
**Transient loss of consciousness/postural tone** secondary to an **acute decrease in cerebral blood flow**
Syncope
120
**Harsh** systolic ejection crescendo-decrescendo murmur at the **right upper sternal border (aortic area)** with **radiation to the neck and apex** heard best by **leaning forward with expiration**
Aortic stenosis
121
Soft, early **diastolic blowing murmur** along the left sternal border with the patient sitting leaning forward after exhaling
Aortic regurge
122
**Diastolic** low pitched decrescendo **rumbling** murmur with **opening snap** heard best at the **apex (mitral area)** with the patient in **the lateral decubitus position**
Mitral stenosis
123
**Holosystolic high-pitched blowing** murmur at the **apex (mitral area)** that **radiates to axilla** with a split S2
Mitral regurge
124
Flank pain, hypotension, **pulsatile abdominal mass**
Abdominal aortic aneurysm
125
Tx of AAA
* Surgical repair if \> 5.5 cm or expands \> 0.6 cm per year
* Monitor annually if \> 3 cm. Monitor every 6 months if \> 4 cm
* Beta-blockers
126
**sudden arterial occlusion**
**Remember** the **P's of arterial emboli:** **P** ain, **P** allor, **P** ulselessness, **P** aresthesia, **P** aralysis, **P** oikilothermia
Arterial embolis or thrombolism
127
Gold std tx of arterial embolism/thrombolism
Angiography
128
Tx of acute arterial occlusion
* Treat with IV heparin if not limb-threatening then **call the vascular surgeon for angioplasty, graft or endarterectomy**
129
Why does phlebitis occur
Spontaneous or after trauma, or IV/PICC lines
130
Tx of phlebitis/thrombophlebiits
* Treatment: Symptomatic: NSAIDs, warm compress
131
**three different atrial ectopic foci (at least 3 different P wave)** depolarize to pace the heart
**MAT**
**_Multifocal Atrial Tachycardia_**
* Associated with older patients and those with COPD
* Rate will be 100–200 beats/min
* PR interval will differ
* Notable feature: **at least three different P wave forms**
* Treatment is to treat the underlying cause, calcium channel blockers
132
What is the name for an occasional contraction generated from a single ectopic atrial focus?
Premature atrial contraction
133
Which med is contraindicated in right ventricular infarct
**Nitroglycerin →** which is commonly used in acute myocardial for its preload and afterload reducing effects, should not be used in right ventricular infarction because it can precipitate critical hypotension and cardiovascular collapse.
134
Anterior & Septal leads for ECG
V1-V4 = LAD
135
Inferior leads of ECG what artery
Right coronary artery 70%
136
Which leads are lateral leads of ECG?
I, avL, V5-V6
AVL → L= LATERAL
137
Tx of afib
* Treatment
* Unstable: cardioversion
* Stable: rate control is mainstay (**diltiazem**, metoprolol)
* \> **48 hours**: anticoagulate for 21 days prior to cardioversion
* Determine the need for anticoagulation by using **CHA2DS2-VASc** score
138
**S4 gallop** and a **harsh (as opposed to soft blowing) systolic murmur loudest in early or mid**-**systole**, **best heard at the apex, and diminishing before S2**
Mitral regurg
* PE
* Acute: unique, harsh, **midsystolic** murmur **best heard at apex** that **radiates to the** **base** rather than the axilla
* Chronic**: blowing holosystolic** murmur **best heard at apex** with **radiation to axilla**
