Cardio exam 3 Flashcards by Grant Oakley

% blockage with angina and unstable angina

UA-90%

A-75%

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Post MI 4-12hr

mottling/necrosis/hemorrhage

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Post MI 12-24hr

Red/blue mottling

pyknosis

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Post MI 1-3 days

Yellow/tan center
neutrophils
loss of striations/nuclei

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Post MI 3-7 days

Phyagocytosis (macrophages), decreasing neutrophils
myofiber disintegration
hyperemic border

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Post MI 7-10 days

Red/tan margin with yellow center

early granulation tissue

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Post MI 10-14 days

Red/gray border
granulation tissue
neovascularization + collagen

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Post MI 2-8 wks

scar

collagen

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Ankle/brachial index

Ankle systolic (higher of the two)/brachial (higher of two)

For peripheral arterial disease

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When to tx carotid stenosis

symptomatic and over 50% occluded or

asymptomatic and over 80% occluded

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3 Criteria for MI dx on EKG

acute ST elevation
significant Q waves
deep, symmetrical inverted T waves

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1st sign of STEMI on EKG

T waves>10mm in precordials

T waves>5mm in limb leads

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Most common MI cause

spontaneous thrombus

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Criteria to use thrombolytics

<6hr since onset (most beneficial)
ST elevation over 1mm
new LBBB
ST depression on V1/V2 with prominent R waves

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Contraindications for thrombolytics

Anything with stroke/ICP

Aortic dissection

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Cause of ischemia in UA and NSTEMI

vasospasm (not a full occlusion)

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Use of CPK cardiac marker

detectable for 2-4 days

good to detect reinfarct

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Absolute contraindications for thrombolytics

UA and NSTEMI and aortic dissection

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Long term med tx to avoid with MI

NSAIDS

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Risks of percutaneous intervention and what would help each

hematoma-stop anticoagulants
pseudoaneurysm- thrombin
acute renal failure-decrease contrast use
embolization- decrease cath manipulation

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Emergency tx for ruptured AAA

avoid over fluid resucitation

surgery ASAP

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Aortic dissection vs AAA tx

AAA do not need confirmation on radiograph

AD needs confirmation before surgery

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Emergency tx for ACS

MONA B

morphine, O2, nitrates, aspirin, Beta blockers

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Use of fibrinolytic therapy

Less than 30 minutes since onset

less than 75 y/o

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PCI therapy timeframe

<90 min from onset

1st manifestion of thrombophlebitis

pulmonary embolism

Lymphangitis sx

painful cutaneous red streaks

Lymphedema types

I-hereditary (milroy disease) | II-obstructive

Cavernous hemangioma assc and risk

von Hippel Lindau disease | risk of rupture (stroke)

Cystic hygroma/cavernous lymphangioma

on neck/axilla of children | can cause deformities

Glomus tumor

very painful under the nails

Port Wine Stain feature and assc

CN V distribution | Sturg-Weber syndrome

Hereditary hemorrhagic telangiectasia sx and assc

multiple aneurysmal telangiectasias | assc with Osler Weber Rendu disease

Bacillary angiomatosis description and assc

red papules with nodules | assc with Bartonella (gram - rod)

Types of Kaposi sarcoma

Chronic- older men, distal LE involvment Lymphadenopathic-African distribution/aggresive lymphadenopathy Transplant assc-from long term immunosuppresion AIDS assc-LN and viscera

Stages of Kaposi sarcoma

Patch-distal LE Plaque-violaceous raised lesions Nodule-neoplastic, slit spaces

Cause of hepatic angiosarcoma

carcinogen exposures: arsenical pesticides/thorotrast/polyvinyl chloride

Hemangiopericytoma location

common LE and retroperitoneum | around capillaries/venules

SA node depolarization spike cause

Ca2+ entering cell (not Na like in myocytes)

Cause of spontaneous depolarization in SA node

funny channels that allow Na to enter cell slowly | more (-) hyperpolarization, the more open and the faster the depolarizationAV Need -60mV to open at minimum

Sx of supraventricular tachycardia

syncope

AV nodal reciprocating tachycardia types

typical- slow is antegrade (short RP interval) | atypical-slow is retrograde (no P wave)

AVNRT on EKG

delta wave (pre-excitation)

Orthodromic v Antidromic AVRT

Ortho-retrograde up accessory | Anti-ant down the accessory (AAA)

Tx for AVRT

ibutilide procainamide flecaninide

COPD associated arrhythmia

multifocal atrial tachycardia

Cause of idiopathic VT

increased cAMP/Ca2+

Arrhymogenic RV dysplasia on EKG

epislon wave

Brugada's Sign

R to S length is 0.10sec

Josephson's sign

notch near low point of S wave

Condition assc with Brugada's and Josephson's sign

ventricular tachycardia

Early afterpolarization result

prolonged QT inteval | can cause Torsades

Cause of delayed afterpolarization

increased intracellular Ca2+

EKG changes for Class I antiarrhythmics

1A-prolonged repolarization (long phase 2) 1B-shortened repolarization (short phase 2) 1C-decreased slope of phase 0

Impact of class I antiarrhythmics

block fast Na channels of phase 0

Class 1A antiarrhythmics

quinidine procainamide disopyramide

Quinidine

class 1A antiarrhythmic strong antimuscarinic can cause cinchonism (tinnitus/vertigo)

Procainamide

calss 1A antiarrhythmic weak antimuscarinic less QT prolongation (less Torsades)

Disopyramide

``` class 1A antiarrhythmic negative inotropic effect ```

Class 1B antiarrhythmics

lidocain mexiletine phenytoin

Phenytoin

tx digoxin induced arrhythmias

Class 1C antiarrhythmics

flecainide propafanone for A fib/SV in healthy pts

Class II antiarrhythmics

beta blockers | decrease mortality

Class III antiarrhythmics

``` block K+ current amiodarone sotalol bretylium tosylate dofetilide ```

Amiodarone

``` 1st line for emergency VT less proarrhythmic blocks K+ rectifier current and some Na+ channels causes peripheral vasodilation long t1/2 ```

Side effects of amiodarone

pulmonary fibrosis hyper/hypothyroidism corneal deposits

Sotalol

inhibits K+ currents can cause Torsades inhibits conduction of bypass tracts

Bretylium tosylate

IV for emergency VT/V fib | decreases NE release

Dofetilide

selective K+ blocker for A fib/A flutter can cause Torsades

Class IV antiarrhythmics

verapamil diltiazem block Ca2+ currents

Adenosine

short t1/2 hyperpolarizes with K+ rectifier activation for PSVT

Digoxin

for CHF with A fib decreases AV conduction prolongs PR interval

MgSO4

prevents current Torsades

Indications for ICD (internal defibrillator)

``` sx bradycardia HR 3sec (asystole) ```

Pacing codes for ICD

I-chamber placed II-chamber sensed III-mode of response

When is asynchronus pacing used?

surgery

Demand pacing for ICD

inhibited by intrinsic P or R waves

Telangiectasias v reticular v.

Telangiectasias- red | Reticular-blue

Virchow's triad

stasis of blood hypercoagulability vascular damage

Side effect of hydralazine + IDN

Lupus like syndrome

Cardio exam 3 Flashcards

(80 cards)