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Flashcards in Cardiology Deck (33):
1

Hereditary Angioedema

Reccurent. Fm Hx. Autosomal dominant. Presents as edema and GI cramps/diarrhea (edema of bowel). Airway edema dangerous. Caused by low C1 inhibitor (excess classic complement path) and kinins. Check C4.

2

Ebstein Anomaly

Cognenital: septal leaflet of TV is displaced down. Quadruple gallop, T regurg, mid D murmur, RAH, RV underdeveloped. WPW often.

3

Incidence of congenital heart disease

1-2%. 2-6% with affected relative.

4

marfan heart association

aortic and mitral regurgitation. Dilated aorta.

5

JRA

spiking high fevers, spindle shaped swelling of finger joints and sternoclavicualr joint also affected.

6

Treatment of rheumatic fever

steroids and salicylates (help all but chorea).

7

Wolf Parkinson White

Bundle of Kent, D wave. Causes supraventricular tachy (HR >220). short PR interval. Can have ebstein anomaly.

8

Kawasaki Disease

Conjunctivitis, dry lips, oral erythema, strawberry tongue, limb edema, finger peeling, arthritis, adenopathy, increased platelets. Tx: IVIG once and aspirin.

9

Tricuspid Atresia effects and EKG

Cyanotic. RV hypoplasia with resulting left axis deviation (other cyanotic lesions result in high RV pressure and dilation, causing R shift).

10

Transposition of great arteries

Cyanotic. Egg on string xray. RVH and right axis deviation.

11

Tetralogy of Fallot

Cyanosis takes a few days to come on.

12

Mitral Prolapse

often presents in adolescense. OS then apical systolic murmur. Autosomal domiant inheritance sometimes.

13

Marfan

ectopia lentis (subluxationof the ocular lens), progressive dilatation of the aortic root and ascending aorta, aortic aneurysm, excessive height for age, and disproportionately long and thin extremities, with hypermobility and ligamentous laxity.

14

Down's heart defects

30 to 50%. Including endocardial
cushion defect (30%), ventricular septal defect (30%), and tetralogy of Fallot (about 30%).

15

Ideopathic Hypertrophic subaortic Stenosis

aka: hypertrophic cardiomyopathy. Cause of death/arrhythmias in young people. Gene mutation, sometimes inherited. Usually asymptomatic till event.

16

Long QT

Usually presents in late childhood or adolescence with syncope. Palpitations.

16

QTc

QT/root of RR interval. Normal is less than 440 ms.

Causes: cardiomyopathy, hypothyroid, hypothermia, hypoCa, CAD, congenital, drugs, other electrolytes.

18

HR calc

60/RR

19

EKG signs of RVH

right axis deviation and V1 R wave greater than S

20

EKG signs of LVH

V1 S wave with R wave in V5/6 greater than 35mm.
R wave in aVL >11mm
R wave in I > 15mm

21

P wave and enlargments

Best seen in Lead II.
Left atrial enlargment best in V1: greater negative deflection than normal.
Right: initial depolarization is larger than normal.

22

QRS and abnormality classification

Normal = 0.12 or 3 boxes

23

EKG RBB signs

Normal RV depolarization interrupted.
initial depolarization of septum is normal: normal V1 R and V6 Q. Sequence is normal as it goes a bit because first part is overwhelmingly LV. RV though is later, widening QRS - get an abnormal terminal upwave (R').
In V1, this is called rabbit ears.

24

EKG LBB signs

More prominent than RBB.
Normal initial depolarization of septum doesnt occur, causing initial vector to be to the right parts of septum - initial downward spike in V1 and absence of normal q wave in V6.

25

syncope differential

CARDIAC
Obstructive: valvular disease, hypertrophic cardiomyopathy, pulm hypertension, PE, cardiac tamponade, atrial myxoma.
Arrhythmia
Ischemia

Non Cardiac:
Metabolic derangement (hypoNa and HypoGlu)
CNS: stroke, seizure
Peripheral circulation: orthostatic hypotension, hypovolemia, drugs, vasovagal)

26

Orthostatic Hypotension

drop after 3 minutes in standing/sitting of >20mmHg systolic or >10mmHg diastolic.

27

handgrip as clinical maneuver for murmurs

Clench hand 30sec.
Valsalva increases murmur of hypertrophic cardiomyopathy but hand grip decreases it. (systolic)
Decreases murmur of mitral regurgitation (holosytolic)

28

Etiology of tachycardias

1) Supraventricular Tachy: A tachy, A Flutter, A Fib, MAT.
2) Ventricular Tachy: wide QRS
3) Pre-excited Tachycardia: anterograde accessory path (WPW, LGL)

29

Atrial tachycardia

Ectopic focus in atria. Abnormal P wave shape. 100-250 bpm.

30

Atrial flutter

ReEntrant tachy with atrial rates of 250-350 bpm and ventricular rates of 2 or 3:1 (usually around 150bpm)(depends on AV node conduction).

31

Multifocal atrial tachycardia

multiple ectopic foci in atria causing irregular rate. 3 or more p wave shapes. Rate >100 bpm.

32

Diseases that lead to Atrial Fibrillation

hypertension
coronary artery disease
cardiomyopathy
valvular heart disease
hyperthyroidism
Post cardiac surgery, pericarditis, myocarditis
Predisp factors: alcohol, PE, pulm disorders.

33

Mgmt of Atrial fibrillation

Hemodynamically unstable: immediate cardioversion.
Stable: antiarrhythmics like class 1A (procainamide, disopyramide, quinidine), Class 1C (highest potency): propafenone and flecainide or K channel blockers/class III: amiodaraone, sotalol.

Control rate to 60 - 80 bpm: Beta blockers, Ca blockes, or digoxin.