Cardiology Flashcards
(115 cards)
1
Q
ECG
A
2
Q
Which leads point in the downward direction?
A
- aVF (straight down, 90 degrees)
- II (60 degrees)
- III (120 degrees)
3
Q
Which lead is at 0 degrees?
A
I
4
Q
What is a normal range for mean axis of depolarization?
A
-30 to 110
5
Q
What is a quick way to know that the axis of depolarization is in the normal range?
A
“Thumbs up sign”
If pt is positive in lead I and positive in aVF, they are in normal range (0-90)
6
Q
What part of electrical conduction of the heart does the P wave represent?
A
Atrial depolarization
7
Q
What part of electrical conduction of the heart does the QRS complex represent?
A
Ventricular depolarization
8
Q
What part of electrical conduction of the heart does the T wave represent?
A
Ventricular repolarization
9
Q
If lead I is isoelectric, which lead do you look at to determine direction of the axis of depolarization?
A
aVF
- If (+), axis is +90
- If (-), axis is -90
10
Q
If lead II is isoelectric, which lead do you look at to determine direction of the axis of depolarization?
A
aVL
- If (+), it is -30
- If (-), it is +150
11
Q
If lead aVF is isoelectric, which lead do you look at to determine direction of the axis of depolarization?
A
Lead I
- If (+), it is 0
- If (-), it is +180
12
Q
What does a long QT interval indicate?
A
Problems with repolarizing the ventricles
13
Q
How is heart rate calculated?
A
Find an R wave which peaks on a heavy line – the next heavy black line is 300, followed by 150, 100, 75, 60 and 50
14
Q
In normal sinus rhythms, the P wave is upright in which leads?
A
Leads I and II
15
Q
What does the PR interval indicate?
A
Time it takes for stimulus to travel from the SA node to the ventricles
16
Q
What does an inverted T wave represent?
A
Ischemia
17
Q
How is the QT interval affected by LV hypertrophy?
A
Lengthened
18
Q
How is the QT interval affected by digitalis?
A
Shortened
19
Q
How is the QT interval affected by hypokalemia?
A
Lengthened
20
Q
How is the QT interval affected by MI?
A
Lengthened
21
Q
How is the QT interval affected by Hypercalcemia?
A
Shortened
22
Q
How is the QT interval affected by myocarditis?
A
Lengthened
23
Q
How is the QT interval affected by thyrocosis?
A
Shortened
24
Q
How is the QRS complex affected by AV node escape rhythm?
A
Narrowed
25
How is the QRS complex affected by ventricular escape rhythm?
Widened
depolarization wave spreads slowly via abnormal pathway in the ventricular myocardium and not via the His bundle and bundle branches
26
What is the inherent HR of the following?
* Atria
* AV node
* Ventricles
* Atria: 75/min
* AV node: 60/min
* Ventricles: 30-40/min
27
What do you look for on an ECG to determine whether the patient has heart block?
Whether every P wave is followed by QRS
Yes =\> No heart block
28
What do you look for on an ECG to determine whether the patient has ischemia?
Inverted T wave
29
Diagnose:
Sinus bradycardia
* Sinus rhythm
* HR = 45
30
What are the characteristics of 1st degree heart block?
* P is followed by QRS
* PR interval is more than a box away (\>250ms)
31
What are the characteristics of 2nd degree heart block type I?
PR prolongation but just drops a beat out of no where
32
What are the characteristics of 2nd degree heart block type II?
PR interval is the same before and after the block
(block is below the His-purkinje system)
33
What are the characteristics of 3rd degree heart block?
* QRS complexes are going at their own rate
* don’t always see a p wave at end b/c it is superimposed on QRS
34
What are the characteristics of a 2:1 AV block?
Pattern: P, QRS, P, (skip), P, QRS, P, (skip)
35
What are the characteristics of atrial fibrillation?
* Ventricular rate is irregularly irregular, no discernable P waves
* upper chambers are just quivering
* see slide 88
36
What are the characteristics of atrial flutter?
* Fast, but it is a circuit in the atrium going about 300 bpm
* See a saw-tooth pattern
37
Determining L from R bundle branch block
* Bundle branch block
* Widened QRS
* L or R?
* Look at lead V1
* Look at last part of QRS
* If most energy is above the isoelectric line =\> Right
* If most energy is below the line =\> Left
* \*\*\*Think of a turn signal
* Reference: ekg.academy
38
What are the characteristics of acute ischemia? How can you tell if it affects the anterior heart or the inferior heart?
* Acute ischemia:
* ST elevation
* Anterior heart
* Leads V2, V3
* Inferior heart
* Leads II, III, aVF
39
What are the characteristics of an old infarct?
Significant Q wave
* wider than 1 mm or
* length 1/3 QRS amplitude
40
What are the characteristics of ischemia?
* T wave inversion
* ST interval depression
* See slide 103
41
What are the characteristics of pericarditis?
* Diffuse ST elevation (everywhere)
* PR depression
* They will have a rub that is worse when they lean forward
42
Intro to CHF
43
Decreased perfusion to the kidney activates what system? What is the result?
* Activates Renin - Angiotensin - Aldosterone system
* Result:
* Na and water retention
* Vasoconstriction
44
What is abnormal about the beta receptors in CHF?
* Downregulate themselves
* not as affected by NE (doesn't permit vasodilation for example)
45
What is the effect of the SNS in CHF?
* Increases afterload
* Increases HR
* Impairs contractility
* Increases O2 demand of the heart
* provokes ischemia
* Triggers arrhythmia
* Ca overload and apoptosis
46
What electrical abnormalities can be present in CHF?
* A-V **dysynchrony**
* **Abnormal** impulse **propagation** in the ventricules
* Atrial or ventricular **arrhythmias**
47
What can cause high-output CHF?
* Thyrotoxicosis
* Beri beri
* A-V fistula
48
What are the physical signs of Right sided CHF?
1. JVD
2. Tricuspid regurg
3. Peripheral edema
4. S3 gallop
5. Hepatojugular reflex
* pushing on liver makes jugular distention increase
49
What are the physical signs of Left sided CHF?
* Rales (crackles)
* Mitral regurg
* Pulmonary congestion
* S3 gallop
* early diastolic sound
* Abnormal apical impulse
50
What are the symptoms of CHF?
* Dyspnea
* Orthopnea
* Parosysmal nocturnal dyspnea
* Cheyne-stokes respiration
* breathing pattern with apnea and hyperventilation
* Nocturia
51
What is most important for diagnosis of CHF?
Thorough H&P
52
What are some causes of CHF?
* CAD (Most common)
* Valvular disease
* Congenital disease
* Tachycardia
* Chagas
* Toxins:
* ETOH
* Cocaine
* Adriamycin
53
What toxins can result in CHF?
* EtOH
* Cocaine
* Adriamycin
54
Should CHF patients be on ACE inhibitors?
Yes
55
What is the MOA of Beta-blockers in CHF?
* Improve relaxation
* Protect myocardium from catecholamines
* Negative chronotrope
* Decrease O2 demand
* Increase beta-receptor density
56
What response do natriuretic peptides cause in the body?
Na and H2O diuresis
| (counter the RAAS system)
57
Shock
58
Patient has mild hypotension, tachycardia, and tachypnea. There is also an increase in the anion gap. In what stage of shock is the patient? How effective is treatment?
* Stage I
* Compensated
* Treatment is most effective in this stage
59
Patient appears cool, cyanotic, and diaphoretic. He has hypotension, tachycardia, and tachypnea. He also has a decrease in urine output. In what stage of shock is the patient? How effective is treatment?
* Stage II
* Compesatory mechanisms begin to break down
* Aggressive therapy can reverse changes
60
Patient is found to have hypotension, tachycardia, and tachypnea. There are also signs of end organ damage and DIC. In what stage of shock is the patient? How effective is treatment?
* Stage III
* Irreversible
* Therapy is not effective
61
What is the cause of acidosis in shock? What problems result? What are the corrective measures?
* Cause:
* anaerobic metabolism
* Toxins
* Result:
* alters oxy-hemoglobin dissociation
* Hypoxia worsens
* Corrective measures:
* Add buffer (NaHCO3)
* Correct respiratory component
62
What type of shock is characterized by a low CO and a high SVR? What is the cause?
* Cardiogenic shock
* Cause: cardiomyopathy
* Volume replacement makes worse
* Hypovolemia
* hemorrhage
* dehydration
* fluid loss due to injury or burns
* Volume replacement makes better
63
What type of shock is characterized by a decreased SVR and a CO that may be normal, high, or low?
Septic Shock
64
Patient has a low CO and a high SVR. Volume replacement worsens the problem. Which type of shock is this?
Cardiogenic shock
65
Patient has alow CO and a high SVR. Volume replacement fixes the problem. Which type of shock is this?
Hypovolemia
66
When can pressor support be used in the treatment of shock?
Only once hypovolemia is corrected
67
Pulmonary Hypertension
68
What is the effect of an increase in length of the vessel on vascular resistance?
Resistance will increase proportionately
69
What is the effect of an increase in viscosity of blood on vascular resistance?
Resistance will increase proportionately
70
What is the effect of an increase in radius of the vessel on vascular resistance?
The resistance will decrease (by a power of 4)
Ex: radius increases by a factor of 2, resistance will decrease by a factor of 16
71
In pulmonary HTN, how is the intima and media changed?
* Intima:
* hyperplasia
* Media
* Hypertrophy
* Also interstitial fibrosis occurs
72
What is Eisenmenger's Syndrome? What is the result?
* Eisenmenger Syndrome
* A previously L =\> R shunt changes to a R =\> L shunt
* often due to increased pulm pressure from overload and damage
* Result
* Fatal (lack of oxygenation)
73
What is the result of Cor Pulmonale?
RV failure
74
In pulmonary HTN, how is JVP affected?
* Large a wave
* Prominent v-wave
75
What murmurs are common with Pulm HTN?
* Closely split S2 with loud P2
* PA click and murmur
* RV S3 gallop
76
What changes in the carotid occur with Pulm HTN?
Low volume
| (blood stuck in veins)
77
What laboratory abnormalities can be found in Pulm HTN?
* Polycythemia
* response to hypoxia
* Increased liver function tests
* response to congestion of liver
78
What ECG findings occur in Pulm HTN?
* Right axis deviation
* R atrial abnormalities
* LV hypertrophy
79
How is primary Pulmonary Hypertension diagnosed? What population is most affected? What are the symptoms?
* Diagnosis
* exclusion of other possibilities
* Population
* young women
* Symptoms
* Chest pain
* Loud P2
* Dyspnea on exertion
80
What is the best treatment for Cor Pulmonale?
O2
81
Cardiomyopathy
82
Dilated cardiomyopathy results in dysfunction of what cardiac mechanism?
Contraction
| (systole)
83
What causes dilated cardiomyopathy?
* EtOH
* Cobalt
* Uremia
* Hypocalcemia
* Hypophosphatemia
84
Hypertrophic cardiomyopathy results in dysfunction of what cardiac mechanism?
Filling
| (diastole)
85
What causes hypertrophic cardiomyopathy?
1. Genetics
2. Abnormal sympathetic stimulation
3. Ischemia (coronary artery disease)
4. Collagen abnormality
86
What are the clinical manifestations of hypertrophic cardiomyopathy?
* Dyspnea
* Angina pectoris
* Fatigue
* Syncope
* Palpitations
87
What murmurs can be present with hypertrophic cardiomyopathy?
* S3 gallop
* S4 gallop
* Systolic crescendo - decrescendo murmur
* Systolic thrill
* Mitral regurg (if systolic anterior motion is present)
\*\*\*Best heard at apex
88
Treatment of HCM is focused on trying to change what cardiac characteristics?
* Decrease contractility
* Increase ventricular compliance
* Increase ventricular volume
* Increase systemic arterial pressure
* Increase dimensions of outflow tract
89
What pathophysiological signs are present in restrictive cardiomyopathy? What forms of cardiac dysfunction result?
* Myocardial fibrosis
* Hypertrophy
* Infiltration
This causes:
* Excessively rigid ventricular walls
* Abnormal diastolic function
* impeded ventricular filling
* Abnormal systolic function
90
What are the clinical manifestations of restrictive cardiomyopathy?
* Weakness and fatigue
* Increased central venous pressure
* JVD
* Peripheral edema
* Ascites
* Anascara
* Inspiratory increase in venous pressure
* aka Kussmaul's sign
91
What is Kussmaul's sign?
An inspiratory increase in venous pressure
(present in Restrictive Cardiomyopathy)
92
What causes restrictive cardiomyopathy?
* Amyloidosis
* Sarcoidosis
* Inherited infiltrative diseases
* Endomyocardial disease
93
What are the causes of myocarditis?
* Infectious
* most common is Coxsackie A and B
* Toxic
* Chemical
* Drugs
* Physical Agents
Not more specific than that in ppt
94
A patient has a history of prodromal "flu". Which type of pericarditis is most likely? How can this be confirmed?
* Viral pericarditis
* Cocksackie A or B
* Echovirus
* EBV (mono)
* Confirmation
* Viral titers
95
Patient with pericarditis has been on dialysis. What is the most likely cause of the pericarditis? What complication can result?
* Cause:
* Uremia
* Complication
* Hemodynamic instability
96
What type of MI is most likely to cause pericarditis? How long post-MI is it most likely to occur?
* Type:
* Transmural MI
* Time frame
* 2-3 days post-MI
* May have atrial arrhythmias
97
Which cancers are most likely to cause pericarditis?
* Bronchogenic
* Breast
* Lymphoma
* Leukemia
* Melanoma
98
What symptoms commonly occur with pericarditis?
* Chest pain
* Pleuritic
* Dyspnea
* Fever
99
What findings on physical exam indicate acute pericarditis?
* Friction rub
* Tachycardia
* Increased JVP
* Pulsus paradoxus
* large decrease in systolic BP on inspiration
100
What is the differential diagnosis for the signs and symptoms of Acute Pericarditis?
* Acute MI
* Pneumonia with Pleuritis
* Acute pulmonary embolism
* Chest trauma causing Pneumothorax
* GI disturbance
101
What are the clinical manifestations of Cardiac Tamponade?
* Physical exam:
* Beck's Triad:
* Hypotension
* Elevated venous pressure
* Small, quiet heart
* Pulsus paradoxus
* Tachycardia
* Tachypnea
* History:
* Chest pain
* Dyspnea
102
What is found on ECG for a patient with cardiac tamponade?
* ST elevation (pericarditis)
* Electrical alternans
* alternation of QRS complex amplitude oraxis between beats and a possible wandering base-line
* Low voltage
103
Which part of the heart cycle is affected by constrictive pericarditis?
Diastole
| (Restricted filling of the heart)
104
What are some causes of constrictive pericarditis?
* TB
* Uremia
* Irradiation
* Surgery
* Connective tissue disorders
* Cancer
105
What are the clinical features of Constrictive Pericarditis?
* Diastolic pericardial knock
* Elevated venous pressure
* Edema
* Hepatomegaly
* Ascites
* Elevated jugular venous pressue (Kussmaul's sign)
* Elevated left heart pressure
* Dyspnea
* Cough
* Orthopnea
* Low cardiac output
* Fatigue
106
What are the differences in signs and symptoms between cardiac tamponade and constrictive pericarditis?
107
Congenital Heart Disease
108
Atrial septal defect
* Type of shunt
* Cyanotic?
* Complications
* Murmur
* ECG findings
* Method of diagnosis
* Type of shunt
* L =\> R
* Cyanotic?
* No
* Complications
* Asymptomatic thru mid adult life
* A-fib
* Murmur
* Systolic ejection murmur: upper LSB
* Persisten split of S2
* ECG findings
* RV conduction delay
* Method of diagnosis
* Echo
109
Ventricular Septal Defect
* Type of shunt
* Cyanotic?
* Complications
* Murmur
* ECG findings
* Method of diagnosis
* Type of shunt
* L =\> R
* Cyanotic?
* No
* Complications
* Infective endocarditis
* Heart Failure
* Murmur
* holosystolic murmur at lower LSB and apex
* ECG findings
* LV enlargement
* Method of diagnosis
* Echo and Doppler
110
Patent Ductus Arteriosus
* Type of shunt
* Cyanotic?
* Complications
* Murmur
* Type of shunt
* L =\> R
* Cyanotic?
* No
* Complications
* Infective endocarditis
* LV failure
* Murmur
* Machine murmur
* Bounding pulse
* Wide pulse pressure
*
111
Eisenmenger Syndrome
* Type of shunt
* Cyanotic?
* Type of shunt
* R =\> L
* previously L =\> R, but reversed due to pulm HTN
* Cyanotic?
* Yes
112
Coarctation of the Aorta
* Definition
* Presentation
* Consequences
* Definition
* stenosis of aorta
* No shunt or cyanosis
* Presentation
* Upper body HTN
* Consequences
* Aortic rupture or dissection
* Heart Failure
* Infective endocarditis
* Cerebral hemorrhage
113
Tetrology of Fallot
* Definition
* Presentation
* Definition
* Pulmonary stenosis
* VSD
* Transposed aorta
* RV hypertrophy
* Presentation
* Cyanotic
* Dyspnea
* Squatting
* increases systemic bp to force more blood into pulm circulation
114
Ebstein's Anomaly
* Definition
* Consequences
* Definition
* Abnormal tricuspid valve (displaced into RV)
* Pulm or aortic valve stenosis
* Consequences
* May be asymptomatic until adulthood
* (doesn't describe consequences specifically)
115
Transposition of the Great Vessels
* Consequence
Cyanosis
Must have other defect to serve as a shunt between the sides of the heart
