Flashcards in CARDIOLOGY Deck (122)
Late diastolic murmur with an opening snap (no change with inspiration)
Systolic murmur heard best in the second right IC space
Systolic murmur heard best in the second left IC space
Late systolic murmur best heard at the apex
Diastolic murmur with a widened pulse pressure
Holosystolic murmur that is louder wit inspiration at the left lower sternum
Holosystolic murmur heard at the apex and radiates to the axilla
When do PVCs become concerning for development of other ventricular arrhythmias?
Anti-arrhythmic commonly used in Vtach?
Lidocaine or tocainamide, type IB.
Causes of sytstolic dysfunction
Caused by decreased contractility, increased preload, increased after load, HR abnormalities, or high output conditions such as anemia, hyperthyroidism
Causes of diastolic dysfuntion
Hypertrophy or restrictive cardiomyopathy.
Chronic constrictive pericarditis is most commonly caused by?
Radiation, heart surgery
Pathophys of Brugada Syndrome
Mutation in the gene that encodes for sodium ion channel in the cell membranes of the myocytes. Loss-of-function mutations in this gene lead to a loss of the action potential dome of some epicardial areas of the right ventricle. This results in transmural and epicardial dispersion of repolarization. The transmural dispersion underlies ST-segment elevation and the development of a vulnerable window across the ventricular wall, whereas the epicardial dispersion of repolarization facilitates the development of phase 2 reentry, which generates a phase 2 reentrant extrasystole that captures the vulnerable window to precipitate ventricular tachycardia and/or fibrillation that often results in sudden cardiac death.
Genetics of Brugada syndrome
AD, more common in males and higher prevalence in Asians
ECG of Brugada syndrome
Persistent ST elevations in V1-V3 with right BBB with or without terminal S waves. Prolongation of PR interval is also sometimes seen.
Why is there an elevated pulse pressure in aortic regurg:
Due to insufficiency of aorta, blood flows back into LA, lowering DBP. This widens the pulse pressure.
Treatment of AR
Decrease after load with a vasodilator like an ACE-I or CCB like nifedipine.
High levels of what are associated with 3x risk of atherosclerosis
Unique symptoms of inferior wall MI
Bradycardia, diarrhea, lightheadedness.
Inferior wall MI is caused by infarction of posterior descending artery. The supply of PDA is posterior (duh) heart, and when this is irritated, it irritates the surrounding structures which happen to include the left vagus nerve. This is why you see vagal sx.
Pt is in vtach and pulseless
Non-synchronized CVN / defibrillation
Arrhythmia + no pulse.
Pt has PEA or asystole
Give 1 mg of IV epi during CPR.
NYHA Class I CHF
HF with no limitations on physical activity and no symptoms, even with exertion
NYHA Class II CHF
Slight limitations on physical activity and symptoms of heart failure with physical activity.
NHA Class III CHF
Symptoms such as angina, SOB and palpitations qitth physical exertion
NYHA Class IV heart failure
sx of heart failure even at rest
what is Heyde's syndrome
Combo of calcific aortic stenosis and GI bleeding due to colonic angiodysplasia. It is thought that aortic stenosis causes type 2 von willebrand syndrome which results in inefficient hemostasis in high flow areas. This results in bleeding from angiodysplastic lesions.
Medical treatment of PAD
Cilostazol to improve flow to LE and decrease claudication. CONTRAINDICATED IN HEART FAILURE.
Second line medical treatment of PAD
Pentoxifylline, also contraindicated in CHF. Ginko biloba. Thats fun.
When are compressing stockings effective in post op prevention of DVT?
In low risk post op general surgery or neurosurgery pts.