Cardiology Flashcards
(30 cards)
Healthy young person with insidious onset palpitations at rest. ECG shows narrow-complex tachycardia with regular R-R intervals, and may show retrograde P waves
Paroxysmal supraventricular tachycardia. Patient most likely has irregular electrical pathway such as an atrioventricular nodal re-entrant tachycardia. Condition commonly associated with WPW. Vagal maneuvers and adenosine can slow heart rate down to better visualize on ECG. If patient unstable they should undergo urgent synchronized cardioversion (rare), otherwise this is treated non-urgently with ablation of the secondary conduction pathway.
No p waves an irregularly irregular rhythm
a-fib
Initial acute treatment with AV nodal blocker (B-blocker).
Chronic treatment with Amiodorone (slows AV node conduction).
Saw tooth pattern on ECG
a-flutter
Elderly patient with COPD and pulmonary exacerbation with palpitations and tachycardia (atrial rate >100), ECG with irregular rhythm and p waves with 3 or more different morphologies.
Diagnosis?
Multifocal atrial tachycardia
Best treatment is appropriate management of the inciting illness. If electroylte abnormalites are present also treat those if MAT does not resolve (eg, hypokalemia, hypomagnesemia)
What do you need to be aware of for patients on Nitroprusside with decreased renal fxn?
Cyanide toxicity
Nitroprusside is a potent vasodilator that works on both arterial and venous circulation and is used for hypertensive emergency management. It has rapid onset and offset of action. The most important side effect is cyanide accumulation and toxicity.
Sx: skin flushing, confusion, seizures, metabolic acidosis
Patients with chronic renal failure or those receiving a high-dose or prolonged infusion of sodium nitroprusside are at increased risk for cyanide toxicity. As a result, low infusion rates, short-term usage, and close monitoring are recommended. Treatment involves cessation of nitroprusside and administration of sodium thiosulfate.
2 murmurs that decrease with increased left ventricular end diastolic volume (such as with increased preload from squatting or passive leg raising).
Mitral valve regurgitation
HOCM
Most common causes of exertional angina and sudden cardiac death in young people?
HOCM: can see increased voltage in left sided leads and visible hypertrophy on echo
Anamolous coronary artery: the anomalous artery passes between the aorta and the pulmonary artery, making it susceptible to external compression during exercise, also there is often sharp curve to the artery which could limit flow. Diagnosed by CT coronary angiography or coronary magnetic resonance angiography.
CCS - orders for CHF exacerbation with pulmonary edema?
oxygen, furosemide, nitrates and morphine
CXR, ECG, oximeter, echo
ICU
*if no response to preload reduction: positive inotropic agents (increase force of contraction; Dobutamine, Milrinone, Inamrinone)
Chronic management of CHF
Systolic dysfxn (decreased EF): *Beta blocker (Metoprolol, Carvedilol, bisopropolol) *ACE-I/ARB *Spironolactone Diuretics Digoxin - decreases symptoms but no mortalily Hydralazine/nitrates Sacubitril with valsartan -If, EF <35% recommend ICD
Diastolic dysfxn (nl EF):
- Beta blocker
- Diuretics
*decrease mortality
Patients with regular, narrow complex tachycardia should be initially managed with….
Vagal maneuvers or adenosine
atients with persistent tachyarrhythmia (narrow or wide complex) causing hemodynamic instability should be managed with immediate….
synchronized direct-current cardioversion.
What areas of the heart do coronary vessels supply?
Right coronary
LAD
Left circumflex
- Right coronary: right ventricle and inferoposterior walls of the left ventricle.
- LAD: anterior interventricular groove and supplies the anterior wall of the left ventricle
- Left circumflex: the lateral wall of the left ventricle
Avoid beta blockers in patients with COPD b/c?
It can induce bronchoconstriction
Use this blood pressure medication for patients who need blood pressure reduction and also have BPH?
Doxazosin (alpha blocker)
What to look for on ECG to diagnoses Wolff-Parkinson-White syndrome?
short PR interval with a characteristic delta wave and widened QRS complex (>0.12 sec).
These patients can subsequently develop Paroxysmal supraventricular tachycardia and syncope can result. If recurrent symptoms this condition can be treated with catheter ablation.
Indications for statin therapy?
Clinical:
- ACS
- Stable angina
- Hx CABG
- Stroke, TIA, PAD
- Age 40-75 with DM
LDL >190
Estimated 10 yr ASCVD risk >7.5%
When do you repair AAA?
- Large size, >5.5 cm
- Rapidly Expanding, >0.5 cm in 6 mo
- presence of additional PAD or aneurysm
*most protective factor is smoking cessation
The medical regimen for CAD
- Aspirin
- Beta blocker
- Statin
- ACEi/ARB
When do you initiate fibrate therapy (gemfibrozil or fenofibrate) is to reduce triglyceride levels in patients with severe hypertriglyceridemia?
> 880 mg/dL
Symptoms of digoxin toxicity and the medications that cause it?
nausea, vomiting, anorexia, fatigue, confusion, visual disturbances, and cardiac abnormalities.
Verapamil, quinidine, and amiodarone
Treatment of cocaine related chest pain?
-Benzodiazepines (decrease sympathetic outflow) & nitroglycerin
-CCBs for persistent chest pain
-Phentolamine for persistent hypertension (alpha blocker)
± PCI for myocardial infarction
**Beta blockers contraindicated
Indications for CABG
Coronary revascularization is indicated primarily for 2 groups of patients with stable angina:
- Patients with refractory angina despite maximal medical therapy
- Patients in whom revascularization will improve long-term survival. This includes those with left main coronary stenosis and those with multivessel CAD (especially involving the proximal LAD) along with left ventricular systolic dysfunction.
*PCI with stenting is good for 1 or 2 vessel disease.
MI with ECG showing sinus bradycardia with a 3-mm ST-segment elevation in leads II, III, and AVF.
II, II, aVF = inferior wall and right ventricle, Right Coronary Artery
Can be preload dependent and require NS fluids.
Can have effects on SA node causing bradycardia (give atropine).
If increasing rate doesn’t help can give dobutamine (B1 agonist to help increase contractility, DO NOT give epinephrine as this has alpha agonist properties and can lead to increased myocardial ischemia)
V3, V4 corresponds to this heart anatomic location
anterior wall
