cardiology Flashcards
(64 cards)
1
Q
ECG in Supraventricular tachyarrythmia (SVT)
A
narrow QRS
2
Q
Tx for SVT
A
- vagal maneuvers (carotid massage) to block AV conduction
- adenosine to block AV conduction (6mg IV push)
3
Q
untreated SVT can lead to
A
cardiomyopathy (also CHF, hypotension)
4
Q
SVT pulse rate typically
A
between 100-300 bpm
5
Q
ECG findings in Dilated Cardiomyopathy
A
Nonspecific ST-T wave changes
6
Q
ECG in Hypertrophic Cardiomyopathy
A
abnormal and prominent Q waves, short P-R
7
Q
Imaging (besides ECG) for cardiomyopathy
A
- 2-D echo-cardiography
- Cardiac MRI (useful in Dx and assessing severity)
8
Q
Heart sounds in Hypertrophic cardiomyopathy
A
- Split S2, S4, harsh systolic ejection (crescendo-descrecendo) murmur - best heard along lower left sternal border or apex and best heart during valsalva
- palpable double apical impuse (@ PMI)
9
Q
ECG in restrictive cardiomyopathy
A
- normal, or nonspecific ST-T wave changes
- low QRS voltage
10
Q
Restrictive cardiomyopathy is caused mostly by
A
- amyloidosis, sarcoidosis
- myocardial fibrosis after open-heart surgery
- radiation
11
Q
pathophys of hypertrophic cardiomyopathy
A
- autosomal dominant (chromosome 14)
- hypertrophy of myocardium (with GREATER hypertrophy of Interventricular Septum than Left ventricular wall)
- thus, L ventricle outflow may be obstructed
12
Q
dilated cardiomyopathy is what
A
four chambered hypertrophy, unexplained dilation and impaired systolic function of one or both VENTRICLES
13
Q
causes of dilated cardiomyopathy
A
- alcoholism
- genetic
- myocarditis
- drugs (chemo (doxorubicin), cocaine, heroin)
- organic solvents (“glue sniffers”)
- peripartum (last trimester or within 6 months postpartum)
14
Q
Symptoms/signs of Endocarditis
A
- fever (m/c), weakness, night sweats, weight loss, anorexia
- SOB, chest pain, regurgitation murmurs
- Vascular: SPLINTER hemorrhages in nail beds (linear, reddish brown lesion); JANEWAY’s lesions (painless, 5mm pustular, hemorrhagic lesions on PALMS/SOLES); petechiae
- splenomegaly
- microscopic hematuria, flank pain
- immune complex vasculitis (Glomerulonephritis, ROTH’s spot (retinal hemorrhage), OSLER’s nodes (painful nodules on pads of fingers or toes)
15
Q
what valve is most commonly effected in endocarditis
A
Mitral
16
Q
what is the most common form of myocarditis
A
viral myocarditis (from parvovirus B19, coxsackie, HIV, polio, influenza, mumps)
17
Q
What drugs can cause myocarditis
A
doxorubicin, catecholamines, cocaine
18
Q
systemic diseases that can cause myocarditis
A
collaged vascular disease (SLE, RA), autoimmune, sarcoidosis
19
Q
Signs of myocarditis
A
- fever, chest pain, pericardial friction rub, heart failure, elevated JVP, PE, murmurs (usu mitral), sudden death
20
Q
ECG in myocarditis
A
nonspecific ST-T changes
21
Q
blood work/imaging in myocarditis
A
- increased CK-MB and tropinins I and T
- Antibodies of pathogens
- LDH and AST (in acute)
- check WBC, ESR, ANA, RF
- echo shows dilated, hypokinetic chambers
- CXR
- Endomyocardial biopsy
22
Q
Diagnosis of myocarditis
A
Endomyocardial biopsy (EMB) is the criterion standard for diagnosis
23
Q
most common viral cause of Acute Pericarditis
A
Coxsackie B virus
24
Q
Diagnostic triad of acute pericarditis
A
- chest pain
- friction rub
- ECG changes (diffuse ST elevation and PR depression)
25
Test of choice for detecting pericardial effusion and diagnosing tamponade in acute pericarditis
Echocardiography
26
ECG changes in Acute pericarditis
- PR-segment depression (important, in 80% of cases)
| - ST elevation initially
27
major diagnostic Jones criteria for diagnosis of rheumatic fever
(requires presence of 2 major or 1 major and 2 minor criteria)
Major diagnostic criteria:
1. carditis
2. polyarthritis (swollen large joints)
3. chorea (rapid movts in face and arms, don't occur until at least 3 months from onset of infection)
4. subcutaneous nodules (painless, firm collagen on bones/tendons- common at wrist, elbow, knees)
5. erythema marginatum (spares face, begins on trunk or arms, snake like appearance, worse with heat)
28
minor diagnostic Jones criteria for diagnosis of rheumatic fever
```
(requires presence of 2 major or 1 major and 2 minor criteria)
Minor criteria:
1. fever
2. arthralgia (no swelling)
3. increased ESR or CRP
4. leukocytosis
5. ECG with prolonged PR interval
```
29
forward heart failure
- inadequate cardiac output
| - systemic edema (d/t kidneys not receiving blood and thus conserving salt and water)
30
backwards heart failure
- increased congestion of venous circ
- results in overfilling of ventricles
- systemic OR pulmonary edema
31
Which valve is usually effect in L heart failure
mitral
32
Which valve is usually effect in R heart failure
tricuspid
33
Types of angina
1. chronic/stable angina (CPain on exertion)
2. prinzmetal/variant angina (occurs at rest; ST elevation)
3. unstable angina (an acute coronary syndrome, at rest, increasing CPain)
34
ECG during MI
MOST IMPORTANT TEST
- perform within 10 mins of MI if possible
- Q waves, ST-segment elevation, T-wave inversion
35
cardiac markers of MI
- CK-MB peak day 1 for 3 days
- Troponins I and T peak day 1 or 2, stay elevated for up to 2 weeks
- New CK-MB elevation can be used to diagnose re-infarction
36
What is needed for diagnosis of AFIB
```
ECG:
- no organized P waves
- irregular R-R intervals
- narrow WRS
blood work: TSH and cardiac markers
```
37
ECG during PVC (premature ventricular contraction) aka VPB (ventricular premature beats)
ECG needed for Dx
- QRS width > 120 msec, abnormal QRS, no preceding P wave
- holter monitor
38
3 consecutive VPBs (aka PVCs) create what
ventricular tachycardia
39
heart block ECG changes
long PR interval that remains constant (>200 msecs), P-wave present
40
Mobitz type 1 heart block ECG
QRS does NOT follow each P wave, PR progressively increases
41
Mobitz type 2 heart block ECG
QRS does NOT follow each P wave, PR does NOT progressively increase, MULTIPLE irregular P WAVES
42
3rd degree heart block ECG
no relationship between P waves and WRS, but consistent P waves
43
ventricular fibrillation ECG
erratic, no identifiable waves
44
ventricular tachycardia ECG
wide, regular WRS (>140msec), abnormal P-wave pattern
| and HR > 100bpm
45
most common arrythmia in cardiac arrest
ventricular fibrillation
46
aortic stenosis murmur
crescendo decrescendo ejection murmur (heard at right 2nd interspace)
- radiates to R clavicle, both carotids, musical sound at apex, S4, S3
- murmur increases with positions that increase LV volume (valsalva, squat)
47
what Tx to avoid in severe aortic stenosis
nitrates and ACE-I's
48
mitral stenosis murmur/ascultation
- mid-distolic rumble (best heard in L lateral decubitus position after exertion)
- loud opening SNAP - leaflets closing tightly (right after S2)
- loud S1 and S2
- palpable diastolic thrill at apex
49
pulmonary stenosis murmur
- midsystolic, crescendo-descrescendo murmur at 2nd L interostal space
(accentuated by inspiration/valsalva)
- R side S4
- pulmonary ejection click
50
what imaging is needed for Dx of pulmonary regurgitation, mitral regurgitation, pulmonary stenosis and tricuspid stenosis
Echo
51
most common cause of mitral and tricuspid stenosis
rheumatic disease
52
aortic regurgitation murmur
early decrescendo, diastolic murmur at Lower left or lower right sternal border
(accentuated by leaning forward/holding breath/squat)
- soft S1, absent S2, late S3
53
pulmonary stenosis etiology is usually
congenital
54
mitral regurgitation murmur
holosystolic at apex (radiates to axilla)
55
pulmonary regurgitation murmur
decrescendo diastolic at Lower left sternal border (LLSB)
| accentuated by inspiration and valsalva at 2nd and 3rd L intercostal space
56
tricuspid regurgitation murmur
holosystolic at LLSB (accentuated by inspiration)
57
mitral valve prolapse murmur
mid-systolic click followed by mid-late systolic murmur at apex
(accentuated by valsalva/squat)
58
Mitral valve prolapse ECG
non specific ST-T wave changes
59
orthostatic hypotension - amount systolic and diastolic drops
systolic drop of more than 20, diastolic more than 10
60
hypertensive crisis systolic and diastolic
Systolic > 180, diastolic > 120 mmHg
61
abnormal ankle-brachial indices is less than what
ABI < 0.90
62
what imaging has 100% sensitivity in aortic aneurysm
abdominal US
63
bloodwork/imaging in aortic aneurysm
- bloodwork: CBC, electrolytes, urea, creatinine, PTT, INR
| - CT, MRI, Abd US, doppler
64
pulmonary embolism imaging
- CXR,
- pulmonary angiogram (gold standard but invasive, done rarely),
- ventilation/perfusion scan (V/Q)
