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English 2 > Cardiovascular > Flashcards

Cardiovascular Flashcards

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1
Q

ECG for LBBB

A

QRS > 120ms
In V1: deep S and no R
In I, V5, V6: tall R

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2
Q

ECG for RBBB

A

QRS > 120ms
In V1: qR or R
In I, V5, V6: S

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3
Q

3 consecutive changes in ECG when acute ischemia

A

1- T inversion
2- ST changes
3- Q wave (>40ms or >1/3 of QRS amplitude)
Poor R wave progression in precordial waves

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4
Q

ECG for RA and LA enlargement

A

RA: amplitude of P > 2.5mm in II
LA: width of P > 120ms in II or terminal negative deflection in V1 (> 1mm and > 40ms)

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5
Q

ECG for RVH and LVH

A

RVH: right-axis deviation, R > 7mm in V1
LVH: S in V1 + R in V5 or V6 > 35mm

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6
Q

Pulsus paradoxus
Pulsus alternans
Pulsus parvus et tardus

A

Paradoxus: pericardial tamponade, obstructive lung diseases, tension pneumothorax, foreign body inhalation.
Alternans: cardial tamponade, impaired LV systolic function.
Parvus et tardus: aortic stenosis

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7
Q

Management options for AFib

A

A: Anticoagulate
B: Beta-blockers (rate control)
C: Cardiovert/CCB
D: Digoxin (if refractory)

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8
Q

Estimate stroke risk in AFib + ttt

A

CHA2DS2-VASc ≥2

CHF (1)
HTN (1)
Age ≥ 75 (2)
Diabetes (1)
Stroke or TIA history (2)
Vascular disease (1)
Age 65-74 (1)
Sex category (female = 1)
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9
Q

3 steps after diagnosis of WPW on ECG

A

Advice against vigorous physical activity
Procainamide for arrhythmias
Electrophysiology study

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10
Q

Sinus bradycardia (etiologies + ttt)

A

Normal response to conditioning, SN dysfunction, excess B-blockers/CCB

None (if asymptomatic), Atropine, Pacemaker (if severe)

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11
Q

AV block (etiologies + ttt)

A

1st: ass w/ ↑ vagal tone, B- or CCB; PR >200ms; no ttt
2nd + Mob I: digox/B-/CCB, ↑ vagal tone, right coro ischemia/infarction; PR lengthening then drop; stop drug, Atropine
2nd + Mob II: fibrotic ds of conduction (MI); dropped beat; pacemaker
3rd: no A-V communication; pacemaker

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12
Q

Sick sinus syndrome (etiologies + ttt)

Multifocal atrial tachycardia

A

SSS: Intermittent SupraV tachy+brady arrhythmias
ttt: Pacemaker

MAT: multiple atrial pacemakers/reentrant paths/COPD, hypoxemia (≥3 diff P waves)
ttt: underlying cause, Verapamil/B-, suppress pacemakers

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13
Q

Sinus tachycardia (etiologies + ttt)

A

Normal response to pain/exo/fear, hyperthyroidism, volume contraction, infection, PE

ttt underlying cause

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14
Q

AFib (etiologies + ttt)

A

Acute: pulmonary ds, ischemia, rheumatic heart ds, anemia, atrial myxoma, thyrotoxicosis, ethanol, sepsis
Chronic: HTN, CHF

ttt chronic: Rate control (B-/CCB/Digoxin) + Anticoag Warfarin (CHA2DS2-VASc ≥2)
ttt unstable or <2d: cardiovert
ttt >2d or unclear: TEE to r/o atrial clot

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15
Q

Atrial flutter (etiologies + ttt)

A

“sawtooth” P waves
240-320 bpm in atria and 150bpm in ventricles

ttt chronic: Rate control (B-/CCB/Digoxin) + Anticoag Warfarin (CHA2DS2-VASc ≥2)
ttt unstable or <2d: cardiovert
ttt >2d or unclear: TEE to r/o atrial clot

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16
Q

AVNRT (etiologies + ttt)

AVRT (etiologies + ttt)

A

AVNRT: reentry in AV node (A+V depol simultaneously); 150-250 bpm (P buried in QRS)
ttt: carotid massage/Valsalva/adenosine (stop it), cardiovert if unstable

AVRT: ectopic connection of A+V causes reentry (ex: WPW); P after QRS
ttt: carotid massage/Valsalva/adenosine (stop it), cardiovert if unstable

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17
Q

Paroxysmal atrial tachycardia (etiologies + ttt)

A

Ectopic pacemaker in A
>100 bpm; P before QRS but unusual axis
ttt: adenosine (unmask A activity by slowing rate)

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18
Q

PVCs (etiologies + ttt)

WPW (etiologies + ttt)

A

PVCs: ectopic beats from V; ass w/ hypoxia, e- abnl, hyperthyroidism; wide QRS w/o P
ttt: underlying cause; B- if symptomatic

WPW: abnl path A to V; delta wave + wide QRS + short PR
ttt: observation if asymptomatic

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19
Q

VT (etiologies + ttt)

VF (etiologies + ttt)

A

VT: ass w/ CAD, MI, structural heart ds; < 30sec or > 30sec; ≥3 consec PVCs, regular rapid wide QRS
ttt: cardiovert if unstable, antiarrhythmics

VF: ass w/ CAD, structural heart ds, cardiac arrest; erratic wide complexes; no BP no pulse
ttt: immediate defibrillation and ACLS

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20
Q

Torsades de pointes (etiologies + ttt)

A

Ass w/ long QT, medications, hypokalemia, cong deafness, alcoholism
Polymorphous QRS, VT 150-250 bpm
ttt: magnesium then cardiovert if unstable, correct hypoK, stop medication

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21
Q

NYHA classification of CHF

Study These Flashcards
A

I: no activity limitation, asymptomatic w/ Nl activity
II: slight activity limitation, comfortable w/ rest + mild exertion
III: marked activity limitation, comfortable only at rest
IV: discomfort w/ any activity, symptoms also at rest

22
Q

Acute CHF management

Study These Flashcards
A 
L: Lasix (furosemide)
M: Morphine
N: Nitrates
O: Oxygen
P: Position (upright)
23
Q

Acute systolic dysfunction ttt

Chronic systolic dysfunction ttt

Study These Flashcards
A

Acute: loop diuretics, ACEIs/ARBs, avoid B- when decompensated, ttt underlying cause

Chronic: lifestyle (↓ salt/fluid), B- and ACEIs/ARBs (↓ mortality), avoid CCB, diuretics (loop), low-dose spironolactone (↓ mortality), ASA and statin if cause is prior MI, ICD if EF < 35%, LVAD or cardiac transplant if refractory

24
Q

Nonsystolic dysfunction ttt

Study These Flashcards
A

Diuretics
Rate and BP control: B-, ACEIs/ARBs, or CCBs
(No digox)

25
Dilated CM Hypertrophic CM Restrictive CM
Dilated: impaired contractility, LVsizeED ↑↑, LVsizeES ↑↑, EF ↓↓, wall thickness ↓ Hypertrophic: impaired relaxation, LVsizeED ↓, LVsizeES ↓↓, EF ↑/Nl, wall thickness ↑↑ Restrictive: impaired elasticity, LVsizeED ↑, LVsizeES ↑, EF ↓/Nl, wall thickness ↑
26
Dilated CM
Idiopathic (#1) or 2* (many causes esp. ischemia, long HTN) Gradual CHF, JVD, S3/S4, MR/TR Echo for dg ttt: underlying cause (infection, endocrino, alcohol, ...) and the CHF (lifestyle, meds, ICD)
27
Hypertrophic CM
HOCM (AD), HTN, Ao stenosis Systolic ejection cresc-decresc murmur that ↑ w/ ↓ preload and ↓ w/ ↑ preload; S4 Echo for dg LVH (on ECG), MR than LA enlarged ttt: B- (#1), CCB (#2); surgery for HOCM + avoid intense exo
28
Restrictive CM
2* to infiltrative ds, scarring, fibrosis Right HF > Left HF Echo for dg LBBB (on ECG) ttt: palliative; diuretics if overload, vasodilators to ↓ filling P*
29
CAD (RF, dg, ttt)
CAD = Angina pectoris (subst chest pain 2* to myoc ischemia w/ stress/exertion and ↓ w/ rest/nitrates) and Prinzmetal (ST elev w/o cardiac enzymes) DM, fam Hx of premature CAD (M<55, F<65), Smoking, Dyslip, abdo obesity, HTN, age (M>45, F>55), male ECG then stress test for dg ttt: if stable angina ASA, B-, nitrogl, ↓RF ASA + B- reduce mortality
30
ACS
``` Unstable angina (pain is new, accelerating, at rest) maybe ST changes, no enzymes NSTEMI (+ Trop I and CKMB) ``` ttt: ASA, O2, IV nitrogl, IV morphine, B- (if hemod stable) Admission (serial card enz to r/o MI) TIMI score for UA/NSTEMI (if ≥3 enoxaparin (not hep), GPIIbIIIa inhib and early angiography)
31
ACS (cont.)
STEMI (ST elevation and + card enz) LV EF best predictor of survival Atypical/silent MI (women, DM, elderly, post-heart transpl) ttt: morphine, O2, ASA, nitrates (not if inf MI), clopidogrel, B- (not if shock/HF, instead ACEI but not if hypoTN) PCI in 90 min If >90min + no CI for thrombolysis + within 3h, tPA/reteplase/streptokinase
32
Coronary arteries and MI
Inferior MI: RCA/PDA (II, III, aVF) Anterior MI: LAD/diagonal (V1-V4) Lateral MI: LCA (I, aVL, V5, V6) Posterior MI: Cx/PDA (V7-V9)
33
Long-term ttt and complications of STEMI
Long ttt: ASA, ACEIs, B-, high-dose statins (LDL<100), clopidogrel (if PCI) + modify RF (exo, diet, tobacco) Arrhythmias (#1 + #1 death) HF (d1), arrhythmia/pericarditis (d2-4), LV wall rupture/tamponade/papill M rupture + MR (d5-10), V aneurysm/thrombus (wks-months) Dressler (2-10 wks)
34
Dyslipidemia (RF for CAD, etiologies, dg)
Total cholest > 200 mg/dL, LDL > 130, Tg > 150, HDL < 40 Obesity, DM, alcoholism, hypothyroidism, nephrotic sd, hepatic ds, Cushing sd, OCP, high-dose diuretics, familial hypercholest. If high Tg or LDL: xanthomas, xanthelasmas, lipemia retinalis Dg: lipid test for >35yo or ≥20yo w/ CAD RF. Repeat every ≤5y acc to levels
35
ttt of dyslipidemia
First, 12-wk trial diet + exo if no known atheroscl vasc ds. High-intensity statin (↓ LDL >50%): Hx of CAD/CVA/PAD, LDL 70-189 w/o DM w/ ≥7.5% 10yR, LDL 70-189 w/ DM w/ ≥7.5% 10yR, LDL ≥190 Moderate-intensity statin (↓ LDL 30-50%): LDL 70-189 w/o DM w/ 5-7.5% 10yR, LDL 70-189 w/ DM w/ ≤7.5% 10yR No statin: LDL 70-189 w/o DM w/ ≤5% 10yR
36
Hypertension (def, RF, dg)
<60yo: SBP > 140 and/or DBP > 90 (x3 separate measures) ≥60yo w/o CKD/DM: SBP > 150 and/or DBP >90 RF: faml Hx of HTN/heart ds, high-Na diet, smoking, obesity, black, age Dg: urinalysis, BUN/creatinine, e-, possible 2* causes (Cushing sd, Hyperaldo/Conn, Ao coarctation, Pheo, Stenosis of renal arteries)
37
ttt of hypertension
Lifestyle modif (↓ weight, exo, diet, ↓ alcohol and salt) Diuretics/CCB/ACEIs/B- reduce mortality in uncompl HTN Periodic testing for end-organ damage: renal, cardiac, ocular, cerebral
38
Hypertensive emergencies (def, ttt)
BP > 180/120 lead to end-organ damage (AKI, MI, Ao dissection, encephalopathy) HTN urgency: mild to mod sympt, no end-org dam. Oral ttt (B-, ACEI) w/ gradual lowering in 24-48h HTN emergency: end-org dam (intracran hge, papilledema, pulm edema, ...). IV ttt (labetalol, nitroprusside, nicardipine) w/ lowering of ≤25% in 2h
39
Pericarditis (etiologies, dg)
Collagen vascular ds, Ao dissection, radiation, drugs, infections, AKF, MI, rheumatic fever, injury, neoplasms, Dressler sd Pain worse in supine and w/ inspiration (so pt stays sitting + bend forward) CXR, ECG, echo to r/o MI/pneumonia ECG (diffuse ST elevation, PR depression)
40
ttt of pericarditis
``` CS/immunosupp for SLE Dialysis for uremia ASA for post-MI (no CS) ASA/NSAIDs for viral pericarditis If asymptom, monitor If tamponade, pericardiocentesis w/ continuous drainage ```
41
Tamponade (RF, dg, ttt)
Excess fluid leading to compromised LV filling/CO RF: pericarditis, malignancy, SLE, TB, trauma Beck triad (JVD, hypoTN, distant heart sounds), pulsus paradoxus, Kussmaul sign Echo, CXR, ECG (electrical alternans is dg) ttt: abundant IV fluids, urgent pericardiocentesis
42
Aortic stenosis (etiologies, dg, ttt)
Elderly (unless uni/bicuspid AV) Asymptom for years, then angina/syncope/CHF/death Pulsus parvus et tardus, systolic murmur to carotids Dg by echo ttt: AV replacement
43
Aortic regurgitation (etiologies, dg, ttt)
Acute: rapid pulmonary congestion, shock, dyspnea Chronic: slow progression of dyspnea Blowing diastolic murmur, wide pulse pressure (head bob) Dg by echo ttt: vasodilator until severe, AV replacement
44
Mitral valve stenosis (etiologies, dg, ttt)
#1 by rheumatic fever Sympt: dyspnea, infective endocarditis, arrhythmias Opening snap/mid-diastolic murmur at apex, pulm edema Dg by echo ttt: antiarrhythmics (B-/digox), mitral balloon valvotomy, MV replacement
45
Mitral valve regurgitation (etiologies, dg, ttt)
Rheumatic fever, chordae tendineae rupture after MI, infective endocarditis Dyspnea, fatigue Holosystolic murmur to axilla Dg by echo ttt: antiarrhythmics, nitrates/diuretics (↓ preload), MV replacement
46
Aortic aneurysm (RF, dg, ttt)
>50% dilatation of the 3 layers, ass w/ atherosclerosis Esp abdominal, >90% below renal art Asympt, pulsatile abdo mass/bruits RF: HTN, high cholest, vasc ds, fam Hx, smoking, male, age Dg: screen all men 65-75yo w/ Hx of smoking by US, follow by US ttt: monitor (asympt + <5cm), surgery (rapid, abdo >5.5cm, thor >6cm), emergent surgery (sympt, ruptured)
47
Aortic dissection (dg, ttt)
2* to HTN Esp above AV + distal to subclavian art, 40-60yo, male HyperTN/hypoTN (tamponade/bld loss), asymmetric pulses/BP Dg: CT angiography (#1), MRA if contrast CI Types: A (prox to left subclav), B (other) ttt: manage BP/HR, B- before vasodilator, surgical emergency if asc Ao
48
Deep venous thrombosis (RF, dg, ttt)
Virchow triad (venous stasis, endothelial trauma, hypercoagulability) Homans sign (calf tendern with dorsiflexion) Dg: Doppler US ttt: anticoagulation (IV heparin/subQ LMWH then PO warfarin for 3-6mo), IVC filter (if CI to anticoag), DVT prophyl (hospit ptts)
49
Peripheral arterial disease
``` Restriction of bld by atheroscl plaque Intermittent claudication (relieved by rest) then pain at rest, cold/numb/ulcerations in feet, ↓ pulse ``` ``` Acute ischemia (emboli): Pain, Pallor, Paralysis, Pulse deficit, Paresthesias, Poikilothermia Chronic ischemia: muscle atrophy, pallor, cyanosis, hair loss, gangrene/necrosis ```
50
Peripheral arterial disease (dg, ttt)
Ankle-brachial index, Doppler US, arteriography for surgery ttt: underlying condition (DM/smok), foot care, exo to form collateral art, ASA/cilostazol/thromboxane inh, angioplasty, surgery (bypass), amputation
51
Lymphedema (etiologies, dg, ttt)
Peripheral edema, chronic infection 2* to surgery/parasitic infection Dg is clinical. R/o cardiac + metabolic disorders ttt: exo/massage/pressure garments, G+ antibiotic prophyl CI of diuretics
52
Syncope (etiologies, dg, ttt)
``` Cerebral hypoperfusion (2* to cardiac, neuro, other) [valvular, arrhythmias, PE, tamponade, Ao dissection, subarachnoid hge, ortho hypoTN, metabolic, vasovagal, psy, medications ``` Ask: age, triggers, prodromal symptoms, ass symptoms Dg: dep on cause (ECG, Holter, echo, stress test, EEG, CT head, orthost BP, tilt test, glucose ttt: the cause

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