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Flashcards in Exam 4 Deck (31):
1

ischemia

- deprivation of oxygen and nutrients to myocardium
- heart needs more oxygen than arteries can deliver
- causes- exs, tachycardia, hypotension, anemia

2

angina

- chest pain resulting from diminished BF to a region of the heart
- due to CAD or coronary spasm
- stable or unstable

3

stable angina

- exs induced
- predictable

4

unstable angina

- pain at rest
- if exertional angina is getting worse considered unstable

5

acute coronary syndrome (ACS)

- unstable CAD or evolving infacrtion
- STEMI
- nSTEMI
- unstable angina

6

classic presentation of MI

- prolonged ( >20 min) crushing sub-sternal chest pain
- pain radiates to L arm, jaw, or shoulder
- associated with nausea, diaphoresis, SOB

7

EKG during MI

- initial EKG may not always be diagnostic
- evolution of EKG varies person to person
- impt to obtain serial EKGs

8

stages of STEMI

- transient T wave changes happen immediately (T wave peaking and inversion)
- ST segment elevation 0-24 hours
- pathologic Q waves within hours to days (permanent)
- T wave inversion- within hours to days and often normalize

9

pseudonormalization vs normalization of T waves

- pseduo- pt has chronic T wave inversions which normalize in setting of chronic ischemia
- normalization- T waves invert due to ischemia eventually return

10

ST elevation

- myocardial injury beyond ischemia
- potentially reversible if perfusion occurs soon enough

11

reciprocal changes during MI

- a distant lead from infarct may record ST segment depression

12

Inferior infarction

- RAD
- Leads II, III, and aVF

13

Lateral infarction

- left circumflex a
- in leads I, aVL, V5 and V6

14

anterior infarction

- LAD
- "widow maker"
- leads V1-V4

15

posterior infarction

- occlusion of RCA
- reciprocal changes in anterior leads
- often missed because you do not see the ST elevation only depressions

16

treatment for STEMI

- urgent reperfusion therapy
- door to balloon time <90 min
- aspirin
- oxygen only when hypoxic
- sublingual nitroglycerin to treat chest pain
- morphine to treat chest pain
- beta blockers within 24 hours

17

hyperkalemia

- due to renal disease, adrenal insufficiency, and meds
- meds: ACEI, angiotensin receptor blockers, K sparing diuretics
- EKG finding- peaked T waves, may develop sine wave
- can lead to v fib

18

hypokalemia

- dietary deficiency
- alkalosis
- excess mineralocorticoids
- meds- diuretics
- presents with T wave flattening and sometimes U wave

19

hypocalcemia

- malabsorption
- vit D def
- hypoparathyroidism
- EKG findings- T wave flattening, prolonged QT, shortened PR
- increased risk of torsades

20

R on T phenomenon

- occurs due to hypocalcemia
- R wave forms at same time as T is forming

21

hypercalemia

- malignancy
- granulomatous disease
- medication induced
- primary hyperparathyroidism
- EKG findings- shorted QT interval

22

hypothermia

- metabolism slows
- sinus bradycardia
- segments and intervals prolong
- distinct ST elevation called osborne wave
- arrhythmias develop, usually slow a fib

23

digitalis effect

- slows down AV node conduction
- occurs at therapeutic levels
- ST depression with gradual downslope
- T wave flattening or inversion
- expected and does not necessitate d/c of drug

24

digitalis toxicity

- occurs at supratherapeutic levels
- sinus node suppression -> sinus exit block
- AV conduction blocks 1-3rd degree
- tachyarrhythmias
- most common= paroxysmal atrial tachycardia

25

paroxysmal atrial tachycardia (PAT)

- from ectopic focus or reentrant circuit
- usually cannot distinguish from SVT
- have P waves hiding behind T waves
- rate usually 100-200

26

acute pericarditis

- often post viral infection
- pt presents with sharp chest pain
- EKG shows diffuse ST elevation, T wave changes, and PR depressions in multiple leads
- usually self limited
- associated with pericardial effusions
- tx- NSAIDs

27

pericardial effusions

- low voltage because harder for electrical energy to make through fluid
- heart rotates freely within fluid filled sac -> varied amplitude of waveforms called electrical alternans

28

COPD

- low voltage
- R axis deviation
- poor R wave progression
- R atrial enlargement

29

acute PE

- right ventricular hypertrophy or dilation
- RBBB
- S1, Q3, T3
- tachycardia (sinus or a fib)

30

S1, Q3, T3

- occurs in acute PE
- large S in I
- Q wave in III
- inverted T wave in III

31

brugada syndrome

- rare
- inherited autosomal dominant train
- most common in men in 20s and 30s
- pt presents with syncope
- EKG shows RBBB and ST elevation in V1 V2 and V3
- risk of V tach -> sudden death