Exam I Flashcards
(208 cards)
1
Q
P wave
A
depolarization of atria, 80-100 ms
2
Q
PR Segment
A
when signal travels in AV node –> slower
0 voltage
3
Q
PR Interval
A
time between atrial depolarization and ventricular depolarization, 120-200ms
estimates AV node function
4
Q
PR interval >200ms*
A
First Degree AV Block
5
Q
QRS complex
A
ventricular depolarization, 60-100ms
6
Q
QRS >100ms
A
bundle branch block –> ventricular foci –> slower, increase PR
7
Q
the different ectopic foci
A
atrial foci: 60-80/min
junctional foci: 40-60
ventricular foci: 20-40
8
Q
ST segment
A
plateau phase when ventricle completely depolarized
completely flat!
9
Q
Raised ST segment*
A
acute injury
ongoing MI*
pericarditis
etc
10
Q
Depressed ST segment
A
ischemia
11
Q
T wave
A
ventricular repolarization, takes longer than depolarization
12
Q
QT interval
A
ventricular depolarization AND repolarization
Ventricular AP time
200-400ms
13
Q
Increased QT interval
A
Bradycardia
14
Q
Decreased QT interval
A
Tachycardia
15
Q
prolonged QT can lead to…
A
arrhythmias
16
Q
how is QT interval presented?
A
cQT to adjust for heart rate
QT/sqrtRR
17
Q
normal cQT
A
<440ms
18
Q
long cQT
A
sudden cardiac death
19
Q
When is Q wave significant?
A
> 40ms or >1/3 of QRS amplitude
20
Q
R wave pattern
A
increases from V1 TO V5 normally
21
Q
What orientation is P wave usually?
A
same polarity as QRS
22
Q
Inverted P wave
A
retrograde conduction from AV
23
Q
Tall P wave
A
atrial enlargement
24
Q
No gradual increase in R from V1 to V5
A
loss of ventricular conduction, eg MI
25
Tall R wave
ventricular hypertrophy
26
Right ventricular hypertrophy on EKG
Tall R in V1-V2
27
Left ventricular hypertrophy on EKG*
Tall R on V5-V6
28
S wave pattern
Large on V1, Large in V2, progressively smaller V3-V6
29
U wave
follows T wave, not usually present, don't know much
30
Hypocalcemia on EKG
Prolonged QT, T wave inversion in some leads
31
Hyperkalemia*
increased amplitude and peaking in T wave
32
Hypokalemia
T wave flattening or inversion
33
Hypercalcemia
short ST, short QT, PR prolonged, U wave
34
Cause of Angina pectoris
imbalance in myocardial O2 supply and demand
35
Difference between ischemia and infarction
ischemia: temporary
infarction: tissue death
36
Angina in elderly can present as
SOB
37
Who experiences silent ischemia?
women, DM, obese, elderly
38
What is silent ischemia?
symptoms without chest discomfort, abnormal nerve
39
What to rule out if patient complains of epigastric pain?
Angina
40
What happens to myocardial cell when supply can't keep up with demand?
anaerobic metabolism --> progressive impairment of functions
41
Levine sign
place fist in center of chest
42
What BIG 5 to rule out with chest pain?
```
Acute coronary syndrome (MI, unstable angina)
Aortic Dissection
Pulmonary Embolism
Tension Pneumothorax
Esophageal Rupture
```
43
Medication for angina
nitroglycerin
ASA
Beta Blocker
44
Treatment of stable angina
risk modification, eg lifestyle changes
45
What medication to never use in renal artery stenosis?**
ACE-I/ARB
| Bc of risk of azotemia from efferent arteriole dilation
46
What medication to use for isolated HTN?
Ca Channel Blockers
47
Who cannot use ACE-I
African Americans bc lower serum renin
48
Everyone with renal dz should be on what medication?
ACE-I
49
Stable Angina
predictable, with precipitating event
50
cause of stable angina
atherosclerosis --> stenosis
51
Prinzmetal's Variant Angina
occurs at rest, morning
52
Cause of Prinzmetal's variant angina
coronary artery spasm WITHOUT plaques
53
What is Prinzmetal's variant angina likely to cause?
ventricular arrhythmias
54
Unstable Angina
NEW ONSET
increase severity of chronic angina
at rest or with minimal exertion, not relieved by normal measures
55
HTN pathophysiology
baroceptors has higher set point, need higher pressure to activate system to decrease
56
what is a physiologic effect of HTN
Reflex tachycardia from medication that decrease BP, causing body to automatically increase sympathetic stimulation
57
Beta Blockers usage in HTN
block reflex tachycardia, eventually will reset set point to normal!
58
4 worst outcomes in HTN
Stroke, MI, Renal Failure, Encephalopathy
59
Hypertensive Emergency
Diastole >120, ONE HOUR TO TREAT
60
How to treat hypertensive emergency
Sodium Nitroprusside
61
Action of B1 Blockers in heart
prevent sympathetic stimulation of heart
62
Action of A1 Blockers
vasodilation
63
Action of A2 agonists
suppress sympathetic outflow in brainstem
64
Action of B1 Blockers in kidneys
block renin release (JG cells)
65
What do all HTN drugs that work on RAAS system do?
block or decrease production of angiotensin II to DILATE
66
When do you have patients go on BP lowering medication?
BP 130-139/80-89
67
First line drugs for HTN
Thiazide diuretics, CCB, ACE-I, ARB
68
Captopril
ACE-I
69
Isosartan, Valsartan
ARB
70
Classes of Calcium Channel Blockers
Dihydropyridines: more effective/selective
| Non-DHP: less effective/selective
71
What is DHP recommended for?
all patients with stable ischemic heart dz, improves angina and potent BP lowering
72
HMG-CoA
cholesterol synthesis
73
What drug treats hyperlipidemia
statins (HMG-CoA Reductase Inhibitors)
74
Crestor (Statin) used in
pts with normal LDH, used as primary prevention
75
Who are Statins contraindicated in?
Pregnancy, category X
76
Pathology of Stable Angina in pts with CAD
Arteries already dilated at rest due to plaques so can't dilate on exertion
77
O2 demand factors
HR
Contractility
Afterload
Preload
78
Afterload
peripheral vascular resistance
| Systemic arterial resistance
79
Preload
Intravascular volume
| Ventricular diastolic dilation (ventricular filling pressure)
80
Treatment for chronic stable angina pectoris
decreased cardiac O2 demand
81
Treatment for variant angina pectoris
increase cardiac O2 supply --> vasodilators (Nitrates, CCB)
82
All patients with angina with be on what medication
Antiplatelet like ASA
83
Treatment for Unstable Angina
medical emergency
| hospitalized and given : anti-ischemic (Nitro, BB), Anti-platelet (ASA), anti-coag
84
Adrenergic agonists treat
shock, cardiac arrest, respiratory difficulty
85
Effect of EPI
Increases HR
| Usually Increase BP
86
Effect of ISO
Increase HR
| Decrease BP
87
Effect of NE
Decrease HR
| Increase BP
88
Most potent drug for B1 receptor
ISO
89
Most potent drug for B2 receptor
ISO
90
Most potent drug for A1 receptor
EPI
91
Most potent drug for A2 receptor
CLO
92
Chest Pain DDx
```
Acute coronary syndrome
acute aortic dissection
mediastinitis
pericardial tamponade
pulmonary embolism
tension pneumothorax
```
93
What lab to draw for chest pain?
Cardiac Troponin I and T: cardiac ischemia marker, serial draws
94
Quick Estimate for rate in EKG
300, 150, 100, 75, 60, 50, 43, 38
95
6 second strip method
number of cycles in 6 seconds x 10
96
Axis Determination
"Two Thumbs Up": QRS positive in Lead I and AVF
97
QRS in LAD
UP in I
| DOWN in AVF
98
QRS in RAD
DOWN in I
| UP in AVF
99
QRS in Extreme RAD
DOWN in I and AVF
100
Wolf-Parkinson-White Syndrome*
LAD, right-sided accessory pathway
SEE DELTA WAVE*
Shrt PR, Wide QRS
101
Sinus Block
no P wave, QRS complex, and T wave --> missed complete cycle
102
First Degree AV Block*
PR interval >200ms
103
Second Degree AV Block: Mobitz I Wenkebach*
PR interval progressively longer
104
Second Degree AV Block: Mobitz II*
sudden P waves without QRS, fixed PR Interval
105
Third Degree AV Block
complete block between atrium and ventricle
Junctional or Ventricular foci takeover
atria regular
106
"bunny ears" on EKG
Bundle Branch Block
107
Left Bundle Branch Block*
QRS >120ms at V5 and V6, widened QRS
108
Right Bundle Branch Block*
QRS >120ms at V1 and V2
109
Divisions of Fascicular/Hemiblock in LBBB
Posterior
| Anterior
110
Anterior LBBB
more common, left axis deviation, Q1S3
111
Posterior LBBB
Less common, right axis deviation, S1Q3
112
Right Ventricular Hypertrophy
Large R Wave V1, progressively smaller V1-V4
113
Left Ventricular Hypertrophy*
Large S in V1, Large R in V5
Voltage criteria: >35mm
inverted T waves ("strain")
114
Atrial Hypertrophy on EKG
Bi-phasic P-waves
115
LAH
Increase in terminal negative deflection
116
RAH
Increase in initial positive deflection
117
What can be a cause of LAH?
Mitral Stenosis
118
Ischemia on EKG
ST depression
119
Tissue death on EKG
ST Elevation
120
You can hear S1 loudest where and why?
apex because closure of AV valves
121
You can hear S2 loudest where and why?
base because closure of pulmonic and aortic
122
physiologic splitting of S2
aortic closing before pulmonic, widened during inspiration
123
Paradoxical splitting of S2
Pulmonic closes before aortic during EXPIRATION, widened during expiration
124
S3 gallop
due to limitation of ventricular wall expansion, early diastole sound
"kentucky"
125
S4 gallop
stiff non-compliant wall
late diastolic, right before S1
"tennessee"
126
major cause of S3 gallop
CHF
127
major cause of S4 gallop
hypertrophic cardiomyopathy, LVH
128
aortic ejection kick*
early systolic, just after S1
| aortic stenosis
129
opening snap*
```
early diastolic sound, just after S2
mitral stenosis (or tricuspid)
```
130
systemic approach to EKG
1. Rate
2. Rhythm
3. Axis: look at I and AVF
4. Hypertrophy
5. Infarct
6. ST-T changes (injury/ischemia)
7. Measure interval: PR, QRS, QT
131
RAV
tall R greater than 11mm
132
LAV
deep S in V1 + tall R in V5 = > 35mm
133
Classic Pericarditis
diffused ST elevation
134
if irregularly irregular with no clear P wave
A fib
135
Ischemia on EKG*
ST depression or T wave inversion
136
acute injury on EKG*
ST elevation
137
Look for what abnormal PR interval?*
<120ms
| >200ms
138
Look for what abnormal QRS interval?*
>120ms
| LBBB (V5 and V6) OR RBBB (V1 and V2)
139
Look for what abnormal QT interval?*
> Half of RR interval
140
Difference between PAC and PVC
PAC: non-compensatory pause (not full)
PVC: full compensatory pause, wide QRS
look at the beat after premature one
141
AVNRT
AV nodal re-entry tachycardia
abrupt onset tachycardia
narrow QRS no P wave
rate >150
142
Large P wave
Atrial hypertrophy
143
Most common cause of LAH
Left ventricular hypertrophy
144
Sick Sinus Syndrome
can be slow, fast, or both (Tachy-Brady)
| dec in AV nodal cells
145
Types of PAC's
Paired PAC
| Bigeminal PAC
146
Sinus Arrhythmia
normal changes with respiration
147
Types of Atrial Tachycardia
PSVT: AVNRT or ectopic
| Multiform
148
Atrial Flutter
loop in atrium, rate 250-300bpm
| "saw tooth", "picket fence P" in II, II, AVF
149
Atrial Fibrillation
atrial foci --> mult re-entry points
atrial rate: 350-450 bmp
NO P WAVES
150
Premature Ventricular Contraction
premature contraction from ectopic --> asynchronized
wide QRS
full compensatory pause
151
PVC from RIGHT ventricle
LBBB morphology
| dominant S wave in V1
152
PVC from LEFT ventricle
RBBB morphology
| dominant R wave in V1
153
What is associated with V Tach?*
ISCHEMIA*
ischemia causes re-entrant circuit
hides P wave
154
Torsades de Pointes (TdP)
"party streamer", polymorphic VT
| Triggered by PVC on T wave
155
V Fibrillation*
erratic rhythm from multiple foci
no p wave or properly formed QRS
"bag of worms"
NEED IMMEDIATE DEFIBRILLATION!!! FATAL IN 3-5MIN
156
Brugada Syndrome
congenital channelopathy
| ST Elevation in one lead in V1-V3
157
Commotio Cordis
blunt blow to heart during T wave --> V Fib
158
V Flutter
BIG saw tooth --> goes into V Fib and Asystole
| 250-350 bpm
159
First Line treatment for VT/VF
Implantable cardioverter Defibrillator
160
subendothelial infarction on EKG
ST depression
161
Injury on EKG
ST elevation facing injury >1mm
162
Dx prior MIs
presence of significant Q waves
163
transmural injury on EKG
ST elevation
164
Old infarcts on EKG
Q waves and ST elevations disappear
165
How long does Q waves last?
forever!
166
Inferior leads
II, II, AVF
167
Lateral leads
I, AVL, V5, V6
168
Septal leads
V1-2
169
Apical leads
V3-4
170
Anterior leads
V1-4
171
What is occluded in STEMI: Anterior Wall?
LAD
| higher mortality
172
EKG characteristic of STEMI: Anterior wall
ST elevation
173
Anterolateral leads
I, AVL, V2-5
174
What is occluded in STEMI: Inferior Wall?
Right coronary artery
175
EKG characteristic of STEMI: Inferior wall
II, II, AVF ST Elevation
176
EKG characteristic of STEMI: Lateral wall
I, AVL, V5-6 ST Elevation
177
EKG characteristic of Posterior Wall MI
V1-3 ST DEPRESSION
178
Difference between unstable angina and STEMI/Non-STEMI
Cardiac enzymes normal in unstable angina
179
syncope with exertion is what until proven otherwise?
Cardiac!
180
What to evaluate in the neck for HTN
Carotid bruits, JVD, enlarged thyroid
181
Patients with congestive heart failure and HTN should be on what?*
ACE-I and BB
182
most common cause of secondary increase in LDL
Hypothyroidism
| DM
183
What warrants high intensity statin therapy?*
LDL > 190
184
What is triglyceride level of >1000mg/L at risk for?*
Spontaneous Pancreatitis
185
What Dx test can you investigate abnormal heart sounds?
Echocardiogram
186
pulse pressure*
difference between systolic and diastolic pressure; KEY in opening/closing of valves
187
when does atria contract?
end of diastole
| atrial diastole before ventricle diastole
188
stroke volume
amount of blood ejected by LV with each beat
189
ejection fraction is normally...?
55-70%
190
What is S2 divided into and how is it heard best?
A2, P2
| with diaphragm
191
Physiologic splitting
at S2 with inspiration
A2 before P2 bc blood flow increased to right heart with inspiration
inspiration --> increase venous return --> more filling in right heart --> longer ot eject
192
Paradoxical splitting
opposite of physiological splitting
| A2 FOLLOWS P2 during expiration
193
S3 Gallop
sudden intrinsic limitation of ventricular wall expansion
CHF
"Kentucky"
194
S4 Gallop
atrial contraction hitting a stiff noncompliant wall
"tennessee"
Hypertrophic Cardiomyopathy (HCM), LVH
195
Summation Gallop
both S3 and S4
| sounds like 3 heart beats
196
Aortic ejection click
Early systolic sound – Heard just after S1
abnormally shaped or stenotic aortic valve*
aortic stenosis
197
Opening Snap
Opening of abnormal tricuspid or mitral valve
Early diastolic sound — Heard just after S2
mitral stenosis
198
Friction rub*
pericardial inflammation
199
“Life’s Simple 7”
```
No smoking
Be physically active
Have normal BP
Have normal blood glucose
Have normal total cholesterol
Be a normal weight
Eat a healthy diet
```
200
Effective Refractory Period
ABSOLUTE, allow heart to fill/eject
201
Relative Refractory Period
follows ERP
need bigger stimuli to get AP
get slower and wider APs, not all Na channel recover
202
what keeps HR lower than true intrinsic SA rate?
vagal tone dominant at rest
203
Class I antiarrhythmics
sodium channel blockers:
lidocaine and quinidine
decrease conduction velocity
204
How are ectopic foci created?
non-pacemaker cells becoming hypoxic --> spontaneous depol and automaticity
205
AV Block
Ventricular Bradycardia
| PR interval affected
206
BBB
increase in QRS and change in its shape
207
Global reentry
between atria & ventricles
abnormal accessory pathways (Bundle of Kent)
retrograde AV node
supraventricular tachyarrhythmias - wolf-parkinson
208
What has greater compliance?
Veins
