Cardio Flashcards by tcarlso 3

What defines unstable angina?

New onset in the last 2 weeks
Increasing severity
Pain at rest
Hemodynamic changes with pain

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What defines pathologic Q waves?

I square wide

- 1/3 of the height of the QRS

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Is a myocardial rupture/valve rupture an early or late complication of an MI?

Late

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“Good” or “Bad” prognosis arrhythmia: mobitz type 1

Good

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“Good” or “Bad” prognosis arrhythmia: Mobitz type II

Bad

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“Good” or “Bad” prognosis arrhythmia: narrow complex bradycardia

Good

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“Good” or “Bad” prognosis arrhythmia: PVCs

Good

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“Good” or “Bad” prognosis arrhythmia: persistent tachycardia

bad

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“Good” or “Bad” prognosis arrhythmia: non-sustained VT

Good

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“Good” or “Bad” prognosis arrhythmia: new LBBB

Bad

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What are the complications of an anterior MI? (3)

CHF/Shock
Ruptures
Bad bradycardias

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What causes PR prolongation/blocks in MIs (2)?

AV node ischemia

- Vagal tone

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How can you tell a RV infarct based on leads II and III?

If STE is higher in lead III compared to lead II, more likely to be RV infarct

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How can you tell a RV infarct based on leads V1 and V2? (2)

If STE in V1 more than V2

- If STD in V2 and not V1

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What is the treatment for a myocardial rupture?

Fluid load and surgery

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What is the treatment for an acute VSD 2/2 septal wall rupture?

Unload, IABP, surgery

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What is the treatment for a papillary muscle rupture?

Unload, surgery

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When do you start lytics on a STEMI pt? (3)

CP for over 30 minutes, less than 12 hours
No PCI within 90 minutes
No contraindications

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What are the three broad Sgarbossa criteria?

If J point on same side as QRS complex
If J point over 5 mm on opposite side
J point depression/elevation on the same side

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What are the absolute contraindications for thrombolytics as they relate to the head? (4)

Prior ICH ever
Ischemic stroke last recently
Intracranial neoplasm
Close head or facial trauma

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What is the risk of ICH with thrombolytics, generally?

1-2%

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What are the indications that a thrombolytic worked (3)?

Pain reduced
ST segment lowering
Reperfusion arrhythmia (accelerated idioventricular rhythm)

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How long does accelerated idioventricular rhythm last for, typically?

Less than a minute

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What is the management for idioventricular rhythm?

Observation

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What are the three indications (besides STEMI) for PCI in the setting of ACS?

- Shock - Contraindications to thrombolysis - Failed thrombolysis

What is the pure alpha blocker used in cocaine induced HTN?

Phentolamine

What is the most common infected heart valve in a non-IVDU?

Mitral

What are the two antibiotics used to treat endocarditis?

Vanc and gent

What is the acute treatment for aortic regurgitation?

Afterload reduction, then surgery

What is the de Musset's sign?

Head bobbing from aortic regurg

What is the Quincke's pulse sign?

Pulsatile nail beds from aortic regurgitation

CV collapse in a pregnant women during delivery, has heart murmur = ?

Mitral stenosis

Myocardial ischemia + shock + new murmur = ?

Ruptured chordae tendineae

What is the treatment for a chordae tendinae rupture?

Decrease afterload (nitroprusside) them, call surgery

What are the two most common causes of HF in the developed world?

HTN and ischemia

What are the most common causes of diastolic HF in the developed world?

- HTN - Aortic stenosis - Scarring after MI - Glycosylation of the heart from DM - Ischemia

What is the end result for most diastolic heart failure?

Systolic HF

Who gets pressors in acute HF exacerbations?

Only super sick, hypotensive patients

What is the role of nesiritide in acute HF?

Never indicated ever

What is the most common cause of cor pulmonale?

Left sided HF

What is the most common cardiomyopathy type?

Dilated

What is the functional consequence of dilated cardiomyopathy?

- Poor contraction - Low EF - dilation is a compensation

What is the treatment for dilated cardiomyopathy?

- Remove underlying cause - anticoagulation - Treat CHF

What is the functional consequence of restrictive cardiomyopathy?

- diastolic HF | - fibrosis

Does valsalva increase or decrease the murmur of HOCM?

Increases

Does hand grip/squatting increase or decrease the murmur of HOCM?

Decreases

What position is pericarditis classically better in?

Sitting forward

True or false: pericarditis may have a trop bump

False--myocarditis if this is the case

Pericarditis + trop (+) =?

Myocarditis

What are the stages of pericarditis EKG changes?

1. PR depression, STE diffuse 2. Return to baseline 3. TWI 4. Normalization

What is the common rhythm that myocarditis presents with?

Unresolving sinus tachycardia

How does myocarditis present?

Viral syndrome - CHF - arrhythmias, - Pericarditis

What drug is used to decrease BP emergently?

Diltiazem

Where in the CV system does nitroprusside primarily have an effect?

Dilates arteries, more so than veins

What is the relative half-life of nitroprusside?

minutes

What is the major side effect of nitroprusside?

Cyanide poisoning, especially if poor renal function

What is the drug of choice for acute reduction of HTN with neuro s/sx? Why?

- Nicardipine | - Little direct heart effects

What are the components of the CHESS mnemonic for syncope?

- CHF - HCT less than 30% - EKG abnormalities - SOB - SBP less than 90 mmHg

What are the 5 concerning EKG changes for patients with syncope?

- Ischemia - WPW - Brugada - HOCM - QTc prolongation

What are the EKG changes associated with HOCM?

- Needle like Q waves | - LVH

What is the bacteria that is responsible for plague?

Yersinia Pestis

Blue toe syndrome = ?

Peripheral emboli from aorta

What is the best way to determine the cause of acute limb ischemia?

Feel pulses and work proximally to determine if local or from aorta

What is the treatment for an acutely ischemic limb?

Heparin

What are the components of Virchow's triad?

- Stasis - Hypercoagulable - Endothelial damage

What is the dosing for diltiazem for SVT? (2)

- 15-20 mg/ 2 minutes | - 2.5 mg/min total 50 mg

What is the simple way to remember cardioversion doses of electricity?

50 J the double until you get response

What is the treatment for unstable a-fib?

- Shock | - rate control

What does WPW with a-fib look like?

Irregular wide and narrow, super fast

Where is the reentrant circuit most commonly found with SVT?

Within the AV node

What are the three major causes of bradycardia? (DIE)

- Electrolytes - Drugs - Ischemia

What type of QRS duration (wide or narrow) will atropine work well for? Why?

-Narrow, since it is likely amenable to changes in vagal tone

Atropine + ischemia = ?

Death

How do you make an epi drip?

10 mL of 1:10000 epi in 1 L NS = 1 mcg/mL | -Run at 2-10 mL/min

Cardio Flashcards

(74 cards)