Term
| 1st degree AV block (define and treat) |
|
Definition
long PR; (> 0.20 or one large box)
-benign, no treatment necc. The AV node will pick up at a lower point. |
|
|
Term
| 2nd degree Type I AV nodal block (2 other names, define and treat) |
|
Definition
1. Mobitz I, 2. Wenkebach
PR gradually lengthens with each cycle until the last P wave in the series does not produce a QRS.(dropped beat)
-also benign, no treatment necc. The AV node will pick up at a lower point. |
|
|
Term
| 2nd degree Type II AV nodal block (other name, define and treat) |
|
Definition
-Mobitz II
-some P waves don’t produce a QRS response. (regularly dropped beats)
-may produce a 3:1 pattern or even
higher AV ratio
tx:ventricular pacing is required because Type II can develop to third degree block. |
|
|
Term
| 3 types of dilated cardiomyopathy |
|
Definition
| Idiopathic, toxic (alcohol), postpartum |
|
|
Term
| 3rd degree AV nodal block (define and treat) |
|
Definition
-No A-V conduction (AV dissociation)
-QRS is wide
-ventricular rate is slower (< 50 bpm)
-requires permanent pacer if chronic or episodic. |
|
|
Term
| Acute coronary syndromes (ACS) |
|
Definition
Unstable Angina [Pectoris] (UAP)
Myocardial Infarction (MI) |
|
|
Term
| Acute management of a wide complex tachycardia in a hemodynamically stable patient |
|
Definition
IV procainamide, sotalol, or amiodarone is acceptable.
(antiarrhythmic agents) |
|
|
Term
| Acute management of a wide complex tachycardia in a hemodynamically unstable patient |
|
Definition
|
|
Term
| Adverse effects of beta blockers |
|
Definition
- decreased cardiac output
- bronchial constriction
- may cause bronchospasm
- bradycardia
- heart block
- hypotension |
|
|
Term
|
Definition
|
|
Term
Alpha-adrenergic blockers
examples |
|
Definition
- At low doses, alpha-adrenergic receptor blockers may be used as monotherapy in the treatment of hypertension.
- At higher doses, they may cause sodium and fluid to accumulate.
- Phentolamine (Regitine) |
|
|
Term
Beta-adrenergic blockers
examples |
|
Definition
Inhibit chronotropic, inotropic, and vasodilatory responses to beta-adrenergic stimulation.
- Labetalol (Normodyne, Trandate)
- Esmolol (Brevibloc)
- Metoprolol (Lopressor, Toprol XL) |
|
|
Term
Calcium channel blockers
example |
|
Definition
- cause vascular smooth muscle to relax, which in turn leads to vasodilation and a corresponding drop in blood pressure.
- verapamil
- Diltiazem (Cardizem, Dilacor, Tiamate) |
|
|
Term
| Antibiotic prophylaxis against bacterial endocarditis |
|
Definition
|
|
Term
| Anticoagulation for stroke prevention in a-fib |
|
Definition
| Warfarin more effective than ASA but higher bleeding risk, needs monitoring. |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| Ascites, anorexia and leg edema are signs of which cardiac event? |
|
Definition
R ventricular failure
(backs up to the body) |
|
|
Term
|
Definition
hypertrophic cardiomyopathy
In response to intensive endurance training, there can be physiologic increases in left ventricular wall thickness, cavity size and mass |
|
|
Term
| Best place to hear valvular murmurs |
|
Definition
|
|
Term
|
Definition
| thromboangiitis obliterans |
|
|
Term
|
Definition
| coronary artery bypass graft |
|
|
Term
| CVD Drugs which lessen symptoms |
|
Definition
Nitrates (vasodialators)
Calcium channel blockers (vasodialators)
Beta Blockers (blocks adrenergics)
|
|
|
Term
| CVD drugs proven to prolong life |
|
Definition
-Antiplatelet agents (Aspirin, clopidogrel)
-Lipid-lowering, especially statins
-ACE inhibitors
-Beta blockers |
|
|
Term
|
Definition
• Hypertension
• Obesity
(body mass index >30 kg/m2)
• Dyslipidemia
• Diabetes mellitus
• Cigarette smoking
• Physical inactivity
• Microalbuminuria, estimated
glomerular filtration rate <60 mL/min
• Age (>55 for men, >65 for women)
• Family history of premature CVD
(men age <55, women age <65) |
|
|
Term
| Can cardiovert pt if a-fib is known to begin in __-__hour. |
|
Definition
|
|
Term
| Cardioversion of a-fib (two ways) |
|
Definition
-Electrical most effective
-RX: ibutilide and propafenon moderately effective. |
|
|
Term
| Cause of hypertrophic cardiomyopathy |
|
Definition
hereditary - autosomal dominant trait with incomplete penetrance
-genetic disease of the cardiac sarcomere |
|
|
Term
|
Definition
• Improper BP measurement
• Excess sodium intake
• Inadequate diuretic therapy
• Medication
– Inadequate doses
– Drug actions and interactions (e.g., nonsteroidal anti-inflammatory drugs
(NSAIDs), illicit drugs, sympathomimetics, oral contraceptives)
– Over-the-counter (OTC) drugs and herbal supplements
• Excess alcohol intake
• Identifiable causes of hypertension |
|
|
Term
| When would conservative strategy be used vs catheterization? |
|
Definition
-TIMI risk score 0 to 2
-Lacking the more s/s of urgent or immediate referral to cath lab |
|
|
Term
| Decision to treat sustained V-tach and the treatment for each. |
|
Definition
-significant LV dysfunction, subsequent sudden death is common. ---treat with implantable cardioverter-defibrillator devices (ICDs)
-preserved LV function, the mortality rate is lower
---Treatment with amiodarone, optimally in combination with a b-blocker. |
|
|
Term
|
Definition
| Diastolic dysfunction refers to cardiac dysfunction in which left ventricular filling is abnormal and is accompanied by elevated filling pressures. |
|
|
Term
|
Definition
| Diastolic dysfunction refers to cardiac dysfunction in which left ventricular filling is abnormal and is accompanied by elevated filling pressures. |
|
|
Term
Dilated cardiomyopathy (define)
What is the ejection fraction? |
|
Definition
Dilated cardiomyopathy is characterized by dilatation and impaired contraction of one or both ventricles...requires evidence of dilatation and impaired contraction
(left ventricular ejection fraction <40 percent) |
|
|
Term
| Dysfunction of dilated cardiomyopathy |
|
Definition
| systolic function that may or may not develop overt heart failure. |
|
|
Term
|
Definition
-characterized by wide QRS complexes that differ in morphology from the patient's normal beats
-usually not preceded by a P wave, although retrograde ventriculoatrial conduction may occur. |
|
|
Term
| Echo finding after large MI |
|
Definition
| severe wall motion abnormalities seen as hypokinesis, decrease L ventricular fx |
|
|
Term
|
Definition
|
|
Term
|
Definition
Grade 1 murmur is heard in ideal circumstances.
Grade 2 murmur is louder
Grade 3 murmur is loud but not accompanied by a thrill
Grade 4 murmur is loud and associated with a palpable thrill
Grade 5 murmur is associated with a thrill, and the murmur can be heard with the stethoscope partially off the chest.
Grade 6 murmur is audible without a stethoscope. |
|
|
Term
|
Definition
| Mitral stenosis, tachycardia. |
|
|
Term
Fixed split S2 and grade II-IV systolic ejection murmur over pulmonic region...best test:
EKG, CXR, echo or cath |
|
Definition
|
|
Term
|
Definition
| L ventricular sys dysfunction (Heart failure) |
|
|
Term
|
Definition
|
|
Term
|
Definition
Aortic stenosis
Mitral regurg
pulmonic stenosis
tricuspid regurg |
|
|
Term
|
Definition
Aortic regurg
Mitral stenosis
pulmonic regurg
tricuspid stenosis |
|
|
Term
|
Definition
|
|
Term
| HTN drug tx for Chronic kidney disease |
|
Definition
|
|
Term
|
Definition
| THIAZ, BB, ACEI, ARB, CCB |
|
|
Term
| HTN drug tx for Heart failure |
|
Definition
| THIAZ, BB, ACEI, ARB, aldosterone antagonist |
|
|
Term
| HTN drug tx for High CVD risk |
|
Definition
|
|
Term
|
Definition
| BB, ACEI, aldosterone antagonist |
|
|
Term
| HTN drug tx for Recurrent stroke prevention |
|
Definition
|
|
Term
| Long-term medical management for patients with PSVT |
|
Definition
| radiofrequency catheter ablation |
|
|
Term
| Hallmark of Wolff-Parkinson-White syndrome |
|
Definition
Short PR with a Delta wave
--frequently causes paroxysmal supraventricular tachycardia |
|
|
Term
| Heart defect secondary to rheumatic fever? |
|
Definition
|
|
Term
|
Definition
| acute ETOH abuse or ETOH withdrawal predisposing onset of a-fib |
|
|
Term
| How do you cardiovert a-fib? |
|
Definition
-initial shock with 100-200 J is administered in synchrony with the R wave.
-an additional attempt with 360 J, if indicated.
-If this fails,
---intravenous ibutilide (1 mg over 10 minutes, repeated in 10 minutes if necessary)
---or intravenous procainamide (500-1000 mg administered at a rate of 20 mg/min with careful monitoring of blood pressure |
|
|
Term
| How do you count the rate using big boxes on an ECG? |
|
Definition
300, 150, 100, 75, 60, 50
300 bpm = one box = 1 beat/0.20 sec.
150 bpm = two boxes = 1 beat/0.40 sec.
100 bpm = three boxes = 1 beat/0.60 sec.
75 bpm = four boxes = 1 beat/0.80 sec.
60 bpm = five boxes = 1 beat/1.0 sec.
50 bpm = six boxes = 1 beat/1.20 sec. |
|
|
Term
| How do you treat PVCs if necc? What should be avoided and why? |
|
Definition
B-blockers
Avoid class I and III agents, are effective in reducing ventricular premature beats but often cause side effects and may exacerbate serious arrhythmias. |
|
|
Term
| How is acute V-tach treated? |
|
Definition
synchronized DC cardioversion with 100-360 J should be performed immediately.
If the patient is tolerating the rhythm,
lidocaine, 1 mg/kg as an intravenous bolus injection,
or amiodarone 150 mg as a slow intravenous bolus over 10 minutes, followed by a slow infusion of 1 mg/min for 6 hours and then a maintenance infusion of 0.5 mg/min for an additional 18-42 hours can be used.
If the ventricular tachycardia recurs, supplemental amiodarone infusions of 150 mg over 10 minutes can be given.
If the patient is stable, intravenous procainamide, 20 mg/min intravenously (up to 1000 mg), followed by an infusion of 20-80 mcg/kg/min could also be tried.
Empiric magnesium replacement (1 g intravenously) may help.
Ventricular tachycardia can also be terminated by ventricular overdrive pacing.
If the ventricular tachycardia recurs, supplemental amiodarone infusions of 150 mg over 10 minutes can be given. If the patient is stable, intravenous procainamide, 20 mg/min intravenously (up to 1000 mg), followed by an infusion of 20-80 mcg/kg/min could also be tried. Empiric magnesium replacement (1 g intravenously) may help. Ventricular tachycardia can also be terminated by ventricular overdrive pacing, and this approach is useful when the rhythm is recurrent. |
|
|
Term
| Obstructive Hypertrophic Cardiomyopathy can cause |
|
Definition
|
|
Term
| Hypertrophic cardiomyopathy |
|
Definition
| A condition in which the heart muscle become thick. The thickening makes it harder for the heart to work. |
|
|
Term
| Ideal diagnostic test for f/u of AAA repair |
|
Definition
|
|
Term
| Immediate referral to the catheterization laboratory |
|
Definition
-Hemodynamic instability or cardiogenic shock
-Severe left ventricular dysfunction or heart failure
-Recurrent or persistent rest angina despite intensive medical therapy
-New or worsening mitral regurgitation or new ventricular septal defect
-Sustained ventricular arrhythmias |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| Initial onset of cardiac enzymes, early to later. |
|
Definition
| Myoglobin, Troponin, CK/CKMB |
|
|
Term
| Invasive treatment for WPW, AV nodal re-entrant tachycardia, atrial flutter, and V-tach |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Labs for initial onset a-fib? |
|
Definition
|
|
Term
| Leads of lateral infarction |
|
Definition
|
|
Term
|
Definition
Aortic stenosis
Mitral regurg |
|
|
Term
| Lown-Ganong-Levine syndrome (ECG findings and cause) |
|
Definition
| -short PR interval -normal QRS morphology -Accessory pathways between the atria and the ventricle that avoid the conduction delay of the AV node. |
|
|
Term
|
Definition
pain @ rest
Pain lasting > 30 min
nausea
diaphoresis |
|
|
Term
| Med found to reduce mortality post MI |
|
Definition
|
|
Term
| Most common early sign of L ventricular failure? |
|
Definition
|
|
Term
| Most noninvasive procedure for evaluating angina pectoris. |
|
Definition
| Excercise electrocardiography testing |
|
|
Term
| Murmur associated with hypertrophic cardiomyopathy |
|
Definition
| AS-like murmur increases w/ Valsalva |
|
|
Term
|
Definition
| Non-ST elevation myocardial infarction |
|
|
Term
| Name the cardiac reasons at risk for bacterial endocarditis. |
|
Definition
| 1. artificial (prosthetic) heart valve 2. Hx of previous endocarditis 3. Heart valves damaged (scarred) by conditions such as rheumatic fever (rheumatic fever = mitral stenosis) 4. various kinds of congenital heart defects 5. hypertrophic cardiomyopathy 6. people who have had a heart transplant who develop a heart valve abnormality |
|
|
Term
| Normal Q-wave are seen in leads... |
|
Definition
|
|
Term
|
Definition
| represents the depolarization impulse across the atria |
|
|
Term
| P-wave in Paroxysmal atrial tachycardia |
|
Definition
| different from sinus but no other changes. |
|
|
Term
| PE finding with longstanding varicose veins and/or venous insufficiency. |
|
Definition
| hyperpigmention and thinning of the overlying skin. |
|
|
Term
| ECG findings in a-flutter |
|
Definition
| Atrial rate almost always 300 Vent. rate usually 150 (2:1) “Sawtooth” flutter wave |
|
|
Term
| PE findings with 3rd degree AV block. |
|
Definition
-S1 varies in intensity
-a changing SBP level
-cannon venous pulsations in the neck |
|
|
Term
| PE findings with dilated cardiomyopathy |
|
Definition
-S3 gallop (not sensitive)
-pulmonary congestion
-peripheral edema
-elevated jugular venous pressure |
|
|
Term
| PE findings with hypertrophic cardiomyopathy |
|
Definition
An increase in intensity, due to enhancement of obstruction, is seen with going to upright posture from a squatting, sitting, or supine position.
A decrease in intensity, due to attenuation of obstruction, is heard after going from a standing to a sitting or squatting position, with handgrip, and following passive elevation of the legs.
S2 split is paradoxic if there is severe outflow obstruction.
A third or fourth heart sound is common in young patients but rarely heard in later life.
There is often a diffuse, forceful LV apical impulse. |
|
|
Term
|
Definition
|
|
Term
| PSVT, short-term management |
|
Definition
intravenous adenosine
calcium channel blockers
beta-blockers |
|
|
Term
|
Definition
| percutaneous transluminal coronary angioplasties |
|
|
Term
| Type of pain associated with venous insufficency? |
|
Definition
|
|
Term
|
Definition
| Papilledema is an optic disc swelling that is secondary to elevated intracranial pressure |
|
|
Term
| Pleuritic substernal chest pain, SOB, worse lying, better sitting. |
|
Definition
|
|
Term
| Portion of the heart affected by hypertrophic cardiomyopathy. |
|
Definition
-often asymmetrical
-one part of the heart is thicker than the other parts. |
|
|
Term
| Possible CXR finding for atrial septal defect |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Presentation of restrictive cardiomyopathy? |
|
Definition
| Dyspnea, right-sided heart failure, and fatigue. |
|
|
Term
| Presurgical tx of varicose veins |
|
Definition
| elastic support stockings and elevation |
|
|
Term
| Pulmonic stenosis is most commonly heard where? |
|
Definition
| 2nd L intercostal space, pulmonic area |
|
|
Term
|
Definition
all these three waves represent the ventricular depolarization
-the downward stroke followed by and upward stroke is called Q wave
-the upward stroke is called R wave
-any downward sroke preceded by an upward stroke is called S wave |
|
|
Term
| Rate and rhythm of V-tach |
|
Definition
-usual rate is 160-240 beats/min
-moderately regular |
|
|
Term
| ST depression and T-wave inversion |
|
Definition
| subendocardial ischemia or infarction |
|
|
Term
| Sick Sinus Syndrome (second name, define and treat) |
|
Definition
Tachy-Brady syndrome
Baseline bradycardia +/- AV block punctuated by tachyarrhythmias
Tx: pacer for bradycardia + beta blocker for tachyarrhythmias if needed |
|
|
Term
|
Definition
|
|
Term
|
Definition
-ST Segment depression
-Occurs with exertion
-Resolves after rest
-< 15-20 min
-Smooth plaques
-Old MI may be a clue
-T-wave inversions may
be present |
|
|
Term
| Sx of Lown-Ganong-Levine syndrome and Wolff-Parkinson-White syndrome |
|
Definition
-palpitations
-light-headedness
-syncope |
|
|
Term
|
Definition
| Surgical procedure that destroys nerves in the sympathetic nervous system. The procedure is done to increase blood flow and decrease long-term pain in certain diseases that cause narrowed blood vessels. |
|
|
Term
|
Definition
| Systolic dysfunction is characterized by a decrease in myocardial contractility |
|
|
Term
|
Definition
| represents the repolarization of the ventricles |
|
|
Term
| TIMI risk factors for severity of unstable angina or NSTEMI. (Higher score would get cath'd) |
|
Definition
-Age 65 years
-Presence of at least three risk factors for CHD
-Prior coronary stenosis of 50 percent
-Presence of ST segment deviation on admission ECG
-At least two anginal episodes in prior 24 hours
-Elevated serum cardiac biomarkers
-Use of aspirin in prior seven days |
|
|
Term
|
Definition
| TIMI risk score was developed in an attempt to risk stratify patients with unstable or NSTEMI. |
|
|
Term
| The 1st heart sound (S1) (represents ____ and best heard ____) |
|
Definition
| It represents the closure of mitral and tricuspid valves. It is best heard in mitral and tricuspid areas. |
|
|
Term
| The 2nd heart sound (S2). (Represents ______ best heard _______) |
|
Definition
| Represents the closure of the aortic and pulmonary valves. It is best heard in the aortic area (right 2nd intercostal), pulmonic area (left 2nd intercostal) and Erb's point (left 3rd intercostal). |
|
|
Term
| The 3rd heart sound (S3) (Represents _____, best heard _____) |
|
Definition
| Occurs shortly after S2. It is early diastolic and occurs during passive diastolic filling. It Is low pitched, has a long duration and is best heard with the bell in the mitral and tricuspid areas. |
|
|
Term
| The 4th sound (S4) (Represents ______ best heard ____ ) |
|
Definition
Occurs just before S1. It is produced by the augmented diastolic ventricular filling near the end of the diastole and is caused by atrium contraction. It is loud due to a stiff ventricle.
Always abmormal.
low-pitched sound and best heard with the bell of the stethoscope.
The ventricle can made stiff by : aortic stenosis, acute ischemia, hypertensive heart disease and myocard infarct. |
|
|
Term
| Thromboangiitis obliterans |
|
Definition
| Disorder that leads to obstruction of the blood vessels of the hands and feet. The blood vessels become constricted or totally obstructed because of the inflammation and clots which reduces the availability of blood to the tissues.[image] |
|
|
Term
| Torsades de pointes ECG findings |
|
Definition
| QRS morphology twists around the baseline |
|
|
Term
| Torsades de pointes may occur spontaneously in the setting of |
|
Definition
| hypokalemia or hypomagnesemia or after any drug that prolongs the QT interval |
|
|
Term
| Treatment of non-sustained ventricular tachycardia |
|
Definition
b-Blockers reduce these risks in patients who have coronary disease with significant LV systolic dysfunction (EFs < 35-40%)
an implantable defibrillator may be indicated. |
|
|
Term
| Two initial tx for thromboangiitis obliterans and one long-term tx |
|
Definition
initial: smoking cessation and sympathectomy
long-term: exercise program |
|
|
Term
| Typical EKG findings in pericarditis |
|
Definition
| DIFFUSE concave-upward ST-segment elevation and, occasionally, PR-segment depression. |
|
|
Term
|
Definition
-Occurs at rest
-Ulcerated plaques
-Unpredictable
- > 15-20 min |
|
|
Term
| Urgent referral to the catheterization laboratory |
|
Definition
-Prior PCI within six months or prior CABG
-New or presumably new ST segment depression
-Elevated cardiac enzymes
-Recurrent angina or ischemia at rest or with low level activity despite intensive antiischemic therapy or with the development of heart failure symptoms.
-Reduced left ventricular ejection fraction
-TIMI risk score greater than 2 |
|
|
Term
| Emergent vasodilators with examples and MOA |
|
Definition
- Reduce systemic vascular resistance (SVR), decreasing afterload and improving cardiac output.
- Nitroprusside (Nipride) - Arteriolar and venous dilator.
- Fenoldopam (Corlopam) - agonist for D1-like dopamine receptors and binds with moderate affinity to [image]2-adrenoceptors.
- Enalaprilat (Vasotec IV) - ACE-inhibitor with a rapid onset of action and long duration of action.
- Labetalol (Transdate) - Combined beta-adrenergic (B1 and B2) and alpha-adrenergic blocker. |
|
|
Term
| Ventricular tachycardia is a frequent complication of ___________ and _________ but may occur in _______, ________, _________, and ________ |
|
Definition
AMI
dilated cardiomyopathy
chronic coronary disease
hypertrophic cardiomyopathy
mitral valve prolapse
myocarditis
most other forms of myocardial disease. |
|
|
Term
| Ventricular tachycardia is defined as |
|
Definition
| three or more consecutive PVCs (premature ventricular beats). |
|
|
Term
| What are nitrates good for if they do not improve mortality |
|
Definition
| ischemic pain and lowering BP |
|
|
Term
| What decreases occasional PVCs? |
|
Definition
|
|
Term
| What drugs can cause 1st degree AV block? |
|
Definition
digitalis
calcium channel blockers
b-blockers
other sympatholytic agents |
|
|
Term
| What is Bueger's dz and who gets it? |
|
Definition
| intermittent claudication secondary to insufficiency of veins and arteries. found commonly in young men who smoke. |
|
|
Term
| What is PSVT? (Drug that can cause it too) |
|
Definition
-digitalis toxicity
-reentry circuit most commonly involves dual pathways (a slow and a fast pathway) within the AV node.
-reentry is due to an accessory pathway between the atria and ventricles. |
|
|
Term
Two types of bigeminy, trigeminy quadrigeminy.
What do they confirm? |
|
Definition
Premature atrial contraction (PAC) and premature ventricle contraction (PVC)
-arrhythmias in which every second, third beat or forth beat is premature
-these patterns confirm a reentry mechanism for the ectopic beat. |
|
|
Term
| What is relieved by sitting up and leaning forward? |
|
Definition
|
|
Term
| What must be present for the dx of malignant htn? |
|
Definition
| papilledema must be present |
|
|
Term
| When does CPKMB begin to rise, what time does it peak, when does it return to baseline? How specific? |
|
Definition
Begin: 4-6h
Peak: 14-30h
Back to baseline: 48-72h
More specific |
|
|
Term
| When does Troponin begin to rise, what time does it peak, when does it return to baseline? How specific? |
|
Definition
Begin: 3-12h
Peak: 8-12h
Back to baseline: 5-14 days
Highly specific |
|
|
Term
| When does myoglobin begin to rise, what time does it peak, when does it return to baseline? How specific? |
|
Definition
Begin: 1-4h
Peak: 6-7h
Back to baseline: 24h
Poor specificity |
|
|
Term
| When is acute V-tach treated? |
|
Definition
| if ventricular tachycardia causes hypotension, heart failure, or myocardial ischemia |
|
|
Term
| When should abx prophylaxis be given for bacterial endocarditis @ dental procedure? |
|
Definition
|
|
Term
| When would Nafcillin be used in bacterial endocarditis? |
|
Definition
| empiric tx while cx are pending |
|
|
Term
| Which is more likely heard with angina? Split S1 or S3 |
|
Definition
| gallop rhythm with S3 (severe dz: third heart sound, a consequence of the increased ventricular filling volume that is ejected into the left ventricle under higher than normal pressure) |
|
|
Term
| Why is IVP bad in renal insufficiency? |
|
Definition
| contrast dye can cause renal failure |
|
|
Term
| Why is an apical systolic murmur associated with classic angina? |
|
Definition
| transient mitral regurg secondary to papillary muscle dysfunction |
|
|
Term
|
Definition
Risk of stroke
Improved systolic function |
|
|
Term
| Why would a heart appear larger with pericarditis? |
|
Definition
| associated pericardial effusion |
|
|
Term
| Wolff-Parkinson-White syndrome (ECG findings and cause) |
|
Definition
| -short PR interval -early delta wave at the onset of the wide, slurred QRS complex -direct connections between the atria and ventricle through Kent bundles |
|
|
Term
| absence of pain in association with ulcers. |
|
Definition
|
|
Term
| cardiovascular autonomic nervous system dysfunction (define and treat) |
|
Definition
Disease or malfunction of the autonomic nervous system (ANS). The autonomic nervous system controls heart rate and blood pressure.
Depresson is one cause.
Give beta-blocker |
|
|
Term
| anterior MI reciprocal leads |
|
Definition
|
|
Term
|
Definition
|
|
Term
| anterolateral MI reciprocal leads |
|
Definition
|
|
Term
| anterolateral wall artery |
|
Definition
| Left Anterior Decending, circumflex |
|
|
Term
|
Definition
|
|
Term
|
Definition
| Left Anterior Decending, Right Coronary Artery |
|
|
Term
| cause of 2nd degree, Type II AV nodal block |
|
Definition
| almost always due to organic disease involving the infranodal conduction system |
|
|
Term
| cause of 3rd degree AV nodal block |
|
Definition
(Complete heart bllock)
AV Node is completely blocked, often due to a lesion distal to the His bundle and associated with bilateral bundle branch block. |
|
|
Term
| cause of Restrictive cardiomyopathy |
|
Definition
|
|
Term
| cause of sx in hypertrophic cardiomyopathy |
|
Definition
-LV outflow tract obstruction at rest
-LV outflow tract obstruction that is present only with provocation, such as exertion or straining
-Impaired myocardial function in the absence of obstruction
-Arrhythmias or conduction delay
-Impaired filling due to diastolic dysfunction |
|
|
Term
| causes for precordial thrill |
|
Definition
| aortic stenosis, patent ductus arteriosus, ventricular septal defect and mitral stenosis. |
|
|
Term
|
Definition
-COPD
-rheumatic or coronary heart disease, --CHF
- atrial septal defect (ASD)
-surgically repaired congenital heart disease |
|
|
Term
|
Definition
| affecting the time or rate, as the rate of contraction of the heart. |
|
|
Term
| classic ECG findings for transmural MI |
|
Definition
-ST segment elevation with tall T-waves
THEN
-T-wave inversion and wide Q-waves |
|
|
Term
| classic murmur of mitral regurgitation |
|
Definition
| high-pitched holosystolic murmur beginning with the first heart sound and extending to the second heart sound |
|
|
Term
| complication of varicose veins requiring surgical intervention |
|
Definition
|
|
Term
| criteria for Lown-Ganong-Levine Syndrome |
|
Definition
1. PR interval less than 0.12 second
2. normal QRS upstroke and duration
3. paroxysmal supraventricular tachycardia.
--> NOT atrial fibrillation or atrial flutter. |
|
|
Term
| criteria for Lown-Ganong-Levine Syndrome |
|
Definition
1. PR interval less than 0.12 second
2. normal QRS upstroke and duration
3. paroxysmal supraventricular tachycardia.
--> NOT atrial fibrillation or atrial flutter. |
|
|
Term
| diagnostic study of choice for AAA |
|
Definition
|
|
Term
| difference of sustained vs non-sustained V-tach |
|
Definition
non-sustained < 30 seconds
sustained > 30 seconds |
|
|
Term
| drug for isolated hypertriglyceridemia |
|
Definition
|
|
Term
| echo findings in heart failure |
|
Definition
-elevated left ventricular end-diastolic pressure
-reduced left ventricular ejection fraction |
|
|
Term
| eye finding with long-term, uncontrolled HTN |
|
Definition
|
|
Term
| fixed split S2 and grade II-IV systolic ejection murmur over pulmonic region |
|
Definition
|
|
Term
| four types of vavular heart dz |
|
Definition
Aortic stenosis
Aortic regurgitation
Mitral stenosis
Mitral regurgitation |
|
|
Term
| functional classification of heart dz (NY classification) |
|
Definition
Class I: No limitation of physical activity. Ordinary physical activity does not cause undue fatigue, dyspnea, or anginal pain.
Class II: Slight limitation of physical activity. Ordinary physical activity results in symptoms.
Class III: Marked limitation of physical activity. Comfortable at rest, but less than ordinary activity causes symptoms.
Class IV: Unable to engage in any physical activity without discomfort. Symptoms may be present even at rest. |
|
|
Term
| hallmark of mitral valve prolapse. |
|
Definition
|
|
Term
| harsh sys murmur heard @ 2nd R intercostal space |
|
Definition
|
|
Term
| holosystolic, blowing murmur |
|
Definition
|
|
Term
| holosystolic, blowing murmur |
|
Definition
|
|
Term
| hypertrophic cardiomyopathy |
|
Definition
| genetic disorder characterized by disproportionate hypertrophy of the left ventricle, and occasionally of the right ventricle |
|
|
Term
| increased frequency of ventricular premature beats during exercise is associated with... |
|
Definition
| a higher risk of cardiovascular mortality |
|
|
Term
| inferior MI reciprocal leads |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| affecting the force or energy of muscular contractions. |
|
|
Term
| lateral MI reciprocal leads |
|
Definition
|
|
Term
|
Definition
aortic regurg
mitral stenosis |
|
|
Term
| lifestyle risks for developing PACs |
|
Definition
| smoking, alcohol and high-stress. |
|
|
Term
|
Definition
| Between L ventricle and aorta |
|
|
Term
|
Definition
|
|
Term
| location of pulmonic valve |
|
Definition
| between R ventricle and Pulmonary artery |
|
|
Term
| location of tricuspid valve |
|
Definition
|
|
Term
| major factor of ankle ulcer formation? |
|
Definition
|
|
Term
| major factor of ankle ulcer formation? |
|
Definition
|
|
Term
| major factor of ankle ulcer formation? |
|
Definition
|
|
Term
|
Definition
characterized by:
- papilledema of the ocular fundus with vascular exudative and hemorrhagic lesions,
- medial thickening of small arteries and arterioles
- left ventricular hypertrophy. |
|
|
Term
|
Definition
| HMG CoA reductase inhibitor |
|
|
Term
|
Definition
-theophylline
-b-adrenergic agonists |
|
|
Term
|
Definition
|
|
Term
| murmur associated with dilated cardiomyopathy |
|
Definition
| mitral or tricuspid regurg murmur |
|
|
Term
| name the AV nodal blocks (you get to define them later!) |
|
Definition
1st degree
2nd degree
Mobitz I (Wenkebach)
Mobitz II
3rd degree |
|
|
Term
|
Definition
|
|
Term
| occlusive polyarteritis w/predilection for the aortic arch. |
|
Definition
|
|
Term
|
Definition
| The inability to breathe easily unless one is sitting up straight or standing erect. |
|
|
Term
| pain in the saphenous veins |
|
Definition
| superficial thrombophlebitis |
|
|
Term
| pain located distally in the feet and toes is associated with.... |
|
Definition
| acute arterial occlusions |
|
|
Term
| paleness, pain and pulselessness |
|
Definition
|
|
Term
| paroxysmal nocturnal dyspnea |
|
Definition
|
|
Term
| pathogen of rheumatic fever? |
|
Definition
|
|
Term
| pathogen of viral myocarditis |
|
Definition
|
|
Term
| pathological causes of a-fib |
|
Definition
-rheumatic and other forms of valvular heart disease
-dilated cardiomyopathy
-Atrial septal defct (ASD)
-hypertension
-coronary heart disease
-may be the initial presenting sign in thyrotoxicosis
-Pericarditis
-chest trauma
-thoracic or cardiac surgery
-pulmonary disease |
|
|
Term
| physical finding and most common cause of secondary htn |
|
Definition
| abd bruit caused by atherosclerosis (stenosis) of renal artery. (Most common cause of secondary HTN.) |
|
|
Term
|
Definition
|
|
Term
|
Definition
| pulmonary stenosis and tricuspid regurg |
|
|
Term
| radiation of classic murmur of mitral regurgitation |
|
Definition
|
|
Term
| reversible precipitating causes of sustained V-tach |
|
Definition
-acute myocardial infarction or ischemia
-electrolyte imbalance
-drug toxicity, etc |
|
|
Term
|
Definition
pulmonary regurg
tricuspid stenosis |
|
|
Term
|
Definition
|
|
Term
|
Definition
| venous stasis, trauma (injury to vessel wall), hypercoagulability (obesity) |
|
|
Term
|
Definition
-Warfarin anticoagulation
-Maintaining sinus rhythm with amiodarone
-Rate control with:
---Beta blockers
---CCBs (Verapamil, Diltiazem)
---Digoxin |
|
|
Term
|
Definition
-Warfarin anticoagulation
-Maintaining sinus rhythm with amiodarone
-Rate control with:
---Beta blockers
---CCBs (Verapamil, Diltiazem)
---Digoxin |
|
|
Term
|
Definition
-Warfarin anticoagulation
-Maintaining sinus rhythm with amiodarone
-Rate control with:
---Beta blockers
---CCBs (Verapamil, Diltiazem)
---Digoxin |
|
|
Term
| s/s hypertrophic cardiomyopathy |
|
Definition
-Dyspnea on exertion (most common)
-Orthopnea and paroxysmal nocturnal dyspnea
-Chest pain
-Presyncope and syncope
-Palpitation
-Postural lightheadedness
-Fatigue |
|
|
Term
|
Definition
| chills, fever, malaise. Red streak from wound or area of cellulitis. Proximal nodes are enlarged and tender. |
|
|
Term
| secondary cause of cardiac hypertrophy |
|
Definition
Fabry disease
-X-linked recessive glycolipid storage disease.
-rare |
|
|
Term
| signs & sx aortic aneurysm |
|
Definition
| mid-abd or LBP w/pulsatile abd mass |
|
|
Term
|
Definition
| -Fast, narrow, regular rythm -Sometimes see retrograde p-waves (they follow the QRS) -begin and end abruptly and may last a few seconds to several hours or longer. -HR 160-220 beats/min -perfectly regular -P wave usually differs in contour from sinus beats |
|
|
Term
| signs/sx thrombophlebitis |
|
Definition
| induration, erythema & dull pain locally or in only one extremity. Possible fever and hx trauma. |
|
|
Term
|
Definition
| dilated, tortuous, superficial veins associated w/ fatigue, and aching BILATERAL discomfort. |
|
|
Term
| signs/sx venous insufficiency |
|
Definition
| edema of affected extremity and ulceration at or above the ankle. |
|
|
Term
| surgical option for a-fib |
|
Definition
-Pulmonary vein ablation,
-radiofrequency AV node ablation and permanent pacing ensure rate control |
|
|
Term
|
Definition
asymptomatic
or
weakness and/or dyspnea |
|
|
Term
|
Definition
-Patients may be asymptomatic except
-awareness of rapid heart action
-mild chest pain
-shortness of breath, |
|
|
Term
| sx of dilated cardiomyopathy |
|
Definition
-progressive dyspnea with exertion
-impaired exercise capacity
-orthopnea
-paroxysmal nocturnal dyspnea
-peripheral edema
(SIGNS OF CHF!!!) |
|
|
Term
|
Definition
| asymptomatic or dull pain w/exertion |
|
|
Term
|
Definition
| quick stab of pain that subsides quickly and does not cause other signs. |
|
|
Term
| syncope or near syncope owing to arrhythmias, give...... |
|
Definition
|
|
Term
| test of choice dilated cardiomyopathy |
|
Definition
|
|
Term
| test to most common cause of secondary htn |
|
Definition
| renal arteriogram for renal artery stenosis |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
-Carotid sinus massage
-Intravenous adenosine
-Calcium channel blockers or beta blocker
-Cardioversion
PT CAN DO:
-Valsalva's maneuver
-stretching the arms and body,
-lowering the head between the knees,
-coughing
-splashing cold water on the face
-breath holding |
|
|
Term
| tx chronic dilated cardiomyopathy |
|
Definition
| ACE inhibitors and beta blockers |
|
|
Term
| tx for new onset rapid a-fib with cardiogenic shock |
|
Definition
| direct-current cardioversion |
|
|
Term
| tx hypertrophic cardiomyopathy |
|
Definition
either verapamil (CCB) or a beta blocker, with dosing titrated to symptom relief.
End-stage: diuretics and ultimately heart transplant. |
|
|
Term
| tx of Lown-Ganong-Levine syndrome and Wolff-Parkinson-White syndrome |
|
Definition
-if symptomatic, radiofrequency ablation.
-adenosine
-avoid digoxin, calcium channel blockers, and even b-blockers because they might increase vent. rhythm.
-can cardiovert |
|
|
Term
| tx of V-fib and pulseless V-tach |
|
Definition
|
|
Term
|
Definition
-Usually reverts to sinus or a-fib w/o treatment
-If persistent/recurrent treat as for a-fib
RX: amiodarone and dofetilide are the antiarrhythmics of choice. |
|
|
Term
| tx of infrequent, PVCs in an asymptomatic pt |
|
Definition
|
|
Term
| tx of initial PSVT in hemodynamically stable pt |
|
Definition
|
|
Term
| tx vasovagal hypotension triggered by stress, |
|
Definition
| reassurance and stress-management tecniques |
|
|
Term
| vasodilator tx is helpful peripheral vascular syndrome? |
|
Definition
|
|
Term
| ventricular bigeminy rhythm (s/s) |
|
Definition
| reg irreg (no systemic sx) |
|
|
Term
|
Definition
| Ectopic impulse formation occurs at atrial rates of 250-350 beats/min, with transmission of every second, third, or fourth impulse through the AV node to the ventricles. |
|
|
Term
| what needs to be done before contrast dye is given to renal insuff pt? |
|
Definition
|
|
Term
| when is it safe to cardiovert a-fib? |
|
Definition
| after anticoagulation for 2-4 weeks before cardioversion and 4 weeks after unless a-fib is new (<48 hours) |
|
|
Term
| why might mitral valve prolapse be followed by a mid to late systolic murmur? |
|
Definition
| development of mitral valve regurg |
|
|
Term
| young athletes who seem completely healthy but die during heavy exercise. |
|
Definition
| hypertrophic cardiomyopathy |
|
|
Term
| Where is the aortic area? |
|
Definition
| 2nd right intercostal space. |
|
|
Term
Where is the pulmonic area? |
|
Definition
| 2nd left intercostal space. |
|
|
Term
|
Definition
| 3rd left intercostal space. (Left sternal border) |
|
|
Term
| Tricuspid valve listening area |
|
Definition
| 4th intercostal space (left lower sternal border) |
|
|
Term
| Mitral valve listening area |
|
Definition
| 5th left intercostal space, midclavicular line (apex) |
|
|
Term
| Acronym for heart listening area, location and what you are listening to. |
|
Definition
All People Enjoy Time Magaizine
Aortic - 2nd right intercostal space, aortic valve
Pulmonic - 2nd left intercostal space, pulmonic valve
Erb's Point - 3rd left intercostal space, left sternal border, S2 is best auscultated
Tricuspid Area - 4th left intercostal space, Left lower sternal border, Tricuspid valve
Mitral Area - Apex, - 5th left intercostal space at midclavicular line. |
|
|
Term
S1, S2, S3 and S4
When do they occur and what do they represent? |
|
Definition
| S1 |
Isovolumetric contraction |
Closure of mitral and tricuspid valves |
| S2 |
Isovolumetric relaxation |
Closure of aortic and pulmonic valves |
| S3 |
Early ventricular filling |
Normal in children; in adults, associated with ventricular dilation (e.g. ventricular systolic failure) |
| S4 |
Atrial contraction |
Associated with stiff, low compliant ventricle (e.g., ventricular hypertrophy |
|
|
|
Term
| What does TIMI score stand for, what is it used for and how is it scored? |
|
Definition
Thrombolysis In Myocardial Infarction
simple prognostication scheme that categorizes a patient's risk of death and ischemic events and provides a basis for therapeutic decision making.
- Age >= 65
- Aspirin use in the last 7 days (patient experiences chest pain despite ASA use in past 7days)
- At least 2 angina episodes within the last 24hrs
- ST changes of at least 0.5mm on admission EKG
- Elevated serum cardiac biomarkers
- Known Coronary Artery Disease (CAD) (coronary stenosis >= 50%)
- At least 3 risk factors for CAD, such as: Hypertension -> 140/90 or on antihypertensives, current cigarette smoker, hypercholesterolemia, diabetes mellitus, Family history of premature CAD (CAD in male first-degree relative, or father less than 55, or female first-degree relative or mother less than 65). |
|
|
Term
|
Definition
| inhibits distal convoluted tubule sodium and chloride resorption |
|
|
Term
|
Definition
selectively antagonizes angiotensin II AT1 receptors
-sartans |
|
|
Term
|
Definition
inhibits calcium ion influx into vascular smooth muscle and myocardium, relaxing smooth muscle, decreasing peripheral vascular resistance, dilating coronary arteries and prolonging AV node refractory period
-dipines, diltiazam, verapamil |
|
|
Term
Loop Diuretics MOA
examples |
|
Definition
inhibits loop of Henle and proximal and distal convoluted tubule sodium and chloride resorption
bumetanide, torsemide,furosemide |
|
|
Term
|
Definition
selectively antagonizes alpha-1 adrenergic receptors; antagonizes beta-1 and beta-2 adrenergic receptors (selective alpha and non-selective beta blocker)
-olols, ilols |
|
|
Term
|
Definition
height < 2.5 mm in lead II
width < 0.11 s in lead II
|
|
|
Term
|
Definition
| 0.12 to 0.20 s (3 - 5 small squares) |
|
|
Term
What is a short PR segment?
What should you consider? |
|
Definition
< 0.12
Wolff-Parkinson-White syndrome or Lown-Ganong-Levine syndrome
|
|
|
Term
normal QRS complex
Reasons for wide QRS complex |
|
Definition
< 0.12 s duration (3 small squares)
Abnormally wide QRS consider right or left bundle branch block, ventricular rhythm, hyperkalaemia |
|
|
Term
ECG
One small square = __ mm = __ sec
One large square = __ mm = __ sec |
|
Definition
One small square = 1mm = 0.04 sec
One large square = 5mm = 0.20 sec |
|
|
Term
|
Definition
causes of tall T waves include hyperkalaemia, hyperacute myocardial infarction and left bundle branch block
|
|
|
Term
| causes of small, flattened or inverted T waves |
|
Definition
| causes of small, flattened or inverted T waves are numerous and include ischaemia, age, race, hyperventilation, anxiety, drinking iced water, LVH, drugs (e.g.digoxin), pericarditis, PE, intraventricular conduction delay (e.g. RBBB)and electrolyte disturbance. |
|
|
Term
|
Definition
|
|
Term
| What is digitalis and digoxin? MOA and uses. |
|
Definition
| It is used to increase cardiac contractility (it is a positive inotrope) and as an antiarrhythmic agent to control the heart rate, particularly in the irregular (and often fast) atrial fibrillation. |
|
|
Term
Directional leads and reciprocal leads |
|
Definition
|
|
Term
| What makes the S1 sound and what is a good way to remember it? |
|
Definition
Closing of the tricuspid and mitral valves.
The "1" in S1 looks like an "I" so the "I"nternal valves close. |
|
|
Term
|
Definition
| Aortic and pulmonic valves closing. |
|
|
Term
| What does lidocaine do to the heart? |
|
Definition
| depresses action potential phase 0 (class IB antiarrhythmic) |
|
|
Term
| What does amiodarone do to the heart? |
|
Definition
| prolongs action potential phase 3 (class III antiarrhythmic) |
|
|
Term
| What does procainamide do to the heart? |
|
Definition
| stabilizes membranes; depresses action potential phase 0 (class IA antiarrhythmic) |
|
|
Term
| What does adenosine do to the heart? |
|
Definition
| for PST conversion and ACLS/PALS, tachycardia use: slows AV node conduction time, interrupts AV node re-entry pathways; for cardiac stress testing use: activates A1 and A2 adenosine receptors, producing coronary vasodilation and incr. blood flow |
|
|
Term
| What supplement is helpful in V-tach? |
|
Definition
| Empiric magnesium replacement |
|
|
Term
| Difference in ECG findings of Lown-Ganong-Levine and Wolff-Parkinson-White? |
|
Definition
| WPW has a delta wave to the QRS and it is a normal QRS in LGL. |
|
|
