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186 Cards in this Set
- Front
- Back
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Familial Hypercholesterolemia
Hetero and homozygous (lab findings, physical exam findings) |
Total Chol=275-500
Serum TG=normal *men develop heart disease by 4th decade *PE shows tendon xanthomas, tuberous xanthomas and xanthelasmas |
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Familial Hyptertriglyceridemia
(lab findings and |
TG=250-1000
cholesterol=normal HDL=decreased |
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Hyperlipidemia
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Increased LDL and TG
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Increased Risk Factors for Coronary Heart Dz
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*HDL less than 40
*Hyperlipidemia *HTN *DM *Smoking *Obesity *Inactivity *Increased serum homocystein level *1st degree male relative <55 *1st degree demal relatives <65 |
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Evaluation for Dyslipidemia
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1. peripheral pulses
2.check for bruits 3.BP 4.Ht, Wt, abdominal girth 5.xanthomas present? |
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Secondary Dz evaluations:
*Hypothyroidism *Nephrotic Syndrome |
Hypothyroidism
-cool, dry skin -decreased heart rate -hair loss, coarse hair -thinning of eyebrows Nephrotic Syndrome -edema (periorbital) |
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Step 1 diet
for lipid disorder |
*Total Fat less than 30%
*Saturated Fatty Acids <10% *Cholesterol <300mg/day Avg Serum Chol Reduction of 30-40 mg/dL |
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Step 2 diet
for lipid disorder |
*Total Fat <30%
Saturated Fatty Acids <7% Cholesterol <200mg/day Aveg serum Chol reduction additional 15mg |
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Atherosclerosis
clues for dx |
*Smoking pack year
*Risk factors *Metabolic syndrome *Coronary Artery Dz |
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Subclavian Steal Syndrome
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Symptoms= poikilothermia and low BP in left
Pathophys:upper extremity stenosis at subclavian artery |
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Thoracic Outlet Syndrome
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compression of thoracic outlet from abnormal scalenus muscle, cerivcal rib, clavicle or pectoral minor muscle that compresses the subclavian artery and brachial plexus
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Occlusive PAD sx
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*Claudication
*5 P's (pain, pallor, pulselessness, paresthesia and paralysis) |
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PE
what to look for |
*skin color
*Palpate pulses(allen test) *Auscultate for Bruits *Skin temp(poikilothermia)/Foot temp *hair loss on toes/shins *Blanch test |
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Pulse Grading
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0-absent
1-diminished 2-expected 3-full,increased 4-bounding |
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What are some special tess for Occlusive PVD?
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*Postural change watching for leg flushing
*Ankle BP compared to bracheal (ABI) |
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Tx of PAD
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-Control other conditions
-QUit smoking -Protect limbs from trauma -exercise -meds/surgery |
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what are some meds used to treat PAD?
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*Trental
(decreased blood viscosity, increases RBC flexibility) *Pletal (vasodilator and antiplatelet properties) *Clopidrogel(Plavix) |
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what are some surgical procedures for PAD
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Invasive Radiology
Vessel Surgery |
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What is LeRiche Syndrome?
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tissue hypoxia due to decreased perfusion
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Acute Arterial Occlusion
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Hx:
-heart disease -afib -claudication -Mitral Valve Dz Sx: -sudden onset -acute MI -afib -5 P's Tx: -keep limb warm, analgesia, thrombolytic therapy, angioplasty, ebolectomy |
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Raynauds Phenomenon
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signs:
-bilateral symmetric pallor and cyanosis followed by rubor of skin and digits symptoms: -worsened by cold and emotionlal upset causes: primary-idiopathic secondary-scleroderma, lupus, rheumatoid arthritis, arterial occlusive dz, drugs, neurogenic tx: -underlying cause, stop smoking, drugs(CCB/s, BB's, Alpha blockers) |
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Thromboangitis Obliterans
(Buerger's Dz) |
inflammatory occlusive vascular disorder affecting distal medium sized and small arteries
Hx: -smoker, under 40 Sx: -claudication of extremity -Raynauds -superficial vein thrombophlebitis Tx: -stop smoking -pain meds, antibiotics, amputation |
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Aneurysm
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dilation of thoracic or abdominal aorta caused by a weakening of all three arterial layers due to atherosclerosis
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what are the assoc. factors for aortic aneurysm
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*males older than 60
*Coronary artery dz *CNS dz *marfans, trauma, syphilis parasite |
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aortic aneurysm
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complications
-rupture assoc syndromes -blue toe syndrome |
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thoracid aortic aneurysm
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sx:
-substernal neck or back pain -asymptomatic -sudden dilation may cause chest pain -rupture may present as hemodynamic collapse Diagnosti test: -chest x-ray -Transthoraci or Transesophageal Echocardiography -CT/MRI -Angiography Tx: -surgery -control HTN -betablockers -vasodilators (Na, nitroprusside) |
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Abdominal Aortic Aneurysm
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Sx:
-mostly asymptomatic -male over 50 -mid abdominal or lower back pain -pulsating abdominal mass -abdominal "fullness" complications? -rupture could be life threatening -hypotenstion -paralysis -diminished peripheral pulses Dx: -abdominal ultrasound -CT and MRI -Spiral CT -Aortagram Tx: -serial ultrasound or CT measurement (less than 4.5 cm) -surgical repaireif greater than 5 cm with endovascular stent graft |
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Aortic Dissection
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def: a tear in the aortic wall which disrupts the intima
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Debakey Classification of Aortic Dissection
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I=intimal tear of ascending and descending aorta
II=limited to ascending III=tear in descending aorta with distal propagation of dissection |
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Stanford Aortic Dissection classification
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Type A=dissection of ascenidng aorta
TypeB=dissection limited to descending aorta |
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Aortic Dissection
diagnosis clues |
Presenting symptoms:
-atherosclerosis or tauma -pain -suddent on set severe ant. chest pain with readiation -hemodynamic compromise -signs of occlusion dur to side vessel occulsion Signs(PE finds) -differential in pulses -murmur of aortic insufficiency -murmer from high velocity jet of blood entering disscetion |
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Aortic Dissection tx
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-if high index of suspicion start medical therapy to reduce BP while initiating diagnostic eval
(beta blockers, IV nitroprusside) Type I and II-surgery Type III=medical management |
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Iliac Aneurysm Sx
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Sx:
-obsturctive urologic symptoms -groin pain -venous occlusion due to compression |
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Popliteal Aneurysm sx
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-2 cm pulsating mass in popliteal fossa
-cocomitant abdominal aneuryusm |
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peripheral artery aneurysm
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-bilateral,
tx with prpophylactic surgery |
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arterial aneurysm
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true aneuryam is dilation of artery to mreo than twice noraml size with stretching and thinning of all vessel wall layers
false aneurysm is a pulsatie hematoma not confined by the vessel wall ayers but confined by a fibrous capsule |
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Varicose Veins
(3 types) |
1. thread or spider
2. primary 3. secondary |
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Varicose Veins
(sx and symptoms) |
Symtpms:
-dull ache or pressure sensation in legs -particularly after prolonged standing -releif w/ leg elevation -legs feel "heavy" -occasional mild swelling (pitting edema) Sx: -inspection in dependent position reveals dilated, tortuous vessels confimre by palpation -leg pain or tenderness may reveal a firm thickened throbosed vein assoc w/ spider veins |
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Varicose Veins
Clinical Tests |
1. Brodie-Trendelenburg
2.Perthes 3.Duplex Ultransonography 4. Doppler Exam 5. Venography *Hx and Doppler studies most effective |
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Possible Varicose Vein Tx
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NON OPERATIVE
1. Compression Stockings 2. Sclerotherapy 3. Radio Frequency Ablation SURGERY 1. Subfascial Endoscopic Perforator surgery(SEPS) 2.Endo Venous Laser Treatment(EVLT) |
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Superficial venous Thrombosis
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a thrombosis in the greater or lesser saphenous vein or tribulatries
Symptoms: -localized pain Signs: -red, warm and tender cord with edema Tx: -supportive -bed rest with elevation and compress -NSAID for pain and possible anticoag if potential of deep system involvement |
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Deep Venous Thrombosis
Virchow's triad |
1. Abnormal Vein wall
-varicose veins, previous thrombophlebitis, trauma, inflammator process to veins 2. Venous stasis -bed rest, prolonged position dependecy, CHF, shock 3. Hypercoaguability -trauma,hyperviscosity, cancer, oral contraceptives, deficiency of antithrombin III Protein S and Protein C |
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DVT: Genetic Considerations
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*patients have underlying predispostion that is triggered by an acquired stressor (surgery, obesity, pregnancy)
*Factor V Leiden (inhertied hypercoaguability state) |
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DVT Signs and Sx
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General:
-unilateral leg swelling, warmth and erythema -tenderness along involved vein that mayb be palpable -increased skin turgor -superficial vein distenstion *most common complaint is calf pain Femoral Vein: -pain and tenderness in distal thigh -prominent swelling in calf Iliofemoral -MOST SEVERE FORM -cyanosis -Phegmasias ala dolens is most severe form |
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DVT diagnostic tests
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1. homan sign(nonspecific)
2. Venous Doppler Ultrasound 3. Venous Duplex Ultrasound 4. Ascending Phlebography 5. Plethysmography 6. Radioactive fibrinogen |
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DVT Tx
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1. Heparin/Coumadin
2.Thrombolytics |
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Pulmonary Embolis
sx and symptoms |
Sx: (TRIAD)
-Chest pain, Dyspnea and Hemoptysis -sudden onset Signs: -VQ lung scan -EKG T wave inversion and ST segment depression |
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Pulmonary Embolis (Tx)
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*thrombolytics-clot dissolution
*Embolectomy-clot removal *anticoag -heparin, Low molec weight hep and coumadin *IVC filter *supportive therapy *pulmonary thromednarterectomy BEST TREATMENT IS PREVENTION. Identify high risk |
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Systolic HF etiology
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myocarditis, post MI and chronic mitral or aortic regurg
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Systolic HF symtpoms
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fatigue, weakness, mental obtundation and later dyspnea
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what are typical signs on PE?
of SYStolic HF |
dilated LV< BP variable depending on previous BP and CO, cool skin, apical s3 gallop, mitral gegur murmu
later, rales and peripheral edema |
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Etiology of Diastolic HF
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LVH of any cauese, infiltrative myocardical diz
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what are the symptoms of Diastolic HF
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dyspnea and later weakness
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what are typical signs on PE of diastolic HF
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apical lift, S4 gallop, pulmonary rales and Pulmonary edema
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what are neurohumoral responses released with heart failure
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RAAS system and ADH, (RAAS include arteriolar vasoconstriction as well as Na rabsorption
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etiology of High output HF
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hyperthyroidism, AV fistulas, Pagets dz of bone, beri beri
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what is major symptom of high output heart HF
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dyspnea
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what are signs on PE of pulse pressure
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*wide pulse pressure
*tachycardia *bounding pulse *rales |
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what is etiology of right heart failure
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*chornic systolic left HF
*mitral valve stenosis *Pulm HTN(chronic lung disease, pulmonary vasc dz or congenital Dz) *MI |
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what are common symtpoms of right output HF
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*Nausea and loss of appetite due to liver congestion with blood
*abdominal pain with distention *peripheral edema |
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what are physical signs?
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increased Jug Venous Pressure
*left parasternal lift *hepatosplenomageal *ascites(fluid in abdomen) *tricuspid regurg murmur |
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Classificationof HF severity
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Class1=no cardiac sypmtoms with ordinary activity
ClassII=symptoms with marked activity Class III=symptoms with mild activity Class IV=cardiac symptoms at rest |
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what are lab studies to determine heart failure causes
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1. blood count b/c anemia can exacerbate LV dysfxn
2. BUN/Serum creatinine can show azotemia from chronic renal dz causing HTN 3.thyroid check 4. EKG to check arrhythmia, ischemia/infarction, AV or intraventricular conductin defect 5. biopsy if suspected infiltrative dz |
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what are good imaging studies with heart failure
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1. CXR=size and shape of heart, may show edema with Kerley B lines, intraalveolar edema or pleural effusion
2. echocardiogram=shows chamber size and wall thickness, ejection fraction, diastolic properites of myocardium, valve dysfxn and pericardial effusion |
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Meds CONTRAINDICATED in treating HF
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*NSAIDS (inhibit)
*thiazolidinediones *metformin *cilostazol *sildenafil et alia *ibutilide and stalol |
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how are diuretics useful in treating chronic systolic HF
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alleviate breathlessness and reduce edema
*overall effect is to reduce cardiac output |
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how is digoxin used?
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with chronic systolic HF to increase ventricular contractility and reduce ventricular rate in afib and aflutter
*DO NOT USE DIGOXIN DIASTOLIC HF *DO NOT USE DIGOXIN IN ACUTE SYSTOLIC FAILURE b/c will not increase contractility |
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how are nitrates used in chronic hf
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-reduce venous return so therefore reducing preload
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how are ACE inhibitors and hydralazine used in systolic HF
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-afterloadreducers
*promote venodilatation as well by reducing andrenerigc tone -patients with HTN -patients with DM *ACE can cause cough so if that happens use ARB |
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when should beta blockers be used?
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Beta blockers slow heart rate and increase preload
-HTN -angina pectoris (stable and unstable) -acute MI (w/o acute heart failure) -great in systolic Heart Failure -angina with PVC's -afib and aflutter -post MI to prevent reoccurence |
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when should you NOT use BB's
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in acute heart failure
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So overall what are good drugs to use in chronic systolicHF
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-diuretics
-digoxin -nitrates -ACE inhibitors -beta blockers |
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what are drugs used to treat acute systolic HF?
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-IV nitro if bp is ok
-diuretics -afterload reducing agents (ace inhibitors and hydralazine) -beta agonists |
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what are drugs used to treat diastolic HF
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-diuretics
-CCB/s b/c lessen ventricular stiffness and increase ventricular filling -beta blockers b/c slow HR and increase preload -ACE may reverse LVH |
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what are some other treatments of HF
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-low na diet
-structered exercise remove precipitating factors |
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what is cardiomyopathy/myocarditis and what are three types
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-heart muscle disease of unknown etiology
1. congestive(dilated) 2 hypertrophic 3. restrictive |
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what are common etiologies?
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-idiopathic
-inherited autosomal dominant or x linked -toxins such as coke and drunk -metabolic abnormalities -infections -inflammatory dz -electrolyte abnormality -neuromuscular dz |
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what type of impairment does congestive myopathy cause
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systolic(contractile impairment)
so is very similar to systolic HF |
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what is common patient pop of congestive cardiomyopathy
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-20-50 yrs
-MOST COMMON CAUSE OF HEART TRANSPLANT IN KIDS |
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what are symptoms of congestive cardiomyopathy
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-weakness w/ later dyspnea
-mental obtundation -BRAIN SX RELATED TO ARRHYTHMIA or EMBOLISM |
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what are common signs on PE of congestive cardiomyopathy
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-dilated left ventricle or biventricular dilatation
-diffuse sustaine apical impulse -S3 gallop -murmus of mitral AND Tricuspid regurg |
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what are some good dx tests for congestive cardiomyopathy
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1. echocardiography
2. cardiac catheteriztion 3.endomyocardial biopsy |
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what is tx of congestive cardiomyopathy?
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diuretics, ACEI and BB's(same as systolic therapy)
-anticoag if patient in afib -antiarrhythmic agents as indicated |
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what is the most common cause os sudden death in kids and college athletes
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hypertrophic cardiomyopathey
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what is etiology of hypertrophic cardiomyopathy
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a genetic mutation affecting cardiac sarcomeres that can be autosomal dominant or sporadic
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what is the pathophysiology of hypertrophic cardiomyopathy similar to?
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diastolic HF
-MLAP is increased in order to push blood into noncompliant LV, blood backs up into lungs=dyspnea |
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what is different about the hypertrophy in cardiomyopathy opposed to diastolic HF
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the hypertrophy causes the obstruction instead of the obstruction causing the hypertrophy
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what are the symptoms of hypertrophic cardiomyop
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same triad as aortic stenosis
1. angina pectoris 2. dyspnea 3. syncope |
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What are the phys. signs of hypertrophic
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-apical lift/heave
-double or triple apical impulse -ejection murmur which intensifies as LV becomes smaller -S4 gallop -bisferiens carotid pulse |
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what are good diagnosit tests for hypertrophic
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-echocardiogram
-cardiac catheterization |
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tx of hypertrophic
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1. CCB's (major)
2.BB's 3.low dose diuretics to mainatin preload 4.disopyramide 5.Select cases can use dual chamber cardiac pacing or alcohol injection into myocardium |
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what is effect of valsalva, and squatting on hypertrophic
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valsalva intensifies
squatting makes go away (b/c it makes Ventricle bigger) |
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what is effect of upright posture, amyl nitrites on hypertrophic
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less venous return to heart makes ventricle smaller so you will hear the hypertrophic more (note this is the oppostie in aortic stenosis)
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what is restricitve cardiomyopathy
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a myocardial dz related to deposition of abnormal substance in the myocardium
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what are examples of etiolgies of restrictives
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-amyloid
-idiopathic -saroidosis -scleroderma -radiation -metabolic storage dz -melanoma -endomyuocardial fibroelastosis |
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what restrictive similar to?
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it is an impaired filling of ventricles similar to constrictive pericarditis
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what are clinical presentation of restrictive cardiomyopathy
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-heart failure
-symptoms of underlying dz |
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what are signs of restrictive cardiomyopathy
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-right heart failure
(nausea, hepatosplenomegaly,increased JVP) -S4 gallop |
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what is tx of restricive cardiomyopathy?
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-depends on underlying disease
-poor prognosis |
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what is the definition of myocarditis?
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an inflammatory dz of myocardium due to infectious or non infectious agents
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what is the most common cause of sudden death in US air force and Israel defense?
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myocarditis
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what is the most frequent cause of infectious myocarditis?
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enteroviruses
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what are examples of non-iunfectious meds that can cause myocarditis
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doxorubicin, interleuikin 2, interferon catecholamines,(pheochromocytoms) alcohol, coke
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what are the cardiovascular effects of cocain??
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1. tachycardia and HTN
2.myocarditis 3.atrial and vetricular arrhtymias 4.atrial and ventricular arrhtymia 4.acute myocardial infarction due to coronary artery spasm 5.diessection of aorta |
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what is pheochromocytoma
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tumor on adrenal medulla
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what is the pathophysiology of myocarditis?
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systolic HF
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what are are cliinical assoc with myocarditis?
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-recent URI (flu)
-pleuropericardial pain is common -sudden death -HF -syncope |
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what are physical exam findings of myocarditis?
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tachycardia
-S3 gallop -atrial and ventricular arrhthmias |
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what are some good diagnostic tests?
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echocardiogram, endomyocardial biospy
serologic studies |
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what is the treatment of myocarditis?
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-same as systolic HF therapy
-arrhythmias as indicated -remove offending agent *many cases seem to resolve spontaneously and other cases appear to result in dilated (congestive)cardiomyopathy |
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what is the most common cause of acute pericarditis in the USA?
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neoplasia
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what are general symptoms of pericarditis?
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chest pain:shapr and constant, increased by recubmency, inspiration and swallowin
-pain in precordial or retreosternal and radiates to neck -dspnea due to inability to take a deep breath -PERICARDITIA in NEOPLASIA IS OFTEN PAINLEASSS (same in hypothyroidism) |
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what are general PE signs of pericarditis?
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-low fever
-PRECORDIAL RUB guarantees dx but is oftentransitory -SV arrhtymias due to compression of SA node -CXR may show neoplasm or pleural effusion |
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what diagnosing what should all females with acute pericarditis be thought to have first?
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SLE
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what are lab findings of diagnosti CBC, Echo and EKG in pericarditis
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CBC=leukopenia and antinuclear ab in serum
Echo=may be normal or show pericardial effusion EKG=ST and T wave changes with no change in QRS.ST upward convavity in leads except V1 and VR. T wave inversion is isoelectirv |
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what aresx of acute pericarditis with MI?
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acute onset of chest apain that is diagnosed with recurrent ischemia/infarction
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what is a PE finding of acute pericarditis with MI
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pericardial rub
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what is tx of acute pericarditis?
|
ASA or NSAIDS usually subside in a few days
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what are some causes of acute pericarditis with systemic dz?
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1.vasculitis(SLE, scleroderma, rhumatoid arthritis, polyarteritis )nodosa
*consider SLE in any female with pericarditis |
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what are some possible complications due to vasculitis?
|
tamponade and constriction
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what is cause of idiopathic pericarditis?
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commonly thought to be viral (EBV, HIV, echovirus, adenovirus
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what is etiology of idiopathic pericarditis?
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typically occurs in adults with preceding URI's
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what are symptoms of idiopathic pericarditis?
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onset of chest pain is dramatic
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what are PE findings of idiopathic pericarditis?
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no underlying diseases found onn PE or labs (perhaps mild leukocytosis and high erythrocyte sedimaatation rate)
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what is tx of idiopathic pericarditis?
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ASA, NSAID or other analgesic along with corticosteroid in selected cases
* is often self limiting |
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what may be a result of EKG's in idiopathic pericarditis?
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-may be abnormal for life with inverted T waves
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what are two common causes of Infectious bacterial pericarditis
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1. staph and Strep Pneumonia
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what is common pathophysiology of bacterial pericarditis
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-constriction
*seticemia from joint disease or periodontal dz may cause pericarditis |
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what are symptoms of bacterial pericarditis
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-these patienst look very ill
-patient with obsious ite of infection that 1 week later develops tachy, low BP, increased JVP with hard to hear heart sounds=bacterial pericarditis |
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what do lab values show in bacterial pericarditis
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leukocytosis with left shift and pus for thoracocentesis
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what is tx or bacterial pericarditis
|
-antibiotics
-surgical drianige -mortality still significent |
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what is etiology of uremic pericarditis?
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occurs in untreated uremia and in stable dialysis patients but cause is unknown
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what is pathophys of uremic pathophys
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dramatic onset witypcially with tamponade and constriction
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what are symptoms of uremic pericarditis?
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chest pain but some patients may not have it
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what is common PE finding with uremic pericarditis?
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afebrile
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what are lab values that indicate uremic pericarditis?
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high BUN and creatinine
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what is tx of uremic pericarditis?
|
drainage in tamponade and initation or more aggressive dialysis
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what is rarely seen in systemic pericarditis?
|
tamponade (pericardial effusion is present though)
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what are meds that can cause acute pericarditis?
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-hydralazine
-INH -PCN -minoxidil -doxorubicin -diphenylhydantoin -procaineamide (all have common chemical radical) |
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what is pericardial effusion
caused by? |
infectious, neoplastic, metabolic, renal and autoimmune dz
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what determines clinical state of the patient
|
the rate at which effusion develops
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do all effusions have to be painful
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/no, think neoplastic
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what are symptoms and signs due to?
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underlying dz unl;ess tampnade is present
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what is pericardial tamponad
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a lifethreatening emergency that occurs when arapidly expanidng effusion reduces of heart chambers and subsequently, CO filling
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what are signs of tampnade?
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-elevation of CVP
-tachycardia -tachypnea -paradoxical pulse is common |
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what is paradoxical pulse
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a weak pulse on inpiration and a stronger pulse on expiration that raises BP greater than 10mmHg
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what imaging studies show tamponade?
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echocardiographic demonstation of right atrial or right ventricular diastolic collapse
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what is the tx of tampnade
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pericardiocentesis and treat underlying dz
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what is constrictive pericarditis?
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a tighteing vise around the heart
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what is the most common cause of constrictive pericarditis in USA?
|
chest radiation (7 yrs but may aooccur as earl s 1 month after end of therapy
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what are other causes of constrictive?
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-viral,neoplasia, bacterial, fungal infection, vasculitis, uremia and sarcoid
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what are signs of constrictive pericarditis
|
-elevated JVP
-congestive hepatosplenomegaly -periph edema -Kussmauls Sign |
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what is constrictive pericarditis similar to that must be ddx
|
-RHF and Cardiomyopathy b/c of similar symtpoms
*dx with echocardiogram and MRI to see thickening or calcification |
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what is txof constrictive pericarditis
|
pericardiectomy
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what are arrhtymias that are absent of underlying dz usually due to?
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-caffeine, alcohol, OTC sympathomimetic and prescribed meds, electrolyte imbalance, acid-base disorders, hypoxemia tobacco and emotional stress
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what does prognosis of arrhthmia depend on?
|
the clinical setting in which arrhythmia occurs
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what are patients with chronic or paroxysmal afib at increased risk fo
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stroke
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what are the tx goals of afib
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restore sinus rhtym to acute afib
-control the ventricular rate -prevent recurrent afib -prevent stroke |
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how do you treat afib in patient absent of HF and pre excitation syndrome
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verapamil, dilitiazem, beta blocker, digoxin
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how do you treat an afib patient in HF
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-combination of digoxin and dilitiazem or less often digoxin plus beta blocker
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if AFib patient has excessively high ventricular rate during exercise, has had an infarction or is exercise induced angina which med to use?
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BB
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if patins has COPD, DM or peripheral artery dz what med to u use to treat afib?
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ccb
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what must be used in caution with chronic renal patients
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digoxin (verapamil increases digoxin)
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what do you treat afib with to restore NSR
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anticoagulation
* all patients with chronic afib get anticoag |
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what are risk factors for thromboembolism in the non-valvular AF patient
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-HTN
-HF -Previous stroke or TIA -LV ejection fraction less than 35% -dilated left atrium |
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when can warfarin be discontinued in hyperthyroid patients
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at some point after euthyroid status is reahed
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what is the tx for non-compliant patients with contraindications to warfarin?
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asa 325 mg /day
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what is pre-excitation syndrome
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atrial depolarizations reach the ventricle via accesory AV conducting fibers w/o impulses traversing the AV node
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what can happen to heart rates with pre excitation syndrome ?
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prone to Afib over 300/min and vfib
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what is the EKG pattern on pre excitation
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short PR interval, delta wave in initial portion of QRS complex and wide QRS
(afib with wide qrs is worse than with normal qrs) |
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what is tx of pre excitation syndrome
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PSVT with normal QRS=IV adenosine or CCB
wide ARS tachy=IV procainamide or emergent cardioversion |
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what is sick sinus syndrome
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intermittent supraventricular tachyarrhtymias interspersed with bradycardia
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what are symptoms of sick sinus syndrome
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syncope, angina pectoris HF, lightheadedness
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what is tx of SSS
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remove offenicng agent
-permanent pacemaker with medication to prevent the tachyarrhtymias -med=digoxin, beta blocker, CCB may cause trnasient SSS |
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what are electrolyte imbalances oyou should look for in ventricular arrythmias
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hypokalemia and hypomagnesemia
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what is prefered tx of ventricular arrythmia in acute infarction intensive care setting
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licocaine is preferred initial med
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what is the definition of Vtach
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3 or more consecutive VPB's
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what are the clinical categorizations of VT?
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acute, chronic recurrent sustained VT and chronic recurren non sustained VT
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i Vfib assoc w/ MI is primary or secondary assoc with poor LV fxn?
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secondary (prognosis is poor)
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what is Vfib not associated with MI?
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Sudden cardiac death
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how is torasades de pointes treated?
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with class Ia, Ic, and III antiarrhytmic drugs
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what is first degree heart block commonly due to?
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meds such as digoxin, beta blockers and CB?s
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why is Mobitz II worse than mobitz I
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b/c it is related to a heart diz and not medication effects
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what is the ventricular rate during 3rd degree herart block?
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30-40
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what are sypmtoms of 3rd degree block?
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sycndope, angina, dyspnea
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how do we treat 3rd degree blocks
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temporary pacing for acute infarction and permanent pacing for chronic
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