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EM Cardio
Emergency Medicine Cardiology
80
Medical
Post-Graduate
01/21/2009

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Cards

Term
Si/Sx of traumatic aortic rupture?
Definition
-Chest/back pain
-Harsh systolic murmur
-Upper extremities HTN (pseuocoarctation syndrome)
-Pulse deficit
-Voice changes
-Ischemic pain in legs
-Paraplegia
Term
Which anti-HTN drug can incr. risk of anaphylaxis & may make anaphylaxis difficult to tx?
Definition
β-blockers -add glucagon to tx
Term
MCC Myocarditis
Definition
Viral |Others: bacterial, parasite, kawasaki, giant cell arteritis, sarcoidosis
Term
MCC RV (right ventricle) failure
Definition
LV (left ventricle) failure |
Other: Pulmonary art HTN, valvuar dz, restrictive cardiomyopathy, myocarditis
Term
NTG mech of action
Definition
Venodilation -> ↓preload |↓afterload at incr. dose |
↑coronary blood flow (questionable if CAD present)
Term
DOC for AMI ischemic pain
Definition
NTG
Term
Dilated (congestive) cardiomyopathy
Definition
Dilation of all 4 chambers (ventr > atria) |↑ myocardial mass |Systolic pump failure
Term
Most specific finding for DVT
Definition
-unilateral swelling
-pain
-cord
-sup. venour dilatation
-discoloration
-Homan's (+)
Term
Cardiac glycosides, other than digitalis
Definition
Digoxin-long acting | Plants: oleander, lilly of the valley, foxglove, dogbone, redsquill | Animal: boofoc frog
Term
DOC for WPW w/a wide complex SVT
Definition
Procainamide
Term
Rx C/o for WPW w/ wide complex SVT
Definition
Verapamil & digitalis
Term
DDx for EMD
Definition
MC: hypovolemia |Other: hypothermia, hypoxia, tension pneumothorax, cardiac tamponade, AMI, hyperK+, acidosis, PE, O/D (TCA, b-blocker, CCB, digitalis)
Term
Jones criteria
Definition
Major: "SPECs"
S:Subcutaneous nodules
P: Migratory polyartheritis
E: erythema marginatum
C:Carditis; Chorea
Minor:
Fever, arthralgias, Hx of RF, Prolonged PR, Incr. acute phase reactants, (+)ASO titers
Term
How NTG works in AMI?
Definition
Limits infarct size -preserves LV fxn -preents aneurysm -reduces mortality -dilates colateral coronaries -increase collateral flow -decrease myocardial O2 demand by decr. preload & LVEDC w/afterload
Term
Most lethal dysrrythmias?
Definition
Pre-hospital
Term
MCC pacer failure
Definition
Oversensing
Term
Digitalis effect on EKG
Definition
DALI MUSTACHE: ST seg sagging, prolonged PR, 1st AV BLok, short QT, flat or inverted T-wave
Term
EKG in acute Inf wall MI
Definition
•↑ ST: 2,3,avF • ↓ST: I, aVL, V1-V6 *Lo opuesto a Ant. Wall)
Term
EKG in Post wall MI
Definition
ST↓ V1,V2 ; Tall R-wave in v1, v2 | ST elevation V8,V9 (post leads)
Term
Inverted U-wave
Definition
CAD, LV strain, HTN, SAH or ICH
Term
EKG in hypoMg+ is similar to and asooc w?
Definition
Similar to & assoc w/ ↓K+& ↓Ca2+
Term
EKG changes in ↓Mg+
Definition
Prolonged QT & PR, Wide QRS, ↓ ST, flat or inverted T-waves, PVC's, V-Tach, V-Fib, Torsades
Term
Restrictive cardiomyopathy presents w/?
Definition
Diastolic pump failure, ↓CO
Term
MC presentation acute throracic aortic dissection
Definition
Sudden pain w/maximal intensity at onset
Term
DDx AV Blocks
Definition
AMI (Inf or Ant), Drugs (Dig, Lido, procain, phenytoin, quinidine, BB, CCB), myocarditis, endocarditis, ↑K+, ↑Mg+, hypothermia, congenital conduction defects
Term
DOC ectopic SVT 2 to Dig toxicity
Definition
✓Dilantin |✓Mg+ *Also Tx for ↓K+
Term
Inf wall MI increases risk for
Definition
Vagal tone dysrtythmias: sinus brady, 1st AV-Block, Mobits I
Term
Conduction disturbance assoc. w/ Ant. MI assoc.
Definition
2° AV Mobits II
Term
DDx of PEA
Definition
Hypovolemia, Hypoxia, Tension Ptx, Cardiac tamponade, TCA O/D
Term
Nipride in CHF / Pulm Edema
Definition
•Venous & afterload dilatation •↓Preload •↓Pulmonaary congestion •↓CO
Term
DOC Ventricular dysrrythmia in pts w/ hyperthropic cardiomyopathy
Definition
Amiodarone
Term
MCC Mobits II
Definition
Anteroseptal MI
Term
EKG in Acute RV MI
Definition
ST ↑ in V3-V4 ; Most ofter assoc. w/AIMI
Term
MCC Mobitz I (Wenckeback)
Definition
Inferior MI
Term
DDx Prominenet U-Wave
Definition
↓K+(<3 mEq); ↑Ca2+; Thyroitoxicosis; Meds: Dig, phenothiazine, quinidine, epi
Term
MC symptom PE
Definition
Dyspnea, pleuritic chest pain
Term
Causes of V-Fib
Definition
✶Ischemia; •hypothermia •drug tox •severe elyte dist •blunt chest trauma •meds
Term
Digitalis toxicity
Definition
Malaise, anorexia, N/V/D, blurred vision, yellow green halos, changes MS: confusion, drowsiness, psychosis
Term
Rx: 1°line (+) inotrope Cardiogenic Shock
Definition
❑ Dobutamine: 2.5-15 μg/kg/min •Mech β1-β2, ↑CO, Most effectice over 12 mo/age
Term
Rx: Rx:21°line (+) inotrope Cardiogenic Shock
Definition
❑ Epi (after dobutamine)
Term
AC causes ____ to the heart immediately
Definition
V-Fib
Term
EKG ↓Ca2+
Definition
•Prolonged QT •Terminal T-wave inversion
Term
A-Fib with ______may suggest accessory pathway
Definition
Ventricular rate > 200bpm
Term
Rx: Verapamil & Dig are C/I for _____dysrythmias b/c ____
Definition
C/I drugs A-Fib & pre-excitation syndrome b/c may cause V-Fib
Term
Rx Stable V-Tach
Definition
❑Lidocane ❑Procainamide ❑Bretyllium ❑Mg2+
Term
MC Digitalis induced rhythm disturbance
Definition
PVC's - often bigeminal & multiform | Others:A-Thac w/Av block, junctional tachy, V-Tach, bidirectional V-tach, V-Fib, Sinus brady, SA & AV nodal blocks
Term
DDx A-Fib
Definition
•HTN •Ischemia •RA •Thyrotoxicosis •Acute EtOH - Holiday Heart •PE
Term
EKG in Acute Ant. wall MI
Definition
•↑ST I, aVL, V1-V6 • ↓ST II, III, aVF *Lo opuesto a Inf. Wall MI
Term
DOC Torsades
Definition
❑ Magnesium: 1-2 grm blous, then 1-2 grm/hr ❑Overdride pacer ❑Isuprel (Isoprenaline or Isoproterenol)
Term
Rx C/I in Torsades
Definition
Call 1A & 1C
Term
Rx C/I in Torsades
Definition
Cat 1A (Quinidine, Procainamide, Disopyramide) & 1C (Flecainide, Propafenone, Moricizine) - Na+ channel blockers
Term
DDx A-flutter
Definition
AMI Ischemis heart Dx, Congestive cardiomyopathy, PE, Myocarditis, Dig, Toxicity, Blunt chest trauma
Term
Pt abx prophylaxis of infective endocarditis
Definition
Prosthetic heart vale, Hx of endocarditis, RHD, Congenital heart dz, IH/Septal hyperthrophy undergoing: I/D, nasal pack, dental w/gingivitis, foley, anoscopy
Term
Morphine in AMI
Definition
↓Pain & anxiety, ↓catecholamines, ↓preload &↓afterload =O2 demand
Term
Relative C/O for thrombolytics in AMI
Definition
•CVA/TIA •Active PUD •Diabetic hemorrhagic retinopathy •Recent veniucture in noncompressible vessels •Known bleeding diathesis •Anticoagulant tx (except ASA) •Pronolonged CPR • Sig trauma <2wks •Surgery < 2 mo •Stk or APSAC <12 mo •Left heart thrombus (A-Fb & mitral stenosis)
Term
DDx PVC
Definition
•Dig Toxicity •Methylxanthines •Cocaine •Tob, EtOH, Caff •AMI •↓K, ↓Mg •↓O2 • ↑thyroid •Cardiomytpahty •Myocardial contussion
Term
EKG Cold Heart ?
Definition
Osborn J waves, slow rhythm, A-Fib
Term
Cold heart dysrhythmias
Definition
PVC's, V-Fib, A-Fib
Term
Rx Cold Heart
Definition
Bretylium
Term
DDx Sinus brady
Definition
•Inf wall MI •Vagal syncope •Hypothermia •Hypothyroid •β-Block •Sinus node dz •Normal athlete •Dig o/d •Cushing reflex (↑ICP)
Term
DDx PSVT
Definition
•Pre-excitation syndrome •Mitral prolapse-stenosis •AMI •Preicarditis •Dig tox •Hyperthyroid •RHD •Drugs, EtOH, Tobacco, caff.
Term
DDx MFAT
Definition
✓MC: COPD •CHF •Sepsis •Methylxanthines Tox •Theo tox
Term
DOC acute A-Fib - hemodinamically stable
Definition
Diltiazem
Term
DDx sustained junctional rhythm
Definition
•CHF •Myocarditis •↑K ↑Dig Tox
Term
EKG in hypothermia
Definition
•J-wave/Osborn wave •Bradycardia •↑deflections ↑QRS conductions delays •A-fib slow ventricular response •V-Fib & asystole w/severe hypothermia
Term
Cardiac maneuvers that ↓LV volume
Definition
Valsalva, standing
Term
Cardiac maneuvers that ↑LV volume
Definition
Passive leg raising, handgrip, squatting
Term
EKG changes in SAH
Definition
• Peaked or symmetrically inverted T-waves
• U-waves
• Prolonged QRS
• Prolonged QT
Term
Anterior Wall MI ↑risk of?
Definition
High degree AV-Block
Term
Nitrates antidote
Definition
Methylene blue 1% S/N - 0.1 - 0.2 ml/kg IV x 5min
Term
DDx Prolonged QT in a tox pt
Definition
•Phenothiazines •Lithium •Arsenic •Class IA (Quinidine, Procaina) •Class III (amiodarone, sotalo) •Heterocyclic antidepressants
Term
Clinic of Periocardial tamponade
Definition
❑Beck's Triad: JVD, ↓BP, Muffled heart sounds •↓PP, ↑CVP >15, Kussmaul's sign (JVD on inspiration), tachycardia
Term
EKG pathognomonic of pericardial tamponade
Definition
Electrical alternans - QRS axis alternates between beats; due to the heart moving in the effusion
Term
Cardiomyopathy req abx prophylaxis
Definition
Hyperthrophic cardiomyopathy
Term
Gold standard for dx thoracic aortic dissection
Definition
Aortography However, TEE is very sensitive & specific
Term
EKG changes in hypocalcemia
Definition
Shot QT, can have U-wave
Term
Gold standard for Dx DVT
Definition
Contrast venography. However: duplex sono is the initial dx of choicce
Term
Initial Dx test of choice for DVT
Definition
Duplex sono. Gold: contrast venography.
Term
MC sustained tahydysrhythmia
Definition
A-Fib: 2% gen pop, 5% > 60y/o
Term
Type of antiarrhythmic agent that increases risk of asystole
Definition
1B: Lidocaine, Phenytoin, Mexiletine
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