EKG diagnosis of Anterior wall infarct based on leads showing Q waves?
"SAL" Anteroseptal: V1-V2 (LAD) Anterior: V1-V4 (LAD Anterolateral: V4-V6 (LCX)
Key Terms
EKG diagnosis of Anterior wall infarct based on leads showing Q waves?
"SAL" Anteroseptal: V1-V2 (LAD) Anterior: V1-V4 (LAD Anterolateral: V4-V6 (LCX)
EKG diagnosis of Lateral or Inferior wall infarct based on leads showing Q waves?
"Love Is Incredible. Nothing Like It" Lateral: I, aVL (LCX) Inferior: II, III, aVF
Dresslers Syndrome | PathoPhys
Autoimmune phenomenon resulting in fibrinous pericarditis several weeks post MI
Causes of Dilated Cardiomyopathies
Most common cause = idiopathic (>50%) "A Bold, Devout Christian Crusader Charged Petrified Hindus" Alcohol, wet Beriberi, Doxorubicin, Chagas, C...
Dilated Cardiomyopathy Common? Sound, US, CXR What kind of hypertrophy? What kind of dysfunction? Treatment
Most common cardiomyopathy (90%) S3, US = dilated heart, CXR = balloon Eccentric hypertrophy w/ sarcomeres added in series --> systolic dysfunct...
HOCM: PathoPhys Genetics Association
Hypertrophied IV septum is too close to mitral valve and obstructs aortic outflow 60-70% are caused by autosomal dominant mutation in β myosin heav...
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| Term | Definition |
|---|---|
EKG diagnosis of Anterior wall infarct based on leads showing Q waves? | "SAL" Anteroseptal: V1-V2 (LAD) Anterior: V1-V4 (LAD Anterolateral: V4-V6 (LCX) |
EKG diagnosis of Lateral or Inferior wall infarct based on leads showing Q waves? | "Love Is Incredible. Nothing Like It" Lateral: I, aVL (LCX) Inferior: II, III, aVF |
Dresslers Syndrome | PathoPhys | Autoimmune phenomenon resulting in fibrinous pericarditis several weeks post MI |
Causes of Dilated Cardiomyopathies | Most common cause = idiopathic (>50%) "A Bold, Devout Christian Crusader Charged Petrified Hindus" Alcohol, wet Beriberi, Doxorubicin, Chagas, Coxackie B, Cocaine, Postpartum, Hemochromatosis |
Dilated Cardiomyopathy Common? Sound, US, CXR What kind of hypertrophy? What kind of dysfunction? Treatment | Most common cardiomyopathy (90%) S3, US = dilated heart, CXR = balloon Eccentric hypertrophy w/ sarcomeres added in series --> systolic dysfunction? Treat w/ Na restriction, ACEI, diuretics, digoxin, transplant |
HOCM: PathoPhys Genetics Association | Hypertrophied IV septum is too close to mitral valve and obstructs aortic outflow 60-70% are caused by autosomal dominant mutation in β myosin heavy chain --> disorganized, tangled myocardial fibers Associated with Friedreich's Ataxia |
HOCM Classic Pt Size, Sound, Murmur, Impulses Treatment | Cause of death in young athletes Normal sized heart, S4, Systolic murmur, apical impulses Treat with II or nonDHP IV |
HOCM Hypertrophy Kind of dysfunction? May produce? | Concentric hypertrophy with sarcomeres added in parallel Diastolic dysfunction ensues May produce syncopal episodes. |
Causes of Restrictive Cardiomyopathies | "A SHELF" Amyloidosis, Sarcoidosis, Hemochromatosis, Endocardial fibroelastosis (thick fibroelastic tissue in endocardium of young children), Loffers Syndrome (endomyocardial fibrosis with eosinophils), Fibrosis (post radiation) |
What kind of dysfunction ensues in restrictive cardiomyopathies? | diastolic |
Treatment for CHF Mortality reducers? Symptom relief? Both? | Mortality reducers: ACEI, II (except in acute decompensated HF), ATII antagonists, Spironolactone Symptom relief: Thiazide and Loop Diuretics Both: Hydralazine and Nitrates |
CHF presentation | Dyspnea, fatigue, edema, rales |
What produces Cardiac Dilation? | Greater EDV |
Why do Pts experience dyspnea on exertion | Failure of CO to Increase |
Results of LHF? | Pul Edema: transudation of fluid into alveoli. Hemosiderin laden Macs in lung Paroxysmal Nocturnal Dyspnea and Orthopnea: Increased venous return --> pulmonary vascular congestion |
Results of RHF? | Hepatomegaly (nutmeg liver), Peripheral edema, JVD |
Bacterial Endocarditis Presentation | "FROM JANE" | Fever, Roth Spots, Osler's Nodes, Murmur, Janeway Lesions, Anemia, Nail-bed hemorrhages, Emboli |
Roth Spots | Round, white spots on retina surrounded by hemorrhage |
Osler's Nodes | Tender raised lesions on finger and toe pads caused by IC deposition |
Janeway Lesions | Small, painless, erythematous lesions on palm or sole. Hemorrhagic |
Complications of Bacterial Endocarditis | Chordae rupture, Glomerulonephritis, Suppurative pericarditis, emboli |
Site of infection in Bacterial endocarditis? | Usually Mitral Valve | Tricuspid in IV drug users |
Main Causes of Bacterial Endocarditis | Acute: S aureus (large vegetations on normal valve) Subacute: S. viridans (small vegetations on abnormal or diseased valve) Common after dental procedures |
Organisms Causing Tricuspid Bacterial Endocarditis | S aureus, Pseudomonas, Candida |
Causes of non bacterial endocarditis | Malignancy, Hypercoagulable state, SLE |
Bacterial endocarditis in colon cancer caused by | S bovis |
Bacterial endocarditis with a prosthetic valve caused by… | S epidermidis |
Rheumatic Fever Presentation | "FEVERSS" Fever, Erythema marginatum, Valve damage, ESR ↑, Red-Hot Joints (migratory polyarthritis), Subcutaneous nodules, St. Vitus dance (Sydenham's Chorea) |
RF Organisms causing it Valves affected Early vs Late Type of Disease? | GAS (β hemolytic strep) mitral > aortic >>> tricuspid Early MR, late MS Type II Hypersensitivity Rxn with Abs against bacterial M protein |
RF Histology Blood titers | Aschoff Bodies (granuloma with giant cells), Antischkow cells (activated histiocytes), Elevated ASO |
Acute Pericarditis Presentation PE findings EKG | Sharp pleuritic pain relieved by sitting up and leaning forward. Friction rub Widespread ST elevation and/or PR depression |
Fibrinous Pericarditis Causes Findings | Dressler's, Uremia, Radiation | Loud Friction Rub |
Causes of Serous Pericarditis | Viral (often resolves spontaneously), noninfectious inflammatory disease (SLE, RA) |
Causes of SuppurativePurulent Pericarditis | Bacterial infection (Pneumococcus Streptococcus) Rare now with antibiotics |
Cardiac Tamponade What happens to diastolic pressures? HR? Sounds? BP? PE findings? | Diastolic pressures equalize in all 4 chambers. HR↑, Distant heart sounds, hypotension and Pulsus Paradoxus, JVD |
Pulsus Paradoxus Definition Seen in what diseases? | ↓ in systolic P by >10mmHg during inspiration | Seen in pericarditis, tamponade, asthma, obstructive sleep apnea, croup |
Syphilitic Hearth Disease Causative agent MoA Risk for | Tertiary Syphilis disrupts vasa vasorum of the aorta and vessel wall atrophys and dilates. Risk for aortic aneurysm (ascending and arch) and aortic insufficiency (dilation of aorta and valve ring) |
In Syphilitic Hearth Disease, what happens to the aortic root and ascending aortic arch? How does the aorta appear? | Calcification | Tree bark appearance |
Cardiac Myxoma Common? Usually described as Location Present with | Most common primary cardiac tumor in adults. "ball valve" obstruction of LA presents with multiple syncopal episodes |
Rhabdomyomas Common? Associated with? | Most common primary cardiac tumor in children. Associated with Tuberous Sclerosis |
Most common cardiac tumor? | Metastatic (melanoma, lymphoma) |
Kussmaul's Sign Definition Seen in | ↑ in JVP during inspiration because negative intrathoracic pressure not transmitted to the heart Constrictive Pericarditis, Restrictive Cardiomyopathy, RA or RV tumors, Cardiac Tamponade |
Raynaud's Phenomenon PathoPhys Location Disease Syndrome Presentation | ↓ blood flow to skin due to arteriolar constriction in response to cold or stress Fingers and toes Disease if primary (idiopathic) Syndrome if secondary to connective tissue disease, SLE, CREST Cyanosis of fingertips and toes |
Temporal Giant Cell Arteritis Kind of vasculitis? Classic Pt Presentation Risk of Associated with Affects which vessels? Histo Blood Treatment | Large vessel Old female with unilateral temporal headache and jaw claudication Risk of blindness due to ophthalmic artery occlusion Associated with Polymyalgia Rheumatica Branches of Carotid artery.Focal Granulomatous inflammation, ↑ESR, Treat with corticosteroids |
Takayasu's Arteritis Kind of vasculitis? Classic Pt Presentation Affects which vessels? Histo Blood Treatment | "FAN My Skin On Wed" Large vessel Asian female < 40 with weak upper extremity pulses, fever, night sweats, arthritis, myalgias, skin nodules, ocular disturbances Granulomatous thickening of aortic arch and proximal great vessels, ↑ESR Treat with corticosteroids |
Polyarteritis Nodosa Kind of vasculitis? Classic Pt Presentation Affects which vessels? Histo What mediates the disease? Ages of lesions? Arteriogram Treatment | "Scalded My Right Hand on the PAN" Medium vessels Young Adult with HepB with fever, wt loss, malaise, headache, abdominal pain, melena, HTN, Neuro dysfunction (wrist drop), Cutaneous eruptions, renal damage Renal and Visceral vessels Transmural inflammation with fibrinoid necrosis IC mediated Typically of different ages Arteriogram shows many aneurysms and constrictions Corticosteroid and cyclophosphamide |
Kawasaki Disease Kind of vasculitis? Classic Pt Presentation Affects which vessels? Risk of Treatment | Medium vessels "FEAR ME" Asian child < 4 with Fever, conjunctival infection (Eye), cervical lymphAdenitis, desquamating Rash, Mouth and Extremity erythema Coronary vessels Risk of coronary aneurysm --> MI, Rupture Treat with IV Igs and Aspirin |
Buerger's Disease (Thromboangiitis Obliterans) Kind of vasculitis? Classic Pt Presentation Treatment | Medium vessels "SCRAPS" Male < 40 with Segmenting Thrombosing vasculitis, Claudication (may lead to gangrene and auto-amputation), Raynaud's, Smoker, Painful, Superficial Nodular Phlebitis Treat with smoking cessation |
Microscopic Polyangiitis Kind of vasculitis? Histo Organs involved w/ manifestation? Blood Treatment | Small vessels Necrotizing vasculitis w/ No Granulomas Lungs, Kidney (Pauci Immune Glomerulonephritis), and Skin (Palpable Purpura) P-ANCA Cyclophosphamide and Corticosteroids |
Wegener's Granulomatosis (Granulomatosis with Polyangiitis) Kind of vasculitis? Presentation Histo Blood CXR Treatment | Small vessels Upper Respiratory Tract: Perforated nasal septum, sinusitis, otitis media, mastoiditis Lower RT: Hemoptysis, Cough, Dyspnea Renal: Hematuria, RBC Casts Focal Necrotizing vasculitis + Necrotizing granulomas in the lung and upper airway + Necrotizing glomerulonephritis c-ANCA Large Nodular Densities Cyclophosphamide and corticosteroids |
Churg Strauss Syndrome Kind of vasculitis? Classic Presentation But can also affect Histo Blood | Small vessels "BEAN SAP? No, Go to Hell" Blood Eosinophils, Asthma, Neuropathy (food/wrist drop), Sinusitis, Allergies, Palpable Purpura, glomeruloNephritis (pauci immune), GI, Heart Granulomatous, necrotizing vasculitis w/ eosinophilia p-ANCA + ↑ IgE |
Henoch-Schonlein Purpura Kind of vasculitis? Most common vasculitis in... Classic Presentation Disease Mediated by Associated with Age of lesions? | Small vessels Most common vasculitis in children "NAPA" Child following URI with Nephropathy, Abdominal pain (melena), Purpura, Arthralgia Mediated by IgA complex deposition Associated with IgA nephropathy Multiple lesions of same age |
Essential HTN therapy | ACEI, ARB, Diuretics, IV |
When are II contraindicated? | Cardiogenic shock and must be used with caution in decompensated CHF |
Treatment for Diabetes Mellitus? | ACEI, ARB, Diuretics, II, α blockers, IV |
Ca Channel Blockers Names MoA Used to treat Tox | Verapamil, Diltiazem, Nifedipine, Amlodipine --/ Voltage gated L-type Ca channel in plasma membrane Used to treat HTN, Angina, Arrhythmias (not N), Prinzmetals Angina, Raynaud's Cardiac depression, AV block, Peripheral edema, Flushing, Dizziness, Constipation |
Hydralazine MoA Used to treat First line therapy for Coadministration Tox Contraindicated in | ↑cGMP --> Smooth Muscle relaxation. Vasodilates arterioles > veins --> ↓ afterload Used to treat HTN, CHF First line therapy for HTN in pregnancy with methyldopa Coadministered with II to --/ reflex tachycardia Compensatory tachycardia, fluid retention, nausea, headache, angina, Lupus. Contraindicated in Angina/CAD |
Treatment for MHTN | Nitroprusside (short acting) --> Release of NO --> ↑cGMP --> Smooth Muscle relaxation. Can cause cyanide poisoning Fenoldopam = D1 agonist --> coronary, peripheral, renal, and splanchnic vasodilation. ↓ BP and ↑ Natriuresis |
Nitric Oxide (NO) Releasing Drugs Names MoA Use Tox | Nitroglycerin, Isosorbide, Dinitrate NO --> ↑cGMP --> Smooth Muscle relaxation. Dilates veins > arteries --> ↓ preload Used to treat angina and Pul Edema Reflex tachycardia, Hypotension, Flushing, Headache, Monday disease (industrial exposure) |
Goal of Antianginal therapy | Reduce O2 demand of myocardium | Reduces Contractility, Afterload, Rate, Size (wall tension = Preload) |
Nitrates as Antianginal EDV BP Contractility HR Ejection time MVO2 | EDV ↓ BP ↓ Contractility ↑ (response) HR ↑ (response) Ejection time ↓ (response) MVO2 ↓ |
II as Antianginal EDV BP Contractility HR Ejection time MVO2 | EDV ↑ BP ↓ Contractility ↓ HR: ↓ Ejection time: ↑ MVO2: ↓ |
Nitrates + II as Antianginal EDV BP Contractility HR Ejection time MVO2 | EDV: No change or ↓ BP: ↓ Contractility: NC HR: ↓ Ejection time: NC MVO2: ↓↓ |
Which IV are similar to Nitrates? | Which IV are similar to II? | Nitrates: Nifedipine II: Verapamil |
Partial β blockers contraindicated in angina | Pindolol, Acebutolol |
Strawberry Hemangioma Benign or malignant? What kind of vessels? Time and frequency Course | Benign capillary hemangioma of infancy Appears in first few weeks of life 1/200 births Grows rapidly and regresses spontaneously at ages 5-8 |
Cherry Hemangioma Benign or malignant? What kind of vessels? Time and frequency Course | Benign capillary hemangioma of the elderly Does not regress Frequency increase with age |
Cystic Hygroma What kind of growth? Where on body? Associated with? | Cavernous lymphangioma of the neck. Associated with Turners Syndrome |
Pyogenic Granuloma What kind of tumor? What can it do? Associations? | Polyploid capillary hemangioma that can ulcerate and bleed. Associated with trauma and pregnancy |
Glomus Tumor Benign or malignant Painful or not? Color? Location? Arises from? | Benign, painful, red-blue, tumor of fingernails. Arises from modified smooth muscle cells of glomus body |
Bacillary Angiomatosis Benign or malignant Which vessels? Location? What kind of Pts? Cause? Frequently confused with | Benign capillary skin papules found in AIDS pts. Caused by Bartonella henselae infection. Frequently mistaken for Kaposi Sarcoma |
Angiosarcoma Frequency? Kind of malignancy? Location on body? Associated with what kind of pts? Prognosis? | Rare blood vessel malignancy typically occuring in head, neck and breast areas. Associated with pts recieving radiation therapy (breast cancer, Hodgkin's lymphoma). Very aggressive and difficult to resect due to delayed diagnosis |
Lymphangiosarcoma What kind of malignancy? Associated with? | Lymphatic malignancy associated with persistent lymphedema (post-radical masectomy) |
Kaposi Sarcoma What kind of malignancy Location on body Associated with Frequently mistaken for... | Endothelial malignancy found on skin, mouth, GI tract, respiratory tract. Associated with HHV8 and HIV. Frequently mistaken for bacillary angiomatosis |
Sturge Weber Disease What kind of disease? Vessels affected? Manifestation? | Congenital Capillary sized blood vessels Port-Wine stain (nevus flammeus) on face, Ipsilateral leptomeningeal angiomatosis (intracerebral arteriovenous malformation), Seizures, early onset Glaucoma |
HMG CoA Reductase Inhibitors (Statins) LDL HDL Tri MoA Tox | LDL ↓↓↓ HDL ↑ Tri ↓ MoA --/ conversion of HMG-CoA to mevalonate (a cholesterol precursor) Hepatotoxic (↑LFTs), Rhabdomyolysis |
Niacin (Vit B3) LDL HDL Tri MoA Tox | LDL ↓↓ HDL ↑↑ Tri ↓ MoA Inhibits lipolysis in adipose tissue. Reduced hepatic VLDL secretion Red, flushed face (↓ by aspirin). Hyperglycemia (acanthosis nigricans), Hyperuricemia (exacerbates gout) |
Bile Acid Resins Names LDL HDL Tri MoA Tox | Cholestyramine, Colestipol, Colesevelam LDL: ↓↓ HDL: Slightly ↑ Tri: Slightly ↑ Prevents intestinal reabsorption of bile acids forcing liver to use cholesterol to make Bile Bad taste, GI discomfort, ↓ absorption of soluble vitamins, Cholesterol Gallstones |
Cholesterol Absorption Blockers Names LDL HDL Tri MoA Tox | Ezetimibe LDL: ↓↓ HDL: - Tri: - MoA: Prevents cholesterol reabsorption in small intestine brush border Rare ↑ in LFTs, Diarrhea |
Fibrates Names LDL HDL Tri MoA Tox | Gemfibrozil, Clofibrate, Bezafibrate, Fenofibrate LDL ↓ HDL ↑ Tri ↓↓↓ Upregulate LPL --> ↑ TG clearance Myositis, hepatotoxic (↑ LFTs), cholesterol gallstones |
Cardiac Glycosides Names Bioavailability Protein bound? T1/2 Excretion | Digoxin 75% bioavailability 20-40% protein bound T1/2 40h Urinary excretion |
Digoxin MoA Use | --/ Na/K ATPase. ↑ Na --/ Na/Ca exchanger --> ↑ Ca --> ↑ contractility --> Vagus Nerve --> ↓ HR Used to treat CHF (↑ contractility), Afib (↓ conduction at AV node, depression at SA node) |
Digoxin Tox EKG Factors predisposing to toxicity | Cholinergic --> nausea, vomiting, diarrhea, blurry yellow vision AV block, Hyperkalemia, ↑ PR, ↓QT ST scooping, T wave inversion, arrhythmias Predisposition: renal failure (↓ excretion), Hypokalemia (permissive binding of Na/K pump), Quinidine (↓ clearance. displaces digoxin from tissue binding sites) |
Digoxin OD antidote | Slowly normalize K, Lidocaine, Cardiac Pacer, Anti Digoxin Fab Fragment, Mg |
Class I antiarrhythmics What kind of molecules What do they do? Dependence? Toxicity is aggravated by... | Local anesthetics ↓ conduction in depolarized cells. ↓ slope of phase 0. ↑ threshold for firing in abnormal pacemaker cells Are state dependent (selective depress frequently depolarized tissues) Hyperkalemia ↑ toxicity |
Class IA antiarrhythmics Name Action on AP? Action on EKG? Regions of heart? | Especially useful in treating Procainamide, Disopyramide, Quinidine ↑ AP duration. ↑ effective refractory period ↑ QT Affect both Atria and Ventricles Reentrant and Ectopic SVT and Vtach |
Class IA antiarrhythmics | Toxicity | Thrombocytopenia, torsades de pointes Q --> cinchonism (headache + tinnitus) P --> SLE D--> heart failure |
Class IB antiarrhythmics Names Affect on AP? Preferentially affects Useful in Tox | Lidocaine, Mexiletine, Tocainide, (Phenytoin) ↓ AP duration Preferentially affects ischemic or depolarize Purkinje and ventricular tissue Useful in acute ventricular (Is Best Post MI) + digitalis induced arrhythmias. Local anesthetic, CNS↑↓, CV depression |
Class IC antiarrhythmics Name Affect on AP? Useful in Usually only used as Affect on AV node Toxicity Contraindicated | Flecainide, Propafenone No affect on AP duration Useful in Vtach that progresses to Vfib + intractable SVT Usually used only as a last resort for refractory tachyarrhythmias Prolongs refractory period in AV node Tox: Proarrhythmic Contraindicated Post MI and structural heart disease |
Class II antiarrhythmics Names MoA Affect on AP Area particularly sensitive? Use | Metoprolol, propanolol, esmolol (very short acting), atenolol, timolol Decrease SA and AV nodal activity by ↓ cAMP --> ↓ Ca currents Decreases phase 4 slope in pacemaker cells AV node particularly sensitive (↑ PR interval) VTach, SVT, Slows ventricular rate during Afib + Aflutter |
Class II antiarrhythmics | Tox | BBC Loses Viewers in Houston Bradycardia (AV block, CHF), Bronchoconstriction (aggravates asthma), Claudication, CNS effects (sedation), Lipids (metoprolol), Vivid dreams, Hypoglycemia masked |
Propanolol can exacerbate | Vasospasms in Prinzmetal's angina |
Beta Blocker OD treatment | Glucagon |
Class III antiarrhythmics Names MoA Effect on AP Used when EKG effects | "AIDS" Amiodarone, Ibutilide, Dofetilide, Sotalol --/ K channels ↑AP duration, ↑ERP, Used when other antiarrhythmics fail ↑QT interval |
Class III | Toxicity | Sotolol: TdP, excessive β Block Ibutilide: TdP, Amiodarone: Pul Fibrosis, Hepatotoxic, Hypo/HyperThyroidism |
Amiodarone Toxicity | Real Classification | Pul Fibrosis, Hepatotoxic, Hypo/HyperThyroidism (40% I by weight), Corneal deposits, Skin deposits (blue/gray) --> photodermatitis, neurological effects, constipation, AV affects (bradycardia, heart block, CHF) Affects lipid membranes so has I, II, III, and IV activity |
Class IV antiarrhythmics Names Affects on AP Used to Tox | Verapamil, Diltiazem ↓ conduction velocity, ↑ERP, ↑PR Used to prevent nodal arrhythmias (SVT) Constipation, Flushing, Edema, CV (CHF, AV block, Sinus node depression |
Adenosine MoA Drug of choice for Speed Toxicity Affects blocked by | ↑K out of cells --> hyperpolarization and ↓ Ca current. Drug of choice for SVT (diagnosis and treatment) Very short acting (15 sec) Flushing, hypotension, angina Blocked by caffeine and theophylline |
Mg used to treat | TdP and Digoxin toxicity |
Names of β1 selective β Blockers | Start with A-N |
Names of non-selective β Blockers (β1 and β2) | Start with O-Z |
Breathing in a pt with CHF | Cheyne Stokes Breathing |