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Arrythmia
Arrythmia
- Keywords: Cardiology General
- tag: #note
Inherited Arrhythmia Syndromes
Patients younger than age 40 years with unexplained SCD, unexplained near drowning, or recurrent exertional syncope, who do not have ischemic or other structural heart disease, should be evaluated for inherited arrhythmia syndromes. Additionally, unexplained premature death (age <35 years) or sudden death in a
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Atheroembolism Is a Complication of Cardiac Catherization
Atheroembolism is a complication of cardiac catherization
- related: Cardiology, ACS
- tags: #cardiology
- Risk of cardiac catherization is small. One risk is atheroembolism
- Atheroembolism: atherosclerotic fragments dislodged from aortic wall and embolizes elsewhere
- Sx:
- livedo reticularis or blue toe syndrome
- Other locations: kidney (renal failure), retina, cerebrum, GI
Case:
A 68-year-old male with a pas
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Medicine
Medicine
Todos
- tolearn
- MKSAP todos
- heart murmurs
Organ Systems
- Allergy and Immunology
- Rheumatology
- Cardiology
- Dermatology
- Endocrine
- ENT
- GI
- Hemeonc
- ID
- MSK
- Nephrology
- Urology
- Neurology
- Pulmonology
- Podiatry
Subject Areas
- General
- Biostats
- Psychiatry
- [[Geriatric
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Mitral Regurgitation
Mitral Regurgitation
- Keywords:: Step 3, Medicine, Cardiology, Valvular Diseases
Mitral Regurgitation
Pathogenesis
Mitral regurgitation, also known as mitral insufficiency, refers to the retrograde flow of blood through the mitral valve from the left ventricle to the left atrium during systole due to anomalies of the mitral valve or the papillary muscles.
Myocardial infarction involving supply to the papillary muscles can cause
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PAD
PAD
- related: Cardiology
- manage risks: e.g. smoking cessation
- initial management: supervised exercise program best for claudication
- 30-45 minutes of supervised walking >3 times a week for >3 months
- Once the walking time required to develop claudication is determined, the sessions are gradually increased until the patient can walk for a longer period wi
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Peripartum Cardiomyopathy
Peripartum Cardiomyopathy
- related: Cardiology
- population:
- age > 30
- multiple gestation
- preeclampsia
- happens between 36 weeks gestation and 5 months postpartum
- symptoms: heart failure sx
- diagnosis: LVEF <45%, and no other cause of heart failure (ie, diagnosis of exclusion)
- treatment: treat systo
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Valvular Diseases
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Acute Pericarditis
acute pericarditis
- related: Cardiology, myocarditis myopericarditis
- tags: #cardiology
- Naproxen in combination with colchicine is the treatment of choice for most patients with idiopathic or viral acute pericarditis.
- Avoid nsaids other than aspirin and glucocorticoids for peri-infarction pericarditis due to decreased healing and increased rupture ris
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Heart Failure 9-2 Lecture
heart failure 9-2 lecture
- related: Medicine, Cardiology, heart failure
Definition
- HFrEF: <EF < 40%
- HFpEF: EF > 50%,
- Intermediate: HF with intermediate ejection 40-50%
- EF normal does not mean CO is normal. Can have preserved EF but low CO
Classifications
- NYHA: functional classification
- 1: no sx
- 2: sx with normal activity
- 3: sx with reduced activity
- 4: sx at rest
- ACC/AHA staging: more structural elements
- A: high risk o
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Left Axial Myxoma
left axial myxoma
- related: Cardiology
This patient's presentation with transient vision loss (amaurosis fugax), unintentional weight loss, and diastolic murmur is suggestive of cardiac myxoma. Myxomas are the most common benign primary cardiac tumors, with approximately 80% located in the left atrium.
Left atrial myxomas can cause obstruction of b
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Mechanical Heart Valve Anticoagulation
mechanical heart valve anticoagulation
- related: Valvular Diseases, Cardiology
The risk of systemic thromboembolism (eg, stroke) is approximately 4% per patient per year in those with mechanical prosthetic valves with no anticoagulation, compared to about 2% in patients treated with aspirin, and <1% in patients treated with warfarin. Patients with mechanical mitral valves have twice the ri
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Multifocal Atrial Tachycardia
Multifocal Atrial Tachycardia
- related: Medicine, Cardiology, tachycardia
- tag: #note
Multifocal atrial tachycardia (MAT) is an irregularly-irregular supraventricular tachycardia (SVT) characterized by the presence of 3 or more ectopic atrial pacemaking foci.
MAT occurs more commonly in patients with COPD, hypoxemia, and underlying pulmonary dysfunction. Other
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Syncope
syncope
- related: Cardiology, pacemaker, bradycardia
- syncope: short ddx
- presyncope: very long ddx
- good history is very important
- differentiate between true syncope vs presyncope
- does this sound like arrhythmia, tachy brady syndrome
- cereral hypoperfusion
- abrupt, no prodromal, no confusion
- lights off/on
- no tired/confused/postictal
- PE: carotid sound
- ECG
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Tricuspid Regurgitation
Tricuspid Regurgitation
Tricuspid regurgitation occurs when the tricuspid valve allows retrograde flow of blood from the right ventricle into the right atrium during systole.
A small, clinically insignificant amount of tricuspid regurgitation is present in about 70% of adults and can be considered a variant of normal anatomy.
Most clinically significant tricuspid regurgitation is functional; elevation of right ventricular end-systolic pressure (RVESP) cau
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SvO2
SvO2
- related: Cardiology, Pulmonology
- tags: #note
- mixed venous O2 saturation
- measures end O2 consumption and delivery
- must be obtained from pulmonary artery catheter or another central line device
- ScvO2 (central venous O2) useful surrogate and measured via CVC in SVC, measures venous blood from upper half of body
- normal 65-70%
- If low:
- increased demand: hyperthemia, shiver, pain, seizure
- decreased delivery: ane
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HFpEF
HFpEF
- related: Cardiology
- tags: #note
Pathophysiology
normal
- Passive: LV relaxation
- Active: Atrial kick
- As we age, LV stiffens up
- Passive filling goes down
- we rely more on atrial kick
- LA pressure is normal however
Pseudonormal LV filling
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Cardiology with Critical Care
cardiology with critical care
- related: Cardiology, ICU
mechanical ventilation
- Increasing oxygenation
- increase FiO2
- Increase PEEP, I:E ratio (increase alveolar recruitment)
- Decrease O2 consumption (increase sedation, analgesia, paralysis, synchrony)
- Minute Ventilation = RR X tidal volume
modes of ventilation
- AC: assist control. Specified volume or pressure for all breaths regardless whether patient or machine initiates breath
- default
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ACS
ACS
Acute Coronary Syndromes
- acute or subacute disruption in blood flow
- plaque rupture unlike narrowing in stable angina
- no clear precipitant
- STEMI: ST elevation of 1 mm or more in 2 or more contiguous limb or chest leads, except V2 and V3
- ST elevation in 2mm or more in
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EKG Basics
EKG basics
- related: Cardiology, bundle branch blocks, ECG samples
EKG leads
- Chest leads aka precordial leads:
- V1-V2: anteroseptal
- V3-V4: anteroapical
- V5-V6: anterolateral
- Limb leads:
- LA: left arm
- RA: right arm
- LL: left leg
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Stable Angina
stable angina
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related: Cardiology, ACS
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Definition:
- reproducible angina sx: chest pain/pressure
- at least 2 months
- triggered by stress or exertion
- have not worsened
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Unstable angina
- new-onset angina or angina at low level exertion
- occur at rest
- accelerating in frequency or severity
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sx
- classic: tightness, heaviness, gripping chest
- atypical in women/DM: exertional dyspnea
Diagnosis
- step 1: determine pretest likelihood
- base
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Bundle Branch Blocks
bundle branch blocks
- related: Cardiology
- source: https://litfl.com/right-bundle-branch-block-rbbb-ecg-library/
- tags: #note
- WilLiam MoRrow
RBBB
- RSR in V1
- slurred S in lateral leads
- sometimes T wave inversion in precordial leads, appropriate discordance
- incomplete RBBB: RSR in V1 but QRS < 120
- M shape, then W shape
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Pacemaker
pacemaker
- related: Cardiology
- rate response: increase HR based on metabolic rate
1st 2nd 3rd A A I D D D V V I - 1st letter: chamber pased, atrial, ventricular, dual
- 2nd letter: sensing, atrial, ventricular, dual
- 3rd letter: inhibition
- I: inhibit atrial on ventricular pacing
- D: lead in A, V. Sensing in A or V. Can pace in A or V. Can inihibit. Can trigger ventricular pacing base
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Drug Induced Lower Extremity Edema 1
drug induced lower extremity edema
- related: Cardiology
The most appropriate next step in the management of this patient is to discontinue pregabalin and initiate duloxetine. In most patients with lower extremity edema, a detailed history and physical examination will suggest the cause. The most common causes of lower extremity edema include venous obstruction or insufficiency, heart failure (including right-sided heart failure secondary to pulmonary disease), cirrh
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Drug Induced Lower Extremity Edema
drug induced lower extremity edema
- related: Cardiology
The most appropriate next step in the management of this patient is to discontinue pregabalin and initiate duloxetine. In most patients with lower extremity edema, a detailed history and physical examination will suggest the cause. The most common causes of lower extremity edema include venous obstruction or insufficiency, heart failure (including right-sided heart failure secondary to pulmonary disease), cirrh
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Atrial Fibrillation
atrial fibrillation
- related: tachycardia, Arrythmia, Cardiology
- tag: #note
epidemiology
- most common sustained arrhythmia
- affect more than 33 million persons worldwide
- Lifetime risk for atrial fibrillation is 25% in patients older than 40 years.
- Incidence is strongly associated with and increases with age.
- 10% of persons older than 80 years.
- fivefold increased risk for stroke
- increased risk for heart failure and dementia
- Among patie
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Bradycardia
bradycardia
- related: syncope, Cardiology, Arrythmia
- tag: #note
definition
- HR < 60
causes
- problems with
- SA node
- AV node or purkinje
- extrinsic: vagal tones
SA node dysfunction
sinus bradycardia
- normal: trained athletes, sleep
- pathological:
- right coronary ischemia
- age related myocardial fibrosis
- intracranial hypertension
- postop scarring
- infiltrative disease: sarcoidosis
- sleep apnea: nocturnal bradycar
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Sinus Tachycardia
sinus tachycardia
- related: Medicine, Cardiology, tachycardia
- tag: #note
Causes
- sepsis
- fever
- usually persistent
- volume
- Anemia
- Dehydration
- usually persistent
- stress
- Pain
- Anxiety
- ACS
- HF
- others
- Withdrawal
- Intoxication
- TSH
Inappropriate sinus tachycardia
- IST
- pt: women in 30s-40s
- elevated resting heart rate
- exaggerated increase with light activity
- decreased rate with sleep
- treatment:
- remova
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Brugada Syndrome
Brugada syndrome
- related: Cardiology, EKG basics, bundle branch blocks
- tags: #note
Pathophysiology
- Na channel mutation
- triggered by stress or drugs
Brugada sign
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ST elevation in V1-V3 followed by negative T wave
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Electrocardiogram demonstrating a type 1 Brugada pattern, ≥2 mm J-point elevation,
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Wellens Syndrome
Wellens syndrome
- related: Cardiology, ECG samples
- tag: #note
Significance
- highly specific for critical stenosis of LAD
- very high risk for anterior wall MI in subsequent days to weeks
- do not stress test: can cause MI or cardiac arrest
Dx
- biphasic or deeply inverted T in V2-3
- AND recent chest pain that's resolved
- normal or slightly elevated cardiac markers
- E
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DAPT
DAPT
- related: Cardiology
- tags: #note
History
90s:
- CURE trial: DAPT in ACS
- ASA vs ASA and Plavix
- Improvement in 24 hours, 30 days, and 1 year mortality
- 2% ARR in composite (MI, stroke, death) 2000s
- Prasugrel vs Plavix: TIMI 38?
- Ticag vs Plavix: PLATO trial: same reduction + mortality benefit over tigag 2016
- Prasugrel vs tigag: prasugrel barely better and safer
- Prasugrel: 1x/day, generic, no dyspnea
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Amiodarone Dosing
amiodarone dosing
- related: Cardiology
- tags: #note
- amiodarone PO: 7-8 grams
- 400 BID x 7-10 days = 10 gram
- then 200 daily until follow up outpatient
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Cardiogenic Shock
cardiogenic shock
- related: Cardiology
- tags: #note
- add hydralazine/lisinopril when pulling off dobutamine for afterload reduction
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Angiography 4 21
angiography 4 21
- related: Cardiology
- tags: #note
Angiography
Cases
- atenolol cleared by kidney
- beta blocker first line because only one prevents MI
- CCB can be good for vasospastic angina
- need nitrate free period of 12 h
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Indications for CRT
indications for CRT
- related: Cardiology
- tags: #cardiology
CRT is most effective in heart failure patients in sinus rhythm and with QRS duration ≥150 msec. CRT is also reasonable for patients with QRS duration >120 msec and <150 msec; the benefit of CRT in this group is clinically significant but less substantial.
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Adult Congenital Heart Disease
Adult Congenital Heart Disease
- related: Cardiology
- tags: #cardiology
Introduction
Medical and surgical advances have resulted in more adults living with congenital heart disease (CHD) than children with these conditions in North America. All patients with repaired congenital cardiac defects require regular follow-up, specialized screening, and preventive care.
Women with CHD should be provided with reproductive health counseling. The use of contraceptive
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Arrhythmias
Arrhythmias
- related: Cardiology
- tags: #cardiology
Introduction
Arrhythmias are traditionally categorized as supraventricular or ventricular based upon simple electrocardiographic (ECG) findings. Supraventricular arrhythmias originate from the atrium or atrioventricular (AV) node and are characterized by normal-appearing QRS complexes unless complicated by an aberrant ventricular condition. Ventricular arrhythmias originate below the AV node and are charac
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Cardiovascular Disease in Cancer Survivors
Cardiovascular Disease in Cancer Survivors
- related: Cardiology
- tags: #cardiology
Cardiotoxicity of Radiation Therapy to the Thorax
Radiation therapy improves survival in patients with Hodgkin lymphoma, early-stage breast cancer, and other thoracic malignancies. With higher survival rates, cardiovascular disease has emerged as the most common nonmalignant cause of death in patients treated with chest radiation therapy, accounting for 25% of deaths in survi
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Coronary Artery Disease
Coronary Artery Disease
- related: Cardiology
- tags: #cardiology
Stable Angina Pectoris
Diagnosis and Evaluation
Stable angina pectoris is defined as reproducible angina symptoms (chest pain or pressure) of at least 2 months' duration that are precipitated by exertion or emotional stress and have not appreciably worsened. In contrast, unstable angina is defined by new-onset angina or angina occurring at a relatively low level of exertion, occurring at r
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Diagnostic Testing in Cardiology
Diagnostic Testing in Cardiology
- related: Cardiology
- tags: #cardiology
Clinical History and Physical Examination
The clinical history and physical examination are cornerstones in the diagnosis of cardiovascular disease. A careful history that includes symptom characteristics, timing, and duration; factors that exacerbate or relieve symptoms; and functional capacity is critical to ensure a focused and appropriate diagnostic evaluation. Abnormal findings on
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Diseases of the Aorta
Diseases of the Aorta
- related: Cardiology
- tags: #cardiology
Introduction
Diseases of the aorta include chronic conditions, such as thoracic and abdominal aortic aneurysms and aortic atheromas, and potentially life-threatening acute conditions, such as aortic dissection and aneurysm rupture. Once chronic aortic diseases are diagnosed, surveillance and treatment are critical to prevent disease progression, complications, and mortality.
Thoracic Aortic A
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Myocardial Disease
Myocardial Disease
- related: Cardiology
- tags: #cardiology
Hypertrophic Cardiomyopathy
Clinical Presentation
Hypertrophic cardiomyopathy (HCM) is a common autosomal dominant heritable disorder related to mutations in the genes that predominantly encode sarcomeric proteins. It is characterized by the presence of increased left ventricular (LV) wall thickness in the absence of loading conditions or other underlying causes. HCM affects approximately 1 in
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Pericardial Disease
Pericardial Disease
- related: Cardiology
- tags: #cardiology
Acute Pericarditis
Clinical Presentation and Evaluation
Pericarditis is defined as inflammation of the pericardium, the thin fibrous sac surrounding the heart. Pericarditis may be subclinical or present as sharp precordial pain of acute onset. Acute pericarditis has many causes (Table 30), but it is most often idiopathic o
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Peripheral Artery Disease
Peripheral Artery Disease
- related: Cardiology
- tags: #cardiology
- Asymptomatic (20%-50%)
- Physical examination findings
- ↓ or absent pulses below the level of stenosis
- Occasional bruits over stenotic lesions
- Poor wound healing in areas of diminished perfusion
- Cool extremity with prolonged venous filling time
- Shiny, atrophied skin with nail changes
- Foot pallor with leg elevation (Buerger test)
- Specific pain patterns
- Buttock & hip pain (a
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Pregnancy and Cardiovascular Disease
Pregnancy and Cardiovascular Disease
- related: Cardiology
- tags: #cardiology
Cardiovascular Changes During Pregnancy
Knowledge of the cardiovascular changes of pregnancy is necessary to distinguish between normal and pathologic signs and symptoms in the pregnant patient (Table 42). During a normal pregnancy, patients develop a relative anemia due to increases in plasma volume and, to a
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Valvular Heart Disease
Valvular Heart Disease
- related: Cardiology
- tags: #cardiology
General Principles
Valvular heart disease (VHD) is characterized by underlying functional or anatomic abnormalities in the cardiac valves that result in regurgitation or stenosis. VHD is common, occurring in approximately 20 million persons in the United States. Although there are congenital forms, VHD is largely age dependent, and 3% to 6% of those aged 65 years and older are affected.
A thoro
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Subclavian Steal Syndrome
subclavian steal syndrome
- related: Cardiology
- tags: #cardiology
Subclavian steal syndrome is usually due to atherosclerotic narrowing of the proximal subclavian artery, which results in flow reversal in the ipsilateral vertebral artery. This occurs most often on the left side, and many patients are asymptomatic. A significant percentage has symptoms of arterial insufficiency in the affected upper extremity (eg, exercise-induced fatigue, pain, numbness, cool
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Perioperative Warfarin Management
perioperative warfarin management
- related: Cardiology, Perioperative
- tags: #cardiology
In patients with a mechanical prosthetic valve undergoing elective surgery, the decision to continue or hold warfarin anticoagulation is based on the risk of s
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Treat ICD Infection as Endocarditis
treat ICD infection as endocarditis
- related: Cardiology
- tags: #cardiology
Infection of a cardiovascular implantable electronic device (CIED) (ie, pacemaker, implantable cardioverter-defibrillator) has become common due to the increased frequency of device placement. Appropriate management of a known or suspected CIED infection involves removal of the entire device (generator and leads) if any of the following are present:
- Evidence of **valve o
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Different Types of Exercise Stress Test
different types of exercise stress test
- related: Cardiology, Cardiac Ischemia
- tags: #cardiology
The pretest probability of coronary heart disease (CHD) is used to determine the need for noninvasive diagnostic evaluation or coronary angiography in patients with suspected chest pain symptoms. Chest pain symptoms are
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Hypertension with Primary Hyperaldosteronism
hypertension with primary hyperaldosteronism
- related: Nephrology, Cardiology
- tags: #nephrology
Primary hyperaldosteronism (PH) is characterized by hypertension associated with hypokalemia and metabolic alkalosis. Some patients may not have spontaneous hypokalemia but rapidly develop hypokalemia if given diuretics. Despite increased renal reabsorption of sodium, edema
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Myocarditis Myopericarditis
myocarditis
- related: Cardiology
- tags: #cardiology
This patient's chest pain, characteristic ECG findings of diffuse ST elevations, and mildly elevated troponin are likely due to viral myopericarditis, defined as acute pericarditis with myocardial involvement noted with either elevated cardiac enzymes, myocarditis on cardiac MRI, or newly depressed left ventricular function.
Pericardit
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Medicine
Todos
Organ Systems
- Allergy and Immunology
- Rheumatology
- Cardiology
- Dermatology
- Endocrine
- ENT
- GI
- Hemeonc
- ID
- MSK
- Nephrology
- Urology
- Neurology
- Pulmonology
- Podiatry
Subject Areas
-
Heart Failure
heart failure
- related: Cardiology, HFpEF
- tags: #cardiology
Causes
Drug induced cardiomyopathy includes trastuzumab and anthracycline. Structural causes can include acute mitral regurgitation from either ruptured chordae tendinae or papillary muscle.
HFrEF Causes
- ischemic: angina, risks, wall motion, LHC, EKG changes, positive stress te
