Cardiology
|
Sick Sinus Syndrome
|
Causes: Digitalis (reversible), CCBs, sympatholytics, antiarrythmic drugs, coronary dz
|
|
AV block
|
Refractory conduction of impulses format he atria to the ventricles through the AV node/bundle of HIS
|
|
First degree
|
PR Interval of 0.4 sec or more
|
|
Second degree
|
Mobitz Type I (Wenckebach) & Mobitz Type II
|
|
Third degree
|
Complete dissociation from atria to ventricles
|
|
Treatment
|
Permanent pacing
|
|
Sinus bradycardia
HR <60 bpm. Sinus node pathology, increased risk of ectopic rhythms.
|
|
Sinus tachycardia
HR >100 bpm. Occurs with fever, exercise, pain, emotion, shock, thyrotoxicosis, anemia, heart failure, drugs.
|
|
Atrial premature beats
Usually benign
|
|
PSVT
Most *common paroxysmal tachycardia. Usually benign.
|
|
Atrial fibrillation
Most common chronic arrhythmia, "holiday heart" when caused by EtOH or withdrawel
|
|
Atrial flutter
Usually in pts. with normal hearts, or with myocarditis, CAD, or dig toxicity
|
|
Clinical features
Palpitations, angina, fatigue
|
|
Treatment--PSVT
Adenosine, verapamil. Prevent with diltiazem, B-blocker.
|
|
Treatment--Acute Afib
Electric cardioversion, rate control, prevent thromboembolism
|
|
Treatment--Chronic Aflutter
Amiodarone
|
|
Ventricular premature beats
May be benign or lead to sudden death if underlying heart disease
|
|
Ventricular tachycardia
3 or more ventricular premature beats in a row. Complication of MI and dilated cardiomyopathy. Sustained or unsustained.
|
|
Torsades de Pointe
A polymorphic VTach. Happens spontaneously, or from hypokalemia, hypomagnesemia, or QT-prolonging drugs
|
|
Long QT Syndrome
Congenital or acquired, recurrent syncope. Interval 0.5-0.7 sec. Can get ventricular arrhythmias and sudden death.
|
|
Brugada's syndrome
Genetic disorder, Asians and men, causes syncope, Vfib, sudden death.
|
|
Ventricular fibrillation
No cardiac output, associated with sudden death, more in early morning.
|
|
Treatment--Vfib
B-blockers if symptomatic
|
|
Treatment--Vtach
Synchronized cardioversion if severe hypotension or LOC. Rx: lidocaine, amiodarone, magnesium.
|
|
Treatment--Chronic sustained Vtach, congenital long QT, Brugadas
Implantable defibrillator
|
|
Treatment--Torsades de Pointe
B-blockers, magnesium, temporary pacing
|
|
Treatment: if identifiable site of arrhythmic origin
Radiofrequency ablation
|
|
DILATED Cardiomyopathy
Can't squeeze/contract, most common*, reduced strength or ventricular contraction and dilation of left ventricle.
|
|
Etiology
Genetic (most common), EtOH, chemo, idiopathic
|
|
Takotsubo
Type of dilated cardiomyopathy, occurs after major catecholamine discharge, sx similar to acute MI, "broken heart syndrome"
|
|
Clinical features
Sx of CHF, *dyspnea. Possibly S3 gallop, rales, JVP.
|
|
Treatment
Abstain from ThOH, treat underlying disease, supportive tx for CHF.
|
|
HYPERTROPHIC Cardiomyopathy
Can't fill/too tight, hypertrophy of septum and left ventricle, diastolic dysfunction
|
|
Etiology
Almost exclusively *genetic
|
|
Treatment
B-blockers, CCB or disopyramide (negative inotrope)
|
|
Sudden cardiac death
from hypertrophic cardiomyopathy occurs in patients <30yo 2-3% yearly
|
|
RESTRICTIVE Cardiomyopathy
Heart fibers of ventricle all scrambled up, mildly reduced function of L ventricle. Pulmonary HTN.
|
|
Etiology
From ibrosis or infiltration from diabetes,radiation, amyloidosis
|
|
Treatment
Diuretics may be helpful.
|
|
Pericarditis
Inflammation of the pericardium most often from infection, autoimmune, s/p radiation/chemo, drug toxicity.
|
|
Clinical Features
Pleuritic substernal pain, friction rub, pain relieved by sitting upright and leaning forward, fever if infectious
|
|
Pericardial Effusion
Secondary to pericarditis/uremia/cardiac trauma. Produces restrictive pressure on the heart
|
|
Clinical Features
Painless or painful (dyspnea and cough)
|
|
Cardiac Tamponade
Occurs when fluid compromises cardiac filling and impairs cardiac output
|
|
Clinical Features
Tachycardia, tachypnea, narrow pulse pressures, pulses paradoxes
|
|
EKG Signs
Electrical alternans
|
|
Treatment
If hemodynamic compromise-->pericardiocentesis to relieve fluid accumulation. O/W just NSAIDs if strictly inflammatory or abx if infectious
|
Cheatography n. The art of mapping complex subjects into clear, instantly navigable reference guides.
