Indications for temporary transvenous pacing in acute MI:
1) 2nd degree heart block, type II or greater; 2) Brady despite Atropine; 3) Junctional or idioventricular rhythm w/ hypoperfusion or slow ventricular rate; 4) LBBB in acute MI; 5) Bifascicular block with 1st degree AV block; 6) New bifascicular block
RV infarct is associated with what other MI area?
Treatment for right ventricular infarction
Indications for IABP (intra-aortic balloon pump)
1) recurrent or persistent MI; 2) severe left or biventricular failure +/- shock
Indications for ACE inhibitors post-MI
Low EF or LV dysfunction
Most common cause of CHF
MI or ischemia
Precipitating causes of CHF
1) increased salt intake; 2) inappropriate reduction in drug regimen; 3) excess exertion or stress; 4) arrhythmias; 5) systemic infection; 6) cardiac depressants; 7) fluid overload; 8) renal failure; 9) MI
4 tests used to make diagnosis of CHF
1) BNP screening -- >100 has 95% sensitivity 2) CXR; 3) Echo; 4) MUGA scan or radionuclide ventriculography
3 main therapeutic objectives in management of CHF:
1) reduce cardiac workload; 2) improve cardiac performance; 3) control excess salt and water
Mechanism of action of digoxin
Inhibition of Na/K ATPase --> --> increase intracellular Ca --> inotropic effect
systolic and diastolic thrill (double murmur) heard over the femoral arteries; related to high pulse pressure in Aortic Regurgitation (insufficiency)
Visible pulsations of the retinal arterioles
Corrigan's "water hammer" pulse
Abrupt distention and collapse of the peripheral arterial pulse;
Austin Flint murmur
a mid-diastolic, low pitched rumbling murmur best heard at the cardiac apex; seen in AR
de Musset's sign
Bobbing of the patient's head with each heartbeat
SBP with Popliteal cuff is 40 mm Hg higher than SBP at brachial cuff
Visible pulsations of the fingernail bed with light compression of nail
Treatment for Aortic Regurgitation
Treat like CHF secondary to systolic dysfunction: 1) pre-load reduction by salt restriction and diuretics; 2) digitalis; 3) afterload reduction by ACE inhibitor
Austin flint murmur is associated with which valvular disease?
Aortic Regurgitation = aortic insufficiency
Pathophys (cause!) of austin flint murmur
Regurgitant blood from the aortic valve strikes the anterior leaflet of the mitral valve, causing turbulent mixing.
Effect of amyl nitrate on austin flint murmur
Murmur of PDA Patent ductus arteriosus
continuous "machine-like" murmur throughout cardiac cycle
Effect of Hypertrophic cardiomyopathy on stroke volume and ejection fraction
stroke volume: normal to increased; ejection fraction: increased
What drugs are used in treatment of Hypertrophic Cardiomyopathy, and what drugs should be avoided.
Beta blockers Calcium channel blockers Amiodarone is used rarely Avoid inotropic drugs especially digitalis Avoid nitrates and sympathomimetic amines, except in concomitant coronary artery disease Use diuretics with caution
Effect of dilated (congestive) cardiomyopathy on stroke volume and ejection fraction
Decreased stroke volume and ejection fraction
What is the most common cause of heart transplants, and what are it's 2 main etiologies?
Dilated cardiomyopathy is the most common cause of transplant. It is either familial/ idiopathic or alcohol induced.
Strategy & Treatment for dilated cardiomyopathy
Srategies are same as for CHF w/systolic dysfunction: Preload reduction, Afterload reduction and Diuresis: Treatment includes 1) Decrease preload = salt restriction & diuretics; 2) Positive inotrope = digoxin; 3) Decrease afterload with ACE inhibitors & hydralazine; 4) ventricular remodeling with Beta Blockers PLUS 5) Anticoagulants to protect against high frequency of pulmonary and systemic embolisms.
Beriberi is secondary to what vitamin deficiency?
thiamine (vitamin B1)
Beriberi disease results in which type of cardiomyopathy?
Clinical manifestations of dilated cardiomyopathy:
same as those for left and right ventricular failure
How to differentiate between constrictive pericarditis and restrictive cardiomyopathy on cardiac catheterization:
in constrictive pericarditis, end-diastolic pressures are equal in all 4 chambers. In restrictive cardiomyopathy, left ventricular end diastolic pressure is greater than right ventricular end diastolic pressure.
Procedure of choice for constrictive pericarditis:
Rx tx for constrictive pericarditis:
conservative: salt restriction and diuretics
Treatment for constrictive pericarditis
Rx tx for symptomatic sinus bradycardia
What initiates torsades de pointes?
ventricular premature beat in the setting of abnormal ventricular repolarization characterized by prolonged QT
Sxs of torsades de pointes:
recurrent dizziness or syncope
What 2 electrolyte disturbances are associated with torsades de pointes?