Cardiology

describe sinus arrhythmia rhythm pattern

normal sinus rhythm that varies w respirations

increases w inspiration

Decreases w expiration

what meds cause slowing of heart rate

1. beta blockers

2. CCB

3. digoxin

4. adenosine

5. narcotics

what meds increase heart rate for severe sinus brady

1. atropine

2. epinephrine

3. dopamine

MCC of sick sinus syndrome

degenerative fibrosis

what does sick sinus syndrome look like on EKG

alternating bradycardia and atrial arrhythmia

(tachy-brady syndrome)

what is the most helpful part to look at on EKG to determine presence of AV block

PR interval

normal PR interval vs AV block

Normal PR: 0.12-0.2 seconds

AV block: >0.20 seconds

preferred initial diagnostic for atrial flutter

transthoracic echo

drug of choice for acute pharmacologic cardioversion of atrial flutter

ibutilide

types of a.fib

1. paroxysmal: stops within 7 days

2. persistent: doesnt stop within 7 days (requires intervention)

3. permanent: persistent AF >12 months

4. lone: any type of a.fib w/o evidence of heart dz

how long anticoagulation fo cardioversion of a.fib

3 weeks before and 4 weeks after

(if a.fib for <48 hours then dont have to wait 3 weeks, just need anticoagulation for 4 weeks after tho)

what EKG finding orthodromic AVRT associated w vs antidromic

orthodromic → narrow QRS

antidromic → widened QRS

AV node blocking agents

ABCD

1. adenosine

2. beta blockers

3. ccb

4. digoxin

what pathway is WPW associated with

bundle of kent

reyes syndrome

rapid liver degeneration and encephalopathy

in children w viral infxn tht take aspirin

right ventricular infarction triad

1. inc JVP

2. Clear lungs

3. positive kussmaul sign

when do you not give ACS pt nitroglyceride for chest pain

1. inferior MI

2. recent PDE-5 use

3. hypotension (SBP <90)

levine sign

clenched fist over chest → chest ishemia

pt education abt nitrate storage

deteriorates w light, air and moisture

tx in HFrEF vs HFpEF

HFrEF → GDMT

1. ARNI

2. BB

3. MRA

4. SGLT2i

HFpEF → SGLT2i ± MRA

• can add diuretics

• tx comorbidities**

meds to avoid in HFrEF

1. Thiazolidinediones (glitazones)

2. CCB - esp ND-CCB (can use amlodipine)

3. NSAIDs

4. Combo of ace, arb, aldosterone blocker (spironolactone) → hyperkalemia

EKG effects from digoxin use

1. PVCs (MC)

2. downsloping ST segment

Endocarditis tx for native valve

vanco (MRSA) or Nafcillin/Oxacillin (MSSA)

PLUS

Ceftriaxone

Endocarditis tx of prosthetic valve

1. vanco (6 wks)

2. rifampin (6wks)

3. gentamicin (2 weeks)

mitral facies

facial pallor w flushed cheeks

How to distinguish mitral regurg from tricuspid regurg

Carvallo’s sign → TR intensity increases w inspiration

PAD is associated w what type of ulcers

Lateral malleolus

Clear margins

Chronic venous insufficiency is associated w what type of ulcers

Medial malleolus

Unclear margins

pulsus paradoxus is pathognomonic for what cardiac condition

cardiac tamponade