Cram the PANCE Cardiology

Dilated Cardiomyopathy

PP: dilation+impaired contraction of one/both ventricles→ impaired systolic function

Ventricles: baggy

Stretched out

Weak

E: most common type (90%)

Idiopathic (50%)

Alcohol

Cocaine

Doxorubicin

Infection (coxsackie virus)

Vitamin B1

“Dilated starts with a D”

*drinking (alcohol)

Dunno (idiopathic)

Deficiency (vitamin B1)

Doxorubicin

Drugs (cocaine)

Disease (coxsackie virus)

CM:

left-sided HF:

Dyspnea

Cough

Wheezing

Right sided HF:

Hepatomegaly

Jugular venous distention

Peripheral edema

PE: S3 gallop

DX:

Echocardiogram:

Ventricular dilation

Thicken/stretched out ventricular walls

Decreased ejection fraction

CXR:

Cardiomegaly

Pleural effusion

EKG:

Arrhythmias

Sinus tachycardias

Tx:

Decrease mortality:

ACE inhibitors “the -prils”:

Lisinopril

Captopril

Beta blockers:

Carvedilol

Metoprolol

Hydralazine+nitrate (isosorbide dinitrate)

Spironolactone

“BASH the heart to make it beat harder”

Beta blockers

Ace inhibitors

Spironolactone

Hydralazine+nitrate

Lower sx:

Loop diuretics:

Furosemide

Digoxin

Low ejection fraction: implantable cardiac defibrillator (ICD)

restrictive cardiomyopathy

PP: infiltrative disease→ stiffening of ventricles→ inability to fill during diastole→ diastolic dysfunction

E: rare (1%)

Amyloidosis

Hemochromatosis

Sarcoidosis

“AMY HAS restrictive cardiomyopathy”

AMYloidosis

Hemochromatosis

Amyloidosis

Sarcoidosis

CM:

Right sided more common

Right-sided:

Hepatomegaly

Jugular venous distention

Peripheral edema

Kussmaul sign (increased jugular venous pressure breathing in

Left-sided:

Dyspnea

Cough

Wheezing

DX:

Echocardiogram:

Normal/slightly thickened ventricles

Diastolic dysfunction (decreased filling of ventricle)+normal ejection

Atrial dilation

Endomyocardial biopsy:

Definitive

Apple-green birefringence on staining→amyloidosis

TX:

Underlying cause

Hypertrophic cardiomyopathy

PP: autosomal dominant genetic disorder

Mutations in sarcomere genes:

Left-ventricle Hypertrophy (thickened left ventricle)

Diastolic dysfunction

Outflow obstruction

CM:

Dyspnea (most important)

Angina

Fatigue

Presyncope/syncope

Sudden cardiac death

Asymptomatic

PE:

Harsh systolic murmur best heard at left sternal border

Decreased venous return (standing/valsalva maneuver)→ increased murmur intensity

Increased venous return (squatting/leg raise)→ decreased murmur intensity

Opposite of other murmurs

S4 on auscultation

DX:

Echocardiogram:

Left ventricular wall 15+mm thickness (family hx→13+mm thickness)

EKG:

Repolarization

Left axis deviation

Left ventricular Hypertrophy

TX:

P:

1st line: Beta blockers

Carvedilol

Metoprolol

2nd line: calcium channel blockers (Non-Dihydropyridine):

Diltiazem

Verapamil

“they Decrease Velocity of the heart by decreasing AV node conduction”

Diltiazem

verapamil

NP (refractory to P therapy):

Septal myomectomy

Alcohol septal ablation

Avoid:

Digoxin

Niltrates

Diuretics

Exertion

Dehydration

Exacerbation of obstruction from increased contraction of heart+dehydration

heart failure (general)

PP: structure/functional disorder of heart→can’t fill heart or can’t pump blood

RF:
coronary artery disease (60-65%)
HTN
valvular heart disease
diabetes
obesity
pulmonary disorders
Doxorubicin
cardiomyopathy

Systolic heart failure (heart failure with reduced ejection fraction

Pp: weakened/thin/compliant ventricles→pumping problem→decreased ejection fraction (less than 50-70%)

E:
post MI (heart cells die)
dilated cardiomyopathy
valvular disease

Pe: auscultation: s3 gallop (blood splashing on compliant left ventricle
“shape=3 on its side"

Diastolic heart failure (heart failure with preserved ejection fraction)

pp: stiff+thickened ventricles→lowered filling (normal ejection fraction)

e:
long-standing hypertension
“heart walls thicken and become strong due to hardened vessels from HTN”
valvular heart disease “heart becomes stronger due to increased HTN pressure”
cardiomyopathy

pe:
auscultation: s4

left-sided heart failure

e:
acute MI

HTN
“left side=lungs"

cm:
dyspnea/SOB
orthopnea (SOB laying flat)
chronic cough+maybe frothy sputum

right-sided heart failure

e:
left-sided heart failure
pulmonary conditions

cm:
peripheral edema
jugular venous distention
N/V
hepatojugular reflex (jugular vein distends when pressed)
“right side=rest of body”

new york heart association functional class

Class 1: no symptoms

class 2: mild symptoms/slight limitation of physical activity

class 3: comfortable only at rest

class 4: symptoms even at rest

heart failure DX/tests

CXR:
cardiomegaly
pleural effusion
cephalization of flow
kerley B lines
butterfly/batwing appearance (progression of kerley B lines)

BNP:
hormone secreted from cardiomyocytes due to stretched ventricles+fluid overload
BNP over 100 (can also be due to kidney failure)
low BNP=obesity

ECG

echo (best)

heart failure TX/meds

NP:
stop smoking
less than 2 grams of sodium daily
less than 2 liters of fluid daily

end stage:
left ventricular assist device
automatic implantable cardioverter defibrillator (AICD)

P:
Systolic:
decrease mortality:
beta blockers:
Carvedilol
Metoprolol

ACE inhibitors/ARB:
Lisinopril
Captopril

spironolactone

hydralazine+nitrate(isosorbide dinitrate)

“BASH the heart to make it beat harder”

support:
loop diuretics:
furosemide
torsemide

positive intropes:
digoxin
dobutamine
dopamine

diastolic: treat associated conditions

acute decompensated heart failure

pp: sudden worsening of heart failure symptoms

cm:
dyspnea
peripheral edema
fatigue

dx:
CXR
BNP
echo

tx:
“LMNOP”
Lasix (furosemide)
Morphine
Nitrates
Oxygen (100% in nonbreather mask)
Position (sit up/legs hanging off table)

infectious endocarditis (general)

pp: infection of the endocardial surface of the heart (valves)

normal: mitral valve
IV drug user: tricuspid valve
“do you want to TRI IV Drugs”

rf: old age (60+)
males
IV drug use
poor dentition/dental infection
structural heart disease hx
valvular heart disease hx
infectious endocarditis hx
prosthetic heart valves

types:
acute bacterial endocarditis:
normal heart valves
e: staph. aureus (A for acute/addiction)
sudden onset

subacute bacterial endocarditis:
abnormal/damaged heart valves
strep viridans (V for vulnerable valves)
slow onset

IV drug use related endocarditis:
normal valves
staph aureus (A for acute/addiction)
tricuspid valve infxn

prosthetic valve endocarditis:
early (before 60 days) vs. late (after 60 days)
staph epidermidis (EPI= Enters Prosthetic Implants)

extra organisms:
enterococcus (ENT= Enema N Turp→recent GI (enema) or GU (turp) exam)
strep bovis (BOvis=BOwel)

cm:
fever
night sweats
fatigue
myalgia
new onset of murmur
worsening of existing murmur
weird stuff:
janeway lesions (painless macules/plauques on palms and soles)
osler nodes (painful nodules on pads of fingers and toes)
roth spots (pale retinal lesions/hemorrhages on fundoscopy)
splinter hemorrhages (nail bed hemorrhages/spots)
emboli
anemia
“I got endocarditis FROM JANE”
Fever
Roth spots
Osler nodes
Murmur
Janeway lesions
Anemia
Nail bed hemorrhages
Emboli

dx:
clinical manifestations
blood cultures
echocardiography

Duke Criteria:
2 major or 1 major+3 minor or 5 minor

Major Criteria: 2 separate positive blood cultures w. related organisms
evidence of endocardial involvement by echo

minor criteria:
all of the FROM JANE (5 points total)
positive echo with no endocardial involvement
positive blood culture w. non-related organisms
predisposing factors (IV/indwelling catheter/etc.)

tx:
empiric abx:
anti-staphylococcal penicillin:
nafcillin
oxacillin

+ceftriaxone or gentamicin

“Only Native Cardiac Gears”
Oxacillin
Naficillin
Ceftriaxone
Gentamicin

prosthetic valve:
vancomycin+gentamycin+rifampin
“Valves Generally Repaired"“

fungal infxn:”
amphotericin B x6=8 weeks

prophylaxis:

1st line: amoxicillin x30-60 min before procedure
penicillin allergy: clindamycin

hypertension

e:
primary/essential:
common (95%)
idiopathic

secondary:
rare (5%)
renal artery stenosis (1st line)
cortacion of the aorta
cushing syndrome
pheohromocytoma
mx
sleep pnea

rf:
advancing age
obesity
family hx
african american
high sodium diet (3+g daily)

dx:
2017 ACC/AHA guidelines:
normal blood pressure:
systolic: less than 120
diastolic: less than 80

elevated blood pressure:
systolic: 120-129
diastolic: less than 80

stage 1 HTN:
systolic: 130-139
diastolic: 80-89

stage 2 HTN:
systolic: 140+
diastolic: (and/or) 90+

*need 2+ readings on 2 separate visits*

newly diagnosed:
fasting blood glucose
urinalysis
urine to albumin creatine ratio
CBC
TSH
lipid profile
ECG
electrolytes and serum creatinine
10 year aetherosclerotic CVD reisk
fundoscopy

c:
cardiovascular:
left ventricular hypertroophy
heart failure
ischemic heart disease (MI)

renal:
chronic kidney disease
end stage renal disease

neurologic:
CVA
TIA
retinopathy

tx:
lifestyle changes:
weight loss
DASH diet (Dietary Approaches to Stop Hypertension)
exercise
limit alcohol (men: 2 or less/women: 1 or less)
stop smoking
potassium supplementation

Px:
uncomplicated/non-african american:
ACE inhibitors:
Lisinopril
Captopril
“the -prils”

ARBS:
“sartans”

Thiazide type diuretics (HCTZ)

CCB:
amlodipine

diabetes/chronic kidney disease hx:
ACE inhibitors
ARB

African American:
CCB
thiazide

ischemic heart disease hx/decreased ejection fraction heart failure:
beta blockers:
atenolol
carvedilol

not getting to goal (under 140/90)=add second drug from different class

hypertension refractory to multiple mx classes=secondary HTN

Hypertensive Emergency/Hypertensive Urgency

hypertensive urgency:
systolic: over 180
diastolic: over 120
no evidence of end organ damage

hypertensive emergency:

systolic: over 180
diastolic: over 120
evidence of end organ damage

end organ damage signs:
chest pain
back pain
dyspnea/SOB
altered metnal status
seizures
headache (most common)

tx:
urgency:
anti-hypertenstive agents PO
reduction of mean arterial blood pressure no more than 25% over 24-48 hours

emergency:
anti-hypertensive agents IV
reduction of mean arterial blood pressure 10-25% in 1st hour
reduction of mean arterial blood pressure 5-15% next 23 hours

exceptions:
ischemic stroke
acute aortic dissection
interacerebral hemorrhage

mx:
nitroprusside
neurological HTN emergency:
nicardipine
clevidipine
CV HTN emergency:
labetalol
esmolol

atrial septal defect

pp: abnormal opening between the interatrial septum

e: secundum ASD (70-75%)

cm:
small: asymptomatic
large:
dyspnea
palpitations
syncope
emboli
etc.

pe: *systolic ejection murmur (crescendo-decrescendo)
*heard at pulmonic area (left upper sternal border)
“All Patients Eagerly Take Medicine”
Aortic area: right side of chest
Pulmonic area: upper portion of left chest
Erb’s point: below pulmonic area
tricuspid area: way below erb’s point
mitral area: on 5th intercostal space to the left

*wide fixed split S2
“Atrial septal defect=wide split forms an A”
“A=Anchor=Fixed”

dx:
echocardiography (definitive)
EKG
CXR

tx:
less than 5mm: observation
over 5mm: surgery (definitive)

ventricular septal defect

pp: hole in the interventricular septum→shunting blood from left to right ventricle

e: congenital heart disease of childhood
perimembranous (70-80%)

cm:
small: asymptomatic
moderate:
respiratory infection
fatigue
large:
reversal of shunt
cyanosis

PE:
high pitched+holosystolic murmur
lower left sternal border

dx:
echo
EKG: LVH

tx:
small: observation
large: repair

“Very Sharp Dagger CHOPS a hole in your ventricular septum”
Ventricular
Septal
Defect

Common (MC congenital heart disease of childhood)
Holosystic/high-pitched murmur
Observation (small)
Perimembranous (type)
Surgery (large)

patent ductus arteriosus

pp: ductus arteriorsus doesn’t close after birth
continued prostaglandin E1 production

e:
prematurity
female
higher altitude
congenital rubella

cm:
poor feeding
common lower respiratory infections
weight loss
cyanosis (eisenmenger syndrome)

pe:
continuous machine like murmur
bounding peripheral pulse
wide pulse pressure

dx:
echo
ECG:
left ventricular hypertrophy
left atrial enlargement

tx:
1st line: NSAIDS (naproxen/indomethicin/ibuprofen/etc.)
non-responsive→surgery

coarctation of the aorta

pp: narrowing of descending aorta

e:
bicuspid aortic valve (70%)
turners sydnrome

cm:
neonates: asymptomatic
poor feeding

older infants/children:
angina
cold extremities
claudication (pain in extremities) with exertion

adults:
hypertension

pe:
HTN in upper extremities
hypotension in lower extremities

dx:
echocardiogram
CTA
MRA
CXR:
posterior rib notching
figure 3 sign

txt:
surgery
prostaglandin before surgery to maintain opening of ductus arteriosus

tetralogy of the fallot

starts with a T=teal=cyanotic condition
pp:
right ventricular outflow obstruction
right ventricular hypertrophy
overriding aorta
ventricular septum defect

rf:
down syndrome
DiGeorge syndrome
alagille syndrome

cm:
cyanosis
tachypnea
tet spells: right ventricular outflow blocked→severe cyanosis episodes

pe:
harsh systolic ejection murmur
left sternal border

dx:
echo
ECG
CXR: boot shaped heart

txt:
prostaglandin:
alprostadil
maintain patency of ductus arteriosus to imrpove circulation
surgery (1st year of life)

“CRAVE oxygen”
Cyanosis
RVH/RV outflow obstruction
Alprostadil
VSD
Echocardiogram

Unstable Angina

pp: partial occlusion of vessel

cm: symptoms at rest
not relieved by nitrates

dx:
EKG: ischemia
ST depression
T wave inversion
negative cardiac enzymes

NSTEMI

Non-ST Elevation Myocardial Infarction

positive cardiac enzymes (myocardial cell death)
EKG: ST depression
T wave inversion

STEMI

ST Elevation Myocardial Infarction
EKG: ST elevation (100% occlusion)
positive cardiac enzymes
more severe sx

Acute Coronary Syndrome (General)

pp: acute myocardial ischemia/infarction

e: plaque rupture→secondary artery thrombosis→blood flow in vessel occluded
women
elderly
diabetic

types:
unstable angina
STEMI
NSTEMI

cm:
angina/chest pain
not relieved with rest
note relieved with nitro
duration: over 30 minute
radiation (left arm/lower jaw/back)
pain doesn’t vary with position
non-pleuritic
not reproducible

sympathetic activation:
tachycardia
diaphoresis
nausea
vomiting

atypical:
syncope
weakness
palpitations
dyspnea if no angina
epigastric pain

dx:
EKG (10 minutes of patient arrival)
leads:
inferior wall:
II
III
AVF

anterior wall:
v2-v5

septal:
v1-v2

lateral wall:
I
AVI
v5-v6

posterior:
v1-v2 ST depression

v7-v9 ST elevation

cardiac biomarkers:
troponin
CK-MB
myoglobin

hx
pe

tx:
“MOAN and BASH”

MOAN:
Morphine
Oxygen
Aspirin
Nitrate

BASH:
Beta blockers
Ace inhibitors
Statins
Heparin

adjunct:
clopidogrel
glycoprotein
antiplatelets:
IIb inhibitors
IIIa inhibitors

tx:
reperfusion therapy:
percutaneous coronary intervention or thrombolytics
percutaneous coronary intervention (first 90 minutes)
-angioplasty/stenting
thrombolytic (fibrinolytic therapy):
TPA (Alteplase)

cardiac enzyme tests

troponin:
most sensitive
Most specific
found in cardiac+skeletal muscle
released into blood stream when muscle is damaged
problems:
elevated in chronic kidney disease
pulmonary embolism
trauma like after cardioversion
cardiopulmonary resuscitation

CK/CK-MB:
CK:
creatinine kinase
found in heart/brain/skeletal muscle/tissue damage/enzyme rise
CK-MB:
more specific variation
found in cardiac tissue
uses:
no cardiac troponin assay
early reinfarction

myoglobin:
peaks very fast (under 2 hours)
“my-o-my it’s fast"“

cocaine induced myocardial infarction

cm similar to MI:
chest pain
diaphoresis
ST segment elevation
EKG

cocaine induces coronary artery vasospasm

EKG: transient ST elevation

tx:
calcium channel blockers
nitrates
avoid non-selective beta blockers

vasospastic angina

chest pain at rest (not at middle of night)

EKG: transient ST elevation

angiography: coronary vasospasm

tx:
calcium channel blockers
avoid beta blockers

Dressler Syndrome

PP: post MI pericarditis

cm:chest pain
fever
pericardial friction rub

tx:
aspirin
colchicine
avoid other NSAIDS

right ventricular infarction

cm:
increased JVP
clear lungs
kussmaul sign

tx:
avoid nitrates
avoid morphine
also avoid in inferior/posterior MI due to decrease in preload

Aortic Heart Murmur

pp: narrowing of aortic valve

e: most common valvular disease
young (under 70)→congenital
Old (over 70)→calcification of the valve

cm:
Angina Syncope Heart Failure (late stage)
dyspnea on exertion

pe:
systolic
crescendo-decrescendo
right upper sternal border
pulsus parvus et tardus (weak and late pulse)

tx: valve replacement

Heart Murmurs (General)

systolic: between s1-s2

diastolic: after s2 (between s1 and s2)

“MS. PRARTS DIED”
Mitral
Stenosis

Pulmonary
Regurgitation

Aortic
Regurgitation

Tricuspid
Stenosis

DIed→DIastolic

all murmurs:
increase in intensity with increased venous return/preload
decrease in intensity with decreased venous return/preload

exceptions:
mitral valve prolapse:
increased venous return→murmur duration decreased (click heard later)
decreased venous return→murmur duration increased (click heard earlier)

hypertrophic cardiomyopathy:
increased venous return→murmur decreases in intensity
decreased venous return→murmur increases with intensity

“MVP Hates Conforming”
MVP: Mitral Valve Prolapse

Hates Conforming: Hypertrophic Cardiomyopathy

left vs right:
right sided murmurs increase intensity with inspiration
left sided murmurs decrease intensity iwth inspiration

“RINspiration”

RIght-sided
INspiration
INcrease

“all patients eagerly take medicine pneumonic (ascultation location)”

aortic regurgitation

pp: aortic valve leaflet insufficiency→difficulty remaining closed during diastole→blood leaks back into left ventricle

e:
chronic: rheumatic heart disease
acute:
endocarditis
aortic dissection
acute MI

cm:
asumptomatic
severe:
angina
dyspnea
heart failure sx

pe:
diastolic
decrescendo murmur
left upper sternal border
bounding pulses (MC=increased stroke volume)
quincke’s pulses (pulse in fingertips/nailbeds)
“Quincke in the pinky”
corrigan/water hammer pulse (rapid rising and collapse)
“corrigan=raise the hand”
de mussets sign (head bobs up and down)
mueller’s sign (systolic pulsation of the uvula)

tx: surgery
prophx:
ACE
ARBS
Hydralazine

mitral regurgitation

pp: abnormality in the mitral valves

e: mitral valve prolapse
rheumatic heart disease

cm:
dyspnea
hypertension
atrial fibrillation (atrial enlargement)

pe:
holosystolic murmur
apex (mitral area)
radiation to axilla

tx:
surgery
prophx:
ACE
ARBS
nitrates

mitral stenosis

pp: obstruction of blood flow in mitral valve

e: rheumatic heart disease

cm:
atrial fibrillation
hoarseness (ortner’s syndrome)
mitral facies

pe:
diastolic rumbling murmur
apex
opening snap

“MicroSoft Operating System”
Mitral Stenosis Opening Snap

tx:
percutaneous balloon valvuloplasty
valve replacement

mitral valve prolapse

pp:2 mitral valve flaps don’t close properly/buldge up into atrium

rf:
younger women
anxiety
chest pain
palpitations
MVP

e:
primary: myxomatous degeneration
no associated connective tissue disease

secondary:
connective tissue disease present:
ex: marfan syndrome
ehlers-danlos

cm:
asymptomatic
MVP syndrome (anxiety/palpitations/dizziness)

pe:
mid-late systolic ejection click
“MVP hates conforming to the rules”
increased preload→later click
decreased preload→earlier click

tx:
asymptomatic: reassurance
severe+MVP: surgery
sx: beta blockers

pulmonic stenosis

pp: stenotic pulmonary valve of rv→outflow obstruction

rf: children w. congenital heart disease (7%)

e:
tetralogy of fallot
congenital rubella syndrome
noonan syndrome

cm:
asymptomatic
mild exertional dyspnea
right heart failure sx

pe:
systolic
crescendo-decrescendo
left upper sternal border (pulmonic area)
radiate to neck
increased intensity with inspiration (RINspiration)

tx:
mild: observation
moderate/severe: balloon valvuloplasty

pulmonary regurgitation

pp: valvular abnormality of the pulmonary valve → backflow from pulmonary artery into right ventricle

e: congenital
tetralogu of fallot
endocarditis
rheumatic heart disease

cm:
asymptomatic
severe: right-sided heart failure sx

pe:
diastolic
decrescendo murmur
left upper sternal border (pulmonic area)
increased intensity with inspiration (RINspiration)=Graham-Steell murmur
“graham-steeell protector of realm”
graham-steell pulmonary regurgitation

tx:
observation
txt underlying cause

tricuspid stenosis

pp: stenosis of tricuspid valve→blood goes back into right atrium→ atrial enlargement→ untreated=right sided heart failure

e:
rheumatic heart disease
iatrogenic (radiation/endocardial pacemaker leads/etc.)

cm:
fatigue
dyspnea

pe:
diastolic
left lower sternal border (tricuspid)
opening snap
increases intensity w. inspiration (RINspiration)

tx:
surgery
prophx: diuretics

tricuspid regurgitation

pp: backflow of blood into right atrium during systole

e: adults (70%)
ebstein anomaly
infective endocarditis
marfan syndrome

cm: asymptomatic
dyspnea
exercise intolerance

pe:
holosystolic
tricuspid

tx:
surgery
fluid overflow prophylaxis: diuretics

AV Block (General)

electrical conduction:
“Send A Big Bounding Pulse”
SA node
AV node
Bundle of His
Bundle branches
Purkinje fibers

PR interval: delay between SA and AV node

types:
first degree
second degree:
mobitz type 1
mobitz type 2
third degree

First Degree AV Block

pp: slow AV node

e:
normal
mx:
“ABCD”
Adenosine
Beta blcokers
Calcium channel blockers
Digoxin
myocarditis (lyme disease)
MI

cm: asymptomatic

dx:
ECG: PR interval over 200ms

tx:
asymptomatic: observation
pacemaker

Mobitz Type 1/Wenckebach

pp: progressive PR interval lengthening
impaired conduction of AV node→non-conducted impulse
block at AV node

e:
normal
mx (“ABCD”)
myocarditis (lyme disease)
MI
hyperkalemia

“BLOCKS”
Beta blockers
Lyme disease
Ordinary=normal variant
Calcium channel blockers
K+ increase (Hyperkalemia)
Stemi

cm:
asymptomatic
bradycardia=hypoperfusion

dx:
ECG: progressive PR interval prolongation followed by non-conducted P wave (“longer and longer then drop/Wenkebach”) (tries until it fails)

tx:
asymptomatic: none
unstable: atropine
pacemaker

Mobitz Type 2

pp: occasional dropped beats
PR interval fixed and consistent
(“same and same then drop”)

e: underlying heart disease (“BLOCKS” without the “O”)

cm:
fatigue
dyspnea
syncope
cardiac arrest

dx:
consistent/unchanging PR intervals followed by non-conductive P wave (“some p’s get through then a Mobitz 2”) (all or nothing)

tx:
stable:
monitoring
transcutaneous pacing pads

unstable:
beta-adrenergic agonist
temporary cardiac pacing
pacemaker

2:1 AV Block

p: 2 P waves: 1 QRS complex

Third Degree AV Block

pp: all atrial impulses don’t reach ventricles→separated atrium-ventricle contractions

e:
mx
MI
myocarditis (Lyme disease)
hyperkalemia

cm:
fatigue
dyspnea
syncope
cardiac arrest

dx:
ECG:
P wave/QRS complex dissociation (P>QRS)
“if Qs and Ps don’t agree, then you have a third degree”

tx:
stable: pacer pads
unstable:
atropine
beta-adrenergic agonists
temporary cardiac pacing
pacemaker