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Wolf-Parkinson-White Syndrome Accessory conduction pathway to ventricles. Produces delta wave on QRS, may shorten P-R interval -> tachycardia
Torsades des pointes Leads to Vfib. Causes: Congenital long QT (K chanel mutations): Jervell&Lange-Nielson Synd. (Deaf,AR), Romano-Ward Synd. (AD) HypoKalemia/Magnesmia, Bradycardia, K-blocking drugs (Quinidine, procainamide) Erythromicin, Haloperidol, Methadone
Atrial Flutter High & organized SA rhythm, too fast for ventricular refractory time. Saw-toothed P wave & fixed ratio of SA: AV conduction (ie 3:1)
Atrial Fibrilation disorganized quivering atria (600 bpm). Few will trigger AV node-> irregularly irregular rhytm.
1st Degree AV Block Prolonged PR (>.2 sec). Due to high vagal tone, AV ischemia, Dig, beta blockers, CCBs, MIs
2nd Degree AV Block/Mobitz I/Wenckenbach Progressive AV delay/PR lengthening until a beat is dropped.
2nd Degree AV Block/Mobitz II Beat dropped without change in PR interval. Due to post-AV node conduction problems.
3rd Degree AV Block No Atrial-Ventricular conduction. P & QRS complexes are independent. Ventricular rhythm ~40-60
Aortic arch & Carotid Sinus Baroreceptors AORTIC ARCH: Vagus->Medulla->lower sympathetic tone. CAROTID SINUS (high or low bp): GLOSSOPHARYNGEAL->medulla->increase/decrease sympathetic tone.
Carotid, Aortic & Central Chemoreceptors Carotid & Aortic: Low PO2 (<60), pH, High PCO2. Central: Low pH & high PCO2 only-> Cushing Rx (Increased ICP->cerebral ischemia -> hypertension & reflex bradycardia)
Vascular Pressures RA:<5, RV <25/5, Pulmonary: <25/10, PCWP/LA:<12, LV:<130/10
Congenital R->L Shunts #1 Tetralogy of Fallot. #2 Transposition of the great arteries. #3 Truncus Arteriosus. #4 Tricuspid Atresia. #5 Total Anomalous Pulmonary Venous Return.
22q11 DiGeorge Syndrome: Truncus arteriosus, T of F + Parathyroid, Thymus aplasia
Congenital Rubella ASD, VSD, PDA, Pulm artery stenosis
Turners Coarctation
Marfan Aortic insufficiency
Diabetic mother TGA
Atheroma Plaques in blood vessels
Corneal Arcus Lipid deposits on cornea (hyperlipidemia)
Monckenberg Arteriosclerosis Medial calcification of arteries, esp. radial & ulnar. Benign
ARTERIOLOsclerosis Hyaline thickening of small arteries. Essential HTN. Malignant HTN: Onion-skin
ATHEROsclerosis Fibrous plaques & atheromas in elastic artery intima.
Location of Atherosclerosis AA > Coronaries > Popliteals > Carotids
MI Day 1 4 Hrs+: Coagulative Necrosis, contraction bands. Dark mottling. Tetrazolium Stain pale.
MI Day 2-4 Coagulative necrosis. Inflammation: neutrophils & dilated vessels(hyperemic). ARRHYTHMIA RISK
MI Day 5-10 Macrophage-mediated tissue removal. Yellow-brown. Soft. RUPTURE RISK
MI Week 7 Fibrovascular tissue. VENTRICULAR ANEURYSM RISK
MI Protein Markers Troponin (4 hrs-1 week)> CK-MB (Cardiac & Skeletal muscle, rises later) > AST (Cardiac, skeletal muscle & liver)
MI Complications Arrythmia (early), LV Failure->PE, Cardiogenic shock, Wall/papillary rupture, Aneurysm (low CO, arrythmia, embolus), Fibrinous pericarditis, Dressler's Syndrome (AI)
Dilated Cardiomyopathy Etiology Alcohol, Beriberi, Coxackie B, Cocaine, Chaggas, Doxorubicin. Genetic: Mitochondrial OxPhos protein, Cardiac Dystrophin.
Hypertrophic Cardiomyopathy 1/2 are AD, Familial(beta-myosin, myosin binding protein, troponin T), Friedrich's Ataxia. Tx w/ Beta blocker or non-dihydropyridine CCB (Verapamil).
Restrictive/obliterative Cardiomyopathy Sarcoid, Amyloid, Hemachromatosis, fibroelastosis (Radiation, pediatric endocardial fibroelastosis)
Bacterial Endocarditis Sx FROM JANE Fever, Roth Spots, Osler Nodes, Murmur, Janeway lesion, Anemia, Nail bed hemmorhage, Emboli
Bacterial Endocarditis Complications Chordae rupture, glomerulonephritis, suppurative pericarditis, emboli.
Libman Sacks Endocarditis Vegetations on both sides of valve. Mitral regurg> Mitral Stenosis. SLE->LSE
Rheumatic Heart Disease Findings Anitschkow's Cells (activated histiocytes), Aschoff Bodies (giant cell granuloma), Migratory Polyarthritis, Erythema marginatum, Elevated ASO. Acute: Myocarditis. Chronic: Mitral > Aortic >>Tricuspid.
Cardiac Tamponade Elevated JVD, pulsus paradoxus & electrical alternans, hypotension.
Serous Pericarditis SLE, RA, Viral, Uremia
Fibrinous Pericarditis Uremia, MI, Rheumatic Fever
Hemorrhagic Pericarditis TB, Malignancy (melanoma)
Syphilitic Heart Disease Aortic calcifications, aneurysm & valve incompetence
Wegner's Granulomatosis NEcrotizing granulomas in Lung & URT, Necrotizing glomerulonephritis. Dx: c-ANCA, CXR. Tx:Cyclophosphamide & Corticosteroids
Microscopic Polyangitis Wegners like, minus granulomas. P-ANCA
Primary Pauci-Immune Crescentinc Glomerulonephritis Renal vasculitis, lack of antibodies
Churg-Strauss Syndrome Granulomatous vasculitis w/ eosinophilia. Lungs, heart, skin, kidneys, nerves. P-ANCA
Sturge-Webber Disease Port-Wine Stain on face, Intracerebral Arterio-venous malformation
Henoch-Schonlein Purpura Skin Rash(palpable purpura), Joints arthralgia, GI abdominal Pain. Post- URI. IgA & C3 Deposition
Buerger's Disease Smokers. Nodular phlebitis, raynauds, gangrene. Medium vessels.
Kawasaki Disease CRASH & Burn: Conjunctivitis, Rash (truncal), Adenopathy (cervical), Strawberry tongue, Hand & Feet swelling/desquamation & Fever
Polyarteritis Nodosa Cutaneous eruptions @ different stages, neuro dysfunction, fever, HTN (renal artery involvement), GI. Hep B Seropositive-associated. Tx: corticosteroids, cyclophosphamide.
Takayasu Arteritis "Pulseless disease" Thickening aortic arch. Elevated ESR. Asian females 40+. Fever, arthritis, night sweats, Myalgial, skin, occular, weak pulse
Temporal Arteritis Focal granulomatous inflammation. Elderly females. Unilateral HA, jaw pain, impaired vision. Elevated ESR. Tx: High dose Steroids.
ANCA + Vasculitides C: Wegener's. P: Microscopic Polyangitis, Primary Pauci-Immune Crescentic Glomerulonephritis, Churg-Strauss Syndrome,
Acute AFib Binge Alcohol, Sympathetic stimulation, Pericarditis
Phenoxybenzamine Irreversible Alpha blocker (pheochromocytoma tx)
Class 1A Antiarrhythmic Use Effect: Increases AP, ERP, QT interval. USE: Atrial & Ventricular arrhythmias, esp reentrant & ectopic SVT & ventricular tachycardia.
Class 1B Antiarrhythmic Use Affect ischemic/depolarized Purkinje & ventricular tissue. Use: Acute ventricular arrhythmia (esp post-MI), Dig-induced arrhythmias.
Class IC Antiarrhythmic Use Ventricular tachs ->VFib, intractable SVT. A last resort reatment.
Class 2 Antiarrhythmic Use Beta Blockers lower cAMP -> lower Ca current. Suppress abnormal pacemakers by slowing phase 4. Increase PR interval. USE: VTach, SVT, slow ventricular rate in AFib/Flutter.
Class 3 Antiarrhythmic Use Increase AP, ERP, QT. Last resort tx.
Class 4 Antiarrhythmic Use Slow AV node conductance, increase ERP, PR. Use: Prevent nodal arrhythmias (SVT).
Class 1A Antiarrhythmic Drugs Quinidine, Amiodarone, Procainamide, Disopyramide (Queen Amy Proclaims Disco's Pyramid) SE: HyperK. Quinidine SE: HA, tinnitus, thrombocytopenia, torsades de pointes (long QT). Procainamide (SLE-like syndrome)
Class 1B Antiarrhythmic Drugs Lidocaine, Mexiletine, Tocinide. SE: Local anesthesia, CNS stimulation/depression, CV depression. HyperK.
Class 1C Antiarrhythmic Drugs Flecainide, Encainide, Propafenone. SE: Proarrhythmic (CI'd post-MI), prolongs AV ERP. HyperKHyperK
Class 2 Antiarrhythmic Drugs Propanolol, Esmolol, Metoprolol, Atenolol, Timolol. SE: Asthma, bradycardia, AV block, CHF, mask hypoglycemia sx.
Class 3 Antiarrhythmic Drugs Sotalol (TdP, excessive Beta block) Ibutilide (TdP), Bretylium (arrhythmia & HypoTN), Amiodarone (Pulm Fibrosis, Hepatotoxicity, Hypo/HyperThyroid, loads of others)
Class 4 Antiarrhythmic Drugs Verapamil, Diltiazem. SE: Constipation, flushing, edema, CHF, AV block, TdP.
Adenosine K Efflux-> hyperpolarization. Use:
Potassium Depress ectopic pacemakers in hypokalemia (ie-dig toxicity)
Magnesium Treates Dig-toxicity & TdP
Antihypertensives during Pregnancy Methyldopa (Anti-Rh hemolytic anemia) & Hydralazine (drug-induced lupus)
Created by: Kyle Tiemeier



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