Cardiology Review

• These are study notes for Exam 1 covering Cardiac topics. The exam consists of 39 questions, totaling 50 points, with a possibility of 5 bonus points.

Post-Cardiac Arrest Meds

• Lidocaine is used to prevent dysrhythmias by delaying electrical conduction and reducing automaticity in the heart.
• Epinephrine increases coronary and cerebral perfusion during CPR to help achieve the return of spontaneous circulation (ROSC).
• Amiodarone treats ventricular fibrillation (VF) and ventricular tachycardia (VT), especially when other treatments fail, helping manage arrhythmias during and after cardiac arrest.
• Healthcare staff will perform pulse checks to confirm effective heart pumping after resuscitation attempts.
• Quality of pulse reveals insights into hemodynamic status providing indication of how resuscitation is succeeding.
• Weak pulse suggests inadequate cardiac output or shock, a strong pulse suggests better hemodynamic stability.

Valvular Stenosis

• This occurs when a heart valve narrows, restricting blood flow.
• Assessment includes loud/harsh murmurs due to turbulent blood flow.
• Symptoms include fatigue, shortness of breath, chest pain, especially during physical activity.
• Possible signs of heart failure may occur due to increased workload on the heart.

Valvular Regurgitation

• This occurs when a heart valve doesn't close properly, causing backflow.
• Assessment may include soft or blowing systolic/diastolic murmurs, depending on the affected valve.
• Symptoms may include palpitations, fatigue, shortness of breath.
• Signs of heart failure may be present due to volume overload.

Heart Murmurs

• Murmurs are abnormal heart sounds due to turbulent blood flow through the valves.
• Systolic murmurs occur between S1 and S2 heart sounds (e.g., aortic stenosis).
• Diastolic murmurs occur between S2 and S1 heart sounds (e.g., mitral regurgitation).

EKG Components

• P Wave represents atrial depolarization, lasting 0.06-0.12 seconds.
• PR Interval is the time from P wave onset to the start of the QRS complex, lasting 0.12-0.20 seconds.
• QRS Complex represents ventricular depolarization, lasting 0.06-0.10 seconds.
• ST Segment represents the time between ventricular depolarization and repolarization; changes can indicate ischemia or infarction.
• T Wave represents ventricular repolarization.
• QT Interval represents total time for ventricular depolarization and repolarization; affected by heart rate, gender, and medications.

Atrial Fibrillation (A-Fib) and Atrial Flutter

• Atrial Fibrillation involves rapid, disorganized atrial electrical activity, leading to ineffective atrial contraction.
• Atrial Flutter involves rapid, regular atrial activity with a characteristic "sawtooth" pattern on EKG.
• Common causes include hypertension, heart failure, coronary artery disease, and valve disorders.
• Treatment aims at rate control (slowing ventricular response) and rhythm control (restoring normal sinus rhythm).
• Medications for rate control include beta blockers (e.g., metoprolol) and calcium channel blockers (e.g., diltiazem).
• Medications for rhythm control include amiodarone or cardioversion. Catheter ablation may be used for flutter.
• Risk for Stroke secondary to developing clots in the atria that travel out to the body. Atrial kick is reduced (25 to 30%) in cardiac output can occur.
• Administer Anticoagulants to prevent clot formation and reduce risk of embolization.

Sinus Tachycardia

• Sinus Tachycardia involves a heart rate greater than 100 bpm.
• Causes of sinus tachycardia can be physical or psychological stressors.
• Other causes include hypotension, hyperthermia, hypovolemia, anemia, hypoxia, hypoglycemia, myocardial infarction, heart failure, hyperthyroidism.
• Treatment may include beta blockers (e.g., metoprolol) or calcium channel blockers (e.g., diltiazem) to slow heart rate.
• Adenosine is used for supraventricular tachycardia (SVT), and synchronized cardioversion may be needed if the patient is unstable.
• Symptoms include dizziness, dyspnea, and hypotension due to reduced cardiac output.

Anticoagulant Medications

• Common Medications include Warfarin, Heparin, Direct Oral Anticoagulants (DOACs) such as apixaban, rivaroxaban, dabigatran.
• Monitor for problems such as bleeding, thrombosis, and drug interactions.
• Prothrombin Time (PT) / International Normalized Ratio (INR) are used to monitor warfarin, with a target INR of 2-3
• Activated Partial Thromboplastin Time (aPTT) monitors heparin therapy.
• Complete Blood Count (CBC) checks hemoglobin, hematocrit, and platelet levels for bleeding or clotting issues.
• Warfarin reversal: Vitamin K.
• DOAC Reversal: andexanet alfa is used for rivaroxaban and apixaban.
• Heparin reversal: protamine sulfate.

Heart Failure

• Heart failure is a common cause of hospitalization for older Americans in acute decompensated heart failure.
• Signs of decreased perfusion include hypotension, decreased urine output, cool extremities, and altered mentation.

Right-Sided Heart Failure

• Findings include increased HR, murmur, jugular vein distention, edema, weight gain, ascites, and hepatomegaly.
• Symptoms include fatigue, anxiety/depression, right upper quadrant pain, anorexia & GI symptoms, and nausea.

Left-Sided Heart Failure

• Findings include increased HR, poor O2 exchange (low PaO2 and elevated PaCO2), crackles, S3 & S4 heart sounds, and pleural effusion.
• Change in mental status, restlessness/confusion, dizziness, shallow rapid respiration, dry/hacking cough, and frothy/pink sputum during advanced pulmonary edema.
• Symptoms include weakness, fatigue, anxiety/depression, dyspnea, paroxysmal nocturnal dyspnea, and orthopnea.
• Complications include pleural effusion, dysrhythmias, hepatomegaly, cardiorenal syndrome, and anemia.
• Goals of therapy include symptom relief, optimizing volume status, supporting oxygenation/ventilation/CO/end-organ perfusion, identifying and addressing the cause, avoiding complications, and providing discharge teaching

Cardiac Tamponade

• Fluid accumulates in the pericardial sac, "squishing" the heart and preventing complete filling.
• The fluid can be pus or blood.
• Symptoms include dyspnea, dizziness, chest tightness, increasing restlessness, pulsus paradoxus (>10mmHg drop in systolic BP during inspiration), tachycardia, muffled heart sounds, and jugular vein distention.
• Management may include administering fluids for hypotension and preparing for pericardiocentesis.

Pericarditis

• Pericarditis is the inflammation of the pericardium.
• Causes can be from viral, bacterial, or fungal infections.
• Can be cause by cancer, HIV/AIDS, kidney failure, rheumatic fever, and tuberculosis.
• Symptoms include chest pain, sharp/stabbing pain worsen with laying flat or deep breathing.
• Pain is often relieved by sitting up and slightly forward. Muffled heart sounds during auscultation
• Additional symptoms may include fever, chills, swelling in lower extremities, difficulty breathing, dry cough, and fatigue.
• Treatment to drain fluid from the sac to improve heart function.

Angina

• Angina is chest pain.
• Stable Angina: Predictable discomfort often relieved by rest or nitroglycerin.
• Unstable Angina: More serious, unpredictable, can occur at rest, and may precede a heart attack (MI)
• Variant Angina (Prinzmetal's Angina): Less common, caused by coronary artery spasms, occurs at rest.
• Common Features: Location in chest, arms, neck, jaw or back. Described as pressure, squeezing, burning or tightness. Usually lasts a for a short time typically a few minutes.
• Risk Factors include CAD, age, gender, smoking, hypertension, high cholesterol, diabetes, and family history.
• Managment: Lifestyle modifications and medications.
• Medication: nitroglycerin, beta-blockers, calcium channel blockers, and antiplatelet agents
• Antiplatelet drugs (eg, aspirin) are given as an antiplatelet aggregate to prevent clot formation.
• Patients with angina typically get EKG and Stress Tests as non-invasive testing to check for heart conditions.
• Nitroglycerin has a rapid onset and causes vasodilation to improve blood flow to the heart, lowers blood pressure and may cause a headache.
• Angina (Stable) - consistent, chronic pain, relieved with Nitroglycerine
• Angina (Unstable) - new episode, may increase in severity, new areas of the heart are experiencing ischemia which is an EMERGENCY

Myocardial Infarction (MI)

• Myocardial ischemia causes a Blood clot (coronary thrombosis) or Atherosclerotic plaque.
• ACS is a medical emergency includes unstable angina, NSTEMI, and STEMI.
• Results from the rupture or erosion of plaque leading to blood clot formation that partially/completely blocks blood flow.
• Unstable Angina: Considered a type of ACS without permanent heart damage.
• NSTEMI: Heart attack with myocardial damage, indicated by cardiac biomarkers (e.g., troponin) in the bloodstream, without ST-segment elevation on ECG.
• STEMI: A severe heart attack with complete blockage of a coronary artery, resulting in significant heart damage with ST-segment elevation on ECG.
• Common Symptoms of ACS Includes: Chest pain or discomfort, Shortness of breath, Nausea and vomiting, Sweating, Fatigue, Dizziness
• The diagnosis is made via the ECG testing and blood tests to assess cardiac biomarkers.
• Oxygen utilized if O2 is

Test your knowledge of cardiology with questions covering medications used during cardiac arrest, heart valve conditions, and EKG interpretation. Assess your understanding of cardiac physiology and assessment. Ideal for medical students and healthcare professionals.