What are the causes of Palpitations? correct answers Arrhythmia (about 160/minute)
Regurgitant valves (especially aorta)
Catecholamines (increased sympathetic response, B1 stimulation)
Stress (increased sympathetic response)
Hyperthyroidism (revs you up like catecholamines)
What causes head...
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What are the causes of Palpitations? correct answers Arrhythmia (about 160/minute)
Regurgitant valves (especially aorta)
Catecholamines (increased sympathetic response, B1 stimulation)
Stress (increased sympathetic response)
Hyperthyroidism (revs you up like catecholamines)
What causes head bobbing? correct answers Regurgitant valves, loss of blood pressure during
diastole -> increased blood pressure in systole leads to head bobbing (basically losing
consciousness and regaining it, think of Matsui's lectures)
What is paroxysmal atrial fibrillation? correct answers last < 7 days; self terminates
How does Atrial Fibrillation decrease cardiac output? correct answers Loss of atrial kick -> last
3rd of diastolic filling doesn't occur -> lower cardiac output
Why is rate control important in A-fib patients? correct answers -prevent ventricular tachycardias
which are life-threatening we reduce the number of atrial impulses that reach the ventricles by
slowing conduction through the AV node.
- Decreasing the heart rate increases diastolic filling time and leads to greater stroke volume and
actually (paradoxically) increases cardiac output
What are some symptoms of hyperthyroidism? correct answers hyperactivity; anxiousness;
weight loss, increased appetite
can cause a fib
How do we define Syncope? What are some classical causes? correct answers Aortic Stenosis!
Large Pulmonary Embolism
valvular Disease
Arrhythmia
Jones Criteria correct answers Polyarthritis (joints)
Heart Issues
Nodules subcutaneous
Erythema marginatum
Sydenham chorea
(For rheumatic fever)
(J<3NES), if 3 or more probably rheumatic fever
What are we most concerned about with A-Fib? correct answers Stroke (stasis in the atrium leads
to stroke), Stroke Prophylaxis is key in treatment, can also embolize to other parts of body
What should we ask about when people present with valvular or mitral problems? correct
answers Rheumatic Fever! childhood strep infections, joint pain
,What do we look for on PE to rule out infective endocarditis? correct answers FROM JANE
F = Fever
R = Roth Spots
O = Osler Nodes (painful lesions on fingers and toes)
M = Murmur (especially mitral and aortic)
J = Janeway lesions
A = Anemia
N = Nail Hemorrhage (splinter hemorrhages)
E = Emboli (petichiae)
What does a heave indicate? Why might it happen in Mitral regurgitation? Will we hear an S4
with atrial fibrillation? correct answers Indicates LVH, caused by overloaded Left ventricle due
to back flow during systole and overload in diastole
We won't hear S3 because there is no atrial kick
What other heart sounds does Mitral regurgitation cause? correct answers - Soft S1, mitral valve
doesn't close completely
- Wide splitting (A2 after P2 longer on inspiration)
Why does wide splitting occur with mitral regurgitation? correct answers - Less blood to push
out of aorta so A2 occurs early
- breathing in increases venous return from inferior vena cava and lengthens RV emptying time -
> delayed P2 on inspiration
Mitral regurgitation murmur correct answers Pansystolic, often loud, blowing, best heard at apex,
radiates well to left axilla
atrial fibrillation correct answers occurs when the normal rhythmic contractions of the atria are
replaced by rapid irregular twitching of the muscular heart wall
Sends 300-600 impulses to the AV node but it can't catch all of them -> make it through to
Ventricle in an irregularly irregular pattern
no atrial kick
stasis in atria because no contraction
Atrial Fibrillation EKG correct answers - P-R interval not measurable, no P waves seen, a lot of
electrical activity where the P-wave should be
- Atria quiver instead of contracting
- Rhythm does not follow a set pattern, irregularly irregular
- tachycardia (usually around 160)
Treatment of A Fib correct answers Rate control + Anticoagulation -> if symptoms don't reside
or emergency then cardioversion + antiarrythmics
Rate control first line: metoprolol
Anticoagulant first line: Warfarin (Heparin first because Warfarin is slow acting)
, What do we look for on EKG that informs A-Fib treatment? Why? correct answers - look for
Delta waves (sign of WPW arrhythmia)
- WPW is an accessory pathway that allows transmission of impulses to the Atria bypassing the
AV node, A-fib and WPW much more dangerous than A-fib alone
- If you use anti arrhythmics that slow AV node conduction it leads to a shunt of impulses toward
the accessory pathway and can lead to V tach (Torsades)
Digoxin and A-Fib correct answers Helps to catch more impulses in AV node -> slows rate,
increases ventricular filling time -> increased Cardiac output + decreases rate and prevents
ventricular tachycardia
Don't use when WPW is present or it will shunt towards accessory pathway
Why do we give people with Heart problems an anti-streptolysin O titer? correct answers
Rheumatic Heart Disease, if they have anti strep antibodies then they have a history of Strep
What are Causes of A-Fib? correct answers Shit PP
Stenosis
Hypertension
Infarct/Ischemia
Hyperthyroidism
Pericarditis
Pulmonary Embolism
Dabigatran correct answers direct thrombin (IIA) inhibitor
Oral
Contra: GI bleeding
Check guiac stool test
2nd line in A-fib if patient can't handle warfarin
no testing necessary
Rivaroxaban and Apixaban correct answers Direct factor Xa inhibitors
Ejection fraction and ultrasound, why does normal EF on Mitral regurgitation indicate ? correct
answers normal value 60%
<40% abnormal
ESV/EDV
If there is mitral regurgitation, blood can flow into the relatively lower pressure left atrium so EF
should be high, if its normal this indicates heart weakness
What are night sweats associated with? correct answers TB and malignancies
they're specific
Signs of TB correct answers cough 2+ wks, chest pain, blood, weak, weight loss, fever, night
sweats
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