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Emergency Med: CVS
Emergency Med: CVS
57
Anatomy
Graduate
01/14/2012

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Term
Septal EKG leads:
Definition
v1, v2
Term
Anterior EKG leads:
Definition
V2, V3, V4
Term
Lateral EKG leads:
Definition
V5, V6
Term
High lateral EKG leads:
Definition
I and L
Term
common causes of SOB:
Definition
- CHF
- COPD
- MI
- PE
Term
Ventricular tachycardia has __ complex QRS.
Definition
wide
Term
Supraventricular tachycardia has __ complex QRS.
Definition
narrow
Term
Non-drug option for treatment of Supraventricular Tachycardia (SVT):
Definition
Vagal maneuvers: hold breath, valsalva maneuver
Carotid massage
Term
SVT treatment options when vagal maneuveres do not work:
Definition
- Short term control: 6 mg IV Adenosine
- Calcium Channel Blockers: Verapmil, Diltiazem
- Beta Blokcers (slower than CCBs): Esmolol, Metroprolol Tartrate
Term
With the treatment of Atrial fibrillation and atrial flutter, the goal is to control ___ __ and prevent __ __.
Definition
- ventricular rate
- emoblic complications
Term
Treatment options for Atrial Flutter and Atrial Fibrillation:
Definition
- Calcium channel blockers
- Digoxin
- Amiodarone

may have to use electrical cardioversion to restore sinus rhythm
- Beta blockers
Term
Wide complex tachycardia, aka __ __, in a stable patient should be treated with __ ___, __, or ___. __ should be used in patients with heart failure or structural heart disease.
Definition
- Ventricular tachycardia (b/c wide complex)
- IV procainamide, propafenone, or flecainide
- Amiodarone
Term
Unstable wide complex VT should be treated with:
Definition
- Adenosine- to test be careful though
- Immediate cardioversion
Term
Common presenting symptoms of paroxysmal supraventricular tachycardia from most common to least common:
Definition
1. Palpitations
2. Dizziness
3. Shortness of Breath
4. Syncope
5. Chest pain
6. Fatigue
7 Diaphoresis
8. Nausea
Term
EKG sinus tachycardia:
Definition
- heart rate greater than 100 bpm
- p waves similar to sinus rhythm
Term
Sinus Node Reentrant Tachycardia:
Definition
- p waves similar to sinus rhythm
- abrupt onset and offset
Term
Atrial Tachycardia:
Definition
- Heart rate 120-250 bpm
- P wave morphology different than sinus rhythm
- Long RP interval
- Tachycardia not terminated by AV block
Term
Multifocal Atrial Tachycardia on EKG:
Definition
- Heart rate 100-200 bpm
- 3 or more different P wave morphologies
Term
Atrial flutter on EKG:
Definition
- Heart rate 200-300 bpm
- AV conduction 2:1 or 4:1
Term
Atrial Fibrillation on EKG:
Definition
- irregularly irregular rhythm
- lack of discernable P waves
Term
AV Nodal Reentrant Tachycardia:
Definition
- Heart rate 150-200 bpm
- P wave either within the QRS or shortly after
- Short RP interval in typical AVNRT, long RP interval in atypcial AVNRT
Term
AV Reentrant Tachycardia on EKG:
Definition
- Heart rate 150-250 bpm
- Narrow QRS in orthodromic conduction
- Wide QRS in antidromic conduction
- Dx excluded by AV block during SVT
- P wave after QRS
Term
How do you exclude dx of AV Reentrant Tachycardia:
Definition
- if there is an AV block during SVT then it is not AV reentrant tachycardia
Term
List the different types of Supraventricular Tachycardias (SVTs):
Definition
- Sinus tachycardia
- Inappropriate sinus tachycardia
- Sinus node reentrant tachycardia
- Atrial Tachycardia
- Multifocal Atrial Tachycardia
- Atrial Flutter
- Atrial Fibrillation
- AV Nodal Reentrant Tachycardia
- AV Reentrant Tachycardia
Term
Paroxysmal SVT can lead to:
Definition
- Heart Failure
- Pulmonary Edema
- Myocardial Ischemia
- Myocardial Infarction

Chronic SVT can cause cardiomyopathy
Term
HTNsive emergency:
Definition
- target end organ damage
- systolic > 220 OR
- diastolic > 125
Term
HTNsive Urgency:
Definition
- greater than 180/110
- symptoms are NOT progressive and there is not end organ damage
Term
Malignant hypertension is usually associated with __ __ and is characterized by ___ and ___ due to __ in ___.
Definition
- renal disease
- hemolysis and thrombocytopenia
- necrosis in arterioles
Term
End Organ Damage due to HTNsive emergency, from most common to least common:
Definition
1. Cerebral Infarction
2. Hypertensive Encephalopathy
3. Acute Heart Failure Syndrome
4. Acute Coronary Syndrome
5. Intracerebral/Subdural Bleed
6. Aortic Dissection
Term
Under normal circumstances, with an increase in blood pressure, the cerebral arterioles __ and cerebral blood flow stays the same. But during HTNsive emergencies, the elevated BP overwhelms autoregulation causing ___ leakage across capillaries and continued arteriole damage. This leads to __, the sine qua non of malignant HTN. The end result is __ __.
Definition
- constrict
- transudate
- PAPILLEDMA- sin quo non
- hypertensive encephalopathy
Term
Signs of HTNsive encephalopathy:
Definition
- Headaches
- Irritability
- Confusion
- Somnolence
Term
With HTNsive emergencies the heart is experiencing an increased ___ which leads to increased oxygen demand and __, this eventually can cause __ __, __ __, or __.
Definition
- workload
- ischemia
- pulmonary edema
- myocardial ischmia
- myocardial infarction
Term
With HTNsive emergencies the renal system undergoes ___ and __ __, and an overall impairment of the autoregulation. this can manifest itself as:
Definition
- arteriosclerosis and fibrinoid necrosis
- worsening renal function
- hematuria
- RBC cast formation
- proteinuria
Term
HTNsive retinopathy:
Definition
- Papilledema (optic disc swelling)
- Cotton whool spots
- Hemorrhages
- Macular star
Term
Demographics of HTN:
Definition
- more common in African Americans
- males at greater risk for HTNsive emergencies than females
- most commonly in middle aged (40s-50s)
Term
Explain Cushing's Reflex:
Definition
brain hemorrhage> space occupying lesion in the brain> pushes against the brain> decreased blood flow to the brain> ischemia to the brain tells body that brain isn't getting enough blood> increased pressure> increased bleeding etc. etc.
Term
Work-up in pt with HTNsive emergency:
Definition
- CBC
- Chemistry
- UA
- Pregnancy test
- CXR, Head CT, Chest CT, aortic angiogram
- EKG, cardiac enzymes
Term
In a HTNsive emergency, the blood pressure should be lowerd by __ of the mean arterial pressure.
Definition
25%
Term
2 main classes of drugs to lower blood pressure in the ER;
Definition
- Vasodilators
- Anti-Adrenergic Agents
Term
4 vasodilators that are good to use in ER to lower bp with HTNsive emergencies:
Definition
- Nitroprusside
- Nicardipine
- Enalapril
- Fenoldopam

(Don't use nitroglycerin or hydralizine in these cases b/c bp will drop too rapidly)
Term
Nitroprusside is a vasodilator that can be given in HTNsive emergencies. Give the dosage, onset, and adverse effects:
Definition
Dosage: 0.25-10mcg/kg/min
Instant onset 1-2 minutes
Adverse effects: cyanide poisoning
Term
Nicardipine is a vasodilator that can be used in HTNsive emergencies. Give the dosage, onset, and adverse effects:
Definition
Dosage: 5-15 mg/hr
Onset/duration: 5-10 min/1-4 hours
Side effects: Tachycardia, flushing
AVOID WITH HEART FAILURE
Term
Enalapril is an ACE-I vasodilator used in HTNsive emergencies. Dosage, onset/duration, side effects:
Definition
dosage: 10-40 mg IM, 1.25-5 mgIVq6hours
onset: 20-30 min/6 hours
SE: hypotension, renal failure, hyperkalemia
Term
Fenoldopam is a ___ ___ vasodilator used in HTNsive emergencies. Dosage, onset/duration, side effects:
Definition
- dopamine 1 agonist
- dosage: 0.1-0.3 mcg/kg/min
- onset/duation: 20-30 min/6 hours
- SE: flushing, headache, tachycardia
Term
Name 3 adrenergic antagonists that can be used with HTNsive emergencies:
Definition
- Labetalol (alpha1, beta 1 and 2 blocker), some sympathomimetic effect
- Esmolol- beta-1 selective blocker
- Phentolamine- alpha 1 blocker
Term
Adverse effects of Labetalol:
Definition
- heart block
- orthostatic hypotension
- avoid in heart failure and asthma
Term
Esmolol SE:
Definition
- hypotension
- avoid with heart failure and asthma


very short acting
Term
Phentolamine SE:
Definition
- tachycardia
- flushing
- headache

can use this one in asthma b/c only block alpha 1 receptors, no effect on beta receptors
Term
Oral drugs that can be used in HTNsive emergencies:
Definition
- Captopril- ACE-I
- Clonidine- central acting alpha 2 agonist
- Labetalol
Term
Captopril sE:
Definition
hypotension in high renin states

benefit: very short acting
Term
Clonidine SE:
Definition
- dry mouth
- sedation
- bradycardia
Term
Labetaolol SE:
Definition
- heart failure
- heart block
- bronchospasm
Term
How to rapidly reduce bp with acute myocardial ischemia?
Definition
- IV nitroglycerin, beta blockers, ACE-inhibitors
Term
How to rapidly reduce bp in pt with CHF with pumonary edema:
Definition
- IV nitroglycerin, furosemide, morphine
Term
How to rapidly reduce bp in acute aortic dissection:
Definition
- IV nitroprusside + beta blocker
OR
- IV trimethaphan + beta blocker
Term
How to rapidly decrease bp with hypertensive encephalopathy or SA hemorrhage:
Definition
- IV nitroprusside, labetalol or nimodipine
Term
How to rapidly reduce bp with MAO tyramine interactions with acute HTN:
Definition
IV phentolamine
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