EKG - Lecture 1
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EKG - Lecture 2
● Asymmetric T wave inversion - Heart strain
● Tension pneumothorax with mediastinal shift--poor R wave progression
● Digoxin Toxicity--second degree block type 1
● Azithromycin/levaquin--long QT syndrome
EKG - Lecture 3
● Irregularly irregular - Atrial Fibrillation
● Wavy baseline - Atrial Fibrillation
● “Camel hump”/biphasic p wave--premature atrial complex
Hypertension
● Hourglass appearance - AV nicking
Vascular Disease
● Scapular Pain--Aortic dissection
● “Blue toe syndrome”--PVD
● Gangrene--PVD
● Hemiparesis--Aortic dissection
● Phosphodiesterase inhibitors--PVD tx
● Focal areas of discoloration: pallor/white w/ elevation, red w/ lowering--PVD
Valvular Disorders
● Widened Pulse Pressure - Aortic regurgitation
● Best heard leaning forward at end expiration—AR
● Heard after S2 before S1–AR
● Apical impulse displaced laterally—AR
● Hyperparathyroidism—mitral stenosis
● Symptom onset young (3rd or 4th decade of life)—mitral stenosis
● Systolic ejection murmur between S1 and S2- AS
● De Musset Sign--Aortic regurgitation
● Muller Sign--Aortic regurgitation
● Quickens pulses--Aortic regurgitation
● Ortner’s Syndrome--Mitral stenosis
● Double density on CXR-mitral stenosis
● Opening snap - Mitral stenosis (murmur)
● Mid to late systolic click- MVP
● Fen-phen (appetite suppressant) --risk factor for aortic regurgitation
● Osteogenesis imperfecta--mitral valve prolapse
● Hyperparathyroidism-causes calcific mitral stenosis
● Crackles/rales--mitral regurgitation
● Holosystolic murmur - mitral regurgitation
● Cancer radiation therapy--causes calcific mitral stenosis
● Pulsus Parvus Tardus - Aortic stenosis
● High mortality with valve replacement—tricuspid stenosis
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Found in 70% of the population—tricuspid regurgitation
Tricuspid annuloplasty—tricuspid regurgitation tx
Lift in right ventricle--Mitral stenosis
Traumatic, Infectious, and Inflammatory Heart Conditions:
● Febrile patient with a new heart murmur--infectious endocarditis
● Fever of unknown origin—infective endocarditis
● Night sweats—infective endocarditis
● Chronic hemodialysis, poor dentition—risk factors for infectious endocarditis
● Tricuspid valve most commonly affected—infective endocarditis
● Janeway lesions-Infectious endocarditis
● Osler’s nodes-infectious endocarditis
● Roth spots-infectious endocarditis
● Splinter hemorrhages-Infectious endocarditis
● Modified Duke Criteria--infectious endocarditis diagnostic criteria
● Vegetation on valves - infectious endocarditis
● Most common disorder involving the pericardium—pericarditis
● Occurs in young patients <50–acute pericarditis
● Dressler Syndrome--post-MI pericarditis
● Sharp, pleuritic chest pain relieved by sitting forward--pericarditis
● Colchicine--acute pericarditis tx
● TB infection--Constrictive pericarditis
● Pericardial friction rub--acute pericarditis
● Calcified pericardium--constrictive pericarditis
● Prednisone/pericardectomy--constrictive pericarditis tx
● Pericardial knock--constrictive pericarditis
● Muffled heart sounds-pericardial effusion
● Unexplained cardiomegaly—pericardial effusion
● Isolated left pleural effusion—pericardial effusion
● Low QRS voltage with cyclic beat-to-beat shift in QRS axis--pericardial effusion
● Electrical alternans—pericardial effusion
● Chest heaviness--pericardial effusion
● Enlarged cardiac silhouette--pericardial effusion
● Obstructive shock—cardiac tamponade
● Right ventricular collapse--cardiac tamponade
● Malignancy—main cause of tamponade
● Beck’s triad (hypotension, distant or muffled heart sounds, JVD)--Cardiac tamponade
● Pulsus paradoxus--Cardiac tamponade
● “Water bottle shaped heart”--cardiac tamponade
● Dobutamine—cardiac tamponade tx
Cardiomyopathies
● S3 sound--dilated cardiomyopathy OR restrictive cardiomyopathy
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S4 sound--hypertrophic cardiomyopathy
Increased septum to wall ratio--hypertrophic cardiomyopathy
Septal myectomy--hypertrophic cardiomyopathy
Alcohol septal ablation-hypertrophic cardiomyopathy
Exercise induced arrhythmias—HOCM
Congenital
● S2 split with expiration--bicuspid aortic valve
● Cryptogenic stroke/migraines—patent foramen ovale (ostium secundum)
● Mitral valve leaflet cleft—ostium primum
● Crux of the heart—ostium primum
● Wide and fixed splitting of S2–atrial septal defect
● Most common congenital heart defect—ventricular septal defect
● Biventricular enlargement on echo—VSD
● Grunting/retractions in a newborn—patent ductus arteriosus
● Continuous, machinery-like murmur—patent ductus arteriosus
● Maternal diabetes, maternal rubella, maternal alcohol/phenytoin use—VSD
● Common in prematurity—patent ductus arteriosus
● Catheter-based closure/surgical ligation—patent ductus arteriosus
● Tx with COX inhibitors (ibuprofen)—patent ductus arteriosus
● Early cyanosis present at birth—transposition of the great arteries
● Tx with prostaglandin—transposition of the great arteries OR aortic coarctation
● Balloon septostomy—transposition of the great arteries
● Arterial switch procedure—transposition of the great arteries
● Radial pulses bounding, femoral/popliteal pulses weak—aortic coarctation
● Liver/spleen edges palpable below costal margin—aortic coarctation
● Hypercyanotic episodes/“tet spells”—tetralogy of fallot
● Loud S2–tetralogy of fallot
● Poor nutrition during pregnancy, maternal age >40–tetralogy of fallot
● Boot shaped heart—tetralogy of fallot
● Heart failure by 6 weeks of age--complete AV septal defect
● Right-sided aortic arch and knob - tetralogy of fallot
● WANT ductus arteriosus to remain open
Heart Failure
● Kerley B lines, cephalization, pleural effusion, cardiomegaly—HF CXR findings
● BNP >500
● Hyponatremia on CMP—severe HF
● <2G sodium per day
● 1.5-2L fluid per day
● Cardiac resynchronization therapy/biventricular pacing—HF tx
● JVP rise >4cm on hepatojugular reflex
● Anorexia nervosa from systemic congestion
● Displaced PMI from LVH
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S3
Check liver function tests because liver could be affected by hepatic congestion
Metabolic syndrome--risk factor for HF
HTN--biggest risk for HF
TSH--High OR low can precipitate HF--check when doing workup
Hypotension/Shock
● Morning cortisol—check for orthostatic hypotension
● Head-up tilt table testing—orthostatic hypotension
● Small frequent meals—tx for orthostatic hypotension
● Fludrocortisone—tx for orthostatic hypotension
● Isometric counter-pressure—tx of vasovagal syncope
● “Wet and cold shock”—cardiogenic shock (pulmonary edema is wet, extremities are
cold)
● Oliguria—cardiogenic shock
● Metabolic acidosis/high serum lactate levels—cardiogenic shock
● Vasopressors—tx for cardiogenic shock