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Cardio III: Rate/Rhythm, Pericarditis Cheat Sheet by

Cardiology

Conduction Distur­bances

Sick Sinus Syndrome
Causes: Digitalis (rever­sible), CCBs, sympat­hol­ytics, antiar­rythmic drugs, coronary dz
AV block
Refractory conduction of impulses format he atria to the ventricles through the AV node/b­undle of HIS
First degree
PR Interval of 0.4 sec or more
Second degree
Mobitz Type I (Wenck­ebach) & Mobitz Type II
Third degree
Complete dissoc­iation from atria to ventricles
Treatment
Permanent pacing

Suprav­ent­ricular Arrhyt­hmias

Sinus bradyc­ardia
HR <60 bpm. Sinus node pathology, increased risk of ectopic rhythms.
Sinus tachyc­ardia
HR >100 bpm. Occurs with fever, exercise, pain, emotion, shock, thyrot­oxi­cosis, anemia, heart failure, drugs.
Atrial premature beats
Usually benign
PSVT
Most *common paroxysmal tachyc­ardia. Usually benign.
Atrial fibril­lat­ion
Most common chronic arrhyt­hmia, "­holiday heart" when caused by EtOH or withdrawel
Atrial flutter
Usually in pts. with normal hearts, or with myocar­ditis, CAD, or dig toxicity
Clinical features
Palpit­ations, angina, fatigue
Treatm­ent­--PSVT
Adenosine, verapamil. Prevent with diltiazem, B-blocker.
Treatm­ent­--Acute Afib
Electric cardio­ver­sion, rate control, prevent thromb­oem­bolism
Treatm­ent­--C­hronic Aflutter
Amiodarone
 

Ventri­cular Arrhyt­hmias

Vent­ricular premature beats
May be benign or lead to sudden death if underlying heart disease
Vent­ricular tachyc­ardia
3 or more ventri­cular premature beats in a row. Compli­cation of MI and dilated cardio­myo­pathy. Sustained or unsust­ained.
Torsades de Pointe
A polymo­rphic VTach. Happens sponta­neo­usly, or from hypoka­lemia, hypoma­gne­semia, or QT-pro­longing drugs
Long QT Syndrome
Congenital or acquired, recurrent syncope. Interval 0.5-0.7 sec. Can get ventri­cular arrhyt­hmias and sudden death.
Brug­ada's syndrome
Genetic disorder, Asians and men, causes syncope, Vfib, sudden death.
Vent­ricular fibril­lat­ion
No cardiac output, associated with sudden death, more in early morning.
Trea­tme­nt-­-Vfib
B-blockers if sympto­matic
Trea­tme­nt-­-Vt­ach
Synchr­onized cardio­version if severe hypote­nsion or LOC. Rx: lidocaine, amioda­rone, magnesium.
Trea­tme­nt-­-Ch­ronic sustained Vtach, congenital long QT, Brugadas
Implan­table defibr­illator
Trea­tme­nt-­-To­rsades de Pointe
B-bloc­kers, magnesium, temporary pacing
Treat­ment: if identi­fiable site of arrhythmic origin
Radiof­req­uency ablation
 

Cardio­myo­pathies

DILATED Cardio­myo­pathy
Can't squeez­e/c­ont­ract, most common*, reduced strength or ventri­cular contra­ction and dilation of left ventricle.
Etiology
Genetic (most common), EtOH, chemo, idiopathic
Takot­subo
Type of dilated cardio­myo­pathy, occurs after major catech­olamine discharge, sx similar to acute MI, "­broken heart syndro­me"
Clinical features
Sx of CHF, *dyspnea. Possibly S3 gallop, rales, JVP.
Treat­ment
Abstain from ThOH, treat underlying disease, supportive tx for CHF.
HYPE­RTR­OPHIC Cardio­myo­pathy
Can't fill/too tight, hypert­rophy of septum and left ventricle, diastolic dysfun­ction
Etiology
Almost exclus­ively *genetic
Treat­ment
B-bloc­kers, CCB or disopy­ramide (negative inotrope)
Sudden cardiac death
from hypert­rophic cardio­myo­pathy occurs in patients <30yo 2-3% yearly
REST­RICTIVE Cardio­myo­pathy
Heart fibers of ventricle all scrambled up, mildly reduced function of L ventricle. Pulmonary HTN.
Etiology
From ibrosis or infilt­ration from diabet­es,­rad­iation, amyloi­dosis
Treat­ment
Diuretics may be helpful.

Perica­rdial Disorders

Peri­car­ditis
Inflam­mation of the perica­rdium most often from infection, autoim­mune, s/p radiat­ion­/chemo, drug toxicity.
Clinical Features
Pleuritic substernal pain, friction rub, pain relieved by sitting upright and leaning forward, fever if infectious
Peri­cardial Effusion
Secondary to perica­rdi­tis­/ur­emi­a/c­ardiac trauma. Produces restri­ctive pressure on the heart
Clinical Features
Painless or painful (dyspnea and cough)
Cardiac Tampon­ade
Occurs when fluid compro­mises cardiac filling and impairs cardiac output
Clinical Features
Tachyc­ardia, tachypnea, narrow pulse pressures, pulses paradoxes
EKG Signs
Electrical alternans
Treat­ment
If hemody­namic compro­mis­e--­>pe­ric­ard­ioc­entesis to relieve fluid accumu­lation. O/W just NSAIDs if strictly inflam­matory or abx if infectious

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