Chronic vs. Acute, NYAA / AHA classification, R side vs L side, treatment guidelines.
 

Cardiology #4 – Congestive Heart Failure

Physician assistant PANCE/PANRE board review in audio format. Let’s pass together.

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Atrial Septal Defect (ASD)
Coarctation of aorta
Patent ductus arteriosus (PDA)
Tetralogy of Fallot
Ventricular septal defect (VSD)
Transposition of Great Vessels (not listed on blueprint)
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Cardiology #3 – Congenital Heart Disorders

Episode 2 – Conduction Disorders
Hot Points:

* Atrial Fibrillation

* Irregularly irregular w/ no P waves


* Atrial Flutter

* Sawtooth pattern


* Atrioventricular block

* 1st degree – PR interval >0.2 sec
* 2nd degree Type I (Wenckebach) “going going going gone”
* 2nd degree Type II (Mobitz) dropped QRS complex– Pacemaker!
* 3rd degree – Complete AV dissociation, wide QRS, independent P waves


* Bundle branch block

* Rabbit ears! RBBB V1/V2  LBBB V5/V6
* indicates raised pressures, hypertrophy, possible previous ant. MI


* Paroxysmal supraventricular tachycardia

* SVT– not serious, vagal maneuvers, sync. cardioversion


* Premature beats

* PVCs, may herald the onset of other problems


* Sick sinus syndrome

* degenerative changes, tx w/ pacemaker


* V-Fib

* Chaotic non-discernable rhythm — Shock em!!


* Ventricular tachycardia

* Usually hypoK+, hypo Mg++ Sync. Cardioversion


* Torsades de pointes

* Think hypokalemia/hypomagnesia
* Give MgSO4!




Cardiology #2 – Conduction Disorders

Episode 1 – Dilated, Restrictive, and Hypertrophic Obstructive Cardiomyopathy.
Hot Points:
Dilated: systolic failure, thinning and weakening of the ventricles, low EF

* most common form by far
* defined as EF <40%
* likely hx: ETOH, HIV+, Hep C, ischemic disease / previous MI (but here’s a more comprehensive list of Causes)
* 50% of cases idiopathic, no cause found
* Mitral & Tricuspid Regurg. usually present.
* Tx w/ diuretics,


Restrictive: diastolic failure, filling problem, normal EF

* stiff fibrotic ventricular walls of normal size,
* usually caused by Amyloidosis or Sarcoidosis
* increased diastolic pressure leading to back up into the lungs.
* MUST DDx from Restrictive Pericarditis
* Tx w/ Beta Blockers or Ca++ Blockers to lower rate and increase filling time, pacemaker, transplant.


* 

Hypertrophic: diastolic failure, LV thickening of wall and septum
* septum thickening leads to outflow obstruction
* usually genetically inherited (autosomal dominant)
* Murmur of HOCM increases with valsalva –> decreases preload, increases outflow obstruction of septum.
* Classic presentation is high school athlete or teenager
* Tx w/ Beta Blockers or Ca++ Blockers to reduce work of the heart


Cardiology #4 – Congestive Heart Failure

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