Download - Back To Basics: Cardiology Review I Michael Froeschl, MD FRCPC Assistant Professor of Medicine
![Page 1: Back To Basics: Cardiology Review I Michael Froeschl, MD FRCPC Assistant Professor of Medicine](https://reader035.vdocument.in/reader035/viewer/2022062407/56649e4b5503460f94b3f03a/html5/thumbnails/1.jpg)
Back To Basics:
Cardiology Review I
Michael Froeschl, MD FRCPC
Assistant Professor of Medicine
![Page 2: Back To Basics: Cardiology Review I Michael Froeschl, MD FRCPC Assistant Professor of Medicine](https://reader035.vdocument.in/reader035/viewer/2022062407/56649e4b5503460f94b3f03a/html5/thumbnails/2.jpg)
F R O E S C H L
Overview
1. CADa. Atherosclerosis
b. Stable Obstructive CAD
c. Unstable CAD: Acute Coronary Syndrome
2. ECG/Arrhythmiaa. Review
b. Bradydysrhythmias
c. Tachydysrhythmias
3. Syncope
![Page 3: Back To Basics: Cardiology Review I Michael Froeschl, MD FRCPC Assistant Professor of Medicine](https://reader035.vdocument.in/reader035/viewer/2022062407/56649e4b5503460f94b3f03a/html5/thumbnails/3.jpg)
NB: Key Feature Questions
Learn how to answer them!
![Page 4: Back To Basics: Cardiology Review I Michael Froeschl, MD FRCPC Assistant Professor of Medicine](https://reader035.vdocument.in/reader035/viewer/2022062407/56649e4b5503460f94b3f03a/html5/thumbnails/4.jpg)
F R O E S C H L
1. Two Concepts
1. Ischemia: Tissue oxygen demand exceeds tissue oxygen supply
2. Infarction: Tissue necrosis secondary to tissue ischemia
![Page 5: Back To Basics: Cardiology Review I Michael Froeschl, MD FRCPC Assistant Professor of Medicine](https://reader035.vdocument.in/reader035/viewer/2022062407/56649e4b5503460f94b3f03a/html5/thumbnails/5.jpg)
F R O E S C H L
1. Supply-Demand Mismatch
↓ Supply
Coronary obstruction Microvascular
obstruction ↓ Perfusion pressure ↓ PaO2 ↓ Hemoglobin
↑ Demand
↑ Heart Rate ↑ Contractility ↑ Wall Tension
![Page 6: Back To Basics: Cardiology Review I Michael Froeschl, MD FRCPC Assistant Professor of Medicine](https://reader035.vdocument.in/reader035/viewer/2022062407/56649e4b5503460f94b3f03a/html5/thumbnails/6.jpg)
F R O E S C H L
1. CAD
Obstructive CAD
ACS
Atherosclerosis
![Page 7: Back To Basics: Cardiology Review I Michael Froeschl, MD FRCPC Assistant Professor of Medicine](https://reader035.vdocument.in/reader035/viewer/2022062407/56649e4b5503460f94b3f03a/html5/thumbnails/7.jpg)
F R O E S C H L
1a. Atherosclerosis Targets
Mode-of-Life Issues
Smoking Diet Exercise Alcohol Stress
Medical Issues
Dyslipidemia Hypertension Diabetes Mellitus Obesity
INTERHEART, Lancet 2004
![Page 8: Back To Basics: Cardiology Review I Michael Froeschl, MD FRCPC Assistant Professor of Medicine](https://reader035.vdocument.in/reader035/viewer/2022062407/56649e4b5503460f94b3f03a/html5/thumbnails/8.jpg)
F R O E S C H L
1a. Atherosclerosis Targets
“Vascular Protection”
1. ASA
2. Statins
3. ACE-Inhibitors or ARBs
4. Beta-Blockers
![Page 9: Back To Basics: Cardiology Review I Michael Froeschl, MD FRCPC Assistant Professor of Medicine](https://reader035.vdocument.in/reader035/viewer/2022062407/56649e4b5503460f94b3f03a/html5/thumbnails/9.jpg)
F R O E S C H L
1b. Stable Obstructive CAD
Usual manifestation is Angina Pectoris:
(“strangling”) chest pain secondary to myocardial ischemia
![Page 10: Back To Basics: Cardiology Review I Michael Froeschl, MD FRCPC Assistant Professor of Medicine](https://reader035.vdocument.in/reader035/viewer/2022062407/56649e4b5503460f94b3f03a/html5/thumbnails/10.jpg)
F R O E S C H L
1b. Stable Obstructive CAD: DX
1. Clinical assessment in all Chest Pain
Sqeezing retrosternal Brought on by stress Relieved by rest or NTG
Patient (age, gender, vascular risk) Physical exam and basic blood work
3/3: Typical anginal CP2/3: Atypical anginal CP0-1/3: Non-anginal CP
![Page 11: Back To Basics: Cardiology Review I Michael Froeschl, MD FRCPC Assistant Professor of Medicine](https://reader035.vdocument.in/reader035/viewer/2022062407/56649e4b5503460f94b3f03a/html5/thumbnails/11.jpg)
F R O E S C H L
1b. Stable Obstructive CAD: DX
2. Testing in some (for diagnosis and prognosis)
a. Functional Assessment (“stress test”) Exercise ECG Dipyridamole Perfusion Scan Dobutamine Echocardiogram
b. Anatomical Assessment Coronary Angiography (conventional, CT)
![Page 12: Back To Basics: Cardiology Review I Michael Froeschl, MD FRCPC Assistant Professor of Medicine](https://reader035.vdocument.in/reader035/viewer/2022062407/56649e4b5503460f94b3f03a/html5/thumbnails/12.jpg)
F R O E S C H L
1b. CCS Angina Severity Scale
I Ordinary activity does not cause angina; angina only with increased activity
II Slight limitation of ordinary activity (> 2 blocks level, > 1 flight of stairs)
III Marked limitation of ordinary activity (< 2 blocks level, < 1 flight of stairs)
IV Inability to carry out any activity without discomfort; symptoms may be present at rest
![Page 13: Back To Basics: Cardiology Review I Michael Froeschl, MD FRCPC Assistant Professor of Medicine](https://reader035.vdocument.in/reader035/viewer/2022062407/56649e4b5503460f94b3f03a/html5/thumbnails/13.jpg)
F R O E S C H L
1b. Stable Obstructive CAD: MX
Vascular Protection (ASA, statin, ACE-I/ARB)
Beta-Blocker (non-DHP CCB if not tolerated)
NTG Address Risk Factors Possibly Revascularize (PCI or CABG)
![Page 14: Back To Basics: Cardiology Review I Michael Froeschl, MD FRCPC Assistant Professor of Medicine](https://reader035.vdocument.in/reader035/viewer/2022062407/56649e4b5503460f94b3f03a/html5/thumbnails/14.jpg)
F R O E S C H L
1c. Acute Chest Pain
Management:
ABC Vitals IV, O2, Monitor
![Page 15: Back To Basics: Cardiology Review I Michael Froeschl, MD FRCPC Assistant Professor of Medicine](https://reader035.vdocument.in/reader035/viewer/2022062407/56649e4b5503460f94b3f03a/html5/thumbnails/15.jpg)
F R O E S C H L
1c. Acute Chest Pain: DDX
1. Myocardial Ischemia2. PE3. Aortic Dissection4. Pneumothorax5. GI Rupture6. Other (pericarditis, pneumonia,
GERD/PUD/gastritis, MSK, skin)
![Page 16: Back To Basics: Cardiology Review I Michael Froeschl, MD FRCPC Assistant Professor of Medicine](https://reader035.vdocument.in/reader035/viewer/2022062407/56649e4b5503460f94b3f03a/html5/thumbnails/16.jpg)
F R O E S C H L
1c. Acute Myocardial Ischemia
↓ Supply
Coronary obstruction Microvascular
obstruction ↓ Perfusion pressure ↓ PaO2 ↓ Hemoglobin
↑ Demand
↑ Heart Rate ↑ Contractility ↑ Wall Tension
![Page 17: Back To Basics: Cardiology Review I Michael Froeschl, MD FRCPC Assistant Professor of Medicine](https://reader035.vdocument.in/reader035/viewer/2022062407/56649e4b5503460f94b3f03a/html5/thumbnails/17.jpg)
F R O E S C H L
1c. Acute Coronary Syndrome
Definition: myocardial ischemia due to acute coronary insufficiency
90% due to plaque rupture, thrombus +/- spasm
![Page 18: Back To Basics: Cardiology Review I Michael Froeschl, MD FRCPC Assistant Professor of Medicine](https://reader035.vdocument.in/reader035/viewer/2022062407/56649e4b5503460f94b3f03a/html5/thumbnails/18.jpg)
F R O E S C H L
1c. Two Manifestations of ACS
![Page 19: Back To Basics: Cardiology Review I Michael Froeschl, MD FRCPC Assistant Professor of Medicine](https://reader035.vdocument.in/reader035/viewer/2022062407/56649e4b5503460f94b3f03a/html5/thumbnails/19.jpg)
F R O E S C H L
1c. Two Manifestations of ACS
Complete Coronary Occlusion
No blood flow beyond
Transmural ischemia
ST-elevation on ECG
Localizes
Reciprocates
Threatened Coronary Occlusion
Decreased blood flow
Subendocardial ischemia
ST-depression or normal
Not localizing
No reciprocal ST ↑
![Page 20: Back To Basics: Cardiology Review I Michael Froeschl, MD FRCPC Assistant Professor of Medicine](https://reader035.vdocument.in/reader035/viewer/2022062407/56649e4b5503460f94b3f03a/html5/thumbnails/20.jpg)
F R O E S C H L
1c. ACS
![Page 21: Back To Basics: Cardiology Review I Michael Froeschl, MD FRCPC Assistant Professor of Medicine](https://reader035.vdocument.in/reader035/viewer/2022062407/56649e4b5503460f94b3f03a/html5/thumbnails/21.jpg)
F R O E S C H L
49M with chest pain X 1 hour:
![Page 22: Back To Basics: Cardiology Review I Michael Froeschl, MD FRCPC Assistant Professor of Medicine](https://reader035.vdocument.in/reader035/viewer/2022062407/56649e4b5503460f94b3f03a/html5/thumbnails/22.jpg)
F R O E S C H L
1c. STEMI
ABC; Vitals; IV, O2, Monitor HX, O/E, ECG: STEMI Acute reperfusion therapy (ART): lytics vs
PPCI ASA, NTG, BB (if safe), clopidogrel, anti-
coagulation (UFH), morphine
![Page 23: Back To Basics: Cardiology Review I Michael Froeschl, MD FRCPC Assistant Professor of Medicine](https://reader035.vdocument.in/reader035/viewer/2022062407/56649e4b5503460f94b3f03a/html5/thumbnails/23.jpg)
F R O E S C H L
1c. STEMI
Contraindications to Lytics:
90-min assessment CP ECG +/- Reperfusion Arrhythmia
1. Hemorrhagic stroke ever2. Ischemic stroke < 3 mos3. Intracranial AVM4. Intracranial malignancy5. Head trauma < 3 mos6. Active bleeding 7. Aortic dissection
![Page 24: Back To Basics: Cardiology Review I Michael Froeschl, MD FRCPC Assistant Professor of Medicine](https://reader035.vdocument.in/reader035/viewer/2022062407/56649e4b5503460f94b3f03a/html5/thumbnails/24.jpg)
F R O E S C H L
1c. NSTE ACS
ABC; Vitals; IV, O2, Monitor HX, O/E, ECG: NSTE ACS ASA Risk Stratify (HX, PE, ECG, TNT) Treat accordingly
![Page 25: Back To Basics: Cardiology Review I Michael Froeschl, MD FRCPC Assistant Professor of Medicine](https://reader035.vdocument.in/reader035/viewer/2022062407/56649e4b5503460f94b3f03a/html5/thumbnails/25.jpg)
F R O E S C H L
Risk Assess
High Interm Low
HX Ongoing CP
CP>20 min resolved
New/progrCCS
3-4
O/E ↓BP, S3, MR, rales
N N
ECG ST↓
trans ST↑
T inv N
TNT >0.1 0.01-0.1 <0.01
![Page 26: Back To Basics: Cardiology Review I Michael Froeschl, MD FRCPC Assistant Professor of Medicine](https://reader035.vdocument.in/reader035/viewer/2022062407/56649e4b5503460f94b3f03a/html5/thumbnails/26.jpg)
F R O E S C H L
TX High Interm Low
Admit? Yes Yes No
RX ASA
NTG
BB
clopidogrel
-coag
GP 2B3A-I
ASA
NTG
BB
clopidogrel
-coag
ASA
NTG SL
BB
IX Coronary Angio
Inpt stress Outpt stress
![Page 27: Back To Basics: Cardiology Review I Michael Froeschl, MD FRCPC Assistant Professor of Medicine](https://reader035.vdocument.in/reader035/viewer/2022062407/56649e4b5503460f94b3f03a/html5/thumbnails/27.jpg)
F R O E S C H L
1c. Complications Post-MI
Recurrent ischemia HF/shock Arrhythmia Mechanical Thromboembolic Pericarditis Depression
![Page 28: Back To Basics: Cardiology Review I Michael Froeschl, MD FRCPC Assistant Professor of Medicine](https://reader035.vdocument.in/reader035/viewer/2022062407/56649e4b5503460f94b3f03a/html5/thumbnails/28.jpg)
F R O E S C H L
1c. Prognosis Post-MI
LV systolic function remains the most important determinant of prognosis post-MI
Usually assessed by means of echocardiogram prior to discharge
![Page 29: Back To Basics: Cardiology Review I Michael Froeschl, MD FRCPC Assistant Professor of Medicine](https://reader035.vdocument.in/reader035/viewer/2022062407/56649e4b5503460f94b3f03a/html5/thumbnails/29.jpg)
F R O E S C H L
1c. Secondary Prevention: RX
ASA in all Statin in almost all (LDL < 2) ACE-I in most Beta-Blocker NTG if angina Clopidogrel x 1 year post-ACS, post-stent Treat risk factors
![Page 30: Back To Basics: Cardiology Review I Michael Froeschl, MD FRCPC Assistant Professor of Medicine](https://reader035.vdocument.in/reader035/viewer/2022062407/56649e4b5503460f94b3f03a/html5/thumbnails/30.jpg)
F R O E S C H L
1c. Secondary Prevention: Life
Smoking Diet Exercise Weight Alcohol Stress
![Page 31: Back To Basics: Cardiology Review I Michael Froeschl, MD FRCPC Assistant Professor of Medicine](https://reader035.vdocument.in/reader035/viewer/2022062407/56649e4b5503460f94b3f03a/html5/thumbnails/31.jpg)
F R O E S C H L
2. ECG = EKG
Identify the study Setting Technical Details Read: rate, rhythm, axis, alphabet Interpret Previous
![Page 32: Back To Basics: Cardiology Review I Michael Froeschl, MD FRCPC Assistant Professor of Medicine](https://reader035.vdocument.in/reader035/viewer/2022062407/56649e4b5503460f94b3f03a/html5/thumbnails/32.jpg)
F R O E S C H L
2a. Electrical Anatomy
The heart is a pump coordinated and powered by an integral electrical system
![Page 33: Back To Basics: Cardiology Review I Michael Froeschl, MD FRCPC Assistant Professor of Medicine](https://reader035.vdocument.in/reader035/viewer/2022062407/56649e4b5503460f94b3f03a/html5/thumbnails/33.jpg)
F R O E S C H L
2a. Electrical Anatomy
The SA Node has the steepest slope of spontaneous Phase 4 depolarization and therefore is the dominant pacer
![Page 34: Back To Basics: Cardiology Review I Michael Froeschl, MD FRCPC Assistant Professor of Medicine](https://reader035.vdocument.in/reader035/viewer/2022062407/56649e4b5503460f94b3f03a/html5/thumbnails/34.jpg)
F R O E S C H L
2a. Electrical Anatomy
Atrial depolarization normally flows from top to bottom and from right to left
![Page 35: Back To Basics: Cardiology Review I Michael Froeschl, MD FRCPC Assistant Professor of Medicine](https://reader035.vdocument.in/reader035/viewer/2022062407/56649e4b5503460f94b3f03a/html5/thumbnails/35.jpg)
F R O E S C H L
2a. Electrical Anatomy
The AV Node delays then relays electrical activation to the ventricles
![Page 36: Back To Basics: Cardiology Review I Michael Froeschl, MD FRCPC Assistant Professor of Medicine](https://reader035.vdocument.in/reader035/viewer/2022062407/56649e4b5503460f94b3f03a/html5/thumbnails/36.jpg)
F R O E S C H L
2a. Electrical Anatomy
The His-Purkinje System conducts electrical activation to all areas of both ventricles
![Page 37: Back To Basics: Cardiology Review I Michael Froeschl, MD FRCPC Assistant Professor of Medicine](https://reader035.vdocument.in/reader035/viewer/2022062407/56649e4b5503460f94b3f03a/html5/thumbnails/37.jpg)
F R O E S C H L
2a. Electrical Anatomy
Three phases of ventricular depolarization:
1. Septum LR(atrial repolarization
occurs simultaneously)
![Page 38: Back To Basics: Cardiology Review I Michael Froeschl, MD FRCPC Assistant Professor of Medicine](https://reader035.vdocument.in/reader035/viewer/2022062407/56649e4b5503460f94b3f03a/html5/thumbnails/38.jpg)
F R O E S C H L
2a. Electrical Anatomy
2. Depolarization of both ventricles simultaneously from endocardium to epicardium
![Page 39: Back To Basics: Cardiology Review I Michael Froeschl, MD FRCPC Assistant Professor of Medicine](https://reader035.vdocument.in/reader035/viewer/2022062407/56649e4b5503460f94b3f03a/html5/thumbnails/39.jpg)
F R O E S C H L
2a. Electrical Anatomy
Ventricular repolarization ensues, from epicardium to endocardium
![Page 40: Back To Basics: Cardiology Review I Michael Froeschl, MD FRCPC Assistant Professor of Medicine](https://reader035.vdocument.in/reader035/viewer/2022062407/56649e4b5503460f94b3f03a/html5/thumbnails/40.jpg)
F R O E S C H L
2a. The 12-Lead ECG
![Page 41: Back To Basics: Cardiology Review I Michael Froeschl, MD FRCPC Assistant Professor of Medicine](https://reader035.vdocument.in/reader035/viewer/2022062407/56649e4b5503460f94b3f03a/html5/thumbnails/41.jpg)
F R O E S C H L
2a. PQRSTU
PR ST TP
PR QT
Segments
Intervals
QRS
![Page 42: Back To Basics: Cardiology Review I Michael Froeschl, MD FRCPC Assistant Professor of Medicine](https://reader035.vdocument.in/reader035/viewer/2022062407/56649e4b5503460f94b3f03a/html5/thumbnails/42.jpg)
F R O E S C H L
2a. PQRSTU
PR ST
Segments
Intervals
PR ST TP
PR QT
QRS
![Page 43: Back To Basics: Cardiology Review I Michael Froeschl, MD FRCPC Assistant Professor of Medicine](https://reader035.vdocument.in/reader035/viewer/2022062407/56649e4b5503460f94b3f03a/html5/thumbnails/43.jpg)
F R O E S C H L
2a. Reading an ECG
1. Rate
2. Rhythm
3. Axis
4. Alphabet
![Page 44: Back To Basics: Cardiology Review I Michael Froeschl, MD FRCPC Assistant Professor of Medicine](https://reader035.vdocument.in/reader035/viewer/2022062407/56649e4b5503460f94b3f03a/html5/thumbnails/44.jpg)
F R O E S C H L
1. Rate: “Count-Off” Method
Start300
150100
7560 Normal Rate = 60-100 bpm
![Page 45: Back To Basics: Cardiology Review I Michael Froeschl, MD FRCPC Assistant Professor of Medicine](https://reader035.vdocument.in/reader035/viewer/2022062407/56649e4b5503460f94b3f03a/html5/thumbnails/45.jpg)
F R O E S C H L
2. Rhythm
Normally, the sinus node controls the entire heart
This is known as “Normal Sinus Rhythm” (NSR):- P wave axis is normal (0-90°)- Each P is followed by a QRS- Each QRS is preceded by a P
![Page 46: Back To Basics: Cardiology Review I Michael Froeschl, MD FRCPC Assistant Professor of Medicine](https://reader035.vdocument.in/reader035/viewer/2022062407/56649e4b5503460f94b3f03a/html5/thumbnails/46.jpg)
F R O E S C H L
3. QRS Axis
1. If QRS + in I AND II, QRS axis is normal2. If QRS not + in I AND II, you must
calculate QRS axis3. To do so, use leads I and aVF to identify
the 90°-quadrant4. Then use the isoelectric lead to quantify
QRS axis (to nearest 30°)
![Page 47: Back To Basics: Cardiology Review I Michael Froeschl, MD FRCPC Assistant Professor of Medicine](https://reader035.vdocument.in/reader035/viewer/2022062407/56649e4b5503460f94b3f03a/html5/thumbnails/47.jpg)
F R O E S C H L
4. Alphabet
P waves PR (segments and intervals) QRS (Qs, height, width) ST segments T waves QT interval
![Page 48: Back To Basics: Cardiology Review I Michael Froeschl, MD FRCPC Assistant Professor of Medicine](https://reader035.vdocument.in/reader035/viewer/2022062407/56649e4b5503460f94b3f03a/html5/thumbnails/48.jpg)
F R O E S C H L
Arrhythmia = Dysrhythmia
1. Slow
2. Fast
3. Normal rate
![Page 49: Back To Basics: Cardiology Review I Michael Froeschl, MD FRCPC Assistant Professor of Medicine](https://reader035.vdocument.in/reader035/viewer/2022062407/56649e4b5503460f94b3f03a/html5/thumbnails/49.jpg)
F R O E S C H L
2b. Bradydysrhythmias
1. Sinus Node Sinus brady, pause, arrest, block
2. “AV Node” 2° AVB (Type I and Type II) 3° AVB
![Page 50: Back To Basics: Cardiology Review I Michael Froeschl, MD FRCPC Assistant Professor of Medicine](https://reader035.vdocument.in/reader035/viewer/2022062407/56649e4b5503460f94b3f03a/html5/thumbnails/50.jpg)
F R O E S C H L
2b. AV Block
Nodal 1° AVB2° AVB I 3° AVB
Infra-Nodal 2° AVB II 3° AVB
![Page 51: Back To Basics: Cardiology Review I Michael Froeschl, MD FRCPC Assistant Professor of Medicine](https://reader035.vdocument.in/reader035/viewer/2022062407/56649e4b5503460f94b3f03a/html5/thumbnails/51.jpg)
F R O E S C H L
2b. AV Block
Nodal AVB is more benign because:- Causes are often functional (as opposed to
infranodal block which is almost always structural)
- If progression to CHB, nodal escapes available
![Page 52: Back To Basics: Cardiology Review I Michael Froeschl, MD FRCPC Assistant Professor of Medicine](https://reader035.vdocument.in/reader035/viewer/2022062407/56649e4b5503460f94b3f03a/html5/thumbnails/52.jpg)
F R O E S C H L
90F presents with fatigue:
![Page 53: Back To Basics: Cardiology Review I Michael Froeschl, MD FRCPC Assistant Professor of Medicine](https://reader035.vdocument.in/reader035/viewer/2022062407/56649e4b5503460f94b3f03a/html5/thumbnails/53.jpg)
F R O E S C H L
2c. Tachydysrhythmia
SVT NCTWCT
VT WCT
![Page 54: Back To Basics: Cardiology Review I Michael Froeschl, MD FRCPC Assistant Professor of Medicine](https://reader035.vdocument.in/reader035/viewer/2022062407/56649e4b5503460f94b3f03a/html5/thumbnails/54.jpg)
F R O E S C H L
2c. NCT
Regular Irregular
AVN-Indep AVN-Dep AF
ST AVNRT MAT
AFL AVRT AFL/AT +
AT variable block
![Page 55: Back To Basics: Cardiology Review I Michael Froeschl, MD FRCPC Assistant Professor of Medicine](https://reader035.vdocument.in/reader035/viewer/2022062407/56649e4b5503460f94b3f03a/html5/thumbnails/55.jpg)
F R O E S C H L
75F to ER with palpitations:
![Page 56: Back To Basics: Cardiology Review I Michael Froeschl, MD FRCPC Assistant Professor of Medicine](https://reader035.vdocument.in/reader035/viewer/2022062407/56649e4b5503460f94b3f03a/html5/thumbnails/56.jpg)
F R O E S C H L
25F to ER with palpitations:
![Page 57: Back To Basics: Cardiology Review I Michael Froeschl, MD FRCPC Assistant Professor of Medicine](https://reader035.vdocument.in/reader035/viewer/2022062407/56649e4b5503460f94b3f03a/html5/thumbnails/57.jpg)
F R O E S C H L
72M without symptoms:
![Page 58: Back To Basics: Cardiology Review I Michael Froeschl, MD FRCPC Assistant Professor of Medicine](https://reader035.vdocument.in/reader035/viewer/2022062407/56649e4b5503460f94b3f03a/html5/thumbnails/58.jpg)
F R O E S C H L
2c. Atrial Fibrillation: 2 Issues
Symptoms
Rate Control
(BB, CCB, dig)
vs
Rhythm Control
(e.g. amiodarone)
Stroke Risk (CHADS2)
CHF/LVEF <= 35% = 1
Hypertension = 1
Age > 75 = 1
Diabetes = 1
Stroke (embolic) = 2
2 = OAC1 = ASA or OAC0 = ASA
![Page 59: Back To Basics: Cardiology Review I Michael Froeschl, MD FRCPC Assistant Professor of Medicine](https://reader035.vdocument.in/reader035/viewer/2022062407/56649e4b5503460f94b3f03a/html5/thumbnails/59.jpg)
F R O E S C H L
2c. WCT
VT
AV Dissociation
Fusion/Capture Beats
Bizarre QRS Axis
Wide QRS
QRS Concordance
DDX
SVT + Aberrancy Accessory Pathway Pacemaker Bundle Branch Block Metabolic
derangement
![Page 60: Back To Basics: Cardiology Review I Michael Froeschl, MD FRCPC Assistant Professor of Medicine](https://reader035.vdocument.in/reader035/viewer/2022062407/56649e4b5503460f94b3f03a/html5/thumbnails/60.jpg)
F R O E S C H L
66M prior MI with palpitations:
![Page 61: Back To Basics: Cardiology Review I Michael Froeschl, MD FRCPC Assistant Professor of Medicine](https://reader035.vdocument.in/reader035/viewer/2022062407/56649e4b5503460f94b3f03a/html5/thumbnails/61.jpg)
F R O E S C H L
2c. Torsades de Pointes
Polymorphic VT due to a long QTc (often with a characteristic appearance)
Causes: Congenital Acquired
1. Electrolyte disturbances (Hypo K, Ca, Mg)2. Drugs (antipsychotics, antidepressants, antibiotics,
antiarrhythmics)3. Other
![Page 62: Back To Basics: Cardiology Review I Michael Froeschl, MD FRCPC Assistant Professor of Medicine](https://reader035.vdocument.in/reader035/viewer/2022062407/56649e4b5503460f94b3f03a/html5/thumbnails/62.jpg)
F R O E S C H L
3. Syncope
PumpObstructionArrhythmia
FluidHypovolemia
PipesSubclavian StealVBIMigraine
NeurocardiogenicCSHVasovagalSituational
![Page 63: Back To Basics: Cardiology Review I Michael Froeschl, MD FRCPC Assistant Professor of Medicine](https://reader035.vdocument.in/reader035/viewer/2022062407/56649e4b5503460f94b3f03a/html5/thumbnails/63.jpg)
Questions?