BUMC Basics.pdf - Anesthesia Home

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sleeping, EKG: ST elevation and TWI in V1-3 in setting of
RBBB)
• Hypothermia (Osborn Wave = small wave at J point)
• Pulmonary Embolism (R heart strain signified by
RBBB/RAD/RVH/RAE, sinus tachycardia, S1Q3T3:broad
S in I, Q wave in III, inverted T in III)
• Pericarditis (PR depression in II, diffuse STE)
• COPD (R heart strain like above + Low Voltage of
Precordial Leads only, Prominent P Waves)
• Digitalis (therapeutic: sloping downward ST, T
depressed or inverted, short QT) vs (Excess: SA Block,
PAT w/ Block, AV Block, AV Dissociation) vs (Toxicity:
Afib, JT, VT, multiple PVC, VFib)
HEART FAILURE
The heart cannot produce output to match the metabolic
demands of the body.
Systolic Dysfunction: Decreased EF, pump failure
Diastolic Dysfunction: Preserved EF, but impaired
relaxation of the ventricle.
Causes:
• CAD/MI
• HTN
• Valvular Disease: AS, AR, and MR
• Arrhythmias: Long standing tachycardias
• Metabolic/Toxic/Drugs: Beriberi, Pagets disease,
chemo drugs, alcohol, thyroid
• Infectious: Sepsis, coxsackie virus, chagas disease, etc
• Pericardial Disease
• Infiltrative Disease of Myocardium: Amyloid, sarcoid,
and hemochromatosis
Initial work up — H&P, CBC, CMP, EKG, chest X-ray,
cardiac enzymes, TSH, TTE, if new onset +/- inpatient
coronary angiography
Functional classification:
NYHA Class I: Symptomatic only with greater than
ordinary activity.
NYHA Class II: Symptomatic with ordinary activity.
NYHA Class III: Symptomatic with minimal activity.
NYHA Class IV: Symptomatic at rest.