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