Cardiology List of Most Commons for Physician Assistant Students

Dear Readers,

Below are the most commons in cardiology that I’ve put together from this block. I’m sure once I enter rotations I will be adding many more. Can I just say that one of my biggest pet-peeves right now is the incorrect pronunciation of medical terms? For example, angina. This word has been produced in two ways by various professors, but there must be a correct way to pronounce it, so naturally, I looked it up. “An-jen-uh” is the correct pronunciation, while “an-jine-ah” is colloquially used, but incorrect.

Cardiology Most Commons

• Most common pathologic process of the pericardium - Pericarditis
• Most common etiology of Acute Pericarditis - coxsackievirus A and B
• Most common cause of death in the U.S. - Coronary Artery Disease (CAD)
• Coronary microcirculation disease more common in women - this is why CAD affects more women than men annually
• Exercise electrocardiography less accurate in women
• More women die each year of CAD
• Most common cause of sudden cardiac death: ventricular fibrillation
• Most common cause of sudden cardiac death in young athletes: hypertrophic obstructive cardiomyopathy (HOCM)
• Hypertension
• More common in women as age increases
• More common in men in young and middle aged people
• More common in African Americans and lower socioeconomic groups
• African Americans develop at earlier age compared to other races
• Secondary HTN - more common in children
• White coat HTN - affects more treated women than men
• HTN is the SECOND most common cause of CKD
• Obesity most common in African Americans, Hispanics, and Native Americans than Caucasians in US
• Resistant HTN - most common reason for referral to hypertension specialist
• Persistent BP 140/90+ despite treatment with full doses of 3+ classes of meds
• The most common cause of CAD is HTN
• The most common cause of right ventricular heart failure is left ventricular heart failure!
• Most common reason patients 65+ are hospitalized each year: congestive heart failure (CHF)
• Most common etiology of LV systolic dysfunction: CAD
• Most common secondary cause of dyslipidemia: diabetes/insulin resistance
• Most common etiology of mitral stenosis: rheumatic heart disease
• Most common etiology of endocarditis: staph aureus
• More common in males living in urban areas
• Native valve infective endocarditis (IVDU) most commonly
• Affects the tricuspid valve +/- mitral or aortic
• Affects normal valves
• Most common microbe: staph aureus
• Native valve infective endocarditis (non-IVDU) most commonly
• Affects the mitral and aortic valves
• Abnormal valves affected (RF and bicuspid aortic valve)
• Most common microbe: strep mutans

Other Most Commons and Tips for Memorization!

• While automaticity is greatest at the SA node, conductivity is greatest in the Purkinje Fibers (4000 mm/s) and slowest in the AV node (200 mm/s)
• Pericardial Friction Rub - hallmark finding of acute pericarditis
• “Water bottle” configuration - CXR finding of pericardial effusion
• Clinical Presentation of Constrictive Pericarditis
• WADE (heart failure symptoms)
• Weakness
• Ascites
• Dyspnea
• Edema
• Increased JVP (without decrease upon inspiration)
• +/- Pericardial “knock” - early diastole, L sternal border
• Beck’s Triad - classic presentation of Cardiac Tamponade
• Decreased arterial pressure
• Distended neck veins
• Faint heart sounds
• Pulsus Paradoxus - decrease in pulse and systolic pressure (10 mmHg+) with inspiration; seen in cardiac tamponade, but also seen in hypovolemic shock, COPD, and pulmonary embolism; thus, it is non-specific and not good to rule in or out
• Order of Heart Sounds
• SEM-SOSS “some-sauce”
• S1, Ejection click, Midsystolic click, S2, Opening snap, S3, S4
• Murmurs
• Mid-systolic (HAPI) Murmurs
• Hypertrophic cardiomyopathy
• Pulmonary stenosis
• Aortic stenosis, Example 2
• Innocent
• Holosystolic (MTV) Murmurs
• Mitral regurgitation
• Tricuspid regurgitation
• “Carvallo’s Sign” - increase in murmur with inspiration
• Ventricular septal defect
• Diastolic (ARMS) Murmurs
• Aortic Regurgitation
• “Austin Flint Murmur” - a diastolic rumble heard with chronic aortic regurgitation
• Peripheral Pulses (Chronic Aortic Regurgitation)
• Waterhammer pulse (Corrigan’s pulse) - rapid increase in pulse
• Bobbing of head (de Musset’s sign) or uvula (Muller’s sign) with each heartbeat
• Quincke’s pulses (capillary pulsations)
• Traube’s Sign (“pistol shots” over femoral arteries)
• Duroziez’s sign (systolic and diastolic femoral murmurs)
• “Rule of 55” - operate before LVEF <55% or LV end-systolic dimension >5.5 cm
• Mitral Stenosis
• For more advanced learning, the American College of Cardiology has Heart Songs for purchase available through their website. While it is expensive, you might consider purchasing this one as a group and sharing it amongst students.
• 2007 European Guidelines for treating HTN: “It is not important how treatment is started, but very important that BP goals are achieved”
• CHADs2 Score - Atrial Fibrillation Stroke Risk
• CHF = 1 Pt
• HTN = 1 Pt
• Age 74 + = 1 Pt
• DM = 1 Pt
• Secondary Embolic (stroke) Event: 2 Pts
• Cardiac Tamponade
• +/- in Pericardial effusion
• Medical Emergencies in Cardiology
• Cardiac Tamponade
• Ventricular Tachycardia - sudden cardiac death
• Ventricular Fibrillation - sudden cardiac death
• Hypertrophic Obstructive Cardiomyopathy (HOCM)
• Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC)
• Wolff-Parkinson-White Syndrome
• QT Prolongation
• Severely elevated BP (HTN) + acute or rapid organ dysfunction
• Various EKG Findings (keep in mind this is from a very basic understanding)
• Atrial Flutter - “sawtooth pattern” or “rapid regular”
• Atrial Fibrillation - “wavy baseline” “rapid irregular” “CHF promotes A-fib, A-fib aggravates CHF”
• PVC - “wide, bizarre QRS complex”; inverted wide-QRS; inverted T-wave; no p-wave;
• Wolff-Parkinson-White Syndrome - delta wave
• Idioventricular rhythm - “slow v-tach”
• Chronic Unstable Angina - 1 mm horizontal or down sloping ST segment depression in V5
• NSTEMI - ST segment depression + T-wave inversion
• STEMI - ST elevation
• Acute Myocardial Infarction
• Active injury: ST elevation, wide/deep Q wave, R wave normal, T-wave peaked
• As heart necroses: deeper Q-waves
• Post-injury: ST very elevated, R wave notching and loss of amplitude
• T-wave inversion within hours and before ST segment isoelectric
• ST elevation returns to normal within hours
• Depressed PR segment
• Acute Pericarditis - ST elevation/T-wave inversion (lasts days), decreased QRS amplitude
• Pericardial Effusion: decreased QRS voltage, QRS alterans
• Chronic Pericarditis - decreased QRS voltage, T-wave inversion
• Cardiac Tamponade - decreased QRS voltage
• Left Ventricular Hypertrophy (LVH) - thick lines, increased QRS voltage
• Hyperkalemia - tall T-wave, sine-wave
• ST depressions + deep T-wave inversions - HCM (apical variant)
• ARVD (arrhythmogenic right ventricular dysplasia) - Epsilon waves
• Takotsubo “octopus trap” Cardiomyopathy is sometimes referred to as the “broken heart syndrome” or “stress cardiomyopathy” - mimics MI without CAD present
• Obviously patient history and physical exam are going to be more important in these cases, but here is a comparison that can be useful for remembering labs. This will especially be helpful in your ED rotation.
• Remember for sensitivity and specificity:
• SNOUT (SeNsitivity - rules OUT)
• SPIN (SPecificity - rules IN)

Diagnosis	Identification/ Detection	Extras
Acute Pericarditis	TTE
Chronic Constrictive Pericarditis	R-heart Catheterization
CHF	BNP (rule IN)	Increases with sepsis, pulmonary emboli Decreases with obesity
AMI	Myoglobin (rule OUT) CK-MB (rule OUT) Troponin (rule IN)	If all 3 elevated - acute phase of MI
NSTEMI	CK; CK-MB Troponin

Sources:

http://lifeinthefastlane.com/ecg-library/basics/left-ventricular-hypertrophy/