33. Seminar: Valve Disease Flashcards
what are the common underlying causes of afib?
any condition associated with LAE, like concentric hypertrophy, HTN or aortic stenosis.
any condition associated with RAE, like RVH, cor pulmonale
things associated with increased atrial irritability like pericarditis, EtOH, hypoxia
afib patient: what are the first things we do for rate control?
slow the AV node transmission. Beta blocker, Ca blocker, or digitalis
afib patient: what are the first things we do for rhythm control?
chronic use of a type III anti-arrhythmic (amiodarone, sotalol).
what is the difference between verapamil and nifedipine?
- both are Ca channel blockers
- verapamil primarily affects the myocardium
- nifedipine works more on smooth muscle in the peripheral vasculature
afib: what is a primary concern?
thrombus formation. give warfarin.
diltiazem (anti-HTN): does it have AV node blocking effect?
yes
Why wait before cardioverting someone in afib?
afib is associated with stasis in the atria, which can be pro-thrombotic. before correcting afib, want to anticoagulate and get rid of clots.
Loud P2 associated with what?
pulm HTN
Biggest way to see if something is a cardiac problem or pulm problem?
wedge pressure: LV filling pressure = LA pressure indicates cardiac problem
Orthopnea/PND: more indicative of pulm or cardiac problem?
cardiac
Hypoxia: more likely with pulm or cardiac problem?
Hypoxia is more likely with pulmonary disease, usually not until later stages with left heart failure.
2 mechanisms by which LV can inc diameter, and how they help with mitral regurg?
- acute dilation, stretching to ideal overlap to max efficiency between actin/myosin fibers.
- chronic hypertrophy (eccentric). usual degree of shortening by a longer wall achieves a greater stroke volume.
How might you distinguish between primary and secondary causes of valve failure based on history?
A long history of heart murmur preceding the development of dyspnea would favor primary valve disease. The development of a murmur following a myocardial infarction would favor secondary regurgitation.
name 2 peripheral venodilators
nitro, morphine
what would you use venodilation for?
in setting of pulmonary edema, redistribute blood from the pulmonary circulation to the systemic veins. would also use diuretics, sit patient upright, give 02.
