acute cards pt 2 Flashcards
s/s chronic PH
prominent S2
S2 splitting
RV heave
loud pulmonary valve
JVD
tricuspid regurgitation murmur
peripheral edema
ascites
hepatomegaly
cardiac tamponade exam findings
becks triad - elevated JVP, hypotension, muffled heart sounds
pulsus paradoxus
JVD
narrow pulse pressure
tachycardia
hemodynamic impact depends on rate of fluid accumulation
cardiac tamponade diagnosis
TTE
maybe clinical diagnosis
cardiac tamponade management
preload support - IVF, avoid sedation, inotropes
pericardiocentesis / pericardial window
endocarditis etiology
infection with gram positive cocci (most common), IVDU, prosthetic valves, dental procedures
infection of endothelial layer of heart causes valvular dysfunction
endocarditis exam findings
fever
murmur
petechiae
osler’s nodes
splinter hemorrhages
laneway’s lesions
Roth’s spots
splenomegaly
embolic disease
osler’s nodes
painful, red, sub cuticular nodules on finger tips
splinter hemorrhages
linear, subungual hemorrhages
Janeway’s lesions
painless macules on palms
endocarditis diagnostics
persistent bacteremia in BC x3
leukocytosis
TTE/TEE - TEE more sensitive
pathologic & clinical criteria needed for definite diagnosis
endocarditis mgmt
consult ID
prolonged IV abx w empiric therapy, then narrow
4-6 weeks abx
may need surgery if causes HF
endocarditis prophylaxis
for pt w prosthetic valves, previous endocarditis, unrepaired CHD, transplant recipients
for dental, oral, respiratory tract procedures
with amoxicillin 2g PO 1h before procedure
myocarditis
inflammatory disease of the myocardium
often in otherwise healthy person
progresses to rapidly progressive heart failure
myocarditis s/s
may be asymptomatic
chest pain
flu like symptoms
recent URI
HF symptoms - severe
tachycardia, gallop, MR, edema, pericardial friction rubm
myocarditis diagnositics
leukocytosis (eosinophilia)
elevated ESR/CRP
trop elevation (50%)
TTE - r/o other causes
EKG - mimic ischemia
endomyocardial biopsy - gold standard
cardiac MRI - standard
myocarditis mgmt
supportive
treat like HF (devices, diuretics, inotropes)
avoid NSAIDs
vaccination (MMR, varicella, flu)
aortic aneurysm s/s
asymptomatic until expanding, dissecting, or rupture
back/flank/chest pain
pulsating sensation in abdomen
palpable mass in abdomen
hypotension, tachycardia, overt shock, bleeding
aortic aneurysms diagnostics
labs helpful for supportive care
US - screening (refer if 4cm +)
CTA - more sensitive and detailed, determine if candidate for surgery
aortic aneurysm mgmt
rupture - surgical emergency
consult vascular (descending thoracic, AAA)/cardiac surgery (ascending/arch) if >4cm
supportive care (SBP 100-120, IVBB)
surgical repair - significant preop testing (open or endovascular options)
DVT/PE RF
virchow’s triad - venous stasis, hyper coagulability, endothelial injury
acute infectious disease or injury/ obesity, prior DVT, cancer, immobility, surgery
DVT diagnostics
wells score - pretest probability
duplex US
acute DVT mgmt
distal DVT w/o severe symptoms or RF - serial imaging for 2 weeks (preferable to AC)
severe sx or RF - AC
superficial w RF: AC for 45 d (fondaparinux/rivaroxaban)
CI to AC - consider IVC
AC: DOACs
major provoked - 3 mos
minor provoked - consider extended
unprovoked - extended phase
stopping AC is shared decision making, consider ASA if d/c
post-thrombotic syndrome
chronic venous insufficiency following DVT
venous stasis ulcers, pain, can lead to permanent disability
PE s/s
gradual progressive dyspnea vs. sudden catastrophic hemodynamic collapse
tachypnea, shocky, hypoxia, CP, hemoptysis, crackles, febrile, diaphoresis, RHF s/s, murmur
