Adult - Cardiology III Flashcards
Does nitroglycerin relieve MI pain?
it has very little effect
Does every patient with MI have ECG changes initially?
No - about 30% do not
When present, what are the ECG changes of MI?
peaked T waves
elevated ST segment
~ Q wave development
ECG changes in I, aVL indicate what MI location?
lateral
ECG changes in II, III, aVF indicate what MI location?
inferior
ECG changes in V leads,or V3 and V4 indicate what MI location?
anterior
Within 4 - 6 hours, what enzymes will be elevated after MI?
Troponin T
Troponin I
CK-MB
(second two are 100% cardio selective)
In order, what is acute management of MI?
ASA
nitro
O2
What medication may be given for MI pain?
morphine
What medication may be given for pulmonary edema in MI?
furosemide (Lasix)
If on coumadin, what is theraputic range of INR?
2 - 3 mg/dL
What are the coagulation studies?
INR ACT APTT PT PTT
ACT
Activated Coagulation Time
PT
Prothrombin Time
PTT
Partial Thromboplastin Time
What are the indications for clot busting with TPA?
aka pharmacologic revascularization / fibrinolytic
unrelieved chest pain (>30 min and <6 hours)
WITH
ST segment elevation
A partial or complete occlusion of a vein by thrombus with secondary inflammation to the wall of the vessel.
venous thrombosis
can be superficial or deep
What’s going on in peripheral vascular disease?
decreased blood supply
ARTERIOsclerotic
Typical patient with peripheral vascular disease?
40 - 70 year old
smoker
hyperlipidemia
DM
Typical initial symptom of peripheral vascular disease?
claudication
What are physical findings of peripheral vascular disease?
shiny, hairless skin
dependent rubor
elevational pallor
reduced pulses
Diagnositics for peripheral vascular disease?
doppler U/S
ankle-brachial index
arteriography - most definative test
Management of peripheral vascular disease?
exercise - 1 hour per day, rest during pain
weight reduction PRN
bypass surgery
amputation
Medication management of peripheral vascular disease?
pentoxifylline (Trental)
cilostazol (Pletal)
What’s going on in chronic venous insufficiency?
impaired venous return
Is chronic venous insufficiency more common in men or women?
women
Typical complaint of chronic venous insufficiency?
Lower leg:
ACHING relieved by elevation
EDEMA after prolonged standing
NIGHT CRAMPS
Physical findings in chronic venous insufficiency?
brownish discoloration
stasis leg ulcers
dermatitis
cool to touch
Diagnostics for chronic venous insufficiency?
clinical picture
Management of chronic venous insufficiency?
support stockings
weight loss PRN
treatment of dermatitis or ulcers
What is the treatment for acute weeping dermatitis related to chronic venous insufficiency?
wet compresses
hydrocortisone cream
ABT only if clearly infected
