Advanced cardio2 Flashcards
Aortic coarctation: CF?
Lower extremity claudication & hypotension, upper extremity htn, brachiofemoral delay
HS: continous murmur, systolic murmur at left sternal border or no murmur if no other cardiac defects present
Chest xray: rib notching & fig 3 sign at aortic narrowing site
Echo: confirm dx
Aortic coarctation?
Usually congenital & distal to lt subclavian, associated e turner syn but commonly sporadic & affects male pts.
Antithrombotic therapy in pts e mechanical heart valves?
- Aspirin
• 75-100 mg/day( in addition to warfarin) in allpts e aortic/mitra valve replacement
• 75-325 mg/day in pts who cannot take warfarin
Antithrombotic therapy in pts e mechanical heart valves?
Warfarin goal INR 2-3 (aortic valve replacement if no risk factors present)
Warfarin goal INR 2.5-3.5 (mitral valve replacement, aortic valve replacement e presence of risk factors, first 3 months after aortic valve replacement)
Mechanical heart valves: antithrombotic therapy?
Guidelines on target INR vary with valve position, type of mechanical valve and associated comorbid conditions.
Inferior wall MI?
Blockage of RCA involve only or both lt & rt ventricles. SA node supplied by RCA & bloackade leqd to increase vagal tone causing bradycardia, hypotension.
sinus bradycardia: transient & self limited but can lead to cardiogenic shock so rxn IV atropine that inc CO & imorove symptoms
Cardiogenic shock CF?
Hypotension, cold extremities, pulmonary oedema
Down syndrome: common CHD?
Endocardial cushion defect
Other disorder: duodenal atresia, hirschsprung’s disease, atlanto axial instability & hypothyroidism
Endocardial cushion defect: investigation of choice?
Echo( identify defect & determine position & size)
Other: chest xray, ecg, hyperoxia test narrow down D/D & evaluate extent of cardiac damage
Down syndrome: long run complication?
Increase risk of acute leukemia
Other conditions e higher frequency: Alzheimer like dementia, autism, depressive disorder and seizure disorder
Acute aortic dissection: CF?
- History of htn, genetic disorder(eg.marfan syndrome)
- Severe, sharp, tearing chest pain
- > 20mmHg difference in SBP betn arms
Acute aortic dissection: dx?
- ECG: normal or nonspecific ST & T wave changes
- Chest xray: mediastinal widening
- CTA or TEE for definitive dx
Acute aortic dissection: rxn?
- Pain control(morphine)
- IV beta blockers ( esmolol)
- +/- sodium nitroprusside (if SBP > 120mmHg)
- Emergent surgical repair for ascending dissection
Goals of initial therapy for both ascending & descending AD?
- Adequate pain control 2. Lowering SBP <120 mmHg 3. Dec LV contractility to reduce aortic wall stress
IV beta blockers( propanolol, labetalol, esmolol)
In acute setting esmolol used due to short half life( 9 mins)
Complications of ascending AD?
AR, ACS(RCA occlusion), cardiac tamponade(hemopericardium), stroke (carotid artery occlusion), horner syndrome( SG compression), vocal cord paralysis (recurrent LN compression)
