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)
Complications of descending AD?
Hemothorax or hemoperitoneum, renal injury( renal artery occlusion), mesenteric ischemia (SMA occlusion), lower extremity ischemia, lower extremity paraplegia( spinal cord ischemia)
Unstable angina/non ST elevated MI: rxn?
- Dual antiplatelet therapy( aspirin + p2y12 receptor blocker: clopidogrel, prasugrel, ticagrelor)
- Nitrates 3. Beta blockers 4. Statins
- Anticoagulation therapy (unfractionated heparin, LMWH, bivalirudin, or fondaparinux)
Multiple clinical trials show that dual antiplatelet therapy and anticoagulant significantly reduce risk of nonfatal MI & CV death in ACS pts.
SVT: ecg?
Rate > 150, regular rhythm, P wave often not visible buried within QRS or T wave
