Block 63, 64: cardio Flashcards
define pulseless electrical activity
organized rhythm on cardiac monitoring without a measurable blood pressure or palpable pulse in a cardiac arrest patient
clinical symptoms of supravalvlar aortic stenosis
- unequal carotid pulses
- differential blood pressure in upper extremities
- palpable thrill in suprasternal notch
systolic anterior motion of mitral valve in patients who have
hypertrophic obstructive cardiomyopathy
supravalvular aortic stenosis have angina during exercise, why?
increased myocardial oxygen demand
Beck’s triad
hypotension
distended neck veins
muffled heart sound
Decreased cardiac contractility is seen in patients who have
systolic heart failure
Beck’s triad is diagnostic for what? what causes these symptoms
cardiac tamponade
- shift of interventricular septum toward left ventricular cavity
what causes the patient’s dyspnea and weakness in cardiac tamponade
decreased left ventricular preload
what are pathologicial causes of exterional syncope
- v tachs
- outflow obstruction
when do you see prominent capillary pulsations in the fingertips or nail beds
aortic regurgitation
history of recent upper respiratory tract infection followed by sudden onset of cardiac failure in otherwise healthy person suggests
dilated cardiomyopathy, secondary to acute viral myocarditis
what is performed in patients with cardiac tamponade for diagnosis and management
echocardiography
what is pulmonary capillary wedge pressure in PE
low to normal
single photon emission CT scan of heart at rest and during stress shows what? treatment
can show ischemia
- anti platelet
treatment for Wolff-Parkinson-White syndrome who develop atrial fibrillation with RVR
cardioversion
Procainamide
diagnosis for intermittent coronary artery vasospasm? treatment?
prinzmetal angina
- calcium channel blocker ( diltiazem, amlodipine)
PE finding for mesenteric ischemia
severe preumbilical abdominal pain
prolonged ‘PR’ interval
first degree heart block
‘F’ waves
atrial flutter
treatment for first degree AV block
observation
captopril radionuclide renal scan can diagnose
renovascular disease or renal artery stenosis
irregularly irregular, narrow complex tachycardia, fine fibrillatory waves
a fib.
when do you defibrillate a patient
ventricular fibrillation
pulseless ventricular tachycardia
treatment for chronic venous insufficiency
leg elevation
exercise
compression threapy
PE findings for chronic venous insufficiency
varicose veins
skin discoloration
medial skin ulceration
most dangerous complication of Marfan syndrome
aortic dissection
complication of aortic dissection
aortic regurgitation: early diastolic murmur
pulsus parvus et tardus ? seen in
arterial pulse with decreased amplitude and delayed peak,
- aortic stenosis
treatment for uremic pericarditis
hemodialysis
high voltage QRS complexes, lateral St segment depression, lateral T wave diagnosis
left ventricular hypertrophy
history of uveitis with mild dyspnea and 2-week history of presyncope episodes likely due to conduction abnormalities. X-ray: bilateral midfield lung opacities
Sarcdoisis involving the heart
define cardiac sarcoidosis
noncaseating granuloma infiltration of myocardium
- arrhythmia, cardiomyopathy, HF, sudden cardiac death
Apixaban MOA
factor Xa inhibitor
MOA of Carvedilol
non-selective beta and alpha-adrenergic blocker
Dofetilide? side efffect
class III antiarrhythmic drug - prolong QT
exertional dyspnea, pounding heart sensation, widened pulse pressure, valve problem?
aortic regurgitation
common cause of aortic regurgitation in developing countries
rheumatic heart disease
most common cause of aortic regurgitation in developed countries
aortic root dilation
congenital bicuspid valve
“water hammer” or Corrigan pulse
wide pulse pressure ( systolic-diastolic)
Aortic regurgitation
characterise aortic stenosis
- pulse with delayed upstroke
- delayed peak
when can you hear a pounding sensation and increased awareness of heartbeat in aortic regurgitation
left lateral decubitus position
- brings LV close to chest wall
A-fib finding on EKD
no P waves
narrow-complex tachycardia
irregularly irregular rhythm
3 main risk factors for aneurysm expansion and rupture
large diameter
rate of expansion
cigarette smoking
when do you perform surgery on abdominal aortic aneurysm
size greater than 5.5 cm
what other drugs may potentiate the anticoagulant effects of Warfarin
Acetaminophen
NSAIDS
amiodarone
what are drugs that decrease the anticoagulant effects of Warfarin
Ginseng, St. John’s wort
Rifampin
3 major mechanical complications of MI include
- MI due to papillary muscle rupture
- left ventricle free wall rupture
- inter ventricular septum rupture
inferior wall MI with delayed presentation, sudden onset of hypotension, dyspnea and tachypnea, pulmonary edema, and soft sysolic murmur
acute MR due to papillary muscle rupture
when does MR due to papillary muscle rupture occur after an MI
3-5 days
use dependence of drugs?
- faster heart rates, Flecanide has less time to dissociate from sodium channels
- decrease in impulse conduction and widening of QRS
Class IC antiarrythmic agents and IV calcium channel blcokers
initial management of drugs for cocaine users in Er
Benzodiazepines
aspirin
nitroglycerin
calcium channel blockers
a thickened and often calcified pericardium that limits diastolic filling can result in
constrictive pericarditis
constrictive pericarditis is an important cause of what? and what are symptoms
right heart failure
- peripheral edema
- ascites
- elevated jugular venous pressure
- pericardial knock ( middiastolic sound)
- pericardial calcification on chest radiograph
what is a complication of MI that occurs weeks to months after MI? treatment?
ventricular remodeling
- dilation of ventricles
- use ACE inhibitors
what mitral abnormality is seen in hypertrophic cardiomyopathy
abnormal leaflet motion
- b/c basal anterior septum is thickened. and thinner near valve
patients with unexplained congestive heart failure, proteinuria, and left ventricular hypertrophy in absence of history of hypertension
amyloid cardiomyopathy
how does arteriovenous fistula impact the heart
high-output cardiac failure
increase cardiac preload
get heart failure with good cardiac output
PE findings for severe aortic stenosis
- pulses parvus and tardus: diminished and delayed carotid pulse
2. mid- to -late peaking systolic murmur at second right intercostal space
3. soft and single second heart sound
