Buzzwords - Cardio Flashcards
TX: tachy, stable (no hypotn, ams, chest pain, acute hf)
w/ ATRIAL FLUTTER
beta blocker or calcium channel blocker 1st line
skip adenosine
TX: tachy, stable (no hypotn, ams, chest pain, acute hf)
w/ A-FIB
beta blocker or calcium channel blocker 1st line
skip adenosine
TX: tachy, stable (no hypotn, ams, chest pain, acute hf)
w/ WOLFF-PARKINSON-WHITE
PROCAINAMIDE or amiodarone
-avoid adenosine, bb, ccb, digoxin
2 “shockable” rhythms using defibrillation (UNsynchronized cardioversion)
VENTRICULAR FIBRILLATION
PULSELESS VENTRICULAR TACHYCARDIA
TX: ventricular tachycardia
stable, sustained –> ANTIARRHYTHMICS (AMIODARONE, lidocaine, procainamide)
unstable vt w/ pulse –> CARDIOVERSION (SYNC)
vt w/ no pulse –> DEFIBRILLATION (UNSYNC) + CPR
torsades de pointes –> IV MAGNESIUM
TX: ventricular fibriollation
DEFIBRILLATION (UNSYNC) + CPR
TX: pulseless electrical activity
organized rhythm on monitor but no palpable pulse (electrical activity not coupled w/ mechanical contraction)
CPR + EPINEPHRINE + CHECK FOR “SHOCKABLE RHYTHM EVERY 2 MINUTES
TX: asystole (flat line)
tx like PEA
CPR + EPINEPHRINE + CHECK FOR “SHOCKABLE RHYTHM EVERY 2 MINUTES
increased JVP + crackles/rales in lungs
CONGESTIVE HEART FAILURE
increased JVP + normal pulm exam
PERICARDIAL (EX TAMPONADE OR CONSTRICTIVE PERICARDITIS)
increased JVP + decreased breath sounds
TENSION PNEUMOTHORAX
inc aldosterone
inc Na retention
-at expense of K and H (inc secretion of K and H)
inc ADH
inc H2O retention
LEVINE’S SIGN
clenched fist over chest –> ANGINA
C/I in cocaine-induced MI or variant/prenzmetal angina
DONT USE B-BLOCKER (causes unopposed alpha-1 vasoconstriction)
USE CALCIUM CHANNEL BLOCKER
acute MI protocol
- ECG w/in 10 minutes
- door to thrombolytics/fibrinolysis w/in 30 min
- door to PCI w/in 90 min (+/- 30m)
- MONA regimen: morphine, oxygen, nitrates, aspirin
- perform hx/exam
- obtain cardiac markers
- O2 at 4L/min
STEMI: BB, NTG, ASA, heparin, ACEI, REPERFUSION (PCI or thrombolytics/fibrinolysis)***
UA or NSTEMI: BB, NTG, ASA, heparin, NO EMERGENT REPERFUSION!
COCAINE INDUCED: ASA, NTG, heparin, benzos (avoid BB bc of vasospasm)
- *R ventricular (inferior wall) MI –> caution w/ nitrates and morphine (may reduce preload) + give fluids
- *if viagra or erectile meds –> NO NITRATES (reduces preload)
Dressler syndrome
POST-MI PERICARDITIS + FEVER + PULMONARY INFILTRATES
decreased ejection fraction
thin ventricle walls
dilated LV chamber
+S3 gallop
systolic heart failure
normal/increased ejection fraction
thick ventricle walls
small LV chamber
+S4 gallop
diastolic heart failure
dyspnea
pulmonary congestion (rales, rhonchi)
cheyne-stokes breathing
increased adrenergic activation
left-sided heart failure
inc pulm venous pressure from fluid backing up into lungs
peripheral edema
jugular venous distention
GI/hepatic congestion
right-sided heart failure
inc systemic venous pressure –> systemic fluid retention
BECK’S TRIAD: DISTANT/MUFFLED HEART SOUNDS, INC JVP, SYSTEMIC HYPOTENSION
PERICARDIAL TAMPONADE
viral damage to heart mc cause
ENTEROVIRUSES (COXSACKIE B, echovirus)
-cardiomyopathy, myocarditis, pericarditis
ejection click
MITRAL VALVE PROLAPSE - chordae tendinae abruptly pulls mitral valve tight - SYSTOLE
opening snap
MITRAL VALVE STENOSIS - diastole
harsh/rumble murmur sounds
THINK STENOSIS (AS, MS) - abnormal forward flow through stenotic valve that should be open -lead to pressure overload
blowing murmur sound
THINK REGURGITATION (AR, MR) - abnormal backflow of blood through an incompletely closed valve -leads to volume overload
systolic vs diastolic murmurs
SYSTOLIC: AS, MR
DIASTOLIC: AR, MS –> “ARMS REST”
murmurs radiate to?
AS –> carotid
AR –> left upper sternal border
MS –> no radiation
MR –> axilla
murmur position
AORTIC: sitting up and leaning forward accentuates
MITRAL: lying on left side accentuates
- JANEWAY LESIONS - red, painless on palms/soles
- ROTH SPOTS - retinal hemorrhages w/ pale center
- PETECHIAE - conjunctiva, palate
- OSLER’S NODES - tender nodules on pads of digits
- SPLINTER HEMORRHAGES of proximal nail bed
infective endocarditis
VIRCHOWS TRIAD
THROMBI - peripheral venous disease
INTIMAL DAMAGE - trauma, infx, inflam
STASIS - prolonged sitting >4 h
HYPERCOAGUABILITY - factor V leiden, C or S deficient, OCP, malignancy, pregnancy
TROUSSEAU’S SYNDROME
MIGRATORY THROMBOPHLEBITIS IS ASSOC W/ MALIGNANCY
peripheral VENOUS vs ARTERIAL disease
VENOUS
- worse w/ standing, sitting, leg dependency
- better w/ walking, elevation
- cyanotic leg when dependent
ARTERIAL
- better when resting, leg dependent
- worse with walking, elevation, cold
- redness w/ dependency and cyanotic w/ elevation
TYPE OF SHOCK, DON’T GIVE LARGE AMOUNTS OF FLUID
CARDIOGENIC SHOCK
