Cardiac 08 Cardiac Tamponade, Pericarditis and Hypertensive Emergencies

Question 1

What is a cardiac tamponade?

Answer 1

A cardiac effusion within the pericardial space that begins to affect cardiac function.

Question 2

A lot of things can cause cardiac tamponade. What is the most common one?

Answer 2

Pericarditis.

Question 3

Signs and symptoms of a tamponade is similar to HF. What are some stand out symptoms?

Answer 3

Fever.
Unstable BP. EKG changes specific to pericarditis.
Pericardial friction rub.
Chest pain worsens when supine.
Beck’s triad

Question 4

What is Beck’s Triad? 3Ds

Answer 4

1. Distant Muffled heart sounds from fluid accumulation
2. Decreased sBP. Narrowing of the pulse pressure and hypotension. dBP either stay the same or rise. lower EF.
3. Distended JVD: Kussmaul’s sign. Inspiration, JVD increases.

Question 5

What is pulsus paradoxus?

Answer 5

pressure from inspiration limits cardiac filling, decreases CO and causes a weaker pulse. There is a difference of 10mmHg between inspiration and expiration. A drop of sBP when breathing in .

Question 6

What is the medical management of cardiac tamponade?

Answer 6

Oxygen, CPR, ACLs meds. Stabilize the heart enough to have fluid removed.

Question 7

Diastolic murmurs occurs from what valvular defects? PAID

Answer 7

Pulmonic and Aortic insufficiency/ regurg. Mitral and Tricuspid stenosis. During this time, P & A are supposed to be closed for diastolic filling.

Question 8

Systolic murmurs occurs with which defects? PASS

Answer 8

Pulmonic and Aortic stenosis. Tricuspid and mitral insufficiency.

Question 9

What does TAVR stand for?

Answer 9

Transvascular Aortic Valve Replacement

Question 10

What is the difference between Hypertensive Emergency and Hypertensive Urgency?

Answer 10

• Emergency has NEW or worsening target organ DAMAGE. Immediate BP reduction is required within a FEW hours. BP just has to be out of danger range.
• Urgency is BP>180/120 w/o acute/impending change in organ damage. Reduction of BP is important, can be done within 1-2 days.

Question 11

What medications you MUST avoid in a hypertensive crisis?

Answer 11

Diuretics

Question 12

What are the medication treatments for hypertensive crisis? ABC Mnemonic.

Answer 12

Arteriole/Venous Dilator
Beta Adrenergic Blockers
Calcium Channel Blockers

Question 13

What’s the difference between stenosis and insufficiency?

Answer 13

Stenosis is narrowing of valve that restricts blood flow. Heart has to pump harder.

Insufficiency is weak valves, blood backflows.

Question 14

What are osler nods?

Answer 14

tender, red/purple sq nodules on the end of fingers. Late symptoms of endocarditis

Question 15

What is compartment syndrome?

Answer 15

Compartments are any closed spaces containing muscle, nerves etc.

Increased pressures in the compartment can lead to necrosis.

Question 16

Where are alpha1 receptors and what happens when they’re stimulated?

Answer 16

Located in smooth muscles of the vessels.

Vasoconstriction happens when they’re stimulated.

Question 17

Alpha 2 are in presynapic nerve terminals. What happens when they’re stimulated?

Answer 17

peripheral vasodilation.

ex clonidine..

Question 18

What do alpha1 adrenergic blockers do?

Answer 18

Cause vasodilation by blocking receptors from being stimulated.

Question 19

Types of alpha1 adrenergic blockers?

Answer 19

doxazonsin, prazonsin, perazonsin
ZONSIN

Question 20

root of CCB?

Answer 20

-dipine

Question 21

What is Pressure Induced Natriuresis?

Answer 21

High BP leads to more loss of Na+ in urine, as a compensatory mechanism. Issue is it leads to more volume depletion, which stimulates vasoconstriction and drives up BP. SO NOW DIURECTICS IN HTN CRSIS>

Question 22

How quick should you lower BP during a HTN crisis?

Answer 22

25% within two hours, in a safe fashion. Then goal of 160/100 within 2-6 hours.

Question 23

What is Kussmaul’s Sign?

Answer 23

paradoxical rise in jugular venous pressure (JVP) on inspiration, or a failure in the appropriate fall of the JVP with inspiration.

Question 24

If an EKG has ST elevation in all leads, it’s indicative of

Answer 24

pericarditis

Question 25

How would you treat pericarditis?

Answer 25

Anti inflammatory, pain meds, colchicine

Question 26

Endartectomies can lead to hyperperfusion syndrome, which consists of what triad?

Answer 26

1. transient focal deficits associated with ipsilateral migraine-like headache
2. seizures
3. ICH

Question 27

What’s the greatest risk of hypertensive crisis/emergency?

Answer 27

Stroke

Question 28

4 signs and symptoms of acute symptomatic carotid artery disease?

Answer 28

TIA
Monocular visual disturbances
Aphasia
Stroke

Question 29

What is hyperperfusion syndrome in patients with a revascularized carotid artery?

Answer 29

HA ipsilateral to the revascularized carotid artery.Focal motor seizures and or ICH.