Cardiac 08 Cardiac Tamponade, Pericarditis and Hypertensive Emergencies Flashcards
What is a cardiac tamponade?
A cardiac effusion within the pericardial space that begins to affect cardiac function.
A lot of things can cause cardiac tamponade. What is the most common one?
Pericarditis.
Signs and symptoms of a tamponade is similar to HF. What are some stand out symptoms?
Fever.
Unstable BP. EKG changes specific to pericarditis.
Pericardial friction rub.
Chest pain worsens when supine.
Beck’s triad
What is Beck’s Triad? 3Ds
- Distant Muffled heart sounds from fluid accumulation
- Decreased sBP. Narrowing of the pulse pressure and hypotension. dBP either stay the same or rise. lower EF.
- Distended JVD: Kussmaul’s sign. Inspiration, JVD increases.
What is pulsus paradoxus?
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 .
What is the medical management of cardiac tamponade?
Oxygen, CPR, ACLs meds. Stabilize the heart enough to have fluid removed.
Diastolic murmurs occurs from what valvular defects? PAID
Pulmonic and Aortic insufficiency/ regurg. Mitral and Tricuspid stenosis. During this time, P & A are supposed to be closed for diastolic filling.
Systolic murmurs occurs with which defects? PASS
Pulmonic and Aortic stenosis. Tricuspid and mitral insufficiency.
What does TAVR stand for?
Transvascular Aortic Valve Replacement
What is the difference between Hypertensive Emergency and Hypertensive Urgency?
- 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.
What medications you MUST avoid in a hypertensive crisis?
Diuretics
What are the medication treatments for hypertensive crisis? ABC Mnemonic.
Arteriole/Venous Dilator
Beta Adrenergic Blockers
Calcium Channel Blockers
What’s the difference between stenosis and insufficiency?
Stenosis is narrowing of valve that restricts blood flow. Heart has to pump harder.
Insufficiency is weak valves, blood backflows.
What are osler nods?
tender, red/purple sq nodules on the end of fingers. Late symptoms of endocarditis
What is compartment syndrome?
Compartments are any closed spaces containing muscle, nerves etc.
Increased pressures in the compartment can lead to necrosis.
Where are alpha1 receptors and what happens when they’re stimulated?
Located in smooth muscles of the vessels.
Vasoconstriction happens when they’re stimulated.
Alpha 2 are in presynapic nerve terminals. What happens when they’re stimulated?
peripheral vasodilation.
ex clonidine..
What do alpha1 adrenergic blockers do?
Cause vasodilation by blocking receptors from being stimulated.
Types of alpha1 adrenergic blockers?
doxazonsin, prazonsin, perazonsin
ZONSIN
root of CCB?
-dipine
What is Pressure Induced Natriuresis?
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>
How quick should you lower BP during a HTN crisis?
25% within two hours, in a safe fashion. Then goal of 160/100 within 2-6 hours.
What is Kussmaul’s Sign?
paradoxical rise in jugular venous pressure (JVP) on inspiration, or a failure in the appropriate fall of the JVP with inspiration.
If an EKG has ST elevation in all leads, it’s indicative of
pericarditis
How would you treat pericarditis?
Anti inflammatory, pain meds, colchicine
Endartectomies can lead to hyperperfusion syndrome, which consists of what triad?
- transient focal deficits associated with ipsilateral migraine-like headache
- seizures
- ICH
What’s the greatest risk of hypertensive crisis/emergency?
Stroke
4 signs and symptoms of acute symptomatic carotid artery disease?
TIA
Monocular visual disturbances
Aphasia
Stroke
What is hyperperfusion syndrome in patients with a revascularized carotid artery?
HA ipsilateral to the revascularized carotid artery.Focal motor seizures and or ICH.
