Cardiac 2 Flashcards
primary hypertension
dt genetics and lifestyle. (multifactorial and poorly understood)
secondary hypertension
dt pathological process e.g. alcohol, OCP, sympathomimetics, corticosteroids, cocaine
*if pt has malignant/moderate-severe hypertensive retinopathy and under 30yrs…
look for secondary cause!
signs and sxs of HTN
usu asymptomatic!
may have dizziness, facial flushing, HA, fatigue, epistaxis, nervousness
may have 4th heart sound
How to dx HTN
2 BP readings on 3 days….average
Malignant HTN
now called mod-severe hypertensive retinopathy. HTN w retinal hemorrhages, exudates, papilledema
(usu diastolic >120mmHg)
hypertensive urgency
severe HTN defined by a diastolic BO >120 mmHg in asx pts
Tests for HTN
UA, resting ECG, homocysteine, CMP, fractionated lipids
Risks factors for CAD and atherosclerosis
obesity, dyslipidemia, HTN, insulin resistance, prothrombic states, inflammation, smoking, elevated CRP
Signs and sxs of CAD
can be asymptomatic for decades.
sxs depend on where plaque is! angina, TIA, IC…unstable angina, stroke, limb pain, sudden death
IC
intermittent claudication. angina in legs
*if it is brought on by exercise and relieved by rest…
think CAD!
angina pectoris etiology
dt ischemia. leading cause of death in industrialized countries (dt atherosclerosis)
Signs and sxs of angina pectoris
transient precordial pain (brought on by exertion, relieved w rest); substernal heaviness. Lasts 2-5 min
Worse with: cold air, after meal, anxiety, morning
elevated HR and BP
*patterns consistent for an individual
(may also have SOB, belching, nausea, indigestion, dizziness)
variant angina
due to coronary a spasm. occurs at rest.
see ST elevation on EKG, happens at same time each day
silent ischemia
CAD without symptoms…DM!
chest pain DDX
GI dz, pulmonary dz, pericarditis, psychological, costochondral separation, costochondritis, dyspnea, aortic dissection, MVP, radiculopathy
unstable angina
NOT destroying heart cells. no change in cardiac enzymes. transient ECG changes
NSTEMI
Non-ST segment elevation MI. myocardial necrosis without acute ST elevation of Q waves. increased cardiac enzymes
STEMI
ST segment elevation MI. more dramatic symptom picture
cardiac enzyme that sticks around longest
Troponin. 10 days. (onset 3-12 hrs)
cardiac enzyme that comes first, leaves first
Myoglobin. 1-4 hrs onset, duration 24 hrs
acute coronary syndrome etiology
Obstruction of artery, usu dt thrombus in coronary a
Testing is suspect MI
ECG within 10 mins (see inverted T wave and small ST elevation), cardiac enzymes
Complications of MI
Arrhythmias, heart failure, myocardial rupture, hypotension, post MI syndrome: pericarditis, pleural effusion, pneumonitis, fever
Caused of CHF
Structural abnormalities, cardiomyopahties, valve dz, MI, CAD, HTN, arrhythmias
What can LCHF lead to?
RCHF plus renal insufficiency, liver dz
LCHF
W decrease in CO, pulmonary venous P rises…edema and SOB
Ssxs: DOE, tachycardia, cold intolerance, cough/wheezing, S3 and S4, displaced apical impulse
DDX things that cause pulmonary edema
LCHF, ARDS, COPD, IPF, cancer
Idiopathic pulmonary fibrosis
RCHF SSxs
Fatigue, ankle swelling, ascites, sense of fullness, JVD, hepatomegaly, peripheral cyanosis, cool extremities
RCHF causes
LCHF, sever lung disorders (cor pulmonale), PEs, RV infarction, pulmonary HTN
DDX things that cause peripheral edema and hepatomegaly
RCHF, nephrotic syndrome, idiopathic edema, myxedema, lymphedema, liver dz, pericarditis
Tests to dx CHF
Echocardiography!! (See LVH, reduced wall motion/EF)
CXR, BNP
Cor pulmonale
Enlargement of RV secondary to lung dz
Ssxs: RCHF signs, lung issues!, SOB, syncope, chest pain
How to dx cor pulmonale
Echo, CXR, BNP, ECG
Causes of cardiomyopathy
Drugs, chemical, radiation, serum rxns, CT dzs, virus/bacteria, aging, thyroid dz, anemia, nutritional def (selenium, CoQ10)
Dx: ECG, CXR, echo
Dilated cardiomyopathy
Systolic dysfunction
Sxs: SOB, fatigue, peripheral edema
Hypertrophic cardiomyopathy
Diastolic dysfunction
20-40 yrs.
sxs: chest pain, SOB, palpitations, syncope
Restrictive cardiomyopathy
Stiff, resist filling. –>pulmonary HTN.
sxs: arrhythmias, AV block, S4, weakness, SOB, hepatomegaly, JVD
Arrhythmias
Dt weird discharge from SA node or “ectopic pacemaker”
Sxs: asx, palpitations, sxs of hemodynamic compromise (SOB, chest discomfort, presyncope), cardiac arrest
How to dx an arrhythmia
12 lead ECG, electrolytes, diet analysis
Bradyarrhythmias
Rate <60bpm. Problem in AV node or His-Purkinje sys
Tachyarrythmias
Rate >100bpm. Dt sympathetic stimulation, hypertrophy, ischemia
Sinus node dysfunction
Sick sinus syndrome. Supraventricular arrhythmia. Dt SA node fibrosis.
Sxs: slow, irregular pulse
*def dx: electrophysiology study done by cardiologist
Atrial premature beats
Etiology: emotion, fatigue, alcohol, tobacco, coffee, stimulants
Dx: ECG: early P wave
Wandering atrial pacemaker
WAP! 3+ P waves. Irregularly irregular w random discharge from ectopic foci
Usu in hypoxic/COPD
Multi focal atrial tachycardia
MAT. Well organized contractions but fast and from a different area
Not wandering but racing
Atrial tachycardia
Regular. Single naughty focus has taken over. Rare
Atrial fibrillation
No discernible P wave! Atria depolarize from variety of foci… Chaotic motion and random reentry
Quiz: **Irregularly irregular. Common, esp w preexisting heart condition
Increased risk of thrombus
Atrial flutter
Rapid, Regular rhythm.
Causes: CAD, MI, inflammatory dz, rheumatic heart dz
Dx: ECG: sawtooth P waves, normal QRS
(Easier to tx than Afib)
Ventricular premature beats
Ectopic beats generated in ventricle and transmitted outside the usu conduction sys.
Pts have flip flop sensation
ECG: early QRS is widened notched and slurred, no P wave, inverted T wave
Ventricular tachycardia
Regular rhythm. Irregular thready pulse
ECG: inverted T waves, no P
*cardiac emergency if prolonged
