cardiac 2024 pt 2 Flashcards
CAD usually due to what?
describe pathophysiology
r/f
ages gender
atherosclerosis.
inadequate tissue perfusion due to imbalance between increased demand and decreased coronary artery blood suppy.
DM is worse then smoking.
men >45 or women>55 with FH of CAD= male before 55 or female before 65.
virchow’s triad
think DVT risk factors:
intimal damage, stasis, hypercoagulability(protein S or C def, factor V leiden mutation, antithrombin III def, oral contraceptive, malignancy, PG, smoking
DVT
1. most specific sign
2. first line imaging
3. gold standard
- edema LE >3cm
- venous doppler ultrasound
- contrast venography, invasive
IVC filter for DVT when?
recurrent DVT/PE despite adequate anticoagulation OR stable pts in whom anticoagulation is contraindicated OR right ventricular dysfunction w/ an enlarged RV on echo
DVT tx in …
1. PG
2. malignancy
- LMWH as initial and long term therapy.
- same plus Warfarin or direct oral anticoagulants are alternatives to LMWH in these pts.
Common causes of right and left heart failure
left: CAD and HTN. Others include valvular disease and cardiomyopathyies.
right: left sided heart failure. Pulm disease(COPD and pulm HTN), mitral stenosis.
Rt sided heart failure pneumonic
S W E L L I N G
swelling in legs, feet, abdomen
wt gain (early sign, retaining fluid)
edema(pitting)
large neck veins
lethargic (low cardiac output)
irregular heart beat (careful to get afib)
nausea
girth of abdomen increased(hepatomegaly)
systolic heart failure.
describe EF,
___ ventricular systolic dysfunction,
___ ventricle cannot eject blood properly
reduced EF.
left, left
diastolic heart failure.
describe EF,
___ ventricular systolic dysfunction,
ventricle issue
preserved EF
left, ventricle too stiff to allow for filling of blood
left sided heart failure 5 S/S
SOB, crackles, orthopnea, difficulty breathing at night, pulm edema
gallop and LV chamber in systolic and diastolic heart failure
Systolic: S3, LV small with thick walls
Diastolic: S4, LV dilated with thin walls
left sided heart failure pneumonic for s/s
D R O W N I N G
difficulty breathing
rales/crackles
orthopnea
weakness
nocturnal paroxysmal dyspnea
increased hrt rate(fluid overload)
nagging cough(watch for frothy foam)
gaining wt
pathophysiology of heart failure: afterload, preload, contractility
initial insult leads to increased afterload, increased preload, and decreased contractility.
cheyne stokes breathing
deeper, faster breathing with gradual decrease and periods of apnea and cyanosis. think left sided heart failure.
3 ways to manage diastolic heart failure
- heart rate control
- BP control
- Relief of ischemia(BB, ACE, CCB, diuretics for volume overload).
No CCB in systolic heart failure.
4 ACE inh precautions
A A C E
avoid in PG
ANGIOEDEMA
Cough
Elevated potassium (watch for hyperkalemia)
high potassium on ecg
ST elevation (high pumps)
peaked T waves and ST elevations
No CCB in what d/s
SYSTOLIC heart failure
BB and CCB 3__ tropics
neg chronotropic(lower rate)
neg inotropic(less force)
neg dromotropic(less beats)
BB decreases what 3 things(not including HR and BP)
resistance, workload, cardiac output
avoid BB in what 2 conditions
COPD and asthma
avoid BB in 4 kinds of treatments (pneumonic)
B B B B
. bradycardia
2. breathing problems (wheezing, …)
3. bad for heart failure pts
4. blood sugar masking (70 or less)
Before giving CCB, count what
count HR and BP.
avoid in systolic below 100 and HR below 60
what is digoxin toxicity
Over 2.0
vision changes, anorexia, nausea, dizzy