Cardiac Flashcards
Best physical exam indicator of Heart Failure
S3 heart sound
followed by: elevated JVP, Hepatojugular reflex
Two most common causes of CHF
CAD- Coronary Artery Disease
Hypertension
Acute mgmt of CHF exacerbation
IV diuretics like Furosemide (Lasix)
What meds can improve survival in Heart Failure pts
ACE-I “pril”
ARB “sartan”
Long acting cardio-selective Beta blockers
Abdominojugular reflux is most consistent with
Right sided Heart Failure
Medication triggers to CHF exacerbation
NSAIDs
Non dihydro CCBs (Verapamil and Diltiazem)
TZDs (Pioglitazone)
Non med triggers to CHF exacerbation
Non adhering to meds Ischemia Thyroid disorder Uncontrolled HTN Arrhythmia Anemia
Inflammation of the Pericardium (sac)
Pericarditis
Infection of the heart muscle
Myocarditis
Infection of the valves/or endocardium
Endocarditis
Two most common causes of Pericarditis
Idiopathic (dk why)
Viral- Coxsackie or Echovirus
2 most common viruses causing Pericarditis
Coxsackie
Echovirus
Dressler synd
a type of Pericarditis, after MI
Tx: NSAIDs
Steroids or Colchicine if refractory
can use NSAIDs bc this is weeks-months after MI
Pleuritic CP (relieved when sitting fwd)
Pericarditis
Pericardial friction rub heard when pt is Exhaling and Leaning fwd
sign of Pericarditis
EKG shows diffuse STE with PR deprerssion
Pericarditis
Tx of Pericarditis
NSAIDs or ASA
Colchicine
What usually causes Myocarditis?
VIRAL- Coxsackie, or
Auto-immune (Lupus)
Sx are Fever, muscle ache, fatigue –> Systolic dysfx
Dilated Myocardiopathy
SOB, exercide induced
S3 gallop heard on PE
Myocarditis
Sinus tachy, maybe increased ESR
Myocarditis
Definitive dx of Myocarditis
Endomyocardial biopsy showing: Lymphocytes w/ myocardial tissue necrosis
(biopsy is reserved for severe cases though)
Tx of Myocarditis
Same as HF:
ACE-I
B-blockers
Diuretics
Endocarditis
infection of VALVES or endocardium
Valve most commonly affected by Endocarditis
Mitral valve
Valve most commonly affected by Endocarditis if person has hx of IVDU
Tricuspid
IVDU –> Endocarditis
Staph Aureus
Dental –> Endocarditis
Step Viridans
Prosthetic valve –> Endocarditis
Staph epidermis
GI/GU procedure –> Endocarditis
Entero
Persistent fever, fatigue, Anorexia
Osler nodes (PAINFUL, purple nodules on hands/feet)
Janeway lesions (no pain, macules on palms/soles)
Splinter hemorrhage
Roth spots on eyes
Splenomegaly
Endocarditis
TIMI heart score
age >65 >3 CAD risk factors known CAD Aspirin use in past 7d severe CP EKG changes \+ cardiac marker
CRITICAL causes of CP
MI Aortic dissection PE Tension PNX Tamponade Mediastinitis Esophogeal rupture Perforated ulcer
Normal trop value
<10
Post MI Pericarditis (2-3 days after heart attack)
AVOID NSAIDS
Do not want to mess up the healing process of the heart
Cardiac tamponade- heart is getting pushed on by all the fluid surrounding it
Beck’s triad:
- hypotension
- JVD
- muffled heart sounds
Tx for Tamponade
drain pericardial effusion
How is Dressler’s synd diff than Post MI pericarditis?
develops longer after MI
weeks- months
can use NSAIDs here- NSAIDs, Steroids, Colchicine
Endocarditis
IVDU
infection of the VALVES
Osler nodes
Janeway lesions
Splinter hemorrhage
Subungual petechiae
Tx of Endocarditis
3 things
Vanco + Ceftriaxone + Genta
Two types of Aortic dissection
Acute ascending- type A- EMERGENCY
Descending- managed w meds
Tx of Aortic dissection
If hemodyn unstable, intubate
Bedside echo, Vascular consult, admit
Give: pain meds, BP CONTROL (IV beta blocker like Esmolol)
Give what beta blocker to Aortic dissection
IV Esmolol
Marfan syndrome is associated with what murmur
Mitral valve prolapse
Peri-infarction (post MI) Pericarditis will appear 2-3 days after Heart Attack
SOON AFTER
Supportive tx (usually self limited, Give Tylenol)
can give: ASA +/- Colchicine
AVOID NSAIDs
bc want to let the heart heal
Tx for Endocarditis
Abx for 6 weeks
Vanco + Rocephin
or sub Rocephin for Genta
