Cardiac and Vascular Flashcards
JVP on inspiration is called
Kussmaul’s Sign
It indicates poor RIGHT ventricular filling, usually due to RIGHT SIDED HEART FAILURE.
Blood backs up into the superior vena cava + into the external jugular. It may even appear as a BULGE in the jugular on inspiration.
Can also indicate restrictive cardiopathologies like pericarditis or tamponade.
Normally on inspiration there is a DECREASE in central venous pressure so Kussamaul’s sign is said to be a PARADOXICAL rise in JVP on inspiration
Delayed Femoral Pulse, Brachial fine
Coarctation of the Aorta
Pericarditis Pain
Changes with position, specifically it is relieved by leaning forward.
Tearing pain that radiates to the back
Aortic Dissection, can be in the chest or in the abdomen but both tend to radiate back.
How do we get our patient to qualify dyspnea during history taking?
By asking how much activity precedes it:
1 flight, 2 flights, walking to the kitchen, sitting…
Classic Exam Findings in Tamponade
Distended Neck Veins
Muffled Heart Sounds
Pulsus Paradoxis - BIG drop in SBP on inspiration. This occurs because thoracic pressure is about all that’s keeping BP up in tamponade and during inspiration that pressure drops to allow air to rush in. That drop in pressure is usually compensated for by the beating of the heart but in tamponade the heart cannot compensate and the SBP drops precipitously.
On exhalation, SBP and DBP will be close in Tamponade, a condition known as NARROW Pulse Pressure
Pain in the calf on ambulation, name it and the #1 Ddx associated with it:
Claudication
DVT
Signs of Chronic Venous Insufficiency
Statsis Dermatitis
Bronzing and
ankle/calf Edema
Chest Pain worse on inspiration relieved by sitting fwd. Diffuse ST segment elevation on ECG (there can be notching of the R wave as well)
Pericarditis
Most Common Cause of Sudden Death in Teens/Athletes?
HyperTrophic Cardiomyopathy or Super-thick
septum (usually only on the left side) and left ventricular wall may also be thicker. This reduces the volume that can be moved by the left ventricle.
Its genetic. If found, test the entire family
South East Asians especially
The murmur sounds similar to AORTIC STENOSIS on auscultation but…
1) Valsalva Increases Murmur Intensity in HTC
but Decreases intensity in AS
2) HTC murmur intensity will DECREASE with
squatting or raising legs above heart
Delay between 1st Heart Sound and corresponding Carotid pulse
Ejection CLICK after S1 followed by crescendo-decrescendo murmur best heard at Rt 2nd intercostal space, radiating to carotids
Aortic Stenosis
signs of cardiac tamponade
JVD- decreased ventricular capacity backs up the works and the jugulars coming down from the head can’t empty…
Diaphoresis
Shock signs
Becks Triad of…
Tamponade
JVD
Distant Heart Sounds
Hypotension
also Narrow Pulse Pressure
Pulse Pressure
Normal is 120-80= 40
Wide is over 100 and is normal (briefly) in exercise but if chronic, think atherosclerosis
If WIDE in combo with BRADYcardia and IRREGULAR breathing think INCREASED IntraCranial Pressure
If Narrow (less than 25% of systolic) think Blood Loss first then…Restrictive Cardiomyopathies like Tamponade or anything that restricts filling of the left ventricle.
New Diastolic Murmur
Valvular Dz
Common lipid drug that is contraindicated if pt also has gout
Niacin
At doses over 3g/day Can precipitate gout even in those who don’t have it
superior vena cava syndrome
l
pericarditis vs constrictive pericarditis
Chest radiation causes constrictive
JVD
Hx of radiation
Viral pericardidits doesn’t usually progress to constrictive
“Corkscrew” arteries at the wrists and ankles on angiogram of a Smoker’s extremities.
Claudication and Hypoxia are additional symptoms
Think Beurger’s Dz
aka Thromoangitis Obliterans
Smoking so damages the arteries (and veins) that blood supply and drainage of the hand
that any use results in claudication. Very painful.
Amputation is often required.
Smoking cessation, obviously. There really is no great treatment for this.
Nifedipine (Procardia)
A DiHydroPyradine CCB, meaning it works more on peripheral vasculature than on myocytes, though it is the #1 for Prinzmetal’s Angina.
Displaced by ACE/ARB for HTN, this is the BP med that you cannot mix with grapefruit juice as it is metabolized by CYP3A4. It remains the drug of choice for HTN in AFRICAN AMERICANS on whom ACES/ARBS don’t seem effective.
Used for Reynaud’s
Extended Release formulations are probably best as it can effect symptomatic swings in BP.
Sinus-y Tach with Short PR (less than 0.12) and Delta Waves
WPW Re-Entry Tachycardia
COPD - Most common Arrythmia
Multifocal Atrial Tachycardia
Irregularly irregular but d/t different pacemakers so Ps are visible (they’re not distinguishable in AFIB) and there are several different P-Wave morphologies.
Left sided heart attack but no lingering arrhythmia? Which med ?
ACE
Mysteriously prevents left ventricular hypertrophy and remodeling and preserves ejection fraction
Pt had Rheumatic Fever and still has opening snap murmur (aortic stenosis). What prophylaxis should he have for dental surgury
Amoxacillin 1 hr before dental surgery and 6 hrs after.
