Cardiac CIS Flashcards
ddx for dyspnea
- medications (B blocker in COPD pt_
- cardiac
- metabolic- thyroid dz
- neuromuscular
- psychogenic- anxiety, PTSD
- pulm
- upper airway
- other- anemia, obesity
platypnea
-diff in breathing when erect
PND (paroxysmal nocturnal dyspnea)
- SOB at night- wakes pt after an 1-2 hrs
- caused by pulm congestion from left HF
hyperpnea
-breathing deeper and more rapid
hypopnea
-breathing shallower and slower
NYHA classification of Heart Disease/Failure
- 1- no limitation of physical activity
- 2- slight limitation of physical activity- ordinary physical activity causes symptoms
- 3- marked limitation of physical activity- less than ordinary activity causes symptoms
- 4- unable to engage in any physical activity w/o discomfort, can occur at rest
- 5- atypical symptoms, either at rest or exertion
ACC/AHA classification of Heart Disease/Failure
- A- at high risk, no symptoms
- B- structural heart dz, no symptoms
- C- current or prior symptoms
- D- refractory HF- need device or special intervention
left HF- symptoms
- low cardiac output
- elevated pulm venous pressure
- congestion
- dyspnea!
right HF- symptoms
-fluid overload- edema, JVD!
systolic HF
- dec ejection fraction
- LVEF < 40%
- CAD/MI, HTN, tachycardia or atrial arrhythmias
diastolic HF
- dec ability of ventricles to fill with blood
- aging and myocardial stiffening
- LVH from HTN
management of chronic HF
- ACEI
- aldosterone antagonist
- B blockers
Hydrochlorothiazide- can lead to what electrolyte abnormalities
- low K, Na, Cl, Mg
- high Ca, uremic acid
ACEIs- adverse reactions
- dry cough
- angioedema
- hyperkalemia in setting of AKI
Delirium tremens (DTs)
- severe alcohol withdrawal
- hallucinations, disorientation, agitation, tachycardia, HTN, etc
- 48-96 hrs after last drink, can last up to 7 days
- hyperventilate-> resp alkalosis
DTs- why give thiamine and glucose?
-prevent Wernicke’s encephalopathy
what is a banana bag
- IV infusion of thiamine, folate, multivitamin in isotonic saline with 5% dextrose
- treats DTs
causes of black colored stools
- iron supplements
- beets
- pepto-bismol
- upper-GI bleed
treatment for sinus tachycardia
-treat underlying cause
cause of absent pedal pulses
-peripheral vascular dz
rheumatic fever
- group A streptococcal infection
- rash- erythema marginalization
acute coronary syndrome- presentation
- chest pain
- radiation
- palpitations
- nausea- from vagal stimulation
- diaphoresis
- dyspnea
acute coronary syndrome- most commonly presents as?
pressure-type chest pain- occurs at rest or minimal exertion, >10 min
- radiate to arms, neck, jaw
- inc exertional dyspnea
atypical presentation of acute coronary syndrome
- older pts, women
- diabetes mellitus, impaired renal fxn, dementia
- epigastric pain, indigestion, inc dyspnea
immediate treatment for ACS
MONA-B
-morphine, O2, nitroglycerine, ASA, B blocker
ACS- labs
- cardiac markers- Troponin- Q6h x3
- CXR
- EKG
- lipid panel- fasting in am
- urine drug screen
STAT cath lab- when?
uncontrollable chest pain, new left BBB, STEMI
nitroglycerine- contraindicated when?
-when pt is taking phosphodiesterase inhibitors (sildenafil- viagra)
pericarditis- DDX
- idiopathic
- infectious- viral!!
- autoimmune
- neoplasm
- cardiac
- trauma
- radiation
history for pericarditis
- autoimmune disorders
- viral infection
- trauma
- medications
- TB and HIV
pericarditis- major clinical manifestations
- chest pain- pleuritic, sharp, radiation to shoulders
- pericardial friction rub
- pain improved by sitting upright, leaning fwd
pericarditis- EKG
- diffuse ST segment elevations
- PR depression
pericarditis- stages of EKG
- diffuse ST segment elevation with PR depression
- ST segment returns to isoelectric line
- T wave inversions
- EKG becomes normalized
pericarditis- used to monitor treatment progression
-CRP (acute phase reactant)
pericarditis- treatment
- ASA 650-1000 mg PO TID for 1-2 wks
- Colchicine 0.5-0.6 mg PO BI for 3-6 months
refractory pericarditis
-use corticosteroids
contraindicated in pericarditis
-anticoagulation- risk for cardiac tamponade
