cardiac management Flashcards
SVR equation & normal
[ (MAP - CVP) / CO ] x 80
- 800 to 1200 (1000)
MI door-to-needle
30 min
MI door-to-cath
60 min
MI elevations (CK-MB, Trop I & T) & note
CK-MB: gt 120 IU/L
Trop I: gt 0.35 mcg/L
Trop T: gt 0.2 mcg/L
note: repeat 8 hours later
cardiac reserve
difference between the rate at which the heart pumps blood and its maximum capacity for pumping blood at any given time
metabolic syndrome criteria
3 of 5
- waist 40 m/ 35 f
- hyperlipidemia
- hypertension
- ↑ CRP
- insulin resistance (FBG 110+)
What precedes S1 and what is it?
Diastole precedes, S1 = closure of AV valves.
What precedes S2 and what is it?
Systole precedes, S2 = closure of semilunar valves.
dilated cardiomyopathy: pathophys
severe ventricular dilation + systolic dysfxn
causes: idiopathic, postpartum, EtOH, viral myocarditis, ischemic heart disease
dilated cardiomyopathy: mgmt
↓ preload: restrict Na, fluid
↓ afterload: vasodilation
↓ workload: activity restriction
↑ contractility: digoxin, dobutamine
SAME TX AS HF D/T REMODEING
hypertrophic cardiomyopathy: pathophys
aka idiopathic hypertrophic subaortic stenosis
increased muscle mass of septum obstructs LVOT
hypertrophic cardiomyopathy: mgmt
max preload/more filling time: BB, CCB
control dysrhythmias: amiodarone (CCB)
reduce septum size: septal myectomy OR alcohol ablation
NOTE - AV node, Bundle of His in septal wall = conduction problems
hypertrophic cardiomyopathy: dx
Echo: septal wall hypertrophy, increased pressure gradients between aorta & LV
12 lead: LV hypertrophy
PE: systolic murmur
restrictive cardiomyopathy: pathophys
muscle becomes constricted & can’t fill/pump
causes: amyoidosis (produced in bone marrow, accumulates in organs) or collagen disorders
ankle brachial index: calculation & purpose
highest dopplered –
SBP (PT or DP) / SBP (brachial)
screening for PAD severity
ABI scoring
- no disease
- mild to mod
- severe
- rigid/calcified arteries
- rigid/calcified arteries: gt 1.3
+ ultrasound to evaluate! - no disease: 0.91 - 1.3
+ no sx - mild to mod: 0.41 - 0.90
+ intermittent claudication & visual signs - severe: lt 0.40
+ sx @ rest
gold standard diagnosis for PVD
ultrasound!
PAD mgmt
pharm: PDE-3 inhibitor + antiplatelet + ACE-inhibitor
medical: risk factor reduction, tx comorbs, exercise 30-45 min walking/day, avoid restrictive clothes
endovascular mgmt: stent, bypass
what is critical limb ischemia?
severe PAD complication (2-5% pts)
EMERGENCY! reperfusion needed.
critical limb ischemia: s/s
pain pulseless paresthesia paralysis pallor
carotid artery stenosis often asx until
severe - 50 to 60% occlusion
most common presentation of carotid artery stenosis patient
TIA
carotid artery stenosis gold standard diagnostic
suplex ultrasound
carotid artery stenosis mgmt
asx + 30-50% stenosis: ↓ risk factor tx comorbs antiplt rx vascular surgery follow up
over 50% + sx OR over 80% w/o sx:
vasc surg consult: @ risk complications
- carotid endarterectomy, angioplasty, stent
renal artery stenosis presentation
uncontrolled htn refractory to meds
gold standard for renal artery stenosis diagnosis
renal angiography (beware contrast since renal problems!!!)
so doppler US is most common (initial catch)
virchow’s triad: what are the s/s and purpose?
s/s VTE!
- venous stasis
- hypercoagulability
- vascular endothelial injury
thoracic vs abominal aortic aneurysm
AAA = past renal arteries
aortic aneurysm s/s
usually asx, found incidentally 80 - 90%
chest, back pain
new/changing abdominal mass (80% are palp when gt 5.5 cm)
what is an aortic dissection?
results from intimal layer tear (aorta)
occurs when blood = in between intima/media → false lumen
ruptured aneurysm without dissection possible
best diagnosis tool for aortic dissection
CTA - visualize the intimal flap
aortic dissection physical exam findings
new diastolic aortic valve murmur
unilateral: pulse deficit, cold/mottled extremity
BP discrepancy in extremities
abd pain on palpation
how to tell compartment syndrome vs critical limb ischemia
HISTORY!
intracompartmental pressure: normal vs compartment syndrome vs surgical intervention needed
normal: 10 - 12 mmHg
compartment: 25- 30 mmHg
fasciotomy time: ΔP = DBP - highest intracompartmental pressure = gt 30mmHg
fasciotomy purpose
for compartment syndrome - prophylactic: prevents change from occurring, doesn’t reverse damage from initial injury
AAA diagnostics
- bedside ultrasound (stat)
- CTA (time to eval if op appropriate)
- angiogram (least sensitive)
reperfusion injury
serious complication following reoxygenation of tissues after ischemia/hypoxia
highly reactive oxygen intermediates (oxidative stress) cause further membrane damage + mitochondrial Ca overload
WBC especially affected
beck’s triad - what is it & purpose
muffled heart sounds
increased JVD
BP decreased 20 between S1 & S2 (pulsus paradoxus)
signs of cardiac tamponade
pulsus paradoxus
BP decreased 20 between S1 & S2
