Cardio 1 Flashcards
Hamman’s Sign
Diangosis- Spontagnous Pneumomediastium
crunching sound heard on auscultation of the mediastinum with each heartbeat
Treatment for Spontagnous Pneumomediastium
Self limiting
on CXR will show air around heart
* painful neck area and crunching heard
PPD what size of induration to be postitive
HIV
<5mm
PPD what size of induration to be postitive
Health Care worker
> 10mm
PPD what size of induration to be postitive
IV drug user
> 10mm
PPD what size of induration to be postitive
Child
> 10mm
PPD what size of induration to be postitive
know risk factor for TB
> 15 mm
which of the following findings is most suggestive of Pneumocystis jiroveci pneumonia
Serum Lactate dehydrogenase
the higher the value the worse prognosis
Sarcodosis will have what main buzz words
cough, fever
uveitis
bilateral adenopathy
Subcutanous nodules - erythema nodosom
Causes of Trasudative pleural effusion
CHF
Cirrohsis
PE
Nephrotic
Causes of Exudative pleural effusion
Maligancy TB Bacterial or viral PNA pancreatitis Collagen disorders Esophagus rupture lupus *
Age 55-80 history of 30 years Smoking what is the screening test
low dose CT scan
What lab value is elevated in Scarcodosis
ACE
serum angiotensin converting enzyme *
ESR
Hypercalcemia
most common cause of restrive cardiomyopathy
amlyodosis
what is the most common cardiomyopathy
dilated - “Fat heart”
Systolic or diastolic
Dilated
Systolic
Systolic or diastolic
Restricitive
Diastolic
Systolic or diastolic
Hypertrophic
Diastolic
Most common cause of Dilated cardiomyopathy
*Virus- young healthy Genetic *Alcoholism postpartum chem heroin
Key terms- CHF, weakness, SOB, periperal edema
on exam- crackles, S3, JVD
xray- fluffy inflitrates, increased cardiac sillouette
Dilated cardiomyopathy
Best diagnostic tool for cardiomyopathies
ECHO-> either
TTE
TEE
Most common cause of restricitive cardiomyopathy
*Amyloidosis
Sarcoidosis
radiaion
Diabetes
What is the diagnosis-
TTE shows marked biatrial enlargment with non-dialted ventricles
Restrictive cardiomyopathy
Best diagnostic test for Restrictive cardiomyopathy
TTE & definitive Biopsy
Key terms- heart murmur
middiastolic crecendo-decredo increases with valsalva and decreases with squatting
Hypertrophic cardiomyopathy
Treatment for HOCM
what do you want to avoid?
BBlockers, impant defib
avoid postitive ionotropes - epi
Rate is 50 P waves in II, III, AVF
Sinus bradycardia
Rate 50 No P waves in II, III AVF, QRS narrow
Junctional Rhythm
Rate 20-40 wide QRS
Ventricular rhythm
1 P wave for every QRS, PR prolonged >0.2 constant
1 degree AV block
P waves upright, QRS narrow, PR progessively increasing and one dropped QRS not followed by a P wave
2 degree, Type I AV block
Wenckebach
P waves upright, QRS narrow, PR is contant, dropped QRS not followed by a P wave
2 degree, Type II AV block
PACE THEM
P waves upright, QRS regular, but irregular PR intervals
P waves and QRS waves are unrelated
3 degree AV block
PACE THEM
Rate >100, P wave for every QRS
Sinus Tachycardia
P wave can be attached to T wave - camel hump
Rate >150, P waves can be hidden or followed by a QRS
Superaventricular Tachycardia
Rate >300, sawtooth waves
Atrial flutter
Treatment for Atrial Flutter
AV node blockers
amiodarone
cardioverision
anticoagulation
No distinct P waves, regular artial activity but irregularly irregular
Atrial Fibrillation- A fib
Treatment for A fib
AV node blockers
amiodarone
cardioverision
anticoagulation
3 or more P wave Morphology
Multifocal artial tachycardia
caused by:
COPD
Theophyllin
How do you figure out someones max heart rate?
Their age - 220
Rate >120, Wide QRS complex, no clear P waves
Ventricular Tachycardia
Treatment of V tachycardia
Liocaine
Procainamide
Amiodarone
Cardioversion
Polymorphic V- Tach
Torsades de pointes
Prolonged QT >500msec
Polymorphic V- Tach
Torsades de pointes
Causes of Polymorphic V- Tach
Torsades de pointes : Hypo K Hypo mag Hypo Calcium sodium channel blockers increase intracrainal pressure Hypothermia
What drugs do you need to avoid in WPW
AV node blockers -> bblockers -> calcium channel blockers -> digoxin -> amirodarone YOU WILL KILL THEM
Exteme rapid rate, disorganized ventricular activity, No pulse, patient is unresponsive
what is diagnosis & treatment
Ventricular Fibrillation
DEFIBRILLATION
What are the two Tachycardias that you DO NOT SHOCK
Sinus tachy and Multifocal atrial tachy
Treatment for SVT
- Vagal - ice pack on face
- Bolus of saline
- Adenosine- type IA
- Bblockers
- Amidrodrone
How do you administer
Adenosine?
what are some side effects to warn the patient?
PUSH ! half life of 10sec
Then follow by saline
and elevate arm
warn the patient they will feel super flushed and feel pressure in their chest
What is the most effective medication for cardioversion
Procainimide
Drug category:
Pheneizine
Tranylcypromine
Selegiline
Monoamine Oxidase Inhibitors- MAOI’s
MOA: inhitibts MAO which breaks down catecholamines
Monoamine Oxidase Inhibitors- MAOI’s
Pheneizine
Tranylcypromine
Selegiline
Side effect: Hypertensive crisis with tyramine containing foods like cheese, wine.
Monoamine Oxidase Inhibitors- MAOI’s
Pheneizine
Tranylcypromine
Selegiline
Drug category:
Amitriptyline
Imipramine
Doxepin
Ticyclics
MOA: inhibits reuptake of serotonin, norepinephrine and dopamine
Ticyclics
Amitriptyline
Imipramine
Doxepin
Side effects: Dry mouth, urinary retention, blurred vision, sedation, orthostatic hypotension, setotonin syndrome
Ticyclics
Amitriptyline
Imipramine
Doxepin
Drug category: Fluoxetine paroxetine Sertaline Citalopram Escitalopram
Selective serotonin reuptake inhibitors- SSRI’s
MOA: Inhibitis reuptake of serotonin
Selective serotonin reuptake inhibitors- SSRI’s
Side effects of this drug:
Loss of libido
weight gain
serotonin syndrome
Selective serotonin reuptake inhibitors- SSRI’s
Drug category:
Venlafaxine
Desvenlafaxine
Duloxetine
Serotonin Norepinephrine reuptake inhibitors - SNRI
MOA: inhbits reuptake of serotonin and norepinephrine
Serotonin Norepinephrine reuptake inhibitors - SNRI
Side effects of this drug: Loss of libido, increased blood pressure, serotonin syndrome
Serotonin Norepinephrine reuptake inhibitors - SNRI
Drug category: Nefazodone Vortixetine trazodone Vilazodone
SSRI/ 5HT agonists
MOA: norepinephrine and dopamine retuptake inhibitor
Bupropion
Bupropion side effects
anxiety
Restlenssness
insomnia
lowers seizure threshold * do not give to anorexic patient
Drug cateogry: Diazepam Lorazepam Temazepam Oxazepam
Benzodiazepine
MOA: GABA agonist, decreases neuronal excitability
Benzodiazepines & Barbiturates
What is the reversal agent to Benzodiazepines
Flumazenil
Drug category:
Phenobarbital
Pentobarbital
Barbiturates - used for anesthesia and seizures
what drug increases the P450 system
Barbiturates:
Phenobarbital
Pentobarbital
what are the two types of heart failure
low out put
high out put
What are cause of low-out put heart failure
- Coronary artery disease
- hyptertension
- valve disease
- cardiomyopathies
EXAM*
What are cause of High-out put heart failure
- Thyrotoxicosis
- Severe anemia
- Beriberi - thiamine def
- Paget’s disease
What is the most common cause of right heart failure
LEFT heart failure
BNP levels are important for what disease state?
Heart failure
>500 decompensated CHF
if chronic 100-500
what conditions can cause mild elevation in BNP
EXAM*
- chronic CHF
- eldery women
- Pulmonary embolism
- COPD
- pulmonary hypertension
What will a x-ray of CHF look like
in progression of disease
- cardiomegaly
- cephalization-> fluid in upper lungs
- Kerley B lines-> lateral lung fields
- Alveolar fluid
- Pleural effusions
what two medications have been proven to reduce morality in Heart Failure
ACE - reduces afterload
BBlockers
What medications decrease preload?
Nitrates
Loop diuretics
What medications decrease afterload ?
ACE
high nose nitrates
Nitroprusside
What medication decrease preload and afterload
Nitrates
Most common cause of Primary essential hyptertension
Alcohol AA Smokers Lack of exercise NSAIDS
Normal BP
Prehypertension
Stage 1
Stage 2
<120 / 80
120-139 / 80-90
140-159 / 90-99
>160
What are blood pressure goals for
ALL
>60, DM & CKD
< 140 / 90
<150 / 90
If an african amercian is placed on ACE what are they are risk for?
Angioedema
Causes of refactory hypertension
phenochromocytoma Renal artery stenosis coractation of the aorta Cushings chronic steroid use hyperaldosteronism
what are some causes of hypertensive emergencies
Aortic dissection pulmonary edema MI Cerebral hemorrhage encephalopathy preeclampsia/ ecclam
Severe HTN, elevated BUN, optic disc is fuzzy
Malignant hypertension
- > paplliedema
What is the BP level of Hypertensive urgency
Hypertensive emergency
urgency > 180 / 120
no organ damage
Emergency > 160/120
organ damage
Treatment for urgency
Quicker!
24 hour rule
25% within the first few hours
IV drip
Treatment for Emergency
Gradually!
24-48 hour rule
less than 25% within the first hour
Goal 2-6 hours get BP 160/100
Hypertensive emergency will have what organs affected?
Hypertensive stroke seizure Encepahlopathy retinopathy- hemorrhages, exudates, papilledema elevated BUN/creatinin
Treatment for Acute aortic syndrome with
hypertensive emergency
this one you can decrease BP as fast as you can
IV bblocker
<60bpm, systolic 100/120
Treatment for Neuologic hypertensive emergency
CCB first line
Nicradipine
Treatment for Aortic hypertensive emergency
- bblocker : Esmolol
2. Nitroprusside
Treatment for Acute MI hypertensive emergency
- Nitro
2. BBlocker - give 2
Treatment for
Acute heart failure hypertensive emergency
Nitroprusside
What cardiac drug can cause cyanidie toxicity and drug is light sensitivity
Nitroprusside
Treatment for
Renal hypertensive emergency
- CCB- nicardipine
2. BBlocker- lobetalol
Treatment for
Pregnancy with hypertensive emergency
- Hydralazine
- Labetalol
- magnesium sulfate with preclampsia/eclampsia
