Cardio Flashcards
Diagnostic and laboratory studies
Abdominal Aortic Aneurysm
1: Initial imaging study of choice: Abdominal Ultrasound (also used to determine presence, size, and extent, and monitor progression)
2: GOLD STANDARD: Angiography
Formulating most likely diagnosis
Abdominal Aortic Aneurysm
- Men >65 yo; smoker
- Asx until expanding/ruptures:
- Ruptured = sudden, severe, constant, back/flank abdominal/groin and/or in shock
- palpable pulsatile abdominal mass on PE
Pharmaceutical therapeutics
Acute MI
IV fluids, O2, ASA, NTG, beta blocker, ACE- I, statins, anticoags, antiplatelets,
(every patient s/p MI leaves on S.A.B.A)
Formulating most likely diagnosis
Acute MI , anterior
ST elevations in V1-V4
ST depressions in 2 other contiguous leads
Pharmaceutical therapeutics
Adverse Drug Effect: Antiarrhythmics
- Amioderone SE’s = “Eye, thy, liver, lung” / optic neuritis, thyroid disease, hepatitis, pulmonary fibrosis
- Na+ channel blockers OD = Wide complex QRS
Formulating most likely diagnosis
AFIB
EKG: Irregularly irregular rhythm, no P waves, usually narrow complex QRS.
Presents as either an arrhythmia or an embolic event (Green, red, yellow light)
Pharmaceutical therapeutics
Aneurysm, thoracoadbominal
BBs - help to reduce shearing forces, decrease expansion, and ruptures risk
Pharmaceutical therapeutics
Angina
Stable = Nitro/BB/CCB
Unstable = “MONA”
Clinical Intervention
Aortic Aneurysm
Lifestyle mods (quit smoking is the main one), decrease DM, control cholesterol, regular exercise
Meds: BB, statin, daily low does ASA, plavix
anticoags,
Surgical Revascularization
(many AAA’s that rupture die of CV collapse prior to arrival 2 hospital)
Clinical Intervention
Aortic Stenosis
- Aortic Valve replacement only effective treatment
- Mild AS: No exercise restrictions
- Severe AS: Avoid physical exertion/vasodilators (ex. nitrates or negative inotropes (Ex. BB/CCB)
Clinical Intervention
Arrhythmia, Complete heart block
- Acute/symptomatic: Temporary pacing –> permanent pacemaker
- Definitive tx: Permanent pacemaker
Formulating most likely diagnosis
Arrhythmia, PAC’S
PAC is a premature “beat”/QRS that has a P wave before it
Formulating most likely diagnosis
Arrhythmia, Paroxysmal SVT
Heart rate >100 bpm; rhythm usually regular with narrow QRS complexes; P waves hard to discern due to rapid rate
Clinical Intervention
Arrhythmia, Paroxysmal SVT
1: Vagal nerve stimulation with maneuver
2: Adenosine
3: CCB ( verapamil)
4: Cardioversion
Clinical Intervention
Arrhythmia , V-FIB
These patients are in cardiac arrest, CPR and defibrillation (unsynchronized cardioversion)
Clinical Intervention
Arrhythmia , V-TACH
- Stable sustained V-tach: Antiarrhytmics (amiodarone**, lidocaine, procainamide)
- Unstable V-tach WITH a pulse: synchronized cardioversion
- V-tach NO PULSE : Defibrillate (unsynchronized cardioversion + CPR
- If proceeds to tornadoes: IV MAG
Pharmaceutical therapeutics
A-fib
1: Slow heart rate (BB/CCB)
2: Anticoag (almost always)
3: Convert (pharmacologically or electrically)
Applying basic scientific concepts
Atrial Septal Defect
Oxygenated L-atrium blood crosses ASD and mixes with deoxygenated R-atrium blood; greater blood volume in R-atria can lead to R-HF, arrhythmia, pulmonary HTN
Formulating Most likely diagnosis
Atrial Septal Defect
- Systolic ejection crescendo=decrescendo murmur best heard @pulmonic area (LUSB);
- Widely fixed split S2 that does NOT vary with respiration
Clinical intervention
Cardiac Arrest
1: CPR
if in V-TACH or V-FIB : DEFIBRILLATE
Give epinephrine and other medications as indicated
Formulating most likely diagnosis
Cardiac Tamponade
- Beck’s Triad: JVD, muffled heart sounds, hypotensive
- pulses paradoxus: >10mmHg decrease in SBP w/ inspiration
- Electrical alternans on EKG
Using diagnostic and laboratory studies
Cardiac Tamponade
ECHO: Ventricles collapse in diastole (+ presence of an effusion)
Clinical Intervention
Cardiogenic Shock
1: Emergent ECHO
2: O2, isotonic fluids, (only shock we do NOT use agressive fluids)
3: Positive inotropes
4: Pressors
5: Admit to ICU and tx underlying cause
Formulating most likely diagnosis
Coarctation of the Aorta
- **Suspect in a child with secondary HTN
- BL lower extremity claudication
- Systolic murmur that radiates to back/scapula or chest
- Systolic BP in upper extremities > lower extremities
- Delayed or weak femoral pulses
- CXR: Rib notching/ “3” sign
Clinical Intervention
Coarctation of the Aorta
Surgical Correction : Balloon Angioplasty +/- stent
PGE1 (prostaglandin) pre-op to decrease sis/improve lower extremity blood flow
(** remember prOstaglandins keep PDA Open)
Applying Basic scientific Concepts
CHF
Poor pumping –> blood stalls and backs up in the circulation
