cardio 15 Flashcards
What are symptoms indicate 2ndary HTN secondary to primary hyperparathyroidism?
Hypercalcemia
recurrent renal stone
Neuropsychiatric symptoms
Pathophysiology?
Increase renin secretion
Sympathetic hyperresponsiveness
Pheripherial vascular constriction
Other CVS complications of PHPT?
LV hypertrophy
Arrhythmia
vascular and Valvular calcification
Management of ST elevated MI?
"2ABONS" O2(O2<90 or dyspnea) Antiplatlates(asprin and clopidogril) Beta-blocker(If no CI) Nitrates(sublingual) High dose statin Anticoagulants
Persistent pain, HTN, or HF despite 2ABONS?
IV nitrates
Onley persistent pain despite 2ABONS?
Morphin
Unstable patient with sinus bradycardia?
atrophin
Pulmonary edema?
diuretics
The last major treatment?
PCI
Thrombolytics if within 120 min PCI not availabele
C/I for beta-blocker?
CHF Bradycardia heart block Hypotension pulmonary edema 2nd to HF
Why is digoxin C/I in acute MI?
increase o2 demand
What indicates if CI is low in septic shock?
Late septic shock(grave prognosis)
What CM indicates peripartum cardiomyopathy?
Onset in last month of Px and within 5 months of postpartum
LV systolic dysfunction with EF <45%
Ruling out of other cause of HF
No heart disease prior to last month of Px
Associated finding?
hollosystoic murmur at cardia apex
Diagnosis?
Transthoracic Echocardiography
management?
like other
Immediate delivery if have advanced HF/hemodynamic instability
Cause of orthostatic hypotension in aging?
loss of baroreceptor responce
Another contributing factor?
arterial stiffness
decrease sympathetic neurotransmitter
decrease response to sympathetic stimulation
Definition of orthostatic hypotension?
Systolic d/c 20 and diastolic d/c 10
What is the comp of GERD?
Esophageal–EE,Barret esophagus,stricture
Extra esophagial–Asthma and laryngitis
How we treat if pt has this symptom?
8 month of PPI
ECG futur of Pericardial temponad?
Pulses Alterans
Vasospastic angina cause?
Hyperactivity of intimal smooth muscle
Due to
Inbalance Autonomic activation
clinical manifestation?
Age <50
Smoking
Recurrent chest discomfort occurs at rest(sleep) and usually resolves within 15 min.
Diagnosis?
Ambulatory ECG
C.angiography:absent CAD
Treatment?
CCB(Preventive)
Nitroglycerin( abortive)
Which CCB is preferred?
NDP(verapamil and diltiazem)–more coronary vasodilatory effect
What is the cause will be patient with AR develop a sudden sign of C pulmonary edema?
AR–Rapid rise in LVEDP–PVH–PE
Which antiarrhythmic has a use-dependent Effect?
Class IC antiarrhythmic(propafenone and flecainide)
what is the use-dependent Effect?
More pronounced effect(QRS prolongation and QT prolongation) during high HR like during the stress test.
Why?
They attach to activated NA Chanel and detach during repolarization?–so more effective in high HR.
management of cocaine intoxication?
BZD
Asprin
Ninroglycerine and CCB
BZD benefit?
Decrease sympathetic outflow–Reduce anxiety, HR and B/P
Asprin?
Reduce thrombus formation
NG and CCB?
Vasodilators—reduce pain
Contraindicated management?
BB–increase alpha effect–increase vasoconstriction
Fibrinolytic–Increase the risk of ICH
Drugs used in MI and unstable angina that exacerbate cough in patients with AS?
Asprin
Beta-Blocker(non selective /cardioselective in high dose)
ACE inhibitor
Symptom of cor pulmonale?
Dyspnea and fatigue on exercise
Exertional angina(Due to low CO)
Syncope(increase cardiac demand)
PE finding on cvs?
RV heave
Loud P2
Functional TR murmur
ECG finding?
Incomplete/complete RBB
Right axis deviation
RV hypertrophy
RA enlargement
ECHO?
RV enlargement
TR
Pulmonary HYTN
Catheterization?
Elevated pressure
Decrease CO
Pulmonary HYTN
AF treatment in old >65 and young treatment d/c?
In the young, we may consider rhythm control medication in symptomatic patients but in the old, we should first try improvement with rate controllers to avoid antiarrhythmic s/e.
Indiaction to do scraning U/S for AAA?
Male
Any smoking history(>100 cigarettes)
age > 65
Family history
Hypertryglycerimia managment?
If TG 150-500(lifstyl modification)
- –Wight loss
- –Increase Exersise
- –Moderate alcohol intake
What if >500-1000?
The goal should be decrease pancratitis risk.
- –Fibrates
- –Stop alcohol
- -fish oil
Secondary cause of HTG?
Obeity DM Hypotyroidism Nephrotic syndrome alcohol
Drugs cause HTG?
Beta blocker
Antiretroviruses
Corticosteroids
Tamoxifine
sign of acute pericarditis in ECG?
Difuse ST elevation
Difuse PR depresion
Difuse T wave inversion
