cardio Flashcards
management of unstable and stable Wolf parkinson white
Unstable WPW = synchronized cardioversion
Stable WPW = procainamide or ibutilide
II, III, avF. arteria y que tipo de infarto?
Proximal right coronary artery (also supplies SA and AV node)
Infarto cara inferior
a quien se anticoagula usandosela CHA2DS2-VASC y que signidnca ese acrónimo
sigfinicado del acronimo: score used to assess thromboembolic risk and the risk for stroke in patients with atrial fibrillation.
CHA2DS2-VASc score ≥ 2 in males or ≥ 3 in females? Oral anticoagulants
caracteristicas en ekg de WPK?
wide QRS complex >120 ms
a short PR interval <200
delta wave
Triada de taponamiento cardiaco y que le pasa al pulso?
Becks triad:
- muffled sounds
- hypotension
-jugular venous distention
que le pasa al pulso?
pulsus paradoxus (drop in systolic blood pressure > 10 mm Hg during inspiration)
In cardiac tamponade, outward expansion of the ventricles is limited because of fluid in the pericardial space. During inspiration, increased venous return leads to increased right ventricular volume. As outward expansion is limited, the right ventricle expands via the interventricular septum, which bulges into the left ventricle. This effect leads to further reduction in left ventricular filling during inspiration, resulting in decreased stroke volume and a subsequent drop in blood pressure. A drop in systolic blood pressure > 10 mm Hg during inspiration is known as pulsus paradoxus, a sign characteristically seen in moderate and severe cardiac tamponade but also in some cases of severe asthma, tension pneumothorax, and constrictive pericarditis.
en que se ve enfisema subcutáneo?
- bronchial rupture
- esophageal rupture
- pneumothorax (traquea away)
endocarditis valvula afectada en iv drug use?
tricuspid valve, consecuencia pulmonary embolism
tricuspide regurgitation? 4th L ICS systolic.
endocarditis causal IV drug use?
staph aureus si ACUTE
strep pyogenes si SUBACUTE
staph apidermidis causa endocarditis en quien?
venous catheters
prosthetic heart valves, or medical devices (e.g., pacemakers, ICDs)
IV drug use SUBACUTE (acute es staph aureus)
DVT prophylaxis in individuals at increased risk of thrombotic complications prior to surgery?
low molecular weight heparin (enoxaparina, delteparina)
start 12 h before surgery and continue x 3 weeks
LMWHs are contraindicated in patients with renal failure; therefore, all patients should be screened prior to LMWH initiation, si renal insufficiency use unfractionated heparin)
DiGeorge syndrome defecto cardiaco?
truncus arteriosus defect (single overriding vessel seen on echocardiography), VSD, tetrallogy of fallot
cromosoma 22
micrognathia, cleft palate, a broad nasal bridge, a short philtrum, and low-set ears.
Impaired development od parathyroids: hypoparathyroidism and hypocalcemia, which may lead to tetany and seizures during infancy.
turner sd
45 X,O
bicuspid aortic valve or coarctation of the aorta
down sd
atrioventricular septal defect
rubela congenital
patent ductus arteriosus (continuous machine-like murmur)
catarata bilateral
hearing loss
thoracic aortic aneurysm on x ray findings?
boton aortico+wide mediastinum
dx: estable tac angiografia // inestable us trastoracico
cuales aneurismas aorticas se reparan?
elective endovascular aneurysm repair:
large asymptomatic AAAs (≥ 5.5 cm in men; ≥ 5.0 cm in women)
rapidly expanding AAAs (≥ 0.5 cm/6 months)
saccular aneurysms
symptomatic AAAs (as these are most likely to rupture) regardless of size
high risk comorbidities
chronic use of amiodarona can cause?
Chronic interstitial pneumonitis
Pulmonary fibrosis
Hypothyroidism
Hyperthyroidism or thyrotoxicosis
bradicardia
av block
Corneal micro-deposits
Optic neuritis
heart sound pathognomonic for chronic constrictive pericarditis
golpe pericardio
(ventricles are working against a calcified and thickened pericardium)
estenosis aortica pulso?
Pulsus parvus et tardus
A physical examination finding in which a distal arterial pulse (e.g., the radial pulse) is weak and delayed.
soplo de fiebre reumatica?
mitral stenosis
5h L ICS, diastolico, opening snap
murmur that radiates to interscapular area?
coartacion de aorta (Narrowing of the descending aorta near the ligamentum arteriosum)
usualmente asociado a turner sd (tamb aorta bicuspide)
miopatia inducida por estatina que se hace?
stop statin and after 2–4 weeks change start using Pravastatin, Pitavastatin, Fluvastatin (son las estatinas con menor riesgo de miopatia)
miopatia aumenta creatinine kinase
tx para emergencia hipertensiva?
nitroprusside IV (no usar en renal failure)
otras opciones:
labetalol
nicardipina
en que se ve el milkmaids grip?
syndheham chorea (fiebre reumatica aguda)
Milkmaid grip
A physical examination finding characterized by the inability to maintain muscle contraction in the hands. The patient is asked to grip the examiner’s fingers. Intermittent loss of contraction results in alternating squeeze and release of grip (“milking”). Can be seen in Sydenham chorea.
que dano valvular puede causar la fiebre reumatica?
mitral STENOSIS PRINCIPALMENTE (popening snap)
mitral regurgitation (radiates to axilla)
disena con pulmones limpios
hipotension
JVD
que piensas?
daño a corazon DERECHO
que medicamentos se suspenden antes del cardiac stress test? y cuanto tiempo?
SUSPENDER 48 HORAS ANTES
B Bloq
CCB aka Inhibidor canales de calcio
Nitrates
Methylxanthines (e.g., caffeine, theophylline)
cardiac stress testing is to evaluate for stress-induced ischemic changes on ECG and/or imaging. The stress is created by increasing heart rate and contractility (using exercise or dobutamine) or by inducing a coronary steal phenomenon (using vasodilators).
Beta blockers (e.g., metoprolol) and calcium channel blockers (CCBs), especially the nondihydropyridine CCBs (e.g., verapamil), can affect the diagnostic value of cardiac exercise stress testing because they attenuate the chronotropic (heart rate) and inotropic (contractilidad) effects of exercise. These medications may be withheld prior to testing at the clinician’s discretion.
dressler syndrome cuanto tiempo después del infarto sucede?
2-10 semanas después del infarto
dressler sd sx y tx?
dresler sd: daño autoinmune al pericardio
sx: (los mismos q perdicarditis)
dolor de pecho que mejora al leaning forward
fiebre
pericardial rub
tos seca (due to inflammation of the mediastinal pleura adjoining the pericardium)
tx: NSAIDs preferiblemente high dose aspirin
que se ve en ekg con dressler sd?
diffuse ST elevation
endocarditis en IV drug use cual es el soplo?
tricuspid regurgitation
profilaxis en paciente con historia de endocarditis SIN dano valvular pero CON carditis (nuevo soplo)
penicilina benzatinica IM cada 4 semanas por 10 años o hasta los 21 años (lo q ocurra primero)
profilaxis en paciente con historia de endocarditis SIN dano valvular y SIN carditis
penicilina benzatinica IM cada 4 semanas por 5 anos
profilaxis en paciente con historia de endocarditis CON dano valvular y CON carditis
penicilina benzatinica IM cada 4 semanas por 10 años o hasta los 40 años (lo q ocurra primero)
cuando se hace remplazo de valvula por endocarditis? y que valvulas se usan?
reemplazo de valvula cuando:
- regurgitacion aortica+fallo izquierdo
-embolizacion sistemica
-infeccion no controlable
-endocarditis fungica
-valvula prostetică
que valvula?
<65 anos: mecanica, requiere anticoagulacion de por vida
>65 anos, current bleeding, mujeres q quieres tener hijos, o contraindicacion para anticoagulacion: history of intracranial hemorrhage, coagulopathy, or severe thrombocytopenia (< 50,000: porcina
a quien se le da profilaxis antibiótica antes de procedimiento dental ? y con q?
valvula prostetica
hx de endocarditis infecciosa
unrepaired congenital valve deffect
amoxicilina oral 1 hora antes del procedimiento
common cardiac complication of Turner syndrome?
Bicuspid aortic valve
Turner syndrome is also associated with preductal coarctation of the aorta, which may present as a femoral pulse less than brachial pulse
como se ve hipoCALCEmia en el ekg?
QT prolongation
