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PAS 531 > Cardio > Flashcards

Cardio Flashcards

1
Q

Blood pressure classifications

A

Normal:<120/180
Elevated:120-129/80
Stage 1 HTN: 130-139/80-89
Stage 2 HTN:>140/90

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2
Q

What is the goal blood pressure

A

<130/80
<120/80 if pt has CKD

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3
Q

Primary HTN

A

Genetic
Onset between 30-50y/o
95% of cases

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4
Q

Secondary HTN

A

Can be cured
Weird
Suspect if early or abrupt onset.

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5
Q

HTN Physical exam findings

A

Left ventricular heave
Abdominial bruit
Radial femoral delay
Pulsatile abdominal mass

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6
Q

HTN diagnostic tests

A

LVH on ECG or echocardiogram
proteinuria on UA

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7
Q

Common diseases associated with secondary HTN

A

Obstructive sleep apnea
Cushings
Renal artery stenosis
Aortic coarctation
Pheochromocytoma
Hyperthyroid
Hyperaldosterone
Hypercalcemia
Hyperparathyroid

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8
Q

Common causes of secondary HTN

A

Alcohol
Amphetamines
Antidepressants
Atypical antipsychotics
Caffeine
Cocaine
Decongestants
EPO
Herbal supplements
Immunosuppressants
OCPs
NSAIDs
Systemic cortisol

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9
Q

Renal artery stenosis cause

A

Usually caused by atherosclerosis
Sometimes caused by fibromuscular dysplasia (usually in young adults).

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10
Q

What makes someone high risk for ASCVD

A

Coronary artery disease
Diabetes
CKD
Or any three of the other risk factors

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11
Q

What to do if BP is 120-129/80

A

TLCs
Follow up in 3-6 months

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12
Q

What to do if BP is 130-139/80

A

Calculate 10 yr ASCVD risk Follow give meds and follow up in one month if ASCVD risk >10%
Follow up in 3-6 months if ASCVD risk <10%

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13
Q

What to do if BP>140/90

A

TLCs and follow up in 3-6 months
Start two meds

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14
Q

Four meds for HTN

A

Ace or arb
Hydrochlorothiazide
Calcium channel blocker
Spironolactone

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15
Q

What med to give someone with diabetes or CKD for HTN

A

ACEi or ARB

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16
Q

Non-pharmacological therapy of HTN

A

Weight loss of 10% body weight
Reduced sodium diet
<2 alcoholic drinks per day
Reduced sat fats
Exercise 30 mins per day
Stop smoking

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17
Q

Thiazide diuretics

A

Inhibit sodium reabsorption in distal renal tubules.
Drug of choice for HTN if no compelling indications

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18
Q

Calcium channel blocker

A

-dipine
inhibit transmembrane influx of extracellular calcium that inhibits cardiac and vascular smooth muscle contraction
Good for HTN in blacks

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19
Q

Beta blockers

A

-olol
Do NOT use for cocaine MI or pheochromocytoma until after alpha blockage
Decrease heart oxygen consumption
Decreases BP and HR

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20
Q

HTN drug of choice for pregnant

A

Labetalol
Nifedipine
HCTZ
Methyldoapa

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21
Q

HTN drug of choice in pt with Advanced CKD

A

Calcium channel blocker
Clonidine
Hydralazine
Alpha blocker

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22
Q

Aliskren

A

Direct renin inhibitor
Do NOT use in combo with ace/arb

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23
Q

Alpha-1 blockers

A

-zosin
Used for BPH and PTSD
First dose syncope

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24
Q

Arteriolar vasodilators

A

Hydralazine, minoxidil

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25
Q

Centrally acting HTN drugs

A

Clonidine, Methyldopa, Guanfcine
Last line agents
Clonidine gets BP to drop quickly but once gets out of body can have bad rebound HTN (very dangerous) so dose three times per day

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26
Q

Dangerous side effect of clonidine

A

Rebound HTN

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27
Q

HTN urgency

A

BP>180/120
No evidence of end organ damage
Goal is reduce BP in hours

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28
Q

HTN emergency

A

BP >180-220/120
Evidence of organ damage
Goal is reduce BP by 10% in first hour

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29
Q

Troponin

A

Measured to detect eschemia
Has predictive value for prognosis in patients post ACS
Levels begin to rise 4-8 hrs after injury and peak 12-24 hrs after and can be elevated for days.
TREND

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30
Q

Brain natriuretic peptide (BNP)

A

released when ventricular myocytes are stretched
Used to evaluate for HF and valvular disease
TREND
Elevated by CKD, PE, Pulm HTN, and sepsis

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31
Q

When to order echocardiogram (TTE or TEE)

A

To evaluate murmurs or congenital disease

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32
Q

TTE

A

Transthoracic echocardiogram

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33
Q

TEE

A

Transesophageal echocardiogram

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34
Q

Pros of Echocardiogram

A

Noninvasive
Lots of info
cheap

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35
Q

Cons of echocardiogram

A

Body habitus and heart rate can limit

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36
Q

Cardiac CTA

A

Angiogram to determine the anatomy of arteries including aorta.
More of a special test for cardiac specialties

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37
Q

When to order cardiac CTA

A

Low/intermediate risk for CAD
Abnormal stress test in pt you don’t want to cath

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38
Q

Pros of Cardiac CTA

A

High specificity
Leads to diagnosis of ASCVD

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39
Q

Cons of Cardiac CTA

A

Dye
Weight restriction
HR must be <60bpm
Must hold breath for 20 sec
Hard to get covered by insurance
Blooming artifact

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40
Q

Coronary angiography

A

Heart cath

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41
Q

How to order Coronary angiography (heart cath)

A

Hold DOACtx or for 48 hrs
Do NOT hold antiplateletes (aspirin)
Hold nephrotoxic agents (ace/arb/arni/metformin/loops)
48 hours before procecdure

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42
Q

When to order coronary angiography

A

High suspicion of ASCVD
Abnormal MPS
STEMI/unstable angina

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43
Q

Right heart catheterization

A

Measures pressures in chambers of the heart

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44
Q

When to order right heart catheterization

A

Shock
HF
Valvular disease
Pulm HTN
Congenital heart disease

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45
Q

When to order cardiac MRI

A

pre-op “mapping”
Suspeced amyloidosis

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46
Q

Cardiac MRA

A

Info about arteries not tissues or organs
Alternate for pt that can’t get CTA bc HR<60 or can’t tolerate die

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47
Q

When to order cardiac MRA

A

To evaluate for stenosis or clot

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48
Q

Bruce protocall stress test

A

HR, BP, EKG changes to stress.
Run on treadmill hooked up to monitors

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49
Q

Stress test MPS imaging

A

Myocardial perfusion scan
Myocardium uptake of dye at rest vs exertion.
Should look like a good donut

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50
Q

Stress test echocardiogram

A

Looks at myocardium’s response to exercise
Good for lean pts because can get good views of heart
Cheap

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51
Q
A
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52
Q

Why would you do a stresss test

A

Evaluate possible blockage
Risk stratification for surgery
Evaluated electrical systems in response to exertion

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53
Q

Contraindications to stress test

A

Active chest pain
Active ECG changes
Aortic stenosis
Endocarditis
Unstable vital signs or rhythm

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54
Q

Ambulatory event monitor

A

Can be continuous or triggured
Worn between 24 hrs to 4 weeks to monitor heart

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55
Q

Electrophysiology test

A

Advanced and invasive.
Maps cardiac electricity
Induce arrhythmias
Requires venous access

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56
Q

Tilt table

A

Monitors B, HR, and rhythm in various position.
Use in workup of syncope

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57
Q

Coronary artery calcium score

A

Gives you a score to tell calcified plaque in arteries.
Anything greater than 0 is abnormal

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58
Q

Arterial brachial index

A

Get blood pressure at arms and legs.
Looking for peripheral arterial disease

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59
Q

Arterial brachial index interpretation

A

Normal: >0.9
Mild obstruction: 0.71-0.9
Moderate obstruction: 0.41-0.7
Severe obstruction: 0-0.4

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60
Q

CTA with runoffs

A

Looking for peripheral artery disease.
Can evaluate for clot, aneurysm, bblockage
Do ABI first because this uses lots of dye and radiation

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61
Q

When to do a carotid doppler

A

Bruit on physical exam
TIA/CVA symptoms

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62
Q

What is needed to rule out blockage

A

Heart cath

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63
Q

Best test to measure ejection fraction

A

Echocardiogram

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64
Q

Types of lipids

A

Cholesterol
Triglyceride
Lipoproteins

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65
Q

Cholesterol

A

Animal cell membrane
Backbone of steroid hormones and bile acids

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66
Q

Triglycerides

A

Transfers energy from food into cells

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67
Q

Lipoproteins

A

Transport lipids
Apoprotein is dense
Triglyceride is less dense

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68
Q

Types of lypoproteins

A

Chylomicrons
Very-low-density lipoproteins
Low-density lipoproteins
High-density lipoproteins

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69
Q

Chylomicrons

A

Least dense lipoprotein
Mostly triglyveride
Found in blood after fat containing meals
Travel from gut via portal vein
Creamy layer on top of non-fasting serum

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70
Q

Very-low-density lipoproteins

A

Large
Mostly triglycerides
Converted to LDL once TG is transferred into cells

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71
Q

Low-density lipoproteins

A

Carry most of the cholesterol
Increase of 10mg/dL increases CHD by 10%

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72
Q

High-density lipoprotein

A

Most dense and smallest lipoprotein
Made of apoprotein and cholesterol
Reverse cholesterol transport
Increase of 5mg/dL reduces risk of CHD by 10%

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73
Q

Apolipoprotein B (apoB)

A

Protein that carries LDL
Helps LDL bind to cell wall.
Contributes to atherogenesis, MI, ASCVD risk
Screen if TH>200
High risk if level >130

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74
Q

Lipoprotein (a)

A

Genetically determined more potent subfraction of LDL.
Can cause atherosclerosis

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75
Q

How is VLDL calculated

A

Triglycerides/5

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76
Q

How is LDL calculated

A

TC-HDL-(TG/5)

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77
Q

What lipids are directly measured in lipid panel (not calculated)

A

Total cholesterol (HDL+LDL+VLDL)
HDL
Triglycerides

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78
Q

What lipids are calculated in lipid panel (not directly measured)

A

LDL
VLDL

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79
Q

Non-HDL cholesterol

A

Surrogate marker for apolupoprotein B containing particles
Measured directly and less sensitive to fasting status
Better predictor of CV risk than LDL
Goal is 30 points higher than LDL goals

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80
Q

Men cholesterol goal

A

TC: <200
Non-HDL: <130
LDL: <100
HDL: >60 is best. <40 is too low

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81
Q

Women cholesterol goal

A

TC: <200
Non-HDL: <130
LDL: <100
HDL: >60 is best. <50 is too low

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82
Q

Normal triglyceride level

A

<150

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83
Q

Borderline high triglycerides

A

150-199

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84
Q

High triglycerides

A

200-499

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85
Q

Very high triglycerides

A

> 500

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86
Q

Cardiac calcium score

A

Non-contrast cardiac gated CT.
Repeat every 3-7 years
Most useful in people with inttermediate risk of ASCVD

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87
Q

Levels of calcium score

A

0: no evidence of CAD
1-10: minimal evidence of CAD
11-100: Mild evidence of CAD
101-400: moderate evidence of CAD
>400: Extensive evidence of CAD

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88
Q

Levels of 10-year ASCVD

A

<5%: Low risk
5-7.4%: borderline risk
7.5-19.9%: Intermediate risk
>20%: high risk

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89
Q

Atherosclerosis

A

Plaque with large amounts of cholesterol build up in arterial walls
Associated with high LDL low HDL
Smaller LDLs are more dangerous bc can squeeze into spots
Antibodies to oxidized LDL play role in plaque growth and destabliztion

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90
Q

Familial hyper-cholesterolemia

A

Defective or absent LDL receptors
Homozygotes have LDL levels 8x normal
Heterozygotes have LDL levels 2-3x normal

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91
Q

Familial hypertriglyceridemia other names

A

AKA lipoprotein lipase deficiency, Fredrickson type 1, familial chylomicromnemia

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92
Q

Familial hypertrigyveridemia causes

A

Abnormality of lipoprotein lipase that is responsible for the ability of tissues to take up triglycerides from chylomicrons

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93
Q

Famililial hyperglyceridemia complicatoins

A

Recurrent pancreatitis
Hepatosplenomegaly

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94
Q

Dysbetalipoproteinemiia

A

Elevated levels of remnant lipoproteins
Rare familial disease
Associated with premature ASCVD

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95
Q

Familial combined hyperlipidemia

A

Polygenic combo of lipid abnormalities
Usually on genes LDLR, APOB, or PCSK9

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96
Q

Clinical presentation of dyslipidemia

A

Asymptomatic usually
Found in labs
Screening and fam history
Can have eruptive xanthomas or tedinous xanthomas, or retinalis

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97
Q

Non-pharmalogic treatment for dyslipidemia

A

Better diet
Exercise
Quit tobacco
Eat soluble fiber
Mediterranian diet (fish and plants)
Replace saturated fat with monounsaturated fat

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98
Q

Number one way to raise HDL

A

Stop smokingv

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99
Q

Diet guide to help with dyslipidemia

A

Total fat 27-30%
Sat fats <7%
20-30 grams of soluble fiber
Plant stanols and sterols

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100
Q

What does weight loss do for dyslipidemia

A

Lower LDL
Raise HDL

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101
Q

What does modest alcohol use do for dyslipidemia

A

Raise HDL
Contraindicated in those with high triglycerides

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102
Q

Statins

A

-statins
First line med against dyslipidemia
Lowers LDL
Raises HDL
Lowers Triglycerides
Decreases hsCRP

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103
Q

Statin side effects

A

Myalgia
Rhabdomyolysis
CK elevations
Myositis
Elevated transaminases
Diabetes development

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104
Q

When is a statin contraindicated

A

Liver failure

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105
Q

Low intensity statin

A

<30% LDL lowering
Pravastatin 10-20mg
Lovastatin 20mg

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106
Q

Moderate intensity statin

A

30-50% LDL lowering
Pitavastatin 2-4mg
Simvastatin 20-40mg
Pravastatin 40-80mg
Atorvastatin 10-20mg
Rosuvastatin 5-10mg

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107
Q

High intensity statin

A

50% LDL lowering
Atorvastatin 40-80mg
Rosuvastatin 20-40mg

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108
Q

What happens when you double the dose of statin med

A

LDL reduced by 7%

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109
Q

When to give moderate intensity statin

A

Presence of ASCVD and age >75
Age 40-75, diabetes, and LDL>70
Age 40-75, LDL 70-189, CVD risk >7.5%

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110
Q

When to give high intensity statin

A

Presence of ASCVD adn age 40-75
Primary LDL elevation >190
CVD risk >7.5% or other risk enhancing criteria

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111
Q

Cholesterol absorption inhibitors

A

Ezetemibe
Inhibits cholesterol transporter.
Monotherapy or added to statin
Reduces LDL 15-20%.
NOT for liver failure

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112
Q

PCSK 9 inhibitors

A

-ocumab
Inhibits LDL receptor degradation.
Monotherapy or added to statin
Decreases LDL and Lipoprotein (a)
Reduces CV events and deat
SC injection every two week

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113
Q

Adenoside triphosphate citrate lyase inhibitor

A

Bempedoic acid
Decreases LDL by about 18%
Upregulates LDL receptors in the liver
Caution in tendon rupture and hyperuricemia

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114
Q

Cholestyramine, colesevelam, colestipol

A

Bile acid sequestriants
Binds bile acids in the intestine
Good. option for pregnancy or liver disease
Can cause Triglyceride increase

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115
Q

Apheresis

A

Used in treatment of people with homozygous familial hypercholesterolemia.
Removes LDL directly from blood with machine.
Pts need AV fistulas
LDL lowered by 65-70% per treatment

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116
Q

Niacin

A

Good for raising HDL
Take with ASA or NSAID one hour before dose.
Need nicotinic acid for benefit

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117
Q

When to treat triglycerides

A

> 500 or 150-499 with CVD and well controlled LDL on maximally tolerated statin or other LDL lowering agent

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118
Q

How to treat triglycerides through diet

A

Avoid alcohol and simple sugars
Limit refined starches and sat and trans fats
Restrict overall calories

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119
Q

Secondary causes of high triglycerides

A

Obesity
Hyperglycemia
Alcohol abuse
CKD
Oral contraceptive/estrogen
Thiazide diuretics

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120
Q

Meds for high triglycerides

A

Statins
Omega-3 preparations/fish oils
Fibric acid derivatives

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121
Q

Omega-3 peparations/fish oil

A

Med for high triglycerides
Icosapent ethyl, omega-3-acid-ethyl
Antiplatelet, anti-inflammatory, anti-arrhythmia
Don’t give if have fish allergy or bleeding risk

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122
Q

Fibric acid derivatives

A

High triglycerides
Gemfibrozil, fenofibrate
Peroxisome proliferative-activated receptor-alpha (PPAR-alpha) agonist
Reduces TG and raises HDL
Side effects of hepatitis, choleithiasis, and myositis

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123
Q

When to check Lp(a)

A

Once in every adult’s life
Those with premature CVD
High risk ASCVD
Familial hypercholesterolemia
Recurrent pregnancy loss

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124
Q

High Lp(a) treatment

A

-PCSK 9 inhibitors (-ocumab)
Muvalaplin

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125
Q

Angina

A

Chest pain

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126
Q

Coronary vasospasm symptoms

A

Acute onset chest pain
Angina pain at rest
More common in women

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127
Q

Causes of coronary vasospasm

A

Cold, emotional stress, vasoconstricting medications.
Usually involves right coronary artery
History of vasospastic disorder

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128
Q

Coronary vasospasm diagnostics

A

Troponin levels (takes a while to be positive)
ECG - ST elevation

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129
Q

Coronary vasospasm treatment

A

CALCIUM CHANNEL BLOCKERS
Nitrates
AVOID beta blockers

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130
Q

Cocaine induced MI treatment

A

Calcium channel blockers and nitrates
Aspirin, heparin until CAD ruled out
NO beta blockers

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131
Q

Primary prevention of Coronary artery disease

A

BP<130/80
LDL<100
A1C<7
No smoking
Exercise
Target BMI

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132
Q

Secondary prevention of coronary artery disease

A

Diagnosis of DM, PAD,CVA/TIA,CKD
BP<130/80
LDL<55
A1C<7
Antiplatelet (aspirin)
Statin (moderate or high)
GLP-1 for diabetes
ACE/ARB or SGLT2 for CKD

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133
Q

NSTEMI ECG

A

Possibly ST depression
Troponin elevation

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134
Q

STEMI diagnostics

A

Active angina
Troponin elevation
ST elevation
Q wave development old aor infarct
New left bundle branch block (LBBB) looks same

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135
Q

NSTEMI treatment

A

Beta blockers
Aspirin
Statin

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136
Q

STEMI treatment

A

Heart Cath (ALWAYS)/reperfusion
Beta blocker
Aspirn
Statin

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137
Q

What causes ST elevation

A

Muscle dying

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138
Q

Stable angina

A

Chest pain
No symptoms while at rest
No ECG changes
No troponin elevation
Lasts less than 20 minutes

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139
Q

Stable angina treatment

A

Beta blocker, aspirin, high intensity statin treat disease
Nitrates, ronolazine, CCB treat symptoms

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140
Q

Unstable angina symptoms

A

Chest pain at rest
Last >30 mins

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141
Q

Unstable angina treatment

A

Heart cath

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142
Q

What conditions provoke or exacerbate ischemia in stable angina pectoris

A

Hyperthermia
Hyperthyroidism
Cocaine
HTN
Anxiety
Hypertrophic cardiomyopathy
Aortic stenosis

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143
Q

Stable angina diagnostics

A

Negative troponin
EKG usually normal
Stress test or stress echo to check for blockage
Cardiac CTA

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144
Q

Unstable angina diagnostics

A

Negative troponin
Elevated cardiac enzymes
Usually ST depression

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145
Q

NSTEMI diagnostics

A

Troponin positive
No ST elevation

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146
Q

Unstable angina and NSTEMI treatment

A

Morphine
Oxygen
Nitroglycerine
Aspirin
Beta blockers
Antiplatelet
Statin
NOT fibrolytics

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147
Q

How blocked does an artery have to be before stent is put in

A

70%
If it hasn’t reached that much, give statin

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148
Q

Normal ejection fraction

A

> 55%
Ideally >65%

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149
Q

ST elevation of V2-V4

A

Anterior wall
LAD
Prone to ventricular arrhythmias and shock
Widow maker

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150
Q

ST elevatoin of I, avL, V5, V6

A

Lateral wall
Circumflex artery
Not as bad

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151
Q

ST elevation of II, III, aVF

A

Right coronary artery
GIVE IV FLUIDS
Transient AV blocks

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152
Q

Stemi treatment

A

MONA-BAS
Aspirin
P2Y12 inhibitor
Anticoagulation
Reperfusion within 12 hours of onset stmptoms
Fibrinolytic therapy

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153
Q

Reperfusion therapy

A

Primary percutaneous coronary intervention.
Better than thrombolysis
Give fibrinolytics within 30 mins if stent can’t be put in within 90 mins.
Stent is standard for pts with acute MI

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154
Q

Who would you use a bare metal stent in

A

Someone with bleeding issues and can’t be on DAP (dual anti-platelet)

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155
Q

Fibrinolytic agents

A

-plase
Given for STEMI

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156
Q

Fibrinolytic absolute contraindications

A

Previous hemorrhagic stroke within a year
Intracranial neoplasm
Head trauma
Active internal bleeding
Suspected aortic dissection

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157
Q

Fibrinolytic relative contraindiations

A

BP>180/110
CVA>3 months ago
Bleeding/surgery within 4 weeks
Intracranial tumor
Pregnancy
Traumatic prolonged CPR
Dementia

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158
Q

Post fibrinolytic management

A

Conitinue with aspirin and anticoagulatoin until revascularization or for duration of hospital stay.
PPI for GI bleed prophylaxis

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159
Q

What NOT to do after reperfusion therapy

A

CCB
Nonsteroidal antiinflammatories

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160
Q

Post reperfusion therapy management

A

Statins
Beta blockers
ACEi if EF<40%
Aldosterone antagonist if EF<45%

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161
Q

What not to give after reperfusion therapy

A

CCB
NSAIDs

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162
Q

Acute coronary syndrome treatment

A

DAP for one year

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163
Q

Elective or stable PCI

A

Primary percutaneous coronary intervention
Needs to be done within 90 mins of noticed STEMI
Bare metal stent or drug eluding stent

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164
Q

What to do if post MI pt is in shock and you hear a murmur

A

Get an echocardiogram

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165
Q

Acute LV failure presentation

A

Dyspnea
Diffuse rales
Arterial hypoxemia
Diuresis

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166
Q

What to give if pt in post MI shock

A

Fluids (not if rhalles in lungs)
Ionotropic agents
Mechanical support
In that order

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167
Q

Acute LV failure treatment

A

Morphine sulfate in acure pulmonary edema
IV nitroglycerine
IV inotropic agents avoided if possible

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168
Q

RV infarction

A

Consider with inferior infarctions with low BP, raised venous pressure, clear lungs.
Hypotention made WORSE with diuretics, nitrates, and opiods

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169
Q

RV infarction treatment

A

FLUIDS FLUIDS FLUIDS
500mL of 0.9% saline

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170
Q

LV aneurysm

A

Post MI
Delineated area of scar bulges paradoxically during systole causing ST elevation.
May require surgical repair

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171
Q

Myocardial rupture

A

Usually 2-7 days post infarction and involves anterior wall.
No saving them

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172
Q

Pericarditis post MI complication

A

Audible friction rub with chest discomfort.
High dose aspirine and colchicine

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173
Q

Dressler syndrome (post MI syndrome)

A

1-12 weeks post MI
Autoimmune with pericarditis, fever, leukocytosis, pericardial leural effusions.
Treat with high dose aspirin and colchicine

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174
Q

Mural Thrombus

A

Common in large anterior infarcctions 6 weeks post MI
Give anticoagulants (start with heparin then warfarin)

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175
Q

How long does it take tropoonin to show up positive

A

4-8 hours after symptoms

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176
Q

Tunica intima

A

Innermost layer of artery.
Endothelial cells
Most responsive

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177
Q

Tunica media

A

Thick middle layer of artery

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178
Q

Tunica advenita

A

Thin outermost layer of artery
Thinnest layer

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179
Q

Aneurysm

A

Dialation of aorta>3cm
Involves all three layers of vessel wall
Weakness in the wall

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180
Q

Dissection

A

Tear of tunica intima creates false lumen

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181
Q

Rupture

A

Full-thickness tear of aorta

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182
Q

Thoracic aortic aneurysm

A

Involves aortic root, ascedning aorta, arch, and descending aorta above diaphragm

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183
Q

Thoracoabdominal aortic aneyrism

A

involves descending thoracic aorta and abdominal aorta

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184
Q

Abdominal aortic aneurysm

A

Involves descending aorta below diaphragm

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185
Q

Where do most aneurysms occur

A

Below level of renal arteries

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186
Q

Causes of aortic aneurisms

A

Primary connective tissue disorders
Turner syndrome
Menke’s syndrome
Focal medial agenesis
Tuberious scierosis
Poststenotic and arteriovenous fistula and amputation related
Injury
INflammatory stuff
Infection
Graft failure

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187
Q

Abdominal aortic aneurysm risk factors

A

Age
Male
Tobacco
Alcohol
White
Fam history
HTN
Hyperlipidemia

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188
Q

Abdominal aortic aneurysm clinical findings

A

Can be asymptomatic and found on accident in CT
Probably ruptured if symptomatic
Mild to severe deep abdominal or flank pain that is exacerbated by palpation
Pain radiates to back
Poor prognosis for ruptured

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189
Q

Abd aortic aneurysm imaging

A

ABD ULTRASOUND
Abd CT

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190
Q

Abd aortic aneurysm surgical repair indications

A

> 5.5 cm
Rapid expansion in diameter (>0.5cm in 6 months)
Symptomatic

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191
Q

Giant cell arteritis/Temporal arteritis

A

Vasculitis that affects medium and larger arteries of head and neck

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192
Q

Giant cell arteritis/Temporal arteritis symptoms

A

Fever
Fatigue
Weight loss
Malaise
Temporal headache
Jaw claudation
Unilateral vision loss

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193
Q

Giant cell arteritis/Temporal arteritis work up

A

Temporal artery biopsy

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194
Q

Giant cell arteritis/Temporal arteritis treatment

A

High dose of steroids
Give even before biopsy comes back to be safe

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195
Q

Marfan syndrome clinical presetation

A

Connective tissue disorder
Tall with long extremities
Pectus excavatum or carinatum
Increased risk for aortic root aneurisms

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196
Q

Marfan syndrome treatment

A

Screening, monitoring with echocardiogram annually
Beta blockers

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197
Q

Ehlers-Danlos syndrome

A

Increased risk for aortic root aneurisms
13 genetic disorders affecting connective tisue.
Causes joint hypermobility tissue fragility, skin hyperextensibilty
Easy bruising
Joint dislocation
Chronic pain

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198
Q

Ehlers-Danlos syndrome treatment

A

Dcreening, monitoring, fertility counseling

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199
Q

Thoracic aortic aneurysm clinical findings

A

Can be symptomatic.
Symptoms dependent on where it is
Dysphagia, stridor, dyspnea
Uper extremity edema
Cehat pain

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200
Q

Thoracic aortic aneurysm imaging

A

CT ANGIOGRAPHY
Chest radiograph
Echo if probably a rupture

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201
Q

Thoracic aortic aneurysm surgical repair indications

A

Diameter >5.5cm
Symptoms
Pt with special genetic conditions lower threshold for surgery bc of risk of rupture

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202
Q

Aortic rupture cause

A

Blunt force trauma
High speed car accident

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203
Q

Aortic rupture clinical findings

A

Severe pain
Hypotention
Pulsatile abdominal mass

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204
Q

Aortic rupture imaging

A

Thoracic: chest CT or transesophageal echocardiogram
Abd: Abd CT scan
If hemodynamically unstable get to the OR STAT

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205
Q

Aortic rupture management

A

Surgery
50% survive

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206
Q

Aortic dissection

A

Spontaneous tear of tunica intima.
Blood dissects into tunica media
Repetitive torque during cardiac cycle
HTN

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207
Q

Aortic dissection risk factors

A

HTN
Abnormalities of smooth muscle, elastic tissue or collagen from Marfan or Ehlers-Danlos syndrome
Pregnancy
Bicuspid aortic calce

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208
Q

Aortic dissection clinical findings

A

Sudden onset severe persistent chest pain described as ripping, sharp, tearing.
Pain radiates down back, anterior chest, neck
HTN
Syncopy

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209
Q

Aortic dissection imaging

A

ECG
CT of chest and abdomen
CXR
MRI
Transesophageal echocardiogram

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210
Q

Aortic dissection surgical repair type A

A

Urgent intervention
Grafting and replacing arch and branches

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211
Q

Aortic dissection surgical repair type B

A

Malperfusion urgent pintervention.
Bypass surgery to restore flow to rest of tissue
Endovascular stenting
BP control
Thoracic stent graft repair

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212
Q

Aortic dissection management

A

Agressive BP cotntrol
Beta blockers
Nitroprusside

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213
Q

Peripheral artery disease risk factors

A

Coronary artery disease
DM
Metabolic syndrome
HTN
Tobacco
Dyslipidemia

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214
Q

Peripheral artery disease clinical findings

A

Intermittent claudication
Cramping of lower extremities
Cold, pale, shiny, hairless skin

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215
Q

Peripheral artery disease diagnosis

A

Ankle brachial index (ABI)
Ultrasound assessment
CT angiogram or MR angiogram

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216
Q

Peripheral artery disease management

A

Antiplatelet therapy (clopidogrel, aspirin)
High intensity statin
Glucose and BP control

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217
Q

Peripheral artery disease surgical intervention

A

Endovascular revascularization
Balloon angioplasty without stent replacement
Arthrectomy
Bypass

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218
Q

When to do surgery for peripheral artery disease

A

Significant pain
Disability
Inadequate response to treatmetn

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219
Q

Chronic limb threatening ischemia

A

Foot ischemic wounds
Ulceration and gangrene
Severe vascular insufficiency
Ischemic rest pain

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220
Q

Chronic limb threatening ischemia management

A

Refer for vascular evaluation if diabetic
Surgical repair (bypass)
Amputation

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221
Q

Thrombus

A

Blood clot from atherosclerotic plaque or stagnant blood flow from cardiac.
Occlusion of small distal arteries
History of peripheral artery disease

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222
Q

Embolus

A

Blood clot from vascular system that TRAVELS to distal area.
Occlusion of larger arteries
History of cardiac event

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223
Q

Acute limb ischemia clinical findings

A

Abrupt onset pain and extremity.
Pain
Pulselessness
Pallor
Paralysis
Paresthesia
Cold limbs

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224
Q

Acute limb ischemia diagnosis

A

Arterial doppler ultrasound
CT angiography

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225
Q

Acute limb ischemia clinical intervention

A

Anticoagulation
Endovascular revascularization

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226
Q

Phlebitis

A

Inflammation with superficial vein
Usually due to infection or trauma from needles and catheters

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227
Q

Phlebitis clinical presentation

A

Localized pain and burning along length of vein
Tenderness
Erythema
Edema or bulging of vein

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228
Q

Phlebitis treatment

A

Warm compress
NSAIDs

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229
Q

Thrombophlebitis

A

Inflammatory reaction leads to formation of thrombus of superficial vein
Two types: superficial and septic

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230
Q

Superficial venous thromboflebitis

A

USUALLY AT SITE OF RECENT IV/PICC LINE
Can occur spontaneously in pregnant or postpartum.
Can be associated with trauma

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231
Q

Superficial venous thrombophlebitis clinical presentation

A

Dull pain in region
Tenderness along vein
Firm palpable cord

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232
Q

Superficial venous thrombophlebitis diagnostic imaging

A

Venous duplex ultrasound
Vein wall thickening (won’t compress)
Look for Virchow’s thriad

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233
Q

What is in Virchow’s triad

A

Caused by pulmonary embolism
Hypercoagulability
Vascular damage
Circulatory stasis

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234
Q

Superficial venous thrombophlebitis treatment

A

Supportive
NSAIDs
Compression socks
Extremity elevation

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235
Q

Septic thrombophlebitis

A

Usually involves inflammatino and suppuration within wall of vein

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236
Q

Septic thrombophlebitis risk factor

A

Burns
Glucocorticoid use
Injection drug use

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237
Q

Septic thrombophlebitis clinical presentation

A

Proximal estension of induration
Pain
Fever
Chills
Fluctuance or prurulent drainage

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238
Q

Septic thrombophlebitis labs

A

Blood culture
Usually caused by staph

239
Q

Septic thrombophlebitis treatment

A

Remove catheter
Antibiotics (penicillin or aminoglycoside)

240
Q

Thrombophlebitis surgery

A

Rarely needed.
Ligation and devision of vein at junction of deep and superficial veins.
Surgical excision of vein

241
Q

Varicose veins

A

Dilated tortuous superficial veins secondary to defective venous valves.
Weakness of vein wall and increased intraluminal pressure leads to REVERSE VENOUS FLOW.
Phlebitis and thromobosis of lower extremity most likely to occur in varicose veins

242
Q

Varicose veins risk factor

A

Pregnancy
Oral contraceptives
Prolonged heavy lifting
Prolonged standing

243
Q

Varicose veins clinical presentatino

A

Dull ache with pressure sensation worsened with prolonged standing
Releived with elevation
Spider veins
Telangiectasias

244
Q

Most common vein to become varicose veins

A

Greater saphenous

245
Q

Varicose vein treatment

A

Compression sovks
Leg elevation
Exercise
Could use surgery but not usually (sclerotherapy, endovenous ablation (only for superficial), vein stripping (not good))

246
Q

Absolute contraindicatoins of varicose vein treatment

A

Acute SVT, DVT, hypercoagulability
Advanced PAD
Pregnancy
Concurrent general anesthesia
Immobilized state
Prior anaphylaxis to proposed slcerosing agent
Infectoin

247
Q

Venous insufficiency

A

Vascular incompetency of either the deep or superficial veins
Results from centripetal return of venous blood and increased capillary pressure.
Valves get thickened or scared
Most commmonly associate with varicose veins, superficial thrombophlebitis, DVT, or trauma to leg

248
Q

Venous insufficiency risk factors

A

History of DVT
Varicose veins

249
Q

Venous insufficiency clinical presentation

A

Erythema
Leg pain
Hyperpigmentation
Edema
Pulse and temp are normal
Ulcers at MEDIAL malleolus
Stasis dermatitis
Atrophie blanche (atrophic hyperpigmented areas)

250
Q

Venous insufficiency diagnostic studies

A

DUPLEX ULTRASOUND
Trendelenburg test

251
Q

Venous insufficiency treatment

A

Elastic compression stockings
Leg elevatoin
Avoid long term sitting or standing
Wound care

252
Q

Deep venous thrombosis

A

Presence of clot in deep vein
Mostly originate in the calf

253
Q

Deep venous thrombosis risk factors

A

Intrinsic coagulopathy
Impaire fibrinolysis
Recent surgery
Trauma
Immobilization
Increased estrogen
Smoking
Malignancy
Prior DVT
Inflammation
Coronary arter disease
IV catheters

254
Q

Deep venous thrombosis clinical presentation

A

Unilateral swelling/edema of lower extremity >3cm
Calf pain/tenderness
Warmth
Erythema
Homan’s sign

255
Q

Lower extremety deep venous thrombosis

A

Most commonly begin in calf and propgate to popliteal , femoral, and iliac veins
Much more common than upper extremity

256
Q

Upper extremity deep venous thrombosis

A

Usually caused by placement of pacemaker, internal cardiac defibrillators or indwelling central venous catheters.
Likelihood increases as catheter diameter and number of lumens increases

257
Q

Homan’s sign

A

Sign of DVT
Pt supine
Calf pain when examiner dorsiflex foot

258
Q

DVT diagnostics

A

Venous doppler ultrasound.
Venography

259
Q

DVT management

A

Direct oral anticoagulants (DOAC)

260
Q

DVT magement for first event

A

DOAC for 3-6 months

261
Q

Unprovoked DVT treatment

A

Long term anticoagulation

262
Q

Pregnancy DVT treatment

A

Low molecular weight heparin

263
Q

Direct oral anticoagulants (DOAC)

A

DVT treatment
Apixaban
Rivaroxaban
Dabigatran
Prior t stopping you must know if there is any clot left with venous duplex ultrasound

264
Q

What to give for warfarin toxicity

265
Q

Warfarin

A

Should be overlapped with heparin for five days and until INR>2 for 24 hours.
Avoid eating vegetables with increased vitamin K

266
Q

DVT prevention

A

Considered on all hospital pts
Compression boots.
Bed exercise
Ambulation
PT consult

267
Q

Types of cardiomyopathy

A

Hypertrophic
Restrictive
Dilated

268
Q

Dilated cardioomyopathy cause

A

Ischemic
Idiopathic (viral)
DM, thyroid disease
Familial
Tacy mediated
Alcohol abuse
Meds

269
Q

Restrictive cardiomyopathy causes

A

Amyloid
Infultrative disorders
Familial

270
Q

Hypertrophic cardiomyopathy cause

A

Thickening of muscles impairs LV filling and movement.
LV wall >1.5 cm

271
Q

Dilated cardiomyopathy

A

Left ventricle space enlarged
Left ventricle muscle thinned out

272
Q

Dilated cardiomyopathy treatment

A

Beta blocker (carvedilol or metoprolol)
RAAS (ace/arb/arni)
MRA (spironolactone)
SGLT-2 (flozin)
Avoid nondihydropyridine CCB

273
Q

What symptoms does left heart failure have

A

Pulmonary symptoms

274
Q

Dilated cardiomyopathy symptoms

A

Dyspnea with exertion
Impaired exercise capacity

275
Q

Dilated cardiomyopathy physical exam findings

A

Rales
Cardiomegaly
S3
Peripheral edema
Elevated JVP

276
Q

Dilated cardiomyopathy diagnostics

A

BNP, CMP, CBC, TSH
ECHOCARDIOGRAM with dilated LV, decreased EF, and ventricular hypokenesis
Possibly heart cath and CXR

277
Q

Tako-tsubo

A

Stress cardiomyopathy
Broken heart syndrome
Present with acute anterior MI wit apical left ventricular ballooning

278
Q

Tako-tsubo treatment

A

Beta blocker
Ace/arb/arni
Spironolactone

279
Q

Hypertrophic cardiomyopathy causes

A

Genetic most common

280
Q

Hypertrophic cardiomyopathy symptoms

A

Dyspnea
Chest pain
Post exertional syncope
Sudden cardiac death

281
Q

Hypertrophic cardiomyopathy clinical exam findings

A

harsh systolic murmur, S4
Bisferiens carotid pulse
Enlarged PMI
Murmur worsened with valsalva or standing (decreased venous return)
Murmur decreased with squating, supine, leg raise, hand grip (increased venous return)

282
Q

Hypertrophic cardiomyopathy diagnostic tests

A

EKG with LVH, axis deviation
Asymmetric septal wall thickiening (>1.5cm)

283
Q

Hypertrophic myopathy treatment

A

Beta blockers to decrease HR, as much as possible
non-dihydropyridine CCB
Avoid dehydration
Maintain normal sinus rhythm
Surgical myectomy
Alcohol septal ablation

284
Q

Restrictive cardiomyopathy cause

A

AMYLOIDOSIS most common
Sarcoidosis
Carcinoid
Hemocromatosis
Fibrosis

285
Q

Restrictive cardiomyopathy symptoms

A

Pulmonary and systemic congestion
Dyspnea
Peripheral edema
Palpitatoins
Fatigue
Weakness
Exercise intolerance

286
Q

Amyloidosis symptoms

A

Common cause of restrictive cardiomyopathy
Periorbital purpura
Thickened tongue
Hepatomegaly
Diarrhea
Weight loss
Kidney and heart usually involved

287
Q

Resitrictive cardiomyopathy physical exam findings

A

Right sided failure
Elevated JVP
Kussmaul’s sign (increased jugular venous pressure with inspiration)
S3
Ascites
Edema

288
Q

Restrictive cardiomyopathy diagnostics

A

EKG with low voltage, LA enlargement, deep Q waves
Echocardiogram with thickened LV and RV walls and bilateral enlargement
BIOPSY
MRI
Pulm HTN

289
Q

Restrictive cardiomyopathy treatment

A

Treat underlying disorder
Hemochromatosis (chelation)
Sarcoidosis
BB, Diuretics

290
Q

Congestive heart failure

A

Hypervolemia due to impaired cardiac function

291
Q

Congestive heart failure symptoms

A

Dyspnea on exertion
SOB
Orthopnea
Edema
Abd bloating/distention
Cough
Decreased apetite
“Normal” EF (55-65%)

292
Q

Heart failure causes

A

Myocardial eschemia
Arrhythmia
Uncontrolled HTN causes hypertrophy
Diet/med noncompliance
Substance abuse
Anemia
Hyperthyroidism
Sepsis
Pulm emboli
Acute kidney injury

293
Q

NYHA classes heart failure symptoms

A

Class I: no limitation
Class II: symptoms at normal activity (grocery shopping)
Class III: Symptoms at minimal activity (brushing teeth)
Class IV: symptoms at rest

294
Q

Right sided heart failure symptoms

A

Pedal edema
Abd bloating
Nausea/ decrease apetite

295
Q

Left sided heart failure symptoms

A

DOE/SOB
Orthopnea
Cough
Activity intolerance

296
Q

Left sided heart failure physical exam findings

A

Rales/crackles/wheezes
Dullness to percussion
S3 or S4 gallop

297
Q

Right sided heart failure physical exam findings

A

Distended neck veins
Elevated JVP
Abd distension
Pedal edema
Hepatojugular reflx
Ascites
Liver enlargement/tenderness

298
Q

CMP of heart failure

A

Hyponatremic
Renal function
LFTs
Low albumin can cause edema

299
Q

Heart failure ECG findings

A

LVH (uncontrolled HTN)
Afib/Aflutter
LBBB
Q waves

300
Q

Heart failure CXR findings

A

Alveolar edema (bat wing opacities
Blunt margins
Kerley B lines
Dilated upper lobe vessels
Pleural effusion
Pulm edema

301
Q

Heart failure diagnosis

302
Q

Congestive heart failure treatment

A

Treat symptoms (loop for wet)
Treat underlying cause (HTN, Weight, OSA, etc)
Education (low Na diet, fluid restriction, exercise)
SGLT-2. BB, RAAS, Spironolactone (MRA)

303
Q

What does a wide (0.15) QRS tell you about the vetricles

A

Ventricle contraction not synchronized.

304
Q

Entresto

A

Sacubitril + valsartan
(arb + neprilysin inhibitor)
36 hour washout from ACEi
Watch BP
Watch GFR
Used in CHF

305
Q

Drugs to avoid in heart failure when EF<40

A

NSAIDs/COX2 inhibitors
CCBs
Thiazolidinediones
Sulfonylureas

306
Q

Preferred RAS agent in heart failure

A

ARNI unless too expensive or can’t handle side effects

307
Q

Pericarditis

A

Acute inflammation of pericardium

308
Q

Pericarditis causes

A

Mostly viral
Trauma, tumor
Uremia
MI, Medications
Other infectious
Rheumatoid, autoimmune, radiation

309
Q

Periarditis symptoms

A

Pain on deep breath or cough
Leaning forward (tripod)

310
Q

Pericarditis ECG

A

ST elevation in most leads (diffuse)

311
Q

Pericarditis physical exam findings

A

Pericardial friction rub

312
Q

Pericarditis diagnostics

A

CXR normal unless effusion
Echocardiogram
CBC, ESR, CRP (maybe troponin) elevated

313
Q

Acute pericarditis treatment

A

Aspirin or NSAID + colchicine + exercise restriction
Keep seeing them once per week until symptoms better
NSAIDs stop 1-2 weeks after symptoms stop
Colchicine stays on for 3-6 months after symptoms stop

314
Q

Who is at high risk of recurrent pericarditis

A

Autoimmune disease
Not treated with colchicine the first time

315
Q

Most common side effect of cholchicine

316
Q

Constrictive pericarditis treatment

A

Shell around heart
Treated by diuretics, pericardietomy

317
Q

Restrictive pericarditis treatment

A

Treat underlying disorder or transplant

318
Q

Pericardial effusion

A

Extra fluid in pericardial space

319
Q

Cardiac tamponade look on echocardiogram

A

Right ventricular collapse during diastole

320
Q

Pericardial effusion physical exam findings

A

Muffled heart sounds
Dullness to percussion left lung over angle of scapula
Hypotension
Elevated JVP

321
Q

Pericardial effusion diagnositics

A

Low QRS voltage with sinus tachycardia.
Varrying QRS voltages from being bounced around (electrical alternans)
CXR water bottle sign
Echocardiogram assesses hemodynamic impact

322
Q

Pericardial effusion treatment

A

Monitor if stable
NSAIDs, corticosteroids, colchicine

323
Q

Cardiac tamponade

A

Medical emergency
Pressure from pericardial effusion impairs cardiac output

324
Q

Cardiiac tamponade presentation

A

Tachycardia
Tachypnea
Hypotension

325
Q

Cardiac tamponade treatment

A

Pericardiocentesis (can be done at bedside)
Pericardial window for tamponade
Pericardiectomy for recurrent
NO vasodilators or diuretics

326
Q

Pericardial tamponade diagnosics

A

EKG: low voltage, sinus tach
Echocardiogram: RV colapse during diastole
CXR: Enlarged cardiac silhoette
Right heart cath: equalization of pressures in diastole

327
Q

Pericardial tamponade treatment

A

Urgent pericardiocentesis

328
Q

Infective endocarditis most common cause

A

Streptococcus viridians
Staphlococcus arureus (IV drug use at tricuspid)
Enterococci (men with GI or GU procedure)
Mitral valve most commonly effected

329
Q

Infective endocarditis physical exam

A

Fever
Murmur
Splinter hemorrhages
Janewayy lesions
Osler nodes

330
Q

Janeway lesions

A

Infective endocarditis symptom
Painless on palm of hands

331
Q

Osler nodes

A

Infective endocarditis symptom
Painful spots on pads of fingers

332
Q

Roth spots

A

Infective endocarditis symptom
Red spots on retina

333
Q

Major infectious endocarditis diagnosis

A

Blood culure positive for IE
TEE positive for vegetation

334
Q

Minor infectious endocarditis symptoms

A

Fever
Roth spots
Osler nodes
Murmur
Janeway lesions
Anemia
Nail-bed hemorrhages
Emboli

335
Q

Infective endocarditis treatment

A

3 Blood cultures
TEE if TTE not confirmed
Monitor
Valve replacement if fever after 7 days antibiotic therapy

336
Q

How to prevent reccurent infective endocarditis

A

Antibiotic prophylaxis before dental, respiiratory, procedure involving skin/msk tissue
Dental hygiene

337
Q

Rheumatic fever

A

Systemic immune response 2-3 weeks after strep pharyngitis
Affects heart, joint, skin, CNS
Mitral valve usually involved

338
Q

Rheumatic fever presentation

A

Funny looking rash
Joint invilvement
Subcutaneous nodules
Erythema marginatum
Myocarditis

339
Q

Rheumatic fever diagnosis

A

Positive throat culture
risng ASO titer

340
Q

Rheumatic fever treatment

A

Bed rest
Fluids
Pinicillin (erythromycin if allergic)
Salicylates PRN for fever and joint pain

341
Q

Myocarditis presentation

A

Inflammation of myocardium (acute or chronic)
Unexplained heart failure
Chest pain
Arrhythmia
Raised troponin
Fever
Malaise

342
Q

Myocarditis ECG

A

Sinus tachycardia with nonsecific ST/T wave changes
Prolonged QRS

343
Q

Myocarditis imaging

A

Echo to rule out effusion
Cath to rule out ischemia
Cardiac MRI

344
Q

Myocarditis treatment

A

Manage HF and arrhythmia
ACE/ARB/ARNI, BB, SGLT2, MRA

345
Q

S1

A

Closing of AV valves

346
Q

S2

A

Closing of aortic and pulmonic valves

347
Q

S3

A

Usually heard in CHF
Volume overload
Ken-TUUUUUU-cky

348
Q

S4

A

Usually precedes S1
LVH/RVH, AS, PS
Te-nness-eee

349
Q

Tricuspid endocarditis

A

Usually Staph aureus
Usually related to IV drug abuse

350
Q

Tricuspid endocarditis diagnostics

A

EKG (heart block or conduction delay)
ECHOCARDIOGRAM to see enlargemenet of tricuspid valve
CXR (infiltrates, emboli, pulm vascular congestion, abcess)

351
Q

Tricuspid endocarditis treatment

A

Abx for 6 weeks
Maybe surgery after infection cleared

352
Q

Tricuspid regurgitation

A

Blood flows backwards through floppy valve

353
Q

Tricuspid regurgitation causes

A

Primary: PM/ICD leads, chest trauma, ischemic heart disease effecting RV
Secondary: RA or RV dilation, most have pulm HTN

354
Q

Tricuspid regurgitation clinical manifestations

A

JVD
RV heave
Edema
Murmur
Maybe S3
EKG can show RV hypertrophy
CXR can show RV enlargement

355
Q

Tricuspid regurgitation diagnostics

A

ECHOCARDIOGRAM
Cardiac MRI
Right/left cardiac catheterization

356
Q

Tricuspid regurgitation management

A

Surgical repair or replacement

357
Q

Tricuspid stenosis

A

Rare
Present with fatigue, venous HTN
Rarely just tricuspid valve

358
Q

Pulmonic insufficiency

A

Leads to RV enlargement and dysfunction. tricuspid dysfunction.
Usually asymptomatic for years
Related to CHF

359
Q

Pulmonic insufficiency diagnostics

A

ECHOCARDIOGRAM
CMRI for quantification of RV health

360
Q

Pulmonic insufficiency treatment

A

Surgical in extreme
Bioprostetchic
Transcatheter

361
Q

Five major parts of Mitral valve

A

Annulus
Leaflets
Commissures
CHordae tendinae
Papillary muscles

362
Q

Mitral valve prolapse clinical manifestations

A

Rare
Mild
Murmur
Non-ejection click early iin ccardiac cycle while sitting/standing or later in cycle with squating
LA dialation
Arryhythmias
CHF

363
Q

Mitral valve prolapse diagnostics

A

Physical exam
ECHOCARDIOGRAM
Cardiac MRI quantification

364
Q

Primary Mitral valve regurgitation causes

A

Rheumatic heart disease
IE
Trauma
Congenital malformations
Mitral annular calcification
Cardiac amyloidosis

365
Q

Secondary Mitral valve regurgitation causes

A

Coronary disease
Dilated cardiomyopathy
HOCM
RC pacing
Afib

366
Q

Mitral valve regurgitation clinical manifestation

A

CHF symptoms
LA and LV enlargement

367
Q

Mitral valve regurgitation physical exam findings

A

LV enlargement
Murmur
S1 diminished
S2 split
S3 gallop
Murmur radiates to maxilla

368
Q

Mitral valve regurgitation diagnostics

A

ECHOCARDIOGRAM showing regurgitant volume >60mL, regurgitant fraction >50%
EKG - LAE, broad P waves notched with increased amplitude

369
Q

Mitral valve regurgitation treatment

A

Mitral ring
Resection
Alfieri stitch
Replacement
Mitral clip

370
Q

Mitral stenosis

A

90% of cases are rheumatic fever

371
Q

Mitral stenosis diagnositcs

A

Doming on Echocardiogram
Annular or single leaflet calcification

372
Q

Mitral stenosis comorbitity

A

HF
Afib
Death usually caused by CHF
Can cause LA dilation

373
Q

Mitral stenosis diagnostics

A

ECHO, TEE for 3d view to see if annular calcification

374
Q

Mitral stenosis treatment

A

Slow the HR
Mitral valve replacement
Balloon for rheumatic disease NOT for annular

375
Q

What separates the heart from everything else

A

Aortic valve

376
Q

Aortic insufficiency

A

Blood sucked back into ventricle during diastole through non-compliant valve
CHF symptoms

377
Q

Aortic insufficiency diagnostics

A

Echocardiogram (usually TTE but TEE can be used to see exact mechanism)
Diastolic murumur

378
Q

Aortic insufficiency treatmetn

A

Usually volume management
Sometimes surgery if severe
Caths not good

379
Q

Aortic stenosis cause

A

Calcium buildup
Can be born with native bicuspid valves

380
Q

Aortic stenosis symptoms

A

DOE
Chest pain
Syncope
Activity intolerance first symptom

381
Q

Aortic stenosis diagnostics

A

Echocardiogram
Murmur
S4

382
Q

Aortic stenosis treatmen

383
Q

TAVR

A

minimally invasive treatment for aortic stenosis
Put metal thing on balloon and put it in Aortic valve.
Works really good

384
Q

TAVR risk

A

Stroke
Might need pacemaker

385
Q

Acyanotic Congenital heart disease

A

Left to right shunt
Oxygenated blood mixes with venous return

386
Q

Cyanotic congenital heart disease

A

More dangerous
Right to left shung
Venous blood mixes with systemic flow

387
Q

Common things that come with acyanotic congenital heart disease

A

Patent foramen ovale
Atrial septal defect
Ventricular septal defect
Patent ductus arteriosus
Coarctation of aorta

388
Q

Patent foramen ovale

A

Cardiac lesion that persists into adulthood

389
Q

Patent foramen ovale symptoms

A

Most asymptomatic
Stroke at young age

390
Q

Patent foramen ovale diagnosis

A

Echocardiogram after stroke

391
Q

Patent foramen ovale treatment

A

Could do surgical closure but not recommended

392
Q

What happens during atrial septal defect

A

Blood moves from LA to RA bc high pressure in LA
RA becomes enlarge
Overtime blood will get shunted from RA to LA bc of change in pressure (Eisenmenger syndrome)

393
Q

Eisenmenger syndrome

A

Atrial septal defect where blood is shunted from RA to LA so deoxygenated blood is getting pumped into circulation

394
Q

Atrial septal defect symptoms

A

SOB
Tired
Poor weight gain
Cyanosis
Arrhythmias
HF symptoms

395
Q

Murmur of atrial septal defect

A

Wide split S2
RV heave

396
Q

Atrial septal defect diagnosis

A

Echocardiogram (bubble study)
ECG
CXR

397
Q

Atrial septal defect treat

A

Usually closes itself by 2-3 y/o if <5mm`
Surgical closure

398
Q

Long term consquences of atrial septal defect

A

Blood clots–>stroke
Arrhythmias
Recurrent infections

399
Q

What happens in ventricular septal defect

A

Blood from LV flows into RV bc high pressure in LV causing RV hypertrophy
Eventually blood will go from RV to LV

400
Q

Most common type of congenital heart disease

A

Ventricular septal defect

401
Q

What is a preventable cause of ventricular septal defect

A

Fetal alcohol syndrome

402
Q

Ventricular septal defect symptoms

A

Asymptomatic
Weakness
Poor feeding
CHF like symptoms

403
Q

Murmur of ventricular septal defect

A

HOLOSYSTOLIC high pitched

404
Q

Ventricular septal defect diagnosis

A

EKG
CXR
Echocardiogram (bubble study)

405
Q

Ventricular septal defect treatment

A

Most close themselves by 2 y/o
Surgery closure if necessary
Flurosemide (loop diuretic)

406
Q

Ductus arteriosus

A

Attaches pulmonary artery to aortic arch

407
Q

Patent ductus arteriosus

A

Ductus arteriosus doesn’t close after birth causing connection between aorta and pulmonary artery.
Seen in premature babies
Associated with rubella

408
Q

Patent ductus arteriosus pathophys

A

Fetal ductus anteriosus is kept open by low arterial oxygen and circulating prostaglandin.
Causes oxygenated blood from aorta and left heart to flow back into lungs.
Can develop into eisenmenger’s syndrome

409
Q

Patent ductus arteriosus symptoms

A

Small can be asymptomatic
Continuous “washing machine” murmur
Wide pulse pressure
Hyperdynamic apical pulse
Poor feeding
Weight loss
Freq respiratory infections

410
Q

Patent ductus arteriosus diagnosis

A

Echocardiogram
CTA/MRA
EKG
CXR

411
Q

Ductus arteriosus treatment in newborns

A

Prostaglandin synthesis inhibitors (NSAIDs: ibuprofen, indomethacin)

412
Q

Ductus arteriosus treatment in slightly older babies

A

Surgery
Symptomatic treatment with digoxin and flurosemide

413
Q

Follow up after ductus arteriosus surgery

A

Prophylactic Abx for six months

414
Q

Coarctation of aorta

A

Kinked aorta
Associated with bicuspid aortic valve
Associate with Turner syndrome

415
Q

How long does it take ductus arteriosus to close

A

About 15 hours after birth

416
Q

When do coarctation of aorta symptoms start

A

When ductus arteriosus closes.
So baby could seem normal for first few hours

417
Q

Coarctation of aorta in neonate symptoms

A

HF
Shock
Pale
Irritable
DIaphoretic
O2 sat higher in arms than legs

418
Q

Coarctation of aorta in older infants symptoms

A

Chest pain
Cold extremities
Claudication
Lower BP in lower extremities than in upper extremities

419
Q

Coarctation of aorta in adults symptoms

A

Must be very small to go unnoticed this long.
HTN
Underdeveloped lower extremeties
Cold and painful feet/legs with edema

420
Q

Coarctation of aorta murmur

A

Harsh systolic murmur at left sternal border

421
Q

Coarctation of aorta diagnosis

A

Echocardiogram
CXR rib notching and 3 sign

422
Q

Neonate treatment of coarctation of aorta

A

Give prostaglandins (-prost-) to keep the ductus arterosus open until angioplasty/stent

423
Q

Coarctation of aorta follow-up

A

life long with cardiology.
Ned cardiology clearance for participation in sports.

424
Q

Hypoplastic left heart syndrome

A

Left side of heart fails to develop so RV is bigger than LV

425
Q

Hypoplastic left heart syndrome symptoms

A

May not appear until ductus arterious closes
Usually no murmur
Shock
Cyanosis
Respiratory distress
Cool extremities
Decreased peripheral pulses
Very sick

426
Q

Hypoplastic left heart syndrome diagnosis

A

Echocardiogram

427
Q

Hypoplastic left heart syndrome treatmen

A

Norwood in first two weeks
Bidirectional glenn shunt 4-6 months
Fontan 18 months-3yrs
Heart transplant

428
Q

Hypoplastic left heart syndrome post-op

A

Chronic anticoagulation
Screen develoomental delay

429
Q

Transposition of great vessels

A

Occurs when aorta and pulmonary artery are switched
Associated with maternal diabetes
Die within a year if not treated

430
Q

Transposition of great vessels symptoms

A

Severe cyanosis (blue skin)
Tachypnea
Resp distress
Poor feeding
Absent lower pulses
Systolic murmur

431
Q

Transposition of great vessels diagnosis

A

Echocardiogram.
Can be found in-utero on ultrasound
CXR heart has egg/potato appearance

432
Q

Transposition of great vessels treatment

A

Prostaglandins to keep DA open
Surgical correction

433
Q

Pulmonary atresia

A

occur when the pulmonary valve did not form
Complete obstruction of right ventricular flow into pulmonary trunk
Body might make abnormal connection between RV and coronary arteries and a VSD

434
Q

Pulmonary atresia symptoms

A

Murmur if VSD
Crtical condition
Hyperdynamic apical impuls

435
Q

Pulmonary atresia diagnosis

A

Echocardiogram
Possibly caught on prenatal ultrasound

436
Q

Pulmonary atresia treatment

A

Prostaglandins to keep ductus arteriosus open
Surgical repair

437
Q

Tetralogy of fallot

A

Pulmonary stenosis
Right ventricular hypertrophy
Ventricular septal defect
Overriding aorta

438
Q

Tetralogy of falot symptoms

A

systolic crescendo-decrescendo ejection murmur
INcreased RV outflow tract obstruction
INcreased RV impuls4e at left lower sternal border
Baby might be asymptomatic until changes in heart structure causes right to left shunting
Tet spell

439
Q

Tet spell

A

Transient occlusion of right ventricular outflow from tetralogy of falot leading to severe cyanosis spell.
Improves when having kid squat or pull legs up to chest
Clubbing

440
Q

Tetralogy of falot diagnosis

A

Echocardiogram
CXR boot shaped heart

441
Q

Tetralogy of falot treatmetn

A

Prostaglandin to keep ductus arteriosus open till surgery
Surgery in first year of life.

442
Q

Treatment of tet spell

A

Knee-to-chest positioning
Supplemental oxygen
IV morphine
IV fluid bolus

443
Q

Amiodarone

A

Class III antiarrhythmic med that fixes VT, SVT and prevents VT, Afib, VF

444
Q

Amiodarone side effects

A

Corneal microdeposits
Thyrod dysfunction
Pulmonary fibrosis
Blue-gray skin

445
Q

What to do when you put someone on amiodarone

A

Yearly eye exam, PFTs, TSH, CXR

446
Q

Causes of sinus tachycardia

A

Exercse
Anemia
Dehydration
Shock
Hypoxia
Sepsis
Pulmonary disease
Hyperthyroidism
Pheochromocytoma
HF

447
Q

Sinus tachycardia treatment

A

Identify underlying cayse
Beta blockers

448
Q

Sinus bradycardia causes

A

AV blocking meds
Heightened vagal tone
Hypothyroidism
Hypothermia
Obstructive sleep apnea
Hypoglycemia

449
Q

Sinus bradycardia workup

A

TSH
Holter
Echo
Treadmill

450
Q

Sinus bradycardia treatment

A

Discharge av nodal slowing agents r/o underlying diseases
Atropine
Pacemaker
Dopamine

451
Q

What are the qualifications for pacemaker

A

<30bpm
<35bpm with symptoms
>3 second pauses
3rd degree AV block

452
Q

Sinus arrhythmia

A

Heart rate increases with inspiration and decreases with expiration

453
Q

Multifocal atrial tacycardia

A

3 or more distinct P wave morphologies on EKG
Seen in severe COPD
No treatment, just happens

454
Q

Premature atrial contraction

A

Abnormal P wave follwed by normal QRS
Focus in the atrium (not SA node) generates action potential before next scheduled SA node action potential.

455
Q

Premature atrial contraction presentation

A

Asymptomatic to palpitations

456
Q

Premature atrial contractions workup

A

CBC, TSH, Mg, BMP, ECG, holter

457
Q

Premature atrial contractions treatment

A

Monitor
Avoid triggers
Beta blocker
CCB

458
Q

First degree AV block

A

Fixed prolonged PR interval (>.20)

459
Q

First degree AV block treatment

460
Q

Second degree AV block - Wenckebach

A

Progressive PR interal prelongation with each beat until P wave is not conducted

461
Q

Second degree AV block - Wenckebach cause

A

Inferior MI

462
Q

Second degree AV block - Wenckebach treatment

A

Monitor.
If symptomatic, give atropine, epinephrine, pacemaker

463
Q

Second degree AV block - Mobitz II

A

Extra P waves with dropped QRS

464
Q

Second degree AV block - Mobitz II treatment

A

Atropine
Transcutaneous pacing or pacemaker
Usually turns into 3rd degree block

465
Q

3rd degree AV block

A

Complete block
No association between atrial and ventricular impulses

466
Q

3rd degree AV block treatment

A

Trascutaneous pacing followed by pacemaker

467
Q

Afib

A

No P waves
Varying R-R intervals
High risk of coagulation

468
Q

What does Afib usually cause

A

Enlargement of left atria
Causing mitral widening and regurgitation.
Causing left atria to widen more and worsens Afib

469
Q

Afib treatment

A

Anticoagulants
Cardioversion (shock them to reset heart, not permanent fix)
Antiarrhythmic medicine to make cardioversion last longer
Ablation works for longer until it heals (burning tissue in heart causing the bad electricity)

470
Q

Lone Afib

A

Isolated occurrence
Cocaine
Reversible

471
Q

Paroxysmal afib

A

Recurrent episodes <7 days

472
Q

Persistent Afib

A

Recurrent episodes >7 days

473
Q

Longstanding, persistent Afib

A

Had it for >12 months

474
Q

Most common chronic arrhythmia

475
Q

Afib risk factors

A

HTN
Valvular heart disease
CAD
Cardiomyopathy
COPD
Obesity
Sleep apnea
Excessive ETOH
Thyrotoxicosis

476
Q

Afib symptoms

A

Asymptomatic
Palpitations
Fainting
SOB
Chest pain
Stroke

477
Q

Afib work up

A

CBC
CMP
TSH
Holter
Echocardiogram
Sleep study (sleep apnea common in Afib)

478
Q

What Afib patients to put on rate control

A

Old, asymptomatic, presered EF
Give beta blockers or CCB

479
Q

What Afib patients to give rhythm control

A

Young, symptomatic, EF<45%, new onset, HCOM
Give flecainide, propafenone, sotalol, dofetilide, amiodarone, dronedarone
Cardioversion
Ablation

480
Q

Cardioversion

A

Requires sedation
Shock the heart back into good rhythm
Pt must be on anticoagualnts

481
Q

Aflutter

A

Sawtooth
Lack of P waves

482
Q

Aflutter presentation

A

Asymptomatic
Palpitations
DOE
SOB

483
Q

Aflutter workup

A

CBC
CMP
TSH
Holter
ECG
Echo

484
Q

Treatment for stable aflutter

485
Q

Unstable Afluter treatment

A

Cardioversion
Ablation

486
Q

Supraventricular tachycardia EKG

A

Narrow QRS tachycardia (160-200)

487
Q

Supraventricular tachycardia presentation

A

Palpitations
SOB
DIaphroesis
Chest pain
Rapid breathing
Dizziness
Loss of conscousness

488
Q

Supraventricular tachycardia workup

489
Q

Supraventricular tachycardia treatment

A

Valsalva
IV adenosine
IV Calcium channel blockers
IV Beta blockers
Cardioversion if unstable
Ablation is cure

490
Q

Premature ventricular contraction EKG

A

premature, wide QRS
Compensatory pause

491
Q

Premature ventricular contractions presentation

A

Asymptomatic
Palpations

492
Q

Premature ventricular contractions treatment

A

Beta-blockers
non-dihyrdopyridine CCB

493
Q

Ventricular tachycardia

A

Wide QRS (>0.12)
>100bpm

494
Q

Ventricular tachycardia treatment

A

Iniitial: urgent cardioversion, IV amiodarone, epinephrine, short acting beta blocker
Long term: Beta blockers/amiodarone, catheter ablation, implatable cardioverter defibrilator

495
Q

Polymorphic ventricular tachycardia treatmetn

A

Torsades de pointes
IV magnesium after cardioversion

496
Q

Ventricular fibrilation

A

Quivering ventricles with no cardiac output.
Looks like scribbles

497
Q

Vfib treatment

498
Q

Asystole

A

No electrical activity of heart

499
Q

Asystole treatmetn

A

CPR
Epinephrine

500
Q

Hyperkalemia look on EKG

A

Tall peaked T waves
Wide QRS
Increase of PR interval
Bradycardia

501
Q

Hypocalcemia look on EKG

A

Prolonged QT interval

502
Q

Hyper calcemia look on EKG

A

Shortened QT interval

503
Q

Brugada sndrome

A

RBBB
Genetic disorder causing sudden cardiac death from polymorphic VTach or VFib .
Long QRS that looks like M in V1 an V2
Treatment is ICD

504
Q

Wolff-Parkinson-White

A

Accessory patthway that connects electrical system of atria directly to ventricals allowing conduction to avoid AV node

505
Q

Wolff-parkinson-White EKG

A

Delta wave
Shortened PR interval

506
Q

Wolff-Parkinson-White treatment

507
Q

Main unique symptom of distributive shock

A

Warm extremeties

508
Q

Distributive shock presentation

A

Low SVR
Normal/high CO
Low BP
High lactate
Warm extremeties
Tachypnea
Tachycardia
Bradycardia
Hypotension
AMS
Fever
Cough
SOB

509
Q

Distributive shock cause

A

Anaphylaxis
Sepsis
Neurogenic
Adrenal insufficiency

510
Q

Distributive shock treatment

A

IV antibiotics or fluid for sepsis
Epinephrine, corticosteroids, bronchodilators for anaphylactic
Cooling and supportive care for neurogenic

511
Q

Hypovolemic shock presentation

A

High SVR
Low CO
Low PAP
Low CVP
Cold extremities
Massive bleeding
SOB

512
Q

Hypovolemic shock treatment

A

IV fluids
Blood transfusion
Control hemorrhage and pressure
Check for hypercoagulability
Tourniquet

513
Q

Cardiogenic shock

A

Cool extremities
LV or RV failure
Decreased cardiac output
Increased systemic vascular resistance

514
Q

Cardiogenic shock presentation

A

Low CO
High SVR

515
Q

Cardiogenic shock LV failure cause

A

Acute MI most common
Hypertrophic obstructive cardiomyopath
Myocarditis
Myocardial contusion
STEMI, BBB, abnormal axis

516
Q

Cardiogenic shock right ventricular failure cause

A

Acute MI
Myocarditis
Post-cardiotomy
Cardiomyopathy
Pulmonary embolsim
Worsening pulmonary HTN

517
Q

Cardiogenic shock mechanical dysfunction

A

Aortic regurgitation
Acute bacterial endocarditis
Mechanical valve dysfunction/thrombosis
Mitral regurgitation
Mitral and atrial stenosis
Ventricular septal defect or free wall rupture

518
Q

Cardiogenic shock arrhythmia

A

Afib
Aflutter
VTach
Vfib
Bradycardia
Heart block

519
Q

Metabolic cardiogenic shock

A

Calcium channel antagonist
Adrenergic receptor agonist
Thyroid disorders

520
Q

Cardiogenic shock treatment

A

ICU, tele, pulm artery catheter, foley catheter to measure urine
Maintain O2
INtravenous inotropes and vasopreessors
Intraortic balloon pump tandem heart, left ventricular assist device

521
Q

Obstructive shock

A

Blood obstructed from right to left heart.
Acute MI

522
Q

Obstructive shock presentation

A

Low SVR
Low CO
High PAP
High CVP

523
Q

Obstructive shock causes

A

Pulmonary embolism
Pericardial tamponade
Tension pneumothorax
Aortic stenosis

524
Q

Arterial line

A

Put into artery to continuously monitor systemic blood pressure.
Used during hemodynamic instability, vasopressor requirement, Frequent arterial blood gases.
In radial, femoral, axillary, or dorsal pedis arteries

525
Q

Central venous pressure monitoring

A

Measure pressure in right atrium an dvena cava
Needed to assess right ventricular function, systemic fluid status, rapid infusions.
In jugular, subclavian, or femoral veins

526
Q

What does high central venous pressure mean

A

Overhydration
Heart failure
Pulmonary artery stenosis

527
Q

What does low central venous pressure mean

A

Hypovolemic shock

528
Q

Swan-Ganz catheter/Pilmonary artery catheter

A

Measures Central venous pressure and pulmonary artery pressure.

529
Q

Shock definition

A

Inadequate O2 delivery, increased consumption, or decreased utilization to meet metabolic demands.
Can occur with normal or hypotensive BP.
Release of catecholamines triggered to try to raise BP

530
Q

Pre-shock

A

Compensated
No end organ damage

531
Q

Nonhemorrhagic hypovolemic shock cause

A

Vomiting
Diarrhea
Bowl obstruction
Pancreatitis
Burns
Neglect, environmental (dehydration)

532
Q

Hemorrhagic hypovolemic shock cause

A

GI bleed
Trauma
Massive hemoptysis
AAA rupture
Ectopic pregnancy post partum bleeding

533
Q

Cardiogenic shock pathophys

A

MI causes loss of 40% of LV
CO reduction causing lactic acidosis and hypoxia
Stroke volume reduced so tachycardia happens to compensate but makes ischemia worse

534
Q

Beck’s triad

A

Pericardial tamponade (can cause onbstructive andcardiogenic shock)
Hypotension
Muffled heart sounds
JVD

535
Q

Neurogenic (type of distributive) shock symptoms

A

After spinal injury
Sympathetic outflow is disruptie
Hypotension
Bradycardia
Usually only lasts a couple weeks.

536
Q

Neurogenic shock treatment

537
Q

What to give if pt in shock and glucose is low

A

1 ampule of 50% dextrose IV

538
Q

Hemorrhagic shock treatment

539
Q

How much fluid to give to hypovolemic shock patient

A

1 liter
If that doesn’t fix BP give vasopressors

540
Q

How much fluid to give pt in septic shock

A

30mL/kg of crysalloid solution (normal saline or LR)
If that doesn’t fix BP give vasopressors

541
Q

How much fluid to give when pt in cardiogenic shock

A

250
If that doesn’t fix BP give vasopressors

542
Q

DIstributive shock meds for vacoconstriction

A

Norepinephrine
Epinephrine
Dopamine
Vasopressin

543
Q

Septic shock meds for vasoconstriction

A

Norepinephrine

544
Q

First choice vasopressor in shock

A

Norepinephrine

545
Q

Cardiogenic shock meds

A

Dobutamine
Amrinone
Milrinone

546
Q

When to start antibiotics in septic shock

A

ASAP (within hour of recognition)

547
Q

Treatment for shock caused by adrenal insufficiency

A

Corticosteroids (cortisol)

548
Q

Sepsis definition

A

Organ dysfunction caused by dysregulated response to infection

549
Q

What labs to order for septic pts

A

Blood culture
Lactic acid/lactate
CBC
UA
CXR
Head CT if AMS

550
Q

What values show pt will have long ICU stay or die in hospital

A

RR>22
Systolic BP<100

551
Q

Most common source of sepsis

A

Pneumonia
Then intraabdominal
ten GU sources

552
Q

Sepsis risk factor

A

Immunosuppression
Pneumonia
Previous hospitalization
Predisposition to organ dysfunction

553
Q

How to tell if there is kidney damage from sepsis

A

Decreased urine output

554
Q

Pulmonary effects of sepsis

A

Inflammatory response happens causing interstitial edema causing pulmonary shunting and refractory hypoxemia

555
Q

GI effects of sepsis

A

Hypomotility causing translocation of gut bacteria into circulation

556
Q

Neurological effects of sepsis

A

Encephalopathy from ongoing inflammatory response disrupting BBB

557
Q

Endocrine effects of sepsis

A

Decreased CRH
Diminished sensitivity to glucocorticoids
Decreased vascuar tone
Insuline resistance causing hyperglycemia

558
Q

Procalcitonin

A

Elevated with bacterial infections
NOT viral

559
Q

Lactic acid in septic patient

A

2-4 maybe something
>4 is bad

560
Q

Hypotension symptoms

A

Dizziness with position changes
Nausea
Headache
AMS

561
Q

Symptomatic and stable hypotension treatment

A

Fluids
Compression socks
Increase salt intake
Midodrine
Fludrocortisone

562
Q

Symptomatic and unstable hypotension treatment

A

Fluids
Vasopressors IV (dopa, epi, norepi, neosynephrine)

563
Q

Syncope

A

Abrupt, transient loss of consciousness due to decreased cerebral perfusion

564
Q

Cardiac syncope

A

Structural heart disease (valvular, congenital, HCOM)
Arrhythmia
Symptoms usually only on exertion

565
Q

Neurological syncope

A

Carotid sinus syndrome (hypersensitivity)
Vasovagal
Seizure

566
Q

Orthostatic syncope

A

CNS disease (Parkinson’s, MS)
hypovolemia

567
Q

Orthostatic hypotension

A

20mmHg systolic or 10mmHg diastolic pressure drop

568
Q

Orthostatic hypotension cause

A

Meds
Adrenal insufficiency
Prolonged bedrest
Parkinson’s
Hypovolemia

569
Q

Orthostatic hypotension treatment

A

Fluids
Remove vasodilators
Increase salt intake
Midodrine
Fludrocortisone

570
Q

Syncope workup

A

Orthostatic BP
EKG
Echo to see if structural

571
Q

Vasovagal syncope

A

Can be caused by stress
Sitting in hot tub too long and suddenly feel like need to throwup and shit at same time

572
Q

Carotid sinus syncope

A

Pressure on carotid causes them to pass out
Need hydration and avoid neck pressure.
Possibly need pacemaker

573
Q

Causes of hypotension

A

Meds
Adrenal insufficiency
Prolonged bed rest
Spanal cord transection
Parkinson’s
Hypovolemia

574
Q

POTS

A

Orthostatic BP with associated inappropriate tachycardia in young women

575
Q

POTS treatment

A

Difficult
Fluids and sometimes meds
Might need beta blocker to fix tachy but it messes with hypotension too

576
Q

Labs of malnutrition before surgery

A

Hypoalbuminemia (<2.5)
Prealbumin (<10)
Transferrin (<100)

577
Q

NPO pre-op status

A

Usually okay to have lear liquids up to two hours before surgery.
Light meal up to six hours before surgery

578
Q

What to do with aspirin preop cardiac

A

Aspirin continues unless increased risk of bleeding
Stop 5 days prior if bleeding risk
Restrt as soon as no risk of bleeding 325mg/day

579
Q

Other meds to consider before cardiac surgery

A

Give beta blockers atleast 24 hours before surgery
Amiodarone reduces postop arrhythmias
Statins good to give preop, continue if already on it

580
Q

Prophylactic antibiotics in cardiac surgery

A

Mupirocin in nares pre-op
IV cephalosporin an hour preinsision.
Do not continue prophylactic antibiotics beyond 48 hours after surgery

581
Q

Adenosine diphosphate inhibitors /P2Y12 inhibitors

A

Clopidogrel
Prasugrel
Ticagrelor
Cangrelor
Inhibit platelet aggregation
Get pt off of them before surgery if possible

582
Q

IIb/IIIa inhibitors

A

Prevent platelet aggregation and fibrinogen binding
Stop 4-6 hours before incision

583
Q

Enoxaparin (Lovenox) SQ

A

Postpone surgery 48 hours post last doase
Irreversibly inactivates factor Xa

584
Q

Post op meds for radial artery conduit

A

Ca channel blockers to prevent spasms bc very muscular artery

585
Q

Hemoglobin level wanted after cardiac surgery

586
Q

What levels of drainage from chest tube tell you you need to reexplore pt after cardiac surgery

A

> 500mL during first hour
400 mL in each of first 2 hours
300mL in each of first 3 hours
1000mL total in first 4 hours
1200mL total in first 5 hours

587
Q

Holosystolic murmur maybe S3

A

Tricuspid endocarditis

588
Q

Late systolic murmur at apex no ejection click

A

Mitral prolapse

589
Q

Holosystolic murmur at apex, blowing radiates to axilla

A

Mitral valve regurgitation

590
Q

Diastolic murmur at apex with opening snap

A

Mitral stenosis

591
Q

Diastolic murmur at RUSB

A

Aortic insufficiency

592
Q

Holosystolic murmur at RUSB, crescendo decrescendo, radiates to carotids

A

aortic stenosis

593
Q

What two murmurs are made worse while standing (decreased venous return)

A

Mitral valve prolapse and hypertrophic cardiomyopathy

PAS 531 (15 decks)

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