CARDIO Flashcards
cardinal symptoms of AS
Cardinal symptoms: exertional dyspnea, angina pectoris, syncope
Dyspnea: from elevation of PWCP caused by LV diastolic pressures from impaired relaxation and reduced LV compliance
Angina pectoris: develops later, reflects an imbalance between increased myocardial O2 requirements and reduced O2 availability
Exertional syncope: from decline in arterial pressure caused by vasodilation in exercising muscles and inadequate vasoconstriction in nonexercising muscles in the face of a fixed CO, or due to arrhythmia
LV failure and hypoperfusion symptoms not usually prominent until late stages, and right-sided/RV failure symptoms are usually late findings in isolated severe AS
water hammer pulse; rapidly rising pulse which falls rapidly during late systole and diastole
Corrigan’s pulse: water hammer pulse; rapidly rising pulse which falls rapidly during late systole and diastole
Quincke’s pulse: capillary pulsations at root of nail while pressure is applied to tip of nail
Traube’s sign: booming pistol shot over femoral arteries
Duroziez’s sign: to-and-fro murmur if femoral artery is compressed with a stethoscope
Austin Flint murmur: soft, low-pitched rumbling mid-to-late diastolic murmur; produced by diastolic displacement of anterior leaflet of mitral valve by AR stream
capillary pulsations at root of nail while pressure is applied to tip of nail
Quincke’s pulse
booming pistol shot over femoral arteries
Traube’s sign: booming pistol shot over femoral arteries
to-and-fro murmur if femoral artery is compressed with a stethoscope
Duroziez’s sign
Austin Flint murmur:
soft, low-pitched rumbling mid-to-late diastolic murmur; produced by diastolic displacement of anterior leaflet of mitral valve by AR stream
Risk factors for peripartum cardiomyopathy?
- Increased maternal age
- Increased parity
- Twin pregnancy
- Malnutrition
- Use of tocolytic therapy for premature labor
- Preeclampsia or toxemia of pregnancy
Parameters associated with worse outcomes among inpatients with ADHF
Parameters associated with worse outcomes among inpatients with ADHF are the following:
blood urea nitrogen level >43 mg/dL (to convert to mmol/L, multiply by 0.357)
systolic blood pressure <115 mmHg
serum creatinine level >2.75 mg/dL (to convert to umol/L, multiply by 88.4)
elevated cardiac biomarkers including natriuretic peptides and cardiac troponins.
A 45-year-old 90-kg female presents with a 4-day history of unremitting substernal chest pain radiating to the left shoulder. The pain is worse when she is lying down and improves when she leans forward. 12L ECG shows diffuse ST elevations with upward concavity.
Tx?
Aspirin 2-4g /d
Anti-inflammatory treatment with aspirin (2-4 g/d) or nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (600-800 mg tid) or indomethacin (25-50 mg tid), should be administered along with gastric protection (e.g., omeprazole 20 mg/d).
In addition, colchicine (0.5 mg qd [<70 kg] or 0.5 mg bid [>70 kg] should be administered for 3 months. Colchicine enhances the response to NSAIDs and also aids in reducing the risk of recurrent pericarditis. In this patient, a once-daily dose of colchicine is not appropriate since her weight is 90kg.
Bed rest should likewise be recommended.
Use of anti-emetics is not part of the specific treatment recommendations for pericarditis.
What generally defines an ischemic ST-segment response in a treadmill exercise test
Flat or downsloping ST segment depression >0.1 mV below baseline lasting longer than 0.08s
Source: HPIM 21st ed, Ch. 273, p. 2034
The ischemic ST-segment response generally is defined as flat or downsloping depression of the ST segment >0.1 mV below baseline (i.e., the PR segment) and lasting longer than 0.08s.
Upsloping or junctional ST-segment changes are not considered characteristic of ischemia and do not constitute a positive test. T-wave abnormalities, conduction disturbances, and ventricular arrhythmias are also not diagnostic.
To reduce the risk of ventricular arrhythmia for patients with STEMI, the serum potassium and magnesium concentrations should be targeted to what values,
4.5 mmol/L, 2 mmol/L
Hypokalemia and hypomagnesemia are risk factors for ventricular fibrillation in patients with STEMI. To reduce the risk, the serum potassium concentration should be adjusted to ~4.5 mmol/L and magnesium to ~2.0 mmol/L.
Therapeutic threshold BP value for treatment among very elderly, defined as 80 years old and above according to the 2020 PSH Hypertension guidelines
150/90
characterized by a combination of induration, hemosiderin deposition, and inflammation, which typically occurs in the lower part of the leg just above the ankle in the setting of venous extremity pathology
Lipodermatosclerosis
Phlebectasia corona
fan-shaped pattern of intradermal veins near the ankle or on the foot; skin ulceration may occur near the medial and lateral malleoli
white patch of scar tissue, often with focal telangiectasias and a hyperpigmented border; it usually develops near the medial malleolus
Atrophie blanche
lesion often shallow and characterized by an irregular border, a base of granulation tissue, and the presence of exudate
Venous ulcer
conditions that would warrant discontinuation of a treadmill exercise test
chest discomfort
severe shortness of breath
dizziness
severe fatigue
ST-segment depression >0.2 mV (2 mm)
a fall in systolic blood pressure >10 mmHg
development of a ventricular tachyarrhythmia
factors will favor medical therapy and surveillance over revascularization for renal artery diseas
factors will favor medical therapy WITH revascularization for renal artery diseas
- progressive decline in GFR, during tx
- failure to achieve adequate bl
What chronic atherosclerotic occlusive disease involves claudication of the buttocks, thighs, and calves and is associated with impotence in males
Leriche syndrome, or aortoiliac occlusive disease, is comprised of decreased peripheral pulses, claudication, and erectile dysfunction (impotence in males). Claudication characteristically involves the buttocks, thighs, and calves.
In patients with Marfan’s syndrome, ascending thoracic aortic aneurysms of ____ cm should be considered for surgery.
4-5cm
Repair is also recommended when the diameter of a descending thoracic aortic aneurysm has increased ___cm per year.
> 1cm
Operative repair is indicated for patients with degenerative descending thoracic aortic aneurysms when the diameter is ___cm , and endovascular repair should be considered if feasible when the diameter is >5.5 cm.
> 6cm
