cardio Flashcards
exercise induced syncope
HOCM (sub aortic stenosis)
Change in murmur with HOCM
valsalva increases murmur (decreases preload)
squatting decreases murmur (dilates aorta)
tx of hocm
Betablockers
avoid exertion and inotropes
causes of dilated cardiomyopathy
alcohol post viral pregnancy genetics beri beri idiopathic
sick sinus syndrome
classified as bradyarrithmia
2nd degree type 1
can be associated with inferior MI
2nd degree type 2
can be associated with anterior mi
more likely to progress to type 3
3rd degree
can occur with either anterior or inferior mi
if inferior- qrs are more likely to be narrow-better prognosis
if anterior qrs are more likely to be wide- worse prognosis
what to ask about tachycardias
narrow or wide
regular or irregular
what is atrial doing
narrow regular tach
Sinus tach
SVT (usually no p waves or retrograde)
Atrial flutter (2:1)
tell difference by looking at atrium
narrow irregular
a fib
a flutter with variable conduction
Multifocal atrial tach- different p wave morphology
what is multifocal a tach associated with
COPD, pulmonary disease (asthma, pneumonia, pulmonary htn, theophyline toxicity)
wide regular
sinus tach with aberrant conduction (BBB) (p waves present) v tach (has to have HR >120) svt with aberrant conduction (bbb, wpw) (p waves hidden, wpw delta wave)
v tach associated with
hypoxia
cardiomyopathy
ischemia heart disease
electrolyte disorders
wide irregular
a fib w/ bbb (qrs same). tx- av nodal blockers (ca channel blocker, beta blocker, digoxin, amiodarone)
a fib w/ wpw (qrs different - hr >200). tx- procainamide or shock
torsades de pointes
polymorphic v tach w/ QTc > .500
tx w/ magnesium
causes of prolonged qt
hypomagnesia hypokalemia hypocalcemia sodium channel blockers elevated ICP hypothermia congenital
signs of instability
AMS
hypotension
ischemia (chest pain, ekg)
acute chf
tx of 1st degree
no treatment
look for underlying cause
2nd degree
type 1-atropine, pacer
type 2-pacer
make sure you tx depending on ventricular rate
ex- if patient has 2nd degree type 1 with HR of 90 and BP of 80. You don’t give atropine because rate is fine. Fluids or other cause but don’t treat rhythm.
SVT tx
vagal maneuvers adenosine av nodal blockers cardiovert (shock) (vans mneumonic)
vtach tx
procainaminde
cardioversion
high output heartfailure
beri beri (b1 thiamine deficiency) severe anemia thyroxicosis av fistula page's disease of bone
BNP levels
500 likley decompensated heart failure
preload reducers
nitroglycerine
furosemide
afterload reducer
ace inhibitor
high dose nitroglycerine
nitroprusside
tx for htn EMERGENCY
24 hr rule
decrease bp by 25% in few hours
then gradual decrease in rest of 24 hours
iv drip meds
exception is aortic dissection - get bp normal as fast as possible
2ndary htn
sleep apnea, pheo, coarctation of aorta, renal artery stenosis, cushing, chronic steroid, hyper aldosteroism, estrogen use, renal disease, nsaid use
what me do you need to be careful in blacks
acei due to angioedema
best meds for blacks htn
ca channel blocker (long acting- amylodipine)
thiazide
what antihypertensive is contraindicated in pregnancy
acei and arb
most common drug to cause 2ndary htn
nsaids
treatment for aorta dissection
labetalol and +/- nitroprusside
tx for htn emergency with confusion/ encephalopathy
nicardapine (calcium channel blocker- selectively dilates cerebral blood vessels)- new school
nitroprusside- old school tx
metabolic syndrome
need 3 abdominal obesity triglycerides >150 HDL 110 htn
what murmur does rheumatic heart disease cause
mitral stenosis
mitral stenosis
mid diastolic rumble
crescendo decrescendo holo dialostolic murmur
look for:
signs of left heart failure (wet lungs)
rheumatic heart disease
can be bad to pregnant women due to the increased blood volume (pregnant women crashing w/ murmur)
embolic phenoma (endocarditis- osler nodes, etc.., strokes)
aortic regurg
austin flint early diastolic decrescendo murmur look for: wide pulse pressure. bounding pulse aortic dissection hypoperfusion
tricuspid stenosis
IV drug user endocarditis
aortic stenosis
pulsus parvus et tardus (decreased and delayed pulse and loud late peaking split s2)
murmur radiates to carotids
thready carotid pulse
mitral regurgitation
soft s1 blowing early sustained murmur with split s2
h/o heart attack or current
left sided failure (wet lungs)
murmur radiates to axilla
tricuspid regurgication
right sided heart failure
cor pulmonale
asd
systolic murmur with constant split s1
PDA
continuous machinery like murmur
pregnancy/still murmur
due to increased blood during pregnancy
troponin rises in
4-6 hours
returns no normal in 7-10 days
gold standard for acute coronary syndrome
angiography
contraindications to fibrinolytic
h/o hemorrhagic stroke any stroke in past year intracrnial neoplasm active internal bleeding suspected aortic dissection
prosthetic valce endocarditis
first 2 months- coag negative steph
after 2 months- staph aureus
most common staph
most common murmur with endocarditis
regurgitant (changing day to day)
tx for endocarditis
vanco/nafillin + gentamicin
+ rifampin for prosthetic valves
tx of pericarditis
high dose nsaids or asa for 1-3 weeks
phlebitis/thrombophlebitis
palpable cord
tx- local heat, elevation, nsaid
what condition is common with a coarctation of aorta
bicuspid aortic valve
sick sinus syndrome syncope
stokes adams attacks (syncope)
tet of fallot
vsd, overriding aorta, right ventricular outflow obstruction, right ventricle hypertrophy
crescendo-decrescendo holosystolic at LSB
cyanotic congenital
tet of fallot (4)
tricuspid atresia (3)
transposition of great arteries (2 vessels)
truncus arteriosus (1 vessel)
total anomalous pulmonary venous return (5 words)
asd
ostium secundum most common
most common congenital heart
vsd
systolic murmur at llsb
asd
systolic ejection murmur at 2LICS
tx for ulcers from chronic venous insufficiency
wet compress
hydrocortisone
possibly zinc oxide
most common risk factor for aortic dissection
hypertension
