Cardio Flashcards
Three types cardiomyopathy + which is most common?
dilated** (MC)
hypertrophic
restrictive
Dilated cardiomyopathy:
common cause
prognosis
symptoms same as
CAD w/ prior MI (ischemic damage)
death w/in 5 years
CHF symptoms
Treatment of Dilated Cardiomyopathy
-Dig
-Diuretics
-Vasodilators
+/- anticoagulation
HCOM:
- inheritance pattern
- type of dysfunction
- AD
- diastolic dysfunction
Murmur assc with HCOM?
Worse with?
Loud S4 + systolic ejection murmur @ LLSB
worse with Valsalva, standing
Initial drug to treat symptomatic HCOM
BBers
Surgical treatment of HCOM
myomectomy
Restrictive Cardiomyopathy:
-dysfunction type
- impaired diastolic filling
- systolic function variable
Causes of Restrictive Cardiomyopathy
SASH CC sarcoid amyloid scleroderma hemochromatosis chemo carcinoid ....or idiopathic
Echo findings in restrictive cardiomyopathy
large atria, normal ventricles
bright myocardium in amyloidosis
Definitive diagnosis of restrictive cardiomyopathy
biopsy
Hemochromatosis treatment
sarcoid treatment
hemochromatosis- phlebotomy, deferoxamine
sarcoid- steroids
Dig is contraindicated in what type of restrictive cardiomyopathy?
Needed when?
amyloid
used in other cases if systolic dysfunction is present
Three viral causes myocarditis
HHV6
parvo
coxsackie
Bacterial causes myocarditis (3)
GAS
Lyme
mycoplasma
Medication that may cause myocarditis
sulfonamides
Acute pericarditis most common causes
post viral/ coxsackie
Complications of acute pericarditis
effusion
tamponade
How is pericarditis distinguished from MI? (4)
pleuritic pain (assc with breathing)
pain relieved when sitting up
friction rub
DIFFUSE STE, PRD
Specific EKG finding in pericarditis
PRD
Treatment of pericarditis
NSAIDs
colchicine
Fibrous scarring of the pericardium is termed ____.
Dysfunction type is ____.
constrictive pericarditis
diastolic dysfunction
Constrictive pericarditis auscultation:
EKG:
pericardial knock
low voltage QRS, T waves
Pericardial effusion clinical findings
dull heart sounds
soft PMI
Pericardial effusion CXR findings
enlarged heart without pulm vascular congestion
When is pericardiocentesis indicated?
evidence of cardiac tamponade
What causes cardiac tamponade?
dysfunction type?
high rate pericardial fluid accumulation, volume irrelevant
diastolic dysfxn
Aside from penetration, what conditions lead to tamponade?
post MI
pericarditis (neoplastic, uremic esp.)
(3) clinical features of tamponade
high JVP
narrow pulse pressure
pulsus paradoxus
Define pulsus paradoxus
decreased arterial pressure (more than 10) during inspiration
Best diagnosis of tamponade
echo
EKG finding in tamponade
electrical alternans
Mitral Stenosis:
- MCC
- cardiac cascade assc with MS
- RF
- elevated LAP –> pulm congestion & a fib
Unique symptoms of MS (4)
- hemoptysis
- purple/pink cheeks
- emboli
- hoarseness (LAE –> RLN compression)
EKG finding assc with MS
broad based notched P waves
Murmur assc with MS + severity determinant
S2 –> opening snap –> loud S1
decreased distance between S2 –> OS= increased severity
Treatment of MS
- Diuretics
- BBers
- warfarin
(symptomatic only)
Aortic Stenosis:
cardiac cascade assc
AS –> LVH –> mitral regurg
Three causes of AS
- senile calcification (70+)
- bicuspid valve
- RHD
Murmur assc with AS
crescendo-decrescendo systolic murmur at RSIS
radiates to carotids
Pulse abnormality assc with AS
parvus et tardus
diminished pulses, delayed carotid upstrokes
Treatment of AS
valve replacement
Cause of UE differential BP
supravalvular aortic stenosis
Cause of systolic anterior motion of mitral valve
HCOM
Cause of Sudden Cardiac Arrest in post-infarct patients
re-entrant ventricular arrhythmia
4 Labs in initial evaluation of HTN
- U/A
- chem panel
- lipids
- EKG
Aortic Insufficiency (Regurg) PE findings
head bobbing
uvula bobbing
pistol shot sound over femoral arteries
Murmur and pulse assc with AI
widened pulse pressure
diastolic decrescendo murmur
Treatment of acute AR
replace valve emergently
Medical treatment of chronic AR
diuretics
dig
vasodilators
reduce afterload, limit salt
Three acute causes of MR
endocarditis
papillary muscle rupture
chordae tendineae rupture
MR:
murmur
common arrhythmia
holosystolic murmur at apex
afib
MR treatment
vasodilation + anticoagulation with afib
How common is TR?
70% normal adults have asx TR
TR is secondary to ____.
RVD
as in heart failure, inferior MI
Tricuspid endocarditis cause
IVDA
MVP histology
myxomatous degeneration
Murmur assc with MVP (+2 maneuvers that increase)
midsystolic click , increased by Valsalva/ standing
Treatment of MVP
generally benign, none indicated
MC valvular abnormality assc with RF
mitral stenosis
Diagnostic requirements RF
2 major or 1 major/2 minor
Major criteria RF
JONES
- joints (polyarthritis)
- cadiac involvement
- nodules
- erythema marginatum
- Sydenham chorea
How is ARF treated?
NSAIDs, monitor with CRP
px is penicillin/e-ymcin in GAS pharyngitis
New heart murmur + unexplained fever =
endocarditis
Acute endocarditis:
bug
valve type
staph, normal valve
Subactue endocarditis:
bug
valve type
strep viridans, enterococcus
diseased valve
Culture negative endocarditis bugs
HACEK haemophilus actinobacillus cardiobacterium eikenella kingella
Most common bug assc with post op endocarditis
staph epi
MC valve + bug assc with IVDA endocarditis
tricuspid, staph
Gold standard endocarditis dx
transesophageal echo
Major criteria endocarditis
bacteremia , TEE diagnosed endocardial involvement OR new valve regurg
Treatment duration of endocarditis
4-6 weeks
vanc + AG until bug isolated
Marantic endocarditis cause + makeup of vegetations
cancer
fibrin + platelets
Treatment for Libman Sacks Endocarditis
anticoagulate
Most common type ASD + age at onset
ostium secundum (central portion of septum) age at onset- 40
ASD murmur + Dx
wide, fixed split S2 - dx with TEE
Murmur assc with VSD
blowing, holosystolic
Coarctation of the Aorta is assc with what syndrome?
Turners
ECG findings in coarctation
LVH –> Left Axis Deviation
PDA is assc with what syndrome?
Congenital rubella
Murmur assc with PDA
continuous machine like murmur
TOF defects
IHOP interventricular septal defect hypertrophy of RIGHT ventricle (Right is right answer) overlying aorta pulmonic stenosis
Murmur assc with TOF
LUSB crescendo decrescendo
EKG + CXR findings in TOF
RAD
Boot shaped heart
Amiodarone complications + most common
pneumonitis **MC thyroid tox liver tox corneal deposits skin discoloration (blue --> gray) neuropathy
Mechanical failure assc with MI at:
day 1
days 3-5
weeks 1-2
day 1: RVF
days 3-5: papillary/ septal defect
weeks 1-2 free wall rupture
Definition of HTN emergency?
urgency?
- BP above 220/120
- end organ damage
(urgency= BP above 220/120 w/o end organ damage)
Effect of severe HTN on: brain pulm cardio kidneys
brain- AMS, ICH
pulm- pulm edema
cardiac- angina/MI/CHF/dissection
hematuria, renal failure
PRES- define
Posterior reversible encephalopathy syndrome
PREs- radiographic finding
posterior cerebral white matter edema
Treatment of HTN emergency
hydralazine nitroprusside esmolol labetolol (IV)
Ilicit drugs that cause HTN emergency
LSD
meth
cocaine
(+alcohol withdraw)
Management of serve H/A and HTN?
antiHTN agent –> CT –> LP
Goal reduction of BP in HTN emergency? urgency?
emergency-reduce by 25% in 1-2 hours w/ IV meds
urgency- reduce BP over 24 hours with oral meds
Aortic Dissection:
causes
- longstanding HTN
- cocaine
- trauma
- CT disorder
- bicuspid aortic valve, coarctation
- third trimester pregnancy
Two types of aortic dissection:
Type A: ascending aorta involved, retrograde flow **surgical** Type B: distal to subclavian artery
Location of pain in dissection
Type A: anterior chest
Type B: intrascapular
Pulse, BP, auscultation abnormalities in AD
pulse asymmetric between limbs
BP usually ^^ but may be low
aortic regurg
CXR finding in AD
mediastinal widening
Preferred tests in dx of AD
CT
TEE
Medical treatment of AD
- BBer
- IV nitroprusside until BP under 120
Location of most AAAs + MC age/ sex
between renal arteries and iliac bifurcation
males over 50
Signs of impending AAA rupture
flank/umbilical ecchymoses
Triad of AAA rupture
hypotension
palpable pulsatile abdominal mass
abdominal pain
Dx test of choice for AAA
U/S
What AAAs are surgical?
greater than 5 cm or symptomatic
Peripheral Vascular Disease is aka?
Chronic Arterial Insufficiency
Signs of PVD in lower extremities
- color change
- ulcers
- muscle atrophy
- thickened toenails
- hair loss
PVD most important risk factor
smoking
MC site of stenosis in PVD
superficial femoral artery
Symptoms of PVD
intermittent claudication/ rest pain (severe, poor prognosis)
Arteries related to calf claudication? hip?
calf- femoral, popliteal
hip- aortoiliac
Diagnosis of PVD
- ankle to brachial index
- pulse volume
- arteriography (gold standard)
Define ankle to brachial index (ABI)
systolic BP in ankle: arm
normal 0.9-1.3
claudication occurs at 0.7
Medical treatment PVD
reduce risk factors
symptom control (ASA)
cilostazol (PDEi)
Acute arterial occlusion- most common location + common causes
femoral artery
- afib
- aneurysms
- atheromatous plaque
Treatment of acute arterial occlusion
- IV heparin
- surgical embolectomy
Cholesterol Embolization Syndrome most common cause + symptoms
triggered by procedure
small areas of tissue ischemia
Treatment of cholesterol embolization syndrome
supportive, no anticoagulation
Mycotic aneurysm: cause and location
infection, aortic wall
Luetic heart is caused by ____.,
Location? Sex? Age?
syphilis
aorta (ascending aneurysm)
male: 40s-50s
Treatment of luetic heart
IV penicillin + surgery
Virchows triad
endothelial injury
venous stasis
hypercoagulability
Why are many DVT patients asx?
superficial vein remains patent
What is Homans sign?
calf pain on ankle dorsiflexion (DVT sign) I
DVT : Dx
d-dimer, Doppler U/S (sensitive not specific)
Phlegmasia cerulea dolens:
define + cause
severe leg edema = caused by extreme DVT
Treatment of DVT
Heparin to PTT at 1.5-2x aPTT, INR 2-3.
What DVT patients receive tPa/ kinase
massive PE, unstable, no contraindications
LMWH:
benefits
downside?
long half life (once daily)
outpatient
no levels
**more expensive
Postphlebetic syndrome is aka? Pathogenesis?
chronic venous insufficiency
valve destruction –> ambulatory venous HTN =
fluid accumulation + RBCs into tissue (pigmentation)
eventual tissue death = non-healing ulcers
Dig tox- classic EKG finding + cause
a tach with AB block due to increased ectopy and vagal tone
CXR finding in perforated ulcer
air under diaphragm
PE classic symptoms (four)
dyspnea
pleuritic pain
tachycardia
tachypnea
Amlodipine:
MOA
Common ADR?
DHP CCB
edema
Scleroderma renal crisis causes what two phenomena in addition to renal failure?
HTN emergency
DIC
Cardiac amyloidosis:
EKG and echo findings
EKG: low voltage
Echo: LV wall thickening, normal chamber
Common systemic symptoms assc with cardiac amyloidosis
easy bruising
proteinuria
Amyloidosis may be primary or secondary to what ?
chronic inflammatory disoders… IBD, RA etc.
Definitive diagnosis of amyloidosis?
tissue biopsy (fat pad)
When is sinus brady treated?
below 50 BPM, symptomatic
Dosage of atropine for bradycardia?
0.5mg q3-5 min up to 3mg
Dosage of dopamine for bradycardia? epi?
dopa: 2-10 uq/lg/min
epi: 2-10 uq/min
How might MVP cause holosystolic murmur?
longstanding MVP –> MR (mid systolic click) –> progresses to holosystolic murmur
MVP –> MR MCC MR
HyperPTH findings
neuropsych
stones
HTN
Shockable Rhythmns
PEA
Vfib
Anterior MI:
STE or STD?
Assc artery?
V1-6 STE, LAD
Lateral MI:
STE or or STD?
Assc artery?
STE: I & AvL
STD: II,III,and avF
LCX
Right Ventricle MI:
STE or STD?
Assc artery?
STE V4-6
RCA
Posterior MI:
STE or STD?
Assc artery?
V1-3 STD
I&AVL STE-LCX
I&AVL STD- RCA
Inferior MI:
STE or STD?
Assc Artery?
II,III,AVF
LCX or RCA
Hypovolemic shock:
CO? CVP? MVO2? PCWP? RAP? SVR?
All low except SVR = ^^^
Cardiogenic Shock: CO? CVP? MVO2? PCWP? RAP? SVR?
CO, MVO2 low
others high
Septic Shock
Hypovolemic shock:
CO? CVP? MVO2? PCWP? RAP? SVR?
CO, MVO2 high
others low
Location of most venous ulcers?
medial malleolus (and less painful than arterial ulcers)
Superficial thrombophlebitis:
common locations
site of IV infusion
varicose veins in greater saphenous system
Common cause of septic thrombophlebitis
infection of IV cannula
Most common cardiac tumor
primary tumors rare (usually mets)
atrial myxoma is most common primary tumor
Most common location cardiac myxoma
interatrial septum
Murmur assc with myxoma
diastolic “plop” changes with position
Signs common to all forms of shock?
HOTA hypotension oliguria tachy AMS
Effect of neurogenic shock on CO SVR PCWP
all decreased
What one sign suggests cardiogenic shock?
MCC?
JVD
MI
BP/ urine output assc with cardiogenic shock?
systolic under 90
urine output less than 20ml/hr
Intraaortic balloon pump:
function
pumps during diastole, relaxes during systole
increases ventricular emptying
increases coronary perfusion
Pulse + urine output assc with classes I-IV hypodynamic shock
normal, normal
above 100, 20-30 ml/hr
above 120, 20 ml/hr
above 140/ not palpable, none
Amount of fluid lost in classes I-IV hypovolemic shock
10-15
20-30
30-40
40+
How to monitor treatment success in hypovolemic shock
urine output
Clinical progression from SIRS
SIRS –> sepsis –> septic shock –> multiorgan dysfunction
Criteria for SIRS
2+: fever/hypothermia hyperventilation tachycardia increased WBC count
Sepsis criteria
Sepsis:
SIRS + culture +
Septic Shock
Sepsis + hypotension refractory to fluid
Multiorgan dysfunction syndrome:
prognosis
most die
Main characteristics of neurogenic shock
peripheral vasodilation/decreased SVR
Causes of neurogenic shock
spinal cord/ head injury
spinal anesthesia
pharmacologic
Most important lifestyle modifications for lowering BP
#1 weight loss #2 DAG #3 decrease Na/ alcohol
**smoking cessation does not decrease BP
Aortic regurg:
worst position?
pulse?
AR worst in LLD positon
bounding pulse
1 Study for AAA
AUS
Cause of OrthoHTN in elderly
decreased baroreceptor responsiveness
Shockable rhythms?
Rhythms for CPR?
shock: Vfib/ pulseless Vtach
CPR: asystole/ PEA
Coarctation buzzword symptoms
epistaxis
LE claudication
BBer OD symptoms & tx
sx: brady, AVB, hypotension
tx: IVF, atropine, glucagon
Treatment of stable/unstable afib
stable: BBer/CCB
unstable: SCD
Management of Acute MI W/ DHF
NO BBer
Give diuretics
Cause of stenosis post-stenting
early cessation of antiplatelet therapy
noncompliance
Treatment of symptomatic HCOM
Bber –> verapamil/CCBs
Drug that prevents post MI remodeling
ACEi + BBer
Signs of constrictive pericarditis (3)
- pericardial calcifications
- right heart failure
- pericardial knock (mid-diastolic)
Myocarditis findings on echo
all ventricles dilated
diffuse hypokinesis
Afib clot prevention
warfarin or anticoag
not antiplatelet
Cause of syncope + murmur in young person
HCOM
interventricular septal hypertrophy
1 risk Aortic Dissection
systemic HTN
Diagnosis heat stroke
temp 104+
CNS dysfunction
additional organ failure
initial diabetic therapy
lifestyle modification + statin
+metformin if a1c above 7.5
Mitral valve abnormality in HCOM
anterior motion mitral valve
contacts septum in systole= LVOT obstruction
MCC constrictive pericarditis outside of US
TB
Drug class and use for: Xa inhibitor P2y12i colchicine PDE5i
Xa: anticoag, afib
P2y12i: antiplatelet, post MI
colchicine: antitubular, pericarditis
PDE5i: ED
Drugs that increase warfarin bleeding
NSAID
amio
abx
Foods that decrease warfarin fxn
leafy greens
ginseng
Viral myocarditis can result in _____
decompensated heart failure (DHF)
Cause of ascending and descending AD
ascending: cystic medial necrosis (CT disorder)
descending: atherosclerosis
Stable angina:
worst risk
most common risk
worst DM
most common HTN
Labs for stable angina
normal EKG & enzymes
abnormal stress test
Treatment of ACS
MONA antiplatelet BBEr statin ACEi \+thrombolytics/PCI
Drugs that lower mortality post MI
ASA, BBer, ACEi
ACEi+BBer prevent remodeling
Pathogenesis prinzmetal angina
aka?
variant angina
vasospasm; fixed lesion; ventricular dysrhythmia
Prinzmetal:
timing of pain
EKG finding
drug that provokes
night
STE with pain
ergonovine prokokes
Treatment of prinzmetal
CCB
nitrates
MI pain radiates to….
L side of body, jaw, arm, epigastrum, back etc.
Cause of SCD in first 24 hours following MI
vfib
Two signs of RV infarct
JVD
hepatomegaly
EKG changes in MI (broad)
T peaks –> STE –> Q waves
Troponins vs CK:
sensitive? specific?
Troponin more sensitive and specific
obtain every 8 hours first 24 hours following ACS
Marker to rule out second MI
CKMB
Treatment of Dressler syndrome
ASA
Life threatening causes of chest pain (5)
ACS dissection PE tension PTX esophageal rupture
7 factors in TIMI score
65+ 3+ CAD risk factors known stenosis 2 episodes angina/day ASA used last 7 days enzymes EKG changes
“Syndrome X” characteristics
stable angina, + stress
- cath
good prognosis
Metabolic Syndrome X characteristics
obesity -> insulin resistance –> HTN etc
Grading Heart failure I-IV characteristics
I: nearly asx
II: symptoms with mod exertion
III: symptoms with mild exertion
IV: symptoms at rest
Auscultation findings in HF
S3 at apex
S4 at LSB
PMI shifted
crackles and rales
BNP suggestive of heart failure
above 150
First line treatment heart failure
NOT DECOMP.
(systolic?)(diastolic?)
Diuretics + ACEi – systolic
BBer + Diuretic– diastolic
Treatment acute decompensated heart failure
diuretics
nitrates
O2/resp support
Treatment of symptomatic PVCs
BBers
Define couplet/bigeminy/trigemini PVCs
couplet: 2 consecutive
bigeminy: every other
trigeminy: every third
Afib EKG findings
no clear P waves
irregularly irregular
a rate 75-175
Define “lone afib”
Management?
lone: no other abnormalities, under 60, asx
no treatment. observe. low risk.
A flutter EKG finding
saw tooth pattern
300 a rate
1/3 a rate = v rate
MCC a flutter
CHF
MAT:
EKG appearance + MCC
at least 3 p wave morphologies
rate 60-100
severe pulm disease
PSVT
MCC
EKG appearance
AVNRT (assc with ischemia)
narrow QRS, no P waves
Treatment PSVT
vagal
adenosine
WPW:
location of re-entrant path
treatment
Bundle of Kent
procainamide
quinidine
ablation
EKG appearance WPW
narrow tachy
short PR
delta wave
Drugs to avoid in WPW
dig
CCB
MCC vtach
CAD + MI
V tach progression
Vtach –> torsade –> V fib –> death
Treatment of v tach
if lasts 30+ seconds
amio and SCD
Vfib appearance
chaotic, irregular, quivering
When to treat sinus brady
under 45
symptomatic
sick sinus syndrome appearance
persistent spontaneous bradycardia
Which AV blocks get pacers
II/II, III
Electrical alternans:
appearance
association
QRS varies each beat
assc with pericardial effusion
How do vagal maneuvers slow PSVT?
decrease AV node activity
Aflutter
-3 findings
“F” waves on EKG
JVD
Hypotension
High creatinine + recurrent flash PE=
renovascular HTN
Fat embolus symptoms
rash (petechial)
dyspnea
Dig tox symptoms
- N/V/D
- changes in vision
- arrhythmia
Easy bruising, waxy skin are assc with what kind of heart failure?
amyloidosis, restrictive
Unexplained heart failure (no HTN)
+LVH + proteinuria =
amyloidosis
Findings assc with ventricular aneurysm?
mitral regurgitation
CHF
angina
ventricular arrhythmia
Acute limb ischemia following MI is caused by?
LV thrombus
common in large anterior STEMIs
How to Na levels correlate to CHF severity?
Low Na= severe disease
MI type that causes hypotension
RV Mi; will need IV bolus
MOA class I antiarrythmics
block Na/ phase 0 of depolarization
Murmur assc with aortic dissection
ascending dissection –> aortic regurgitation
Causes of pulsus paradoxus
tamponade
asthma
COPD
Treatment for chest pain assc with cocaine
BDZ
Sudden limb ischemia without any previous symptoms=
arterial embolus
How does amiodarone effect dig levels?
increases = NVD + vision changes etc
Treatment of PHTN in the setting of LV dysfxn
diuretics
ACEi
Treamtent of idiopathic PHTN
endothelin inhibitors
How can AV fistula effect cardiac function?
high output heart failure
Acquired causes of AV fistula
trauma, cancer, etc
Who gets statins?
40-75 year olds with CVD risk about 75%
Location of ectopic foci in afib
pulmonary veins
Location of re-entry in aflutter
tricuspid annulus
WPW EKG findings
delta wave
short PR less than 3 small blocks
ST changes
Diagnosis of aortic dissection
stable- CTA
unstable- TEE
Treatment of Dresslers
NSAIDs
no anticoagulation
Aortic stenosis murmur
Right 2nd ICS murmur (systolic)
soft second heart sound
Murmur assc with IVDU endocarditis
Tricuspid regurg (systolic, ^^ with inspiration)
Fibromuscular dysplasia:
in addition to female HTN, what are findings?
neck, abdominal bruits
Pericarditis + ^^BUN=
uremic pericarditis
tx with hemodialysis
Who should be screened for AAA?
smokers 65-75 one time
MOA statins
inhibits HMG CoA —-> mevalonic acid
increases LDL
decreases CoQ (=statin myopathy)
What medications should be held 48 hours before stress test
BBer
CCB
nitrates
+caffeine 12 hours before
SLE = risk factor for what heart condition
early CAD
NG MOA
systemic vasodilation = decreased LVEDV
Peripheral artery disease increases risk for?
mainly MI (20% 5 year risk) rarely limb amputation (1-2% 5 year risk)
When do alcohol withdrawal seizures occurs?
12-48 hours after last drink
How to decrease BP in HTN emergency
down by 10-20% first hour
5-15% next 23 hours
Pulm effusion + widened mediastinum=
AD (get CTA or TEE)
Left sided neck pain + substernal burning-
MI
Risk for AAA rupture
smoking
rapid growth
large diameter
When to operate on AAA
more than 5.5 cm
more than 1cm/yea growth
symptomatic
Treatment of ADHF with Pulm Edema
vasodilators, diuretics
MCC sudden onset afib
hyperthyroid
pressor effect on digits
distal ischemia
treatment of variant angina
CCB
nitrates
(no BBer, ASA)
1mm STE w/ stress test: dx?
nondescript
Treatment of PAD
exercise
statins
antiplatelets
Common cause of AR + assc murmur
- Bicuspid AV in developed countries
- LSB diastolic decrescendo murmur
Cause of ISH in elderly
arterial wall stiffening
Situational (aka ___) syncope:
- caused by?
- occurs during?
reflex
altered autonomic response (cardioinhibitory, vasodepressor)
peeing, pooping, coughing etc
Chronic tachycardia may lead to?
heart remodeling (dilation, hypokinesis) =tachycardia mediated cardiomyopathy
Treatment for tachycardia mediated cardiomyopathy?
rate and rhythm control
1st line therapy for stable angina
BBer
+/-CCB, nitrate
Pericardial effusion:
- CXR appearance
- exam findings
- big heart (“water bottle”), clear lung fields
- diminished heart sounds, hard to find PMI
Weight loss, lid lag, tremor, afib= ? tx?
hyperthyroidism, BBer
Decreased cardiac index + increased PCWP =
Acute MI
Maneuvers that decrease MVP and HCOM
Valsalva
standing
Handgrip decreases what murmurs
HCOM
AS
Post MI ventricular aneurysm:
clinical findings
heart failure, angina, ventricular arrhythmia
Post MI ventricular aneurysm:
ECG findings
echo
persistent Q waves
thinned myocardial wall
Treatment for cardiomyopathy 2/2 alcohol use
abstinence will ^^ LV fxn
cholesterol emboli lab findings
eosinophilia
high creatinine/BUN
low complement
Meds that increase survivial in LV systolic dysfunction
BBer
ACEi/ ARB
mineralocorticoid antagonists
In AA:
hydral
nitrates
Adenosine treats ?
mechanism?
narrow tachy, can help identify P waves
slows AV node
electrical alternans + sinus tach=
large pericardial effusion –> do pericardiocentesis
Cor pulmonale sequence of events
^^Pulm art pressure –> RVP –> RV failure
Marfarns murmur
early LSB diastolic murmur
aortic regurg
AV block + infective endocarditis=
perivavular abscess
Wells Criteria scoring
more than 4= likely PE 3+= DVT on exam, no other cause likely 1.5+= hx DVT/ PE HR above 100 recent sx/ immobilization 1+ = cancer hemoptysis
Any diastolic murmur requires
echo
CHF effect on kidney
^^RAAS
efferent constriction
high IG pressure
high GFR
Treatment of all persistent tachyarrythmia (narrow and wide)
SCD
except v fib, pulseless vtach
Adult Coarctation:
symptoms
UE HTN
H/A
epistaxis
brachial femoral delay
Adult Coarctation murmur
systolic murmur +/- continuous murmur if there are collaterals
Treatment of afib in WPW
cardiovert or antiarrythmics
cannot use BBer, CCB, dig, adenosine in WPW b/c ^^ accessory conduction
Acute inferior MI assc murmur
MR –> pulm edema and ^^LV filling pressure
