cardio 6 Flashcards
Poor prognostic factor in systolic heart failure indicators?
Clinical, laboratory, ECG, ECG, and Ass. symptoms
Clinical?
Hypotension Resting tachycardia Low maximal o2 consumption S3 gallop Elevated JVP Moderate to severe MR High NYHA class
Laboratory?
Hyponatremia(indipedent prognostic indicator) High pro-BNP(a non-functional hormone secreted with VNP) level Renal failure
ECG?
Wide QRS(>120ms) left bundle branch block
ECHO?
Severe LV dysfunction Concomitant diastolic dysfunction Reduced right ventricular function Pulmonary HYTN
Associated factor?
Anemia Atrial fibrilation DM
electrolyte abnormality in HF?
Hyponatremia Hyperkalimia
Hyponatremia mechanism and management?
Due to high ADH Treat with free water restriction Don’t give free salt unlike SIADH secretion-it will Exacerbate fluid retention.
Hyperkalemia mechanism and management?
Low distal Na delivery–Poor K excretion The loop diuretic will lower it
Clinical future of MS?
SOCPS
Skeletal?
Archinoductly(spider finger) Decrease upper to lower body segment ratio Increase arm to length ratio Pectus deformity, scoliosis, and kyphosis Joint hypermotility
Ocular?
Ectopia lentis(Upward and lateral)
CVS?
Aortic regurgitation, dilation, and dissection MVP
pulmonary?
Spontaneous pneumothorax from apical blub
Skin?
Recurrent incisional hernia Skin stria
How we differentiate the cause of AR based on the location of the murmur?
If due to aortic dilation -we hear on right 2nd ICS If due to valvular disease-we hear on left 3rd and 4th ICS.
Genetics of MS?
It is Autosomal dominant Defect in fibrillin 1 gene
What is holt ORAM disease?
Is ASD with upper extremity deformity
Acute decompesated HF managment clasification?
Patient with normal or elevated blood pressure and hypotension.
Patient with normal or elevated blood pressure?
Oxygen Agresive Diuretic treatment vasodilator(notroglycerine or nitropuriside)
Patient with low blood pressure?
oxygen Diuretic as apropriate IV vasopressor (NE,Dobutamin..)
Role of nitrate?
Decrease preload –Decrease dyspnea
When a patient with normal LV function develops pulmonary edema?
When patient has High blood pressure Renal artery stenosis severe renal disease with volume overload
Ethology of aortic coarctation?
Congenital Acquired(rare)–Takayasu
clinical manifestations(in post ductal/adult form0?
UB-well developed, HTN(Headache and epitaxis0 LB-Underdevelopment,claudication Brachiofemoral delay Blood pressure difference in U nad L ex. Left intercostal continuous or systolic murmur NB:In preductal there is other finding
ECG finding?
Left ventricular hypertrophy(high QRS, ST depression, and T wave inversion in the left precordial lead.
Echo?
Diagnostic confirmation(coarctaation mainley at distal segment)
CXR
inferior noching in 3-8 ribs 3-sign
treatment?
Balloon angioplasty +- stent Surgery
How to measure b/p
Bilateral in both extremity Upper on supine lower on pron position
Benifit of asprin in MI?
Reduce the rate of MI Decrease risk of strok Reduce mortality
When we give heparin in ACS suspicion?
when we have ECG confirmation
Walles criterion in PE?
3,1.5, and 1 score criterion <=4–less likely >4—high likely
3 point
-DVT -Other than PE is less likely
1.5
-Previous history of DVT -HR>100 -Recent surgery or immobilization
1
-Hemoptisis -cancer
supraventricular tacycardia diagosis?
Regular(exept Af,AFl), narrow QRS, and high HR
Types of SVT?
sinus T AVNRT AVRT AFIB AFLU multifocal AT junctional T
symptom of SVT?
palpitation dizziness and lightheadedness syncope diaphoresis and SOB
Type of PSVT?
AVRT AVNRT Atrial tachycardia and junctional tachycardia
How to differentiate Type of SVT? done in the first step in hemodynamically stable patients.
Vegal maneuver or adenosine–slow AV conduction
Effect in node dependent T(AVRT and AVNRT)
terminate arrhythmia
Effect in AFLU and atrial tachycardia?
slow conduction–unmask hidden p wave
supra ventricular ECG future?
Narrow QRS Absent P wave(masked in QRS) Retrograde p wave
Retrograde p wave location?
Before QRS After QRS at the apex of QRS
Risk factors for SVT?
Age. Coronary artery disease Congenital heart disease. Thyroid problems. Drugs and supplements. cough and cold medicines Anxiety or emotional stress Physical fatigue Diabetes. Obstructive sleep apnea. Nicotine and illegal drug use.
When we consider isolated ambulatory hypertension?
When a patient has normal blood pressure but has hypertension-related complication signs snd symptoms.
IAH (masked hypertension) diagnosis?
By ambulatory blood pressure monitoring.
How ABPM did
First morning 2x and evening 3x record of elevated blood pressure monitoring.–If abnormality detected do 24 hr continuous B/P monitoring IF B/P >135>85 diagnos HTN
How do we manage pulseless electrical activity?
If SVT is like AF–consider it as asystole, so DO CPR and give vasopressor first then use a defibrillator if you find shockable waves. If VT–Do defibrillation
What is the D/C between defibrillation and Synchronized cardioversion?
three
Defibrillator?
Give just energy to heart electrical activity without synchronization to QRS complex.
Used for VT(with asystole also)
Used for SCA with VF Not used for PEA until you get shockable wave
SCV?
used in persistent symptomatic or hemodynamic unstable patients with VTAC and SVT with rapid ventricular response synchronized to QRS complex
epistaxis and cold symptom in cocaine?
Nasal usage and HTN. A patient may have a tremor
less common endocrine cause of 2ndary HYTN?
hypothyroidism a primary hyperparathyroidism
Renal venous pressure in HF?
Increase due to increase systemic pressure
Stent thrombosis cause?
Medication non adherence (Asprin and Clopidogril)
Duration post stent antithrombotic treatment
6-12 month(recapitalization occur afterward)
Cause of MS in western?
Age-related or radiation-induced
Diagnosis?
Early diastolic sound(OS) with mid-diastolic murmur Echo: high-velocity blood flow through the mitral valve
Management of MS?
Percutaneous valvotomy or surgery If have concomitant AF: warfarin
S/E latex found in glove and folly catheter?
anaphylaxis
c.menifestation of ventricular aneurysm?
Several weeks following MI Heart failure and angina ventricular arrhythmia Systemic embolization
Diagnosis?
ECG: Persistent ST elevation and Q wave ECHO: Thin dyskinetic ventricular wall
What is the specificity of the S3 gallop and its correlation?
99% correlated with left atrial with/out ventricular increment in pressure and BNP
What is specific for digoxin toxicity in ECG?
Atrial tachycardia with AV block(Toxicity)
Below mentioned may not indicate toxicity
1-Downsloping ST depression
2-Flattened, inverted, or biphasic T waves.
3-Shortened QT interval.
Is digoxin use other than HF?
Atrial fibrillation
Clinical presentation of vasospastic angina?
young patient <50
smoking
recurrent chest pain
pain occurs in rest mainly at sleep
resolve within 10-15 min
Diagnosis?
Ambulatory ECG—Transient ST elevation Coronary angiography–no NAD
TREATMENT
CCB(PREVENTIVE) NITRATE(abortive)
Stress-induced (Tocostubo) cardiomyopathy risk
Postmenopausal women Recent physical or emotional stress
Clinical manifestation?
Chest pain mimicking MI Heart failure Moderate troponin elevation ECG-Ischemia sign
Diagnosis?
Catheterization: No CAD ECHO: LV hypokinesis and basilar hyperkinesis
Pathophysiology of TC?
Caticolamin surge –vessel obstruction –myocardial stunning — contractile dysfunction
