Cardio Flashcards
Kussmaul’s sign
JVD rise on inspiration. indicative of right ventricular filling - right sided heart failure. it is a requent finding in patients with constrictive PERICARDITIS on right ventricular infarction
Coarctation of the aorta
affects outflow from the heart d/t stenosis in which results in delayed and decrease on femoral pulses.
The condition is characterized by chest pain, fever, pericarditis with a pericardial friction rub, pericardial effusion, pleurisy, pleural effusions, and multiple joint pain. The cause is thought to be an autoimmune response to the damaged myocardial tissue and pericardium. there is minimal or no increase in cardiac enzymes.
Dressler’s syndrome Treatment includes the use of aspirin, NSAIDs, and, in some cases, corticosteroids.
Pericarditis
- Inflammation of Pericardium
- Fibrous (Dry) or Effusive (purulent, serous, or hemorrhagic)
- Triad of signs: chest pain, pericardial friction rub, and serial ECG changes.
- S/sx: chest pain, fever, myalgia, tripod position, peripheral edema, increase in JVP, (signs of right sided heart failure)
- diagnostics: ecg shows Global ST elevation, PR depression, echocardiogram, serum troponin, ESR, c-reactive protein, FBC, Serum urea
- Management: Periocardiocentesis for tamponade, symptomatic pericardial effusion
Treatment for Recurrent Pericarditis
NSAID + PPI, +/- Cholchicine, +/- Corticorsteriod (severe)
chest discomfort described as dull, aching, or pressure
MI, anginal chest pain
A 64 year-old male, with a long history of COPD, presents with increasing fatigue over the last three months. The patient has stopped playing golf and also complains of decreased appetite, chronic cough and a bloated feeling. Physical examination reveals distant heart sounds, questionable gallop, lungs with decreased breath sounds at lung bases and the abdomen reveals RUQ tenderness with the liver two finger-breadths below the costal margin, the extremities show 2+/4+ pitting edema. Labs reveal the serum creatinine level 1.6 mg/dl, BUN 42 mg/dl, liver function test’s mildly elevated and the CBC to be normal. Which of the following is the most likely diagnosis?
Signs of right ventricular failure are fluid retention i.e. edema, hepatic congestion and possibly ascites.
Results of a beta-natriuretic peptide (BNP)
An elevated BNP is seen in a situation where there is increased pressure in the ventricle during diastole. This is representative of the left ventricle being stretched excessively when a patient has CHF. Sending a patient home would be inappropriate in this case.
In congestive heart failure the mechanism responsible for the production of an S3 gallop is
A contraction of atria in late diastole against a stiffened ventricle.
B rapid ventricular filling during early diastole.
C vibration of a partially closed mitral valve during mid to late diastole.
D secondary to closure of the mitral valve leaflets during systole.
Rapid ventricular filling during early diastole is the mechanism responsible for the S3.
CHF
Congestive heart failure.
Treatment - ACE inhibitor, give lasix for acute phase.
S/Sx cardiomyopathy develops fatigue, increasing dyspnea, lower extremity edema. denies fever
Which of the following is a cause of high output heart failure?
thyrotoxicosis
High output heart failure occurs in patients with reduced systemic vascular resistance. Examples include: thyrotoxicosis, anemia, pregnancy, beriberi and Paget’s disease. Patients with high output heart failure usually have normal pump function, but it is not adequate to meet the high metabolic demands.
Class Functional Capacity
I Patients without limitation of physical activity
II Patients with slight limitation of physical activity, in which ordinary physical activity leads to fatigue, palpitation, dyspnea, or anginal pain; they are comfortable at rest
III Patients with marked limitation of physical activity, in which less than ordinary activity results in fatigue, palpitation, dyspnea, or anginal pain; they are comfortable at rest
IV Patients who are not only unable to carry on any physical activity without discomfort but who also have symptoms of heart failure or the anginal syndrome even at rest; the patient’s discomfort increases if any physical activity is undertaken
Functional Classification of Heart Failure
Which of the following should be avoided in patients with heart failure? A Diuretics B Digoxin C Anticoagulants D Calcium channel block
The ACC/AHA guidelines advise that nonsteroidal anti-inflammatory drugs (NSAIDs), calcium channel blockers, and most antiarrhythmic agents may exacerbate heart failure and should be avoided in most patients. NSAIDs can cause sodium retention and peripheral vasoconstriction and can attenuate the efficacy and enhance the toxicity of diuretics and ACE inhibitors.
In which of the following categories of patients do AHA/ACC guidelines indicate ICDs?
Patients with symptomatic documented hemodynamically unstable ventricular tachycardia with an LVEF < 40%
B Patients who have no history of prior rhythm problems with an LVEF of 40%
C Patients who are asymptomatic (NYHA class I) with an LVEF of 35%
D Patients who are newly diagnosed with an LVEF of 35% 10 days post-MI
The AHA/ACC recommend ICD placement for the following categories of heart failure patients:
Patients with LV dysfunction (LVEF ≤ 35%) from a previous MI who are at least 40 days post-Ml
Patients with nonischemic cardiomyopathy; with an LVEF ≤ 35%; in NYHA class II or III; receiving optimal medical therapy; and expected to survive longer than 1 year with good functional status
Patients with ischemic cardiomyopathy who are at least 40 days post-MI; have an LVEF of ≤ 30%; are in NYHA functional class I; are on chronic optimal medical therapy; and are expected to survive longer than 1 year with good functional status
Patients who have had ventricular fibrillation
Patients with documented hemodynamically unstable ventricular tachycardia (VT) and/or VT with syncope; with an LVEF < 40%; on optimal medical therapy; and expected to survive longer than 1 year with good functional status
↑ BP + target organ damage DBP > 130
Hypertensive Emergency - BP must be reduced in 1 hour to avoid morbidity or death. Reduce pressure by no more than 25% within 1-2 hours and then towards 160/100 within 2-6 hours
Malignant Hypertension
DBP ≥ 130
SBP ≥ 200
Characterized by encephalopathy or nephropathy with papilledema
Ace inhibitors s/e
Associated with cough, angioedema and can cause hyperkalemia
Spironolactone s/e
hyperkalemia
β-blockers s/e and contraindication
Contraindicated in Asthma and may cause impotence
calcium channel blocker s/e
cause leg edema
Verapamil and Diltiazem action
rate control CCBs
α-blockers used for
This class of medicine can be used to treat hypertension and BPH
Hydralazine use and s/e
Lupus like syndrome and can cause pericarditis
Patient will present as → a 22-year-old male is brought to the emergency room after sustaining a stab wound in the chest. He reports shortness of breath. On physical examination, his vital signs are a temperature of 37 C, heart rate 121 bpm, blood pressure 90/60 mmHg, respiratory rate 20 rpm, and oxygen saturation 99% on room air. Physical examination is significant for muffled heart sounds and a drop of BP > 10 mm Hg systolic with inspiration. You note his neck veins are distended. He does not respond to aggressive fluid resuscitation. You order a chest x-ray and the EKG reveals low voltage QRS complexes and electrical alternans.
….
The 3 D’s: Distant heart sounds, Distended jugular veins, and Decreased arterial pressure
Beck’s triad:
Hypotension
Muffled heart sounds
Elevated neck veins (JVD)
Cardiac tamponade
What is cardiac tamponade
Bleeding into the pericardial sac, resulting in constriction of heart, decreasing inflow and resulting in decreased cardiac output (the pericardium does not stretch!)
What is one of the most consistent clinical findings with pericardial tamponade?
Pulsus paradoxus, which is not specific to tamponade
