cardio amboss Flashcards
what happens to the hemodynamic parameters in septic shock
pathologic vasodilation caused by inflammation results in reduced systemic vascular resistance, as well as decreased CVP and PCWP. The decrease in the preload and the afterload will cause an increase in heart rate and thus an increase in the cardiac output
warm and flushed skin
what happens to the hemodynamic parameters in neurogenic shock.
there is a decrease in all of the parameters
what happens to the hemodynamic parameters in hypovolemic shock
There is an increase in SVR. a decrease in CVP and PCWP as the blood volume is reduced. There is also a decrease in the CO as there is less blood return to the heart due to reduced stroke volume
Cold and clammy skin
what happens to the hemodynamic parameters in cardiogenic shock
There is a decrease in the CO. There is an increase in SVR due to sympathetic response of poor output. Furthermore PCWP and CVP both increased due to the lack of forward flow from the heart
what is the diagnosis in an ECG showing no P waves but tachycardia
this is AV node reentrant tachycardia
what is the best first treatment for paroxysmal supreventricular tachycardia
vagal maneuvers
what is second line treatment for PSVT
adenosine
can you use procainamide for pSVT
yes, as second line therapy
premature ventricular contractions are what
brief episodes of V tach caused by lack of sleep, alcohol, caffeine, nicotine
what is the treatment for PVC in a young person that has been staying up late studying in college with no drug use
observation and rest
what are PVC usually described as by the patient
feels like my heart is skipping a beat
what is the treatment for ventricular tachycardia
synchronized cardioversion NOT defibrillation
what are beck’s triad and what does it indicate
muffled heart sounds, hypotension and JVD
cardiac tamponade
what is a physiological cause of cardiac tamponade
diabetes can cause renal insufficiency and then accumulation of urea. urea can cause a pericardial effusion
what is the treatment for pericardial tamponade
pericardial centesis
if a patient is found to be septic with strep. gallolyticus what should be a follow up test
a colonoscopy to assess for colorectal cancer as this is a common GI bug. there is a well known link between strep gallolyticus/GI cancer and bacterial endocarditis
what is the initial treatment and the follow up treatment for rheumatic heart disease with carditis but no valvular damage
initially treat with aspirin and penicillin then follow up Intramuscular benzathine penicillin every 4 weeks for 10 years (or until 21 years of age, whichever is longer) is recommended for secondary prophylaxis of recurrent acute rheumatic fever in patients with manifestations of carditis but no permanent valvular damage.
what are the jones criteria
Major criteria
Arthritis (migratory polyarthritis involving primarily the large joints)
Carditis (pancarditis, including valvulitis)
Sydenham chorea (CNS involvement)
Subcutaneous nodules
Erythema marginatum
Minor criteria Arthralgia Fever ↑ Acute phase reactants (ESR, CRP) Prolonged PR interval on electrocardiogram
what is the most common cause of viral myocarditis in children
coxsackie B virus
what are the echo findings for viral myocarditis
Left ventricular dilation and (usually global) hypokinesis
what is the presentation of viral myocarditis
Subacute onset of dyspnea, chest pain, jugular distention, and inspiratory crackles on lung auscultation is consistent with heart failure, most likely secondary to myocarditis.
what are the lab findings for myocardiitis
↑ Cardiac enzymes (CK, CK-MB, troponin T) ↑ ESR (and CRP) Leukocytosis ↑ BNP Virus serology
what type of myopathy is viral cardiomyopahty
dilated
what does pericarditis put you at risk for
cardiac tamponade due to effusion
Antimicrobial prophylaxis for endocarditis is recommended for
high-risk patients (e.g., patients with prosthetic heart valves, a history of infectious endocarditis, or an unrepaired cyanotic congenital heart defect) undergoing procedures that often result in bacteremia with common pathogens of infective endocarditis.
what is the most commonly used antibiotic for prophylaxis
amoxicillin
do patients have to stop their anticoagulants for dental procedures
no
what is the most common cause of prosthetic valve endocarditis, when is it of particular concern
Staphylococcus epidermidis
and is of particular concern in the first year after valve placement surgery.
what is the treatment for staph epidermidis endocarditis
IV combination therapy with nafcillin and rifampin can be used for at least 6 weeks in combination with gentamicin for 2 weeks to treat S. epidermidis prosthetic valve endocarditis, which requires a longer duration of therapy than native valve endocarditis. Surgical valve replacement may be required.
what is the most likely sequalae of drug-use infective endocarditis
pulmonary embolus
are splinter hemorrhages found in drug-use induced infective endocarditis
no. they are found in left0-sided endocarditis
Patients with left-sided (aortic valve or mitral valve) endocarditis more commonly present with
emboli to the retina (Roth spots), extremities (Janeway lesions, Osler nodes, splinter hemorrhages), kidney, brain, and spleen.
what is the most common cause of bacterial endocarditis in all groups
staph aureus
what is the most common cause of bacterial endocarditis in people with damaged heart valves, such as bicuspid aortic valve
strep sanguinis
what at the HACEK organisms are why are they important
A group of fastidious organisms that are normally part of the oral and pharyngeal flora. Members of this group include species of the Haemophilus genus, Aggregatibacter actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, and Kingella kingae. HACEK organisms can cause infective endocarditis.
what is the treatment for HACEK endfocarditis
IV ceftriaxone
what are the duke criteria
two major criteria, one major and three minor criteria, or five minor criteria.
Major criteria include: (1) two separate blood cultures positive for typical pathogens and (2) evidence of endocardial involvement in echocardiography.
Minor criteria include: (1) underlying heart disease or IV drug abuse, (2) fever, (3) signs of embolism, (4) immunologic findings (e.g., Osler nodes), (5) Roth spots, and (6) positive blood culture for an atypical pathogen.
what is coagulase negative staph
and where does it usually come from to cause disease
staph epidermidis
infected peripheral venous catheter
pulsus paradoxus
A drop in systolic blood pressure > 10 mm Hg during inspiration is a sign observed in pathologies such as severe asthma, tension pneumothorax, constrictive pericarditis, and moderate and severe cardiac tamponade. I
what does an S3 indicate
An S3 gallop is due to a sudden deceleration of blood flow from the left atrium into the left ventricle
Can be normal variant in young, healthy individuals, but can be also associated with congestive heart failure, dilated cardiomyopathy, and/or volume overload.
aortic regurgitation
A valvular disease characterized by incomplete closure of the aortic valve, causing reflux of blood from the aorta into the left ventricle during diastole. On auscultation, characterized by S3 and a high-pitched, decrescendo, early diastolic murmur.
what is the treatment for acute mesenteric ischemia
balloon angioplasty and stenting
Mitral valve regurgitation presents as a
high-frequency, holosystolic blowing murmur that may radiate to the axilla and is best heard at the apex.
Mitral valve prolapse (MVP) is how common and presents how
the most common valvular abnormality in the US and is usually asymptomatic, as in this patient. It typically presents as a high-frequency, mid-systolic click combined with a high-frequency, mid-to-late systolic murmur heard best at the apex
what is the next step if claudication/PAD is assumed
ankle brachial index
Reduced ABI values between what values indicate mild to moderate PAD with claudication and below those values indicates what
0.4–0.9 whereas values below 0.4 correlate to severe PAD with resting pain and/or gangrene.
what causes a plopping heart murmur
cardiac myxoma
does tamsulosin cause orthostatic hypotensino
rarely. it has the most specificity for the prostate
what causes a systolic murmur at the apex
mitral regurgitation
what can cause a new onset mitral regurg
MI subsequent rupture of the papillary muscles.
what can cause a new onset LBBB
MI
cardiogenic shock
hemodynamically unstable patient with a history of atherosclerotic disease has a combination of pulmonary edema, jugular venous distention, and cold, clammy skin,
what is the alternative to CT angio for diagnosing aortic dissection
trans esophageal echo
what is a contraindication to CT angio for diagnosing aortic dissection
renal insufficiency
cardiac contusion can cause what
cardiogenic shock
arrhythmias
if the well’s score is above 4 what is the next step
begin heparin. then CT angio
what is correct management for a pseudoaneurysm
ultrasound guided thrombin injection
what is the strongest risk factor for development and rupture of AAA
smoking
what is the best test for diagnosing acute limb ischemia
digital subtraction angiography
what is Digital subtraction angiography
An imaging method that involves taking a series of x-rays at timed intervals while injecting IV contrast. The pre-contrast images are then digitally subtracted from the images taken with IV contrast to visualize the artery of interest. This test has the highest diagnostic accuracy in testing for peripheral arterial disease and allows real-time visualization of the patient’s arteries.
what is the presentation of mitral valve stenosis
elevated left atrial pressure, causing both left atrial dilatation (resulting in atrial fibrillation) and an increase in pulmonary arterial pressure to overcome the increased left heart pressure (pulmonary hypertension). Over time, this will lead to pulmonary vascular remodeling, increased pulmonary vascular resistance, an S2 split, and right ventricular hypertrophy (as indicated by the right axis deviation) to compensate. RV failure eventually leads to characteristic signs of right heart failure (jugular venous distention and pitting edema).
features of mitral stenosis murmur and consequence s
(opening snap and diastolic murmur along with atrial fibrillation
constrictive pericarditis,
dyspnea, ascites (distended abdomen, shifting dullness), and peripheral edema has a positive Kussmaul’s sign (increase in jugular venous pressure during inspiration) and a pericardial knock (early diastolic sound over the left sternal border). calcifications on chest x-ray and an exaggerated variation of blood flow with respiration on echocardiography indicate which may be confirmed by a positive square root sign on cardiac catheterization (dip-and-plateau waveform).
the fixed (no change with respiration), widely split S2 being the most specific.
atrial septal defect (ASD)
ASD presents how
systolic ejection murmur left upper sternal border and mid-diastolic murmur along the lower left eternal border
when does rib notching show up on X ray and what is the diagnosis
coarctation and not until 5
what is the diagnosis if someone has syncope while tightening a tie
carotid sinus hypersensitivity
what is the cause of VSD intracardiac shunting as the child gets older
As the child gets older they will start to have sweating and cyanosis while feeding. this is due to decreased pulmonary vascular resistance causing the left to right shunt as the child gets older.
what is the presentation of DiGeorge syndrome
micrognathia, cleft palate, a broad nasal bridge, a short philtrum, and low-set ears
truncus arteriosus defect (single overriding vessel seen on echocardiography). Conotruncal abnormalities (e.g., tetralogy of Fallot or persistent truncus arteriosus)
Ventricular septal defect (VSD)
Atrial septal defect (ASD)
impaired development of the parathyroid glands, leading to hypoparathyroidism and hypocalcemia,
thymus aplasia
ebsteins anomaly.
This anomaly typically leads to right atrial enlargement, elongation of the tricuspid valve leaflets, and tricuspid regurgitation, Displaced valve reduces the ventricular volume → regurgitation into the right atrium (tricuspid regurgitation) → atrial dilatation; poorly functioning, small RV (atrialization of the right ventricle); functional pulmonary valve atresia ; obstruction of the RV outflow by the large, sail-like anterior leaflet → blood flows through the patent foramen ovale (right-to-left shunt) → cyanosis
what is the most common heart defect in down syndrome
atrioventricular septal defect
endocardial cushion defects.
treatment for endocardial cushion defects in downs
Diuretics, inotropic agents, and ACE inhibitors are usually given to improve cardiac function. Definitive treatment consists of complete surgical repair.
what are the associated causes of endocardial defects
down sydnrome, maternal diabetes and obesity
what is a endocardial cushion defect
Defect of atrioventricular valves (i.e., mitral and tricuspid valves) as well as the atrial septum and/or ventricular septum
Complete form: ASD and VSD, common AV valve
Partial form: only ASD and minor atrioventricular valve abnormalities
where there is literally only one atrio-ventricular valve and a VSD and ASD; so no tricuspid and mitral, just one valve
what is the management for a small VSD in newborn
outpatient followup. they usually close spontaneously
what do you NOT give to a baby with VSD
prostaglandin; this would increase the left to right shunting and exacerbate the symptoms of the VSD
what is the management of an ASD/PFO
no intervention
what is a venous hum
common benign finding in childhood caused by turbulence in the jugular vein. characteristically disappears when the child flexes the neck or increases the pressure in the jugular.
what is tetralogy of fallot
(a) Pulmonary stenosis
(b) Right ventricular hypertrophy
(c) Ventricular septal defect (VSD)
(d) An overriding aorta (above the VSD)
what determines the degree of cyanosis in TOF
The degree of right ventricular outflow tract obstruction
THE FUCKING DEGREE OF RIGHT-SIDED. RIGHT-SIDED RIGHT-SIDED OUTFLOW TRACT OBSTRUCTION
The more obstructed the right side, the more deoxygenated blood will flow out the left side
what is tricuspid valve atresia
cyanotic neonate, an imperforate atrioventricular septum in the right side. blood is unable to pass from the right atrium (RA) to the right ventricle (RV). Consequently, the RV is almost always hypoplastic. Venous blood, therefore, passes from the RA via the atrial septal defect (ASD) to the left atrium (LA), where it mixes with oxygenated blood from the lungs. The mixed blood is pumped from the left ventricle (LV) into the systemic circulation (resulting in cyanosis) and pulmonary circulation (via a patent ductus arteriosus). LV hypertrophy occurs because the LV is single-handedly pumping blood through both the pulmonary and systemic circulation.
What is the cause of cyanosis with crying and playing and failure to thrive
tet spell.
what is likely to be found with TOF
right axis deviation.
what’s a common heart defect of marfans and how does it present
aortic regurgitation.
diastolic murmur, water hammer pulse
also find mitral valve prolapse