Cardio and pulm Flashcards
Symptoms of beta blocker intoxication
Bradycardia, AV block, Hypotension, diffuse wheezing
Treatment for beta blocker intoxication
Secure airway
Isotonic fluid
IV atropine
if no change, IV glucagon
Patient OD with sx bradycardia, AV block, hypotension, diffuse wheezing
Beta blockers
OD with sx: fatigue anorexia, nausea, blurred vision, disturbed color perception, arrhythmias
Digoxin
Next steps if hear diastolic murmur
Echo
gradually decreasing diastolic murmur best heard with full expiration
Aortic regurgitation
Aortic regurg murmur
Diastolic, high-pitched blowing on left sternal border.
best heard with full expiration
Work up for mid systolic murmur in young asymptomatic adults
NONE
What is isolated systolic hypertension?
systolic >140 with diastolic
Pathophysiology of isolated systolic HTN
Increased stiffness or decreased elasticity of aortic and arterial walls in elderly.
Murmur for aortic insufficiency
early diastolic murmur with echo showing aortic regurg
Hyperdynamic states
anemia, hyperthyroid, av fistula
Signs of hyper dynamic circulation
ventricular heave, hyper dynamic precordium
Features of chest pain caused by MSK
- Persistant pain
- worse with movement
- often after repetitive activity
Features of chest pain caused by GI or esophageal
- Nonexertional pain lasting more than 1hr
- Upper abd and substernal
- Associated with regurgitation, nausea, dysphagia
- NOCTURNAL pain
Chest pain due to pericarditis
sharp/stabbing
- worse with inspiration
- worse when laying flat
Signs and sx of constrictive pericarditis
fatigue and dyspnea (2/2 decreased CO)
-elevated JVP, ascites, pedal edema (signs of venous overload)
- Pericardial knock
- Kussmaul’s sign–lack of inspiratory decline in CVP
- pericardial calcifications
Causes of constrictive pericarditis
Idiopathic or viral
cardiac surgery or radiation therapy
TB
Causes of cor pulmonale
COPD and PE
complicated parapneumonic effusion characteristics
EXUDATIVE
HIGH protein
low glucose (
uncomplicated vs. complicated parapneumonic effusion
Uncomplicated: just fluid- high pH, nl to low glucose, responds to antibiotics
Complicated: bacteria growing in fluid- low pH, low glucose, usually needs drainage
CXR–loculation
Empyema: purulent with positive culture
Exertion dyspnea, chest pain, fatigue, palpitations, pre syncope, syncope
Hypertrophic cardiomyopathy
Maneuvers that decrease intensity of HCM murmur
reduced by increasing after load or preload:
sustained hand grip, squatting from standing, passive leg raise
Murmur of HCM
harsh crescendo-decrescendo systolic murmur at apex
What makes HCM murmur louder
decrease preload:
valsava
standing up from sitting
Nitroglycerine
Management of acute aortic dissection
- Pain relief (morphine)
- IV BB
- ICU
- Vasodilator (nitroprusside) if BP remains high
- surgery
Think it is a PE? What criteria to use?
Wells:
(+3): signs of DVT or alternate dx less likely
(+1.5): previous PE or DVT, HR>100, Recent surgery
(+1): hemoptysis, cancer
> 4=PE likely
Cardiovascular features of Marfan syndrome
Aortic dilation, regurg, or dissection
Mitral valve prolapse
Pulmonary features of Marfan syndrome
Spontaneous pneumothorax from apical blebs
Murmur of aortic regurgitation
early decrescendo diastolic murmur on left sternal border.
Characteristics of atheroembolism (cholesterol embolism)
- skin findings (blue toe syndrome, lived reticularis)
- cerebral or intestinal ischemia
- AKI
- Hollenhorst plaques (yellow plaques in retina)
Timing of cholesterol embolism
immediately or > 30 days after cardiac catheterization.
Tumor that produces beta-HCG and AF
nonseminomatous germ cell tumor
ABG in pt with acute asthma exacerbation
Resp alkalosis (hyperventilation) Low PCO2
Empiric tx for postnasal drip
Oral first-generation antihistamines or combined antihistamine-decongestant
Acute right heart strain
JVD, RBBB
Massive PE
hypotension, syncope, right heart strain, JVD
Ventricular aneurysm EKG
5d to 3 mo post MI
persistent ST-segment elevation after recent MI and deep Q waves in the same leads.
infective endocarditis + new conduction abnormality
perivalvular abscess
Signs of severe aortic stenosis
- delayed and diminished carotid pulse (pulses parvus and tradus)
- Presence of single and soft second heart sound
- mid to late peaking systolic murmur
Signs of cyanide toxicity
AMS, lactic acidosis, seizures, coma
can be due to nitroprusside infusion
