Cardio EM part 2 Flashcards
atrial fibrillation is characterized by about how many atrial depolarizations per minute? what ventricular rate is typically seen?
400-600 depolarization/minute
ventricular rate 120-180
if your patient with atrial fibrillation is not hemodynamically stable, what should your first priority be?
DC cardioversion
what are three major consequences of prolonged atrial fibrillation
1) thromboembolism
2) hypotension and decreased organ perfusion (decreased EF)
3) pulmonary congestion
untreated atrial fibrillation that lasts for 48-72 hours puts you at risk for what?
thromboembolism
if hemodynamically stable, what is the initial goal? how do we treat?
rate control
IV diltiazem effective for rapid control (slows AV node)
alternative: IV beta blocker (esmolol)
if atrial fibrillation is present for over 48-72 hours, how will you manage your patient? (3 steps)
1) fully anticoagulate for 3 weeks (coumadin)
2) cardioversion 3 weeks after initiation of coumadin
3) continue anticoagulation for one month
your patient has had atrial fibrillation for 72 hours. you perform a TEE and rule out the presence of a thrombus. what should you do next?
you can skip the anticoagulation phase
jump straight to DC cardioversion
if your patient does not wish to undergo DC cardioversion or take oral medications to control their a-fib, what is the alternative?
ablation (both acceptable)
what is the IV medication that has been approved for rapid conversion of recent onset atrial fibrillation and flutter? how effective is it?
ibutilide, 45-50 percent effective
what is the main difference in treatment of a hypertensive urgency vs. hypertensive emergency?
hypertensive urgency = warrant BP lowering over a few hours
hypertensive emergency = warrant BP lowering within 1 hour
what are some examples of hypertensive urgencies vs. hypertensive emergencies?
hypertensive urgencies = high BP over 200/100 with optic disc edema, progressive target organ (kidney, heart) complications, perioperative HTN
hypertensive emergencies = hypertensive encephalopathy, hypertensive nephropathy
HA, irritability, confusion, altered mental status in your hypertensive patient characterize what emergency?
hypertensive encephalopathy
hematuria, proteinuria, progressive kidney dysfunction and necrosis may be signs of what?
hypertensive nephropathy
when is the only circumstance that you would consider lowering BP in your patient who is having an acute ischemic stroke?
if the BP is over 200/110
brain will auto-regulate perfusion
when lowering blood pressure, you should lower it no more than ___ percent within 2 hours, then more gradual lowering over _____ hours to a goal of ______
no more than 25 percent within 2 hours
gradual lowering over 2-6 hours to BP of 160/110
what can excessive lowering of BP lead to?
coronary, cerebral, renal ischemia
what is the one exception that does require aggressive lowering of BP?
acute aortic dissection
what are two calcium channel blockers used to lower BP during a hypertensive urgency/emergency?
nicardipine, clevipine
the pathologic dilatation of a segment of blood vessel is also known as what?
aortic aneurysm
what is the most common cause of aortic aneurysm?
atherosclerosis
what percentage of patients die from acute rupture of aortic aneurysm?
50 percent
75 percent of abdominal aneurysms are below which arteries?
renal arteries
what will you note on PE of a patient with an abdominal aortic aneurysm?
pulsatile, non-tender mass
you should screen male _____ over the age of __ with at least one of which 3 risk factors for aortic aneurysm?
male smokers over 60 years old with risk factors:
1) FH off AAA
2) presence of PAD/atherosclerosis
3) presence of peripheral artery aneurysms
