cardio flash-cards Flashcards
what is a hypertensive urgency?
over 220 systolic or 125 diastolic
what is a hypertensive emergency
diastolic >130
spironolactone
aldosterone receptor antagonists, increasingly used in refractory HTN; 2nd line for acute pulm edema or CHF
left sided failure
exertional dyspnea, nonprod cough, fatique, orthopnea, paroxsymal nocturnal dyspnea, basilar rales, gallops, exercise intolerance
right sided failure
distended neck veins, tender or nontender hepatic congestion, nausea, dependent pitting edema
diastolic failure cardiac sign
S4 gallop/hepatomegaly, ascites, JVD
kerley B lines
CHF CXR
nocturia, hypotension, narrow pulse pressure
CHF
CHF treatment and associated angina
loop or thiazide diuretic. Add an ACE. CCB(amlodipine) only to treat associated angina and HTN; LMNOP for pulm congestions
Levine’s sign
clenched fist over sternum and clenched teeth: ischemia
angina pectoris
midsternal but may radiate to jaw, shoulders, arms, wrists, back of the neck; usually on the left. lasts for 3 min
important marker in atherosclerosis
c reactive protein
how to control atherosclerosis
manage blood glucose and BP
what if angina pectoris lasts more than 30 min
unstable angina, MI, or another dx
EKG in angina
horizontal or downsloping ST segment depression. exercise testing will have a depression of 1 mm
definitive diagnostic test in angina
coronary angiography
SE of nitrates
HA, nausea, lightheadedness, hypoTN
medication for chronic angina
Beta blockers first line therapy. it prolongs life of pts with coronary disease
ranolazine
prolongs exercise duration and time to angina
CCB does what
decrease cardiac muscle oxygen demand but are third line agents
aortic stenosis
harsh systolic ejection murmur that radiates to the carotids; narrows the valve opening, impeding the ejection function of the left side of the heart
aortic insuffiency(regurge)
early decresendo DIASTOLIC murmur;results in volume overloading of the left ventricle
mitral stenosis
mid to late low pitch DIASTOLIC murmur; impedes blood flow between the left atrium and ventricle
mitral insufficiency
holosystolic;causes backflow and volume overload of the left atrium
MVP
asymptomatic, but it may cause mitral regurge
What does valve related progressive heart failure lead to?
pulmonary HTN and congestion
sx in valvular disorder
cough, dyspnea, fatigue, decreased exercise tolerance
thready carotid pulses
aortic stenosis
widenen pulse pressures
aortic insuffiency
MVP characteristics
thin females with minor chest wall deformities, midsystolic clicks and late systolic murmur
CXR of aortic valve disorders
left sided atrial enlargement and ventricular hypertrophy
CXR in mitral valve disorders
atrial enlargement alone
how to check pressure gradient assessment
doppler ultrasound
systemic venous congestion sx
JVD, peripheral edema, hepatomegaly
Aflutter occurs in what kind of pts
COPD, CAD, CHF, atrial septal defect
junctional rhythms occur in what pts
nml hearts, mycocarditis, CAD, digitalis toxicity
non pharm tx of PSVT
ablation, *synchronized cardioversion(not in dig toxicity)
medicine to treat PSVT
IV adenosine, PO verapamil.
pharmacological prevention of PSVT
diltiazem verapmil beta blocker
acute A-Fib tx and etio
cardiovert. PIRATES
chronic AFIB tx
rate control and prevention of thromoembolism
atrial flutter tx/ final
chemical conversion with ibutilide or electric cardioversion
chronic atrial flutter tx
amiodarone or dofetilide
what is V tach
3 or more consecutive ventricular premature beats; sustained/unsustained, frequent complication of acute MI and dilated cardiomyopathy
torsades be pointes
Vtach in which QRS complex twists aound the baseline; can happen with hypokalemia, hypomagnesemia, or following drugs that prolong QT
ventricular premature beats tx
beta blockers or class I and II
Vfib
no effective pumping action; sudden death; occurs in early morning
tx of Vtach with severe hypotension or loss of consciousness
synchronized cardioversion if unstable
medication tx of Vtach
lidocaine, procainimide, amiodarone. empiric magnesim
brugadas symdrome
occurs in asians and males. causes syncope, ventricular fib and sudden death. tx is implantable defibrillator
when is sick sinus syndrome reversible
if caused by digitalis, quinidine, beta blockers or aerosols
Describe “silent” MIs
1/3 of pts. most likely older people, women, DM
inferior changes will occur in what leads
II III aVF
posterior changes occur in what leads
V1 V2
anteroseptal changes occur in what leads
V1 V2
anteior changes occur in what leads
V1 V2 V3
anterolateral changes occur in what leads
V4 V5 V6
Cardio PE in ACS
nml or JVD, soft heart sounds, mitral regurge, S4 gallop
dresslers syndrome
post MI syndrome; pericarditis, fever, leukocytosis, pleural/percaridal effusion; usually 1-2 wks after
ECG changes in MI
progression from peaked T waves to ST elevation/depression to Q waves to T wave inversions that occur over hrs to days
doppler studies in MI
postinfarction ventricular septal defect or mitral regurge
CXR in MI
congestive failure or signs of aortic dissection
most sensitive test to quantify the extent of an infarction
MRI with gadolinium
Total CK
initial elevation at 3-5 h, peaks at 24h, and returns to normal with 28-72hr
LDH
initial elevation at 10h, peaks at 24-28h, and returns to normal with 10-14 days
what should u give ACS pts with ST elevation
antiplatelet therapy and anticoagulants
med tx in ACS
beta blocker(if not in hrt failure, bradycardic, heart block), CCB(if cannot take bblocker or nitrates )
what does cyanotic heart anomalies involve
right to left shunts
tetralogy of fallot description
subaortic septal defect, right ventricular outflow obstruction, overriding aorta, right ventricular hypertrophy
tetralogy of fallot murmur
crescendo-decrescendo, holosystolic at LSB, radiating to back
pulmonary atresia definition
pulmonary valve is closed, atrial septal opening and patent ductus arteriosus are present; emergency tx!
cyanosis, clubbing, increased RV impulse at LLSB, loud S2
tetralogy of fallot
cyanosis with tachypnea at birth, hyperdyamic apical impulse, single S1 and S2
pulm atresia
TET spells
cyanosis, hyperpnea, agitation
what is hypoplastic left heart sydrome
group of defects with a small left ventricle
transposition of great vessels PE
*cyanosis in newborn; loud S2 if large VSD
most common type of ASD
ostium secundum
atrial septal defect murmur
systolic ejection murmur second LICS; wide fixed split S2
what does right sided overload lead to
right sided cardiomegaly, systemic venous congestion, and rt sided heart failure
sx of tricuspid/pulmonic valve d/o
JVD, hepatomegaly, peripheral edema
CXR of tricuspid/pulmonic valve d/o
prominent rt heart border with dilation of SVC
ECG of tricuspid/pulmonic valve d/o
right axis deviation, P wave abnormality associated with right atrial enlargement; or prominent R and deep S waves of right ventricular hypertrophy
Tx of tricuspid/pulmonic valve d/o
Na restriction and diuretics to decrease volume filling and right atrial pressure. **surgery
how to treat pulm HTN
arterial vasodilators or positive inotrophic agents
aortic stenosis murmur characterisitics
2ICS; rad to neck and LSB; loud; best if pt sitting and leaning forward
aortic regurge murmur characteristics
2nd-4th LICS; rad to apex and RSB; Loud pitch; best heard sitting, leaning forward, full exhalation
austin flint murmur
midsystolic aortic regurge; suggests large flow nad arterial pulses large and bounding
mitral stenosis murmur characteristics
heard at apex, no rad, low pitch, heard best in left lateral position with full exhalation.
S1 accenuated; opening snap follows S2
mitral stenosis
mitral regurge murmur characteristics
heard at apex, rad to left axilla, med to high pitch.
S2 often decreased; apical impulse prolonged
mitral regurge
tricuspid regurge murmur characteristics
LLSB; holosystolic, rad to rt sternum and xiphoid; increased with inspiration. JVP elevated
2 murmurs with pansystolic timing
mitral regurge and tricuspic regurge
murmur with midsystolic timing
aortic stenosis
pulm stenosis murmur characteristics
2nd-3rd LICS; midsystoic crescendo-decrescendo; rad to left shoulder and neck; medium pitch.
early pulmonary ejection sound
pulm stenosis
medication for ventricular premature beats
beta blocker(class I and II) if pt is symptomatic
tx for severe V tach with severe hypoTN or loss of consciousness
synchronized cardioversion and maybe pacing
medications for Vtach
lidocaine, procainamide, amiodarone. empiric magnesium
what to do if in a ventricular arrhythmia with a pt with an identifiable site of arrhythmic origin
radiofrequency ablation
what to do in a recurrent sustained Vtach, for congenital long QT syndrome, brugadas syndrome
implantable defibrillator
torsades medication tx
beta blockers, magnesium, temporary atrial or ventricular pacing.
AV block sx
weakness, fatigue, light headedness, syncope
wenckebach
mobitz type II 2nd degree heart block
sick sinus sydrome tx
most require permanent pacing
AV conduction tx
cardiac pacing
common type of cardiomyopathy
dilated (affecting left ventricle)
causes of dilated cardiomyopathy
excessive ETOH, postpartum state, chemo toxicitiy, endocrinopathies, myocarditis, idiopathic
Takotsubo cardiomyopathy
occurs after a major catecholamine discharge; apical left ventricular ballooning with sx of acute MI
major cause of hypertrophic cardiomyopathy
genetic; usually asian descent or elderly
what is hypertrophic cardiomyopathy
4%; usually of the septum, small left ventricle, systolic anterior mitral motion, diastolic dysfunction
Sx for dilated cardiomyopathy
*dyspnea. S3 gallop, rales, increased JV pressure
Sx of hypertrophic cardiomyopathy
*dyspnea and angina. also maybe asymptomatic or sudden death
PE for hypertrophic cardiomyopathy
sustained point of maximal impulse or triple apical impulse, loud S4 gallop, variable systolic murmur, bisferens carotid pulse, JV pulsations with a prominent “a” wave
bisferens carotid pulse, JV pulsations with a prominent “a” wave
hypertrophic cardiomyopathy
restrictive cardiomyopathy Sx
decreased exercise tolerance; pulmonary HTN; in advanced disease will have right sided congestive failure
ECG in dilated cardiomyopathy
nonspecific ST and T wave changes, PVC(vent ectopy)
ECG in hypertrophic cardiomyopathy
nonspecific ST and T wave changes, exagerated Q waves, LVH
CXR in dilated cardiomyopathy
pulmonary congestion and cardiomegaly
CXR in hypertrophic cardiomyopathy
not remarkable
hrt studies show high diastolic pressures and low cardiac output
dilated hypertrophy
cardiac studies show LVH, asymmetric septal hypertrophy, small left ventricle, diastolic dysfunction
hypertrophic cardiomyopathy
Key test for restrictive cardiomyopathy
echocardiography! cardiac MRI is distinctive, cath shows reduced mildly left ventricular function.
tx for the cardiomyopathies
dilated(no ETOH, treat underlying cause, CHF); hypertrophic(beta blockers, CCB; disopyramide for negative inotrophic effects, ablation of hypertrophic septum); restrictive(diuretics)
percarditis common in who
men and those under 50 yrs old
what is cardiac tamponade
fluid compromises cardiac filling and impairs cardiac output
Sx of acute pericarditis
pleuritic substernal radiating chest pain relieved by sitting upright and leaning forward. *friction rub
sx of constrictive pericarditis
slowly progressing dyspnea, fatigue, weakness, accompanied by edema, hepatomegaly, ascites
sx of cardiac tamponade
tachycardia, narrow pulse pressure, pulsus paradoxus
ECG changes in pericardial disorders
nonspecific T wave changes and low QRS voltage.
what is pathognomonic for a pericardial effusion
electrical alternans
organism in prosthetic valve endocarditis
staph, gm neg, fungi in first 2 months; strep or staph later on
a changing murmur
rare but diagnostically significant in endocarditis
sx in endocarditis
none in elderly; fever and nonspecific sx
classic features on endocarditis
25% pts have this. palatal, conjunctival, subungal petechiae, splinter hemorrages, osler nodes, janeway lesions, and roth spots
roth spots
exudative lesions in the retina
common sx in endocarditis
pallor and splenomegaly; strokes and emboli may occur
pulm infiltrates on CXR
right side of hrt has endocarditis
antibiotic choice for endocarditis prophylaxis
amoxicillin
empiric antibiotic for endocarditis
vanco ply ceftriaxone
surgery for endocarditis?
maybe necessary, especially aortic valve
what is rheumatic fever
a systemic immune response occurring usually 2-3 wks following a beta hemolytic streptococcal pharyngitis
common people rheumatic hrt disease occurs in
recent immigrants; kids 5-15 years of age
perivascular granuloma lesion with vasculitis
rheumatic valve disease
valve most commonly involved in rheumatic heart disease
mitral(75-80%) then aortic(30%). aortic and tricuspid rarely occurs in isolation
medication tx for rheumatic heart disease
IM PCN, if allergic then emycin
Leriche’s syndrome
ED occurring with iliac artery disease
ankle brachia index for PAD
less than 0.9 indicates significant disease
tests to order for PAD
CT or magnetic resonance angiography
drug for PAD
cilostazol; sildenafil for ED.
brodie-trendelenburg test
differentiates saphenofemoral valve incompetence from perforator vein incompetence
Virchows triad
stasis, vascular injury, and hypercoagulability
what is thrombophlebitis
involve partial or complete occlusion of a vein and inflammatory changes. virchows triad
palpable cord in long saphenous vein
thrombophlebitis
what is d-dimer
fibrin degradation product that is elevated in presence of thrombus
skin changes in chronic venous insufficiency
shiny, thin, itchy, atrophic with dark pigment and subcutaneous induration
how to treat stasis dermatitis
wet compresses, hydrocortisone cream. chronic forms may also need zinc oxide with ichthammol and antifungal cream
1st degree AV block
PR interval constant and >200/asymptomatic/no treatment; can occur with increased vagal tone or with a bb or ccb
mobitz 1
PR progressively lengthens until QRS drops; asymptomatic or palp/no tx; can be from bb or ccb or increased vagal tone or coronary ischemia/infarction
mobitz 2
from fibrotic disease of the conduction system from an MI/occasional syncopeQRS beats are intermittently dropped w/out PR prolongation/asymp or palp/tx: pacemaker
3rd degree AV block
dissociation of P and QRS/no electrical communication between atria and ventricles/syncope,dizziness,hrt fail,hypoTN/ tx: pacemaker
L BBB
QRS >120;deep S wave and no R wave in V1;wide, tall R waves in 1, V5, V6
R BBB
QRS >120; RSR complex;wide R wave in V1, QRS pattern with wide S wave in 1, V5, V6
BBB causes and sx
CAD, Cardiomyopathy, valve disease/asymp, syncope, presyncope
q wave
septal depolarization
r wave
apical and early depolarization
s wave
late ventricular depolarization
t wave
ventricular repolarization;
corresponds to the period when the lower heart muscle chambers are relaxing and preparing for the next muscle contraction
p wave
atrial depolarization/record of movement of electrical activity through atria and recorded when they contract
qrs complex
record of movement of electrical impulses through ventricles and recorded when they contract
ST segment
elevated or lowered means heart muscle damaged or not receiving enough blood
T wave
corresponds to the period when the lower heart muscle chambers are relaxing and preparing for the next muscle contraction
inferior leads and arteries
I, II, avF/ rt coronary arter circumflex branch, and post descending branch
posterior leads and arteries
V1 and V2/ LCA to circumflex branch and RCA to post descending branch
anteroseptal leads and artery
V1 and V2 / LAD plus septal branch
anterior leads and artery
V1 V2 V3; Lt Ant Descending
anterolateral leads and lateral arteries
V4 V5 V6/ lt coronary artery, circumflex branch
PSVT causes and risks
dig too high, WPW/ risks: etoh,caffeine,drugs, smoking
test for aortic dissection
CT angiography
secondary HTN causes
CHAPS: cushing, hyperaldosterone, aortic coarctation, pheochromocytoma, stenosis renal artheries
orthostatic hypoTN
greater than 20 mm Hg drop in systolic or 10 diastolic. if pulse increase by 15 beats, depleting circlulating blood volume
pericarditis sx, PE,
pleuritic CP, dyspnea, cough, FEVER; CP worsens in supine and inspiration(sits and leans); friction rup, inc JVP, pulsus paroxus
pericarditis imaging and tx
ekg: diffuse st seg elev and PR seg dep followed by t wave inv; tx: underlying cause; asa/NSAIDS for viral;no corticosteroids
pulsus paroxus
decreased systolic BP > than 10 mm hg inspiration
beck triad
jvd, hypoTN, distant heart sounds: cardiac tamponade
acute cardiac tamponade
beck triad, pulsus paradoxus, kussmaul, electrical alternans, (water bottle heart), EKG: rt atrial and rt vent diastolic collapse
WPW EKG and tx
DELTA WAVE; procainamide or arrhythmics
S3
early sign of heart failure; ventricular gallop, fluid overload, disappears when pt gets up
S4
atrial gallp, decreased compliance- HTN, diastolic dysfunction
Pulsus parvus et tardus
weak, delayed carotid up stroke, split S2, aortic stenosis
blowing diastolic murmur and tx
aortic regurge; tx: vasodilators
opening snap and mid diastolic murmur at apex an tx
mitral stenosis; rheumatic fever; antiarhythmics
under 65 y/o, EF under 50%, *exertional dyspnea, parasternal lift, S3 S4, JVD, BNP >500
systolic CHF- do loop. no ccb
tx for pulm congestion
LMNOP: lasix, morphine, nitrates, O2, position
murmur heard best in left lateral position in full exhalation
mitral stenosis
high pitch, blowing murmur; heard best sitting and leaning forward, full exhalation
aortic regurge
harsh and medium pitch murmur, heard best sitting and leaning forward
AS
murmur radiation
1)axilla 2)rt sternum/xyphoid 3)lt shoulder/neck
1) AR 2) TR 3) PS
anti-arrhythmic class 2 drugs
beta blockers slow AV conduction for SV tachycardia, may prevent vent fibrillation
anti-arrhythmic class 3 drugs
K++ channel blockers:prolong action potential; for refractory V tach, SV tach; amiodarone,sotalol,dofetilide,ibutilide
anti-arrhythmic drugs class IV
slow CCB for SV tachycardia
anti-arrhythmic class V drugs
Adenosine and Digoxin for SV tachycardia
Sodium channel blockers
Class 1 drugs; Quinidine, procainamide, disopyramide,lidocaine
med for variant/atypical/prinzmental angina
CCB
how do nitrates work
venodilation to decrease preload and O2. also coronary artery dilation to increase blood flow.
how do Beta blockers work
decrease O2 demand. watch out for hypoglycemia
which CCB causes flushing and which ones cause constipation
nifedipine. diltiazam and verapamil
which CCB can cause worsening angina
nifedipine
anteroseptal leads
V1 V2. LAD
MONA
ACS tx. Morphine/merperadine O2 Nitrates, asa
post ACS complications mneumonic
PFARTS. pericarditis, failure, arrhythmia/aneursym, ruptrue, thromboembolism, septal perf
marker for heart failure
BNP
EKG changes in pericarditis
ST segment elevation in 2 or 3 limb leads
acute occlusion S/S
paresthias, pallor, pulseless, pain, paralysis
heart sounds locations
A then P, below is T. to the right is M
sternal lift
RVH
enlarged, displaced PMI
LVH
systole valves
A/P open
diastole valves
M/T open
S1 is what valves
M/T close
S3
early diastolic sound. think heart failure
S4
think chr HTN. its late diastolic
high pitched murmur
M/T valve
cresendo
think A/P
inspiration does what to a murmur
increase venous return
left lateral decubitus affects murmurs how
makes mitral valve murmurs easier to hear
sitting and leaning forward
increases AR murmur
valsalva/standing
decrease venous return
squatting
increases venous return
wide pulse pressure
AR
narrow pulse pressure
AS
marfans
AR
tachycardia
with infections
bradycardia
with AV blocks
JVP
reflects RA pressure.
large A wave
TS
large V wave
TR
bounding pulses
AR
pulsus alternans
with left ventricular failure
slow and delayed carotid pulse
severe AS
roth spots on retina
endocarditis
clubbing
hypoxia
petechiae, splinter hemorrhages
endocarditis
S4
AS
rheumatic fever
MS
radiate to left neck
PS
rt sided S3 S4
PS
murmur with inspiration
PS
heard at aortic region, no radiation. softer with squatting, louder with valsalva/standing
IHSS
how to hear hypertrophic cardiomyopathy
over lower sternum; louder with standing/valsalva; softer with squatting
3 holosytolic murmurs
MR, TR, VSD
MR heard best at
apex
TR heard best at
LLSB
MR
LL deb positiion. radiates to left axilla. blowing
TR
inspiration decreases intensity. blowing
diastolic murmurs: nml flow through valves
mitral and tricuspid stenosis
diastolic murmurs: backward flow through valves
aortic and pulmonic regurge
MS
decresendo-cresendo. heard best at apex. rumbling, S2 accentuated. think rheumatic fever
AR
decresendo. S4, PMI enlarged. head bobbing. increase intensity with leaning forward with expiration.
machine like murmur
PDA
continuous murmur
venous hum. stops with compression of jugular vein
systolic murmurs
AS, PS, MR, TR, VSD, MVP
IV drug use affects
right heart valves
murmur heard best at pulmonic area and increases with inspiration
likely PS
hypoxia, electrolyte abnormalities, HYPERthyroidism; dx and tx
PVC, give BB
systolic dysfunction: defintion, age, EF, cardiomyopathy, PMI, gallop, CXR, ekg
inadequate vent contractility, under 65 y.o, EF under 40%, dilated CM, PMI displaced, S3, Cardiomegaly on CXR, q waves
non systolic dysfunction: definition, age, EF, cardiomyopathy, PMI, gallop, CXR, ekg
impaired relaxation- cannot fill; over 65 y.o, EF over 55%, Hypertrophic and restrictive CM, PMI sustained, S4, CXR pulm htn, LVH
tx for systolic and non systolic dysfunction CHF.
avoid what in each. (3)
Systolic: 1) acute: loop with ACE (avoid BB)
2) chronic: loop, ACE, BB. (avoid CCB)
Diastolic: diuretics first line(avoid digoxin)
loop
1) effects
2) use in what
3) SE
4)disadvantage
1) hypokalemia, hypocalcemia,hypomagnesium,hyperruricemia.
2) 1st line for CHF, also can use in acute pulm edema
3) dehydration, gout, ototoxicity
4) short acting
SE for K sparing agents
hypokalemia, gynecomastia, sexual dysfunction
most common cause of young healthy athletes in US; etio
hypertrophic obstructive CM; inherited as an autosomal dominant trait
echo shows rapid early filling and normal EF; EKG LBBB. which CM?
restrictive
7 major risk factors in CAD
male, inc LDL, dec HDL, smoking, HTN, FH, age(male over 45 and woman over 55),
tx for chronic stable angina
BB, aspirin, and nitro
Xanthelasma, xanthomas, lipemia retinalis; indicates what
yellow deposits in skin around eyes, eruptive nodules in skin over tendons, creamy appearance of retinal vessels; think dyslipidemia
When to conduct a fasting lipid profile
pts over 35 y.o or over 20 y.o with CAD risk factors; repeat every 5 years.
dyslipidemia dx
LDL over 130 or HDL under 40
mnemonic for HTN tx
ace/arb, bb, ccb, diuretics
tests for end organ complications(kidney and heart)- HTN
creatinine, BUN, urine protein to creatinine ratio, EKG to look for hypertrophy
primary renal disease HTN tx
ace
diuretic SE
hypokalemina; HYPER glycemia, lipemia, uricemia; azotemia
BB SE
bronchospasm, bradycardia, CHF exacerbation, impotence, fatigue, depression
ACE SE
angiodema, rash, leukopenia, HYPERkalemia
ARB SE
leukopenia, rash, HYPERkalemia
screening in aortic aneurysm
screen all men 65-75 with hx of smoking once by ultrasound.
when to repair and when to monitor a AAA
under 5 cm -monitor
over 5 cm- surgery
what is a AAA and origination
greater than 50% dilatation of all 3 layers of the aortic wall; most are abdominal and over 90% below renal arteries
AAA commonly associated with what
atherosclerosis
what is aortic dissection
transverse tear in the intima of a vessel that results with blood entering the media, creating a false lumen and leading to a propagating hematoma
aortic dissection commonly linked to what
HTN
common site for aortic dissection; age, gender
above aortic valve and distal to left subclavian artery. age 40-60 and greater in females
imaging of AAA and aortic dissection
AAA: abd ultrasound; aortic dissection is CT angiography
BP classification
(3)
over 60 y/o: 150/90(no CKD, DM,or HTN)
under 60 y/o: 140/90
over 18 y/o with CKD or DM: 140/90
spironolactone SE and uses
hyperkalemia, gynecomastia
2nd line for acute pulm edema and CHF
meds to reduce mortality in CHF
BB with ACE
first test to order for CHF.
echo. look at EF
medication for CHF to add if angina present
amlodipine
most specific and sensitive cardiac enzyme
troponon 1
wide split S2 can be what 2 things
ASD or PS
harsh systolic murmur can be what 2 things
AS(heard best at LSB) or COA
S2 S3 S4 with
AS, AR, PS, MR, MS,
AS and AR S4
PS S3 and S4
MR S2 and S3
MS S2
S2 S3 S4 with
AS, AR, PS, MR, MS,
AS and AR S4
PS S3 and S4
MR S2 and S3
MS S2
pansystolic murmur heard best at apex and rad to left axilla
MR
rib notching or 3 sign
COA
