Cardio MDT Flashcards
- SBP>220mmHg or DBP>125mmHg
- NO signs of end organ damage
- physical examination is usually normal
Hypertensive Urgency
Lab work for HTN urgency
- UA for proteinuria or hematuria
* EKG
Disposition for HTN urgency?
MEDADVICE maybe MEDEVAC – Can progress to end organ damage
And Re-initiate meds
- DBP > 130
* SIGNS of end organ damage:
HTN Emergency
Disposition for HTN Emergency?
MEDEVAC and IV
Differentials for HTn emergency and urgency?
- Aortic dissection
* Ischemic stroke
- Angina
- Left shoulder pain
- Indigestion
- Nausea/Vomiting
- Pale
- Diaphoresis
- New Heart Murmur
- Rales on pulmonary examination
Coronary Artery Disease
Disposition of CAD?
Medadvice and possible medevac if signs of end organ damage or MI
Claudication (cramping on exercise)
Diminished peripheral pulses
Signs of peripheral occlusion
* mainly lower body
Poor cholesterol
PAD (Peripheral Arterial Disease) / PVD (Peripheral Vascular disease)
Special tests for PVD/PAD?
- Thrombosis check
- Homan’s sign (DVT)
- peripheral pulses
Disposition for PAD/PVD?
MEDEVAC - can lead to dvt, pulmonary embolism, ischemia
AFib
Sudden onset of extremity pain with loss or reduction of pulses
6 signs of severe arterial ischemia (6Ps): Pain, Pallor Poikilothermia (coolness) Pulselessness Paresthesia Paralysis
Acute Arterial Occlusion
Differentials for PAD/PVD and AAO?
- Muscle strain
- DVT
- AAO
- PVD/PAD
Concerns with A Fib?
Can lead to thrombosis
- Substernal chest pain
- Pressure like elephant on the chest
- Possible radiation
- Diaphoresis
- N/V
- Anxious
- Weak
- Dyspnea
MI
Treatment for MI?
ONAM
O2 - 4L NC or 12L NRB
N - spray
Asprin - 325mg chew
M - 2-4mg IV
Sudden Severe Chest Pain radiating to the back (ripping or tearing)
HTN
Lower limb paralysis
PALP:
Diminished or unequal pulses
AUSCULTATION:
Possible Aortic regurg/murmur
Dissecting Aortic Annuerysm
Treatment for dissecting aortic annuerysm?
Lower SBP to 100-120 using nitro
Pain control with morphine
LEFT SIDED Sxs:
- Dyspnea
- Orthopnea (laying down dyspnea)
- Non-productive cough
- Exercise Intolerance
- Fatigue
RIGHT SIDED Sxs:
- JVD
- Pitting edema
- Abdominal ascites (abd swelling)
AUSCULTATION:
- Crackles, wheezing, rhonci
- Enlarged or displaced PMI
- Murmurs
Congestive Heart Failure
Hx of viral infection
Hx of bacterial etiologies
Sharp Substernal Chest Px with possible radiation
PAIN RELIEVED BY SITTING UP!!!
FEVER
PERICARDIAL FRICTION RUB
Labs:
Elevated WBC
EKG:
Diffuse ST segment elevation
Pericarditis
Concerns for pericarditis?
CAN TURN INTO PERICARDIAL EFFUSION OR TAMPONADE
Viral and bacterial etiologies
Hx:
- Alcohol, Cocaine
- Insect/Snake bites
- Meds: PCN, Ceph, Sulf, Diuretics
Commonly accompanied by pericarditis so similar symptoms
SINUS TACHY OUT OF PROPORTION TO TEMPERATURE
Excessive fatigue/exercise intolerance
Murmurs
Myocarditis
IV Drug Users
Fever
Cough
Dyspnea
* More sick like presentation
Peripheral lesions:
Nail bed skin signs like petechia or splinter hemorrhages
Janeway Lesions:
erythematous lesions on palms or sole
NEW ONSET MURMUR WITH FEVER
Endocarditis
Trauma, pericarditis
BECK’S TRIAD:
- Muffled heart sounds
- JVD
- Hypotension unresponsive to fluid challenge
- Tachycardia
- Angina
- Tachypnea
- Hypotension
EKG:
Sinus Tachy
Pericardial Tamponade
