cardio misc Flashcards
HOCM PE
apical lift from LVH, systolic ejection murmur near apex and bisferens carotid pulse
apical lift from LVH, systolic ejection murmur near apex and bisferens carotid pulse
HOCM
EF in cardiomyopathies
dec in dilated; increase or nml in hypertrophic; nml in restrictive
Paroxysmal supraventricular tachycardia tx
adenosine or 2nd line BB or CCB; do valsalva, coughing, leaning, splash ice water
avoid what in aortic dissection
diazoxide and hydralazine
pale, hypoTN, angina, syncope
v tach; cardiovert if unstable; or do lido, amio, procainamide
syncope, no BP, no pulse
v fib; defib and ACLS
orthostatic hypoTN tx
hydralazine, nitrates, niacin, CCB
acute sys CHF tx
loop with ace. NO BB
chronic sys CHF tx
BB with other meds. NO CCB
non prod cough, JVD, PND, exertional dyspnea, S3 maybe S4
systolic CHF
diastolic CHF tx
diuretics first line then maintain BP. No digoxin
CP in the early morning and tx
think prinzmental angina. tx with CCB or nitrates
STEMI and NSTEMI muscle
STEMI is transmural and NSTEMI is subendocardial
myoglobin
initial elevation at 1-4 h, peaks at 6-7h, and returns to normal with 24 hr
troponin 1
initial elevation at 3-12 h, peaks at 24h, and returns to normal with 5-10 days
troponin T
initial elevation at 4-8 h, peaks at 12-48h, and returns to normal with 5-14 days
CK-MB
initial elevation at 3-12h, peaks at 24h, and returns to normal with 48-72 hr
pulm atresia murmur
depends on present of tricuspid regurge; single S1 or single S2, hyperdynamic apical pulse
tetrology of fallot
cyanosis, clubbing, increased RV impulse at LLSB, loud S2
hypoplastic lt heart syndrome signs
shock, early heart failure, respiratory distress, single S2
transposition of great vessels PE and signs
systolic murmur(VSD) or systolic ejection(pulm stenosis) and *cyanosis in newborn; loud S2 if large VSD
ASD murmur; affects what compartment
systolic ejection murmur second LICS; wide fixed split S2
*~RBBB, ~RVH
PDA definition, PE, and tx
affects what compartment
failure to close or delay in closing channel bypassing the lungs(allowing now placental gas exchange during the fetal state),
PE: machine like murmur, thrill, wide pulse pressure.
tx: NSAID for prostaglandins
LV failure, may have pulm HTN
COA involves what.
PE
CXR
TX
narrowing the the proximal thoracic aorta
PE: delayed or weak femoral pulse, harsh systolic murmur
CXR: 3 sign or rib notching
TX: under 50 then surgery; over 50 then stent
medication for aortic/mitral valve d/o
(pulm HTN and dysrhythmias)
diuretics and vasodilators for pulm congestion; digoxin and beta blockers for dysrhythmias
torsades medication tx
beta blockers, magnesium, temporary atrial or ventricular pacing.
pulsus paroxus
decreased systolic BP > than 10 mm hg inspiration
Pulsus parvus et tardus
weak, delayed carotid up stroke, split S2, aortic stenosis
Osler nodes and janeway nodes
Osler nodes
occur on finger tips. endocarditits
janeway nodes
palms and soles. think endocarditis
Statins
lower HDL and TG; inc LFT, myositis, warfarin potentiation
fibrates (lipoprotein lipase stimulators) effect and SE
dec Tg and inc HDL; cholelithiasis, myositis, inc LFT, GI upset
cholesterol absorption inhibitors(Ezetimibe) effect and SE
dec LDL; diarrhea, abd pain, maybe angiodema
niacin effect and SE
inc HDL, dec LDL; flushing that be prevented with aspirin, paraesthesias, pruritis, inc LFT, GI pain
bile acid resins(cholestyramine, colestipol, colesevelam) effect and SE
dec LDL; myalgias, constipation, LFT abn, GI upset; can dec absorption of other drugs in small intestine
renal artery stenosis; age/etio
dx how
tx
*dx, HTN tx
under 25 y.o(fibromuscular dyplasia); over 50 y.o(atherosclersis); dx with renal artery doppler u/s; tx with ace only in unilateral disease!
pheochromocytoma; definition, symptoms, dx, and HTN tx
adrenal gland tumor that secretes epi and norepi; episodic HA, sweating, tachycardia; dx with catecholamine levels, urinary metanephrines; tx with both alpha blockers and BB
Conn Syndrome; definition, how to dx, tx
hyperaldosteronism; adenoma; causes: triad of HTN, unexplained hypokalemnia, metabolic alkalosis; check plasma aldosterone and renin; removal of tumor
mnemonic for pericarditis
CARDIAC RIND: collagen vascular disorder, aortic dissection, radiation, drugs, infections, acute renal failure, cardiac(MI), rheumatic fever, injury, neoplasm, dressler
STEMI Tx if in heart failure or shock
ACE. no BB!
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
LBBB
V1 has deep S wave and no R wave;
1, V5, V6 has tall R wave
RBBB
V1 has wide RSR wave;
1, V5, V6 has wide S wave
what is preload
Volume in ventrical at the end of diastolic
what is afterload
pressure required to open aortic valve
what slows AV conduction
digoxin, BB, CCB; do not give in sick sinus syndrome
Narrow QRS means what
depolarization of ventricles originates in or above the AV node
Wide QRS means what
arrhythymia originates in ventricle
Rt atrial enlargement
P over 2.5mm(tall) in II/III and/or AvF OR
O over 1.5mm in V1(may be biphasic)
Lt atrial enlargement
P is over 0.04 and deeply neg over 1mm in V1(biphasic) OR
P is over 0.12 sec in I and/or II(maybe notch)
peaked vs inverted T wave
peaked: hyperkalemia; inverted: early ischemia
what is only lead to show ST dep normally
Posterior leads
Costochondritis
young AA females; exacerbated with deep inspirtaion; warmness and redness; left 3/4th ICS
kussmaul sign
deep inspiration, increased CVP; think pericarditis
angina pain
visceral pain then becomes somatic
good med for HTN assoc with angina pectoris or AFib
verapamil
smooth muscle dilator and also reverses coronary artery spasm
verapamil
high vs low pulse pressure
40 and 60
EKG for rt heart strain
inversion t waves in lead II
increase handgrip does what
increase peripheral resistance and afterload. You hear left sided regurge murmurs louder(AR and MR) and stenosis murmurs softer
MR acute vs chronic symptoms
acute: dyspnea, pulm edema
chronic: waxing/waning dyspnea
good med for HTN assoc with angina pectoris or AFib
verapamil
smooth muscle dilator and also reverses coronary artery spasm
verapamil
high vs low pulse pressure
40 and 60
EKG for rt heart strain
inversion t waves in lead II
increase handgrip does what
increase peripheral resistance and afterload. You hear left sided regurge murmurs louder(AR and MR) and stenosis murmurs softer
MR acute vs chronic symptoms
acute: dyspnea, pulm edema
chronic: waxing/waning dyspnea
assymetric T wave inversions
BBB, digitalis
symmetric T wave inversions
myocardial ischemia
chorda tendinae rupture
think MR
hoarseness, dysphagia, hemoptysis, DOE, orthopnea/PND, pulm edema, angina
Elevated left atrial pressure
Peaked P wave >2.5mm in lead II
P pulmonale(rt atria)
ST elevation..
ischemia, pericarditis(diffuse leads); transmural; do thrombolytics
ST depression
think ACS, LVH, Dig; subendocardial wall; could be significant atherosclerosis, avoid thrombolytics
avoid what is QT prolongation
emycin and procainimide
PVC- give what in the 1st 24 hours
lido
organism, ages, valves in rheumatic fever
betahemolytic strep; kids 5-15, fever 1-3 weeks later, mitral 75-80% and aortic 30%
Jones criteria(major) rheumatic fever
2 major or 1 of major/minor: carditis, polyarthralgia, chorea, erythema marginatum, sub-q nodules
minor Jones criteria
arthralgia, increased ESR and CRP, fever, increased PR interval
leriche syndrome
impotence, bil butt and thigh claudication
trosseau sign
1st sign of pancreatic cancer; superficial thrombophlebitis
left coronary artery suppies what part of heart
anterior (left ventricle) or septal
right coronary artery suppies what part of heart
posterior inferior, septal, or rt ventricle
left circumflex artery suppies what part of heart
antero and posterolateral
Lower extremity arteries
distal aorta-common iliac artery-external iliac-
common femoral artery-superficial femoral artery
pain in calf
superficial femoral artery
pain in thigh
commom femoral artery or ext iliac
pain in butt
distal aorta or common iliac
impotence
distal aorta
constant pain vs acute pain in claudication
occlusion is constant; emboli is acute
danger of VSD, describe murmur
can cause CHF by 6 months; systolic murmur LLSB; and audible in infants 1 month
isenmenger syndrome
VSD; left to right
presentation of symptoms of COA and order what test
failure to thrive, CP, lightheadness, SOB, heart failure in infant, HBP; get echo
what electrolyte abnormalities can cause long QT syndrome
hypocalemia and hypomagnesiumia
phenothiazine, haldol, risperidone, and TCA can all cause what
long QT syndrome
when to avoid thrombolytics(4)
intracranial neoplasm, uncontrolled HTN(170/110), recent signficant trauma, active internal bleeding
what to do in Afib with high risk of thrombus
anticoagulate, control rate; all prior to cardioversion
rate control in Afib with heart failure
*amiodarone, digoxin, or dronedarone
rate control in Afib with no heart failure
BB or CCB(verapamil or diltiazem)
paroxysmal Afib tx
BB or CCB; digoxin 2nd line
cardioversion meds in Afib
*amiodarone, propafenone, ibutilide; 2nd line is flecanide
when to cardioversion vs defib vs pacing
cardiovert in tachy and alive pt; defib in unconscious(no C.O, vfib or v tach); pace in brady(heart block)
3 BB known to reduce mortality in CHF
carvedolol, metoprolol, bisprolol
CHA2 DS2 VASc ( 2 or higher)
CHF, HTN, Age >75, DM, Stroke/TIA, Vascular d/s, Age 65-74, female gender
most common endocarditis pathogens
strep viridans, staph aureus, enterococci
damaged heart valves in endocarditis murmurs
MR or AS
post op valve replacement endocarditis organisms
staph aureus, fungi, gm neg bacteria
IV drug use endocarditis organism
staph aureus
dx endocarditis
3 positive blood cultures, new murmur, transesophageal echo
duke criteria for dx
2 major, one major/3 minor, 5 minor
empiric tx for endocarditis
start vanco and ceftriaxone after 1st positive blood culture; treat for 4-6 weeks IV tx
prophylactic antibiotic for endocarditis
oral amoxicillin 1 hour before procedure
Bradycardia in adults, child, infant
60
70
90
dilated vs HOCM
systolic ?
tx meds
gallop
dilated: systolic, tx with ace and BB
HOCM: diastolic, BB and CCB. NO Ds or ACE
