Cardiology Flashcards
Murmurs and grades
MRASS
MSARD
Grade 1-6: 4 includes a thrill
S3 and S4 sounds along with causes
S3: Kentucky and d/t increased fluid volume
S4: Tennessee: Stiff ventricular wall
Systolic vs Diastolic HF
Systolic: HFrEF
Diastolic HFpEF
Acute vs chronic HF include s/s
Acute: abrupt onset following MI, LVH, Valvular rupture . S/S: S3, mitral regurgitation, pulmonary symptoms
Chronic: Inadequate compensatory mechanisms over time, right sided heart failure. S/S: JVD, Hepatomegaly, dependent edema resulting from increased capillary hydrostatic pressure
Four classifications of HF
i. 1: no limitations, normal activity
ii. 2: slight limitations, comfortable at rest
iii. 3: marked limitations, comfortable at rest, 3 pillows to sleep
iv. 4: severe, symptoms at rest
What is the first line pharmacologic therapy for all HF
Diuretics
What are the 4 cardiomypoathies, ECHO results, and treatment
a. Dilated : Most common, LV dilation, no squeeze, LV thinning, and global dysfunction
ii. Idiopathic, presents like heart failure
b. Hypertrophy: No fill LV thickening >1.5cm
c. Restricted: No fill, LVH, low voltage, speckled myocardium
i. Stress: Takotsuo: ACS with clean arteries
Aldactone for all, avoid CCB with dilated. ACE/ARBs and BB.
Primary vs Secondary HTN
a. Classification
i. Primary
1. Most cases
2. Onset >55yrs of age
ii. Secondary
1. Most common is renal artery stenosis
HTN urgency vs emergency and treatment
Urgency = don’t overtreat
-BP>180/110, may or may not have headache, anxiety, SOB
-Oral therapy: catapress/clonidine (Alpha agonist)
Emergency
-BP > 180/120, requires immediate BP reduction within 1 hour
-OR if you have end organ damage, encephalopathy, ICH, angina, MI, HF, dissection, eclampsia
-Management: ICU admission, Parenteral administration (nicardipine drip or nipride drip)
Reduce to <140 in 1 hour in high risk patient or less than <120 for dissection
-Reduce no more than 25% or SBP 160 in first hour if unstable
Unstable angina Treatment
TX: Elevated give Statin
1. High statin are Atorvastatin and rosuvastatin
2. Can’t handle a statin, you can give questran, fenofibrate, tricor, ezetimide, niacin
h. Aspirin, CCB, Nitrates, BB
EKG interpretation and area of heart that has an MI
e. EKG: ST elevation
i. ST elevation in 1 and AVL = Lateral MI
ii. 2,3,AVF = Inferior
iii. V3, V4 = Anterior
ACS treatment
k. Treatment: Aspirin, nitro, lasix, morphine, possible BB IV if not contraindicated, possible ACE inhibitor (prevented ventricular remodeling), ?anticoagulation (Lovenox 1mg/kg q12)
TPA contraindications
ii. TPA contraindication: Current or prior bleed, neoplasms, ischemic stroke in past 3 months, head or fascial surgery in the past 3 months, severe uncontrolled HTN***
PVD s/s, workup, and treatment
i. arterial sclerosis over time
ii. HX smoking, DM, HLD
iii. S/S: Claudication calf pain, shiny hairless skin, dependent rubor, elevation pallor
iv. Ankle Brachial Index***
v. Exercise, stop smoking
vi. Fletal medication
vii. Angioplasty, bypass, amputation
CVI s/s, workup, and treatment
i. Destruction of valves/thrombophlebitis, venous hypertension, causing venous stasis
ii. S/S: Aching of lower extremities received by elevation, night pain, edema, dermatitis, periphery is cool to touch
iii. R/O edema d/t HF
iv. R/O Ray turner’s syndrome***
1. Results in LLE DVT
v. Treatment: elevate legs, elastic support stockings, weight reduction, dermatitis (Tap water compress, hydrocolloid dressings)
Pericarditis s/s, workup, and treatment
i. Inflammation of outside of heart
ii. Viruses are most common cause*
iii. Classic Presentation: Precordial chest pain worse with coughing/swallowing, SOB, pericardial friction rub, pleural friction rub, fever
iv. Labs: ST elevation is all leads and PR depression*
v. Needs ECHO
vi. Tx: NSAIDs, Ibuprofen, endomethacin, steroids only if there is total failure of high dose NSAIDS (Can increase viral replication)
1. ABX: only if bacterial
2. Codiene and monitor for tamponade
Endocarditis s/s, workup, and treatment
i. Must be excluded in all patients with heart murmur and fever of unknown origin
ii. Typically, bacterial causes
iii. Risk: Rheumatic heart disease, valve prolapse, dental surgery, IVDA, congenital heart disease
iv. S/S: Fever, malaise, night sweats, and weight loss, murmur (not always), Oslars nodes (distal phalanges), splinter hemorrhages, splenomegaly, Janaway lesions (small non painful macula on palms and soles)
v. Night Sweat causes
1. TB, Endocarditis, menopause, HIV/AIDS, heme/onc leukemia
vi. Labs: ALWAYS left shift with band formation, positive BCx, elevated ESR
vii. Acute endocarditis typically due to staph, MRSA, and MSSA
viii. Empiric vanco until results are back
Currigens pulse and quinkes pulse and what do they represent
Aortic Dissection
C: Forecful carotid pulse
Q: Finger nails change from pink to white with heartbeat
A fib managment
- Rate control
a. Typically a BB - Anticoagulation
a. First time, young, no risk factors: Aspirin
b. Elderly, comorbidities, paroxysmal: Coumadin
