Cardiology Flashcards
TIP- AGE OF WOMEN WHERE RISK OF CAD IS EQUAL TO MEN
TIP-CAD RISK FACTORS
TIP-CAD RISK FACTORS WITH HIGHEST RATES
TIP- CAD RISK FACTORS FAMILY HAS TO BE HOW CLOSE AND HOW YOUNG
TIP- CAD RISK FACTORS-HYPERLIPIDEMIA ESPECIALLY WHAT LIPID?
TIP- CAD LESS OF A RISK FACTOR/S… MORE ENVIRONMENTAL
TIP- CAD RISK PREVENTION MOST BENIFICIAL
TIP- AKO-TSUBO CARDIOMYOPATHY MECH. AND
TREATMENT
TIP- HOW MUCH DOES SMOKE QUITING REDUCE RISK?
55-60 YEARS
DIABETES, HYPERTENSION, TOBACCO, HYPERLIPIDEMIA, FAMILY HISTORY, AGE MEN 45 WOMEN 55
HYPERTENSION>DIABETES (IS WORSE)
FIRST DEGREE RELATIVES SIBLING AND PARENTS AND AGE=MEN
LDL
PHYSICAL ACTIVITY, ALCOHOL, LOW FRUIT AND VEG., EMOTIONAL STRESS, CARDIAC CT SCAN HIGH IN CA, PET
EXERCISE
CATECHOLAMINE DISCHARGE CAUSES BALLOONING, TREAT AS MI BETA BLOCKERS AND ACE INH.
1 YEAR = 50%, 2 YEARS =90%
DIAGNOSIS- DULL/SORE/SQUEEZING /PRESSURE-LIKE CHEST PAIN ONGOING/INTERMITTENT
TIP-SHARP/PIN-LIKE/LAST SECONDS PAIN AND CHANGES W/RESPIRATION,POSITION,TOUCH
ISCHEMIC HEART OR CAD
NON ISCHEMIC 95% OF THE TIME
DIAGNOSIS-CHEST PAIN W/CHEST WALL TENDERNESS
ACC. TEST-
CHOSTOCHONDIRITIS
PE
DIAGNOSIS-CHEST PAIN W/RADIATION TO BACK UNEQUAL BLOOD PRESSURE BETWEEN ARMS
ACC. TEST-
AORTIC DISSECTION
CHEST X-RAY WITH WIDENED MEDIASTINUM, CHEST CT, MRI, OR TEE CONFIRMS THE DIESEASE
DIAGNOSIS- PAIN WORSE WITH LYING FLAT BETTER WHEN SITTING UP, YOUNG <40
ACC. TEST-
PERICARDITIS
ELECTROCARDIOGRAM WITH ST ELEVATION EVERYWHERE, PR DEPRESSION
DIAGNOSIS- EPIGASTRIC DISCOMFORT PAIN BETTER WHEN EATING
ACC. TEST-
DOUDENAL ULCER
ENDOSCOPY
DIAGNOSIS- BAD TASTE, COUGH, HOARSENESS
ACC. TEST-
GERD
RESPONSE TO PPI, ALUMINUM HYDROXIDE AND MG OH, VISCOUS LIDOCAINE
DIAGNOSIS-COUGH, SPUTUM, HEMOPTYSIS
ACC. TEST-
PNEUMONIA
CXR
DIAGNOSIS-SUDDEN ONSET, SHORTNESS OF BREATH, TACHYCARDIA, HYPOXIA
ACC. TEST-
PULMONARY EMBOLUS
SPIRAL CT, V/Q SCAN
DIAGNOSIS- SHARP, PLEURITIC PIN, TRACHEAL DEVIATION
ACC. TEST-
PNEUMOTHORAX
CXR
INITIAL TEST- CHEST PAIN OFFICE SETTING DAYS TO WEEKS
INITIAL TEST-CHEST PAIN ER SETTING HOURS
INITIAL TEST- CHEST PAIN WITH EKG NORMAL
TIP- ETT TWO FACTORS TO PERFORM
TIP- MAXIMUM HR FOR EXERCISE AND MIN FOR CARDIO
TIP-ETT CANNOT READ EKG
TIP-EKG BASELINE CANNOT BE READ BECAUSE OF?
EKG
EKG THEN ENZYMES (TROPONIN, CK-MB)
STRESS TEST (ETT)
READ A EKG, PATIENT CAN EXERCISE
220-AGE, 85% IS MIN. FOR CARDIO
NUCLEAR ISOTOPE: THALLIUM OR SESTAMIBI, OR ECO OF WALL MOTION
BUNDLE BRANCH BLOCK, LEFT VENTRICULAR HYPERTORPHY, PACEMAKER USE, OR DIGOXIN USE
TIP-HOW DOES THALLIUM TEST WORK? TIP- ISCHEMIA VS INFARCTION TIP-ETT CANNOT EXERCISE INITIAL TEST- CHEST PAIN + POSITIVE EKG AND ENZYMES FOR CAD TIP- PURPOSE OF ANGIOGRAPH ACC. TEST- CAD TIP- STENSOSIS 50% IS? TIP-STENSOSIS >70% IS?
TAKEN UP LIKE K+ AND READ FOR WALL MOTION
INFARCTION IS IRREVERSABLE SLOW/NO WALL MOTION OF AREA SEEN ON THALLIUM TEST
DIPYRIDAMOLE OR ADENOSINE + NUC. ISOTOPES THALLIUM OR SESTAMIBI/ DOBUTAMINE + ECO WALL MOT. ABNORMALITIES
ANGIOGRAPHY
DETERMINE SURGERY OR ANIOPLASTY (PCI)
ANGIOGRAPHY
IRRELAVENT
RELAVENT
INITIAL TEST- IRREGULAR EKG BUT NOT ISCHEMIC OR CAD
INITIAL TREAT- CHRONIC CAD
IT/TIP- SUBLINGUAL, PASTE AND IV NITROGLYCERIN ARE FOR?
HOLTER
ASPIRIN, BETA BLOCKERS, NITROGLYCERIN
ACS
IT/TIP-CAD=CLOPIDOGREL IS USED IN?
IT/TIP- CAD=PRASUGREL WHEN TO USE AND SIDEFFECTS?
IT/TIP-CAD=TICLOPIDINE WHEN TO USE AND SIDE EFFECTS?
IT/TIP-CAD=RANOLAZINE WHEN TO USE AND SIDE EFFECTS?
IT/TIP- CAD/CHF=ACE INHIBITORS/ANGIOTENSIN RECEPTOR BLOCKERS USE AND SIDE EFFECTS?
IT/TIP- CAD/CHF=LOW EF ON ACE INHIBITOR WITH HYPERKALEMIA SWITCH TO?
ASPIRIN INTOLERANCE (ALLERGY) AND RECENT
ANGIOPLASTY WITH STENTING
ANDIOPLASTY AND STENTING, HEMORRHAGIC STROKE IN AGES 75 AND OLDER
ASPIRIN AND CLOPIDOGREL INTOLERANCE (ALLERGY), NEUTROPENIA AND TTP
IF ALL OTHERS FAIL
LOW EF AND REGURGITANT VALVULAR DISEASE, COUGH AND HYPERKALEMIA
HYDRALAZINE AND NITRATES
P. ASS.- CAD
IT/TIP-CAD=STATINS WHEN TO USE AND SIDE EFFECTS?
TIP-CAD= OTHER LIPID LOWERING DRUGS NOT PROVEN TO DECREASE MORTALITY ALONE BUT HELP STATINS MORE
TIP-CAD=NIACIN SIDE EFFECTS
TIP-CAD=FIBRATES SIDE EFFECTS
CHF, LIPID ATHEROSCLEROSIS, HYPERTENSION
HI LDL (ENDOTHELIAL ANTIOXIDANT), LIVER DYSFUNCTION>RHABDOMYOLYSIS AND RISK OF DIABETES 9%
NIACIN, GEMFIBROZIL, CHOLESTYRAMINE, EZETIMIBE
ELEVATION IN GLUCOSE AND URIC ACID LEVEL, PRURITUS, FLUSH
INCREASE STATIN SIDE EFFECTS IF USED TOGETHER + GALL STONES
TIP-CAD/HYPERTENSION= CALCIUM CHANNEL BLOCKERS
TIP-CAD/HYPERTENSION= TRUE OR FALSE DIHYDROPYRINDINE INCREASE MORTALITY
TIP-CAD/HYPERTENSION= DIHYDROPYRINDINE SIDE EFFECTS
TIP-CAD/HYPERTENSION=WHEN TO USE CCB
TIP-CAD/REVASCULARIZATION= WHEN TO TREAT WITH BY PASS (CABG)
DIHYDROPYRIDINE: NIFEDIPINE, NITENDIPINE,
NICARDIPINE AND NIMODIPINE
TRUE
REFLEX TACHYCARDIA, EDEMA, CONSTIPATION, HEART BLOCK
CANNOT USE BETA BLOCKERS-ASTHMA, PRINZMETAL VARIANT ANGINA, COCAINE USE
THREE VESSELS >70% OCL. LEFT MAIN OCL., TWO VESSELS >70% IN DIABETICS, RECURRENT EVENTS
TIP-CAD/REVASCULARIZATION= PCI WITH 5YR DURATION AND 10YR DURATION
DIAGNOSIS- CULL/SORE/SQUIIZING /PRESSURELIKE CHEST PAIN ACUTE (HOURS)
DIAGNOSIS-ACS=S4
SAPHENOUS AND INTERNAL MAMMARY
ACS
HYPERTENSION>DIABETES (IS WORSE)
DIAGNOSIS- >10MMHG SYSTOLIC DROP (DECREASE) WITH INHALATION
DIAGNOSIS-INCREASED JVD ON INHALATION
DIAGNOSIS-TRIPHASIC SCRATCHY SOUND ON AUSCULTATION
DIAGNOSIS- MAXIMAL IMPULSE DISPLACED TO AXILLA (PMI)
P.PARADOX=TAMPONADE
KUSSMAUL SIGN=CONSTRICTIVE PERICARDITIS OR RESTRICTIVE CARDIOMYOPATHY
PERICARDIAL FRICTION RUB (DRESSLER)
LVH OR DIALATED CARDIOMYOPATHY
P.ASS.- V2 TO V4 ST ELEVATION PROGNOSIS
P.ASS.- II, III, AND AVF LEADS ST ELEVATION
P.ASS.-V1-V2 ST ELEVATION
P.ASS.- RBBB
WORST PROGNOSIS LEFT ANTERIOR WALL (IF UNTREATED MORTALITY 30-40%)
LEFT INFERIOR WALL (IF UNTREATED MORTALITY 5%)
POSTERIOR WALL INFARCTION (READ OPPOSITE)
BENIGN COMPARED TO LEFT
INITIAL TREAT- ACS
INITIAL TREAT-PVC PREMATURE VENTRICULAR COMPLEXES OR FIRST DEG. AV BLOCK
IT/TIP- IN ACS THINK FIRST ________ THEN ___________ WITH TIME.
MONA-ASPIRIN THEN ANGIOPLASTY ONLY DECREASES MORTALITY WITH TIME CONSTRAINT
NOTHING
DOES IT LOWER MORTALITY THEN MOST IMPORTANT TO DO FIRST
INITIAL TEST- ACS IMMEDIATELY
INITIAL TEST-ACS 1-4 HOURS
INITIAL TEST- ACS 4-6 HRS AND WHAT LIMITATION???????REALLY
INITIAL TEST- ACS 4-6 HRS MORE ACC. AND WHAT TWO LIMITATIONS?????
EKG
MYOGLOBIN LASTS 1-2DAYS
CK-MB LASTS 1-2DAYS (CHECK FOR REINFARCT AFTER 2 DAYS)
TROPONIN LASTS 10-14DAYS (FALSE POSITIVE WITH KIDNEY INSUFFICIENCY AND CANNOT DETECT REINFARCT)
DIAGNOSIS- NORMAL ECG ONLY TROPONIN ELEVATED AND HX OF MI OR ANGINA
P.ASS.- MOST COMMON CAUSE OF DEATH WITH MI
INITIAL TREAT- VT OR VF
BEST TREAT- ACS =ANGIOPLASTY VS THROMBOLYTICS
NSTEMI
VT OR VF
CARDIOVERSION OR DEFIBRILLATION
ANGIOPLASTY
TIP-ACS= ANGIOPLASTY BETTER B.C.
TIP-ACS=ANGIOPLASTY DOOR TIME
P.ASS.- PCI COMPLICATIONS
MORTALITY BENEFIT, FEWER HEMORRHAGIC EVENTS, FEWER MI COMPLICATIONS
BALLOON= 90 MIN
RUPTURE, RESTENOSIS (THROMB.), HEMATOMA AT ENTRY
TIP- MOST IMPORTANT TO DECREASE RESTENOSIS IN PCI
TIP- V&W ANTI-THROMBI
TIP- 4 CONTRAINDICATION FOR THROMBOLITIC TREATMENT IN ACS
TIP- THROMBOLIC ASC DOOR TIME
DRUG ELUTING STENT (PACLITAXEL AND SIROLIMUS)
DECREASE FROM 40 TO 10%
VIENS ANTI THROMBI IS WARFARIN
BLEEDING, RECENT SURGERY(2 WKS), SEVER HYPERTENSION, STROKE IN LAST 6 MONTHS
NEEDLE = 30MIN
INITIAL TREAT- AFTER ACS THROMBOLICS, ST DEPRESSION OR NSTEMI/ANGINA
INITIAL TREAT- AFTER ACS NSTEMI AND PCI AND STENTING
HEPARIN (DECREASES MORTALITY UNDER THESE EVENTS)
GII/III INHIBITORS
P.ASS.- BRADYCARDIA, CANON A WAVES
P.ASS. COMPLICATION: BRADYCARDIA (SINUS), HYPOTENSION WITH NITROGLYCERIN
3RD DEG. AV BLOCK
RIGHT VENTRICAL MI
INITIAL TREAT- BRADYCARDIA
P.ASS.- COMPLICATION: TACHYCARDIA, CLEAR LUNGS, ST ELEVATION AS RIGHT (FLIP EKG) RV4
INITIAL TREAT- INFERIOR WALL MI
P.ASS.- COMPLICATION: DAYS AFTER MI, SUDDEN LOSS OF PULSE, LUNGS CLEAR
ATROPINE AND PACEMAKER CHRONIC
NEW INFERIOR WALL MI
HIGH VOL. FLUID REPLACEMENT, AVOID NITROGLYCERIN (WORSEN CARDIAC FILLING
FREE WALL RUPTURE AND TAMPONADE
INITIAL TEST- FREE WALL RUPTURE AND TAMPONADE
INITIAL TREAT- TAMPONADE
P.ASS.- COMPLICATION V TACHYCARDIA OR V FIBRILLATION
INITIAL TREAT- VTACH OR VFIB
ECHO
PERICARDIOCENTESIS AND SURGERY
MI
CARDIOVERION/ DEFIB
P.ASS.- NAME 6 MI COMPLICATION
ACC. TEST- VALVE/SEPTAL RUPTURE
BRADY/TACHYCARDIA, WALL RUPTURE/TAMP, VTACH/FIB, VALVE/SEPTAL RUPTURE, BIGGER INFARCT/REINFARCTION, ANEURYSM/MURAL THROMBUS
ECHO
DIAGNOSIS- POST MI STEP UP SATURATION OF O2 FROM R. ATRIUM TO R. VENTRICAL
DIAGNOSIS- POST MI PULMONARY CONG. AND MITRAL REGURG. MURMUR
INITIAL TREAT- POST MI STRUCTURE COMPLICATION PENDING TO BE FIXED SURGERY
SEPTAL RUPTURE
VALVE RUPTURE
INTRAAORTIC BALLOON PUMP IABP
DIAGNOSIS- POST MI BUMPUP IN CK-MBS ON DAY 2 + PULMONARY EDEMA
INITIAL TEST-
REINFARCT
EKG + CK-MB BUMP UP
TIP- MI DISCHARGE MUST DO?
BEST TREAT- GO HOME POST MI
TIP- NEVER A PROPHYLACTIC IN MI
IT/TIP- BETA BLOCKER SIDE EFFECT?
DETECTION OF PERSISTENT ISCHEMIA=STRESS TEST, IF (+) NEW ANGIOGRAGHY
ASPIRIN, BETA BLOCKERS, STATINS, ACE INHIBITORS( ANTERIOR WALL MI/ LOW EF)
ANTIARRHYTHMIC
ERECTILE DISFUNCTION
TIP- HOW LONG BEFORE POST MI SEX?
TIP- HOW LONG BEFORE POST MI EXERCISE?
WHEN SYMPTOM FREE (SEX DOES NOT LAST ENOUGH TO INCREASE OXYGEN DEMAND ON HEART)
WHEN SYMPTOM FREE (STRESS TEST MUST BE TOLERATED)
DIAGNOSIS 2 OF 2- DYSPNEA/PULMONARY EDEMA, S3, HX OF CARDIOMYOPATH(HYPERTENSION)/MI/VALVE DISEASE
CHF
TIP- MOST COMMON CAUSES OF CHF?
TIP- OTHER CAUSES OF CHF- TRACT PHAP
TIP- TYPES OF CHF AND KEY FEATURES
CARDIOMYOPATHY(HYPERTENSION)/MI/VALVE DISEASE
THIROID, RADIATION, ALCOHOL, CHAGAS, THIAMINE– PERIPARTUM, HEMOCHROMATOSIS ADRIAMYACIN, POST VIRAL
SYSTOLIC DYSFUNCTION AND EVENTUAL LOW EF, DIASTOLIC DYSFUNCTION AND INABILITY TO RELAX/ HIGH TO NORMAL EF
DIAGNOSIS 1 OF 2- ORTHOPNEA, PAROXYSMAL NOCTURNAL DYSPNEA, S3 GALLOP, PERIPHERAL EDEMA*, RALES, JVD
DIAGNOSIS- DYSPNEA, SUDDEN ONSET, CLEAR LUNGS
DIAGNOSIS- DYSPNEA, SUDDEN ONSET, WHEEZING, INCREASED EXPIRATORY PHASE
DIAGNOSIS- DYSPNEA, SLOWER, FEVER, SPUTUM, UNILATERAL, RALES/RHONCHI
CHF
PULMONARY EMBOLUS
ASTHMA
PNEUMONIA
DIAGNOSIS-DYSPNEA, DECREASED BREATH SOUNDS UNILATERALLY, TRACHIAL DEVIATION
DIAGNOSIS-DYSPNEA, CIRCUMORAL NUMBNESS ECAFFEINE USE, HISTORY OF ANXIETY
DIAGNOSIS-DYSPNEA, PALLOR GRADUAL OVER DAYS TO WEEKS
DIAGNOSIS-DYSPNEA,PULSUS PARADOXUX, DECREASED HEART SOUNDS, JVD
PHEUMOTHORAX
PANIC ATTACK
ANEMIA
TAMPONADE
DIAGNOSIS-DYSPNEA,PALPIATIONS, SYNCOPE
DIAGNOSIS- DYSPNEA,DULLNESS TO PERCUSSION AT BASES
DIAGNOSIS- DYSPNEA,LONG SOMOKING HISTORY, BERREL CHEST
DIAGNOSIS- DYSPNEA, RECENT ANESTHETIC USE, BROWN BLOOD NOT IMPROVED WITH OXYGEN, CLEAR LUNGS ON AUSCULTAITION, CYANOSIS
ARRHYTHMIAS
PLEURAL EFFUSION
COPD
METHEMOGLOBINEMIA
DIAGNOSIS- DYSPNEA, BURNING BUILDING OR CAR, WOOD BURNING IN WINTER, SUICIDE ATTEMPT
TIP- THREE SYMPTOMS + DYSPNEA THAT EQUAL CHF
CO POISION
S3, ORTHOPNEA, PND
INITIAL TEST- CHF
ACC. TEST- CHF
TRANSTHORACIC ECHO + EF
MULTIPLE GATED ACQUISITION SCAN (MUGA) OR NUCLEAR VENTRICULOGRAPHY
ACC. TEST- VALVE PATHOLOGY
INITIAL TEST- CHEMO/ CONTROL OF DOXORUBICIN FOR CARDIOMYAPATHY
INITIAL TEST- CHF CAUSE WITH MI, HEART BLOCK
INITIAL TEST- CHF CAUSE WITH DILATED CARDIOMYOPATHY
TEE
VENTRICULOGRAPHY
EKG
CHEST X-RAY
INITIAL TEST- CHF CAUSE WITH PAROXYSMAL ARRHYTHMIAS
INITIAL TEST- CHF CAUSE WITH PERCISE VALVE DIAMETERS, SEPTAL DEFECTS
INITIAL TEST- CHF CAUSE WITH ANEMIA
INITIAL TEST CHF CAUSE WITH HIGH AND LOW THYROID LEVELS
HOLTER
CARDIAC CATHETERIZATION
CBC
TST/T4
INITIAL TEST- CHF CAUSE WITH EXCLUDES INFILTRATIVE DISEASE SUCH AS SARCOID OR AMYLOID WHEN OTHER SITES FOR BIOPSY IS MOST ACCURATE TEST FOR SOME INFECTIONS
INITIAL TEST- CHF CAUSE WITH DISTINGUISHES FROM ARDS
ENDOMYOCARDIAL BIOPSY
SWAN-GANZ RIGHT HEART CATH
INITIAL TREAT- 5 TYPES OF PHARM FOR LOW EF CHF
INITIAL TREAT- 3 TYPES OF PROCEEDURE TREATMENT FOR CHF
INITIAL TREAT- CHF DIASTOLIC DYSFUNCTION NORMAL/HIGH EF NON-HOCM
INITIAL TREAT- CHF DIASTOLIC DYSFUNCTION NORMAL/HIGH EF HOCM
ACE INH., BETA BLOCKERS(ONLY METROPOLOL,BISOPROLOL, CARVEDILOL), SPIRANOLACTONE (ONLY CHF III/IV NON-DIURETIC EFFECT), DIURETICS (LOOPS), DIGOXIN (ONLY HELPS WITH SYMPTOMS)
IMPLANTABLE DEFIBRILLATOR (EF
DIAGNOSIS- DYSPNEA+RALES,JVD,S3,EDEMA ORTHOPNEA, ACITES
P.EDEMA FULL CHF
INITIAL TEST- P. EDEMA
INITIAL TREAT- ACUTE P.EDEMA/ TEMP. AND SEC. CHOICE FOR ACUTE/ CHRONIC P.EDEMA ADD?
BNP,CXR,OXIMETRY, EKG,ECHO
PRELOAD REDUCTION: (O2,DIURETIC,MORPHINE, NITRATES)/ INOTROPE: DOBUTAMINE/ AFTERLOAD RED.: ACE INH
TIP- MURMURS: INCREASE LOUDNESS WITH INSPIRATION/CVR
TIP-MURMURS: INCREASE LOUDNESS WITH EXPIRATION/
INITIAL TEST- VALVE DIESEASE
ACC. TEST-VALVE DIESEASE
RIGHT SIDE OF HEART VALVES
LEFT SIDE OF HEART VALVES
TTE(LESS ACC) THEN TEE (TRANSESOPHAGEAL ECHO)
CATHETERIZATION
INITIAL TREAT- VALVE DIESEASE
TIP- INCREASE LOUDNESS LEAN FORWARD OR LEFT DECUBITUS POSSITION (WITH BELL)
TIP- HOLOSYSTOLIC MURMUR RADIATS TO AXILA
TIP-IF END-SYSTOLIC DIAMETER EXPANDS? >40MM
DIURETICS (ALL CAUSE LUNG FLUID OVERLOAD), STENOSIS=NO PHARM(BALLOON (MS), SURGICAL(AS)),REGURG:VASODILATOR(ACE INH, NIFEDIPINE,HYDRALAZINE)+SURG.
DIASTOLIC MURMUR
MITRAL REGURGITATION
REPLACE REGURG VALVE
TIP-COMMON ETIOLOGY OF MITRAL STENOSIS AND 1 OTHER/ COMMON AGE
TIP-MS CRITICAL NARROWING IS VALVE AREA OF?
P.ASS.-DYSPHAGIA, HOARSENESS, ATRIAL FIBRILLATION, HEMOPTYSIS,EKG(V1,2): BIPHASIC P WAVE
TIP- NAME AND DESCRIBE TWO DIASTOLIC MURMURS AND CHARACTORISTIC
RHEUMATIC FEVER, PREGNANCY INDUCED CARDIOMYOPATHY/ YOUNG ADULT IMMIGRANT PATIENTS
1CM SQUARD
MS
MS/AR, OPEN SNAP/DECRESIENDO, HEARD BEST ON APPEX/HEARD BEST ON LOWER LEFT STERNAL B. AND INC. WITH HANDGRIP AND BETTER WITH VALSAVA AND STANDING
P.ASS.-CXR STRAIGHTENING OF THE LEFT HEART BORDER,ELEVATION OF THE LEFT MAIN STEM BRONCHUS,SECOND BUBBLE BEHID HEART
P.ASS.-ANGINA,SYNCOPE,CHF, OLD OR CONGENITAL
TIP- DESCRIBE AS MURMUR
MS
AS
HEARD BEST SECOND R. INTERCOSTAL AND RATIATES TO CAROTID, (VALSAVA, HANDGRIP AND STANDING IMPROVE)
P.ASS.- CXR RIGHT VENTRICULAR HYPERTROPHY, EKG: S WAVE IN V1 AND R WAVE IN V5 >35MM
TIP- COMMON ETIOLOGY OF MITRAL REGURG
TIP-DESCRIBE MR MURMUR
TIP- MURMUR INCREASES WITH HANDGRIP
AS
HYPERTENSION, MI OR DILATED HEART(CHF
SYSTOLIC DYSFUNCTION), ENDOCARDITIS
PAN/HOLOSYSTOLIC, RADIATES TO AXILLA HANDGRIP WORSENS
AR AND MR
TIP- LEFT MURMUR THAT DOES NOT INCREASE WITH EXPIRATION
INITIAL TREAT- MR LVESD ABOVE 40MM OR EF
MVP OR HOCM
SURGICAL VALVE REPAIR OR REPLACMENT
AR
DIAGNOSIS- WIDE PULSE PRESSURE, WATER HUMMER PULSE, QUINCKE PULSE,HILL SIGN, HEAD BOBBING
AR
TIP- DESCRIBE AR MURMUR
TIP- 2-5% HAVE WHAT ANATOMICAL VALVE?
DIASTOLIC DECRESIENDO MURMUR, HEARD BEST LOWER LEFT STERNAL BOARDER, INCREASES WITH HANDGRIP
MVP
DIAGNOSIS- CHEST PAIN, PALPITATIONS, PANIC ATTACK, MURMUR: MIDSISTOLIC CLICK
TIP- WHAT INCREASES AND DECREASES MVP SOUND?
MVP
VALSALVA AND STANDING (DECREASE RETURN) AND HANDGRIP AND SQUAT (INCREASE PRE AND AFTERLOAD)
DIAGNOSIS- DYSPNEA, EDEMA, RALES, JVD,
INITIAL TEST- CARDIOMYOPATHY
INITIAL TREAT- CARDIOYOPATHY
TIP- MURMURS THAT DO NOT INCREASE WITH EXPIRATION/MORE BLOOD
CARDIOMYOPATHY
TTE(LESS ACC) THEN TEE (TRANSESOPHAGEAL ECHO)
DIURETICS NEVER WITH HOCM
HOCM AND MVP
P.ASS.- ALCOHOL, POSTVIRAL,TADIATION, TOXINS, CHAGAS
INITIAL TREAT- DILATED CARDIOMYOPATHY
DILATED CARDIOMYOPATHY
SAME AS SYSTOLIC DYSFUNCTION CHF
DIAGNOSIS- YOUNG CHEST PAIN WITH EXERCISE, INC. HR, DEC. LEFT VENT. CHAMBER SIZE, LIKE AS
TIP- WHAT DECREASES LEFT VENTRICULAR CHAMBER SIZE?
HOCM
ACEI, ARB, DIGOXIN, HYDRALAZINE, VALSALVA, AND STANDING SUDDENLY
DIAGNOSIS- HYPERTENSION, S4 GALLOP, NO R. CHF SIGNS
HCM
INITIAL TREAT- HOCM OR HCM
INITIAL TREAT- HOCM SPECIFIC
TIP- PHARM QUANTITY FOR DILATED VS HYPERTROPHY CARDIOMYOPATHY
TIP- ETIOLOGY OF RESTRICTIVE CARDIOMYOPATHY?
BETA BLOCKERS, NEG. INOTROPS, NEVER DIURETICS IN HOCM
IMPLANT DEFIB AND ABLATION OF SEPTUM W/ CATH ALCOHOL INDUCED INFARCT OR MYOMECTOMY
5 VS 2
INFILTRATED MUSCLE CAUSES BOTH EFFECTS OF DILATED AND HYPERTROPHIED HEART DUE TO IMMOBILITY.
P.ASS.- SARCOIDOSIS, AMYLOID, HEMOCHROMATOSIS, ENDOMYOCARDIAL FIBROSIS, SCLERODERMA, EKG:LOW VOLTAGE
DIAGNOSIS- DYSPNEA + R.CHF SIGNS, KUSSMAUL SIGN, PULMONARY HYPERTENSION
RESTRICTIVE CARDIOMYOPATHY
RESTRICTIVE CARDIOMYOPATHY
TIP- WHAT IS KUSSMAUL SIGN?
INITIAL TEST- RESTRICTIVE CARDIOMYOPATHY
INSPIRATION INCREASES JVD
TTE(LESS ACC) THEN TEE (TRANSESOPHAGEAL ECHO)
TIP- ECHO SPECKLING SEPTUM
ACC. TEST- RESTRICTIVE CARDIOMYOPATHY
TIP-STANDING AND VALSALVA
RESTRICTIVE CARDIOMYOPATHY
ENDOMYOCARDIAL BIOPSY
DECREASE BLOOD RETURN TO HEART
TIP- TRUE OR FALSE? STANDING AND VALSAVA = DIURETIC USE
TIP- TRUE OR FALES? HANDGRIP = FULLER LEFT VENTRICLE
TIP- TRUE OR FALSE? AMYL NITRATE=ACEi= EMPTIER LEFT VENTRICLE
TIP-REGURG VALVE SOUNDS BEST FULLER AND ALL REST SOUND BEST EMPTY (L.VENTRICAL)
TIP-PERICARDIAL DISEASE: CHRONIC FLUID LEADS TO FIBROSIS/CALCIFICATION= CONSTRICTIVE PERICARDITIS
TIP-PERICARDIAL DISEASE: ACUTE LOTS OF FLUID LEADS TO TAMPONADE
TRUE
DIAGNOSIS- SHARP PAIN INCREASED INTENSITY WITH RESPIRATION AND POSITION(FLAT), EKG: ST ELEVATION AND PR DEPRESSION
PERICARDITIS
TIP- ETIOLOGY OF PERICARDITIS
TIP- AMOUNT OF FLUID IN TAMPONADE
INITIAL TEST- CARDIAC TAMPONADE
ANY INFLAMATION NEAR THE HEART: MAINLY VIRAL OR SYSTEMIC DISEASE
50ML TO 2000ML
ECHO
DIAGNOSIS- EKG: ELECTRICAL ALTERNANS( DIFF. HIGHT QRS),CXR:GLOBULAR HEART,COLLAPSE DIASTOLIC R. ATRIAL AND VENT
DIAGNOSIS- R. HEART CATHETER: EQUALIZATION OF PRESSURES IN DIASTOLE
TAMPONADE
TAMPONADE
INITIAL TREAT- TAMPONADE
PERICARDIOCENTESIS, IV FLUIDS AND WINDOW
DIAGNOSIS- R. HEART FAILURE SIGNS +CHRONIC INFLAMATORY DISEASE
P.ASS.- KNOCK HEART SOUND AND KUSSMAUL SIGN
INITIAL TEST-
ACC. TEST-
INITIAL TREAT-
CONSTRICTIVE PERICARDITIS
CONSTRICTIVE PERICARDITIS
CXR-SHOWS CALCIFICATION FIRST THEN CT/MRI THEN ECHO (TO RULE OUT MYOPATHY)
CT AND MRI
DIURETICS THEN SURGICAL REMOVAL
DIAGNOSIS- LEG PAIN IN CALVES ON EXERTION, LOSS:HAIR FOLLICLES, SWEAT GLANDS, SEBACEOUS GLANDS, SKIN SHINY
TIP- PAIN WHEN WALKING UP HILL OR DOWN
INITIAL TEST-
INITIAL TREAT-
PAD PERIPHERAL ARTERY DISEASE
PAD PERIPHERAL ARTERY DISEASE
ANKLE-BRACHIAL INDEX (ABI) LESS THAN .90 IS + FOR DISEASE
CONTROL CAUSE, ASPIRIN, STOP SMOKING, CILOSTAZOL THEN SURGERY IF ALL FAILS
DIAGNOSIS-PAIN IN BETWEEN SCAPULAE AND BP DIFF. BETWEEN ARMS
INITIAL TEST- AORTIC DISSECTION
ACC. TEST- AORTIC DISSECTION
INITIAL TREAT- AORTIC DISSECTION
AORTIC DISSECTION
CXR- WIDE MEDIASINUM
ANGIOGRAM
CONTROL BP: BETA BLOCKERS, NITROPRUSSIDE, SURGICAL CORRECTION
TIP- ACCURACY IS MRA=CTA=TEE
DIAGNOSIS- BACK PAIN, PULSADING ABDOMIN
AORTIC ANEURYSM
TIP- SCREENING TEST FOR AORTIC ANEURISM AND WHO
TIP- WHEN TO SURGICALLY/CATHETER REPAIR AORTIC ANEURYSM?
TIP- WORST CARDIAC DISEASE IN PREGNANT WOMEN AND TREAT
ULTRASOUND AND SMOKERS OVER 65YEARS
OVER 5CM IN DIAMETER
PERIPARTUM CARDIOMYOPATHY TX: LIKE DILATED CHF, THEN EISENMENGER SX. FROM VSD
