Cardiology Flashcards
HTN
Sx: Usu asx. Dizzy, HA, flushing, S4
PE: Papilledema, Cotton wool spots, Ocular Exudates, Full CVP, Full Neuro, Peripheral pulses, Palpate abdomen
Imx: Stress ECG, AP CXR
Labs: Creatine, BUN, Glucose, Lipids, K, Na, Mg, Ca, Thyroid, hs-CRP, UA (to look for kidney involvement)
Ddx: Kidney dz, Atherosclerosis, Obesity, DM, *ro secondary HTN.
Tx: Diuretics, B Blocker. Decrease Na, K, sugar, alcohol. 100-300mg/d CoQ10. 600-800mg Mg QD.
When do you send HTN to ER and what are some sx?
Diastolic >120
Sx: CNS abnormalities, chest pain, dyspnea, sever retinopathy, JVD, lung crackles
Stages of HTN
Pre: 120-139/80-89
S1: 140-159/90-99
S2: 160+/100+
S3: 180+/110+
How should BP be taken for HTN?
3 separate BP readings (supine or seated, then standing after 2minutes) on 3 separate days
Abdominal Aortic Aneurysm
Sx: Aortic diameter >3cm*, Usu asx. Depp boring back/abdominal pain-sharp pain w rupture.
PE: Listen for bruits, Abdominal exam look for pulsations, palpate diameter, Pulse Ox.
Imx: US, CXR (calcifications)
Labs: Troponin, CK-MB, CMP w lipids, AST, LDH-1 (peaks 3-4d p heart attack), Fibrinogen.
Ddx: HTN, MS, Mass, GI, MI, Angina, Anxiety, Pericarditis, PE.
Tx: >2in may rupture surgery is needed unless risky for pt. Basic lifestyle changes.
Pericarditis
Sx: Pericardial friction rub (high pitched, squeaking, heard learning forward holding expiration). Chest pain worse w breathing, better sitting leaning forward (this ro MI), fever, chills.
PE: Friction rub, JVD.
Labs: ECG; elevated ST. CXR or echo (enlarged silhouette)
Ddx: MI, Angina, LCHF. Costochondritis (if no rub)
Tx: Opoiods/steroids for pain, AI diet, EFA, Vit C & E.
Coronary Artery Disease; Angina Pectoris & MI
Sx: Brought on by exertion and relieved by rest. Substernal pain may radiate to the jaw, neck, L shoulder, pain lasts 15-30s. Pain worse w cold weather, after meal, stress.
PE: Distant heart sounds, Tachycardia, diffuse apical pulse, S4 gallop, decreased peripheral buses, femoral or carotid bruits. RO lung and MS issues.
Imx: ECG stress test, Holter monitoring (ECG w unstable or variant angina), Echo, MRI
Labs (will only pick up risk factors): Lipids, Glucose, Insulin, hs-CRP, Homocysteine, CRP (plaques)
If MI: Troponin, CK, CK-MB, Myoglobin, LDH-1, AST
Ddx: Costochondritis, Anxiety, GI, Pulmonary, Aortic dissection, Mitral valve prolapse, MI if >30m and Nitroglycerin doesn’t help
Tx: Nitroglycerin, Lifestyle, Bypass surgery
How may women’s experience w angina differ from men? (Note: the “default sx” are for men cue eyeball roll)
- More often occurs in women w diabetes than men w diabetes
- More back, jaw, abs and neck pain (not over the heart)
- More nausea, SOB, fatigue
- More “Atypical Angina”… at rest, at night, w mental status
- Women more likely to think of pain as indigestion
- Risk increases post-menopausally and sx may be confused w other disease
Stable Angina
Chest pain occurs w activity or stress. Begins slowly, gets worse over a few minutes. Goes away quickly w meds or rest.
Unstable Angina
Pain experienced w rest
Prinzmetals Angina
AKA; Variant angina. Angina at rest that has no pattern or predictability. High risk of MI.
DVT
Sx: Hx of DVT, Swollen leg/arm, Pain, erythema
PE: Better w leg elevation (vs peripheral artery dz which is worse), Pitting edema, Calf circumference >3cm, + Homan’s sign.
Imx: US w doppler
Labs: D dimer, Fibrinogen, PT, PTT, INR
Ddx: PAD, Venous insufficiency, Lymph obstruction, Cellulitis
Tx: Prevent PE*, Warfarin, Discontinue HRT, Elevate legs, Streptokinase (thrombolytic), No exercise.
CHF
Sx: See next slides for L vs R
PE: Pulse Ox, mb low BP, JVD (w RCHF), Check for pitting edema & temp of feet and hands, Capillary refill mb decreased.
Imx: ECG, Echo (L hypertrophy), CXR **Never stress test
Labs: BNP >100
Ddx: ARDS< COPD, Bronchitis, Cirrhosis, Pericarditis
Tx: Rest, Diuretics, Crateagus, Mg, Hydrotx
LCHF sx
*RESPIRATORY SX; tachypnea, dyspnea on exertion, intolerance to cold.
Displaced apical pulse. S3 best heard at apex w bell in L lateral decubitus position. R sided pleural effusion, Central or peripheral cyanosis.
RCHF sx
*EXTRA FLUID; ascites, JVD, tender enlarged liver, tricuspid murmur, peripheral cyanosis, systen HTN, Nocturia.
May present w LCHF sx since LCHF often cause of RCHF
