cardiology surgery uworld Flashcards
leg cool to touch, pale, distal pulses not palpable, loss of sensation on dorm of foot with mild weakness
dx:
d/t?
tx?
acute limb ischemia
cardiac/arterial embolus
or arterial thrombosis (PAD)
IV HEPARIN INFUSION asap!
MI 1+ month ago, now have fever, leukocytosis, pleuritic chest pain
dx?
tx:
post-cardiac injury syndrome
d/t dressers: autoimmune mediated inflammation
coronary pericarditis
NSAID (HIGH dose aspirin) +/- colchicine
Hx of abdominal pain, anorexia, nausea, diarrhea, vomiting
hyponatremia, hypoglycemia, peripheral eosinophilia, severe hypotension, and shock right before surgery
primary adrenal insufficiency
hyponatremia: hypovolemia-induced ADH secretion
hypoglycemia: cortisol deficiency
eosinophilia: usually inhibited by corticosteroids
severe hypotension d/t mineralocorticoid deficiency (hypoaldosteronism)
often refractory to volume resuscitation and poorly responsive to vasopressors since cortisol is needed to potentiate the effect of alpha-1 stimulation on peripheral vascular tone
give hydrocortisone or dexamethasone
needle paced into intraperitoneal space and CO2 gas insufflation performed, then suddenly severe sinus bradycardia and transient av block
why?
peritoneal stretch receptors – sense increase in intraabdominal pressure and respond by triggering vagal tone
38M with chronic back pain, limited spinal mobility and reduced chest expansion, b/l heel pain
now has laterally displaced point of maximal apical impulse (pmi)
ankylosing spondylitis:
enthesitis (heel pain d/t tendon insertion)
pt has heart failure due to chronic aortic regurgitation
AR seen in ankylosing spondylitis:
results from chronic inflammation of the aortic root and valve cusps –> impaired closure/retrattion.
overtime: left ventricular volume overload with compensatory eccentric hypertrophy and lateral displacement of PMI
Older male with persistent back pain started abruptly, + hx of smoking and htn, X-ray shows prevertebral calcifications
next best step?
suspected unstable Abdominal Aortic Aneurysm
pre vertebral calcifications suggest atherosclerosis
next step: CT abdomen
abdominal aortic aneurysm: strongest modifiable influence for AAA development and progression:
SMOKING
heart problems with turners
aortic coarctation, bicuspid aortic valve
aortic dilation/DISSECTION
abrupt chest and neck pain with hx of HTN
CxRAY: widened mediastinum
what next?
acute aortic dissection:
HTN ** strongest risk factor
cocaine use also: tear in aortic intima layer
next step: CT-angiography or TEE
tx: pain control: morphine, Esmolol, sodium nitroprusside (if SBP>120) IF descending
if ascending: emergency surgical repair
Severe AS + ___ (3) for valve replacement
a mass in the left atrium and mid diastolic rumble at apex
cardiac myxoma: mimics mitral stenosis (middiastolic rumble at apex)
dx: echocardiography and surgical resection
central venous pressure:
shocks that decrease vs increase
hypotension, tachycardia, JVD
cardiac tamponade
recent upper resp infeciton, dyspnea, elevated JVP, clear lungs, increased cardiac sillouette
**Inability to palpate the point of apical impulse
large pericardial effusion (from cardiac tamponade)
shock:
pt with mechanical heart valve: do they need abx ppx for colonoscopy
no
dental procedure 30-60min before, give amoxicillin
complications post MI
pt had MI, then 5 days later has chest pain, unresponsive, sinus tachy, no pulse palpable
(LV) free wall rupture (Chest pain) –> blood fills pericardial space –> (cardiac tamponade –> leads to obstructive shock with hypotension and tachycardia
pt had MI, then 5 days later has chest pain, unresponsive, sinus tachy, no pulse palpable
(LV) free wall rupture (Chest pain) –> blood fills pericardial space –> (cardiac tamponade –> leads to obstructive shock with hypotension and tachycardia
cancer pt keeps getting pericardial effusions, then has malignant cells after they do a pericardiocentesis. next best step ?
pericardial window – to stop build up of drainage –> lets it drain into pleural or peritoneal cavity
or
through prolonged pericardial catheter drainage
