CARDIOVASCULAR Flashcards
CP at rest >20 minutes, transient ST or T-wave changes. Trop normal.
Unstable Angina
What might a new LBBB be?
STEMI
Easy EKG HR identification
300/150/100/75/60
Lateral MI leads
I, aVL, V5, V6
I, aVL, V5, V6
LATERAL MI
Inferior MI leads
II, III, aVF
II, III, aVF
INFERIOR MI
Septal MI leads
V1, V2
V1, V2
SEPTAL MI
Anterior MI leads
V1, V2, V3, V4
V1-V4
ANTERIOR MI
Troponin elevation times
elevation at 4-6 hours, peak at 24-36 hours, normal 5-12 days
When should we consider a fibrinolytic for a STEMI?
If unable to get PCI within 90 minutes (TPA within 30 minutes, still send to cath lab)
When do we give oxygen for CP?
Only if hypoxic
Thrombolytic 1 time dose
Tenecteplase (TNKase)
30% of interior infarcts also involve what?
Right ventricle
What must we do on all inferior infarcts?
Right side EKG b/c 30% of inferior MIs also involve right ventricle. Right side EKG is MIRROR IMAGE
What is the right ventricle critical to?
cardiac output - preload/strech/filling
What is the most specific lead to determine a right side MI?
V4’ / V4r
Good ventricular wall stretch (filling) is needed for maximal ejection. Increased filling (preload) too much will decrease cardiac output.
Sterling’s Law
3 characteristics of PRELOAD
3 characteristics of AFTERLOAD
Preload: right side of heart, managed by fluid, venous system
Afterload: left side of heart, BP/resistance dependent, arterial system
What does increasing afterload also increase?
Heart workload
What 3 meds decrease preload?
Lasix, morphine, nitro
What meds decrease afterload?
Any vasodilator (nipride, ntg)
Symptoms of left sided HF? Right sided HF?
Left = pulmonary edema + dependent edema
Right = venous congestion + anasarca
What BP med is used for eclampsia?
Hydralyzine
-Vaso-dilators that decrease afterload
-Veno-dilators that decrease preload
-Arterilar-dilators that decrease afterload
-Vaso-dilators = alpha-blockers (catapres, clonodine)
-Veno-dilators = morphine, nitro, lasix
-Arterilar-dilators = hydralyzine, CCB
What is the treatment goal for hypertensive crisis?
Decrease BP by 20-30% over 2-3 hours, treat until relief of symptoms
This affects endocardium and valves; symptoms are Janeway lesions and Roth’s spots. Check sed rate for diagnosis.
Endocarditis
What are Janeway lesions? When do we see them?
Micro-emboli causing lesions to hands/fingers seen in endocarditis
What are Roth’s spots? When do we see them?
Micro-hemorrhages on retina seen in endocarditis
Inflammatory, CP relieved by leaning forward, EKG shows ST changes in all leads
Pericarditis
Beck’s Triad
-JVD
-Muffled heart sounds
-low BP
This causes Beck’s triad; associated with pulsus paradoxus; treat with pericardiocentesis
Cardiac Tamponade
What is pulsus paradoxus?
SBP increases by 10mmHg or more during inspiration
Where on the heart does a blunt cardiac injury cause damage?
Anterior (sometimes inferior)
This causes vasospasm of vessels esp in fingers
Raynaud’s
This causes thrombi of vessels esp in fingers
Buergers
What is pain like in PVD?
Pain increases with use and is relieved with rest
Non-obstructing clot on vessel wall waiting to break off and travel downstream
Thrombus in situ
Virchow’s Triad (DVT)
-venous stasis
-hypercoagulability
-endothelial injury
What do we see on CXR in an aortic aneurysm?
Widened mediastinum
Allen’s Test procedure
-examiner grasps the patient’s wrist and applies finger pressure to block the vascular supply from the radial and ulnar arteries.
-The patient then makes a fist three to four times so as to force the venous blood out of the hand via the posterior veins.
-After 1 minute, the patient lets the arm hang down and opens the now pale hand.
The examiner now releases compression, first from one artery then from the other.
-This procedure is repeated with the radial artery released and compression on the ulnar artery maintained.
What is the phlebostatic axis?
MAL, 4th ICS
What 3 things does a good arterial wave have?
-rapid upstroke
-clear dicrotic notch
-definite end diastole
Complications of an a-line
-dislodgement
-bleeding
-infection
-etc
1st degree AV block
PR >0.2 (1 large box)
Heart block Wenckeback
2nd degree type ONE
Associated with endocarditis: tender, purple-pink nodules found on the distal fingers and toes, pain usually proceeds nodule development, and they disappear in hours to days, leaving no sequelae.
Osler Nodes
