Cardiovascular Flashcards
Key lab findings with cholesterol emboli
Eosinophilia, eosinophiluria, and low complement
Skin findings in cholesterol emboli
- Livedo reticularis (reticulated, mottled, discolored skin due to swollen venules from capillary obstruction)
- Blue toe syndrome
Internal organ damage in chiolesterol emboli
- Acute kidney injury
- Pancreatitis
- Mesenteric ischemia
- Embolic stroke, amaurasis fugax
3 potential triggers of vasovagal syncope
Stress, pain, or urination
What, if any, are the warning signs of:
- Syncope 2/2 arrhythmia
- Syncope 2/2/ orthostatic hypotension
- Vasovagal syncope
- Arrhythmia: no warning
- Orthostatic hypotension: lightheadedness when standing up
- VasovagaL; nausea, diaphoresis, pallor in response to stress, pain, or urination
What can be done to abort a vasovagal syncope episode when a person starts feeling nauseous, sweaty, and pale?
Physical counterpressure measures (PCM: squatting, arm-tensing, leg-crossing, and leg-crossing with lower body muscle tensing)
Treatment of primary Raynaud’s syndrome? Secondary?
Primary: Trigger avoidance and CCBs if necessary
Scondary: The same, plus aspirin to patients at risk for digital ischemia
Difference between primary and secondary Raynaud’s in terms of:
- Demographics
- Symmetry
- Risk of tissue injury
Demographics: Primary is younger women (<30), secondary is more older men (>40)
Symmetry: Primary is symmetric, secondary may be asymmetric
Risk of tissue injury and ulceration: only in secondary
Causes of secondary Raynaud’s syndrome (6)
- Connective tissue disease (lupus, scleroderma)
- Occlusive vascular disease
- Hyperviscosity syndromes
- Sympathomimetic drugs
- Birth control pills
- Smoking
An ICU patient on pressures has necrosis of distal fingers and toes. Likely cause?
Norepinephrine-induced vasospasm (can also caused mesenteric ischemia and AKI)
Most common location of cardiac myxoma?
Potential hemodynamic consequence?
Murmur?
Mostly in LA.
Can mimic mitral stenosis by blocking LA outflow, may lead to HF
Early diastolic mumor - “tumor plop”
Complications of cardiac myxoma (3)
- LA outflow obstruction and heart failure
- Invasion leading to arrhythmias or heart block (or effusion)
- Emboli (e.g. stroke)
Murmurs that get louder with standing and valsalva and quieter when squatting
HOCM and MV prolapse
Enlarged “water bottle” cardiac silhouette on CXR
Pericardial effusion (may follow URI)
Signs of pericardial effusion on EKG
- Electrical alternans (in voltage amplitude)
2. Low-voltage QRS complexes
Clinical signs of cardiac tamponade
Beck’s triad: hypotension, elevated JVP, muffled/distant heart sounds
Pulsus paradoxus may also be seen (also seen in constrictive pericarditis, sever asthma/COPD)
What may be seen on CXR in constrictive pericarditis?
Pericardial calcifications
Heart sounds in constrictive pericarditis
Pericardial friction rub: high-pitched grating/squeking sound during systole (most common), diastole, or both
Pericardial knock: high-frequency mid-diastolic sound (due to abrupt cessation of diastolic filling)
JVP increases or stays the same with inspiration. Cause?
Kussmaul’s sign due to constrictive pericarditis
(Normally JVP decreases during inspiration due to blood being drawn into the chest and heart, but here it cannot take the extra volume)
Sharp x and y descents on central venous tracing. Cause?
Constrictive pericarditis
Sharp X descent (systole): RA cannot relax fully because of pericarditis
Sharp Y descent (diastole): RV filling is limited
Causes of constrictive pericarditis (4)
- Idiopathic
- Viral
- Tuberculosis
- Iatrogenic (radiation or heart surgery)
Pain of acute pericarditis
Sharp, pleuritic, and relieved by leaning forward
EKG in acute pericarditis
Diffuse ST elevation and PR depression
First-line treatment for acute pericarditis?
Alternative?
First-line: NSAIDs
Alternative: Colchicine