cardiovascular Flashcards
AV valves
tricuspid and mitral
S1 Atria Ventria valves are
closed
S2 semilur valves
pulmonic and
S3 leading abnormal heart sound in
heart failure, normal in pregnancy kentucky
S4 tennesse
stiff ventricular wall (MI, LVent hypertrohy) uncontrolled HTN
Mitral stenosis
loud S1 murmur, low pitched a
Aortic stenosis radiates to neck
systolic blowing
Acute heart faillure is
L sided
chronic heart failure is
R sided
left failure look for problems in the
Lungs
Order of R heart failure
JVD-hepatosplnomeegaly- peripheral edema
outpatient managment of heart failure
na and water restriction
rest and activity balance
weight reduction
pharma management of heart failure
ace inhibitors (prils) and diuretics
manageent of acute plum edema
O2
morphine and lasix 40 repete q20 or 30
definition of HTN
sustained elevation of sys BP >140 or diastolic BP >90
3times on two different occasions
primary HTN
95% onset usually less than the age of 55
secondary HTN
classic presentations- estrogen use, renal disease, pregnancy, endocrine disorders RENAL ARTERY STENOSIS
HTN exacerbates
smoking, oeisity, too much booze, nsaids
suboccipital HA HTN
HTN gets better over the course of the day
S and S of HT
often silent EPISTAXIS elevatedBP dizzy light headed S4related to left ventricular hypertrophy
HTN labs and diagnostic
primary HTN is a diagnosis of exclusion
Normal BP
less than 120 and less than 80
pre hypertension
120-139/or 80-89
HTN stage 1
140-159/or 90-99
HTN stage 2
more than 160 or more than 100
patients over 60yo
less than 150 less than 90
patients less than 60yo
less than 140 less than 90
non pharma management HNT
low salt weight loss if overweight exercise 30mins most days dash diet streee reduction low booze
pharma management of of HTN thiazide diruetics
screen for sulfa allergy, pee sowatch lytes
jnc 7
stage 1 thiazide diuretics
stage 2 thiazide diuretic and another agent
no BB for dm or
asthma or copd
ace inhibitors
prils - contraindicated in pregnancy
not with an arb watch for cough
angiotensisin II ARB
reserved for patients intolerant to ACE I
lasix particularly effective in
african americans and elderly with isolated systoic hypertension 162/74 kind of thing
hypertensive urgency
180/110 w/o target organ dysfunction
po clonadine(alpha 2 agonist)/catopril(ace I)
may have ha
rarely
hypertensive emergency
>180/120 with nd organ dysfunciton malignant hypertension with changes in the eyes htn pappilidema, swelling of potic disc and blurred lid margins. unstable angina acute MI acute LV failure with edema dissecting aneurysm
hypertensive emergency
nitro gtt, unit admission, and a line
hypertensive emergency
cardne gtt, unit admission, and a line
hypertensive emergency
shoot for 160-180 or less than 105diastolic - no more than 25% withing 2hrs
angina at rest
prinzmetals vs unstable
levines sign
clinched fist sign (sqeezing my heart=angina)
angina ecg
downsloping of ST or T wave peak inversion
ST depression +ischemia
ST elevation is infarction
angina after exercis ecg
serum lipid levels
angina desired serum lipid levels
total less than 200
trigs less than 150
ldl less than 100
hld over 40
lipid goals for DM or CAD
LDL less than 70
HDL over 40
TRI less than 150
angina angiography
coranary angioagraphy is definitive but not indicated soley for diagnosis
angina meds
low dose asa 81enteric coated then nitrates BB CCB 3 classes of meds
optomizing lipids who gets a statin
clinical evidence of athlerosclerotic CVD
elevated LDL-C over 190
diabetics 40-70 with LDL between 70-189 but with an estiated athlersclrotic rsik of 7.5% or higher
statin goal
try and get 50% LDL reduction after you max statin dos u can try and non statin adjunct
mi
alteration intypical anginal pain, most occur at rest, pain is like angina
s4 is common
mi ecg
30% have nothing on ECG
peaked T
ST elevation
maybe Qwave
1-avl
lateral mi
2-3-avf
inferior MI
V 3-4
anterior mi
troponin I and CKMB are
100% cardioslective
leukocytosis after mi
10-20k on the second day
mobtz II
regulr A and PR interval but vent rythm is irregular and complexes are droped
III block
no relationship between p and qrs complexes. PR interval varies with no regularity
MI mangemnt
ASA 325 to chew NItro s q5x3 02 IV kvo 3 12 lead morphine 2-4 lasix 40 for pulm edema BB if not contraindicated ACE I for failure or large infarction to prevent ventricular remodeling hep
INR mormal vs
0.8 -1.2
INR goal in MI
2.5-3.5 of normal 2-2.8—4.2 (2-3)
door to fibriniltyics is
30 mins
door to cath lab is
90 ins
lovenox dose in MI
1mg/kg
indications for pharmacologic recascularization
unreleived chest pain more than thirty mins and less than six hours with st seg elevation of greater than .1 in two or more contiguous leads
contraindications for pharmacologic therapy ie TPA
Prior ICH malignant neoplasm of brain or cerebral vascualr lesion ischemic stroke within 3 months suspected aortic discetion active bleeding closed head or facial trauma within 3 months spinal or brian sx wihting 2 months uncontrolled htn over 185/110 abnormal coags
DVT management
bed rest for 7-14days with leg elevated gradually re-introduce walking lovonox 1mg/kg q12 heparin for 7-10 days coumadin for 12 weeks consult when antigoag is needed
DVT while walking and distal edema
DVT
PVD
40-70years of age
high lipids
smoker
dm
PVD s and s
claudication
cold or numb to extremities
progress to pain at rest
PVD physical findings
shiny hairless skin
dependant rubor
elevational white feet or pallor
PVD lab dx
doppler us, ABI ateriography is most definitive test
PVD treatment
stop smoking walk 1hr per day stop on pain resume when it stops to develo colateral circ trental pletal angioplasty or bipass
CVI
womman greater than men,
may be genetic
history of leg trauma or vericosities
cvi symptoms
aching of LE releived by elevation, edema after stadnign, night cramps in LE
CVI findings
trophic changes iwth brownish redish hue stasis leg ulcers dermatitis cool to tocuh LE
CVI dx
non specific, R/O HF
CIV management
bed rest with legs up
support stockings
weight reduction
CVI treatment of acute weeping dermtis
wet compress
0.5 hydrocortisone cream after comress
systemic abx only if central infection is suspected
heart murmur with fever
must rule out endocarditis
pericarditis vs endo
peri is virus endo is bacterial
pericarditis
pain is localized and retrosternal
rub is present
hurts on ispiration releived when leaning forward
may not have fevers
ST ELEVATION IN ALL LEADS IWTH DEPRESSION OF PR SEGMENT
pricarditis
hihg dose nsads advil 400-600 q 6
steroids only on total failure of nsaids
monitor for tampanod
endocarditis
fever malaise, night sweats and weight loss
endocarditis blood cultures
3 cultures at three sperate sites in one hour
endocarditis oslar nodes
painful red nodules in the distal phalanges
endocarditis janewa lesion
small not painful macul on palm and sole
endocarditis abx 1
penicillin g 2million units IV q4 in combo with gnetimycin
endocarditis
nafcillinn (unipen) 2g q4
endocarditis mrsa
vanc
