Cardiovascular system Flashcards
Is ETOH a known PPT of a fib?
yes
WPW = Findings on ECG
(shortened PR interval, delta wave, wide QRS)
+ symptomatic tachyarrhythmia
CAD: Women are __ likely to have CAD than men;
less
however, women are more likely to present with atypical anginal symptoms (ie: epigastric discomfort)
Diastolic murmurs:
- Mitral stenosis
- Aortic regurg
Mitral stenosis
loud first heart sound (S1) and mid-diastolic rumble best heard at the cardiac apex.
Noonan syndrome:
short stature, facial dysmorphism, and a spectrum of congenital heart defects.
- Cardiac involvement is seen in up to 90% of patients and includes pulmonic stenosis, atrial septal defects, and hypertrophic cardiomyopathy
Patients with bicuspid aortic valve are at risk for developing
aortic dilation, aortic aneurysm, and aortic dissection, and should be screened with imaging of the aortic root and proximal aorta.
Urgent coronary revascularization is indicated for acute ST elevation myocardial infarction (STEMI).
- Optimal therapy is with percutaneous coronary intervention (PCI) within ___ minutes of first medical contact or within ___ minutes for patients who require rapid transfer to a PCI-capable facility.
percutaneous coronary intervention (PCI) within 90 minutes of first medical contact or within 120 minutes for patients who require rapid transfer to a PCI-capable facility.
- In some rural settings, PCI within 120 minutes is not possible, and fibrinolytic therapy (eg, tenecteplase, alteplase, reteplase) is indicated within 30 minutes of hospital arrival.
ECG findings are diagnostic of STEMI:
- New ST elevation at the J point in >2 anatomically contiguous leads with the following threshold:
>1 mm (0.1 mV) in all leads except V2 and V3
>1.5 mm in women,
>2 mm in men age >40, and
>2.5 mm in men age <40 in leads V2 and V3
New left bundle branch block with clinical presentation consistent with ____
acute coronary syndrome
Heart failure with preserved ejection fraction due to left ventricular diastolic dysfunction - Most commonly caused by
prolonged systemic hypertension -> left ventricular hypertrophy and impaired diastolic filling -> decompensated volume overload despite normal left ventricular ejection fraction >50%.
- Comorbidities: Obesity, diabetes mellitus, and obstructive sleep apnea
Kerley B lines
(horizontal lines representing interstitial edema and pulmonary edema)
VSD
most common congenital heart defect at birth
- spontaneous closure in 40%–60% of the patients during early childhood.
- A small restrictive VSD is associated with a loud murmur, but a large nonrestrictive VSD is associated with a softer murmur which occurs early in systole due to early equalization of right and left ventricular pressures
atrial septal defects and large left-to-right shunts reveals which sound?
a characteristic wide and fixed splitting of the second heart sound.
- may also have a mid-systolic ejection murmur resulting from increased flow across the pulmonic valve,
- and a mid-diastolic rumble resulting from increased flow across the tricuspid valve.
Mitral stenosis is best heard with the bell of the stethoscope at
the cardiac apex, which is located in the fifth intercostal space at the left mid-clavicular line. - May be helpful if the patient lies in the left lateral decubitus position.
Peripheral artery disease (PAD) results
atherosclerotic narrowing of peripheral arteries and signifies systemic cardiovascular disease. Patients with PAD should be initiated on antiplatelet and statin therapy at the time of diagnosis
____ recommended for patients with intermittent claudication due to peripheral arterial disease. . What can be added for pts with persistent sx?
supervised exercise program
Cilostazol
If necessary, revascularizatiom via percutaneous stent placement or surgical bypass if critical limb ischemia or continue to have claudication despite risk factor management, exercise, and pharm
goals of initial therapy for both ascending and descending aortic dissection
providing adequate pain control,
lowering systolic blood pressure to 100-120 mm Hg,
and decreasing left ventricular contractility to reduce aortic wall stress
Intravenous beta blockers such as labetalol, propranolol, or esmolol are preferred for slowing the heart rate to <60/min
Esmolol is preferred in acute settings due to its short half-life (~9 minutes), which allows for rapid titration for optimal heart rate and blood pressure control.
n patients with Cocaine related chest pain (CRCP) that is likely of cardiovascular etiology, __________ are the preferred initial medication treatment
benzodiazepines (eg, lorazepam, diazepam)
- These drugs reduce sympathetic outflow to alleviate tachycardia and hypertension and improve myocardial ischemia. In addition, benzodiazepines calm cocaine-induced psychomotor agitation, which helps to decrease myocardial oxygen demand and provide further relief of myocardial ischemia
Nitroglycerin (sublingual or infusion) is also useful in alleviating hypertension (and myocardial ischemia) in these patients
The presence of persistent chest pain and neurologic symptoms in a patient with recent cocaine use should raise suspicion for ________
acute dissection of the ascending aorta. Rapid diagnosis is essential CT angio scan
In addition to medication therapy, emergency surgical repair is needed for ascending dissection.
Acute decompensated heart failure (ADHF) results from
a critical elevation in intracardiac filling pressures
- most commonly occurs due to left ventricular (LV) systolic and/or diastolic dysfunction (eg, coronary ischemia, hypertensive
- Other causes include valvular disease and marked elevations in preload (eg, excessive volume resuscitation) or afterload (eg, severe hypertension).
- Gradually increasing LV filling pressures can reach a critical point, resulting in ADHF and pulmonary edema (bilateral crackles, vascular congestion on chest x-ray, tachypnea, hypoxia).
- JVD is usually present
cardiomyopathy) .
______ is recommended in patients with acute decompensated heart failure (ADHF) who have an inadequate response to initial diuretic therapy.
intravenous vasodilator
- Nitroglycerin: primarily a venous dilator, it leads to a rapid decrease in cardiac preload, resulting in reduced intracardiac filling pressures and improvement in pulmonary edema.
- Nitroprusside is less commonly used due to the risk of adverse effects (eg, cyanide toxicity, severehypotension); it decreases intracardiac filling pressures through balanced vasodilation and reductions in both cardiac preload and afterload.
Because intravenous vasodilator therapy often results in rapid improvement of acutely symptomatic pulmonary edema, it is indicated right away (prior to or instead of intravenous diuretics) in patients with “flash” pulmonary edema due to severe hypertension (>180/120 mm Hg) (ie, hypertensive emergency).
______ should be performed in patients with acute decompensated heart failure of uncertain etiology .
What happens if significant LV systolic dysfunction is present?
Transthoracic echocardiogram should be performed in patients with acute decompensated heart failure of uncertain etiology to evaluate for left ventricular and valvular dysfunction.
- If significant left ventricular systolic dysfunction is present, evaluation for ischemic cardiomyopathy with stress testing or coronary angiography is indicated.
WPW syndrome
- What is it?
- What is the most common arrhythmia?
combination of WPW findings on ECG and symptomatic tachyarrhythmia.
- Paroxysmal supraventricular tachycardia is the most common arrhythmia; it is usually a regular, narrow complex tachycardia.
What happens if patients with WPW develop atrial fibrillation?
they can conduct down the accessory pathway from the atria to the ventricles at a very fast rate, commonly resulting in syncope.
- ingestion of alcohol, a known precipitant of atrial fibrillation, likely placed him at risk for such a scenario.
Name the mutations in:
Marfan syndrome
HOCM
Marfan: fibrillin gene mutation HOCM: myosin gene mutation
What should patients with asymptomatic vs symptomatic myopathy from statin use do?
- Asymptomatic: a CK level >10 times the upper limit of normal range is considered an indication for discontinuation of statin therapy.
- Symptomatic: discontinue therapy.
- However, if it seems to be temporally related to prolonged exercise (tolerated atorvastatin previously without any significant side effects), the most appropriate next step is to recheck CK levels, then restart statin therapy after CK lvls normalize
Transient hypertrophic cardiomyopathy
a cardiac anomaly found in infants of mothers with gestational diabetes.
- This disease occurs in the late second to early third trimesters due to fetal hyperinsulinemia in response to maternal and fetal hyperglycemia.
- Insulin triggers glycogen synthesis, and excess glycogen and fat are deposited within the myocardium, particularly the interventricular septum.
- Increased oxidative stress of the interventricular septum may contribute to this selective thickening.
- A hypertrophic interventricular septum is usually asymptomatic; however, if left ventricular outflow is obstructed, manifestations of congestive heart failure occurs
___ are the second most common congenital heart defect in adults
ASDs are the second most common congenital heart defect in adults (bicuspid aortic valve is the most common).
ASD: mid-systolic murmur at the left upper sternal border with right atrial and ventricular dilation
