chapter 4 cards Flashcards
becks triad
distended neck veins
muffled heart sounds
hypotension
alteration of QRS complexes in 2:1 = electrical alternans
increased pulsus paradoxus = mean drop of 15+ mmhg w/ inspiration
seen in cardiac tamponade
ekg changes in MI
flat T waves/inverted T waves
ST elevation = infarct
depression = ischemia
q waves
how to dx MI
troponin levels every 8 hours 3x
cardiomegaly/pulmonary congestion
LV motion abnormalities
diaphorectic, tachycardic, tachypneic, N/V, BL pulmonary rales, distened neck veins, new S3 or S4, new murmurs, hypotension, shock
hx of angina or chest pain, arrhythmias, murmur, hypertension , diabetes, digoxin, furosemide, other cardiac meds
tx MI
admit to ICU/CCU
early reperfusion is time from onset of s/s <12 hrs
early perfusion <6 hours = fibrinolysis or baloon angioplasty or stent
EKG monitoring, if vtach - give amio.
Give O2 <90
pain control w/ morphine. which can help w/ pulm edema
aspirin + nitroglycerin + BBs + clopidogrel + LMWH + ACEI WITHIN 24 hours + statin
when to give heparin in chest pain?
unstable angina
cardiac thrombus
severe CHF
don’t give if active bleeding
achalasia
esophageal spasm
negative w/u of MI
botox + pneumatic dilation for achalasia
esophageal spasm - CCB
surgical myomotomy
URI preceding chest pain low grade fever diffuse ST elevation ESR is elevated low grade fever is present!! relieved by sitting forward
viral percarditis
TB uremia malignancy coxsackie lupus
pneumonia
pleuritis
severe tearing pain to back
hypertension
marfans syndrome
aortic dissection
blunt chest trauma
aortic laceration or speudoaneurysm
stable angina
exertion reproducible beter w/ rest pressure/squeezing to shoulders acc by dyspnea, diaphoresis relieved by nitro ST depressed normal if no pain relieved with SL nitroglycerin
unstable angina
change from prior
at rest or in greater frequency
normal CK or minimally elevated
EKG: ST depression + prolonged chest pain W/O improvement w/ nitro
TX is similar to that for M
1) O2, nitro, aspirin
2) bb, clopidogrel, heparin, duap, aceI
if pain not resolving? emergent PT CA
variant prinzmetal angina
pain at rest not related to exertion
early morning or at middle of night
ST elevations but normal CK
tx w/ nitro and LT CCB to reduce spasm
silent MI
chf, CONFUSION, delirium = w/o pain
seen in old and diabetes
MS
rheumatic fever
dyspnea, orthopnea, PND
MR
rheumatic fever
post MI chordae tendinae rupture
AS
bicuspid valves w/ sx in childhood dyspnea on exertion elderly only agina, syncope, CHF highest mortality = if CHF present
AR
congenital rheumatic
endocarditis
aortic dissection/root dilation
marfans
(cream)
dyspnea, pulm congestion, shock
DOE, orthopnea, PND
late diastolic BLOWING murmur at apex with opening snap, loud S1
afib + pulm HTN
MS
tx w/ baloon valvutomy or surgery
diuretics, digoxin, BB are sx tx
soft S1, LAE, pulm HTN, LVH
MR
tx if flail leaflet, or severe regurgitation
hydralazine + nitroprusside = vasodilator
hard systolic murmur radiation to caortids slow carotid upstroke s3 and s4 ejection click LVH, CM
AS
tx w/ TAVR if symptomatic
early diastolic decrescendo
wide pulse pressure
S3
AR
tx w/ TAVR if symptomatic + chronic
or if asymptomatic w/ LV enlargement
tx w/ vasodilators
mid systolic click, late systolic murmur
panic d/o
MP
right HF
long standing MS
ENDOCARDITIS PPX
only dental procedures
if prosthetic cardiac valves, prior endocarditis, congential heart disease (cyanotic, shunts, residual defects), cardiac transplants
ABX w/ amoxicillin prior to procedure only one dose
virchows triad
3 findings!
endothelial damage, hypercoagulable, venous stasis
DVT
surgery malignancy trauma pregnancy OCP DIC factor 5 lelilden, AT 3, P C/S, PTT mutation, hyperhomocysteinemia aps
DVT S/S
UL leg swelling, tenderness
homans
superficial palpable cords = superficial thrombophlebitis = not a RF (erythema/tenderness) for PE = can be a/w pancreatic cancer or other malignancy. TX: nsaids + warm compress
venography if not clear (as oppposed to doppler or impedence test) but invasive
DVT TX
Heparin/LMWH –> warfarin bridge
3-6 mo
If 1+ DVT, then for life
DVT PPX
If surgery: early ambulation if low risk
if moderate risk, LMWH, low dose UFH, fondaparinaux
if high risk, LMWH, fondaprinaudx, or vitK antagonist
if bleeding: compression stockings
PE?
tachycpnea chest pain hemoptysis hypotension sycnope death
wedge shaped defect
right heart strain
DVT cannot lead to stroke unless?
ASD/VSD/, PFO, Fistula
ARTERIAL INFARCTS?
afib, CHF, endocarditis, aneurysm can cause arteriral infarcts = renal infarcts/stroke
If V/Q scan or CTPA is indeterminate for PE?
DO pulmonary angiogram conventional
If low probability VQ but high likelihood?
pulmonary angiogram
how to treat PE???
LMWH or IV UFH
switch to oral warfarin for 3-6 mos
if recurrent clots or CI: DO IVC FILTER
if massive PE: do embolectomy or TPA
most impt SE of heparin
non-immune thrombocytopenia (slight fall in 2 days w/ quick return)
HIT type 2(AB against PF4, immune mediated, 50% drop 5-10 days post heparin therapy. arterial and venous thrombuses)
Confirm w/ functional assay
Measure CBCs
aspirin - give platelets
heparinLMWH - protamine
warfarin - FFP, clotting factors, or vit K (longer)
how to reverse anticoagsss
bleeding tendency w/ normal anticoag tests?
steroids + vit C def
Chronic CHF tx
Na restriction ACEi BB DIURETICS DIGOXIN
Acute CHF tx
inpatient: O2, diuretics, positive inotropics
stable = digoxin unstable = dobutamine, milrlinone
what precipitators exacerbation CHF
noncompliance w/ diet or meds
MI, severe HTN, arrhythmia, fever, infection, PE, anemia, thyrodi issues, myocarditis
Corpulmonale
RVH due to lung disease COPD, PE if young women = idiopathic pulm HTN sleep apnea!!!! tachypnea, cyanosis, loud P2, S4
tx: prostacyclin, epoprostanal, viagra, bosentan
heart lung transplant
restriictive CM
AMYLOID, SARCOID, HEMOCHROMATOSIS, myocardial fibroelastosis
abnormal bx
constrict pericarditis
pericardial knock calcification normal ventricular biopsy S4, right sided HF = jvd, peripheral edema restrictive CM
need to remove constrictive via surgery
dilated CM
chronic CAD causes it
alcohol, myocarditis, doxorubicin
asymmetric LVH diastolic dysfunction
systolic ejection murmur on LSB but increases w/ standing and valsalva due to less volume of blood in LV
tx w/ BB or disopyrimide to allow more time for ventricles to fill
digoxin, diuretics, vasodilators are CI
afib
sx: BB, CCB, digoxin
if <24 hrs: cardioversion w/ amio, procainamide, or desynch
if chronic: anticoagulate, then cardiovert
if recurrence: warfarin + rate control meds
if aflutter
tx like afib + vagal maneuvers = carotid massage
sinus tachycardia
check TSH
chads score chf htn age 75 2+ DM S2 - stroke or TIA 2+ v -vascular disease a - 64+ f - female
1 = asa
2 + = oral anticoag
WPW?
child becomes dyspneic and recovers
transient arrhytmia via accessory pathway
delta waves
tx: RF catheter ablation of pathway
PDA = constant machine like murmur LSB, dyspnea, CHF. tx = indomethacin or surgery last resort. keep open w/ PGE1L
seen w/ high altitude or congential rubella
TOF pulm stenosis LVH overriding aorta VSD
tet spells
upper extremity HTN
radiofemoral delay
systolic murmur over mid upper back
rib notching on radiograph + ass w/ turner syndrome!
aortic coarctationsss
non cyanotic congenital heart defects
L to R shunts: blood goes back to lung even though O2
VSD
ASD
PDA
D’s
cyanotic defects
R to L shunts – no oxygentation
truncusu arteriosus = one vessel leaving ventricles transposition of great vessels tricuspid atresia tetralogy of fallot total anamous pulm venous return
what closes foramen ovale?
what closes ductus arteriosus?
foramen ovale = clamping of cord and decreased pulm vascular resistance due to first breath
ductus arterious = oxygen causing low PGE2
