CV 2 Flashcards
systolic murmurs mnemonic
MR PM AS MVP
mitral regur
physiologic murmur
aortic stenosis
MVP
only the ____ murmurs radiate
systolic
where does MR radiate to
axilla
where does AS radiate to
neck
risk factors for bacterial endocarditis include
7
older age > 60
male sex
infection drug use
poor dentition or dental infection
heart disease
chronic HD
HIV infection
classic case for bacterial endocarditis
adult male presents with fever, chills, anorexia, weight loss, malaise, and subungual hemorrhages
bacterial endocarditis CBC findings
elevated WBC
elevated ESR
bacterial endocarditis dx tools include
2
microbiologic data w/ BCs
echo
endocarditis prophylaxis - preferred oral regimen before procedure
give 1 hour before procedure - amoxicillin 2 g PO x 1 dose
considerations for endocarditis prophylaxis - high risk conditions
5
- prosthetic heart valves or prosthetic valve repair material
- previous hx or recurrent bacterial endocarditis
- implanted durable mechanical circulatory support device
- cardiac transplant
- certain types of congenital heart disease
endocarditis prophylaxis - w/ penicillin allergy oral regimen before procedure
oral cephalexin or clarithromycin
red macules on palms/soles but not painful
janeway lesions
painful nodes found mostly on pads of the fingers and toes
osler nodes
a fib dx evaluation includes
7
EKG
TSH
serum electrolytes
renal function
B-TNP
Troponin
digoxin level (if on dig)
A fib - for rate control use what
3
beta blockers
CCBs
digoxin
a fib - for rhythm control use what to maintain normal sinus rhythm
amiodarone
a fib - agent of choice for coagulation in patients with severe MS and mechanical heart valves
warfarin
warfarin target INR
2-3
warfarin initial dose for average adults and for sensitive patients
5 mg or 2.5 mg
warfarin - full anticoagulation effect can take how long, check INR when
can take 3 days; check INR every 2-3 days until therapeutic for 2 consecutive checks, then weekly; check every 4 weeks when stable
a fib - you can take clopidogrel/Plavix how
alone or in combo with ASA or other anticoags, may be better tolerated but are less effective than others
a fib on warfarin - INR 4.01-4.99 do what
hold one dose of warfarin ; do not give vitamin K
drug classes/meds that can interact with warfarin and increase INR
10
glucocorticoids
SSRIs
fluoroquinolones
macrolides
PNCs
azole antifungals
statins
tramadol
Bactrim
fenofibrate
on warfarin - INR < 4.5
skin next dose and/or reduce slightly the maintenance dose; check INR 1-2 x week when adjusting dose
on warfarin, INR 4.5-10 - do what
hold 1-2 doses, w/ or w/o administration of low dose oral vitamin K; decrease maintenance dose
a proximal DVT is a thrombus in what veins
3
popliteal
femoral
iliac
a distal DVT refers to a thrombus where
in the calf veins
virchow triad proposes that VTE occurs as a result of
- alterations in blood flow
- alterations in blood components
- vascular endothelial injury (e.g. cell injury from SARS-CoV-2)
DVT dx to order
6
CBC
platelets
clotting time (PT/PTT, INR)
D dimer
chest x ray
EKG
dx test for choice for DVT
compression US w/ doppler
DVT treatment options
4
- low molecular weight heparin (enoxaprin/Lovenox)
- heparin SQ
- warfarin PO (Coumadin)
- DOACs
HF - pulmonary crackles, cough, dyspnea
left HF
HF - paroxysmal nocturnal dyspnea, orthopnea
both right and left HF
HF - dyspnea, abd distention
right HF
HF - enlarged spleen and enlarged liver
right HF
HF dx eval includes
7
- chest x ray
- 12 lead EKG
- cardiac troponin T or I
- BNP or NT proBNP
- CMP
- CBC
- echo
what is the definitive dx test for right HF
cardiac catheterization
S3 heart sounds are a sign of ___ although what
sx of HF, although can be heard in pregnant people and children/young adults
HFpEF tx plan
diuretic; if elevated BNP then SGLT2 inhibitor and a MRSA is recommended; add sacubitril-valsartan for poorly controlled HTN
HFrEF tx plan
combo tx with diuretic, ACE or ARB or ARNI and a BB
NYHA class - no limitation
class I
NYHA class - ordinary physical activity results in fatigue, exertional dyspnea
class II
NYHA class - marked limitation in physical activity
class III
NYHA class - symptoms are present at rest with or without physical activity
class IV
first line med for stable HF is
ACEI or ARB
