CV Flashcards
MCC distributive shock
septic shock
normal urine output
0.5 mL/kg/hr
HTN Tx with diuretics
- thiazides.
- loop diuretics only if renal dysfn
ACE MOA
incr bradykinin, incr prostaglandins (vasodilator)
Kerley B lines
CHF
Tx HTN urgency/emergency
- nitroprusside.
- with MI: nitroglycerin, BB.
Tx aortic dissection
nitroprusside + BB + urgent surgery
S3 gallop
CHF
Elderly with suspected CHF. What else to order?
TSH (thyrotoxicosis causing CHF)
Acute & Chronic angina Tx
Acute: SL nitroglycerin, SL isosorbide.
Chronic: BB.
NSTEMI Tx
Antiplatelet (ASA, clopidogrel) + Anticoagulant (heparin, enoxaparin)
BB
STEMI Tx
ASA + clopidogrel
PCI or thrombolytics
Thrombolysis contraindications
- Absolute: hemorr stroke previously, stroke within 1yr, intracranial neoplasm, active bleed, aortic dissection
- Relative: trauma within 3-4wks, sure within 3wks, cardiopulm resuscitation, pre, PUD, anticoag use, BP>180, diabetic retinopathy
Tetralogy of Fallot
VSD, RV outflow obstruction (pulm stenosis), overriding aorta, RVH
widened pulse pressure
AR
midsystolic/ejection click
MVP
opening snap
MS
Holiday heart
A. fib with incr ETOH
Tx PSVT
adenosine, verapamil (CCB)
prevention: CCB, BB
Tx chronic A flutter
amiodarone
Brugada’s
asians, male, syncope, VF, sudden death
EKG: RBBB, ST elevation V1-3
Tx VT
cardioversion (unstable), amiodarone, procainamide, lidocaine (stable)
electric alternans
pericardial effusion (pathognomonic)
-cyclic shift in amplitude
pulsus paradoxus
cardiac tamponade, constrictive pericarditis, COPD
> 10mmHg decr SBP with inspiration
narrow pulse pressure
cardiac tamponade, AS
Endocarditis Dx
Duke
- 2 BC
- echo+
- new regurgitant murmur
minor: fever, petechiae, splinter hemorrhages, Osler, Janeway, Roth spots, glomerulonephritis
2major, 1+1, 3 minor
Tx endocarditis
Vanco + ceftriaxone
Vanco + gentamicin
NO anticoag
endocarditis prophylaxis
for invasive dental/surg and infected skin/I&D with:
- prosthetic valves
- previous endocarditis
- congenital heart dz/ HCM
- heart transplant/ heart repairs
-Amoxicillin
NOT for GI/GU, valvular dz
Rheumatic heart dz Dx
Jones
erythema marginatum
minor: fever, polyarthralgia, PR prolong, CRP
2major, 1+2
AND pos cult/rapid strep and strep Ab titer (ASO)
Tx rheumatic heart dz
IM PCN, bed rest, salicylates, corticosteroids
intermittent claudication
PAD
PAD of the iliac artery (Leriche’s syndrome) leads to what?
erectile dysfunction
ABI
PAD
PAD Tx
Cilostazol (antiplatelet for intermittent claudication)
no smoking, exercise, lipid lowering, sildenafil, thromboendarterectomy
Tx venous ulcers
leg elevation, compression bandage/boot
DVT definitive Dx
venography
DVT Tx
lovenox (LMWH)
Giant cell arteritis highly associated with what?
Polymyalgia Rheumatica
- elderly female
- severe stiffness: neck, shoulders, upper back, pelvic girdle
- ESR incr
- Tx: NSAIDS, prednisone/steroids
Giant cell arteritis Tx
high dose prednisone, low dose ASA
MCC aortic aneurysm
atherosclerosis
others: Marfans, Ehlers Danlos
Indications for AAA repair
- > 5.5 cm
- growth >0.5 cm in 6mo
- symptomatic
AAA study of choice
US
BB and HF
BB Tx chronic CHF
BB contraindicated in acute CHF
Digoxin toxicity
Bradycardia
Heart block, ectopy (PVC, VT, PAC)
Hyperkalemia
predisposing to dig toxicity: hypoK, hypoMg
Tx: Fab Ab
Beck’s triad
pericardial tamponade
- muffled/distant heart sounds
- HOTN
- incr JVP
pericardial knock
constrictive pericarditis (pericardial thickening/calcification)
3rd heart sound
Kussmaul’s sign
pericardial tamponade, constrictive pericarditis
-incr JVP with inspiration
MCC acute pericarditis and myocarditis
viral
Enteroviruses (COXSACKIE B, echovirus)
Mobitz I
Wenckebach
progressive PR lengthening
Mobitz II, where?
bundle of HIS
constant prolonged PR
to 3rd AV block
Tx bradycardia
ATROPINE
epi, dopamine, pacemaker
location of MI: lat, ant, inf
lat: circumflex
ant: LAD
inf: right coronary