CV 8 Flashcards
A patient presents with cocaine induced myocardial ischemia (ST ELEVATION)…What 3 meds do you want to give initially?
What is the treatment if persistent ST elevations despite medical treatment?
- IV BZD + NTG + ASA
IF persistent ST elevation despite medical management, go to PCI.
What is the classic presentation of Coarcation of Aorta?
What syndrome is it associated with?
In what situation can infants present with life threatening HF and shock if they have Coarctation of Aorta?
- Upper extremity HTN
- Lower extremity HYPOtn/poor perfusion
- Weak or delayed femoral pulse
- continues machinery murmur if PDA.
Associated with TURNERS
When Ductus Arteriosus closes.
What is the most common location of an Abdominal Aortic Aneurysm?
Who should be screened?
INFRA-RENAL
SCREENING with US= 65- 75 yo X1 who has ANY smoking history.
In managing AAA…
- What is the most important modifiable RF?
- What two medications should you make sure patients are on?
- What is the indication for Surgery?
- How often should you follow up with US?
- STOP SMOKING
- ASA + STATIN
- SURGERY:
- > 5.5cm
- - Increase in size by 0.5 cm in 6 months. - FOLLOW UP US:
AAA < 4cm —> Q 2-3 years
AAA > 4 cm —> Q6-12 months
Generally what do you do with ACEI/ARBS if you plan to do surgery?
HOLD the night before bc risk of post-op hypotn.
Except if HF is present, then continue during surgery.
A child comes in for a routine physical before starting on a sport team…What is the next step in management if you are concerned about Marfans, before allowing sports participation?
ECHO
Acute Limb ischemia presents with the 6 P’s: Pain, pallor, paresthesia, pulselessness, poikilothermic, paralysis…
What is the management?
- Heparin
- Revascularize:
- -> IF signs of threat to limb (severe pain, delayed cap refill, absent arterial doppler, sensory or motor dysfunction) –> Emergent Surgery
–> IF no signs of immediate threat to limb –> catheter based t-PA
POST MI Bradycardia is commonly seen in two areas of intact. Inferior wall MI (AvF, II, III) and Ant wall MI (V2,V3,V4)…
What is the mechanism of Bradycardia in each?
How do you manage symptomatic bradycardia in each?
MI (AvF, II, III):
- Increased Vagal tone
- TRX = Atropine first, then Transcutaneous pacing if persistent.
Ant wall MI (V2,V3,V4):
- Ischemic damage to conduction system
- TRX = Transcutaneous pacing
What are the four main etiologies of CONSTRICTIVE PERICARDITIS?
- Ideopathic or post viral
- After CABG
- Radiation to chest
- Disseminated TB
What are the classic PE findings for Constrictive Pericarditis?
- RHF (edema, ascites, increased JVP, Hepatic congestion)
- Prominent Y desent on Jugular Venous Pulse
- Hepatojugular reflex
- Kussmaul’s sign = increased JVP with inspiration
What is the definition of unstable Angina?
- Worsening Angina (frequency, duration, intensity)
- Angina at rest
- New onset severe CP
AND NO TROPONIN ELEVTION
What is the acute medical treatment of unstable angina or NSTEMI?
1. MONA BASH C Morphine Oxygen NTG (asap) ASA (asap)
BB (asap, as long as no HTN)
ACEI (< 24 hours)
Statin
Heparin (Asap)
Clopidogrel (asap)
What is the management of TCA overdose?
- Activated Charcoal if < 2 hrs of ingestion
2. IV Sodium Bicarbonate (for widening QRS or arrhythmias)
What is the most common cause of sudden death after blunt thoracic trauma by steering wheel in a MVA?
Aortic Injury
Local Vascular complications of Cardiac Cath include…Hematoma, Pseudoaneurism and AV fistula…
How do these differ clinically?
How do you DX and TRX?
Hematoma:
- No bruit
- No pulsation
Pseudo-aneurysm: bleeding into wall of artery
- Pulsatile mass
- systolic Bruit
- DX = US
- TRX - compression if small, surgery if large or expanding.
AV Fistula
- No mass
- Continuous Bruit
- DX = US.
