CV: Endocarditis, Congenital Heart Dz, Arterial and Venous Dz, Shock, Cardiac Neoplasms Flashcards
Rheumatic fever is a type __ hypersensitivity
Symptoms =
2
FEVERSS:
fever, erythema marginatum, valvular damage, ↑ESR, red-hot joints (migratory polyarthritis), subcutaneous nodules, Sydenham chorea
Etiology of multifocal atrial tachycardia?
tx?
end-stage COPD
improve oxygenation
Rheumatic fever :
dx?
MC murmur?
ASO titers
mitral regurg
Rheumatic heart disease:
MC murmur?
mitral stenosis (then regurg when busts)
endocarditis: organism if acute? organism if subacute? a/w IVDA? on prosthetic valves?
Acute: S. aureus
**on normal valves → rapid onset
Subacute:
- dental procedures → S. viridans
- GU/GI procedures → enterococcus
* *on damaged valves → insidious onset
IVDA: S. aureus on tricuspid valve»_space; Pseudomonas, Candida
Prosthetic valves: S. epidermidis
low-grade diastolic rumble murmur w/ fixed split S2
ASD, think paradoxical emboli
holosystolic murmur at mid-LSB
VSD
continuous, machinery-like murmur
MCC death?
PDA
heart failure, infectious endocarditis
Aortic dissection:
type A vs B?
tx?
etiology?
A = acute-onset tearing chest pain --> asc aorta B = interscapular back pain --> desc aorta
type A → Tx β-blockers + surgery
type B → Tx β-blockers
HTN and CT diseases
AAA:
dx?
tx?
MC location?
abdominal U/S
5 cm or sx → Tx synthetic graft
below the renal arteries
small herald bleed followed by massive UGIB s/p aortic graft placement
Aortoenteric fistula
Ruptured AAA:
presentation?
tx?
signs of impending rupture?
triad of tearing abdominal pain, hypotension, pulsatile mass
emergency laparotomy (don’t waste time • on dx tests)
- Cullen sign (umbilical ecchymoses)
- Grey-Turner sign (flank ecchymoses)
Peripheral vascular dz:
dx?
management of mild vs severe?
arteriogram (gold standard) or ABI (normal is >/= 1)
mild (ABI <0.4) → bypass graft vs. angioplasty
Peripheral vascular dz:
MC site?
risk factors?
superficial femoral artery
diabetes, smoking
Leriche syndrome:
symptoms?
PVD of distal aorta above bifurcation → bilateral claudication, impotence, ↓femoral pulses
Acute arterial occlusion:
symptoms?
dx?
tx?
emboli → arterial occlusion → 6 Ps – pain, pallor, paralysis, parasthesias, poikilothermia, pulselessness
arteriogram
IV heparin + surgical embolectomy (if < 6 hrs)
if > 6 hrs, amputation
*** cholesterol embolization syndrome is similar except it presents after surgical or radiographic procedure (disruption of artherosclerotic plaque)
Acute arterial occlusion:
MCC?
MC site?
AFib
common femoral artery
Mycotic aneurysm:
management?
bacterial (not fungal) infx → aortic aneurysm
IV abx + surgical excision
Luetic heart:
etiology?
presentation?
tx?
tertiary syphilis
aortic aneurysm + aortic regurg + coronary artery stenosis
IV PCN G + surgical repair
Heparin vs. enoxaparin?
enoxaparin (Lovenox) and dalteparin (Fragmin) have longer T1⁄2 for qday dosing, more $$$
Superficial venous thrombus:
presentation?
management of mild/severe/septic?
painful, palpable venous cord w/ local erythema and edema
- mild → Tx aspirin
- severe → Tx aspirin + warm compresses
- septic → remove IV cath + give IV abx
Migratory SVT is a/w…
pancreatic cancer (Trousseau phenomenon)
PE on EKG:
sinus tachycardia is more common than S1Q3T3
Phlegmasia cerulea dolens =
dx?
tx?
severe form of deep venous thrombosis which results from extensive thrombotic occlusion of the major and the collateral veins of an extremityvenous → acute onset leg edema with pain and cyanosis
**high risk for massive PE
US or pelvic CT
heparin + venous thrombectomy
Post-thrombotic syndrome (chronic venous insufficiency):
etiology?
presentation?
tx?
DVT damages valves → chronic venous HTN
severe leg edema and ulceration around ankle area
compression stockings + leg elevation; wet-to-dry TID for ulcers
general initial tx of shock?
IV fluids –> pressors (epi > dopamine) then fix root cause)
Axis on EKG:
normal –>
left-axis deviation –>
right-axis deviation –>
I+/II+: normal
I+/II–: left-axis deviation
I–/II+: right-axis deviation
What are Dukes Criteria?
Makes diagnosis of infectious endocarditis
Major criteria:
> + blood culcture/sustained bacteremia
> endocardial involvment (mass, abcess, regurg)
Minor:
> fever
> predisposing heart condition or IVDU
> vascular phenomena: major arterial emboli, septic pulmonary infarcts, mycotic aneurysm, intracranial hemorrhage, conjunctival hemorrhages, and Janeway lesions
> Immunologic phenomena: glomerulonephritis, Osler’s nodes, Roth spots, and rheumatoid factor
> + echo
*to dx 2 major or 1 major and 3 minor or 5 minor
metastatic cancer → hypercoagulable
state → clots form
on valves → can embolize
Tx?
Marantic endocarditis
tx Heparin (controversial)
valve commonly affected in libman-sacks endocarditis
mitral (regurg > stenosis)
**vegetations on BOTH sides of valve
HTNive urgency vs emergency
urgency = >220/120
emergency = >220/120 + endo organ damage (HA, renal failure, pulm edema)
treatment of HTNive urgency vs emergency
urgency = lower BP graduallt over 24 hrs with PO meds
emergency = lower BP by 25% in 1-2 hrs with IV nitroprusside
**if have severe HA then get heat CT to r/o intercranial bleeding, get LP if CT neg
Class I vs II vs II vs IV types of hypovolemic shock
Class I: 40% + ∆MS, anuria
Sirs vs sepsis vs septic shock vs MODS
SIRS: 2+ of the following – ↑/↓T, ↑RR, ↑HR, ↑/↓WBC Sepsis: SIRS + positive blood cx Septic shock: sepsis + ↓BP MODS: multiple organ dysfxn
MCC ARDS
septic shock
Tx unique to neurogenic shock
supine or T berg positioning to maintian BF to brain
pedunculated, benign mass that
presents like intermittent mitral
stenosis
atrial myxoma
MC heart tumor in kids
cardiac rhabdosarcoma
assc with tuberous sclerosis
