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CV II > DARROW: shock, blood vessels, lympathic disorders, and pericarditis > Flashcards

DARROW: shock, blood vessels, lympathic disorders, and pericarditis Flashcards

1
Q

Hypovolemic shock

A

↓ CO and PCWP, ↑ SVR
o Hemorrhage induced
o Fluid loss
o Poor intake

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2
Q

Cardiogenic shock

A

↓ CI (cardiac index), ↑ PCWP and SVR
o Cardiomyopathies
o Arrhythmias
o Mechanical (valvular)
o Extracardiac/obstruction – blocking blood flow
• Tension pneumothorax, PE, cardiac tamponade

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3
Q

Distributive shock

A

↑ CI, ↓ PCWP and SVR
o AKA warm shock → vasodilatory
• Sepsis, toxic shock syndrome, anaphylaxis, SIRS, toxin reactions, spinal cord injury
o May have normal to high central venous O2 saturation due to redistribution of fow
o Increase CO because vascular resistance has dropped

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4
Q

BP that indicates shock

A

SBP

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5
Q

blood lactate that indicates shock

A

> 1.0 mmol/L

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6
Q

treatment of hypovolemic shock

A

give them fluids!
o 0.9% saline: 1-2 liters wide open- continue based on BP, skin, urine, and mentation
o PRBCs

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7
Q

treatment for cardiogenic shock

A
  • Low BP- dobutamine
  • Normal or high BP- IV nitroglycerin or nitroprusside with IV loop diuretic/furesomide
  • Post MI- antiplatelets, norepinephrine
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8
Q

Beck’s triad for Cardiac Tamponade

A
  1. Distended neck veins
  2. Distant heart sounds
  3. Distressed BP (hypotension)
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9
Q

Temp for SIRS

A

> 38.3C (101F) or

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10
Q

HR for SIRS

A

> 90 bpm

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11
Q

RR for SIRS

A

> 20

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12
Q

WBC for SIRS

A

12000 with bandemia

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13
Q

septic shock treatment

A
  1. Fluids: maintain CVP at 8-12 mm Hg
  2. Vasopressors: need to maintain MAP at > 65 mm Hg and cardiac index at 2-4 L/min
    a. Use norepinephrine 5-20 mcg/min- mainly alpha agonist/vasopressor
    b. If norepi fails, give epinephrine- beta agonist
    c. Can also consider vasopressin- potentiates norepinephrine
  3. Maintain central venous O2 saturation of > 70%
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14
Q

What is Osler’s sign?

A

• Pseudohypertension because of calcified vessels

o It is falsely high because you have to pump the cuff way up to get the reading

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15
Q

What is the most potent predictor of stent thrombosis?

A

clacification

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16
Q

Absolute indication for femoral-popliteal bypass

A

resting pain and non-healing ulceration

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17
Q

6 P’s of acute arterial occlusion

A
  1. Pain
  2. Pallor
  3. Paralysis
  4. Paresthesias
  5. Pulslessness
  6. Poikilothermia
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18
Q

When can you see aortic dissection?

A

Marfans, pregnancy, bicuspid aortic valve, and coarctation

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19
Q

causes of mediastinal widening

A 
•	Artifact- patient rotated
•	Mediastinal mass: 4 T’s
o	T and B cell lymphoma, teratoma, thyroid, thymus
•	Vessels- aortic aneurysm
•	Anthrax
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20
Q

venous ulcers

A
  • History of trauma, pregnancy and varicose veins
  • Medial malleolus
  • Superficial, irregular margins
  • Ruddy, beefy, fibrinous, granulation
  • Edema
  • Dermatitis
  • Lipodermatosclerosis- indurated
  • Hyperpigmentation- hemosiderin
  • Moderate to heavy exudate
  • Cap refilling
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21
Q

arterial ulcers

A
  • History of smoking, rest pain, claudication
  • Site of pressure
  • Deep, “punched out” with sharp borders
  • Bed pale grey or yellow
  • Dry necrotic base with eschar
  • Lateral
  • Pale, hair loss, cold feet, atrophic skin, no pulses
  • Cap filling > 4-5 sec
  • Elevation pallor
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22
Q

neuropathic ulcer

A
  • History of numbness
  • Common DM
  • Pressure site
  • Variable depth
  • Surround callus
  • Cap refill normal
  • ABI- normal
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23
Q

Phlegmasia cerulean dolens

A

• Inflammatory, blue, and painful
o Due to primary venous insufficiency with secondary arterial insufficiency

Most common cause is cancer

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24
Q

Most common cause of vena cava syndrome

A

non small cell lung cancer

followed by small cell and lymphoma

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25
Q

What position causes pain to be aggravated in a pericarditis patient?

A

Supine

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26
Q

What position relives pain in a pericarditis patient?

A

Sitting up and leaning forward

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27
Q

Changes seen in EKG that represents pericarditis

A
  • ST segment elevation in all leads

- PR segment increased indicating atrium inflammation

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28
Q

Clinical presentation of pericarditis

A
  • Myocardial involvement
  • Troponin elevations
  • Heart block
  • Wall motion abnormalities
  • CHF
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29
Q

Early disseminated Lyme disease

A

• Triad of acute neurologic abnormalities

  1. Meningitis
  2. Cranial neuropathy- B/l Bell’s palsy
    a. Other causes of b/l cranial nerve palsies: TB, sarcoid, and trauma
  3. Motor or sensory radiculoneuropathy

• Cardiac involvement with heart block and myopericarditis

30
Q

Late Lyme disease

A

oligoarthritis

31
Q

Treatment for pericarditis

A
  • NSAIDs
  • Colchicine
  • Azathioprine
  • IVIGs
  • IL-1 antagonists (anakinra)
32
Q

Pulsus paradoxus

A

Greater than 10 mm Hg drop in systolic pressure
decreased LV ejection during inspiration due to the high CVP
o Leads to increased RV filling with septal motion toward the LV
• Limits LV filling and LVEF
o Inflow across the mitral valve will decrease by 25%

33
Q

Please Dr. BECK, you PAY for the CT

A
  • Beck’s triad
  • Pulsus paradoxus
  • Electrical alterans
  • Slowed Y descent
  • Cardiac tamponade
34
Q

kussmaul sign

A

in constrictive pericarditis, the jugular engorges with inspiration.

usually should decrease in inspiration. indicates blood not going into the right atrium

35
Q

Sharp y

A

seen in constrictive pericarditis
• Tricupsid opens and blood rushes to get in
o Y is much sharper and shorter
o Blood slams into the ventricle due to so much pressure but then meets a steel wall and stops
• Get a sharp descent and then plateau

36
Q

Slow y descent

A

seen in cardiac tamponade
• Cardiac tamponade does not allow blood to come in because there is a bag of water around the heart. There is resistance for blood to leave the atrium
• Results in delayed filling → slow y descent

37
Q

a wave

A

atrial contraction

38
Q

x wave

A

atrial relaxation

39
Q

v wave

A

atrial filling

40
Q

y wave

A

atrial emptying

41
Q

diastolic pericardial knock

A

o Auscultation- like an S3 and “septal bounce” (ECHO) due to rapid early filling in diastole. Also shows decreased mitral inflow

seen in constrictive pericarditis

42
Q

square root sign

A

o On heart cath- rapid ventricular filling followed by a plateau phase during the rest of diastole
o Related to the rigid pericardium imparing mid and late diastolic filling resulting in decreased and equal diastolic filling pressures in all the cardiac chambers

seen in constrictive pericarditis

43
Q

Causes of constrictive pericarditis

A
  • TB
  • Post radiation
  • Cardiac surgery
  • Viruses
  • Trauma
44
Q

how to distinguish between constrictive pericarditis and restrictive cardiomyopathy

A
  • The LV end diastolic pressure is unequal to the RV diastolic pressure – restrictive cardiomyopathy
  • Pressures are equal in constrictive pericarditis –square root sign
  • Also, pulmonary pressure is high in restrictive cardiomyopathy and low in constrictive pericarditis
45
Q

Etiologies of ischemic heart disease (5)

A 
Atherosclerosis
Anemia
Hyperthyroidism
Stress
Variant angina
46
Q

Metabolic syndrome (6)

A 
Obesity
HTN
High TGL
Hyperglycemia
Low HDL
Insulin resistance

2 fold increase in CAD

47
Q

Conditional risk factors of IHD (6)

A 
hrCRP
homocysteine
lipoprotein(a)
LDL particle size
antioxidancts
omega 3
48
Q

Drugs used for pharmacological stress tests

A

Dobutamine- increase cardiac stress and oxygen demand

Adenosine/Dipyridamole- vasodilation

49
Q

Diagnostic testing for IHD

A
  1. cardiac enzymes: troponin, CPK, LDH
  2. stress test
  3. Pharacological stress test
  4. Image augmentation- echocardiography
  5. Angiography: gold standard
  6. CT determined coronary artery calcium score
50
Q

Unstable angina definition

A
  • New onset
  • Occurs at rest
  • Crescendo
51
Q

Aortic dissection

A
  • Tearing chest pain
  • WIDENED MEDIASTINUM

Can look like an inferior wall MI because the dissection can go into the right coronary artery

52
Q

Pericarditis

A

recent viral illness
pleuritic chest pain
pulses paradoxus

53
Q

Pulmonary embolism

A

inactivity
pleuritic chest pain
NEW ONSET OF ATRIAL FIB

54
Q

CHF

A

SOB

ORTHOPNEA

55
Q

thrombolytic therapy vs rapid revascularization in the cath lab

A

90 MIN
if you can’t get them to a cath lab in less than 90 min, give them thrombolytic therapy.
Make sure they are having an MI!

56
Q

Early MI complications (3)

A
  1. Thrombolytics
  2. Inferior wall MI- bradycardia and AV block
  3. Anterior wall MI- pump failure
57
Q

Later MI complications

A
  1. VSD
  2. Cardiogenic shock
  3. Papillary muscle rupture causing MR
  4. Free wall rupture- fatal
  5. Left ventricular thrombus
58
Q

ACS mortality intervention

A
  1. Beta blockers
  2. Aspirin
  3. Ace inhibitor
  4. Statins
  5. Manage hyperglycemia

Percutaneous intervention- not shown to improve overall survival
Coronary artery bypass grafting- only in pts with left main disease

59
Q

Drugs for acute angina

A
  • Oxygen
  • Aspirin
  • Nitroglycerine
  • Morphine if nitro doesn’t work
60
Q

Carvallo’s sign

A

pansystolic murmur that is louder during inspiration indicating tricuspid insufficiency (differentiates from mitral insufficiency)

61
Q

Stokes-Adams attack

A

sudden/transient syncopal episode that is characterized by paleness prior and flushing after attack

indicates heart block and need for pacemaker

62
Q

Gallaverdin phenomenon

A

clinical sign of Aortic Stenosis described by a dissociation of noisy and musical portions of the murmur produced, specifically noisy at the URSB and musical at the apex

63
Q

Raised JVP, normal waveform

A

◦ Bradycardia
◦ Fluid overload
◦ Heart Failure

64
Q

Raised JVP, absent pulsation

A

superior vena cava syndrome

65
Q

large a wave

A

increased atrial contraction pressure

◦ tricuspid stenosis
◦ Right heart failure
◦ Pulmonary hypertension

66
Q

cannon a wave

A

atria contracting against closed tricupsid valve

◦	Atrial flutter
◦	Premature atrial rhythm (or tachycardia)
◦	third degree heart block
◦	Ventricular ectopics
◦	Ventricular tachycardia
67
Q

absent a wave

A

no unifocal atria depolarization

atrial fibrillation

68
Q

large v wave

A

tricupsid regurgitation

69
Q

Austin flint murmur

A

low-pitched rumbling murmur at apex indicating AR

70
Q

Graham Steel murmur

A

high-pitched early diastolic murmur at the LSB (2 nd ICS) indicating Pulmonary regurg

71
Q

Trousseau’s and Chvostek signs

A

Indicates hypocalcemia

CV II (5 decks)

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