deck 10 Flashcards
learn murmurs
…
most common cause of mitral regurg
mitral valve prolapse
- occurs due to myxomatous degeneration of the mitral valve leaflets and chordae
new term for variant angina
vasospastic angina
cause of vasospastic angina
vascular smooth muscle hyperreactivity
RF’s for vasospastic angina
cigarette smoking
ECG for vasospastic angina
contiguous ST elevation during episodes of chest discomfort
hemodynamic features of septic shock
- Low SVR (and thus after load)
- low normal or decreased pulmonary capillary wedge pressure
- increased CO
- high mixed venous O2 saturation
chest pain algorithm for stable patient
1) Obtain ECG + CXR
2) Administer aspirin ASAP if risk for aortic dissection is low
3) O2, IV access
mgmt of patient with chest pain + ECG findings of ACS
heparin
features of venous stasis
- pain worse in evening or following prolonged standing
initial treatment of chronic venous insufficiency
Leg elevation, exercise, compression stockings
main RF’s of aneurysm expansion and rupture
- large diameter
- rate of expansion
- CURRENT cigarette smoking (unknown mechanism but thought to be associated with degeneration of connective tissue in the aortic wall)
med all patients with MI should be discharged home with
ACE inhibitors within 24 hours of MI. Following MI, ventricles of heart undergo remodeling, causing dilation of LV + thinning of ventricular was, resulting in CHF.
most common focus of afib
pulmonary veins
STEMI management
- full-dose aspirin + cath lab
- PCI recommended within 90 minutes.
- additional stabilization measures = 02, platelet receptor blockers, nitroglycerin for pain control, beta-blockers, anticoagulation
treatment of choice for Dressler’s syndrome
NSAIDs
alcohol and cardiovascular disesae
- excessive alcohol intake is associated with increased incidence of HTN
- moderate alcohol intake is associated with decreased incidence of coronary heart disease
meds that can reduce response to antihypertensive agents
- NSAIDs, decongestants, glucocorticoids
presentation of septic emboli
cough + chest pain + hemoptysis
atypical angina can present as
- epigastric burning provoked by exercise
other sequela of lupus
known RF for accelerated atherosclerosis and premature coronary heart disease
recommended test for patients with suspected stable ischemic heart disease
exercise ECG
hyponatremia and CHF
- hyponatremia parallels severity of HF + is an independent predictor of adverse clinical outcomes.
treatment of hyponatremia in CHF
- fluid restriction, ACEi’s, loop diuretics
protein/gamma gap
- gap between total protein and albumin
causes of gamma gap
MM, HIV, autoimmune inflammation (due to acute-phase proteins), amyloidosis
advair
salmeterol + fluticasone
CHADS-VAS cutoff for managing with anticoagulation
greater than 2
NOAC’s used reduce systemic embolization in patients with AFib/eg at high risk of thromboembolic events
apixaban, dabigatran, rivaroxaban, edoxaban
clopidogrel is…
antiplatelet therapy
clinical presentation of constrictive pericarditis
- fatigue + dyspnea on exertion
- peripheral edema and ascites
- increased JVP
- pericardial knock
- pulsus paradoxus
- kussmaul’s sign
- pericardial calcifications on CXR
Causes of clubbing
1) lung malignancies
2) CF
3) Right to left cardiac shunts
* hypoxemia in COPD alone does not cause clubbing.
problem with LMWH (enoxaparin) and Xa inhibitors (fondaparinux, rivaroxaban)
reduce renal clearance
PE presentation
sudden-onset chest pain + dyspnea + tachycardia
common finding associated with PE
Small pleural effusions due to hemorrhage or inflammation
- effusions tend to be exudative and grossly bloody, and can be associated with PAIN due to pleural irritation.
treatment for hypersensitivity pneumonitis from birds
avoid responsible antigen (eg birds)
pleural effusion management
- if CHF, nothing. If no CHF, US for mass, then thoracentesis to determine if transudate or exudate.
How to test for c-spine radiculopathy
spurning’s test
- turns the patient’s head to the affected side while extending and applying downward pressure to the top of the patient’s head.
shoulder exam special tests
Neers –> Hawkins –> cross arm –> biceps
first step in workup of chronic cough in smoker
CXR. Always need to rule out malignancy.
only treatment hasn’t been shown to decrease mortality
CPAP, O2, tobacco cessation
meds that can exacerbate asthma/COPD
beta-blockers, NSAIDs
asthma mimis
**vocal cord dysfunction
Chung-Strauss
Allergic bronchopulmonary aspergillosis
asthma step up from SABA + low-dose ICS
- uptitrate steroid before starting LABA.
- anyone on LABA, must always be on corticosteroid. LABA can mask symptoms.
DLCO is not reduced in…
asthma
It is in emphysema, ILD, and anemia (think about as carrying blood out). You have destruction of lung parenchyma in these conditions.
chronic cough defined as
8 weeks
most common causes of chronic cough
RAD (usually young w/ allergies)
GERD
Postnasal drip
percentage of people who get cough on ACEI’s
20%
bicarb in COPD patients
elevated due to chronic compensation.
