deck 12 Flashcards
palpitations in young patients with structurally normal heart usually due to…
Atrioventricular nodal reentrant tachycardia (AVNRT)
Atrioventricular nodal reentrant tachycardia (AVNRT) pathophys
Due to presence of 2 conduction pathways (slow and fast) in the AV node.
how do vagal maneuvers change heart? (carotid sinus massage, cold-water immersion or diving reflex)
Increase parasympathetic tone through slowing of conduction in the AV node
how do nitrates have anti-ischemic effects?
- systemic dilation of veins lowers preload and LVEDP and reduces myocardial oxygen demand by reducing wall stress.
Mitral valve prolapse presentation
- atypical chest pain + dyspnea + palpitations + dizziness + anxiety + panic disorder
mitral valve prolapse murmur
- short systolic murmur at apex
- disappears with squatting
- clicks
Right sided heart failure in patient with pacemaker think…
- tricuspid regurg
-
tricuspid regurg murmur
holosystolic
aortic regurg murmur
diastolic decrescendo murmur
meds that confer a survival benefit in HCF
ACEIs, ARBs, beta-blockers, spironolactone
pathophys of pericardial effusion
Fluid accumulation in the pericardial cavity increases intrapericardial pressure above diastolic ventricular pressure. This restricts venous return to the heart and lowers right and left ventricular filling. Net result –> DECREASED PRELOAD/SV/CO
first-line for chronic stable angina
beta-blockers
alternatives to bbs for chronic stable angina
CCBs + long-acting nitrates
concerning murmur type
diastolic and continuous
CYP450 inducers
carbamazepine, phenytoin ginseng, st. john's wort OCPs phenobarbital rifampin
CYP450 inhibitors
acetaminophen, NSAIDs antibiotics/antifungals (eg metronidazole) amiodarone cimetidine cranberry juice, ginkgo, vitamin E omeprazole thyroid hormone SSRIs
management of persistent tachyarrhythmia causing hemodynamic instability
immediate synchronized direct current cardioversion.
digoxin toxicity
N/V + diarrhea + vision changes + arrhythmias
exam findings suggestive of severe aortic stenosis
1) delayed (slow-rising) and diminished (weak) carotid pulse (“pulsus parvus and tardus”)
2) presence of single and soft second heart sound
3) mid to late peaking systolic murmur with maximal intensity at 2nd right intercostal space radiating to the carotids
nonallergic rhinitis presentation
1 of nasal congestion, rhinorrhea, sneezing, and postnasal drainage without a specific etiology
nonallergic rhinitis treatment
- intranasal antihistamine, intranasal glucocorticoid, or combination therapy
solids vs liquids for dysphagia
- solids only suggests mechanical obstruction (liquids can still pass)
- solids and liquids suggest neuromuscular
granulomatosis w/ polyangiitis
recurrent sinusitis and otitis + auditory canal ulceration + fatigue + anemia + microscopic hematuria
Urine profile of hypovolemic patient
Hypovolemia –> decreased renal perfusion –> RAAS activation –> aldosterone stimulates aggressive sodium reabsorption –> decreased urine sodium –> FENA less than 1%
high risk lung nodules
old age
greater than 2 cm
smoking history
management of high risk lung nodules
surgical excision
impt MSK side effect of beta-2 agonists
- reduce serum K levels by driving potassium into cells –> hypokalemia with muscle weakness, arrhythmias, EKG changes
Secondary spontaneous pneumothorax (SSP)
- occurs in patients with known lung disease (COPD, CF)
- acute-onset SOB + hypoxia + unilaterally decreased breath sounds + CP
- smoking RF
laterality of pulmonary edema
ARDS and acute MI leading to pulmonary edema is usually symmetric.
pulmonary causes of hemoptysis
bronchitis
lung cancer
bronchiectasis
cardiac causes of hemoptysis
mitral stenosis/acute pulmonary edema
think bronchiectasis with//
recurrent respiratory tract infections + chronic cough
cough duration suggestive of acute bronchitis
greater than 5 days
sequela of PE
10% of patients with PE have occlusion of a peripheral pulmonary artery by thrombus, causing pulmonary infarction
common complication of mitral stenosis
atrial fibrillation
elevation of left main bronchus on CXR suggests
severe LA enlargement –> elevation of left main bronchus
Mitral stenosis symptoms
- gradual + worsening DOE + orthopnea + hemoptysis (due to pulmonary edema)
chronic pulmonary aspergillosis
- common in TB patients, immunocompromised, underlying lung disease
- greater than 3 months of weight loss, cough, hemoptysis, and fatigue
chronic pulmonary aspergillosis diagnosis
IgG serology
common feature of ACEI cough
tickling or scratching sensation in the throat
mainstay of symptom management in COPD
inhaled anti-muscarinic agents (eg ipratropium)
issue with beta blockers in COPD
Can exacerbate pulmonary symptoms in its with severe reactive airway disease.
Safe in most patients with mild to moderate COPD and asthma
tactile fremitus changes
- Increased with consolidation (lobar pneumonia)
- Decreased with pleural effusions, pneumos, emphysema, atelectasis
problem with supplemental oxygen in patients with advanced COPD
Can worsen hypercapnia due to a combination of increased dead space perfusion causing VQ mismatch + decreased affinity of oxyhemoglobin for CO2 + reduced alveolar ventilation. Can lead to seizures.
goal oxyhemoglobin saturation in its with advanced COPD
90%-93%
treatment goals for DM2
1) AIC less than 7%
- long-standing DM w/ high RF’s for cardiovascular disease –> less aggressive
2) Newly diagnosed DM less than 6.5% is reasonable
when do people start feeling hyperglycemic?
9%
hyperglycemia symptoms
Polyphagia - frequent hunger, especially pronounced hunger Polydipsia - frequent thirst, especially excessive thirst Polyuria - increased volume of urination (not an increased frequency for urination) Blurred vision Fatigue Weight loss Poor wound healing (cuts, scrapes, etc.) Dry mouth Dry or itchy skin Tingling in feet or heels Erectile dysfunction Recurrent infections, external ear infections (swimmer's ear) Cardiac arrhythmia Stupor Coma Seizures
problem with sulfonylureas
- eventually lose efficacy
