Ecclectic Flashcards
4 types of cardiomyopathies
Dilated
Hypertrophic
Stress/Takotsubo
Restrictive
definition of dilated hypertrophy
less than 40% EF in the presence of increased left ventricular end-diastolic volume
difference between dilated & hypertrophic cardiomyopathy
NO HYPERTROPHy IN DILATED CARDIOMYOPATHY!
(DOES HAVE: less than 40% EF and increased left ventricular end-diastolic volume.
pathology: dilated hypertrophy
chamber enlarges (w/o hypertrophy) , the myocardial fibrils overstreatch, and their ability to effectively contract is impaired
progression of dilated hypertrophy
- weakened contractility r/t weakened myocardial fibrils
- decreaed CO b/c can’t effectively eject blood forward which creates backwards pressure
- pulmonary/systemic congestion from backward pressrue
what happens when contractility decreases?
SNS/baro & chemoreceptors/RAAS to compensate
ALL TO PRESERVE CO & TISSUE PERFUSION!
vessel diameter & afterload
vasoconstriction increases afterload
RAAS activation & hemodynamics
RAAS increases preload (augments SV/CO) and afterload but over time, the increased workload leads to a oxygen demand increase
s/s of dilated cardiomyopathy
causes systolic dysfunction so they show s/s of heart failure (pulmonary *& systemic
common EKG w/ dilated left ventricle
LBBB
s/s of hypertrophic cardiomyopathy
SOB
CP
palpitations
syncope
SOB
CP
palpitations
syncope
s/s of hypertrophic cardiomyopathy
definition: hypertrophic cardiomyopathy
hypertrophy limited to the left ventricle only (dilated cardiomypathy can be any chamber) & it isn’t dilated
*leading cause of sudden cardiac death in young adults & causes outflow obstruction
DIASTOLIC DYSFUNCTION
most common reason for sudden cardiac death in young adults
hypertrophic cardiomyopathy
treatment goals for hypertrophic cardiomyopathy 4
improve ventricular filling
optimize SV
reducing obstructions to ventricular ejection
reducing risk of sudden cardiac death
what type of problem is dilated versus hypertrophic cardiomyopathy
dilated = systolic disfunction (HF under 40%) hypertrophic= diastolic. leading cause of sudden cardiac death in young adults
rx for hypertrophic cardiomyopathy
BB & CaChB b/c it will improve diastrolic dysfunction to increase ventricualr filling and optimize SV
rx that decreases ventricular wall tension
CaChB
rx to avoid in hypertrophic cardiomyopathy
anything that increases or decreases afterload
*problem b/c they decrease CO by increasing outflow obstruction
why do you give a BB for hypertrophic cardiomyopathy
b/c it will decrease HR & contractility which will improve her s/s
definition: stress induced cardiomyopathy
non-ischemic cardiomyopathy caused by a suden tempoary dysfunction of hte myocardiou
*possibly r/t ANS and exxcessive release of adrenalin
takotsubo
aka stress induced cardiomyopathy
aka broken heart syndrome
b/c the characteristic bulging of the LV apex w/preserved function of hte base looks like the octopus pot = takotsubo
prognosis of stress induced cardiomyopathy
unique b/c it is sudden, tempoary, and the heart returns to normal function in 2 months
5 treatment priorities for stress induced cardiomyopathy
optimize fluid minimize myocardial oxygen demand decrease afterload prevent complications monitor for dysrhythmias
3 potential complications of stress-induced cardiomyopathy
low bp
cardiogenic shock
chronic HF
*fast onset so heart can’t compensate for rapid decrease in function
what type of dysfunction is restrictive cardiomyopathy
diastolic b/c rigid walls so can’t expand to fill
s/s of restrictive cardiomyopathy
fatigue
weak
acrivity intolerance
s/s of congestion
Long QT syndrome
repolarization disorder
*risk torsades & sudden cardiac death
QTc
QT corrected. QT measurement corrected to the ventricular HR changes
5 types of rx that cause Long QT
antiemetics ABX antidepressants antipsychotics antidysrhythmics
*low K or low Mg, bradydysrhythmisas, subarachnoid hemorrhages
how to measure Long QT
beginning of QRS to end of T
normal QTc
QT intervals by HR so it must be “corrected” for HR.
*0.44 seconds are less
risk of Long QT
ventricular arrythmias
do not do if snake bite
NO tourniquet!
complications of snakebite -4
coaguloathy
high RR/HR
oral numbness
treat scorpion bite
Anascorp
OR: benzo & atropine
s/s of scorpion bite
mild = pain/paresthesia severe = cranial nerve dysfunction (abnormal ocular movements) & neuromuscular dysfunction
blood tests arffected by heat injuries
increased Hct
increased BUN
IVF for heat injuries
NS b/c often already low Na
urine in heat injuries
incresed specific gravity
ketones
more concentrationed b/c fluid loss
how to labs/urine look in heat injuries
reflect concentration b/c fluid loss
3 types of heat related injuries
cramps
exhaustion
stroke
ABG in hyperthermia
respiratory alkalosis b/c hyperventilation (blow off CO2)
difference between heat exhaustion & heat stroke
exhaustion = no neuro impairment
stroke = AMS
*DO NOT NEED TO STOP SWEATING IN ORER FOR IT TO BE heat stroke!
mild hypothermia range
90-95F
32.2 to 35C
core temp that = hypothermia
under 35C/95F
when does shivering stop
temps below 32C/89.6F
hallmark sign of hypothermia
paradoxical undressing r/t delirum
IVF temperature to rewarm
39C/102.2
risk of rewarming
afterdrop = return of cold blood to the core
EKG in hypothermia
osborn wave/j wave
osborne wave
EKG in hypothermia
cause of dysrhythmias in hypothermia
increase in lactate & K
mamillian diving reflex
causes HF to drop to 10-25% . slowing down the HR allows the herat/brain to consumew less oxygen so you can stay under water for a longer period of time
**apnea/bradycardia
needed s/p drowing
watch for: hypothermia & spinal immobilazation & increase PEEP & bronchospasm w/beta2 agonsit
vasoC to maintain CPP
initiate ventilation if drowing
widespread atelectasis & pulmonary shunt possible
increase PEEP: treat bronchospasm with beta2 agonist
when can you fly s/p diving
12hrs later
goal of giving oxygen s/p decompression sickness
promotes nitrogen washout
aka diving associated barotrauma
POPS = pulmonary overpressurized syndrome
where do the greatest pressure changes occur
4ft belwo surface
pt looks like they are having a stroke s/p diving
arterial gas embolism
pt has a nosebleed s/p diving
arterial gas embolism
flying s/p diving complications like decompression sickness & arterial gas embolism
pressurized cabin or rotary wing under 1K ft
**ground transportation is preferred
HAPE
high altitude pulmonary edema
s/s of HAPE
rales elevated: HR, RR SOB at rest fever nonproductive cough w/pink frothy spuntum
vitals in HAPE
elevated HR/RR
SOB at rest
fever
treat HAPE
descend supplemental O2 CPAP yperbaric nifedipine to promote pumlonary vascularture dilation
Rx for HAPE
nifedipine to vasoD
HACE
high altitue cerebral edema
what altititude sickness occurs the latest
HACE = high altitude cerebral edema
up to 5 days later
trigger for HACE
after 5 days of sustained high altitude over 12kFt
s/s of HACE
AMS
ataxia
visual changes
coma
treatment of HAPE
descend oxyten NO DIURETICS hyperbaric dexamethasone
rx for HAPE
dexamethasone
NO dieuretics!`
bruise behind ear
battle sign
Bruddzinski sign
flex neck results in flexed hip
meningitis
sign in pelvic fracture
Coopernail’s sign
ecchymosis of perineum around scrotum/labia
bluish discoloration around U
Cullen’s sign