EM - Cardio Flashcards
t/f there has to be some type of prior damage to the tissue for bacterial endocarditis to occur
T
MC source of bacterial endocarditis
oral procedures
MC organism of native valve endocarditis
staph aureus
diseases that increase the risk of endocarditis
-rheumatic fever
-congenital heart diseases
-MVP
-degenerative heart disease
MC organism for prosthetic valve endocarditis
staph epidermis
MC valve affected by IVDU endocarditis
tricuspid
s/s of endocarditis
-fever, chills, weakness, SOB
-murmur
-petechiae
-splinter hemorrhages
-janeway lesions
-osler nodes
-roth spots
janeway lesions
-painless patched on palms or soles caused by emboli
osler nodes
painful lesions on pads of fingers or toes caused by vasculitis
diagnosis of endocarditis
-CBC
-blood cultures
-echo
major criteria for endocarditis
-2+ positive cultures
-evidence on echo
-new regurg murmur
minor criteria for endocarditis
-predisposing heart condition or IVDU
-fever
-vascular or embolic sx
-immunologic sx
-1 positive culture
tx of endocarditis
-native valve
-IVDU
-prosthetic valve
-native valve: pen G + gent
-IVDU: nafcillin + gent
-prosthetic valve: vanc + gent + rifampin
patients who get endocarditis prophylaxis
-prosthetic heart valves
-prior endocarditis
-congenital heart disease
-heart transplant
procedures that require endocarditis prophylaxis
-dental procedures
-respiratory trat procedures
-I&D
antibiotic for endocarditis prophylaxis
-amoxicillin
stable vs unstable angina
-stable: typical and predictable that goes away with rest and NTG
-unstable: unexpected and goes not go away with rest and NTG
prinzmetal angina
vasospasm resulting in angina that is treated with NTG and CCB
treatment of sinus bradycardia
none if asymptomatic, atropine can increase HR, but pacemaker is definitive
sick sinus syndrome
recurrent supraventricular arrhythmias and bradycardia
etiology of sick sinus syndrome
medications
treatment of sick sinus syndrome
pacemaker
treatment of sinus tachycardia
beta blockers
heart blocks
-first degree: PR interval >0.2 seconds
-second degree type 1: longer, longer, longer, drop
-second degree type 2: randomly dropped beats
-third degree: no correlation between atria and ventricles
treatment of heart blocks
-first degree and mobitz 1: none
-mobitz 2 and 3rd degree: pacemaker
Also, Atropine? (2nd and 3rd)
treatment of PAC
-beta blockers or CCB
treatment of PVC
-BB
treatment of SVT
-mechanical measures
-adenosine
-cardioversion if the patient is hemodynamically unstable
treatment of afib
-rate control
-rhythm control
-anticoagulation
how to determine who needs anticoagulation with afib?
CHADS2-VASc
-CHF
-HTN
-over 75
-DM
-prior stroke
-vascular disease
-between 65-74
-female
CHADS2-VASc score interpretation
VASc score interpretation
-0: no antithrombotic therapy needed
-1: ASA or oral anticoagulation
-2: full anticoagulation
afib treatment for patients who cannot have long-term anticoagulation
watchman procedure
treatment of atrial flutter
-catheter based radiofrequency ablation
-anticoagulation same as afib
etiology of junctional arrhythmias
-digoxin toxicity
-electrolyte abnormalities
sustained vs nonsustained Vtach
-nonsustained: less than 30 seconds
-sustained: greater than 30 seconds
brugada
incomplete right bundle branch block and ST-segment elevations
management of brugada
ICD
management of acute sustained VT
-if unstable: cardioversion
-stable: amiodarone
Treatment of nonsustained VT
-with heart disease: BB
-without heart disease: BB if symptoms
treatment of vfib
immediate defibrillation
etiologies of LBBB and RBBB
structural heart disease
treatment of LBBB, treatment of RBBB
No Specific Tx
s/s of cardiac tamponade
-JVD
-muffled heart sounds
-hypotension
-kussmauls sign
-pulsus paradoxus
kussmauls sign
increase in JVD on inspiration
pulsus paradoxus
inspiratory systolic fall in arterial pressure
EKG of tamponade
electrical alternans
CXR of tamponade
water bottle heart
diagnosis of tamponade
echo
treatment of tamponade
pericardiocentesis
which arteries feed which parts of the heart?
-right coronary: inferior wall and RV
-LAD: septum and anterior wall
-left circumflex: lateral wall
angina pectoris
used to describe chest discomfort related to ischemia
most sensitive cardiac marker
Troponin I
most sensitive early marker for MI
myoglobin
positive test for exercise stress test
ST depression of 1mm
initial management of all ACS
-chewable ASA
-NTG
-oxygen if needed
-morphine if pain isn’t managed by NTG
(MONA)
STEMI management
-re-perfusion via fibrinolytics or PCI
-anti-platelet
-anti-coagulant
if using TPA…
-plavix
-lovenox
if doing PCI…
-brilinta
-UFH
timeline for STEMI management
-30 minutes for fibrinolytics
-120 minutes for PCI
presentation of heart failure
-DOE
-PND
-orthopnea
-s3 heart sound
-JVD
-peripheral edema
-ascites
diagnosis of heart failure
-CXR: cardiomegaly, interstitial edema
-BNP
-echo
treatment of heart failure
-lasix
-ace/arb
-BB
-SGLT2
treatment of hypertensive heart failure
-NTG
-then lasix
treatment of cardiogenic shock
-oxygen
-250-500mL of IV fluids
-vasopressors
NYHA classification of heart failure
Class I: symptoms only occur with vigorous activities
II: symptoms with prolonged or moderate exertion, slight limitation of activities
III: symptoms occur during ADLs, markedly limiting
IV: symptoms occur at rest
ACC/AHA classification of heart failure
-A: high risk of heart failure
-B: structural heart defect but no symptoms
-C: structural changes and symptoms
-D: advanced disease causing hospitalization
management for HFpEF vs HFrEF
-HFpEF: lifestyle modifications and diuretics
-HFrEF: combination of multiple meds
s/s of acute decompensated HF
-pulmonary edema
-pink frothy sputum
-diaphoresis and cyanosis
-inspiratory rales
management of acute decompensated HF
-stabilize
-IV lasix
-NTG
presentation of cardiogenic shock
-cool, clammy skin
-tachycardia
-hypotension
hypertensive urgency
-no symptoms
-225/125
-no evidence of end organ damage
Hypertensive Emergency
(>220/130) WITH end organ damage.
treatment of hypertensive urgency
-clonidine
-captopril
-nifedipine
Tx Hypertensive emergency
BP decreased no more than 25% in first 2 HOURS→ goal BP of 160/100 over next 2-6hrs
BB 1st Line
s/s of hypotension
-lightheadedness
-syncope
-nausea
-confusion
-fatigue
definition of orthostatic hypotension
-fall in SBP of 20
-fall in DBP of 10
diagnosis of orthostatic hypotension
-bedside table tilt test
management of orthostatic hypotension
-lifestyle modifications
-fludrocortisone
-midodrine
POTS s/s (eye roll)
-hypotension
-tachycardia
-syncope
diagnosis of POTS
formal tilt table test
-increase in HR by 30 or to 120 in 10 minutes
-no change in BP
strongest risk factors for PAD
-diabetes
-smoking
presentation of PAD
-claudication
-relieved with rest
-decreased pulses
-cool skin
-distal hair loss
-shiny skin
pseudoclaudication
painful cramps that are not caused by peripheral artery disease, but rather, by spinal, neurologic, or orthopedic disorders such as spinal stenosis, diabetic neuropathy, or arthritis
-occurs with standing and can last up to 30 minute
diagnosis of PAD
-ABI < 0.9
-angiography gold standard
treatment of PAD
-lifestyle modifications
-ASA or plavix
-statins
Mcc of embolus occlusion
afibbers
S/S of Arterial Occlusion
-pain
-pallor
-pulselessness
-paralysis
-poikilothermia
-parasthesias
management of arterial occlusion
immediate revascularization and IV heparin
management of arterial occlusion
immediate revascularization and IV heparin
thromboangiitis obliterans etiology
thrombotic processes
s/s of thromboangiitis obliterans
-distal ischemic rest pain or ischemic ulcerations
management of thromboangiitis obliterans
tobacco cessation
required workup for syncope
-EKG
-cardiac monitoring
vasovagal syncope
sudden faint due to hypotension induced by response of the autonomic nervous system to abrupt emotional stress, pain, or trauma
carotid sinus syncope
-reflex syncope due to turning of head, tight collar, or shaving
diagnosis of carotid sinus syncope
carotid massage
-drop of SBP by 50
treatment of carotid sinus syncope
none, f/u with pcp :(
subclavian steal syndrome
stenosis of the subclavian artery which results in decreased perfusion pressure to the distal subclavian leading to arm stealing blood from brain and syncope
s/s of subclavian steal syndrome
-upper extremity pain and paresthesias
-syncope
diagnosis of subclavian steal syndrome
-CTA with contrast
treatment of subclavian steal syndrome
-statins
-antiplatelets and anticoagulants
-smoking cessation
basilar artery insufficiency
insufficiency causes by a blockage from TIA or stroke
s/s of basilar artery insufficiency
-n/v
-weakness
-syncope
-dysarthria
-dysphagia
diagnosis of basilar artery insufficiency
-CT brain without contrast
-HINTS exam
treatment of basilar artery insufficiency
lipid management
antiplatelets
smoking cessation
s/s of aortic stenosis
-angina
-syncope
-midsystolic murmur that radiates to the carotids
treatment of aortic stenosis
surgery
Etiologies of aortic regurgitation
-rheumatic fever
-infective endocarditis
-marfans
-root dilation
s/s of aortic regurgitation
-development of CHF sx
-diastolic murmur that radiated to the apex
-widened pulse pressure
treatment of aortic regurg
-surgery for symptomatic
-vasodilators
mcc of mitral stenosis
rheumatic fever
s/s of mitral stenosis
-pulmonary vascular congestion sx
-diastolic murmur at the mitral post
-opening snap
treatment of mitral stenosis
-BB
-diuretics
-surgery
S/S of mitral regurgitation
-CHF sx
-systolic murmur at apex that radiated to axilla and back
treatment of mitral regurg
-vasodilators
-diuretics
-surgery
s/s of MVP
-CP
-dizziness
-palpitations
-anxiety
-mid-systolic click and late systolic murmur
management of MVP
-typically none
when is it considered a AAA?
when it is over 3cm in diameter
S&S of Ruptured Aortic Aneurysm
-severe mid abdominal pain radiating to lower back
-palpable abdominal mass
-hypotension
diagnosis of AAA
US
screening for AAA
men 65-75 who have ever smoked
treatment of AAA
endovascular repair
types of aortic dissection
-type A: involves arch proximal to the left subclavian
-type B: beyond the left subclavian
presentation of aortic dissection
-severe, tearing, CP that radiates to the upper back
-hypertensive
diagnosis of aortic dissection
-CTA
treatment of aortic dissection
-labetalol
-morphine
-surgery
for aortic dissection, lower BP to…
120 SBP
surgical indications for aortic dissection
-all type A
-type B with end organ damage
presentation of superficial venous thrombophlebitis
-redness, induration, and tenderness along a superficial vein
-palpable cord
management of superficial venous thrombophlebitis
-NSAIDs
-compression socks
-elevation
-warm compress
-anticoagulation
s/s of lymphangitis
-fever and chills
-red streak proximal to lymph node
diagnosis of lymphangitis
CBC and blood cultures
management of lymphangitis
-abx
-NSAIDs
-warm compress
-elevate
