Other Heart Problems Flashcards by Carolyn Schmitt

What is found on Echo that is diagnostic for cardiac tamponade?
What is Beck’s Triad?
EKG findings?

Large effusion and right heart diastolic collapse.
Hypotension, JVD, muffled heart sound.
Low voltage, tachycardia, Alternans–QRS changing in size (Big, small)

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What is sign of pericarditis on EKG?

Diffuse ST segment elevation, PR segment depression in some leads

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What are major causes Infective endocarditis?
What valve is affected? Murmur?
How to make the Dx of endocarditis?
Special Signs of the infection?

IV drug user (Staph aureus) and Prosthetic Valve.
Tricuspid Valve: New regurge murmur changing with time (coming and going).
Dx: new murmur and simultaneous sites of infx (Valve Shoots out septic emboli) so get stroke, pneumonia, change in mental status, renal.
Olsler node, Janeway lesion, splinter hemorrhage.

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Causes of pericarditis?
Acute Pericarditis Signs?
Tx?

Cause–90% viral or idiopathic. Can also be due to SLE, Isoniazid.
Sharp, positional pleuritic chest pain feeling better when leaning forward, Friction Rub.
Asa, NSAIDs , for 1-3 weeks; colchicine

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What is the best initial treatment for acute decompensated heart failure?

IV loop diuretic furosemide: initiate without delay to relieve congestion and fluid overload.

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What are the etiologies of SHOCK?

Sepsis
Hypovolemia
Obstructive
Cardiac (AMI)
Kortisol deficiency

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What is the DX with a CXR showing a widened mediastinum, and EKG showing sinus tach, pain beginning suddenly?
Medical ManagementTreatment?

Aortic dissection.
IV BB (labetalol)

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What is a key lab to determine if CHF is decompensating?

Increased BNP: <100 unlikely decompensated CHF

>500 likely decompensated CHF

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What is the diagnostic study of choice in most disorders of the pericardium?

Echo

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What does the presence of S3 heart sound suggest?

S4?

S3: heart failure; this is due to increased resistance to ventricular filling during passive atrial emptying.
S4: Hypertensive heart disease, CAD, aortic stenosis, cardiomyopathy; occurs when there is increased resistance to ventricular filling during atrial contraction.

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What is Tetralogy of Fallot?

Think “PROVe”

Pulmonary stenosis, Right ventricular hypertrophy, Overriding aorta, ventricular septal defect

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What is the clinical diagnosis of orthostatic hypotension?

> 20 mmHg drop in systolic BP or drop of >10 mmHg in diastolic BP between supine and sitting/standing measurement.
If also a rise in pulse of >15 BPM then depleted circulating blood volume is the probable cause.

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What is the finding on ECG for Variant (Printzmetal)Angina?

Transient ST segment elevations.

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What is the first cardiac marker to rise in an AMI?

Myoglobin arises within 1-3 hours.

Troponin rises in 3-12 hours.

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What heart sound is the beginning of systole with the tricuspid and mitral valves closing.

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What heart sound is the end of systole/beginning of diastole with aortic and pulmonic valves closing.

What is the abnormal heart sound that is heard in early diastole during the passive LV filling?
What condition causes this?

Dilated ventricle as in CHF

What is the heart sound occurring late diastole during active LV filling and is abnormal. What disease state causes this?

S4, stiff ventricle caused by HTN, ischemia

What is the first line treatment for chronic angina?
What is the first line treatment for unstable angina especially in heart failure?
What is needed in all angina patients?

B Blocker.
ACEI.
Plt inhibiting agents: aspirin, clopidogrel

What is the 1st line medication for dissecting aortic aneurysm?

Labetalol

In a patient with acute STEMI and BP of 90/56 despite aggressive fluid resuscitation, what pressor agent is most appropriate?

Dobutamine

What is variant (Printzmetal) angina?
Describe the ST-Segment
What is the treatment of choice(after nitrates)?

Vasospastic angina. Episodes of rest angina that promptly responded to nitrates due to coronary artery vasospasm. Assoced with ST-segment elevation.
Calcium Ch Blocker.

What is stable angina?

Describe the ST-segment.

Effort angina

assoced with ST-segment depression.

What is unstable angina?
Describe the ST-segment?
Do nitrates help?

Closely related to non-ST-segment elevation MI. Less responsive to nitrates. Angina lasting >30 minutes. MC presentation is at rest. Also, new onset of angina sxs, or increasing pattern of pain in previously stable patients.

What do you check for in any elderly patient who faints even without associated chest pain?

Evaluate for acute MI with serum creatinine kinase and troponin levels.

Antibiotics are no longer needed as prophylaxis for which type of Heart/valve disease?

Bicuspid aortic valve, acquired mitral or aortic valve disease including patient's who have undergone valve repair, hypertrophic cardiomyopathy.

When do you need antibiotic prophylaxis in heart/valve disorder patients?

Prosthetic heart valves, Hx of endocarditis, unrepaired cyanotic congenital heart disease, repaired congenital heart defects with prosthetic material or device during 1st 6 mos after procedure,

What is cor pulmonale? What is a common manifestation? Signs? What is seen on the EKG?

An alteration in the structure and function of the R. Ventricle of heart caused by a primary disorder of the respiratory system. Pulmonary HTN that leads to R. Ventricular heart failure. Elevated jugular venous pressure, congestive hepatomegaly, ascites, peripheral edema. EKG: Right Ventricular Hypertrophy

What is the MC congenital heart disease?

VSD

What do you see on the EKG with hypocalcemia? | What do you see with hypokalemia?

Prolonged QT interval. | Flattening of T waves.

What does the Valsalva maneuver do? What type of murmurs does it increase? What type of murmurs does it decrease?

Diagnoses hypertrophy, regurgitation, prolapse, stenosis. Increases the murmur in hypertrophic cardiomyopathy and mitral valve prolapse. Decreases murmurs in stenosis and regurgitation.

An increased size of the cardiac silhouette on CXR is characteristic of what disorder?

Pericardial effusion

What is the #1 RF for aortic dissection?

HTN

What is the diagnosis: trauma(car accident) causing sxs of hypotension, muffled heart sounds, distended neck veins, tachycardia

Cardiac tamponade: accumulation of blood in the pericardial cavity.

What conditions are associated with acute pericarditis?

- 90% idiopathic or due to viral infection - Isoniazid therapy - Systemic Lupus Erythematous: suspect this in a female of any age who has acute pericarditis. - Uremia(high levels of waste product in the blood

What is a clinical symptom associated with atherosclerotic stenosis of a carotid artery?

``` Transient visual loss in one eye. Amaurosis fugax(painless temporary loss of vision) lasts only 1-2 mins: anyone with this needs a duplex US of carotid artery. ```

What is the HTN treatment of choice in a patient with gout? | What is the HTN treatment of choice for HTN with angina or AFIB?

Verapamil as thiazide diuretics increase serum uric acid levels. Verapamil.

What is cardiogenic shock? | Tx:

The heart suddenly can't pump enough blood usually after a severe AMI. Dobutamine(to increase cardiac output) and volume replacement.

What med used in treatment of CHF is most effective for decreasing the patient's mortality?

ACEI

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Other Heart Problems Flashcards

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