Pathophysiology Flashcards
Venous Thromboembolism
(VTE)
DVT and PE
DVT
Epidemiology
- Risk higher in men
- Most common in LE
- Esp. calf veins
- 15-30% propagate to proximal calf veins without treatment
- Risk of PE much higher in proximal DVT
- 40-50% vs 5-10% distal
- UE DVT much less common
UE DVT
Risk Factors
- Central venous line
- Pacemakers
- Trauma
- Extrinsic compression @ thoracic inlet
DVT
Presentation
- Pain and swelling of the area
- Many asympatomatic w/ normal exam
- Exam
- TTP, erythema, warmth, swelling distal to DVT
- Palpable tender “cord” in area of DVT
- Dilated superficial veins
- Low grade fever
- Homan’s sign ⇒ calf pain with dorsiflexion
SVC Syndrome
Can be caused by UE DVT
- Facial swelling
- Blurred vision
- Dyspnea
DVT
Diagnosis
- D-Dimer
- Fibrin degradation product
- Nonspecific
- Duplex US
- Sensitivity⇒ proximal DVT (90-100%), distal DVT (40-90%)
- Contrast venography ⇒ gold standard
DVT
Treatment
- Anticoagulation
- IVC filter
- Should be avoided unless can’t anticoag
- Dec. risk of PE short term
- Inc. risk of recurrent DVT
Thromboplebitis
Superficial inflammation and pain involving a vein.
- Risk ⇒ Virchow’s triad
- Presentation ⇒ firm, tender palpable cord
- Treatment ⇒ local heat and NSAIDS
PR Interval
0.12 - 0.2 secs
or
< 1 large box
QRS Complex
< 0.1 secs
QT interval
< 0.45 secs
Axis Determination
Use lead II or aVF
Inferior Wall
Leads
II, III, aVF
Anterior Wall
Leads
I, aVL, V1-V3
Anterolateral Wall
Leads
V5, V6
Lateral Wall
Leads
I, aVL, -aVR
EKG Leads
Summary
Left Anterior Descending
(LAD)
Anterior wall of both ventricles
Anterior 2/3 of septum
Anterior papillary muscles
Diagonal branches of LAD
Anterior surface of LV
Left Circumflex
Left atrium
Posterior and lateral left ventricle
Right coronary artery (RCA)
Right atrium and right ventricle
SA and AV nodes
Posterior septum
Right marginal artery
RV
Posterior descending artery
Inferior and posterior walls of right ventricle
Posterior 1/3 of septum including posterior papillary muscles
Coronary Circulation
Summary
CAD
Risk Factors
CAD
Biomarkers
Typical CAD History
Levine’s sign ⇒ pt comes in clutching hand to chest
Chest Pain
Patterns
Physical Exam
During Ischemia
Xanthomas ⇒ cholesterol deposits around joints
Xanthelasmas ⇒ cholesterol deposits around eyes
EKG Lead
Patterns
Stable Angina
Treatment
- Medical therapy
-
Modify risk factors
- Lipid lowering drug
- Control BP
-
Drugs to prevent/relieve angina
- Nitrates
- β-blockers
- CCB
- Late sodium current blockers
- Ranolazine - if fail all others
- Antiplatelet agents
-
Modify risk factors
- Interventional therapy
- PCI / stent
Cardiac Cath
Indications
Prinzmetal Angina
S3 gallop
Due to volume overload with poor LV function
S4 heart sound
Due to noncompliant left ventricle
ACS
Treatment
STEMI
Treatment
NSTEMI and Unstable Angina
Treatment
Dressler Syndrome
Acute Bacterial Endocarditis
- Normal valve
- Virulent organism
- Onset days - few weeks
- Mortality rate higher
Subacute Bacterial Endocarditis
- Abnormal valve ⇒ congenital or degenerative
- Less virulent organism
- Viridans strep
- S. epidermidis
- Enterococcus
- Onset weeks to many months
Endocarditis
Risk Factors
- Significant MR ⇒ most common
- MVP ⇒ 20% of NVE cases
- RHD
- Congenital heart disease ⇒ 15% with NVE
- TOF ⇒ highest IE risk
- VSD, bicuspid valve, aortic coarctation
- Degenerative valves ⇒ SBE in elderly pts
- Mitral valve most common
- Hypertrophic cardiomyopathy or asymmetrical septal hypertophy ⇒ aortic valve IE (rare)