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CMT-uno > Pericardial disease/ scripts > Flashcards

Pericardial disease/ scripts Flashcards

1
Q

Functions of pericardium

4

A

1.stabilize heart within the thoracic cavity
2.protect from traum and infection
3.decrease friction
4. prevent excessive dilation

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2
Q

Pericarditis

general

PE

A

Acute inflammation of the pericardium

Hemodynamically stable patient with positional Chest pain ( worse supine/deep inspiration); pericardial friction rub; diffuse ST segment elevation on ECG, new pericardial effusion ( 2 of 4)

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3
Q

pericarditis

Dx
ECG, cxr, labs

A

ECG: diffuse ST changes +/- PR prolongation

Cxray: normal unless have effusion
Echocardiogram: r/o effusion

Labs: CBC, ESR, CRP, troponin ( +/- blood cultures, ANA, TB test, Lyme)

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4
Q

pericarditis

Tx

A

Treatment:
Aspirin 750-1000mg or ibuprofen 600 mg q8 1-2 weeks + Colchicine 0.5 mg po BID x 3 months
Close follow up monitoring symptoms, ECG, CRP

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5
Q

pericaditis

causes

A

Idiopathic (86%)( Echovirus and Coxsackie virus most common)
Neoplastic (5.6%)
Tuberculosis (3.9%)
Autoimmune (1.7%)
Purulent (0.9%)

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6
Q

Acute pericarditis vs Acute MI

ECG changes

A

Acute Pericarditis
Diffuse ST elevation, rarely exceeds 5 mm
No reciprocal ST segment lead changes
PR depression common

Acute MI
Regional ST elevation, often exceeds 5 mm
ST segment depression in reciprocal leads
Rarely involved PR

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7
Q

52 yo male presents with acute onset chest wall discomfort “ sharp” worse with cough/deep inspiration; non-radiating; assoc DOE. Leaning forward helps ease symptoms. PMHX: negVS: 148/90, 110, 20 AF
ECG findings?
Echo?

A

diffuse ST elevation

see if effusion

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8
Q

Treatment of Pericarditis includes which of the following ?
1- anti-inflammatory rx ( nsaid, colchicine)
2-anti-viral rx
3-antibiotics ( Keflex 500 mg po tid x 14)
4-narcotics

A

1- anti-inflammatory rx ( nsaid, colchicine)

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9
Q

Most common side effect of colchine ?
GI upset
Rash
Visual disturbance
swelling

A

GI upset

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10
Q

Constrictive Pericarditis

general

A

Thickened, fibrotic, adherent pericardium reduces elastic properties of myocardium and or intracellular matrix

Kussmal sign: increased JVD w inspiration
Think about the heart having a shell around it

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11
Q

Constrictive Pericarditis

effects

A

Restricts diastolic filling
Produces elevated venous pressures

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12
Q

Constrictive Pericarditis

S/Sx

A

Progressive dyspnea, fatigue, weakness
Chronic edema, hepatic congestion, ascites
(looks more like HF)

+/- Atrial Fibrillation
Elevated jugular venous pressure ( JVP), kussmaul’s sign

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13
Q

Constrictive pericarditis

Dx imaging

A

ECG: no specific changes
Echocardiography: thickened pericardium, septal bounce
Cardiac CT / MRI: thickened pericardium, +/- pericardial effusion
Cardiac Catheterization – confirmatory
Low pulmonary pressures*

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14
Q

constrictive pericarditis

Tx

A

aggressive diuretics ( consider torsemide or bumetanide if bowel edema)
anti-inflammatories 2-3 months
may require pericardiectomy

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15
Q

pericarditis

Constrictive vs restrictive

A
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16
Q

Pericardial effusion

general

A

Extra fluid in pericardial space creates pressure on heart chambers when they beat

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17
Q

Pericardial effusion

Presentation: (6)

A

Asymptomatic (depends on size/effect)- incidental finding
Constant dull ache, tachycardia, hypotension, JVD, muffled heart sounds
Pulsus paradoxus
dysphagia, dyspnea, hoarseness, hiccups secondary to compression of other structures
Diminished heart sounds, “muffled” heart sounds
Dullness to percussion L lung over angle of scapula (Ewart’s sign)

MUST Rule Out TAMPONADE

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18
Q

Pericardial Effusion

Dx
ECG, cxray, echo, labs

A

EKG: low QRS voltage with sinus tach, electrical alternans
Cxray: enlarged cardiac silhouette with clear lungs
Echocardiogram: need to quantify effusion and assess hemodynamic impact
Labs: CBC, CMP, TSH ( +/- ANA), pericardial fluid analysis, poss pericardial bx

Electrical alternans: Changing amplitude of the QRS; caused by the heart swinging in the pericardium

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19
Q
A

ECG at admission showing sinustachycardia of 110 beats per minute, low voltage QRS complexes in the anterior leads and no signs of acute ischemia. In retrospect, an electric alternans was seen. Note, the alternating height of the P–QRS–T complexes.

pericardial effusion

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20
Q

Pericardial Effusion

Tx
Rx, procedure, avoid

A

Monitor if stable (ECG, pulsus, and serial echo)
Rx: NSAIDs, corticosteroids, colchicine (GI side effect)
Pericardiocentesis for tamponade ( can do at bedside); IVF
Pericardial Window for tamponade
Pericardiectomy for recurrent

avoid vasodilators and diuretics!!!

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21
Q

what do you avoid with Tx of pericardial effusion?

A

avoid vasodilators and diuretics!!!

bc youre reducing the pressure within the heart which is bad! you need to counteract the pressure from the effusion

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22
Q

tamponade vs effusion

A

tamponade is just a more severe effusion, so severe it is interferring with hearts ability to move, tamponade is not treated with just monitoring like an effusion

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23
Q

Cardiac Tamponade

general

A

Medical emergency

Impaired filling pressures impairs cardiac output

24
Q

Cardiac Tamponade

General

A

Tachycardia, tachypnea, HYPOTENSION
Narrow pulse pressure
Pulsus paradoxus
Decline of > 10 mm Hg in systolic pressure during inspiration
Elevated JVP
Muffled/distant heart sounds

25
Q

Cardiac Tamponade

Diagnostic

A

EKG: low voltage, Sinus Tach
Echocardiography: RV collapse during diastole, dilated IVC

26
Q

Cardiac Tamponade

Treatment

A

Urgent Pericardial window
Urgent Pericardiocentesis

27
Q

58 yo presents ED with Chest Pain, SOB post MVA with airbag deployment. VS: 88/58, 50, 16PE: diaphoretic, elevated JVP, bruising to sternum with diffuse tenderness, distant heart sounds no murmur.
Which test will confirm your suspected diagnosis?
1- ECG
2- serial cardiac enzymes
3- stat echocardiogram
4- cxray

A

3- stat echocardiogram

28
Q

58 yo presents ED with Chest Pain, SOB post MVA with airbag deployment. VS: 88/58, 50, 16PE: diaphoretic, elevated JVP, bruising to sternum with diffuse tenderness, distant heart sounds no murmur.
What finding on ECG corelates with diagnosis (tamponade)?
1- electrical alternans
2-atrial fibrillation
3-diffuse ST elevation
4-ST depression

A

1- electrical alternans
2-atrial fibrillation- arrythmia
3-diffuse ST elevation- pericaditis
4-ST depression - nonstemi

29
Q

myocarditis

general

A

Inflammation of myocardium
Can be acute or chronic
Inflammation can be focal or diffuse
Variable presentation

30
Q

Myocarditis

presentation

A

Variable!!! Depends on what stage they are in
History of infection ,esp viral, within last 30 days
Unexplained heart failure, decreased exercise capacity, decline activity tolerance
Chest discomfort
Arrhythmia ( sinus tach, pac, pvcs)

31
Q

Myocarditis

S/Sx

A

Suspect in patients w or w/o cardiac symptoms
Rise in troponin
Ecg changes consistent w ischemia
Arrhythmia
Unexplained changes to ventricular function
prodromal stage, looks like MI but theres no bloakcge in cath lab, they had a viral infection.. Seen a lot after COVID

32
Q

Myocarditis

Treatment
Avoid

A

Supportive care ( manage HF, arrhythmia)
Activity restriction
CM therapies: ACE/ARB/ARNI, BB
Cardiac rehab

IF COVID-19 systemic anticoagulation
Controversial: steroids, IL-6 inhibitors, IVIG, colchicine?

NO NSAIDS!!!

33
Q

what do you not give to pt with myocarditis?

A

NO NSAIDS!!!

34
Q

Giant Cell Arteritis

general

A

Aka: Temporal Arteritis or Horton Disease
vasculitis of extracranial branches of carotid artery ( temporal, occipital, ophthalmic, and posterior ciliary artery)
Associated with polymyalgia rheumatica

tends to present with temporal artery involvement- tender to touch

35
Q

Giant cell arteritis

Presentation

A

Headache ( usually temporal, UNI-lateral, acute)
Jaw claudication
Visual changes
Acute vision loss
Fever, malaise night sweats

36
Q

giant cell arteritis

PE

A

Scalp tenderness
Thickened temporal artery
Signs suggestive of polymyalgia rheumatica

37
Q

giant cell arteritis

A
38
Q
A

giant cell arteritis

39
Q

Giant cell arteritis

Dx

A

Clinical diagnosis
Increased ESR, CRP; possible anemia ( normocytic, normochromic)
Temporal Bx - CONFIRMATORY
Temporal artery ultrasound: thickening “ halo sign”, stenosis , or occlusion

40
Q

giant cell arteritis

Tx and complication of disease

A

High-dose corticosteroids- immediately!
Complication is blindness
Low dose asa

41
Q

Components of Script

6

A

1.Patient information
2.Name, strength, and dosage form of the drug
3.Directions for use (Sig)
4.Quantity to be dispensed
5.Number of refills
6.Provider information and signature

42
Q

Controlled Substance Prescriptions

Same as regular prescriptions but must also contain:

5

A

1.Days supply
2.Number to be dispensed numerically and alphabetically
3.ICD-10-CM code
4.DEA registration number of prescriber
5.Refills

No refills allowed for schedule II controlled substances
Only 5 refills allowed for schedule III and IV in a 6th month period
Schedule V may be refilled for 1 year from date of issuance

43
Q

what schedule drugs are required to be electronic only?

A

Schedule 2

44
Q

Two patient identifiers are required such as

A

Name
Date of birth
Medical record number
Address
Social Security Number

45
Q

pharm abbreviation

QHS

A

every bedtime

46
Q

pharm abbreviation

QWK

A

every week

47
Q

pharm abbreviation

Q4H

A

every 4 hours

48
Q

required Provider Information for script

4

A

Must contain the printed full name, professional title, and address of the provider
Must contain a valid telephone number for the provider
Written prescriptions must contain a signature of the provider
Controlled substance prescriptions must include the providers DEA number

49
Q

Physiologic Sx of pain

A

tachycardia, tachypnea, and hypertension

50
Q

Behavioral Sx of pain

A

guarding, grimacing, moaning or grunting, distorted posture, and reluctance to move

51
Q

3 different categories
of pain management

A

Non-opioid analgesics
Opioid analgesics
Adjuvant analgesics

52
Q

Acetaminophen

MOA and indication

A

Mechanism of action: not fully understood, may be due to activation of descending serotonergic inhibitory pathways in the CNS

Indications: Mild to moderate pain, fever

53
Q

Acetominophen

Max dose and adverse effects

A

Max dose is 4gram/day

Adverse events: typically well tolerated, may see N/V with IV admin

54
Q

NSAIDs

MOA/ indications/ adverse effects

A

More than 20 different NSAIDS available for use worldwide

Mechanism of action: Inhibit cyclooxygenase(COX 1 and COX2) preventing the production of prostaglandins which cause inflammation, pain, and fever

Indication: anti-inflammatory, fever

Adverse Events: GI bleed, acute renal failure, hyperkalemia, MI/stroke, neutropenia, thrombocytopenia, TEN or SJS

55
Q

Muscle Relaxants

general

A

Typically used for neck and back pain, also reduces muscle spasms and increases mobility of the affected muscles

Should be ordered in conjunction with physical therapy, rest, and/or NSAIDs

56
Q

muscle relaxants

Examples include:

A

Baclofen
Carisoprodol
Cyclobenzaprine
Metaxalone
Methocarbamol
Tizanidine

CMT-uno (54 decks)

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