Section 4 - Cardiovascular Diseases Flashcards
unstable angina
anginal symptoms increasing in frequency or severity, or occur at rest
most reliable tool in assessing chest pain?
EKG
Peak and wane of CK-MB in MI? Trop?
CKMB - 1d, 2d
trop - 2d, 5d
angina sx?
episodic chest pain that lasts 5-15 min, precipitated by exertion, relieved by rest or sublingual nitrogen
prinzmetal angina
spasm of epicardial vessels wiht normal coronary arteries (1/3) or in patients with underlying atherosclerotic disease (2/3)
- precipitated by tobacco or cocaine
sx of acute pericardial tamponade?
positional or pleuritic chest pain, dyspnea, and palpitations
- tachy, hypotensive, jvd,distant heart sounds
NSTEMI definition
cardiac markers elevation, not STEMI
tx of chest pain
IV, O2, monitor, aspirin 160-325 mg chewed, NTG sublingual (total 3 tabs) 2-5 min intervals, morphine (caution with hypotension), consider clopidogrel, UFH, PCI/thrombolytics, consider beta blockers
disadvantages of UFH?
need for IV, frequent monitoring of aPTT, unpredictable response, HIT, increased bleeding
- reversible with protamine
LMWH advantage?
greater bioavailabliity, lower protein binding, longer half life, safer, more reliable, more risk of ICH in elderly, bad if CABG is planned
sx of cardiogenic shock
hypoperfusion (hypotension) and tachycardia, cool/mottle skin, oliguria, AMS
- possible pulmonary edema, JVD
dx of cardiogenic shock?
step 1: EKG, rule out bleeding, infectious causes, focal neuro deficits
step 2: CXR
tx of cardiogenic shock
airway management, IV access, monitor, PCI, give NTG or morphine cautiously, no beta blockers, pressors:
- norepi for severe hypotension
- dobutamine with dopamine for hypotension no hypovolemia
- sodium nitroprusside for afterlooad reduction
tx of ACS
aspirin 160-325, nitroglycerin, beta blockers (metoprolol), clopidogrel, heparin or enoxaparin
diagnosis of syncope work up?
history, physical, EKG, pregnancy test, consider electrolytes
tx of acute pulmonary edema
oxygen to get sat up to 95% or CPAP or BiPAP if necessary, intubation if patient is tiring
NTG sublingually, drip, nitroprusside may be used if pt still HTN
furosemide 40-80 mg IV or bumetanide 0.5 -1 mg IV or torsemide 10 mg IV, monitor BMP
tx of mitral stenosis?
furosemide 40 mg IV, tx of afib, and anticoag
tx of mitral incompetence?
with pulm edema give: O2, noninvasive ventilation, furosemide 40 mg IV, nitrates
nitroprusside 5 mcg/kg/min IV if normotensive
hypotensive 2.5 mcg/kg/min in addition to nitroprusside
sx of aortic stenosis?
dyspnea, CP, syncope
tx of aortic stenosis?
pulm edema: furosemide 40 mg IV, no nitrates because you need preload
sx of aortic insufficiency? Acute vs chronic?
acute: dyspnea
chronic: widened pulse pressure (head bobbing), water hammer pulse, pulsus bisferiens, duroziez sign (to and fro femoral murmur) and quincke pulse (capillary pulsations visible at prox nailbed while pressure applied at tip
dx of aortic insufficiency?
EKG and echo
tx of aortic insufficiency?
pulm edema: oxygen and noninvasive ventilation
nitroprusside and dobutamine or dopamine can be started
chronic: ACEI or nifedipine
Most common cause of dilated cardiomyopathy?
idiopathic
sx of dilated cardiomyopathy?
DOE, orthopnea, and PND
- CP due to limited coronary vascular reserve
tx of dilated cardiomyopathy?
IV, O2, monitoring
- IV furosemide and dig 0.5 mg IV
- ACEI, beta blocker carvedilol
- amiodarone
- anticoag
sx of hypertrophic cardiomyopathy?
DOE, angina CP, palpitations, syncope
tx of hypertrophic cardiomyopathY?
beta blockers, avoid exercise, monitored
sx of restrictive cardiomyopathy?
dyspnea, orthopnea, and pedal edema
tx of restrictive cardiomyopathy?
- diuretics and ACEI
- corticosteroids for sarcoidosis
- chelation for hemochromotosis
causes of myocarditis?
coxsackie B, echovirus, influenza, parainfluenza, EBV, HIV
- diphtheriae, meningitis, m pneumonia, beta hemolytic strep
sx of myocarditis?
myalgias, headache, rigors, fevers, heart rate elevated disproportionate to temperature elevation
cause of acute pericarditis?
- virus: coxsackie virus, echovirus, HIV
- bacteria: staph, strep, m tb
- fungus: histoplasmosis
- CA: leukemia, lymph, melanoma, mets
- drugs: procainamide and hydralazine
- radiation, CT disease, uremia, myxedema, post MI
sx of acute pericarditis?
sharp stabbing CP that radiates to back, neck, left shoulder or arm, worse with movement and deep breathing, worse by lying supine and lessened by sitting up and leaning forward
- assoc with fever, dyspnea, and dysphagia
best diagnostic test for acute pericarditis?
echo
tx of acute pericarditis?
ibuprofen, tx cause, monitored
sx of cardiac tamponade?
dyspnea, weight loss, pedal edema, ascites, tachycardic low SBP, narrowed pulse pressure. Pulsus paradoxus, neck vein distention, distant heart sounds, RUQ pain
diagnostic test of choice for tamponade?
echo
tx of tamponade?
IV, O2, monitor, IVF bolus, pericardiocentesis, ICU admission
sx of DVT/PE?
hypoxemia, tachypnea, tachycardia, hemoptysis, diaphoresis, low grade fever
dx of DVT/PE?
low or intermediate risk start with d dimer
next step US BLE
CT Chest angio
tx of DVT/PE?
- O2
- IV crystalloid to increase preload and hypotension
- UFH/LMWH
- fondaparineux or lepirudin if can’t have heparin
- also coumadin
- some need thrombolytics
tx of aortic dissection?
esmolol or labetalol
- verapamil, dilt if can’t do beta blockers
- nicardipine or nitroprusside if beta/CCB not working
tx of acute hypertensive pulmonary edema?
NG SL, paste or IV infusion
- enalapril, nicardipine, nitroprusside
tx of hypertensive ACS?
NTG or metoprolol
tx of acute sympathetic crisis?
benzos, NTG or phentolamine
tx of acute renal failure?
labetalol, nicardipine, fenoldopam
tx of preeclampsia?
labetalol, hydralazine
tx of HTN encephalopathy?
nicardipine or labetalol or fenoldopam or nitroprusside
tx of hypertensive SAH?
nicardipine, labetalol, or esmolol
tx of ICH?
nicardipine, labetalol, esmolol
ischemic stroke from HTN?
labetalol, nicardipine, NTG
most common cause of child with HTN?
renovascular lesions and pheochromocytoma
tx of child with hTN?
labetalol, nicardipine, nitroprusside
size for diagnosis of AAA?
> 5 cm
tx of unstable patient with AAA?
bedside US, early consult to vascular, large bore IV, type and cross, pain control
tx of stable patient with AAA?
ICU and early consult with vascular
tx of aortic dissection?
large bore IV, type and cross, esmolol or labetalol, nitroprsside
definition of PAD?
ABI of
sx of PAD?
pain, pallor, poikilothermia, pulselessness, paresthesias, and paralysis
tx of PAD?
IV bore, EKG, echo, ufractionated heparin, vascular consult
