Section 4 - Cardiovascular Diseases Flashcards by Cassie Newburg

unstable angina

anginal symptoms increasing in frequency or severity, or occur at rest

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most reliable tool in assessing chest pain?

EKG

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Peak and wane of CK-MB in MI? Trop?

CKMB - 1d, 2d

trop - 2d, 5d

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angina sx?

episodic chest pain that lasts 5-15 min, precipitated by exertion, relieved by rest or sublingual nitrogen

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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

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sx of acute pericardial tamponade?

positional or pleuritic chest pain, dyspnea, and palpitations
- tachy, hypotensive, jvd,distant heart sounds

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NSTEMI definition

cardiac markers elevation, not STEMI

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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

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disadvantages of UFH?

need for IV, frequent monitoring of aPTT, unpredictable response, HIT, increased bleeding
- reversible with protamine

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LMWH advantage?

greater bioavailabliity, lower protein binding, longer half life, safer, more reliable, more risk of ICH in elderly, bad if CABG is planned

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sx of cardiogenic shock

hypoperfusion (hypotension) and tachycardia, cool/mottle skin, oliguria, AMS
- possible pulmonary edema, JVD

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dx of cardiogenic shock?

step 1: EKG, rule out bleeding, infectious causes, focal neuro deficits
step 2: CXR

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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

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tx of ACS

aspirin 160-325, nitroglycerin, beta blockers (metoprolol), clopidogrel, heparin or enoxaparin

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diagnosis of syncope work up?

history, physical, EKG, pregnancy test, consider electrolytes

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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

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tx of mitral stenosis?

furosemide 40 mg IV, tx of afib, and anticoag

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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

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sx of aortic stenosis?

dyspnea, CP, syncope

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tx of aortic stenosis?

pulm edema: furosemide 40 mg IV, no nitrates because you need preload

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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

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dx of aortic insufficiency?

EKG and echo

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tx of aortic insufficiency?

pulm edema: oxygen and noninvasive ventilation

nitroprusside and dobutamine or dopamine can be started

chronic: ACEI or nifedipine

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Most common cause of dilated cardiomyopathy?

idiopathic

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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

Section 4 - Cardiovascular Diseases Flashcards

(61 cards)