symptoms review Flashcards
Vasovagal syncope
after eating, feels warm and light headed, graying of vision, nausea,
Autonomically mediated brady cardia syncope
No parasympathetic innervation of blood vessels
inputs through central pathways can either excite or inhibit medullary CV centers, triggered by emotion, pain, motor activity
Sympathetic surge causes vigorous cardiac contraction and markedly reduced end systolic volume–> causing reflex bradycardia and vasodilation (hypotension and syncope)
Avoid triggers, alpha 1 agonists (midodrine), B blockers, and fludrocortisone not as effective, if severe, and recurrent implant a pace maker
Hypertrophic cardiac myopathy syncope
classic murmur (harsh systolic murmur at apex and lower LSB that increases from squatting to standing, echo shows LV wall thickening with septal hypertrophy
The longest QT
resting state- high K and low Na Permeability (prolonged QT the result o a slow calcium efflux during depolarization making phase 3 longer)
Cardiac drugs
Class 1 (Na channel blockers, A(quinidine)- both 1 and 3 prolonged, B (lidocaine) 1 prolonged 3 shortened can shorten can shorten AP, C flecainide very prolonged 1 and normal 3
Class 2 B blockers (slows heart rate, a lot)
Class 3 (K channel blocker, amiodarone, sotalol, dofetilite, no change to 1 but very prolonged 3 , prolongs QT does not do TdP
Class 4 (Ca channel blockers verapamil, and diltiazem most drugs that prolong
heart block
1st degree PR longer than .20
2d degree type 1- p waves start to dissociate before they drop, Type 2 p waves give no warning before a beat drops
3rd degree- complete No P and QRS relationship
V tach
wide QRS
WpQ
delta waves
What is stridor
inspiratory monophonic, loudest over trachea
Upper airway problem
What is wheezing
musical sound primarily noted on exhalation
COPD
elderly wheezing and a cough, long smoking, HTN, SOB, humid and cold air harder to breath, running a fan over his face at rest helps, ankle edema, barrel chested, hyper resonance on percussion, wheezing , cxr is hyper inflaation flat diaphragm
COPD includes emphysema, chronic bronchitis, bronchiectasis, and chronic persisitent asthma (FEV remains abnormal after therapy
Spiro loopes- scalloped means obstruction- extrathoracic obstruction decreases inspiratory ability
Key determinants of diffusion
Surface area of the lung with contact to diffusing alveoli, thickness of alveolar capillary membrane, and volume blood available in the capillary bend of the lung
Exercise, asthma, polycythemia, and LR shunts elevated DLCO
Emphysema, fibrosis, anemia, pnemonia, pilm HTN, CO poisoning
FCR and FVR
FCR measurement cannot be done with simple spirometry its the amount of air left in the lung after normal expiration, this is the sum of residual volume
FVC is the difference between the TLC and RV
in restrictive lung disease there is a decreased maximum flow rate and total volume exhaled in a addition to decreased total lng capacity
chronic bronchitis
productive coughfor 3 mo/ 2 years( cough, dyspnea, cyanosis, cor pulmonale, clubbing, associated with smoking and pollution
Reid index is the ratio of the gland depth to the toal thickness of the bronchial wall and indicates chronic bronchitis (
