Test 2 Flashcards
What is infective endocarditis?
an infection of the endocarditis the most inner layer of the heart this includes the valves
What valves does infective endocarditis usually affect?
Aortic and mitral
What are the classifications for endocarditis 3
and two more ways to classify
IV drug use, Fungal, or at site
Acute and subacute
What bacteria are responsible for IE and how do they work
Strep viridans, and staph aureus
make a biofilm that protects them
What are the risk factors for IE 9
Heart damage, marfan syndrome, pacemaker, prostethtic vavles, mitral valve regurg, rheumatic heart disease, dialysis, IV use, age
What are vegetations and what disease are they associated with and one concern
fibrin, leukocytes, platelets, microbes IE can cause embolism
What can IE cause 2. to remember
sepsis and heart block
Manifestations with IE general with 3 things
General dont feel well low grade fever is the biggest
systolic murmur
Subacute form of IE s/s 8
arthalagias and myo back pain ab discomfprt weight loss HA clubing fingers
Vascular manifestations with IE 5
Splinter hem, petechiae, osler nodes-PAINFUL raised legions on hands and feet, janeways roth spots
What to look for in hx for patient with IE and what is the time frame 6
3-6 months
IV stuff, dental work, downstairs procedures, recent cath lab, infections of skin resp or urinary, dialysis
Diagnositics for IE 8
Keep neg cultures for 3 weeks transesoph echo to see veg, EKG for av block, cath for valve function, reg echo. mild leukocytes, erythrocyte sedementaiton and crp increased
criteria for IE diagnosis
2 of the following, positive culture, new or changed murmur, mass or vegetationon echo
tx for IE
antibiotics for 4-6 weeks IV antibiotics
heart compensation people need to prophylactically tx with any incision, infection, uti
What causes acute pericarditis?
Examples for infection-
non infection
autoimmune
infections (limes) noninfection- radition trauma autoimmune- rheumatic fever, rhem arth, systemic lupus, sclerosis
Acute pericarditis s/s 6
severe sharp chest pain- worse when laying down or with inspiration relieved by sitting up and forward pericardial friction rub angina like pain dyspnea fever anxiety
Complications of pericarditis with examples
effusion-couch, tachy hickups
cardiac tamp-confused, anxious, becks (Low art BP, DNV, muffled heart sounds)
Diagnostics for Acute pericarditis 5
WIde spread ST elevation or depression, cardiomegaly, increase crp, esr and leukocytosis
Tx for acute pericarditis
Antibiotics pericardial centesis
Rheumatic fever and rheumatic disease
inflam disease from abnormal immune response to group A strep after about 3 weeks affects skin, joints, cns
chronic scaring and deformity of heart valves vegetations
Manifestations of rhematic fever 7
Erythemia marg, arthritis, carditis, subcut nodules, sydenhams chorea, increase in esr and cpr prolonged PR,
What is the most common thing that rheumatic fever will lead to
mitral valve stenosis or other valve disease
2 things about RF
Antibiotics for 5 yrs maybe life and assess for pulmonary edema and clear lung sounds
patho of MV regurg and major risk
LV thickens, LA enlarges, blood backs up to lungs, makes heart work harder,
cardiogenic shock
S/s of pulmonary edema
Cool, clammy, pink frothy speutum, s3
s/s of mitral valve regurg 6
Thready weak pulse, new holostolic murmur, signs of left vent fail, and peripheral edema, PVC, nitro dosent work
Tx of mitral valve regurg
valve repair
Marfins syndrome risk for
IE and mitral valve prolapse
TX for mitral valve stuff
Beta blockers, keep hydrated, exercise, avoid caffeine or stimulants, if symptomatic-valve surg
Aortic valve stenosis and adults vs kids
Generally found in kids. If found in adults it is due to deterioration or RF ( if associated with mitral valve)
Complications of aortic valve stenosis
dec co, pulm hypertn, heart fail
Symptoms of aortic valve stenosis and one thing to remember
(SAD) Angian, syncope, exertional dyspnea, soft systolic murmur
Dont use nitroglycerin
Aortic Valve regurg caused by
Syphalyis, connective tissue disorder, post surg
Manifestations 1 acute
and 3 others aortic regerg
Sudden vascular colapse
hammer pulse
soft or absent s1
diastolic murmur
TAVR vs TMVR
TAVR- with cath lab and or
TMVR for those who cant have surg and have a long expected life
How do we treat heart fail 3 drugs you really need to know
vasodilators, positive intropes, adrenergic blockers, diuretics, low sodium diet
how do we measure if someone should get a replacement or a repair?
New YOrk assosiation calssification for functional disability
Acid base numbers
Ph 7.35-7.45 Paco2-35-45 Pa02- 80-100 HCO3-22-26 spo2 above 95
s/s of respiratory acidosis 7
skin pale, HA, Hyperk, Dysr, drowsiness, mm weaknees, hyperreflexia
s/s of repiratiory alk 9
tachy, low to normal bp, hypok, numbness and tingling, hyper reflexes, mm cramping, seixures, anxiety, tremmors,
MEtabolic acidosis 8
HA, hyper k, mm twitching, warm flushed skin, NV, decreased mm tone, decreased reflexes, kussumal
Metabolic acidosis s/s 9
confusion, dysr, dizzy, n/v/d/ seixures, tremors, mm cramps, tingling, decreased ca
Cardiogenic shock diastolic vs systolic
d-heart cant fill s-heart cant pump
What is the most common cause of a systolic cardio shock what are the others? 5
MI cardiomyopathy, blunt cardiac injury, systemic or pulmonic HTN =, medibolic problems like diabetes
Patho behind diastolic cardioshock
increase pulm pressure increase edema decrease o2
causes of diastolic cardio shock 6
cardiac tamp, vent hypertrophy, cardiomyopathy, brady or tachy, valve issues tension pneumo
what are the stages of shock give examples in each
initial- no signs lactic acid , compensatory signs, decrease in bp blood shunts , progressive-changes in mental status edema, organs start to fail , refractory organs fail
some risks you did not know about pulmonary emboli2
Oral contraceptives, hormone therapy
s/s of PE 3
Cough, crackles, wheezing, fever,
complications from PE 2
Abcess, pleural effusion,
Best test for PE
CT
What is the movement with fillet chest?
Paradoxical
What is a spontaneous pneumo
Rupture of blebs on surfece of lungs- little air sacs
What is a tension pneumo and one thing about it
air can get in but not out
EMERGENCY
Where does a chest tube go in?
4th or 5th space anterior to midaxil
how is tube secured in chest tube
Heavy no absorbant sutur
What to wrap chest tube in
petrolium gauze and sponge gauze
What is suction on for chest tube?
80
Submurge in how much water for chest tube
250ml
Aortic an measurement for surg
5.5 or bigger
s/s for AA 6
Low back pain, mild heart fail, dyspnea, edema, blue areas, bruit
What is the best diagnostic for AA
CT scan
EVAR proceedure
For AA shorter hospital stay, graft, must have ct rest of life
What is cardiomyopathy 3 types
disease that affects myocardial structure or finction
dilation, hypertrophic, restrictive
Dilatercardiomyop and biomarkers
consistant with heart fail but cath lab rules it out
7 things about cardiomyopathy dilations
follows IE, maybe autoimmune, inflammation and deterioration of mm fibers=vent dilation, blood stasis
causes megaly and contractile dysfunction but no hypertrophy in walls
S/s od dilated cardiomyop
dry cough, palp, ab bloating, abnormal s1 or s4
5 about cardiomyopathy and hypertorpic
LV hypertrophy without dilation, septum inbeteween vents can enlarge and block blood flow
happens in young healthy people
use echo
restirictive cardiomyopathy 3
impairs filling and stretch, stiff walls, can cause pulm issues including effusion
What is something to teach someone with cardiomyop 2
CPR for family members, no drinking
