Texas Internal Medicine 2 Flashcards
How dx and tx Prinzmetal’s angina?
Ergonovine stimulation test
CCB or nitrates
Systolic ejection murmur
Crescendo/decrescendo
Louder with?
+ ?
Aortic Stenosis:
- louder w/ squatting
- softer w/ valsalva
+ parvus et tardus
Systolic ejection murmur
- softer with squatting or handgrip
HOCM
- louder w/ valsalva
Late systolic murmur w/ click
- louder w/ valsalva and handgrip
Mitral valve prolapse
Holosystolic murmur radiating to axilla
w/ LAE
Mitral Regurgitation
Holosystolic murmur w/ late diastolic rumble in kids?
VSD
Wide fixed and split S2
ASD
Rumbling diastolic murmur w/ opening snap
Mitral stenosis
Blowing diastolic murmur w/ widened pulse pressure and eponym parade?
Aortic regurgitation
SOB + history of cancer?
Suspect PE
- or lots of butt sitting!
Tx = heparin
SOB + O2 sats < 90%
Next best step?
Tx = give O2
SOB + s/s of pneumonia
Next best step?
CXR
SOB + murmur or hx CHF
Next best step?
ECHO
How treat acute pulmonary edema?
Nitrates
Furosemide
Morphine
SOB in young pt + s/s CHF
- with prior hx viral infection
Dx?
Myocarditis
- coxsackie B
SOB + young pt + no cardiomegaly on CXR?
Primary pulmonary HTN
CHF
- systolic problem
- diastolic problem
Systolic - decreased EF (<55%)
- ischemia or dilated
Diastolic - normal EF, heart can’t fill
Reasons for Systolic CHF dysfunction?
Ischemia / Dilated
- Viral
- ETOH
- Cocaine
- Chagas
Reasons for Diastolic CHF dysfunction?
HTN
Amyloidosis
Hemachromatosis = restrictive CM
How reverse:
- ETOH dilated CM?
- Hemachromatosis restrictive CM?
Stop the booze
Phlebotomy
5 Drugs to Treat CHF?
ACEi = improve survival (prevent remodeling)
b-blocker (meto/carv) = improve survival (prevent remodeling
Spironolactone = improve survival in NYHA II / IV
Furosemide = only improve sxs
Digoxin = only improve sxs and decrease hospitalizations
What symptoms will furosemide improve in CHF?
SOB
Crackles
Edema
