UWorld Cardio Flashcards
What are the THREE (3) RF/associations for aortic dissection?
- HTN** (most common)
- Marfan syndrome
- cocaine use
What are the clinical features of aortic dissection?
- severe, sharp tearing CP or back pain
- >20mm Hg variation in systolic BP between arms
What are the complications (and involved structures) of aortic dissection [EIGHT-8]?
- stroke–carotid arteries
- acute Myocardial ischemia/infarction–coronary artery
- lower extremity weakness or ischemia–spinal or common iliac arteries
- acute AR–aortic valves
- Horner syndrome–superior cervical sympathetic ganglion
- abdominal pain–mesenteric artery
- pericardial effusion/cardiac tamponade–pericardial cavity
- hemothorax–pleural cavity
a. If a hemodynamically stable pt has an aortic dissection waht is the initial diagnostic study of choice?
b. What will it reveal?
a. CT angiogaphy
b. reveals an intimal flap separating the true and false lumens in the ascending or descending aorta
why drug is contraindicated in patients with suspected aortic dissection and possible hemopericardium?
anti-coagulants
What is the management for pulseless electrical activity (PEA) or asystole?
- uninterrupted cardiopulm resuscitation + vasopressor therapy
- ^^will maintain adequante cerebral and coronary perfusion
What are the reversible causes of asystole/pulseless electrical activity? (5 Hs + 5Ts)
5 Hs:
- Hypo-volemia
- Hypoxia
- H+ ions (acidosis)
- Hypo- or HYPER-kalemia
- Hypothermia
5 Ts
- Tension pneumothorax
- Tamponade, cardiac
- Toxins
- narcotics
- BZ
- Thrombosis (pumonary or coronary)
- Trauma
What are the FIVE [5] components of STAGE 1 HTN-non pharmalogic therapy {+ the recommended plan AND approx DEC in systolic BP}
- weight loss
- reduce BMI <25kg/m2
- 5-20 (per 10kg loss)
- DASH diet
- diet high in fruit, veggies+low sat fat, total fat
- 8-14
- exercise
- 30min/day for 5-6d/w
- 4-9
- dietary sodium
- <3g/d
- 2-8
- alcohol intake
- 2d/d (M); 1d/d (W)
- 2-4
Infective endocarditis in IVDU
- RF: HIV infection
- mc organism: S. aureus
- T (r-sided)>A
- holosystolic murmur increases with inspiration
- A: HF mc
- T: HF rare
- septic PE common
- fewer peripheral IE manifestations (splinter, Jane)
*
Why are single photon emission CT scans usefool tools?
- to evaluate for CAD
- indicates inducible ischemia when a rversable defect is noted on stress and rest images
- Antiplatelet therapy=preferred tx to prevent CAD
STEMI management (seven-pt)
- oxygen for arterial sat <90%
-
nitrates
- caution w/ hypoTN, RV infarction, severe AS
-
ANTI-platelet therapy
- ASA (full dose, chew) + P2y12 receptor blocker (Clopidogrel, Ticagrelor)
-
anticoagulation:
- unfractionated hep, LMWH, or bivalirudin
-
beta blockers
- CI in overt HF
- high r/o cardiogenic shock
- bradycardia
- prompt reperfusion with PCI (per-q coronary intervention)
- ideal first medical contact to PCI =90 min
- Statin therapy ASAP
What is the difference b/w the s/s of an arrythmic cause of syncope and vasovagal or neurocardiogenic causes of syncope?
- arrhythmic:
- usually hv underlying structural heart dz
- may not have prodromal s/s prior
- vv -or- neuro:
- prodrome: nausea, pallor, diaphoresis, generalized sense of warmth prior to episode
Define orthostatic (postural) hypoTN
- drop in systolic BP>20 mmHg or diastolic BP>10mmHg within 2-5min of standing f/m a SUPINE position
- sometimes assoc w/ autonomic dysfunction (neurodegenerative dz)
WPW ECG changes
- short PR interval (<0.12sec)
- delta wave: slurred and broad upstroke of QRS
- QRS widening with ST/T wave changes
WPW pathophys
- d/t an accessory pw (bundle of Kent) that bypasses the AV node and directly connects the atria to the ventricles
- this leads to preexcitation of the ventricles
