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100 Cards in this Set
- Front
- Back
Digitalis
1. Tx for 2. adverse effects 3. toxicity -> 4. what should you do for pt. chronically taking dig? 5. how is it cleared from body 6. causes of toxicity |
1. afib and HF
2. GI stuff (N&V, diarrhea), vision changes, and arrythmias 3. >ed ectopy and >ed vagal tone -> A. tachy + AV block 4. routine monitoring of dig levels 5. renally 6. viral illness, excessive diuretic use (loops -> hypokal -> dig tox) |
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Diastolic dysfnxn:
1. what's wrong? 2. what is the cause 3. Tx 4. other manifestations 4. aka 5. chronically elevated LV pressure can cause what? |
1. impaired filling from poor myocardial relaxation or dimished ventricular compliance
2. HTN 3. diuretics, and antiHTNs 4. chronically elevated LV diastolic pressures -> LA dilation -> Afib 4. CHF w/ preserved or >ed Left EF (ie =/> 60%) 5. LA dilation -> Afib |
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B-type natriuretic peptide
1. what does it Dx 2. what is the value that dxes this? |
1. CHF
2. > 100 pg/mL |
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34 yo angina present w/ active sports and AS
1. what is most likely cause of AS? 2. how does the AS cause the angina? |
1. bc of age, congen. bicuspid aortic valve
2. severe AS -> large LV mass = requires additional O2 -> angina |
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Prinzemetal's angina:
1. aka 2. cause 3. greatest risk factor 4. classic finding 5. ECG findings 6. Tx 7. meds that you shouldn't give 8. other vasospastic disorders assoc.d w/ varient angina 9. most accurate test |
1. variant angina
2. coronary vasospasm 3. smoking 4.pain @ night, wakes pt. 5. transient ST elevations 6. stop smoking + CCBs + nitrates (promote vasodil and prevent vasocnstrxn) 7. nonselective Beta blockers, and ASA bc they can -> vasocnstrxn 8. raynaud's phenom, and migraine headaches 9. ergonovine test |
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*HY*
EKG shows ST elevation in II, III, and aVF: 1. what does this mean? |
1. inferior wall MI <- RCA occlusion
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what would giving lidocaine in ACS (angina or MI) do?
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> risk of asystole
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1.MCC of SBE? (damaged heart)
2. Acute endocarditis (normal heart valves) 3. GU procedures 4. upper Resp procedures 5. coag neg |
1. Viridans group streptococ, enterococci, staph epi
2. S. Aureus 3. enterococci 4. viridans strep. 5. staph epi |
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Afib
1. EKG 2. MCC. other causes 3.Tx |
1. irreg irreg R-R w/ absent P waves and narrow QRS complexes
2. HTN. valv. heart dz, MI, HF, hyperthyr, and ROH (PIRATES) 3. Tx: - unstable = (low BP, altered MS). Immediate cardioversion - Stable: < 48 hours: cardioversion > 48 hours: 3-4 wk rate control and anticoag b4 cardioversion. (Rate control beta blockers or CCB) |
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SVT
1. EKG presentation 2. hemodynamically stable Tx 3. "" unstable TX |
1.tachycard + narrow QRS
2. vagal maneuvers followed by adenosine and AV nodal blockers 3. (dangerously low BP) emergent cardioversion |
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clopidogrel uses:
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1. 2ndary prevention following UA/NSTEMI
2. following PCI - prevents thrombosis |
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meds w/ mortality benefits post MI
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(SSAAB)
1. ASA 2. beta blockers 3. ACE inhibs 4. statins 5.K sparing diuretics (spiro) |
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heat stroke
= clinical appearance systemic effects: |
= >105 F. dehyd, hypOTN, tachycard, tachypnea.
can have systemic effects: seizures, ARDS, DIC, hepatic/renal failure |
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V tach Tx
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- w/ stable BP: amiodarone or lidocaine
- w/ unstable BP: cardioversion |
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what is the most important factor for the survival of pt. who collapses in street and has no pulse?
Leading cause of wtinessed out of hosp. cardiac arrests is? |
Time to defibrillation.
Leading cause of wtinessed out of hosp. cardiac arrests is Vtach, Vfib. |
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how nitrates work in heart
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-> venodilation (ie dilation of CAPACITANCE vessels) -> blood to pool in systemic venous circ. -> <es preload -> <es ventric vol and stretch -> <es myocard O2 demand
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1. risk factors for aortic disxn
2. if HTN present what's the 1st thing you do? 3. when HTN is taken care of or not present? |
1. bicuspid aortic valve, pregnancy, coarctation of aorta, and marfan's syndrome
2. AntiHTN meds b4 dxic studies 3. TEE is initial investigation of choice |
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PEA:
1. what is it? 2. tx 3. important to know 4. potentially treatable causes |
1. discernible rhythm (that isn't vfib or vtach) on cardiac monitor w/ NO palpable pulse
2. CPR and chest compressions, ABCs, and 100% O2, IV access for epi, atropine, and vasopressin 3. NOT A SHOCKABLE RHYTHM! 4. 6 Hs and 5Ts: 6Hs: hypo/hyperkal, hypoxia, H2 (acidosis), hypoglycemia, hypovolemia, hypothermia 5Ts: tablets (drugs), toxins, tamponade (cardiac), tension pneumothorax, thrombosis (MI, PE) |
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atrial flutter
1. pattern 2. cause of pattern 3. classic symptoms 4. Tx |
1. saw-tooth pattern at rate of 300/min
2. RE-ENTRANT RYTHM FROM VARIABLE AV NODE CONDUCTION 3. palpitations, chest pain, sob, lightheaded 4. rate control w/ CCB, beta block; if meds don't work then cardiovert, if still doesn't work then ablate ectopic focus |
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young, healthy person who develops CHF.
1. what is probable cause? |
1. myocarditis from viral infxn, coxsackie B is MCC
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cardiac tamponade:
1. becks' triad 2. pathophys |
1. hypOTN, JVD, muffled heart sounds.
2. pericardial space fills w/ fluid -> ventricles can't expand as much -> decreasing amount of preload |
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aortic stenosis
1. typical symptoms 2. phys exam |
1. exertional dyspnea, syncope, angina
2. systolic ejxn murmur radiating to apex and carotid arteries |
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PVCs:
1. morphology 2. Tx |
1. wide QRS (>120msec)
2. asymptomatic pt. : observation symptomatic pt. : beta blockers |
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-what is a bad prognostic factor in pt.s w/ HF?
-what can help control this? |
- hyponatremia indicates severe HF . also hypo/hyperkal can reflect activity of RAAS.
- <ing H2O intake (not >ing Na intake) |
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Tx of aortic dsxn:
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1) Type A: ascending aorta : Tx = medical (labetolol) + Qx
2) Type B: descending : Tx = labetolol |
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MS
1. MS -> changes in heart? 2. MS is commonly caused by 3. classic auscultative findings 4. ECG findings |
1. MS -> LA dilation -> afib -> thrombus embolizes -> stroke
MS -> >ed LA Press -> >ed pulmonary vascular Press -> hemoptysis 2. rheumatic dz 3. loud S1 and mid diastolic rumbling murmur at apex 4. irreg irreg rhythm and loss of P waves w/ afib |
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*HY*
<ed CO + >ed PCWP : indicative of LV failure = ? |
indicative of LV failure = cardiogenic shock
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*HY*
SEs of thiazide diuretics |
hyperGLUC, hypoNaKal
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MR:
1. type of murmur 2. most common symptoms 3. indication of more severe MR 4. causes |
1. holosystolic murmur heard best @apex with radiation to axilla
2. fatigue and exertional dyspnea 3. dry cough <- pulmonary congestion and edema <- LV dysfnxn 4. rheumatic dz, infective endocarditis, trauma, ischemic heart dz, or HCOM |
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HCOM
1. murmur 2. cause of syncope 3. what is seen on echo? |
1. systolic cresc-decresc on L. sternal border w/o radiation (helps differentiate from AS)
2. LV Hypertrophy 3. asymmetric septal hypertrophy |
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dilated cardiomyopathy
1. cause 2. how do you Dx 3. what will you see on #2 4.Tx |
1. MC coxsackie B (others: parvo B19, HHV 6, adenovirus, enterovirus)
2. echocardio 3. dilated ventricles and diffuse hypokinesia -> systolic dysfnxn = low EF 4. supportive, management of CHF symptoms |
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tx of cocaine-related cardiac ischemia
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benzos + ASA + nitrates (BAN)
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cardiac tamponade
1. signs 2. ECG 3. Tx |
1. hypoTN, tachycard, JVD
2. electrical alternans 3. massive vol resuscitation and emergent pericardiocentesis |
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pt. on bed rest develops a cold leg w/ no distal pulses and mottled in appearance.
what do you do? |
Arterial occlusion:
-LMWH -ECHO to dx thrombus |
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HTNsive pt. b/l upper abdom. masses are palpated.
-what is this? - what is this condition assoc.d w/? -Dx? |
PKD.
also assoc.d w/ hematuria, 2ndary erythrocytosis, and RF. Early Dx w/ abdo US |
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acute mngmt of STEMI
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BMOAN
-reperfusion (thrombolysis or PCA) - antiplatelet therapy -morphine -nitrates (contraindicated in certain circumstances see below*) -beta blockers *AS, recent PDE use, or RV infrxn (30% of inf wall MIs) |
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Presentation and Tx:
1. LV STEMI 2. RV STEMI |
1. hypoTN and PE
BMOAN 2. hypoTN, JVD, clear lungs IV fluid resuscitation to ? RV stroke vol. Nitrates are CONTRAINDICATED |
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acute MI w/ muffled S1 and S2 and presence of S3. basilar crackles that extend 1/2 way up lung fields b/l:
1. what is it? 2. Next step? 3. what do you do after #2 4. what do you do after #3 |
1. flash Pulm edema 2ndary to MI
2. furosemide = DOC 3. anticoag w/ hep 4. emergent PTCA or thrombolysis |
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1. in what 3 scenarios do you do CABG?
2.common complication post CABG |
1. 3 vessels w/ @ least 70% occlusion, Left Main coronary artery occlusion, or 2 vessel dz in pt w/ DM
2.AF. |
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Jervell-Lange-Nielson syndrome
1. what is this 2. tell me about it 3. possible complication 4.Tx. |
-congenital QT syndrome.
-Auto Recess + congenital deaf + QT prolong -QT prolong -> torsades de pointes -> syncopal episode and sudden death 4. propanolol |
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most effective nonpharm intervention to < BP?
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>ed fruit and vegies = DASH diet
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chest pain at night , chronic cough and hoarseness.
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GERD. Tx wih H2 antagonist or PPI
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when do you see JVD
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(4 Cs) CHF, constrictive pericarditis, cardiac tamonade, cor pulmonale
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HTN is defined as
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Normal pt: >140/ 90
DM or renal dz: >130/80 severe HTN: 160/100 = begin tx w/ 2 meds |
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kussmaul's sign
= when do you see it Most accurate test |
rise of JVP on inhalation (from >ed venous return to heart on inhalation)
seen w/ constrictive pericarditis CT or MRI -- look for thickened calcified pericardium |
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pulsus paradoxus
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drop in syst. bp of >10 mmHG w/ inspiration
see it w/ cardiac tamponade, asthma, and emphysema best initial therapy is bolus of fluid |
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when do you do an angio?
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- cardiac stress test is abnormal
- prior to coronary surgery or angioplasty -in ACS like unstable angina (stenosis must be >70% to be significant) |
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stable angina
1. ECG 2. stable angina + HTN Tx - why use this as Tx? |
1. horizontal ST seg depression in stress test
2. beta blocker - will > threshold for anginal episod, control HTN, and is cardioprotective |
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paroxysmal nocturnal dyspnea + long standing HTN + Pulmonary edema (cardiogenic)
1. what kind of HF? 2. what kind of dysfnxn 3. what drug can relieve dyspnea? 4. how does #3 work? 5. what are other mainstays of therapy for decompensated heart failure ? |
1. LVHF
2. diastolic 3. nitroglycerin (NTG) 4, rapidly reduces preload 5. loop diuretics (work by <ing total body volume) |
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Neurocardiogenic syncope (ie vasovagal syncope):
1. common symptoms 2. usually preceded by 3. dx |
1. syncope precede by nausea, diaphoresis, tachycard, and pallor.
2. response to stress (medical needles), pain, or urination 3. tilt table |
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dihydropiridine
1. what are they and examples 2. side effects |
1. CCB. any drug ending in -dipine. ex. nifedipine and amlodipine
2. peripheral edema and don't give if have kidney problems |
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drug that can cause of peripheral edema:
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Dihydropyridines (CCB)
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massive PE
1. PE complicated by ___ &/or _____ 2. symptoms 3. how do you know you have Part 2 of #1 |
1. PE complicated by hypOTN &/or acute Right heart strain.
2. regular PE: dyspnea + pleuritic CP. Massive PE: Syncope 3. indic.s of right heart strain: JVD and RBBB |
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what causes LV dysfunction?
what improves it? |
-tachycardia, neurohumoral activation, absence of atrial "kick" and atrial-ventricular desynchronization
-controlling rate and rhythm |
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Infective endocarditis (IE)
1. major criteria 2. minor criteria 3. how many majors and minors are necessary for DX 4. non-cardiac complications and what causes them? 5. what do you do if kid comes in and probably already experienced prior episode of rheumatic fever? |
1. new murmur; >/= 2 positive blood Cx for org. (S. viridans, S. aureus); endocard involved on echo.
2. predisposing condition (prosthetic valve, IVDrugs); fever, vascular phenom (septic emboli); immuno phenom (glomerulonephritis); or 1 + blood Cx 3. 2 major; 1 major & 3 minor; or 5 minor 4. immune-complex deposition w/in tissues -> JONES (joint, heart,nodules, erythema, syndenham's ) 5. give Abx prophylaxis of penicillin (if kid do it until pt. is 18 yo) |
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Pt. comes in w/ heart attack. Had PMHx of eczema and occasional dyspnea w/ coughing. hospitalized and on day 2 of treatment complains of SOB. PE shows b/l wheezing and prolonged expiration. what caused current resp. symptoms
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Drug SE of metoprolol. PMHx of eczema and dyspnea shows possible asthma.
beta blockers can exacerbate Asthma and COPD |
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1. what is Dxic for malignant HTN
2. what is responsible for pathologic change in end-organ damage in malig HTN |
1. BP >/= 200/140 mmHg + presence of papilledema
2. fibrinoid necrosis |
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best drug Tx for endocard w/ Strep viridans?
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if it is sensitive for pen:
IV pen G or IV ceftriaxone (NEVER TX ENDOCARD W/ ORAL ABX!) |
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Acute Mitral regurg:
1. cause 2. Tx of #1 3. common sequela of MR 4. wht would PCWP show? |
1. papillary muscle dysfnxn in acute MI
2. emergent Qx 3. PE (orthopnea and bibasilar crackles) 4. >ed P in LA |
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Causes of peripheral edema assoc.d w/
>ed cap hydrostatic P |
1. HF (LV or cor pulmonale), primary renal Na retention (renal dz, drugs, pregs), venous obstrxn (cirrhosis, acute PE and venous insuff.)
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Cause of peripheral edema from hypoalbuminemia (<ed oncotic P)
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protein loss (nephrotic synd and GI tract losses)
<ed albumin synth (cirrhosis and manlnutrition) |
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causes of peripheral edema assoc.d w/ >ed capillary permeability
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- burns, trauma, and sepsis
- allergic rxns - ARDS - Malignant ascites |
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Causes of peripheral edema assoc.d w/ lymphatic obstrxn/ <ed oncotic P
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malignant ascites, hypothyroidism
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How to tell btwn MI and gerd from presenting symptoms
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MI will have diaphoresis and SOB, GERD won't
also S4 is a classic finding of MI |
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HTN + ^Ca (stones, bones, psych overtones)
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hyperparathyroidism is an uncommon cause of 2ndary HTN
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How does COPD -> pitting edema?
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COPD (chronic hypoxemia) -> cnstrx of pulmonary arteries -> pulm HTN, RVH, and RVF (cor pulmonale)
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Right heart failure:
1. ECG 2. how to confirm? 3. signs that point to RV failure 4. how does RV fail affect preload? 5. Tx 6. drugs to avoid |
1. ST elevations in inf. leads = inf infarct = RV. and ST depression in leads I and AVL (left most leads) = STEMI affecting R side of heart
2. do a right sided ECG 3. JVD + Kussmaul's sign (>ed JVD w/ insp) + clear lung fields 4. <ed preload -> <ed CO and HYPOTN 5. IV fluids to maintain preload and BP 6. nitrates and diuretics |
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pt w/ hyperthyroid-related afib, what's DOC?
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beta blocker
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3 mechanical complications of MI. when they happen. what you see with each
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1. Papillary muscle rupture : 5 days. -> MR (will hear holosytolic murmur loudest @ apex w/ rad to axilla)
2. LV free wall rupture : day 3-7. Majority are w/ Ant wall MI, Tamponade -> PEA is common of LV free wall rupture 3. interventricular septum rupture : 5 days. -> VSD (new onset holosystolic murmur. no PEA) |
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AAA:
-rad of choice for Dx - " " "" follow up |
Abdo US for both
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MVA pt. driving car w/o seatbelt in (ie blunt chest trauma) w/ JVD, tachycard, and hypoTN despite fluid resusc.
1. DX 2. CXR findings |
1. cardia tamponade
2. normal cardiac silhouette w/o tension pneumothorax |
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End stage renal dz Hemodialysis :
1. absolute indications 2. contraindications |
1. (1) fluid overload not responsive to medical Tx (2) hyperkal not responsive to medical mngt (3) uremic pericarditis (4) refractory metab acidosis
2. severe irreversible dementia |
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1. MCC of 2ndary HTN?
murmur assoc.d w/ it? |
1. Renal artery stenosis,
2. periumbilical |
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1. asymmetrically elevated BP in left arm suggestive of
2. Asymmetrically elevated BP in Right arm or arms>legs |
1.subclavian Artery stenosis
2. coarctation of aorta |
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Dxing PAD in high risk or syptomatic pt.s
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ABI using Doppler
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kussmaul's (K) vs pulsus paradoxus (PP)
1. event 2. mechanism 3. Dz assoc.d w/ |
1. K = JVD w/ inspiration; PP = >ed SBP by > than 10 mmHg on inspiration
2. K = <ed capacitance of RV; PP = <ed capacitance of LV 3. K : constrictive pericard >> cardiac tamp PP : cardiac tamp >> const pericard |
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Outpatient treatment for CHF
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SAAB DL
spironolactone, ACEi, ASA, Beta block, Digox (maybe), loop (furos) |
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Acute Tx of exacerbations of CHF
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LMNOPP
Loop, morphine, nitrate, O2, Pressors (dobutamine) and positioning of legs (legs down and pt sitting up) |
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1. LBBB causes
2. EKG dx of LBBB 3. RBBB causes 4. EKG of RBBB |
1. Acute MI, dilated cardi, AS
2. WiLLiam (of william marrow) V1 W and V6 M (or rabbit ears) 3. relatively benign when compared to LBBB 4. MaRRoW V1 M and V6 W |
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PCI (angioplasty) vs thrombolytics
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door to balloon time = 90 minutes
if > than 90 then use thrombolytics unless contraindication to them |
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absolute contraindications to thrombolytics
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-Nonhemorrhagic stroke w/in the last 6 mo.s
- severe HTN >180/110 - Recent Qx w/in last 2 wks - Major bleeding ex. CNS or GI |
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complications of acute MI:
1- assoc.d with bradyarrhythmia 2- assoc.d w/ tachy |
1- sinus brady or 3rd heart block (cannon a waves)
2. (1) RV infarction (- new inferior wall MI: I, II, AVF and clear lungs; - flip the leads, - Tx: fluid replacement (2) Tamponade/ free wall rupture (3) VTach/ Vfib (4) valve or septal rupture - new onset murmur and pulmonary congestion |
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systolic dysfnx (CHF)
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dilated heart
<ed EF (< 60%) |
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massive pulmonary embolism:
-what will you see? - what are changes in heart chamber pressures? - complication |
PE complicated by hypOTN &/or acute right heart strain.
- Syncope+JVD+RBBB - RA Pressure > 10 (norm = 5), Pulmonary Artery pressure > 40 (norm = 25) - shock (hypoTN & tachycardia) |
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What is most likely cause of 2ndary HTN?: Pt presents w/ agitation, headaches , gained 14 lbs in 3 mo.s, K level of 3.2, glucose of 205.
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Adrenal cortical dz being Cushings in this scenario.
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Dude w/ anterior wall MI one month ago comes in complaining of exertional dyspnea and fatigue. Exam shows pansystolic murmur. EKG shows Q waves and persistent ST segment elevation in anterior leads. Whats the cause?
What symptoms come with this? How do you confirm Dx? |
Ventricular aneurysm:
- symptoms of Vent an: CHF, vent. arrhythmias, mitral regurg and/or thrombus formation. Also persistent ST elevations are also often seen. confirm Dx w/ echo: shows dyskinetic wall motion |
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what drugs do you want to avoid in STEMI?
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dihydropyridine (CCB: nifedipine and amlodipine).
Bc. -> peripheral vasodil and reflex tachycard -> cardiac ischemia |
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32 yo woman, S3, enlarged cardiac silhouette (cardiomeg), b/l pleural effusions (pulm edema), enlarged liver. recent URI.
1. what is the Dx? 2. most likely cause of her symptoms 3. additional cause of Dx 4. complication |
1. myocarditis
2. viral infxn (coxsackie) 3. Drug tox (doxorubicin) 4. CHF |
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how can you clinically determine if edema is cardiac in cause?
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Positive Hepato-jugular reflex indicates that venous pressure is elevated and suggests that heart disease-related edema is present. If reflex is negative if the liver is the cause.
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High-output (= high CO) cardiac failure:
1. causes |
1. Arterio-venous fistula (AVF -> AV shunting -> >ed preload and CO and <ed SVR), thyrotoxicosis, Paget dz, anemia, and thiamine deficiency
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situations that predispose to torsades do pointes
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1. malnourished (ex ROHic)
2. Drugs: moxiflox, fluconazole, TCA, amiodarone 3. familial long QT: jervell -Lange-Nelisen = deaf; Romano ward = not deaf Tx mag sulfate (+ beta blocker for familial long QTs) |
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In tetralogy of fallot why does knee to chest position help?
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When pt. is having a "tet spell" this position increases systemic vascular resistance -> >ed blood flow from the right ventricle to the pulmonary circulation. (morphine and IV fluid bolus can also be given to > pulmonary blood flow)
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Endocarditis Tx:
1. 1st 2. Viridans or HACEK 3. Staph A (sensitive) 4. Fungal 5. S. Epi or S. Aureus (resistant) 6. Enterococci |
1. 1st draw blood then empiric Tx of : Vanc + Gent
2. Ceftriaxone 3. Oxacillin, Nafcillin, or Cefazolin 4. Ampho + valve replacement 5. Vanco + Gent 6. Amp + Gent |
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Pericardial effusions:
1. Causes 2. appearance on CXR 3. when does this become tamponade? |
1. MCC = idiopathic, viral, CA, post MI, uremia, autoimmune, hypothyroid
2. "water bottle" shape 3. when pericardial space can no longer stretch to accommodate the effusion |
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Post MI complication of interventricular wall rupture vs. ventricular free wall rupture:
1. when do they happen 2. what differentiates them |
1. both approx. 5 days post MI
2. interventricular wall -> VSD (new onset holosys murmur) ventri free wall rupture -> pericard tamponade (development of Pulseless Electrical Activity) |
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Post MI complication of recurrent ischemia
1. what will you see bc. of it |
1. ventricular arrythmia (vtach or vfib; not PEA)
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Post MI complic of papillary muscle rupture
1. when does it happen 2. what does it cause? |
1. approx 5 days post MI
2. Mitral regurg (new onset holosys) -> hypOTN |
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Post MI ventricular aneurysm:
1. when 2. what does it present w/ |
1. days to months
2. akinesis of involved LV wall, vent arrhythmias, and systemic embolization |
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peripheral edema causes:
1. non-pitting 2. pitting |
1. lymphatic obstrxn (lymphedema), or >ed interstitial accumulation of albumin and other proteins (ex myxedema assoc.d w/ hypOthyroid)
2. caused by >ed movement of fluid from vascular to interstitial space: - >ed hydrostatic pressure (CHF, portal hyperTN) - <ed plasma oncotic P (low albumin from malnutrition, nephrotic syndrom, cirrhosis) - >ed capillary leak (burns, trauma, or infxn) |
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what can reverse heart failure in alcoholic cardiomyopathy
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abstinence from ROH
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