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110 Cards in this Set
- Front
- Back
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name 4 types of shock
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hypovolemic, cardiogenic, obstructive, shock secondary to poorly regulated distribution of blood volume
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causes of obstructive shock
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tension pneumothorax, massive pulmonary embolism, cardiac tamponade, obstructive valvular disease
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causes of shock secondary to poorly regulated distribution of blood volume
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sepsis, systemic inflammatory response syndromes, anaphylaxsis, neurogenic
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mortality rate of septic shock
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40-80%
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causes of neurocardiogenic shock
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spinal cord injury, adverse effect from epidural or spinal anesthesia
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signs of shock
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hypotension, tachycardia, orthostatic changes, peripheral hypoperfusion, oliguria, anuria, insulin resistance, metabolic acidosis
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exam findings of end organ hypoperfusion
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cool or mottled extremities and weak or no peripheral pulses
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what labs to order on a pt with shock
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cbc, type & cross, coag parameters, lytes, glucose, UA, pulse ox or ABGs
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In a pt who is in shock, how much urine output should be maintained
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0.5 ml/kg/hr or more
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what is CVP?
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central venous pressure--measures BP in right atrium and vena cava
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causes for elevated CVP
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chf, overhydration
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causes for low CVP
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dehydration, hypovolemia
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definition of postural hypotension
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>20 mmhg drop in SBP from lying to sitting or standing
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causes of postural hypotension if heartrate elevates by more than 15 bpm
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probable depleted blood volume
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causes of postural hypotension if heartrate does not change
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probably secondary to meds or peripheral neuropathy
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exacerbating factors of hypertension
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alcohol, tobacco, lask of exercise, NSAIDs, low potassium intake, polycythemia
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secondary causes of hypertension
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OSA, renal artery stenosis, estrogen use, pheochromocytosis, coarctation of aorta, pseudotumor cerebri, chronic steroid therapy, cushings syndrome, thyroid or parathyroid disease, priamry hyperaldosteronism
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definition of malignant hypertension
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elevated BP with papilledema and either encephalopathy or nephropathy
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complications of untreated hypertension
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CV disease, TIA, CVA, dementia, CKD, Aortic dissection, athersclerotic complications
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blood pressure readings to diagnose essential hypertension
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>140 or >90 on three different occasions
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most common symptom of hypertension
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nonspecific headache
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examples of end organ damage secondary to hypertension
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CHF, CKD, dementia, aortic dissection, retinal hemorrhage, atherosclerosis
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workup for hypertensive patient
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ekg, chest x-ray, H&H, BUN/Creatinine, glucose potassium, uric acid, aldosterone concentration, plasma renin activity, lipid profile
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nonpharmalogic treatment of essential hypertension
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DASH diet, weight loss, exercise, smoking cessation, decrease alcohol, decrease sodium intake
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preferable treatment for hypertension in an african american pt
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calcium channel blocker
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preferable treatment for hypertension in a man with symptomatic prostatic hyperplasia
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alpha adrenergic antagonists
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2 examples of high output CHF
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thyrotoxicosis, severe anemia
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is high output CHF cardiac or noncardiac in nature
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noncardiac
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Symptoms of left sided CHF
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DOE, cough, PND, orthopnea, fatigue, gallops, rales
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Symptoms of right sided CHF
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JVD hepatomegaly nausea edema
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S4 gallop may be heard with this kind of CHF
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diastolic failure
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what lab test can be an important marker for CAD
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c-reactive protein
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Men are 4x more likely to have CAD earlier in life than women but at what age is the ratio of men to women 1:1
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age 70
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Signs of metabolic syndrome
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abdominal obesity, trigs >150, HDL <40 men <50 women, fasting glucose >110, hypertension
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what recreational drug is an important cause of myocardial ischemia or infarction
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cocaine
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definition of angina
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paroxysmal chest "squeezing" or pressure often associated with smothering and fear of impeding death
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what is prinzmetal's angina
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vasospasm at rest
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what is unstable angina
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progressive pain, pain less responsive to meds longer lasting pain, pain at rest
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what is levine's sign
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clenched fist over sternum with clenched teeth
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how long does angina typically last
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less than 3 minutes
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first line therapy for chronic angina
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betablockers
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what do calcium channel blockers do
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decrease cardiac muscle oxygen demand
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3 medicines that reduce possiblibity of MI because of reducing risk of emboli
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aspirin, plavix, ticlid
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what % of pts die prior to arriving to hospital with acute MI and why
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20%, usually secondary to v-fib
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what is the likelihood of an MI besing silent
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1/3
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which pts will present with atypical symptoms when experiencing a MI
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elderly, female, or diabetic pts
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symptoms of dressler's syndrome
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pericarditis, fever, leukocytosis, pericardial or pleural effusion
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when does dressler's syndrome typically occur after a MI
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1-2 weeks post infarct
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where will you see EKG changes if a patient is experiencing a posterior wall MI
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V1-V2
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This test is one of the most sensitive tests to quantify the exent of an infarction
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MRI with gadolinium
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when would you use a calcium channel blocker when treating acute coronary syndrome
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pts that cannot take betablockers or nitrates
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time frame for thrombolytics in acute MI
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3 hrs of onset of pain reduces mortality and limits size of MI, some benefit may occur up to 12 hours
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TIMI scoring system (one point for each of the following)
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>65yo, 3 or more risk factors, known CAD (>50% blockage), >1 episode of rest angina in past 24 hours, ST deviation, elevated cardiac enzymes, (>3 points = high risk)
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2 types of congenital heart anomalies
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cyanotic, acyanotic
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all cyanotic heart anomalies involve this type of shunting
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right to left
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name 4 cyanotic congenital heart anomalies
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tetralogy of fallot, pulmonary atresia hypoplastic left heart syndrom, transposition of great vessels
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name 4 noncyanotic congenital heart anomalies
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asd, vsd, pda, coarctation of aorta
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4 findings in tetralogy of fallot
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subaortic septal defect, right ventricular outflow obstruction, overriding aorta, RVH
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these two findings are present with pulmonary atresia
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atrial septal opening and PDA
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hypoplastic left heart syndrome is what?
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group of defects with a small left ventricle and normally placed great vessels
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out of 4 types of ASD, this is most common
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ostium secundum
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exam findings in coartaction of aorta
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differnce in arterial pulse and BP between upper and lower extremities
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exam findings in PDA
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wide pulse pressure, hyperdynamic apical pulse
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exam findings in ASD
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wide fixed split of S2
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Valve-related progressive heart failure leads to this
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pulmonary HTN and congestion
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Most common presenting symptoms of valvular heart disorders
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dyspnea, fatigue, decreased exercise tolerance
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Aortic insufficency does what to pulse pressure
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widens it
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this is the most common paroxysmal tachycardia
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PSVT
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most common chronic arrhythmia
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a-fib
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what do you call a-fib caused by excessive alcohol or withdrawal from alcohol
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holiday heart
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what pts might you expect to develop a-flutter
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copd, chf, asd, cad
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treatment of choice for pts with chronic a-flutter
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amiodarone
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most common type of cardiomyopathy
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dilated
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common causes of dilated cardiomyopathy
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genetic (25-30%), idiopathic alcohol pastpartum chemo myocarditis endocrinopathies
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Findings in this cardiomyopathy include massive hypertrophy particularly of the septum, small left ventricle, systolic anterior mitral motion, diastolic dysfunction
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hypertrophic obstructive cardiomyopathy
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causes of hypertrophic obstructive cardiomyopathy
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almost exclusively genetic
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risk of sudden cardiac death in hypertrophic obstructive cardiomyopathy
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2-3% per year < age 30
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what is restrictive cardiomyopathy
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fibrosis or infiltration of ventricular wall
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most common cause of restrictive cardiomyopathy
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amyloidosis, other causes include radiation, diabetes, postoperative changes
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symptoms of hypertrophic obstructive cardiomyopathy
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dyspnea & angina, syncope & ventricular arrhythmias are common; may be asymptomatic
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signs of hypertrophic obstructive cardiomyopathy
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sustained PMI or triple apical impulse loud S4, variable systolic murmur bisferans carotid pulse
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signs/symptoms of restrictive cardiomyopathy
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decrease exercise tolerance, pulmonary hypertension
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EKG and Echo findings of hypertrophic cardiomyopathy
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exaggerated septal Q's LVH; asymmetric septal hypertrophy small left ventricly diastolic dysfunction
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what test is key in diagnosing restrictive cardiomyopathy
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echo
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treatment of hypertrophic cardiomyopathy
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beta blocker or calcium channel blocker; surgical or nonsurgical ablation of hypertrophic septum; dual chamber pacing ICD MVR may be indicated
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treatment of restrictive cardiomyopathy
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diuretics and steroids may help
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primary presenting complaint of pericarditis
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pleuritic chest pain relieved by sitting upright and leaning forward
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pathognomonic EKG finding for pericardial effusion
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electrical alternans
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3 most common pathogens in pericarditis
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strep viridans, staph aureus, enterococci
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most common pathogen and location in IV drug users
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staph aureus affecting the tricuspid valve
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most common pathogen in prosthetic valves
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staphylococci, gram negative organisms, and fungi (1st 2 months postop)
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most common procedures that put you at risk of endocarditis
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dental, upper resp, urologic lower GI
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classic features of endocarditis
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splinter hemorrhages, osler nodes, roth spots, janeway lesions, palatal conjunctival or subungal petechiae
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what are osler nodes
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painful, violaceous, raised lesions on the fingers, toes, feet
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what are janeway lesions
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painless red lesions of palms or soles
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what are roth spots
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exudatives lesion in the retina
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duke criteria for endocarditis
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major: 2 + blood cultures of typical causative organism echo evidence new regurgitant murmur; minor: predisposing factor, feve >100.4, vascular phenomena (embolic disease, pulmonary infarct), immunologic phenomena (glomerulonephritis osler nodes roth spots), + blood culture not meeting major criteria; need 2 major, 1 major + 1 minor or 3 minor criteria to diagnose
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when do you use or not use anticoagulants in a pt with endocarditis
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contraindicated in native valves, controversial in prosthetic valves
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what is rheumatic fever
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systemic immune response after beta hemolytic streptococcal pharyngitis
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most common age for rheumatic fever
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5-15 years old
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most common valve to be affected by rheumatic fever
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mitral (75-80%), aortic (25%)
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what are the Jones criteria used to diagnose
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rheumatic fever
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how do you use the Jones criteria to diagnose rheumatic fever
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2 major criteria or 1 major and 2 minor criteria
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What are the major Jones criteria
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carditis, erythema marginatum, subcutaneous nodules, chorea polyarthritis
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what are the minor Jones criteria
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fever, polyarthralgias reversible prolongation of PR interval, rapid erythrocyte sedimentation rate or C-reactive protein
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how do u treat rheumatic fever
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bedrest salicylates for fever/joint pain, IM penicillin for documented strep infection (erythromycin if PCN allergic)
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a patient who has erectile dysfunction secondary to peripheral vascular disease has disease in what artery
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iliac
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how do you treat erectile dysfunction secondary to PVD
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revascularization or sildenafil
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risk factors for varicose veins
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pregnancy, family history, prolonged standing, history of phlebitis
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symptoms of varicose veins
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asymptomatic aching fatigue, chronic distal edema, abnormal pigmentation, fibrosis, atrophy, skin ulceration
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