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116 Cards in this Set
- Front
- Back
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RX Tx for HTN
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ACE and Diuretics
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RX Tx for HTN and stable angina
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BB
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angina
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precordial chest pain usually precipitated by stress/exertion; relieved by rest/nitrates
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RX for HTN and unstable angina
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Asprin and heparin; nitrates; BB
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RX for prinzmetal's angina
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nitrates/CCB
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TX in hypertensive emergencies
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In ER - IV Na nitroprusside(antihypertensive)
[office-oral clonadine(antihypertensive-andrenergic)] |
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Cardinal sign of HF
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1. parasternal lift (thrill/heave)
2. enlarged/displaced PMI 3. S3 gallop 4. diminished 1st heart sound |
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34 female/exercise/acute SOB/palpitations/hemoptysis
ER: CXR:Interstitial edema |
Mitral stenosis
(due to back up in mitral valve)Curly B lines on CXR are interstitial edema |
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DVT
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tenderness/edema/redness of Lower extremity = unilateral
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occlusive arterial atherosclerosis
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pain with ambulation, claudication, femoral bruits, diminished pedal pulses
6P's - pain, pallor, pulseless, parathesia, paralysis, popcicle |
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Mild chronic CHF
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ACE/Diuretics
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CHF w/COPD
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avoid BB (b/c blocking of beta cells can cause acute asthmatic rxn)
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unequal peripheral pulses/intrascapular pain
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Aortic dissection
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SVT primary RX
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BB, CCB
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BB
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slow HR/increase strength of contraction
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Tamponade classic finding
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pulsus paradoxus
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risk factors for PAD
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**DM and hyperlipidema
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coronary syndromes and MI
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BB
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CCBs used:
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acute HTN or if BB contraind.
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SVT RX
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usually adenosine, then CCB, BB, digoxin(not 1st line b/c of length of action and need for watching bld levels)
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Drug of choice for recurrent SVT attacks
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digoxin
p362 |
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CABG most patent artery
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internal mammary (long term patency/flow)
[saphenous/radial] |
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AAA
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abdominal US
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Aortic dissection
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unequal pulses; ripping intrascapular chest pain
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Unstable angina surgery cut off
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75-85% occlusion
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CAD risk factors
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FM, male, hyperlipidemia, DM, HTN, physical inactivity, obesity, cigarette smoking
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TOD
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Brain/Heart
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Tamponade classic findings
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***pulsus paradoxus, JVD, tachycardia
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Tamponade side of heart involved
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RV bulges into LV
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Beck's triad
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assoc w/tamponade: muffled heart sounds, JVD, hypotension
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Mgt of Tamponade
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drain fluid
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best diag test for tamponade
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echocardiogram
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avoid what RX in CHF (esp w/L sided failure)
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BB
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CHF causes
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ischemic heart dz, HTN, aortic/mitral valve dz, nonischemic (infection, alcoholic, toxic, postpardum, infiltrative, idiopathic), arrythmias
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at risk for failure but w/o structural heart dz
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Stage A
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structural dz w/o Sx of HF
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Stage B
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structural dz w/Sx of HF
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Stage C
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refractory HF w/special interventions (sx at rest)
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Stage D
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normal HTN
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119/79
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preHTN
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120-139 / 80-89
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Stage I HTN
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140-159 / 90-99
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Stage II HTN
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>160 / >100
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DM / HTN
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initial ACE/ARB
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Aortic insuff
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pul. edema (LV failure)
PF: wide arterial pulse press, lg SV |
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Mitral insuff
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lg LA
Clin Char: pansystolic to axilla; LV impluse; carotid upstroke; 3rd heat sound |
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Marfan's acute Tx RX
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BB
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3 systems involved in marfan's
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ocular, skel, cardio
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MI heart sounds
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S4 gallop (atrial)
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enzyme test for MI
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CK -
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PSVT Tx RX
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1st choice - digoxin
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SVT Tx
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Procedure: radiofrequency ablation
Rx: long term: verapamil, digoxin, BB Avoid:BB, CCB, digoxin with Afib |
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Afib RX
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asprin (with no stroke RF);
w/CHF, LV dysfunc, obstructive valve dz, DM, HTN, >75- warfarin |
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V tach RX
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lidocain bolus (w/unstable)
Chronic: ICD (defib) |
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MVP Tx
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surgury
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Test for new onset murmur
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echo
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Raynauds
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vasospastic disorder
pallor(white)-cyanosis(blue)-rubor(red)-cold-migraine |
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Pericarditis
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water bottle chest on CXR
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Pericarditis Gold star test
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echo
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Tamponade Tx
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pericariectomy
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Cor pulmonale
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RVH - failure due to pul.dz/hyposia/PVD
Common cause: COPD |
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Corpulmonale Sx
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productive cough, DOE, wheezing, fatigue, weakness
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Corpulmonale signs
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cyanosis, clubbing, distended neck veins, RV heave/gallop, lower sternal/epigastric pulsations, large/tender liver, edema
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Rheumatic fever Dx
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jones criteria
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Major jones criteria
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Carditis, erythema margenatum/subcut. nodules, chorea, arthritis
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Rheumatic fever Tx
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bed rest; salicylates, penicillin, corticosteroids
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aortic stenosis
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splitting of S2; 2nd rt ICS/apex/carotids; midsystolic murmur; harsh/rough
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mitral stenosis
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after S2(middiastolic snap)LSB/apex; Afib is common; low pitch(bell); rumbling
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mitral stenosis found with___
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interstitial edema
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acidotic ABG
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<7.35
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alkalinic ABG
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>7.45
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Metabolic
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direct rel btwn pH and HCO3
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Respiratory
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indirect rel btwn pH and PCO2
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Metabolic acidosis cause
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starvation, excessive diarhhea, ketoacidosis
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Metabolic Acidosis S/Sx
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Kussmaul's respiration - severe, deep, reg, sighing respiration
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Metabolic Alkalosis cause
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vomiting/nasogastric suctioning, excessive antiacid, prim aldosteronism, diuretic therapy
No char s/sx; orthostatic htn |
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Metabolic Alkalosis Tx
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correcting fluid imbalance - replace fluid w/NaCL/KCL
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Respiratory acidosis (hypercapnia)
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COPD b/c CO2 build up; acute: confusion, somnolence, asterixis, myoclonis inc intracranial press (papilledema)
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Resp. Alkalosis cause
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**hyperventilation, interstitial lung dz, pneumonia, pul embolism, pul edema
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Resp Alkalosis S/Sx
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light-headed, anxiety, paresthesias, numb mouth, tetany
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Resp Alkalosis Tx in acute hyperventilation
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paper bag to inc pCO2
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mild intermittent asthma
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<2x/wk; asymp; normal PEF b/w exacerbations
NO daily meds quick relief: short acting bronchodilator(beta2antagonist) |
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mild persistant
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>2/wk <1/day; may affect activity
Rx: 1daily anti-inflammatory(inhaled corticosteroid low dose) quick relief: short act.broncodilator |
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moderate persistant
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daily Sx; affect activity; >2/wk
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moderate persistant RX
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Rx daily: anti-inflam(med dose) OR
inhaled cortico.(low/med) AND long acting brochodil (b2 agonist/theophylline) |
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Severe persistant
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continual Sx; limited activity; frequent exacerbations
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Severe persistant Rx
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daily antiinflam(inhaled cort high dose)ANDlong acting bronchodilator AND corticsteroid tablets/syrup
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during exacerbations best med
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short acting inhaled Beta adrenergic agonist (albuterol, bitolterol, pirbuterol, terbutaline)
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if pt does not respond to B agonist
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glucocorticoids systemically
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To control COPD Sx
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bronchodilators
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mild COPD
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short acting brochodilator prn
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moderate COPD
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reg tx w/bronchodilator, inhaled glucocorticoid, pul rehab, long term O2, surgury
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O2 decreases mortality
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1.pO2 <55 or satO2is <89 OR
2.pO2<60 w/sighns or corpulmonale or secodary polythemia or max med therapy or less dyspnic and can inc activity with 2nd therapy |
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exacerbation tx
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inc dose/freq of bronchodil; combine classes of drugs, use nebulizers, change route of admin, abx (vol reduction surgery - 15%pts)
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pink puffer
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emphysema; dyspnea; no cough, little mucus; THIN; use accessory muscles; NO adventitious breath sounds; NO peripheral edema
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Blue Bloater
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bronchitis, chronic cough, productve mocopurulent sputum; mild dyspnea, OVERWEIGHT; cyanotic, comfortable at rest; PERIPHERAL EDEMA; noisy chest; wheezes
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PFT
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pulmonary function test
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FEV1
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amt of air expired in one second during forceful excertion
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Vital Capacity
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tot amt of gas exhaled following maximal inhalation
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Restriction
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reduction in lung vol w/inc. FEV1/FVC ratio; reduced FVC=pul restriction
Causes: dec lung compliance (pul fibrosis), reduced mus strenghth, diaphragm dysfunc, neuromus dz, pleural dz |
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Forced Vital capacity
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tot expired during FEV test
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Obstruction
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ratio decrease; caused by asthma, COPD, bronchiectasis, bronchiolitis, upper airway obstruction
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Sarcoidosis
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systemic - granulomatous inflammation (dx with transbronchial lung biopsy)
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Pul embolism
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dyspnea, chest pain, tachypnea
study of ch: perfusion lung scan pulmonary arteriograph/angiography **gold std |
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pul. HTN
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SYNCOPE, dyspnea, fatigue, chest pain
Dx test: ECG (RVH); CT-pruning of lg pul art |
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pul effusion
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CXR: fluid
CT: fluid thoracentesis to evaluate fluid |
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transudate
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watery
3 causes: HF, nephrosis/nephrotic synd, cirrhosis |
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exudate
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less watery / many pr-
all other causes |
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pleuritis tx
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underlying cause (analgesic/antiinflam) codeine to control cough
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Pleuritis dx test
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CXR/US
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nosocomail pneumon
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polymicrobial gram neg, pseudomonas aeruginosa, s. aureus
MORE GRAM NEG |
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commum aquired pneumon
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strep p, hemophilius influenaza
MORE GRAM POS DX: CXR (GOLD) |
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nosocom tx
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broad spec abx: cephalosporin, quinalone, vancomycin
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comm aquired tx
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macrolides: erythromycin, azithromycin, or doxycylin if high macrolide resistance
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TB s/sx
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fatigue, wt loss, fever, night sweats, cough
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TB tests
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CXR- infiltrates at apices of lungs
PPD |
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PPD pos
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>5=HIV, TB pts, organ transplant, immunosupressed
>10=immigrants, Inject users, myobact lab personel, res/employees in high risk >15 persons with no TB risk |
