Clin Med I Final-Diamond Case Studies

Front 1

Signs and Symptoms of LVH

Back 1

Signs and symptoms of left ventricular hypertrophy depend on the underlying cause. Left ventricular hypertrophy usually develops slowly, so there may be no signs or symptoms for many years or none at all. If signs or symptoms are present, they may include:

Shortness of breath
Chest pain
Irregular heartbeats
Dizziness
Fainting

Front 2

Causes of LVH and possible dx

Back 2

1. in response to increased pressure
-aortic stenosis
-HTN

2. increased volume
-aortic valve regurg
-dilated cardiomyopathy

3. genetic
-hypertrophic cardiomyopathy

Front 3

what are common tx's of LVH?

Back 3

*Diuretics
*BB's
*CCB's

Front 4

what are contraindications of Diuretics?

what are c/i's of BB's

what are c/i's of CCB's

Back 4

Diuretics:
-DM, Dyslipidemai, Gout

BB:
-DM, Dyslipidemia, asthma, 2nd or 3rd degree heart block

CCB's:
-2nd or 3rd degree heart block

Front 5

what are the 5 potential cardiovascular complications of cocaine?

Back 5

1. acute MI from coronary artery spasm
2. aortic dissection
3. tachy and HTN
4. Myocarditis
5. av arrythmia

Front 6

what studes are used to dx complications of cocaine use?

Back 6

Echo: myocarditis and aortic dissection

EKG: tachy and HTN, acute MI, AV arythmia

Front 7

what are therapies of CV effects of cocaine

Back 7

Congestive dilated cardiomyopathy:
-digoxin
-Ace inhibitor
-nitrate
-anticoag if in afib
-antiarrythmic

Front 8

what is the #1 cause of sudden death in kids, teens and young adults?

Back 8

Hypertropohic cardiomyopathy

Front 9

what are bedside maneuvers to dx this?

Back 9

valsalva, straining and amyl nitrate inhalation

valsalva=decreased venous return makes heart smaller which enhances sound

strain increase venous return which cause sound to decrease

amyl nitrate reduces venous return which also will make murmur appear louder

Front 10

what is patho phys of HCM

Back 10

Diastolic HF
*MLAP increased
*Blood backs into lungs=dyspnea

the HYPERTrophy leads to obstruction unlike the obstruction leading to hypertrophy in aortic stenosis

Front 11

what are typical presenting sx and PE for HCM

Back 11

Sx:
-angina pectoris
-dyspnea
-syncope

PE;
-apical lift, heave
-double or triple apical impusle
-ejection murmur intensified with LV smaller (maneuvers)
-S4 gallop
-bisferiens carotid pulse

Front 12

how can you dx this?


what is tx?

Back 12

echo or cardio cath

tx with:
-VERAPAMIL(CCB)
-Bb, diuretic

also some cases cardiac pacing or alcohol injection into myocardium

Front 13

what are patients with paroxysmal and chornic afib at increased risk of?

what therapy should all heart valve dz patienst be on (unless there is a c/i)

Back 13

Stroke


all should be on chronic indefinite warfarin

Front 14

what are five factors that increase risk of stroke?

Back 14

1. HTN
2. HF
3. previous stroke or TIA
4. LV ejection fraction less than 35%
5. dilated left atrium

Front 15

what is a common inducing factor of afib?

Back 15

alcohol

Front 16

what is the #1 tx goal ?

what must be decided after slowing rate?

Back 16

control ventricular rate


decide you want to patient back to sinus rhythm or to leave in afib

*try to determine how long they have been in afib b/c impt in assessing stroke

Front 17

in tx afib you are either controlling this or this?

Back 17

rate or rhythm control

Front 18

when would you choose rhythm control?

when would you choose rate control?

Back 18

in newly dx (young)


in chronic afib

Front 19

what meds control rate in afib

Back 19

Rate control is achieved with medications that work by increasing the degree of block at the level of the AV node, effectively decreasing the number of impulses that conduct down into the ventricles. This can be done with:[3]

Beta blockers (preferably the "cardioselective" beta blockers such as metoprolol, atenolol, bisoprolol)
Cardiac glycosides (i.e. digoxin, XYLACAINE)
Calcium channel blockers (i.e. diltiazem or verapamil)
In addition to these agents, amiodarone has some AV node blocking effects (particularly when administered intravenously), and can be used in individuals when other agents are contraindicated or ineffective (particularly due to hypotension).


perhaps radiofrequency ablation

Front 20

what are rhythm control methods

Back 20

Rhythm control methods include electrical and chemical cardioversion:[3]

Electrical cardioversion involves the restoration of normal heart rhythm through the application of a DC electrical shock.
Chemical cardioversion is performed with drugs, such as amiodarone, dronedarone[28], procainamide, ibutilide, propafenone or flecainide.

Front 21

clinical sx of systolic heart failure

Back 21

first typical sign is weakness

*dilatation of ventricle
*apical displacement
*low CO

Front 22

what are therapies of systolic heart failure

Back 22

(reduce venous return)

*digoxin
*ACE inhibitors
*nitrates
*anticoag if in afib
*antiarrythmic

Front 23

what are adverse effects of:

nitrates and digoxin?
Acei's?

Back 23

digoxin:
-toxicity, ectopic beats, 1st degree AV block

nitrates:
reflex increase in HR

Acei's
-cough

Front 24

what are symptoms of PSVT

Back 24

Symptoms can come on suddenly and may go away without treatment. They can last a few minutes or as long as 1-2 days. The rapid beating of the heart during SVT can make the heart a less effective pump so that the cardiac output is decreased and the blood pressure drops. The following symptoms are typical with a rapid pulse of 140-250 beats per minute:

Palpitations - The sensation of the heart racing, fluttering or pounding strongly in the chest or the carotid arteries
Dizziness, or light-headedness (near-faint), or fainting
Shortness of breath
Anxiety
Chest pain or sensation of tightness
Weakness in legs

Front 25

what is therapy of PSVT

Back 25

try to block AV node

1. valsalva maneuver
2. Adenosine followed up with verapamil, dilitiazem or metropolol


*metropolol recommended for pregnant women

possibly cardiovert if not responding

Front 26

what is clinical presentation of high output heart failure?

Back 26

*quickening heart rate
*active precordium
*widened pulse pressure
*gallop rhytm
*pulmonary rales and peripheral edema

Front 27

what are causes of high output HF?

Back 27

*av fistula
*hyperthyroidism
*beri beri
*paget's dz of bone

Front 28

what are clinical causes of 1st degree AV blocks

Back 28

1st degree block:
-vagal faint during blood drawn
-woman sees a mouse
-meds that slow AV conduction(verapamil, dilitizam, BB's, digoxin)

Front 29

what are clinical causes of mobitz 1 av block (2nd degree)?

Back 29

-heightened vagal tone
-inferior wall infarction
-meds(verap, bb, dilitiazem, digoxin)

Front 30

what are clinical causes of mobitz 2 av block(2nd degree block)

Back 30

-underlying heart dz
-poor prognosis

Front 31

when do you see complete heart block?

Back 31

*can cause fainting
*digoxin toxicity
*sarcoidsosis

Front 32

how do you tx mobitz 2 and complete heart block

Back 32

pacemaker

Front 33

how do you treat preexcitation syndrome?

Back 33

looks like PSVT-use adenosine NOT lidocaine

Front 34

what is sick sinus syndrome?

what is tx?

Back 34

flipping back and forth b/w fast beat (intermitten svt)

*pacemaker and warfarin to prevent stroke

Front 35

what are the three types of pericarditis?

Back 35

1. acute
2. constricive
3. tamponade

Front 36

what is most common cuase of acute pericarditis in USA?

what are causes?

Back 36

neoplasia

causes:
infection
idiopathic,
vasculitis
meds like INH for TB
uremia
MI
radiation, IBD
Sarcoidosis,
invasive procedures

Front 37

what should you think first if a female has acute pericarditis?

Back 37

SLE

will have leukopenia and antinuclear antibody in serum

Front 38

what will an echo show?

what will ekg show/

Back 38

echo may be normal but can show pericardial effusion

EKG shows ST and T wave changes with no change in QRS

Front 39

what are physical signs of acute pericarditis w/MI

how do you tx this?

Back 39

acute onset of chest pain

a pericardial rub often heard

tx with ASA or NSAIDS

Front 40

what is pericarditis in systemic dz?

Back 40

chest pain with radiation into neck

*sharp constant increased by recumbancy, inspiraiton, swallowing and bodymotion

Front 41

when could painless symptoms present in pericarditis?

Back 41

*neoplastic and hypothyroidism

Front 42

what is a pericarditis with tachy, low bp, increased CVP and hard to hear hart sounds?

what what are common causes of this type?

Back 42

bacterial pericarditis

staph and strep

Front 43

whatare complications of pericarditis?

Back 43

1. pericardial effusion that can lead into pericardial tamponade

Front 44

what is pericardial tamponade

Back 44

a lifethreatening emergency with rapid effusion, reduced heart filling and CO

Sx:
-increased CVP,
-tachycardia, tachypnea
-PARADOXICAL PULSE

Front 45

what is a type of pericarditis that commonly causes tamponade?

what type of patient does this occur in?

will these patients have fever?

Back 45

uremic

uremia and stable dialysis patients

afebrile (high bun and creatinine)

Front 46

what is most common cause of constrictive pericarditis?

what are common sx?

Back 46

radiation (7 yrs post)

*elevated CVP
*Kussmauls sign
*paradoxical pusle

tx with pericardectomy

Front 47

what causes idiopathic acute pericarditis?

waht is tx?

Back 47

commonly thought from viral (after URI)

is self limiting but can tx ASA or NSAIDS

Front 48

how can you tell pericarditis from cardiomyopathy?


whati s most common cause of myocarditis?

Back 48

cardiomyopathy (besides HCM) has systolic HR symtpoms

viral infection

Front 49

how can you tell restrictive cardiomyopathy from congestive cardiomyopathy?

Back 49

restrictive has Right HF symptoms and congestive has mental obtundation

*tx congestive with systolic hf tx(acei, bb, nitrates, anticoag)

Front 50

what are common noninfectious causes of cardiomyopathy?

Back 50

*toxins(cobalt, mercury, alcohol, cocaine, doxorubicin)

*metabolic abnormality

*SARCOIDOSIS

*electrolye imbalance

*muscular dz