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39 Cards in this Set
- Front
- Back
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What is Afib have a high risk of causing?
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stroke
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What do contemporary studies suggest the underlying cause of Afib is?
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rapidly firing foci orginating in one or more of the pulmonary veins
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What common cardiac syndromes enhance changes in atrial tissue refractoriness that support Afib?
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-HNT
-valve disorders -coronary disease -ventricular dysfunction |
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What do atria of most pts with Afib have?
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structural abnormalities ranging from fibrosis to dilation
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What are the underlying pulmonary disease that can cause Afib?
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-PNA
-PE -chronic lung disease -acute respiratory failure |
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What are the clinical manifefstation of AFib?
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-palpitations
-tachycardia -breathlessness |
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What are some complications of Afib?
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-thrombus formation
-stroke -cardiomyopathy -decompensation in those with diastolic heart disease because they are preload dependent |
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How do you diagnose Afib?
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-good hx
-physical exam -irregularly irregular pulse -EKG -Echo |
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What is the general management of Afib?
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-diagnosis and treatment
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What is the acute treatment of Afib?
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-rate control w/cardioversion
-control ventrical ith IV CCB or BB |
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When can you cardivert without antiboagulation?
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onset of Afib is <48hrs
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How long do you usually have to wait to cardiovert an AFib pt?
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3 weeks
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How long after cardioversion do you have to anticoagulate/
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4 weeks
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What is the antiarrhythmic agent of choice in pts with structural heart disease?
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amiodarone
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What strategies are equivalent as long-term therapy for Afib?
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rate and rhythm control
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What is the preferred AV node blocking agents?
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Beta-Blockers (esmolol)
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What pts are at greatest risk for stoke with AFib and should be anticoagulated?
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-hx of HTN
-recent CHF -previous thromboembolism |
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What is one of the msot common causes of aortic rupture?
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aortic dissection
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What is aortic dissection?
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tear of the intima that allows blood to dissect into the vessel wall
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What most commonly causes dissection into the descending aortoa?
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penetrating aortic ulcers aossicated with large uncerated atherosclerotic plaques
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What are some predisposing factors for aortic dissection?
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-HTN
-Marfan's Syndrome -cystic medial necrosis -bicuspid aortic valve -coarctation of the aorta -trauma |
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What are the clinical manifestations of aortic dissection/
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-sudden onset of severe pain located in chest or back between scapulae
-syncope -Horner's syndrome -dysphasia -hoarse voice -acute pulmonary edema |
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How do you diagnose aortic dissection?
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-CXR (wide mediastinum)
-aotic angiography is GOLD STANDARD |
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What patients have a much worse prognosis in aortic dissection?
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those who present with hypotention b/c is usually means rupture of aorta
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What drugs should not be used in pts with aortic dissection?
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vasodilators b/c they can cause tachycardia
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What are the goals of HR and systolic BP in aortic dissection treatment?
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-HR in the 60s
-systolic BP 100-120 |
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WHat are the peroperative complications of arotic dissection?
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-MI
-cardiac tamponade -sepsis -spinal ischemia -renal failure |
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What is the definition of thrombocytopenia?
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platelets < 150,000
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What does bleeding disturbances occur (platelet count)
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<50,000
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WHen platelets reach below_________ spontaneous bleeding can occur?
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<20,000
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What are the 4 main categories of thrombycytopenia?
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-Pseudothrmbocytopenia
-Decreased production -Increased destruction -Altered distribution |
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What is the classed pentad of thrombocytopenia?
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-Thrombocytopenia
-hemolytic anemia -fever -renal failure -change in mental status |
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When does HIT usually occur?
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5-10 after the start of heparin
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What can cause altered distribution of platelets?
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Hypersplenism
splenomegaly |
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What is Bernard Soulier?
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autosomal recessive disease resulting in low platelet count
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What is purpura?
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the confluence of numerous petechiae that results in purplish discoloration
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What labs are done in thrombocytopenia?
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-CBC
-peripheral smear |
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What lab if HIT syndrome is suspected?
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serotinin release assay
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When is bone marrow biopsy indicated in thrombocytopenia?
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-when you can't get a diagnosis with hx, CBC, physical exam, and blood smear
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