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291 Cards in this Set
- Front
- Back
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Name the 3 Cardiomypoathies?
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1) Dilated
2) Hypertrophic 3) Restrictive |
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What is the most common cause of Dilated cardiomyopathy?
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Alcohol abuse
May also be idiopathic, infectious, or drugs. |
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Dilated cardiomyopathy has symptoms similar to?
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CHF
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What is Dilated CM?
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Cardiac dilatation leading to right and left systolic dysfunction and then CHF.
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What is the first symptom of Dilated CM?
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Exertional intolerance
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Other S/S or dilated DCM?
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-dyspnea, orthopnea, and edema in lower extremities.
-May have S3, chest pain, and crackles. |
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DX of DCM?
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EXG is diagnostic
Also get Cxt Xray and ECHO |
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What are the ECG finding of DCM?
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nonspecific ST and T wave changes and possible LBBB
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What is the EF with DCM you would most likely see?
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<30% EF
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TX of DCM?
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-Withdraw from alcohol
-TX CHF with diuretics, digoxin and sodium restriction. -ACE and Beta blockers, may need cardiac transplant if really bad. |
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What is the most common cause of sudden death in young athletes?
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Hypertrophic Cardiomyopathy
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What is the death with HCM due to?
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Ventricular arrythmias
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What is the cause of HCM?
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Autosomal dominant gene allele can be seen in most cases.
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What happens on HCM?
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-Hypertrophy of the cardiac septum leads to LV outflow obstuction and impaired diastolic filling.
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And what does impaired diastolic filling lead to?
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Pulmonary congestion
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What is the most common presenting symptom of HCM?
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Dyspnea on exertion
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PE of HCM includes?
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-mitral regurgitation
-possible angina and syncope -S4 -prominent left ventricular impulse |
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How do you dx HCM?
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Echo make the diagnosis
EF > 60% |
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What does EKG reveal with HCM?
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Left Ventricular Hypertrophy
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TX of HCM?
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-B-blockers(Propanalol)
-Ca channel blockers (Verapimil)-improves ventricular compliance. -Diuretics |
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Restrictive Cardiomyopathy?
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-Often caused by an infiltrative process
-Pulmonary congestion -Right sided heart failure |
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What are the signs of Right Sided Heart Failure with RCM?
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Elevated JVD
-may have S4, mitral and tricuspid regurgitation. |
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DX of RCM?
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ECHO is diagnostic
EF 25-50% and thickened LV wall thickness and increased atrial size Specific dx=tissue biopsy |
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Tx of RCM?
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Diuretics to tx CHF
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What is an example of an infiltrative process that can cause RCM?
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-Amyloidosis
-Sarcoidosis -Hemochromatosis |
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Atrial Fibrillation
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What is this?
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What is the most common sustained arrythmia in adults?
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Atrial Fibrillation
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What is the increased risk with A fib that you have to worry about?
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Inta-atrial clot formation, will need long term coagulation like Heparin acutely and Warfarin long- term.
Increased risk of stroke with the micro-emboli |
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What are the EKG finding of A fib?
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-Rapid, irregular-irregular atrial rate >400b/m
-A fib waves may be Coase, fine, and difficult to discern. -Vent rate 100-200 b/m - |
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Tx of A fib?
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1) Rate control(beta blockers, Ca channel blockers, or digoxin
2) Anticoagulation is vital 3) Rhythm control with Amiodarone and possible cardiioversion. |
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What presents with a Sawtooth pattern of P waves?
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Atrial Flutter
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Where do you see the Sawtooth pattern of atrial flutter?
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Leads II, III, and aVF
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What are some to the S/S of atrial flutter?
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-dizziness
-palpatations -cxt pain -dyspnea |
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Treatment of A flutter?
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-Cardioversion
-Beta blockers, calcium channel blockers |
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Esmolol and Metroprolol are examples of?
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Beta blockers
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Verapimil and diltiazem are examples of?
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Calcium channel blockers
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Multifocal atrial tachycardia?
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-Seen in pt's with COPD/severe systemic illness
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EKG findings of MAT?
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-Multiple shaped P waves
-Differing PR intervals |
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What are the agents of choice for TX of MAT?
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Calcium channel blockers
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What is an AV block?
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-defined as when some impulses are delayed or do not reach the ventricle.
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What S/S may be noted with an AV block?
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Syncope
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Definition of a First Degree AV block?
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-PR interval > .02 seconds
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Definition of a second degree AV block?
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-Some P waves fail to produce a QRS.
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Mobitz Type I (Wenckebach)
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-Progressive increase in PR interval, until a P wave is blocked, and the cycle is repeated.
-PR interval after interval is usually the longest |
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Mobitz type II?
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-Sudden block of a P wave with no change in PR interval.
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Third degree block?
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-Occurs when atria and ventricle are controlled by different pacemakers.
-Atria and ventricles are independent of each other. |
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TX of Third degree block?
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-Asymptomatic = no tx needed
-Correct reversible causes -May need atropine or isoproterenol -May need pacing |
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What may develop after an acute MI on EKG?
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Bundle Branch Block
May be seen with CM, pulm embolism, and aortic stenosis |
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What is a BBB due to?
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Conduction delay in the right or left bundle branches
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RBBB
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What is this?
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Qualities of a RBB?
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-Wide QRS >.11 seconds
-rSR in lead V1 -Wide terminal S wave in leads I and V6 -May note ST depression in V1 and elevation in I and V6 |
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-Wide QRS
-Upright and notched QRS in lead I and V6 -Mostly negative QRS in lead V1 -ST elevation in V1 and depression in I and V6 |
LBB?
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WPW?
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-WIde QRS
-A Delta wave is present at the start of the QRS complex -PR interval is short |
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Tx for WPW?
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-tx unerlying cause
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What do you not use in WPW?
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-Digoxin or Calcium Channel blockers, meds which slow down rate rare Contraindicated**
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Paroxysmal Supraventricular Tachycardia?
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-Re-entry Tachycardia
-Elderly with underlying disease -Also called AV nodal re-entry -Palpations/Anxiety |
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What is the Tx of choice for PST?
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-Adenosine (slows rate)
-Vagal man. or anti-anxiety meds too |
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PAC?
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-Underlying rhythm interupted by early beat from atria Other than SA node.
-Tx with antiarrythmic drugs. |
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PVC?
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-Underlying rhythm interupted by an early beat from the ventricles.
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TX PVC?
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-tx underlying cause
-May lead to life threatning Vent arrythmia -May need beta blockers |
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V-Tach?
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-Originates from below bundle of HIS at a rate > 100 b/m
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What can cause V-Tach?
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-electrolyte imbalances
-acid-base abnormalities -Hypoxemia -MI -Drugs |
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S/S of V-tach if unstable?
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-Syncope, cxt-pain, and dyspnea
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What can V-tach cause?
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-Sudden Cardiac Death!
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Torsades De Pointes?
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-Polymorphic VT in which the QRS complexes change in amplitude around the isoelectric axis.
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TX Torsades De Pointes?
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-Antiarrythmic
-cardioversion |
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What can cause V-Tach?
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-electrolyte imbalances
-acid-base abnormalities -Hypoxemia -MI -Drugs |
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S/S of V-tach if unstable?
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-Syncope, cxt-pain, and dyspnea
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What can V-tach cause?
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-Sudden Cardiac Death!
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Torsades De Pointes?
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-Polymorphic VT in which the QRS complexes change in amplitude around the isoelectric axis.
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TX Torsades De Pointes?
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-Antiarrythmic
-cardioversion |
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Amiodarone, Lidocaine, and Procainamide are examples of?
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-Anti-arrhythmics
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Ventricular Fibrillation?
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-Malignant arrhythmia with disorganized elecrical activity leading to failure of cardiac contraction and failure to maintain CO.
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What type of pt's is V Fib seen with?
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Ischemic heart disease
Left ventricular dysfunction |
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V-Fib EKG?
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-Irregular rhythm with and undulating low-amplitude baseline with no organized QRS or T-waves
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Tx for V-fib?
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Electrical Defibrillation!
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V-Fllutter?
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-Very rapid unstable form of VT
-Progresses to V-fib! -electrical defibrillation required |
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Defect in the atrial septum allowing shunting of blood between the atria
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ASD
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What is the most common type of ASD defect?
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-Ostium Secundum defect noted in the mid-portion of the atrial septum
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What can you see on PE for ASD?
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-Slow weight gain history of
-Recurrent lower resp tract infections -Wide split S2 Pt may be asymptomatic |
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What type of murmur is heard with ASD?
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-Systolic Ejection Murmur in the pulmonic area
- Mid Diastolic Rumble in the lower right sternal border |
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What are the murmurs and the rumble of ASD due to?
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-increased flow across the pulmonic and tricuspid valves
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Other findings of ASD?
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Cxt-Xray=Cardiomegaly and increased pulmonary vasularity
EKG= Right ventricular hypertrophy with right ventricular conduction delay |
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Diagnostic for ASD?
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Echocardiogram
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ASD tx?
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-Spont closure in most cases in 1st year of life
-If sypmtomatic close as soon as possible -asymptomatic can close at 2-4 years of age. |
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Murmur for VSD?
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Pansystolic Murmur
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Murmur for TOF?
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Rough, systolic ejection murmur
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Murmur for Aortic Stenosis?
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Sys. ejection murmur at right upper left sternal border and a systolic click at the apex
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Murmur for ASD?
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-Fixed Split S2
-Sys. ejection murmur at left sternal border -Mid-diastolic murmur at the left sternal border, 4th intercostal space |
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Murmur for PDA?
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Continuous Machine-Like murmur
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Cardiac findings for Coar. of Aorta?
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-Decreased femoral pulses
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Cardiac findings for Transp of Great Vessels?
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Vary, depending on position of the VSD
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What is best test to screen for congenital heart disease?
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Echocardiogram
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Turners syndrome
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What syndrome in females is associated with Coarctation of the Aorta?
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Where is the obstruction located with COA?
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in the descending aorta, at the insertion of the ductus arterious.
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Possible Clinical signs with COA?
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-may be present w/or without symptoms
-May have CHF -Upper extremity hypertension -notched ribs maybe |
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What about the pulses with COA?
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absent or weak femoral pulses and delayed when compared to upper extremities.
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Other possible findings of COA?
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-Systolic ejection murmur at apex
-Enlarged aortic knob on cxt x-ray. -Right ventricular hypertrophy on EKG. |
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What is dx of COA?
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-Echocardiogram
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connect aorta and the left pulmonary artery
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what is the function of the ductus arteriosis?
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What type of shunt is associated with a PDA?
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Left to Right shunt
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When does the PDA typically close?
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by 4 days of age
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S/S of PDA?
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-Small defect-no symptoms
-Large defect-CHF, slow growth, recurrent resp infections. -SOB,DOE, Cyanosis |
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What type of murmur with a PDA?
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Bounding pulses and a Machine-Like Murmur
-Murmur starts after S1, peaks at S2, and softens during systole |
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Other findings of PDA?
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Chest X-ray-small PDA-normal
Large PDA-cardiomegaly, left atrial enlargement, and increased pulmonary congestion EKG-left bi- ventricular hypertrophy may be noted with a large PDA. |
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What confirms PDA?
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Echocardiogram
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What is the treatment for closing PDA?
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-Indomethacin (decreases prostoglandin levels)
-May need surgical ligation |
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What is a cause of cyanotic congenital heart disease?
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TOF
Cyanosis due to right to left shunting and decreased pulmonary flow. |
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4 defects of TOF?
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1) VSD
2) Right ventricular outflow obstruction lesion 3) Right ventricular hypertrophy 4) Overriding large ascending aorta |
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Neonates with TOF present cyanosis and agitation, this is a?
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Tet spell
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Murmur with TOF?
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Loud systolic ejection murmur at the left sternal border
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EKG of TOF?
Chest X-ray with TOF? |
EKG-right atrial enlargement
Chest X-ray- normal heart size and decreased pulmonary vascularity |
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Echo of TOF?
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right thick ventricular wall, overriding aorta, and VSD
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Treatment of TOF?
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Surgical tx at about first 3-6 months of life.
-Acute tx-vagal man, O2, vasoconstrictors, B-blockers, morphine, and fluids. |
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Echo of TOF?
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right thick ventricular wall, overriding aorta, and VSD
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Treatment of TOF?
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Surgical tx at about first 3-6 months of life.
-Acute tx-vagal man, O2, vasoconstrictors, B-blockers, morphine, and fluids. |
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What is the most common congenital heart defect?
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VSD
-increased communication between right and left ventricles -increased pulm blood flow that may lead to pulmonary hypertension |
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S/S of VSD?
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-Tachypnea, tachycardia, poor weight gain, trouble feeding, and edema.
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What type of murmur with VSD?
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Holosystolic murmur best heard at middle of left sternal border
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Chest X-ray
EKG with VSD |
Cxt- cardiomegaly and increased pulmonary vascularity in large defects
EKG- left atrial, ventricular, or biventricular hypertrophy. |
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Diagnostic for VSD
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You guessed it, ECHO
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What is the tx for VSD?
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-most close by 10 years old
-large VSD may need surgical repair |
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What can lead to heat failure, CHF?
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-Valvular heart disease
-CAD -arrythmias -hypothyroidism -high cardiac output syndromes -Hypertension! Disease precipitents |
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What is a big cause of cardiac failure with HTN?
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-Medication complaince, they don't take their damn meds!
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Presenting symptoms of CHF?
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-Dyspnea, orthopnea, PND, fatigue, exercise intolerance, and edema
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PE and S/S of CHF
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PE- restless dyspneic pt
S/S-JBD, rales, right upper quadrant tenderness, ascites and peripheral edema |
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Labs?
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-Elevated liver fxn
-Elevated B-natriuretic peptide -Pre-renal azotemia Check CBC and TSH to r/o anemia and tyroid disease as possible causes of failure |
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Chest X-ray with CHF?
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-Cardiomegaly
-Increased pulmonary vasculature -Kerley B lines -Pleural Effusions |
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Kerley B Lines?
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Think CHF
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EKG CHF?
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LVH and possible acute MI
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ECHO of CHF
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-systolic/diastolic dysfunction
-decreased EF |
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TX of CHF
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-DC smoking
-diet control -Low sodium to 1-2 mg daily |
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Pharm tx for CHF?
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-Diuretics
-ACE -Vasodilators -Beta Blockers -Digitalis -O2, Morphine * ASA, NSAIDS, Ca Channel blockers should be avoided |
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Class I heart failure?
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-No cardiac symptoms with ordinary activity
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Class II heart failure?
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-Cardiac symptoms with marked activity but asymptomatic at rest
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Class III heart failure?
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-Cardiac symptoms with mild activity but asymptomatic at rest
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Class IV heart failure?
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-Cardiac symptoms at rest!
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What are some examples of end organ damage with HTN?
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-Left ventricular hypertrophy
-Angina -Heat Failure -Stroke -Chronic Kidney disease -Peripheral artery disease -Retinopathy |
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DX of HTN is based on?
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2 or more elevated BP readings
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What may the EKG with HTN show?
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LVH
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What is normal BP?
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<120/<80
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Prehypertension?
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120-139/80-89
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Stage 1 HTN?
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140-159/90-99
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Stage 2 HTN?
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>160/>100
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TX of HTN?
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1) Lifestyle changes
2) Drugs |
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Lifestyle changes for HTN?
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-Wt loss
-Ltd alcohol -Reg aerobic exercise -DC smoking -Reduce Sodium intake -Reduce sat fats and cholesterol intake |
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Drug therapy with Stage 1 hypertension?
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140-159/90-99
1) Diuretics or Beta blockers other options: 2) ACE, Ca channel blockers, and alpha blockers |
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What is Secondary Hypertension?
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Hypertension due to an identifiable cause
Secondary to a disease process |
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Some examples of Secondary HTN etiologies?
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-RV disease
-Coar of Aorta -Primary Aldosteronism -Cushing's Syndrome -Phenochromocytoma -OSA -Kidney disease |
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Tx of Sedondary HTN due to RV disease?
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-Beta blockers with elevated Renin
-No ACE with bilateral renal artery stenosis -Diuretics with ACE combo -Surgical revascularization |
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What is Malignant HTN?
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-Potentially life-threatening situation
-HTN + retinopathy, CV, or renal compromise or encephalopathy. |
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Etiologies of Malignant HTN?
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-Acute aortic dissection
-Post coronary artery bypass graft -Acute MI -Unstable Angina -Eclampsia -Head Trauma -Severe Burns |
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So Malignant HTN really is?
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HTN with end-organ disease
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Dx of Malignant HTN?
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Elevated BP >220/140
in the presence of headache, blurred vision, N&V, confusion, seizures, hypertensive retinopathy, heart failure, and oliguria |
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TX of Malignant HTN?
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-Gradual decrease in BP by 10% in the first hour of tx and then 15% over the next 3 hour-12 hours, to a target BP of 170/110
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Choice of agents varies with cause:
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-Nitrroprusside
-Propanalol -Oral Clonidine (sedation) |
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What would you use for HTN emergency in a pt with hyupertensive encephalopathy, intracrainial bleeding, and heart failure.
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IV Nitroprusside
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Nitroprusside in combo with what for dissecting aneurysm?
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-Propanalol
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What is Cardiogenic shock?
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Tissue hypoperfusion due to an acute MI or end-stage heart failure
-Poor prognosis -Accounts for most deaths after an acute MI! |
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Etiologies of Cardiogenic shock?
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-Acute MI
-Tachyarrythmia -Valvular heart disease -Traumatic Cardiac injury -Myocarditis |
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What is Hypotension defined as?
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-Systolic BP <90 or a decrease from baseline by >30
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Symptoms of Cardiogenic shock?
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-altered mental status
-cyanosis -oliguria -cool, clammy extremities -Hypoperfusion/hypovolemia -acute MI on EKG may be noted |
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What is helpful with dx of Cardiogenic shock?
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Echocardiogram
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TX of Cardiogenic shock?
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-Adequate oxygenation and treatment of arrythmias very important.
-Improve BP is critical with IV fluids -Vasopressers (Dopamine, Dobutamine) -Intra-aortic baloon pump |
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Orhtostatic/Postural Hypotension?
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-May result in Syncope that could be recurrent
-Defined as a fall in systolic BP of 30 or more or 10 or more in diastolic between laying and upright position. |
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Many etiologies of orthostatic HTN
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-Antipsychotics
-Diuretics -Alpha-Adrenergic blockers -ACE inhibitors -Alcohol -Tranquilizers -Vasodilators -Methyldopa -Polyneuropathies -Parkinson's DZ |
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Clinical manifestations of Orthostatic HTN?
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-change in mental status, cerebral hypoperfusion, weak pulse, cool extremities, reduced urine output, tachypnea, and tachycardia.
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Tx of Orthostatic Htn?
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Tx underlying cause, remove offending medications, and support BP.
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What is Acute MI?
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-Myocardial necrosis brought on by ischemia
-Most deaths occur w/i one hour of onset of symptoms |
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What is most deaths of acute MI caused by?
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-Ventricular fibrillation
Need Rapid Defibrillation!! |
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S/S of Acute MI?
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-Retrosternal pain, heavy, pressure-like, squeezing, or bandlike.
-Pain may radiate to the jaw, neck or left arm -Pain typically is > 20 minutes -Watch for atypical MI presentation in Elderly and Diabetics |
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Associated symptoms of Acute MI?
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-N&V
-Diaphoresis -Dyspnea -Weakness |
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What may you see on PE?
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-Elevated BP and possible S4 and other signs of HF may be present.
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Lab studies for Acute MI?
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-Myoglobin
-CPK -Troponin -Leukocytosis -Lipid profile -C-reactive protein |
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When is Myoglobin detectable?
|
-1-2 hours post MI
-Found in skeletal and cardiac muscle |
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CPK?
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-Total CPK correlates with infarct size
-CPK-MB is specific for cardiac muscle |
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Troponin?
|
Test of choice*****
-Not normally present in blood -Elevated in acute MI -2-6 hours post MI for up to 5-10 days. |
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EKG on Acute MI?
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-ST elevation depending on affected wall
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Inferior MI?
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Leads: II, III, AVF
Artery involved: RCA |
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Lateral MI?
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Leads: I,aVL, V5, V6
Artery involved: Circumflex |
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Anterior MI?
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Leads: V1-V4, I, aVL
Artery involved: LCA |
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Posterior MI?
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Leads: V1,V2
Artery involved: RCA, Circumflex |
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Apical MI?
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Leads: V3-V6
Artery involved: LAD, RCA |
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Anterolateral MI?
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Leads: I, aVL, V4-V6
Artery involved: LAD, Circumflex |
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Anteroseptal?
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V1-V3
LAD |
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What confirms location of injury and coronary vessel involved?
|
Coronary angiography
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Treatment of acute MI?
|
1) MONA + Beta Blockers
2) Thrombolytic therapy (Streptokinase and tPA) 3) Anti-platelet tx(ASA, Plavix) 4) Nitrates 5) B-blockers 6) Ace but not with hypotension 7) Antithrombin tx (Heparin) |
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What do nitrates with MI do?
|
Induce vascular smooth muscle relaxation and reduce cardiac preload and afterload
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What do B-Blockers do with MI?
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-Reduce HR, BP, Myoc contractility, and stabilize the heart electrically.
-Limits Myoc O2 consupmtion |
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What do ACEs do with MI?
|
-Improves remodelling after an acute MI
-Avoid in presence of hypotension |
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What is Stable Angina?
|
-Pain that builds up rapidly in 30 seconds and dissapears w/i 5-15 minutes
-Improved with Nitro -Precipitated with activity and relieved by rest -Related to a fixed stenosis of one or more Coronary atreries |
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Pain with Stable Angina?
|
-Tightness, squeezing, aching or dull discomfort
-Pain is midsternal with radiation to the neck, left shoulder, or left arm |
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What may be heard with Stable Angina?
|
S4 or S3 gallop
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EKG with Stable Angina
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When pain free may reveal arrythmia, prior MI, or LVH
During Pain may have St depression and T wave inversion. |
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DX of Stable Angina?
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-Exercise testing
-Perfusion Scintigraphy -Coronary angiography |
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TX of Stable Angina besides life-style?
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-Lipid managment
-Antiplatelet meds -Beta Blockers -ACE -Nitrates -Calcium channel blockers -Revascularization |
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What is the tx of choice for WPW?
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-Ablation therapy
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Define Unstable Angina
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-Angina at rest*
-New onset angina -increasing angina |
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Unstable angina may be due to?
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Plaque rupture
Nonocclusive thrombus |
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S/S of Unstable angina?
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-dyspnea, palpatations, and fatigue
-pressure, burning, or squeezing pain -may have Nausea, SOB, and diaphoresis -Pain is retrosternal and epigastric |
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What else may you find on PE with unstable angina?
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-S4 gallop, mitral regurg murmur, and rales on lung exam
-May have normal EKG -Normal cardiac labs |
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Tx of Unstable Angina?
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Same as stable
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Prinzmetal's Angina?
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-Pain mostly at rest
-May awaken pt in the morning -Caused by occlusive spasm on a non-severe coronary artery stenosis -May be associated with Raynaud;s phenomenon and Migraine |
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Acute Rheumatic Fever?
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-Inflammatory disease that occurs as a response to an URT infection due to Group A Streptococci
-Proliferative and exudative inflammatory lesions on conn tissue, heart, joints, and SubQ tissue -Peak incidence in 5-15 years of age |
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Jones Criteria for Acute Rheumatic Fever
Major criteria |
JONES
Joints=Polyarthritis O-obvious= Heart (carditis) N=nodule(Rheumatic) (knees, elbows, and wrists) E= Erythema Marginatum S= Syndecham Chorea (rapid, purposlesness, involuntary movements). |
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Jones minor
crITERIA |
Inflammatory cells (Leukocytosis)
Temperature (fever) Esr/CRP elevation Raised PR interval Itself (previous hx of RH Fever-recent strep infection) Arthralgia |
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Tx of Rheum fever
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-Asa
-Steroids Pen G or V or sulfadiazine or Emycin for pen allergy |
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Aortic Aneurism?
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-Pathological dilation of Aorta
*most common is Abdominal AA -Atherosclerosis is major underlying cause |
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Symptoms of AA
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-hypogastric or low back pain
-with rupture pain worsens with drop in BP -Steady gnawing pain -Pulsatile abdominal mass |
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DX of AA?
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Ultrasound for screening
and CT for diagnostic* |
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Older pt with flank pain and new onset hematuria what should you suspect?
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AAA
May be misdiagnosed as renal colic |
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TX of AAA
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Serial imaging and beta blockers to reduce aortic pressure
Imaging every 6 months for AA > 4 cm |
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AA > 5 cm?
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Should be surgically repaired!
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Aortic Dissection?
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Tear in the aorta intima, blood enters the media, cleaving it into 2 layers.
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What pts are at increased risk of Aortic Dissection?
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1) Marfan syndrom
2) 60-80 year olds with history of htn |
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Clinical manisfestations of Aortic Dissection?
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-Severe retrosternal pain described as Tearing, Sharp**
-Elevated BP -Pulse deficits -Enlarged Mediatstinum on X-ray |
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DX of Aortic Dissection?
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CT, aortograph, MRI or transesophageal echocardiogram
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Treatment of Aortic Dissection?
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-BP control with beta blocker, nitroprusside, calcium channel blocker.
-Surgical repair is definitive treatment* |
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S3?
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CHF
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S4?
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MI
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Arterial embolism/Thrombosis
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-Cause of acute arterial insufficiency
-Arterial embolism secondary to many factors (Afib, flutter,mitral stenosis, trasnmural infarct, trauma,hypercoag states, and postarterial procedures). |
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How does emobolism/thrombosis present?
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-acute onset of pain, diminished pulses, cold limbs, and cyanosis.
-Typically unilateral presentation |
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What are the 5 Ps of of embolism?
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1) Pain (constant, worse with any mvmt)
2) Pallor (followed by cyanosis) 3) Pulseless (with cold limb) 4) Parasthesis (periph nerve damage) 5) Paralysis (damage to muscle and motor nerves) |
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Diagnosis of Embolism
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Echo to eval for source of thrombus
Arteriogram to id location |
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Complications of embolsim?
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-Compartment syndrome
-Limb loss |
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TX of embolism?
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-Heparin immedately.
-Embolectomy-thrombectomy |
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Chronic Arterial Occlusion?
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-decrease in 50% of arterial lumen will produce clinical symptoms, ischemia, and necrosis
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Most common cause of chronic arterial occlusion?
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Atherosclerosis
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Most common site of CAO?
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Lower extremities
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Clinical signs of CAO?
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Pain
Calf pain area of occlusion is DISTAl to the site of claudication -decreased peripheral pulses, bruits,ischemic skin changes, and painful ischemic ulcers |
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DX of CAO?
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-Ankle/Brachial Index
>1.0 = normal 0.5-0.9=arterial claudication <0.4 = Severe arterial stenosis**** |
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TX of CAO?
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1) Pentoxifylline
2) Aspirin 3) Ticlopidine 4) Thromboendarterectomy 5) quit smoking 6) Heparin and warfarin no use here |
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Giant Cell Arteritis?
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-A granulomatous vasculitis that affects the temporal artery.
-Pts > 50 -May coexist with Polymyalgia Rheumatica |
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What is the most common symptom of Giant cell arteritis?
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-New onset of headache, located in the temporal region***
-Jaw claudication/visual disturbances -Transient vision loss/blindness |
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PE of GCA?
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-Enlargement, tenderness, and erythema may be noted of the artery
-Bruit may be present |
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Labs of GCA?
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-Elevated ESR
-Anemia -Leukocytosis |
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Dx of GCA?
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Biopsy
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Tx of GCA?
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-Start corticosteroids as soon as possible
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What is the best screening tool for AAA?
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Ultrasound for screening
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Phlebitis/Thrombophlebitis?
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-Inflammatory thrombosis involving the superficial veins of the lower extremity.
-Associated with varicose veins pregnancy, and catheter placement. Septic with IV drug users. |
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TX of Phlebitis?
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-Warm moist compress
-NSAIDS -Abx for staphylococci of septic |
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II, III, AVF?
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Inferior
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V1-V3?
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Anteroseptal
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V2-V4?
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Anterior
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I,aVL, V4,V5,V6?
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Lateral
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V1-V2?
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Posterior
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What is the common cause of Endocarditis in the normal populaton?
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Strep Viridans
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What is the cause of Endocarditis in drug users?
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Staph Aureus
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Cause of Endocarditis with prosthetic valves?
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S. Epidermidis
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A development of clot in the deep veins of the extremities or pelvis is a?
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DVT (Venous thrombosis)
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Risk factors for DVT include?
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-Venous stasis
-Activation of the coagulation system -Vascular damage and many others.... |
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S/S of DVT?
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Pain and swelling at the site and DISTAL from the clot
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Homan's sign?
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Pain with dorsiflexion of the foot, may be positive for DVT
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DX of DVT?
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-Compression ultrasound and venogram are diagnostic
-d-Dimer rules out thormbosis in pts with low proabability for DVT |
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TX of DVT includes?
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-LMWH
-Elastic stockings -Intermitt pneumatic leg compression -Heparin until warfarin levels are therapuetic -Invferior vena cava filter may me needed to prevent PE with pts contraind for anticoag tx. |
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What are Varicose veins?
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Incompetence of the Saphenous vein
-defective valves -often in the medial and anterior thigh, calf, and ankle. |
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PE of Varicose Veins?
TX of? |
-Torturous veins that are easily compressed
-Support stockings -surgical -sclerosing agent |
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Etiology: Rheumatic
Symptoms: Angina, Syncope Cardiac signs: Loud, rough systolic ejection murmur EKG: LVH Chest X-ray: Boot shaped heart |
Aortic Stenosis?
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DX and tx of Aortic Stenosis?
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Dx: Cardiac Cath
TX: Tx CHF if present, No ACE, valve replacement, SBE abx prophalaxis is required |
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Aortic Insufficiency?
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E: Rheumatic
S: DOE, syncope, chest pain, CHF CS: Water hammer pulses, S3, Austin Flint Murmur, LVH |
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DX and TX of AI?
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DX: Cardiac cath confirms wide pulse pressure
TX: SBE antibiotic prophylaxis tx CHF, Surgical valve replacement |
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Mitral Stenosis?
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Etiology: Rheumatic
Symptoms: Dyspnea, orthopnea, angina, hemoptysis Cardiac signs: Diastolic rumble, opening snap EKG: Chest x-ray: Straight left heart border. |
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DX and TX of Mitral Stenosis?
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DX: Echo and cardiac cath, with EKG of left atrial enlargment and A-fib
TX: Tx fib and CHF, SBE proph, valve replacement |
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Mitral insufficiency
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Holosystolic murmur at apex with radiation to the base or left axilla, may have S3
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More common in young females
Crescendo mid to late systolic murmur |
MVP?
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Tricuspid insuff?
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Holosystolic murmur along left sternal border
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Mitral Regurg murmur?
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Holosystolic apical murmur
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Aortic Stenosis Murmur?
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Loud, rough, systolic diamond shaped murmur heard best a the base of heart with radiation to the neck.
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Mitral Stenosis Murmur?
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Soft, low pitched, diastolic rumble head best a the apex in the left decubitus position
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Where do you hear a Austin Flint murmur?
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With Aortic Insufficiency
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Tx for Viridans Strep?
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Pen G or ampicilln plus gentamycin or seftriazone plus gentamycin or Vancomycin
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Acute/Subacute Bacterial Endocarditis (SBE)?
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-Infection of the endothelial surface of the heart
-More common in Elderly people and males |
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Predisposing factors of SBE?
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-MVP
-Deg Vasc disease -IV Drug Use -Prosthetic Valves -Congenital abnormalities |
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Most common community acquired SBE organism?
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Viridans Streptococci
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Nosocomial SBE?
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Stpah epidermidis
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Prosthetic valve SBE?
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S epidermidis
S aureus Enterococci |
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S/S of SBE?
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Fever, fatigue, malais, weight loss, arthritis, and myalgias
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PE or SBE reveals?
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-Petechiae
-Olser's nodes -Janeway's lesions -Splinter Hemorrhages -Roth's spots of fundo exam -Cardiac murmur -Splenomegaly |
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Labs to check for SBE?
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ESR, CBC, Urinalysis(for hematuria)
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What is the name of the criteria for dx of SBE?
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Duke Criteria
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TX of SBE?
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Empiric tx depending on cultures
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GIve abx prophalaxis for these procedures with pts at risk.
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-dental
-tonsilectomy -surgery of resp mucosa -Sclerotherapy of esoph varices -Gallbladder surgery -Cytoscopy |
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Acute Pericarditis?
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Inflammation of the Pericardium
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Clinical Manifestations of Pericarditis?
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-Chest pain taht worsns with deep breathing, cough, or laying down.
--Pain with sitting or leaning forward -Pericardial friction rub -ST elevation -Pericardial effusion on ECHO |
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TX of pericarditis?
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-NSAIDS
-Steroids -Pericardiectomy for restrictive pericarditis |
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Cardiac Tamponade?
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-Accumulation of fluid that results in an increase in pericardial pressure and impairs ventricular filling, us a complication of pericardial effusion.
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What do you see with Cardiac Tamponade?
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-hypotension, bradycardia. DOE
-Distended neck veins, muffled heart sounds, narrow pp, and pulses paradoxus |
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DX and tx of Cardiac Tamponade
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DX: Echo
TX: Pericardiocentesis by echo guidance |
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Pericardial effusion?
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-Porlonged and severe inflammation leads to fluid accumulation around the heart can lead to cardiac tamponade
- May note diminished heart sounds and friction rub |
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What does the heart look like with with pericardial effusion?
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-Enlarged water bottle-shaped heart
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TX of Pericardial effusion?
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Pericardiocentesis confirms and treats
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