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19 Cards in this Set
- Front
- Back
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485. With what 3 conditions is PDA associated?
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1. Congenital Rubella syndrome
2. High altitude 3. Premature births. |
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486. Pathophys of PDA?
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a. Large left-to-right shunting results in volume overload, pulmonary HTN, and right-sided heart failure.
b. Cyanosis occurs late! c. May eventually seen reversal of blood flow |
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487. What keeps the Ductus arteriosus patent in fetal life?
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a. Prostaglandins and low oxygen tension
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488. Clinical features of PDA?
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a. May be asymptomatic
b. Signs of heart failure c. Loud P2 (sign of pulmonary HTN) d. LVH: Secondary to left-to-right shunt e. Right ventricular hypertrophy: secondary to pulmonary HTN f. Wide pulse pressure and bounding peripheral pulses. g. Lower extremity clubbing: toes more likely than fingers to be cyanotic (differential cyanosis). |
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489. Murmur of PDA?
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a. Continuous “machinery murmur” at left second intercostal space (both systolic and diastolic components)
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490. Diagnosis of PDA?
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a. CXR:
1. Increased pulmonary vascular markings 2. Dilated pulmonary Artery 3. Enlarged cardiac silhouette 4. Sometimes calcifications of ductus arteriosus. b. Echo: reveals the PDA and/or turbulent blood flow. |
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491. Treatment of PDA?
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a. If pulmonary vascular disease is absent: surgical ligation.
b. If severe pulmonary HTN or right-to-left shunt is present, do not correct PDA. i. Surgery is contraindicated. |
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492. Hypertensive Emergency characteristics?
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a. Systolic >120 and/or diastolic >120 in addition to end-organ damage- immediate treatment is indicated.
b. Elevated BP levels alone w/o end-organ damage-referred to as hypertensive urgency. |
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493. Hypertensive urgency tx?
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a. Rarely require emergency therapy and can be managed w/attempts to lower BP over a period of 24 hours.
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494. What organs are critical to assess for end-organ damage whenever a pt presents w/markedly elevated BP?
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1. Eyes: Papilledema
2. CNS a. Altered mental status or intracranial haemorrhage b. Hypertensive encephalopathy may develop (suspect when BP is markedly elevated: 240/140 or higher, along w/neurologic findings such as confusion. 3. Kidneys: Renal failure or hematuria. 4. Heart: Unstable angina, MI, CHF w/pulmonary oedema, aortic dissection. 5. Lungs: pulmonary oedema 6. Kidneys: renal failure or hematuria. |
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495. Causes of hypertensive emergency?
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a. Non-compliance w/antihypertensive therapy
b. Cushing’s syndrome c. Drugs such as cocaine, LSD, methamphetamines d. Hyperaldosteronism e. Eclampsia f. Vasculitis g. Alcohol withdrawal h. Pheochromocytoma i. Non-compliance w/dialysis |
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496. Clinical features of hypertensive emergency?
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a. Severe HA
b. Visual disturbances c. Altered mentation |
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497. Treatment of hypertensive emergency?
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497. Treatment of hypertensive emergency?
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498. Predisposing factors to Aortic Dissection?
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a. Longstanding systemic HTN (present in 70% of pts)
b. Trauma c. Connective tissue diseases, such as Marfan’s and Ehlers-Danlos syndrome d. Bicuspid aortic valve e. Coarctation of the aorta f. Third trimester of pregnancy |
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499. Daily (Stanford) classification of Aortic Dissection?
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a. Type A (proximal) involves the ascending aorta (includes retrograde extension from descending aorta).
b. Type B (distal) is limited to the descending aorta. |
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500. Clinical features of Aortic dissection?
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a. Severe, tearing/ripping/stabbing pain, either in the anterior or back of the chest (often the interscapular region)
b. Diaphoresis c. Most are hypertensive, but some may be hypotensive. d. Pulse or BP asymmetry between limbs e. Aortic regurgitation (especially proximal dissection) |
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501. How does the presentation of proximal vs. distal Aortic Dissection vary?
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501. How does the presentation of proximal vs. distal Aortic Dissection vary?
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502. What is the best way to determine the extent of the aortic dissection?
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a. Aortic angiography. It is invasive but the best test for determining the dissection of the surgery.
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a. Aortic angiography. It is invasive but the best test for determining the dissection of the surgery.
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a. Initiate medical therapy immediately
i. IV β-blockers to lower heart rate and diminish the force of left ventricular ejection. ii. IV sodium nitroprusside to lower systolic BP below 120 mm Hg. b. For type A dissections- surgical management c. For type B dissections- medical management |
