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84 Cards in this Set
- Front
- Back
sx of dilated cardiomyopathy
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CHF, angina
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complications of dilated cardiomyopathy
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CHF, dysrhythmias, thrombus
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causes of dilated cardiomyopathy
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- infections
- toxic (alcohol, heavy metals) - endocrine (thyroid, pheo) - metabolic (thiamine ==> wet beriberi, hypo ca and phos) |
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tx for CHF
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- ACE inhibitor, diuretics
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first line treatment for afib? second line?
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CCB
- BB is second line - long term: if >60y.o., add warfarin |
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finding of a fib?
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- irregularly irregular rate
- ECG: irregular p waves, variable R-R interval - Echo: clot in L. atrium |
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when to cardiovert in a fib?
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- if unstable, after rate control
- note: preferred over pharm cardioversion |
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Types of endocarditis?
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acute and subacte
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cause of acute endocarditis?
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s. aureus on healthy valves
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causes of subacute endocarditis?
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previously damaged valves
- strep viridians, GAS, streptococci, enterococci, candida IV drug users - staph aureus, GAS, enterococci prosthetic valves - s. aureus, viridians |
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tx for strep?
- staph? - MRSA? |
PCN G
- naficillin, oxacillin - Vanco |
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def and dx pulsus paradoxus
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- decrease in systolic BP with inspiration
caridac tamponade |
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aortic stenosis hx?
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sycope with exertion
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What are the sx of hypertrophic cardiomyopathy?
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- angina at rest and exercise, unresponsive to nitro
- syncope after exercise |
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describe the mumur with hypertrophic cardiomyopathy?
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- systolic ejection murmur, LSB
- decreases with squatting (increased LV blood volume), increases with higher blood velocities - paraoxical splitting of S2 (A2 occurs after P2 ==> split during exhalation instead of inhalation) |
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paradoxical splitting of S2 suggests what?
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hypertrophic cardiomyopathy
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What drugs to give in hypertrophic cardiomyopathy? What drugs to avoid in hypertrophic cardiomyatophy
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first line: beta blockers ==> decrease heart rate ==> increases filling time
second line: CCB avoid anything that decreases preload: nitrates, diuretics, volume depletion |
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which genetic dz are associated with aortic dissection?
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Marfan's, ehler's danlos, turner's
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which drug is associated with aortic dissection?
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cocaine
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which murmur may be heard with aortic dissection?
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aortic regurgitation
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CXR of aortic dissection?
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widened mediastinum
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tx for aortic dissection
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BP control!
- BB esp esmolol (short acting IV) or propranolol, nitroprusside to keep sBP < 120 |
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chest pain relieved by sitting up and leaning forward indicates?
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pericarditis
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diffuse ST segment elevation and ST depression in aVR indicates
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pericarditis
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ECG of pericarditis?
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diffuse ST segment elevation and ST depression in aVR indicates
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autoimmune dz associated with pericarditis?
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SLE, scleroderma i.e. collagen vascular dz
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what is dressler's syndrome?
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- sx of fever, pericarditis,
- occurs 1 wk-1 mo after MI - immunologic - give NSAIDs and steroids |
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tx for pericarditis?
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NSAIDs for pain and inflammation
- steroids if really bad |
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Causes of MR?
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acute: endocarditis, papillary rupture from MI
chronic: rheumatic fever, LV dilation, mitral prolapse |
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cause of rheumatic fever
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GAS
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complications of rheumatic fever?
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mitral stenosis and a fib
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which Ab titer is found in rheumatic fever?
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antistreptolysin-O
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what is beck's triad
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hypotension, elevated JVD, muffled heart sounds = PERICARDIAL TAMPONADE
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what is electrical alternans?
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- ECG finding for pericardial tamponade
- alternating beat variation from pendular swing of heart in fluid creating motion artifact |
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ECG finding for pericardial tamponade?
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electrical alternans
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diagnostic test for pericardial tamponade?
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MUST DO ECHO
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diastolic dysfx etiology?
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HTN
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pathophys of diastolic dysfx?
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- impaired ventricular filling due to poor myocardial relaxation or decreased ventricular compliance
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tx for viridians endocarditis?
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IV PCN G or IV cetriaxone
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what assessment do you have to make for vtach tx?
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- hemodynamically stable: alert, AAOx3, normal K, normal BP
- unstable |
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tx for heme stable vtach?
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IV amiodarone, procainamide, sotalol, lidocaine, bretrylium
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tx for heme unstable vtach?
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electrical cardioversion
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rate for Vtach?
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100-250
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wide QRS complex versus narrow?
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wide = v tach
narrow = SVT |
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carotid massage is used for what?
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resolve SVT
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causes of vtach/vifb
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torsades de pointes, WPW w/ afib and rapid ventricular rate
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def of bradycardia
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< 60 bpm
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adenosine vs atropine
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adenosine: purine nucleoside ==> inhibits SA node pacemaker current ==> good for tx of AV block in SVT
atropine: muscarinic receptor antagonist ==> inhibits vagal activation of heart ==> good for tx of bradycardia |
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tx of bradycardia
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atropine
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tx of SVT
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adenosine
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drugs that cause bradycardia?
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digioxin, CCB, BB
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first line tx for PSVT prevention
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digoxin!
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tx for recurrent or sympt PSVT
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radiofrequency catheter ablation
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two different pathophys for PSVT
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- AV nodal reentrant: 2 pathways in AV node ==> reentry occurs in AV node
- orthodromic AV reentrant: accessory pathway between atria and ventricles that conducts retrogradely |
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digoxin toxicity
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paroxysmal atrial tachycardia and 2:1 heart block
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first degree heart block
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increased PR interval
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2nd degree mobitz 1
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aka wenchebach
- progressive PR prolongation until beat is dropped |
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2nd degree mobitz 2
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finxed prolonged PR interval followed by dropped beat at regular interval
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3rd degree block
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independent atria and ventricles
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tx for heart blocks
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1st- none
2nd type 1 - atropine, temporary pacing 2nd type 2 - PACEMAKER, can degenerate into complete heart block 3rd - PACEMAKER - temporary pacing before pacemaker: atropine, temporary pacing |
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ddx aortic stenosis vs regurg sx
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stenosis- pulsus parvus et tardus -- quet and slow
regurg: water hammer pulse worse with lying down and lying of left side (heart closer to wall) |
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aortic regurg etiology
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- aortic root dilation (marfan)
- rheumatic heart disease, endocarditis - bicuspic aortic valve - 3rd trimester pregnancy |
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3rd trimester pregnancy is associated with which heart mumur?
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aortic regurg
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collagen vascualr dz, marfan, erhlos, is associated with which valve problems?
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aortic dissection, aortic regurg, mitral valve prolapse
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demusser's sign
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bobbing of head with heart beat seen with aortic regurg
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hill's sign
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systolic pressure in legs >20 mmHg higher than in arms
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sx of wide pulse pressure?
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water hammer pulse
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sx of aortic regurg
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dyspnea, orthopnea, PND, angina, water hammer pulse, demusser's sign, quincke's sign, hill's sign
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quincke's sign
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alternating blushing and blanching of fingernails w/ gentle pressure in aortic regurg
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periumbilical diastolic - systolic bruit
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renal artery stenosis
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renal artery stenosis auscultation
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periumbilical diastolic-systolic brui
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findings in cardiogenic shock
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decreased CO, increased pulmonary wedge capillary pressure which reflects L. ventricular function and thus suggests LV failure
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findings in volume overload
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normal or increased CO and increased pulmonary wedge capillary pressure
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what indicates severe heart failure?
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hyponatremia b/c it's a sign of high neurohumoral activation ==> renin angiotensin, vasopressin, norepinephrine, etc
- indicates increased mortality |
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characteristics of PVCs
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- widened QRS, compensatory pause, weird morphology
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tx for PVCs
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- asympt: observe, antiarrhyth increases mortality
- sympt: beta blocker |
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what decreases murmur of mitral prolapse?
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squatting
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sx of mitral prolapse?
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atypical pain
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tx for mitral prolapse?
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endocarditis prophylaxis
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who usually has mitral prolapse?
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90% women
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BP of cardiac tamponade?
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HYPOTENSIVE
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what new heart sound can be heard with MI?
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new S4
- ischemia ==> diastolic dysfx ==> stiffened LV ==> atrial dysfx |
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what is amlodipine?
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CCB, used for BP control
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which has a greater affect on BP, alcohol or smoking?
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alcohol
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