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31 Cards in this Set
- Front
- Back
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syncope vs seizure?
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- pt is drowsy s/p event or other post-ictal signs
- seizure can be triggered by decreased eating or stress - do CBC, CMP, drug panel, EEG, MRI |
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premature atrial contractions
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- no tx if asymptomatic but advice to decrease risk facotrs: EtOH, smoking, stress
- can lead to sVT |
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aflutter
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- saw tooth edges
- 2/2 REENTRANT rhythm often at 300bpm - AV node blocks conduction to < 180, so usually see 2:1 (ventricular contraction after 2 atrial contractions) or 3:1 or 4:1 - if see variations or greater that 4:1 then know that there is an ABNORMAL AV NODAL CONDUCTION |
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atrial ectopy
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- morphologically distinct P waves => may not conduct to V
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aortic dissection with left sided weakness?
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- dissection extended to carotid
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S3?
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- heard in CHF
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BNP
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- released from cardiac ventricles 2/2 increased volume
- >100 = CHF with good sensitivity and specificity - similar to ANP (released by atria) |
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midsystolic click
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- mitral prolapse, e.g. seen in Marfan
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pt with pericarditis?
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- look at BUN, if >60 then dialysis tx b/c uremic pericarditis is hemorrhagic
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sympathomimetic toxicity
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- hyperthermia, HTN, mydriasis
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pt with hx of afib now with decreaed EJ?
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- tx: controlling rhythm and rate! > changing preload, afterload, inotrope
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which affects HTN more, EtOH or smoking?
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-EtOH
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electrical alternans?
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- pericardial effusion => pericardiocentesis
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pathologic changes in HTN to cause end-organ damage?
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- fibrinoid necrosis
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mechanical complications of MI
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- papillary muscle rupture => mitral regurge (radiates to axilla)
- LV free wall rupture => pericardial tamponade, insta-death - interventricular septum rupture: LSB, thrill, pansystolic |
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abdominal bruit
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- systolic and diastolic bruit = renal artery stenosis
- systolic only = AAA |
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diastolic dysfunction
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- heart failure with preserved LVEF
- 2/2 impaired filling of LV or impaired myocardial relaxation or stiff non compliant ventricle - EF may be normal but decreased CO - etiology: HTN - note: increased LV diastolic pressure => LA dilation => a fib |
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high output heart failure
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- increase in ventricular fx that still can't meet body's metabolic needs
- e.g. anemia, hyperTH, berberi, AV fistula, paget's |
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tx afib
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- stroke prevention by anticoag and rate control with AV nodal blocking = dilt, metoprolol, digoxin
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tx of acute limb ischemia
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- IV heparin immediately => angio => surgical embolectomy or intra-ARTERIAL fibrinolysis/mechanical embolectomy
- DON'T BE TRICKED BY IV FIBRINOLYSIS (must be arterial not venous) |
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RAA system
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- renin cleaves angiotensinogen to Angiotensin I
- ACE converts angiotensin I to angiotensin II - AII vasoconstricts, increases ADH (Vasopressin) and increases aldo |
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aldo
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- works on distal tubule
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sustained handgrip
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- ddx aortic stenosis and mitral regurg
- increased systemic vascular resistance => increased afterload => increased ventricular volume (=> decreases outflow obstruction in HCOM) |
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tx cocaine induced MI
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- PTCA, thrombolysis, ASA, nitrates, but no BB b/c increased vasospasm
- give CCB to decrease vasospams |
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amiodarone tox, verapamil, digoxin?
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- LFTs, TFTs, PFTs
- V: constipation, dizziness, flushing - D: N/V, diarrhea, blurry yellow vision, arrhythmia |
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Aortic dissection
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- HTN = IV labetalol
- if type A (Ascending) = surgery - type B (descending) = medical therapy |
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constrictive pericarditis
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- hepatomegaly, ascites, increased JVP
- 2/2 decreased diastolic filling pressure - hx radiation therapy, viral pericarditis, heart surgery |
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mitral steonsis cardiac sound
- tricuspid stenosis? |
- loud S1, mild diastolic rumbling murmur at apex => left atrial dilation => a fib
- sx of SOB TRICUSPID: LLSB, sx of right heart failure (peripheral edema, hepatomegaly, JVD) - seen in rheumatic fever |
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RF for AAA?
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- smoking >HTN> EtOH
- surgery cutoff is 5cm |
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cardiac enzymes s/p MI?
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- troponin takes 10d to decrease, CKMB takes 1-2
- so if pt with re-occlusion, then check CKMB |
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heart exam on aortic dissection?
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- diastolic murmur = regurg
- do TEE, control HTN |
