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43 Cards in this Set
- Front
- Back
- 3rd side (hint)
Septic Shock
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Infection / Hypotension / Tachycardia / Tachypnea
Decreased sats Increased capillary permeability Pulmonary a. cath shows? |
CO variable; PAWP: High/normal
SVR: low (<900dynes/cm2) |
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Cardiogenic Shock
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Hx of MI, CAD, HLD
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Low CO
High PAWP (RAP) High SVR (compensates for dec CO) |
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Hypovolemic shocck
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Decreased circulating blood
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Low CO
Low PAWP (unique) High SVR |
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Extracardiac obstructive shock
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tamponade, tension pneumo, massive PE
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Low CO
Normal/high PAWP High SVR |
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Vascular surgery risks
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MI (esp if DM, HTN, prior MI)
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Vascular Claudication - management?
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Measure ankle/brachial index. If < 1.0, peripheral artery disease is present.
1. Exercise/Diet modification 2. Cilostazol - phosphodiesterase inhibitor 3. Vascular surgeon consult 4. Percutaneous transluminal angioplasty if surgery is not option. |
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Pericardial Tamponad
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SUSPECT!
Beck's Triad: Hypotension, Faint heart Sounds, JVD - May occur late, post MI |
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Blood reactions
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Acute febrile hemolysis - due to ABO mismatch, presents w/erythema, nausea, pains
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Delayed - 3-10days later, mild course w/fever and malaise
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Hemochromatosis / etiology and risks
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Auto recessive, HFE mutation which interacts w/transferrin and alters iron absorption;
Dx: Transferrin levels most sensitive test |
Present in 40s/50s w/elevated transaminases and cirrhotic changes. Cardiomyopathy is 2nd most common, then Arthropathy and skin bronzing.
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VSD
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Harsh Systolic Thrill, Left Sternal Border; acyanotic; Often young (2month old); echo confirms dx. complications include pulmonary vascular obstruction, CHF; Smaller defects close spontaneously
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ASD
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Common acyanotic, left-to-right shunt, typically *asymptomatic*. Wide, fixed split S2; Pulmonary hypertension, arrhythmias, heart failure are associated
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Coarctation of aorta
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Upper body hypertension, lower body hypotension & weak pulses,
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PDA
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asymptomatic if small; wide pulse pressure, machinery like murmur, apical heave, thrill may all be present.
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blood flows directly from aorta to pulmonary artery
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Mitral Regurgitation
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Holosystolic murmur radiating to axilla
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Need TEE. If end-systolic ventricular dimension > 45-55mm, or if EF < 55% --> cardiac surgeon referral
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Kawasaki's - pres / tx
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CRASH and BURN
Conjunctiva Rash Adenopathy Swelling Hands and Feet (rash) Burn = Fever (high and longer than 5 days) |
Use high dose asprin and IVIG, get echocardiogram to r/o coronary aneurysms,etc
*Influenza vaccine needed w/in one month, if receiving IVIG (prevent Reye's syndrome) |
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Post-MI Meds, Activity
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Asprin
Beta-Blockers |
Avoid strenuous phys activity and sex 1-2 weeks.
Gradually resume aerobic exercise program after that. Submaximal Gx test before d/c (optional) Maximal Gx test 3-5 weeks post-MI |
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Hyperlipidymia Treatment
LDL HDL TGs |
LDL: statins
HDL: #1 nicotinic acid, gemfibrozil, statin (ranked) TGs: nicotinic acid / fibrates (target TGs if over 200, w/fibrates) diet lowers HDL and LDL; Exercise may increase HDL; |
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LDL
risk factors, goals |
Risk Factors:
smoking HDL < 40 hx of MI < 55 in 1st degree M > 45, F > 55 |
1 or less: 160; statin at 190
2 or more: 130; 160; CHD equiv: 100; 130; |
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Potassium Sparing Diuretics
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Spironolactone
Amiloride |
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Conn Syndrome
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Secondary hypertension from hyperaldosteronism, adrenal tumor.
Dx w/imaging of abdomen |
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A-fib
sx? tx? |
Sx may be present: SOB, lightheadedness, nausea, syncope.
risk:mitral stenosis --> dilated LA |
1. Control rapid ventricular response: CCB, BBs, Digoxin; can continue for two weeks w/anticoagulation, then pursue DC Cardioversion
2. If unstable: cardioversion (after TEE) 3. Always: Heparin(Warfarin) cardioversion can be used in combo with dofetilide, ibutilide, flecainamide, amiodarone, propafenone; |
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Temporal Arteritis
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HA/Vison Changes/Jaw claudication
Dx: clinical, ESR, Bx Manage: START prednisone if high sus, don't wait! |
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HOCM
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Systolic ejection murmur at RUSB, no resp variation, (+) going to standing & w/valsalva, (-) w/handgrip
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Suspect in younger patient
- aortic outflow obstruction is dependent on both preload and afterload. As preload (-) w/valsalva or moving to erect, the murmur increases. When afterload (+) as w/sustained handgrip, the end systolic chamber size increases and outflow obstruction decreases along w/murmur intensity. |
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AS
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Systolic Ejection Murmur; cardiac base or LUSB;
Valsalva decreases preload, which decreases murmur. Standing to sitting increases preload, increasing murmur. Lightheadedness, decreased exercise tolerance, syncope, angina |
Signs of left heart strain: downloping ST segments in I, AVL, V5-6; axis deviation to -60
Murmur increases w/increased preload Valve area <0.7 is considered critical |
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MR
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holosystolic murmur at apex radiating to axilla.
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Increases w/increased afterload (handgrip)
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TR
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holosystolic murmur at LLSB, increases w/inspiration
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Right sided flows are increased with more negative intrathoracic pressures (inspiration)
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Hypertension Cutoffs / workup
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Stage
1 - 140/90 --> thiazide 2 - 160/100 --> 2 drugs remember, need TWO readings |
Workup - if young (e.g. <40) and extremely high (e.g >150), look for secondary causes before initiating therapy
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Infective Endo Prophylaxis Indications
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Prosthetic heart valves or shunts
Hx of IE unrepaired cyanotic congenital HD transplanted heart |
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Lead Poisoning
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Anemia, irritability, basophilic stippling, homes before 1950, or renovated homes in 60s or 70s;
- get lead level (>70 considered very toxic) - Dimercapol / EDTA treatment / - XR Abdomen for Pb in bowel - if present may require bowel decontamination |
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Aortitis etiology
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Salmonella - any diseased portion
Syphillis - aortic bulb |
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Pericardial effusion - sx/ dx
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SOB, Diminished heart sounds, electrical alternans (P and R wave variability), cardiomegaly on XR, and effusion visible on CT
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Reentrant v. tach
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Cardioversion (w/epi - better than lidocaine) if unstable
Rate control w/beta blockers if stable |
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V-fib
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Unychronized cardioversion
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Pericarditis
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follows hx of infection; chest pain - mid-sternal and non-radiating, positional and pleuritic,
Diffuse ST elevation / PR depression w/ PR elevation in aVR |
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Post-MI Meds
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Asprin
Beta-blockers Statin +/-CCB? |
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DIC
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Low Platelet count
Elevations in PT / PTT - thrombin values are not useful - etiology: cancers, infections, anything |
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Sarcoidosis
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multiple organ manifestations - easy bruising, hypertrophic heart w/speckled pattern, CHF w/restrictive pattern, proteinuria, BL carpal tunnel - etc.
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Dissecting Aortic Aneurysm
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Excruciating CP radiating to Back; CT scan.
Type A- Operate Type B- Beta Blockers |
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CHF Drugs to Improve Mortality
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Spironolactone, ACE-i, BetaBlockers,
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Variant Angina
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Substernal chest pressrure, spontaneous pain, hx of similar pain, ST changes (e.g. 1.5mm ST elevations in II,III, aVF);
TREAT w/ MONA + * Calcium Channel Blockers * |
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Coronary Syndrome
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NSTEMI, STEMI, Unstable angina
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NSTEMI
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EKG Changes other than ST elevation;
Asprin Heparin gp IIb/IIIa inhibitors (aciximab) Beta Blockers |
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Infective Endo tx
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Vanc if S.Aureus
Vanc, Gent, Rifamampicin for Prosthetic Valves |
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