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14 Cards in this Set
- Front
- Back
what is the first think you determine in a pt with palpataion |
determine it its a life threatening arrhythemia: does the person look sick, are VS stable
Life threatening Arrhythemias: 1. V tach: stable- BP and mental status WNL. Unstable- altered mental status, abnormal BP 2. MI with PVC: ST change with PVC 3. SVT (supraventricular tachy) with hypotension, poor endo organ perfusion. abnomral EKG and BP |
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what are hte 3 life threatening arrhythemias htat you need to ro in person with palpatations
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1. V tach
2. MI with PVC 3. Supravent tachy with hypotension |
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ok so you have a pt with palpatations and you have determined there is no V tach, MI with PVC or supraventricular tachy. what is the next thing you want to determine
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1. is there a cardiogenic problem
-Sick Sinus *tachy-brady) sydndrome -Preexcitation syndrome -CAD -MI -Valvular heart disease -Mitral Valve 2. Risk Factos: male, >40 smoke, family Hx |
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what are hte cardiogenic problmes associated with palpatations
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1. Sick Sinus (tachy-brady syndrome): older ppl. fast and slow HR with syncope or near syncope
2. Preexcitation syndrome: younger pts. 12 lead with short PR or delta wave 3. CAD- hx of angina, do stress test 4. MI: hx suggestive of ischemic pain 5. Valvular heart disease: murmua, PE with murmur 6. Mitral falve: F>M, 30-50's. Fam Hx. Midsystolic click/murmur |
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what are hte 6 main categories that can cause palpatasion
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1. Cardiogenic: sick sinus, pre-excitation syndrome, CAD, MI, valvular disease
2. Metabolic: hypokalemia, hypoxia 3. Endocrine: thyrotoxicosis, pheochromocytoma 4. Infections: septic 5. Physological: anxiety. dx of exclusion 6. Toxins: tob, caffeine, epinepherine, EtOH, cocaine, amphetamines, atropine, digoxin, thyroid replacement |
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what are hte metabolic issues that can cause palpitations
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hypokalemia
hypoxia |
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if a pt says -_____ what are you thinking
1. jumps, skips 2. Attacks, abrupt onset, >120 3. Independent of exercise/excitement, anemia, febrile, hypoglycemia, anxiety 4. Attacks are sudden but not rapid, unrellated to exciteation or exertion 5. sx on standing 6. middle aged woman that is flushed and sweating 7. Rate/rhythem is Reg |
1. extra systole
2. paroxysmyl rapid tachy 3. A fib, A flutter, thyrotoxicosis 4. Hemmorage, hypoglycemia, adrenal medullary tumor 5. postural hypotension 6. menopause 7. anxiety by exclusion |
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what is PE for pt with MVP
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Female, 30-50 yo (14-30 in notes)
*mid systolic click, murmur. Dx with echo. Hx palpitations **click goes away with valsalva |
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whats the presentation of pts with MVP
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1. female 14-30
2 asx 3. PE- midsystolic click, confirm with echo |
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at what stage is tx instituted in pts with MVP
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REASSUREANCE IS KEY!
**AB for prevention of infective endocarditis- prophylax with dental procedures **tx when arrhytemias are common |
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that are hte complications of MVP
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1 regurg. chordal rupture
2. l vent hypertrophy 3. sudden death (rare) |
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what are the clicks
1. aortic/pulmonic 2. Dilation of great vessel 3. MVP |
1. Aortic/Pulmonic: most common. systolic ejection click. early in systole, usually with systolic ejection murmur
2. DIlation of Great Vessels (aorta or pulm a): ejection click 3. MVP: mid systolic click |
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whats the cause of MVP
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unknown
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what arrhythemias are common in MVP
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venticle
*premature vent contraction *paroxysmal supravent/vent tachy **tx when you get this |