Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
19 Cards in this Set
- Front
- Back
124. Acute pericarditis following MI? Tx?
|
a. Tx consists of aspirin!!!!
b. NSAIDs and corticosteroids are contraindicated (may hinder myocardial scar formation). |
|
125. Dressler’s syndrome “Postmyocardial infarction syndrome”? and most effective therapy?
|
a. Immunologically based syndrome consisting of fever, malaise, pericarditis, leukocytosis, and pleuritis, occurring weeks to months after an MI.
b. Aspirin is the most effective therapy. |
|
126. Differential dx of Chest pain?
|
a. Heart, pericardium, vascular causes
b. Pulmonary c. GI d. Chest wall e. Psychiatric f. Cocaine use can cause angina or MI |
|
127. Heart, pericardium, vascular causes of chest pain?
|
1. Stable angina, unstable angina, variant angina
2. MI 3. Pericarditis 4. Aortic dissection |
|
128. Pulmonary causes of chest pain?
|
a. Pulmonary embolism (can have pain w/pulmonary infarction)
b. Pneumothorax c. Pleuritis (pleural pain) d. Pneumonia e. Status asthmaticus |
|
129. GI causes of chest pain?
|
a. GERD
b. Diffuse oesophageal spasm c. Peptic ulcer disease d. Oesophageal rupture |
|
130. Chest wall cause of chest pain?
|
a. Costochondritis
b. Muscle strain c. Rib fracture d. Herpes zoster e. Thoracic outlet syndrome |
|
131. Psych causes of chest pain (3)?
|
a. Panic attacks
b. Anxiety c. Somatization |
|
132. Approach to treating a pt w/chest pain? part 1
|
1. Rule out any life-threatening causes.
a. These include acute MI, unstable angina, aortic dissection, pulmonary embolus, tension pneumothorax, and oesophageal rupture. 2. Assess vital signs 3. Develop a focused hx: i. OLDCAARTS/setting in which it occurred. ii. Does pt have a cardiac hx, ask about previous tests. iii. If pt has a hx of angina, ask how this episode differs. |
|
132. Approach to treating a pt w/chest pain? part 2
|
4. Perform focused physical exam, w/attention to C/V, abdominal, and musculoskeletal examination.
5. Order ancillary tests: enzymes, ecg, CXR, if appropriate- work up for pulmonary embolism PE. 6. Develop a diagnosis. |
|
133. It can be difficult to distinguish between GI causes of chest pain and angina- what is the decision of whether to initiate a cardiac workup based upon?
|
a. The pt’s overall risk of CAD and clinical presentation.
b. If pt is young and w/out risk factors, tx for GERD and follow up if pain recurs. An older pt w/risk factors should undergo a cardiac workup |
|
134. Note: If you suspect a cardiac cause of chest pain, sublingual nitro is appropriate. Also give aspirin if pt does not have a bleeding disorder.
|
a. If nitro relieves pain, a cardiac cause is more likely.
|
|
135. Initial steps in pt w/stable angina who presents w/sx suggestive of USA?
|
a. Obtain ECG and cardiac enzymes
b. Give aspirin c. Begin IV heparin. |
|
136. General characteristics of CHF?
|
a. CHF is a clinical syndrome resulting from the heart’s inability to meet the body’s circulatory demands under normal physiological conditions.
|
|
137. Pathophys of CHF?
|
a. ↓ Cardiac output -> Activation of renin-angiotensin-aldosterone system and activation of sympathetic nervous system.
b. These lead to Systemic vasoconstriction and volume retention. c. -> ↑ Venous return, resulting in ↑ preload. This maintains CO. d. However, if severe CHF, ↑ preload does not result in ↑ CO. e. ↑ LVEDV causes ↑ LVEDP, which is transmitted back to pulmonary veins and leads to symptoms of pulmonary congestion. |
|
138. Frank-Starling Relationship?
|
a. In a normal heart, increasing preload results in greater contractility.
b. When preload is low (at rest), there is little difference in performance between a normal and a failing heart. However, w/exertion, a failing heart produces relatively less contractility and symptoms occur. |
|
139. Systolic dysfunction in CHF?
|
a. Owing to impaired contractility (i.e., the abnormality is decreased ejection fraction).
b. Causes include: 1. After a recent MI- most common cause of systolic dysfunction. 2. Cardiomyopathy 3. Myocarditis. |
|
140. Diastolic dysfunction in CHF?
|
a. Owing to impaired ventricular filling during diastole (either impaired relaxation or increased stiffness of ventricle or both).
b. Echo shows impaired relaxation of left ventricle. |
|
141. 3 Causes of diastolic dysfunction?
|
1. HTN leading to myocardial hypertrophy- most common cause of diastolic dysfunction.
2. Valvular diseases such as aortic stenosis, mitral stenosis, and aortic regurg. 3. Restrictive cardiomyopathy e.g., amyloidosis, sarcoidosis, hemochromatosis. |