Term
| What is considered a family history of premature CAD or MI? |
|
Definition
| first degree relative; <45 if male, <55 if female |
|
|
Term
| In pts with CAD, goal LDL= |
|
Definition
|
|
Term
|
Definition
| exertial angina with normal coronary arteriogram; prognosis is excellent |
|
|
Term
| How much do pts have to exercise for stress ECG? |
|
Definition
| 85% of max heart rate (220-age) |
|
|
Term
| Pts with positive stress test should undergo... |
|
Definition
|
|
Term
| What are the different types of stress tests? |
|
Definition
| exercise tolerance test (EKG), exercise or dobutamine echocardiogram, exercise or dipyridamole thallium |
|
|
Term
| What drugs can be used to pharmacologically stress teh heart? |
|
Definition
| dobutamine, adenosine, dipyridamole |
|
|
Term
| At what percent occlusion of a coronary artery does any type of angina occur? |
|
Definition
|
|
Term
| What is the effect of smoking cessation on coronary heart disease? |
|
Definition
| cuts risk in half by 1 year atfter quitting |
|
|
Term
| What kind of diet should be recommended to decrease risk of coronary heart disease? |
|
Definition
| sat fats should be <7% of calories; <200mg of cholesterol/day |
|
|
Term
| T/F Beta blockers have been shown to reduce the frequency of coronary events. |
|
Definition
|
|
Term
| What is the treatment for stable angina? |
|
Definition
| beta blocker, aspirin, and nitrates for chest pain |
|
|
Term
| Side effects of nitrates= |
|
Definition
| h/a, orthostatic hypotension, tolerance, syncope |
|
|
Term
| How are nitrates administered when angina is chronic? |
|
Definition
| orally or in transdermal patches |
|
|
Term
| Results of courage trial= |
|
Definition
| essentially no difference in all cause mortality and nonfatal MIs between pts with stable angina treated with maximal medical therapy alone versus medical threapy with PCI and bar metal stenting |
|
|
Term
| Pros and cons of revascularization= |
|
Definition
| does NOT decrease incidence of MI, just helps symptoms |
|
|
Term
| pros and cons of percutaneous coronary intervention with stenting and CABG= |
|
Definition
| moratlity and freedom from MI are the same; but with stenting there is a higher frequency of revascularization procedures |
|
|
Term
| What is the risk of restenosis with PCI? |
|
Definition
| up to 40% in the first 6 months; but if there is no restenosis at 6 months it is unlikely to occur |
|
|
Term
| Main indications for CABG= |
|
Definition
| three vessel disease with >70% stenosis in each vessel, left main coronary disease with >50%, left ventricular dysfunction |
|
|
Term
| Difference between unstable angina and NSTEMI= |
|
Definition
| NSTEMI has elevated enzymes |
|
|
Term
| Can you stress test a person with unstable angina? |
|
Definition
| they have a higher risk of adverse events during stress test so they should be stabilized with medicl management before stress testing or undergo cardiac cath initially |
|
|
Term
|
Definition
| clopidogrel reduces MI in pts with USA compared with aspirin alone |
|
|
Term
|
Definition
| LMWH (enoxaparin) was better than heparin group at reducing risk of STEMI, death, MI or recurrent angina and the need for revascularization was lower |
|
|
Term
| How long do you given pts LMWH when they are having some type of anginal pain? |
|
Definition
|
|
Term
| What is the use of getting coag studies in pts post MI/USA? |
|
Definition
| keep PTT at 2 to 2.5 times normal if using unfractionated heparin; PTT is not followed with LMWH |
|
|
Term
| Name some glycoprotein IIB/IIIA inhibitors. |
|
Definition
|
|
Term
| What electrolytes should you make sure to replace in pts with unstable angina? |
|
Definition
|
|
Term
|
Definition
| thrombolysis in myocardial infarction risk score= prognostication scheme that cateogirzes risk of deathand ischemic events in pts with USA/NSTEMI |
|
|
Term
| What are teh components of the TIMI risk score? |
|
Definition
| aspirin use in the last 7 days, age older than 65, >50% CAD stenosis, 4 cardiac enzymes elevated, more than three RF for CAD, at least two episodes of severe angina in the past 24 hours, ST elevation >1 mm |
|
|
Term
| When do you do PCI for MI symptoms? |
|
Definition
| if medical therapy fails to improve symptoms and or ECG changes indicative of ischemia persist after 48 hours; also, hemodynamic instability, ventricular arrhythmias, new mitral regurgitation or new septal defect |
|
|
Term
|
Definition
| statins reduce death, stroke,a nd need for revascularization in pts with prior history of MI |
|
|
Term
| What medicine can be given to provoke chest pain during coronary angiography ikn pts with variant angina? |
|
Definition
|
|
Term
| Treatment for variant angina= |
|
Definition
| calcium channel blockers and nitrates |
|
|
Term
| HOw many pts with ST segment elevation have an infarction? |
|
Definition
|
|
Term
| How many pts with ST segment depression have an infarction? |
|
Definition
|
|
Term
| Describe some EKG chagnes associated with infarct. |
|
Definition
| peaked T waves, ST segment elevation, Qwaves, T wave inversion, St segement depression |
|
|
Term
| Anterior infarct with show EKG changes where? |
|
Definition
| ST segment elevation in V1-V4; Q waves in V1-V4 |
|
|
Term
| Posterior infarct with show ECG changes where? |
|
Definition
| large R wave in V1 and V2, ST segment derpession in V1 and V2, upright and prominent T waves in V1 and V2 |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| How often do you get cardiac enzymes? |
|
Definition
| once on admission and every 8 hours until three samples are obtained; the higher the peak and the longer enzyme levels remain elevated, the more severe the myocardial injury and the worse the prognosis |
|
|
Term
| Agents shown to reduce mortality in pts with MI= |
|
Definition
| aspirin, beta blockers, and ACEI |
|
|
Term
| Describe the time course of troponin rise? |
|
Definition
| increases within 3 to 5 hours, and returns to normal in 5 to 14 days; peaks in 24 to 48 hours |
|
|
Term
| WHen might troponins be falsely elevated? |
|
Definition
| troponin I might be falsely elevated in renal failure |
|
|
Term
|
Definition
| increases within 4 to 8 hourse; peaks in 24 hours; gone in 48 to 72 hours |
|
|
Term
| Describe the therapy pts with MI should get on admission. |
|
Definition
| beta blockers, ACEI, statins, LMWH, morphine, oxygen, nitrates aspirin |
|
|
Term
| PCI benefit is especially pronounced in pts with MI in what time frame? |
|
Definition
| within 90 minutes of arriving at the hospital |
|
|
Term
| What should be medical therapy in pts that get PCI with stent? |
|
Definition
| need clopidogrel + aspirin for at least thrity days in pts who recieve a bare metal stent and at least 12 months in pts who recieve a drug-eluting stent |
|
|
Term
| After MI, all pts should have a ___ before leaving the hospital. |
|
Definition
| stress test; to determien the need for angiography (to determine need for angioplasty or CABG) |
|
|
Term
| What increases the risk of stroke in pts post MI? |
|
Definition
| increasing age and decreasing EF |
|
|
Term
| MC cause of in-hospital mortality of pts with MI= |
|
Definition
|
|
Term
| What is cardiac rehabilitation? |
|
Definition
| physician supervised regimen of exercise and risk factor reduction after MI |
|
|
Term
| Most common cause of death in the first few days after MI= |
|
Definition
| ventricular arrhythmia (either VT or Vfib) |
|
|
Term
| what is the preferred treatment for STEMI? |
|
Definition
| PCI as long as it can be performed within 90 minutes of arriving to ER |
|
|
Term
| What are teh indicaations to give thrombolytic therapy for chest pain? |
|
Definition
| ST segment elevation in two contiguous ECG leads in patients with pain onset within 6 hours who have been refractory to nitroglycerin (can be used up to 24 hours) |
|
|
Term
| What is first choice thrombolytic therapy in many centers despite its high cost? |
|
Definition
|
|
Term
| What are the absolute CIs to thrombolytic therapy? |
|
Definition
| recent head trauma or traumatic CPR, previous stroke, recent invasive procedure or surgery, dissecting aortic aneurysm, acting bleeding or bleeding diathesis |
|
|
Term
| What do you do if a pts is bradycardic post MI/ |
|
Definition
| no treatment is required unless they are symptomatic in which case atropine might be helpful |
|
|
Term
| After an MI all patients should be discharged home with... |
|
Definition
| aspirin, beta blocker, statin and an ACE inhibitor |
|
|
Term
| Treatment for second degree (type II) or third degree heart block after an anterior MI= |
|
Definition
| emergent placement of a temporary pacemaker |
|
|
Term
| Treatment of second degree (type II) heart block or third degree heart block after inferior MI? |
|
Definition
| IV atropine initially; if conduction is not restored a temporrary pacemaker is appropriate |
|
|
Term
| If someone who is admited for MI has another episode of symptoms concerning for reinfarction, what enzyme should you get? |
|
Definition
| CKMB over troponins because troponins will still be elevated from the first MI |
|
|
Term
| How long post MI does free wall rupture occur? |
|
Definition
| 90% occur within 2 weeks; most commonly 1 to 4 days after MI |
|
|
Term
| What is the mortality rate of free wall rupture post MI vs. rupture of interventricular septum post MI? |
|
Definition
| 90% mortality of free wall; IV septum depends on size of hole |
|
|
Term
| When does rupture of the interventricular septum occur post MI? |
|
Definition
|
|
Term
| How do you treat papillary muscle rupture post MI producing acute symptomatic MR? |
|
Definition
| afterload reduction with sodium nitroprusside or IABP; emergenet surgery is needed |
|
|
Term
| What is a ventricular pseudoaneurysm? |
|
Definition
| incomplete free wall rputure where myocardial rupture is contained by pericardium; surgical emergency |
|
|
Term
| Ventricular aneurysms can be associated with a high incidence of what complication? |
|
Definition
| ventricular tachycarrhythmias |
|
|
Term
| How do you treat acute pericarditis after MI? |
|
Definition
| aspirin; NSAIDS and corticosteroids are contraindicated as they may hinder myocardial scar formation |
|
|
Term
| What is Dressler's syndrome? |
|
Definition
| immunologically based syndrome consisting of fever, malaise, pericarditis, leukocytosis and pleuritis, occuring weeks to months after an MI |
|
|
Term
| What is ther treatment for Dressler's syndrome? |
|
Definition
| aspirin is the most effective therapy; ibuprofen is a second option |
|
|
Term
| Name some causes of high output heart failure? |
|
Definition
| pregnancy, hyperthyroidism, severe anemia, mitral regurge, aortic insufficiency, thiamine def (beriberi), paget's disease of bone, and AV fistulas |
|
|
Term
|
Definition
| awakening after 1 to 2 hours of sleep due to acute SOB |
|
|
Term
| which murmur may be a normal finding in children? |
|
Definition
|
|
Term
| What is the most common cause of pedal edema in the elderly? |
|
Definition
|
|
Term
| What can BNP levels tell you? |
|
Definition
| >150 correlates strongly with the presence of decompensated CHF |
|
|
Term
| What can NT-proBNP tell you? |
|
Definition
| NT-proBNP <300 vitrually excludes teh diagnosis of HF |
|
|
Term
| What is teh most accurate test to determine teh extent of heart failure? |
|
Definition
| radionuclide ventriculography using technetium-99m |
|
|
Term
|
Definition
| spironolactone reduces M and M in patietns with class III or IV heart failure |
|
|
Term
| What labs should you monitor if you give a pt spironolactone? |
|
Definition
|
|
Term
| Alternative to spironolactone to avoid gynecomastia= |
|
Definition
|
|
Term
|
Definition
| ace inhibitors reduce moratliy, prolong survival and alleviate symptoms |
|
|
Term
| Most common cause of death from CHF= |
|
Definition
| sudden death from ventricular arrythmias |
|
|
Term
| Name the beta blockers that have been studied to decrease mortality in pts with post MI HF. |
|
Definition
| metoprolol, bisoprolol, and carvedilol |
|
|
Term
|
Definition
| carvedilol led to significant improvement in survival compared with metoprolol |
|
|
Term
| Name the emdications that have been shown to lower mortality in CHF? |
|
Definition
| ACEIs and ARBs, beta blockers, aldosterone antagonists, hydralazine plus nitrate |
|
|
Term
| What are the benefits of digitalis? |
|
Definition
| provides short term symptomatic relief and will decrease the frequency of hospitalizations but has not been shown to improve mortality |
|
|
Term
| When are CHF pts a candidate for dig? |
|
Definition
| EF<40% who continue to have symptoms despite optimal therapy |
|
|
Term
| Name some signs of digoxin toxicity? |
|
Definition
| nausea/vomiting, anorexia, ectopic beats, AV block, |
|
|
Term
| Which CCBs are safe to use in heart failure? |
|
Definition
| amlodipine and felodipine |
|
|
Term
|
Definition
| ventricular assist device; implanted in the abdominal cavity with cannulation to the heart; lifelong anticoagulation is needed |
|
|
Term
| When is an ICD indicated for CHF/MI? |
|
Definition
| pts at least 40 days post MI, EF <35%, and class II or III symptoms despite optimal medic |
|
|
Term
|
Definition
| CRT is cardiac resynchronization therapy which is a biventricular pacemaker; indications are similar to ICD except these pts also have prolonged QRS duration >120 msec; most patients who meet criteria for CRT are also candidates for ICD and recieve and combined device |
|
|
Term
| What kind of therapies rae used for diastolic dysfunction? |
|
Definition
| beta blockers, diuretic for symptom control, DO NOT USE SPIRONOLACTONE OR DIGOXIN, benefit of ACEIs and ARBs is not clear |
|
|
Term
| What is the overall mortality for pts with CHF? |
|
Definition
|
|
Term
| How do you treat acute decompensated heart failure? |
|
Definition
| oxygenation, diuretics, IV nitroglycerin in pts wihtout hypotension to decrease afterload, dobutamine if inotropic support is needed (digoxin takes several weeks to work) |
|
|
Term
| What is the incidence of PACS in normal adults? |
|
Definition
| more than 50%; but may be a precursor of sichemia in a diseased heart |
|
|
Term
|
Definition
| use of antiarrythmic drugs to suppress PVCs after MI increases the risk of death |
|
|
Term
| How do you treat symptomatic PACs? |
|
Definition
|
|
Term
| What percent of normal people have a PVC? |
|
Definition
|
|
Term
| What can you use to treat symptomatic PVCs? |
|
Definition
|
|
Term
| T/F Presence of PVCs in patients with normal hearts is associated with increased mortality. |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| sinus beat followed by a PVC |
|
|
Term
|
Definition
| two sinus beats followed by a PVC |
|
|
Term
| How should you work up a paitent with underlying heart disease and frequent repetitive PVCs? |
|
Definition
| order an electrophysiologic study because patients may benefit from an ICD |
|
|
Term
| What are the endocrine effects of insulin? |
|
Definition
|
|
Term
| What is the rate of depolarization in afib? |
|
Definition
| atrial rate is >400; ventricular rate is 75-175 |
|
|
Term
| What's the difference between cardioversion and atrial defibrillation? |
|
Definition
| cardioversion is a shock in synchrony with the QRS complex (avoiding T wave because that can cause vfib); defibrillation is dshock that is not in synchrony with the QRS complex |
|
|
Term
| When is cardioversion indicated? |
|
Definition
| afib, aflutter, VT with a pulse, SVT |
|
|
Term
| What are the indications for defibrillation? |
|
Definition
| vfib and VT without a pulse |
|
|
Term
|
Definition
| rate control is superior to rhythm control in treating afib |
|
|
Term
| What is the risk of CVA in pts with Afib? |
|
Definition
| "lone afib"= 1%/yr; afib + heart disease= 4%/yr |
|
|
Term
| What is the target heart rate in a person with Afib? |
|
Definition
|
|
Term
| Which is preferred electric or pharmacologic cardioversion for afib? |
|
Definition
| electric is used for pts who are hemodynamically unstable, those with worsening symptoms or first ever case of afib |
|
|
Term
| What can you use to pharmacologically convert afib? |
|
Definition
| ibutilide, procainamide, flecainide, sotalol or amiodarone |
|
|
Term
| when attempting cardioversion, if afib is present for more than ___, you must anticoagulate for ___ . |
|
Definition
| >48 hrs; 3 weeks before and 4 weeks |
|
|
Term
| What do you do if you have afib onset more than 2 days ago but TEE is negative for thrombus? |
|
Definition
| start IV heparin and perform cardioversion within 24 hrs |
|
|
Term
| When do pts with afib not need anticoagulation? |
|
Definition
| lone afib under age 60 are at low risk for ambolization; aspirin may be appropriate |
|
|
Term
| What is teh atrial rate in afib? |
|
Definition
| typically very close to 300, making the ventricular rate close to 150 usually |
|
|
Term
| How do you achieve rate control in pts with afib? |
|
Definition
|
|
Term
| Where are the saw tooth waves of afib best seen? |
|
Definition
| inferior leads (II, III, avF) |
|
|
Term
| What's thee difference between WAP and MAT? |
|
Definition
| in WAP the rate is between 60 and 100 |
|
|
Term
| What do you need to see on EKG to make a diagnosis of MAT? |
|
Definition
| at least three different P wave morphologies and rate greater than 100 |
|
|
Term
| What maneurver can diagnose AMT? |
|
Definition
| vagal maneuvers or adenosine can be used to show av block without disurpting the atrial tachycardia |
|
|
Term
|
Definition
| improve oxygenation and ventilation (strong association between MAT and lung diseaes); if left ventricular function is preserved, acceptable treatments include CCBs, beta blockers, digoxin, amiodarone, IV flecainide, and IV propafenone; if LV function is not preserved use digoxin, diltiazem or amiodarone |
|
|
Term
|
Definition
| two pathways (one fast and the other slow) within the AV node so the reentratn circuit is within the AV node |
|
|
Term
| What is the most common case of SVT? |
|
Definition
|
|
Term
| What initiates and terminates AVNRT? |
|
Definition
|
|
Term
| What does AVNRT look like on ECG? |
|
Definition
| narrow QRS complex with no discernable P waves (because they are buried within the QRS complex); bc impulses are activating the atria and ventricles simultaneously |
|
|
Term
| What is orthodromic AV reentrant tachycardia? |
|
Definition
| when an accesory pathway etween the atria and ventricles that conducts retrogradely ("concealed bypass tract") |
|
|
Term
| What does orthodromic AV reentrant tachycardia look like on EKG? |
|
Definition
| narrow QRS complex with P waves which may or may not be discernible depending on the rate; this is because the accessory pathway is at some distance from teh AV node and there is a difference in the timing of activation of the atria and ventricles |
|
|
Term
| What are the side effects of adenosine? |
|
Definition
| headache, flushing, SOB, chest pressure, nausea |
|
|
Term
| What is the most common arrhythmia associated with digoxin toxicity? |
|
Definition
| paroxysmal atrial tachycardia with 2:1 block |
|
|
Term
|
Definition
| valsava, carotid massage, breath holding, and head immersion in cold water; or IV adenosine (IV verapamil, esmolol or digoxin ar ealternatives), DC cardioversion |
|
|
Term
| How does WPW produce paroxysmal tachycardia? |
|
Definition
| orthodromic reciprocating tachycardia; or supraventricular tachycardia with afib or aflutter |
|
|
Term
| How can you medically treat WPW? |
|
Definition
| procainamide or quinidine; avoid drugs that act on the AV node because they may accelerate conduction through the accessory apthway (IA or IC antiarrhythmics are a better choice) |
|
|
Term
| What is torsades de pointes? |
|
Definition
| rapid polymorphic VT; often leads to vfib |
|
|
Term
| How do you treat torsades de pointes? |
|
Definition
|
|
Term
|
Definition
| lasts longer than 30 seconds and is almost always symptomatic |
|
|
Term
| Physical findings of vfib? |
|
Definition
| cannon A waves in th eneck secondary to AV dissociation which results in atrial contraction during ventricular contraction |
|
|
Term
| What is monomorphic vs polymorphic VT? |
|
Definition
| in monomorphic all QRS complexes are identical |
|
|
Term
| Treatment for hemodynamically stable pts with sustained VT (systolic BP >90)? |
|
Definition
| IV amiodarone or IV procainamide |
|
|
Term
| Treatment for hemodynamically unstable vtach? |
|
Definition
| immediate synchronous DC cardioversion; follow with IV amiodarone to maintain sinus rhythm |
|
|
Term
| Longterm treatment for all pts with sustained VT? |
|
Definition
| placement of ICD unless EF is nomral (then consider amiodarone) |
|
|
Term
| How do you treat nonsustained VT? |
|
Definition
| if pts has no underlying heart disease and is not symptomatic do not treat (no increase risk of death in these pts); if underlying heart disease or is symptomatic get electrophysiologic study if it shows inducible sustained VT, ICD placement is appropriate; second line treatment is amiodarone |
|
|
Term
|
Definition
| prophylactic antiarrhythmic therapy with amiodarone or implantation of AID; but if vfib develops within 48 hrs of an acute MI, long term prognosis is favorable and the recurrence rate is low (2% at 1 yr) |
|
|
Term
|
Definition
| CPR until ready to defibrillate; give up to 3 sequential shocks to establish another rhythm, assess the rhythm between each; if VF persists, continue CPR, intubate, epinephrine 1 mg IV bolus initially then every 3 to 5 minutes later; attempt to defibrillate again 30 to 60 min later; if refractory give IV amiodarone followed by shock; if cardioversion sucessful give IV amiodarone |
|
|
Term
| What is sick sinus syndrome? |
|
Definition
| sinus node dysfunction characterized by persistent spontaneous sinus bradycardia |
|
|
Term
| What is teh EKG finding of first degree AV block? |
|
Definition
|
|
Term
| In third degree AV block how fast is teh escape rhythm? |
|
Definition
|
|
Term
| Name some casues of dilated cardiomyopathy? |
|
Definition
| CAD, alcohol, doxorubicin, daundorubicin, hypothyroidism, hyperthyroidism, pregnancy, viral, chagas, HIV, Lyme disease, thiamine or selenium deficiency, hypophosphatemia, uremia, SLE scleroderma, prolonged, uncontrolled tachycardia, catecholamine induced: pheochromocytoma, cocaine |
|
|
Term
| What is the inheritance pattern of HCM? |
|
Definition
| AD; however there are some spontaneous mutations |
|
|
Term
|
Definition
| sustained PMI, loud S4, rapidly increasing carotid pulse with two upstrokes (bisferious pulse) |
|
|
Term
| What maneuvers increase intensity of HCM? |
|
Definition
|
|
Term
| What maneuvers decresae HCM? |
|
Definition
| squatting, lying down or straight leg raise; sustained hand grip |
|
|
Term
| What drugs can be used to treat symptomatic HCM pts? |
|
Definition
|
|
Term
| Name some causes of restrictive cardiomyopathy? |
|
Definition
| amyloidosis, sarcoidosis, hemochromatosis, scleroderma, carcinoid syndrome, chemotherapy or radiation induced, idiopathic |
|
|
Term
| What does amyloidosis look like on echocardiogram? |
|
Definition
| myocardium appears brighter or may have a sparkled appearance |
|
|
Term
| Name some causes of myocarditis? |
|
Definition
| viral (coxsackie, parvovirus B 19, HHV6) bacteria (GAS in rheumatic fever, lyme disease, mycoplasma), SLE, medications (sulfonamides) |
|
|
Term
| What is the classic patient with myocarditis? |
|
Definition
|
|
Term
| What lab values are consistent with myocarditis? |
|
Definition
| increase in cardiac enzyme levels and ESR |
|
|
Term
| What causes acute pericarditis? |
|
Definition
| idiopathic/post viral, infectious, acute MI, uremia, collagen vascular diseases, neoplasm, drug induced lupus syndrome, after surgery, amyloidosis, radiaiton, trauma |
|
|
Term
| Name some infections that can cause pericarditis? |
|
Definition
| coxsackie virus, echovirus, adenovirus, EBV, influenza, HIV, hep A or B; bacterial= TB; fungal toxoplasmosis |
|
|
Term
| Where does the pain of acute pericarditis radiate? |
|
Definition
| to the retrosternal and left precordial regions and radiates to the trapezius ridge and neck |
|
|
Term
| What aggravates pain from acute pericarditis? |
|
Definition
| pain is positional and is aggravated by lying supine and relieved by sitting up and leaning forward; it is also aggravated by coughing, deep inspiration, and swallowing |
|
|
Term
| What might you find on physical exam of a patient with acute pericarditis? |
|
Definition
|
|
Term
| What changes are seen on ECG in acute pericarditis? |
|
Definition
| diffuse ST elevation and PR depression; ST elevation returns to normal in about 1 week; T wave inversions not seen in all pts |
|
|
Term
| How do you treat acute pericarditis? |
|
Definition
| NSAIDs are the mainstay of therapy; colchicine is also often used; glucocorticoids may be tried if pain does not respond to NSAIDs but should be avoided if at all possible |
|
|
Term
| DO you hospitalize pts with acute pericarditis? |
|
Definition
| relatively uncomplicated cases can be treated as an outpatient. however, pts with more worrisome symptoms such as fever and leukocytosis and patients with worrisome features such as pericardial effusion should be hospitalized |
|
|
Term
| What causes constrictive pericarditis? |
|
Definition
| in most cases the cause is never identified and is considered idiopathic or secondary to a viral infection; other causes= uremia, radiation therapy, TB, chronic pericardial effusion, tumor invasion, connective tissue disorders, and prior surgery involving the pericardium |
|
|
Term
| What are the symptoms of constrictive pericarditis? |
|
Definition
| pts appear very ill and have either symptoms of fluid overload or diminished cardiac output |
|
|
Term
| What are signs of physical exam of constrictive pericarditis? |
|
Definition
| JVD, Kussmaul's sign, pericardial knock, ascites, dependent edema |
|
|
Term
|
Definition
| JVD fials to decrease during inspiration |
|
|
Term
| What arrhythmia is associated with constrictive pericarditis? |
|
Definition
|
|
Term
| Results of cardiac cath in constrictive pericarditis? |
|
Definition
| elevated and equal diastolic pressures in all chambers; ventricular pressure tracing shows a rapid y descent which has been described as a dip and platue or a square root sign |
|
|
Term
| How little fluid in the pericardium can echo pick up? |
|
Definition
|
|
Term
| How much fluid has to be in the pericardial space to be picked up by CXR? |
|
Definition
|
|
Term
| What is the typical appearance of the cardiac shadow if there is a pericardial effusion? |
|
Definition
|
|
Term
| What does ECG of pericardial effusion show? |
|
Definition
| low QRS voltages and T wave flattening; electrical alternans |
|
|
Term
| What should you order on pericardial fluid analysis? |
|
Definition
| protein and glucose content, cell count and differential, cytology, specific gravity, hematocrit, gram stain, acid fast stains, fungal smear, cultures, LDH content |
|
|
Term
|
Definition
| triad of symptoms for cardiac tamponade (hypotension, muffled heart sounds, JVD) |
|
|
Term
| What amount of fluid causes cardiac tamponade? |
|
Definition
| two hundred mililiters that develops rapidly or up to two liters of fluid accumulated slowly |
|
|
Term
| What are the effects of tamponade on venous waveforms? |
|
Definition
| prominent x descent with absent y descent |
|
|
Term
| What is pulsus paradoxus? |
|
Definition
| exaggerated decrease in arterial pressure during inspiration (>10mmHg) |
|
|
Term
| WHen do you perform pericardiocentesis for cardiac tamponade? |
|
Definition
| if the pts is not hemodynamically stable; UNLESS the tamponade is hemorrhagic secondary to trauma in which case pericardiocentesis should NOT be performed if it will delay surgery |
|
|
Term
| Complications of mitral valve stenosis? |
|
Definition
| pulmonary HTN, R ventricular failure, afib |
|
|
Term
| At what extent of stenosis do you need before mitral stenosis becomes symptomatic? |
|
Definition
|
|
Term
| What physical exam fiding can indicate severity of mitral stenosis? |
|
Definition
| distance between S2 and the opening snap |
|
|
Term
| How do you treat mitral stenosis? |
|
Definition
| diuretics and beta blockers; infective endocarditis prophylaxis |
|
|
Term
| When does aortic stenosis cause symptoms? |
|
Definition
| if the orifice is less than 0.7 cm2 |
|
|
Term
| What is the prognosis of aortic stenosis? |
|
Definition
| if angina, average survival= 3 years; if syncope, average survival= 2 years; if heart failure, average survival= 1.5 |
|
|
Term
| Is S3 or S4 associated with aortic stenosis? |
|
Definition
|
|
Term
| How do you manage aortic stenosis? |
|
Definition
if asymptomatic; no treatment
if symptomatic, replace the valve |
|
|
Term
| What is a normal aortic valve surface area? |
|
Definition
|
|
Term
| What is the prognosis of aortic regurgitation? |
|
Definition
chronic aortic regurg= 75% at 5 years
with angina= death within 4 yrs
with HF= death within 2 yrs |
|
|
Term
| What are some causes of primary valvular aortic regurg? |
|
Definition
| rheumatic fever, bicuspid aortic valve, marfan's, ehlers danlos, anklyosing spondylitis, SLE |
|
|
Term
| What are some causes of aortic root disease that can lead to aortic regurg? |
|
Definition
| syphilitic aortitis, osteogenesis imperfecta, aortic dissection, Behcet's syndrome, Reiter's syndrome, systemic HTN |
|
|
Term
|
Definition
| head bobbing assoc with aortic regurg |
|
|
Term
|
Definition
| uvula bobs with aortic regurg |
|
|
Term
|
Definition
| pistol-shot heard over the femoral arteries |
|
|
Term
| T/F Percutaneous balloon valvuloplasty is first line treatment for AS. |
|
Definition
| false; restenosis is a big problem, |
|
|
Term
| What is the name for the pulse assoc with aortic regurg? |
|
Definition
| corrigan's pulse or water hammer pulse |
|
|
Term
| What is an austin flint murmur? |
|
Definition
| low pitched diastolic tumble due to competing flow anterograde from the LA and retrograde from the aorta |
|
|
Term
| What maneuver increases the intesnity of aortic regurg murmur? |
|
Definition
|
|
Term
| How do you manage aortic regurg? |
|
Definition
| if stable and asymptomatic= salt restriction, diuretics, vasodilators, digoxin, afterload reduction and restriction on strenuous activity; definitive treatment is surgery and should be considered in symptomatic pts, pts with acute aortic regurg or those with significant LV dysfunction on echo |
|
|
Term
| What is the treatment for MR? |
|
Definition
| afterload recduction with vasodilators for symptomatic patients; they are not recommended in most asymptomatic patients as they may mask progression of the disease; IABP as a bridge to surgery for acute MR |
|
|
Term
| What percent of adults have mild, physiologic TR? |
|
Definition
|
|
Term
| What is epstein's anomaly? |
|
Definition
| congenital malformation of tricuspid valve in which there is downward siplacement of the valve into the right ventrile |
|
|
Term
|
Definition
| usually right ventricular dilation, tricuspid endocarditis, rheumati cheart disease, epstein's anomaly, carcinoid syndrome, SLE and myxomatous valve degeneration |
|
|
Term
| What are some clinical symptoms of TR? |
|
Definition
| pulsatile liver, prominent V waves in jugular venous pulse with rapid y descent, blowing holosystolic murmur, afib usually present |
|
|
Term
| What are some findings on physical exam of TR besides the murmur? |
|
Definition
| puslatile liver, prominent V waves in jugular venous pulse with rapid y descent |
|
|
Term
| What are some findings on physical exam of TR besides the murmur? |
|
Definition
| puslatile liver, prominent V waves in jugular venous pulse with rapid y descent |
|
|
Term
|
Definition
| diuretics for congestion; severe regurg may be surgically corrected if pulmonary HTN is not present |
|
|
Term
| What causes mitral valve prolapse? |
|
Definition
| myxomatous degeneration of mitral valve leaflets and/or chordae tendinae |
|
|
Term
| What connective tissue disorders are associated with MVP? |
|
Definition
| marfan's, osteogenesis imperfecta, and ehlers danlos syndrome |
|
|
Term
| What kind of maneuvers increase and decrease the intensity of the MVP murmur? |
|
Definition
| standing and valsalva increases; squatting decreases |
|
|
Term
| Most common valvular abnormality of rheumatic heart disease |
|
Definition
| mitral stenosis (aortic or tricuspid is next) |
|
|
Term
| What is the treatment for ARF? How do you monitor treatment? |
|
Definition
|
|
Term
| What is the prognosis of untreated acute endocarditis? |
|
Definition
| fatal in less than 6 weeks |
|
|
Term
| What is the most common organism of acute endocarditis/ |
|
Definition
|
|
Term
| What organisms cause subacute endocarditis? |
|
Definition
| Strep viridans, and enterococcus |
|
|
Term
| Name the organisms that cause native valve endocarditis? |
|
Definition
| s viridans, staph epi or aureus, haemophilus, actinobacillus, cardiobacterium, eikenella, kingella |
|
|
Term
| Name the organisms that cause proesthetic valve endocarditis? |
|
Definition
| within 60 days of surgery (S epi > S aureus); >60 days= strep |
|
|
Term
| Besides S aureus, what are some other causes of endocarditis in IVDUs? |
|
Definition
| enterococci, streptococci, fungi (candida) and GNR (pseudomonas) |
|
|
Term
| What Duke's criteria are needed to diagnose infectiv endocarditis? |
|
Definition
| 2 major, one major and thre eminor, or five minor |
|
|
Term
| What can you use to prophylax for endocarditis in pt with abnormal valves? |
|
Definition
|
|
Term
| How do you treat infective endocarditis? |
|
Definition
| parenteral antibiotics based on culture results for extended periods (4 to 6 weeks) |
|
|
Term
| What is empiric treatment for endocarditis? |
|
Definition
| penicillin (or vancomycin) plus an aminoglycoside |
|
|
Term
| How do you tell the difference between marantic endocarditis and libman-sacks endocarditis? |
|
Definition
| marantic has sterile deposits of fibrin and platelets along the closure line of cardiac valve rleaflets; libman-sacks ahs formation ofsmall warty vegetations on both sides of valve leaflets |
|
|
Term
| nonbacterial thrombotic endocarditis= |
|
Definition
|
|
Term
| What clinical situation is associated with nonbacterial thrombotic endocarditis? |
|
Definition
| debilitating illnesses such as metastatic cancer (found in up to 20% of cancer patients) |
|
|
Term
| Nonbacterial verrucous endocarditis= |
|
Definition
| libman-sacks endocarditis |
|
|
Term
| Libman-Sacks typically affects which valve? |
|
Definition
|
|
Term
| What are the different types of ASDs? |
|
Definition
| osteium secundum (80% of cases, occurs in central portion of interatrial septum), ostium primum (occurs low in the septum), sinus venosus defects (occurs high in the septum) |
|
|
Term
| What are the symptoms of ASD in adults? |
|
Definition
| usually asymptomatic until middle age (around 40), thereafter, symptoms may begin and include exercise intolerance, dyspnea on exertion, and fatigue; if mild patients can live a normal lifespan |
|
|
Term
|
Definition
| type of contrast echo which involves injecting microbubbles and watching them cross the defect via a right to left shunt. This is often used to aid in diagnosis of ASDs |
|
|
Term
| What might you see on EKG with ASD? |
|
Definition
| right bundle branch block and right axis deviation; atrial abnormalities can also be seen (afib or flutter) |
|
|
Term
| What age do pts with ASDs typically get pulmonary HTN? |
|
Definition
| does NOT occur before 20; common in pts over 40 |
|
|
Term
| What is the most common congenital cardiac malformation? |
|
Definition
|
|
Term
| When do you surgically repair ASDs? |
|
Definition
| if they are symptomatic or if pulmonary to systemic blood flow ratio is greater than 1.5:1 or 2:1 |
|
|
Term
|
Definition
|
|
Term
| What are the symptoms of large VSD? |
|
Definition
| CHF, growth failure, and recurrent lower respiratory infections |
|
|
Term
| When is surgical repair indicated for VSD? |
|
Definition
| if pulmonary to systemic flow ratio is greater than 1.5:1 or 2:1 as well as for pts with symptoms or infective endocarditis |
|
|
Term
| Where does coarctation of the aorta occur? |
|
Definition
| origin of the leftsubclavian artery near the ligamentum arteriosum |
|
|
Term
| What are the signs of coarctation of the aorta on CXR? |
|
Definition
| notching of the ribs and "figure 3" appearance of the aorta |
|
|
Term
| Leading causes of death in adults with PDA= |
|
Definition
| heart afilure and infective endocarditis |
|
|
Term
| What are some risk factors associated with PDA? |
|
Definition
| high altitude, congenital rubella syndrome, premature births |
|
|
Term
| What are some extracardiac manifestations of PDA that you can see on physical exam? |
|
Definition
| wide pulse pressure and boudngin peripheral pulses; lower extremity clubbing (toes more likely than fingers to be cyanotic) |
|
|
Term
| What is teh average pulmonary pressure in an adult with a PDA? |
|
Definition
|
|
Term
|
Definition
| indomethacin or surgical ligation if pulmonary vascular disease is absent; if severe pulmonary HTN or right to left shunt is pressent do not correct PDA |
|
|
Term
| What drug can be used to keep a PDA open? |
|
Definition
|
|
Term
| All the defects of tetralogy of fallot are probably secondary to defects in teh development of the... |
|
Definition
|
|
Term
| How do you treat Tet spells? |
|
Definition
| oxygen, morphine, and beta blockers; if squatting maneuver does not resolve cyanosis |
|
|
Term
| What are survival rates after surgical correction of TOF? What are the most common causes of death? |
|
Definition
| 80% 20 year survival; MC causes of death are sudden cardiac death and heart failure |
|
|
Term
| What is the definition of a hypertensive emergency? |
|
Definition
| systolic bp >220 and diastolic BP >120 in addition to end-organ damage--immediate treatment is indicated |
|
|
Term
| What is the definition of hypertensive urgency? |
|
Definition
| elevated BP levels alone without endo organ damage; rarely require emergency therapy and can be managed with attempts to lower BP over a period of 24 hrs |
|
|
Term
|
Definition
| hypertensive encephalopathy |
|
|
Term
| Name some examples of end organ damage caused by hypertensive emergency? |
|
Definition
| papilledema, AMS, ICH, PRES, hypertensive encephalopathy, renal failure or hematuria, unstable angina, MI, CHF with pulmonary edema, aortic dissection, pulmonary edema |
|
|
Term
|
Definition
| posterior reversible encephalopathy syndrome= a radiographic condition which is postulated to be caused by autoregulartory failure of cerebral vessels as well as endothelial dysfunction |
|
|
Term
| What are the symptoms of PRES? |
|
Definition
| insidious onset of headache, altered level of consciousness, visual changes and seizures |
|
|
Term
| What are the classic radiographic findings associated with PRES? |
|
Definition
| posterior cerebral white matter edema |
|
|
Term
| What are causes of hypertensive emergency? |
|
Definition
| noncompliance with antihypertensive threapy, cushign's syndrome; drugs such as cocaine, LSD, methamphetamines, hyperaldosteroneism eclampsia, vasculitis, alcohol withdrawal, pheochromocytoma, noncompliance with dialysis, renal artery stenosis, polycystic kidney disease |
|
|
Term
| How do you manage a pts who presents with severe headache and markedly elevated BP? |
|
Definition
| lower BP with antihypertensive agent; order a CT scan of the head to rule out intracranial bleeding (SAH is on the diff for severe headache); if CT scan is negative one may proceed to lumbar puncture |
|
|
Term
| What agent should you use to lower BP in hypertensive emergency? |
|
Definition
| short acting agents such as hydralazine, esmolol, nitroprusside, labetalol or NTG; oral options= captopril, labetalol, nifedipine, diazoxide |
|
|
Term
| How much do you lwoer the BP in hypertensive emergency? |
|
Definition
| reduce MAP by 25% in 1 to 2 hours |
|
|
Term
| What are some predisposing factors to aortic dissection? |
|
Definition
| HTN, cocaine, trauma, connective tissue disease (ehlers danlos, marfans), bicuspid aortic valve, coarctation of the aorta, third trimester of pregnancy |
|
|
Term
| What is a type B aortic dissection? |
|
Definition
| limited to the descending aorta (distal to the take-off of the subclavian artery) |
|
|
Term
| Typical pain with proximal dissection vs distal disssection= |
|
Definition
| proximal= anterior chest pain; distal= interscapular back pain |
|
|
Term
| What is considered a "widened" mediastinum? |
|
Definition
|
|
Term
| What is the immediate medical management for aortic dissection? |
|
Definition
| IV beta blockers; IV sodium nitroprusside to lower systolic BP below 120 |
|
|
Term
| Where do most AAA's occur? |
|
Definition
| between the renal arteries and the iliac arteries |
|
|
Term
| Are AAAs more likely to rupture in women or men? |
|
Definition
| women; AAAs are much more common in men, however |
|
|
Term
|
Definition
| usually asymptomatic; may have a sense of fullness or pain in the hypogastrium and lower back, usually throbbing in nature |
|
|
Term
| Name some symptoms of sudden expansion and impending rupture of a AAA? |
|
Definition
| sudden onset of severe pain in the back or lower extremities, radiating to the groin, buttocks, or legs; may have grey turner's sign and cullen's sign |
|
|
Term
| What are symptoms of AAA rupture? |
|
Definition
| triad of abdominal pain, hypotension, and a palpable pusatile abdominal mass indicates a ruptured AAA and emergent laparotomy is indicated; also= CV collapse, syncope or near syncope, nausea and vomitting |
|
|
Term
| What test is the scan of choice for preoperative planning of AAAs? |
|
Definition
|
|
Term
| When is surgical resection witih synthetic graft placment recommended for AAAs? |
|
Definition
| >5cm in diameter or symptomatic |
|
|
Term
| How do you manage AAAs less than 5 cm in size? |
|
Definition
| can do periodic imaging to follow up growth; no safe size exists however and small AAAs can still rupture |
|
|
Term
| What is Leriche's syndrome? |
|
Definition
| occlusion of distal aorta just above bifurcation causing bilateral claudication, impotence, and absent/diminshed femoral pulses |
|
|
Term
| How do you evaluate pts with PVD? |
|
Definition
| evaluate the CV system (HTN, carotid bruits, murmurs, AAA), assess arterial pulses, inspect lower extremities for color change, ulcers, muscle atrophy, hair loss, thickened toenails, etc; consider ECG, CBC, renal function tests, and coag profile |
|
|
Term
| What is the msot common artery to be involvedin PVD? |
|
Definition
| superificial femoral artery (in hunter's canal); popliteal artery; aortoiliac occlusive disease |
|
|
Term
| What is the most important risk factor for PVD? |
|
Definition
|
|
Term
| Where is rest pain from PVD usually felt? |
|
Definition
| over the distal metatasals, where the arteries are the smallest |
|
|
Term
| Calf claudication indicates disease of what vessels? |
|
Definition
| popliteal or femoral vessels |
|
|
Term
| At what ABI do you get claudication? rest pain? |
|
Definition
|
|
Term
| Besides ABIs, how else can you evaluate peripheral extremity perfusion? |
|
Definition
| pulse volume recordings; pulse wave foms represent the volume of blood per heart beat at sequential sites down teh leg; a large wave form indicates good collateral flow; noninvasive using pressure cuffs |
|
|
Term
|
Definition
|
|
Term
| What is a part of conservativ emanagement for intermittent claudication? |
|
Definition
| stop SMOKING, graduated exercise program, foot care, atherosclerotic risk factor reduction, avoid extremes of temperature, aspirin + ticlopidine/clopidogrel whos improvements in symptoms; cilostazole is a PDE inhibitor that might also help |
|
|
Term
| What is the five year patency rate of surgical bypass grafting? |
|
Definition
|
|
Term
| How long can skeletal muscle toelrate ischemia? |
|
Definition
|
|
Term
| Where is the sources of emboli that can cause acute peripheral arterial occlusion? |
|
Definition
| 85% from the heart, anerusyms, atheromatous plaque |
|
|
Term
| How do you treat acute peripheral artery occlusion? |
|
Definition
| emergent surgical embolectomy is indicated via cutdown and fogarty balloon; bypass is reserved for embolectomy failure |
|
|
Term
| What is cholesterol embolization syndrome? |
|
Definition
| due to "showers" of cholesterol crystals originating from a proximal source; most commonly the abdomenal aorta, iliacs, and femoral arteries; it is often triggered by a surgical or radiographic intervention (arteriogram) or by thrombolytic therapy |
|
|
Term
| How does cholesterol embolization syndrome present? |
|
Definition
| small, discrete areas of tissue ischemia, resulting in blue/black toes, renal insufficiency, and/or abodminal pain or bleeding (the latter is due to intestinal hypoperfusion) |
|
|
Term
| How do you treat cholesterol embolization syndrome? |
|
Definition
| supportive, do not anticoagulate, control BP, amputation or surgical resection is only needed in extreme cases |
|
|
Term
| What is a mycotic aneurysm? |
|
Definition
| aneurysm resulting from damage to the aortic wall secondary to infection; blood cultures are positive in most cases; treatment= IV antibiotics and surgical exicion |
|
|
Term
| What is a fogarty balloon catheter? |
|
Definition
| used for embolectomy; the catheter is inserted, the balloon is inflated, and the catheter is pulled out; the balloon brings teh embolus with it |
|
|
Term
|
Definition
| stasis, endothelial injury, hypercoagulability |
|
|
Term
| What percent of pts with DVTs have classic findings? |
|
Definition
| only 50%; this is because if a superficial venous system is patent, the blood will be able to drain that way |
|
|
Term
| Treatment for chronic venous insufficiency with ulcers= |
|
Definition
| unna boots; wet to dry dressings |
|
|
Term
| What are the symptoms of superficial thrombophlebitis? |
|
Definition
| local tenderness, erythema along course of a superficial vein |
|
|
Term
| What percent of pts with classic DVT findings have a DVT? |
|
Definition
|
|
Term
| calf pain on ankle dorsiflexion= |
|
Definition
|
|
Term
| What is the sensitivity/specificity of doppler analysis and duplex ultrasound for detecting DVT? |
|
Definition
| high for detecting proximal thrombi (popliteal or femoral) not so for distal (calf vein) thrombosis |
|
|
Term
| Name a study to eval for DVTs that is as accurate as doppler but less operator dependent? |
|
Definition
| impedance plesthysmography |
|
|
Term
| What is impedance plesthymography? |
|
Definition
| blood conducts electricity better than soft tissue so electrical impedance decreases as blood volume increases; high sensitivity for porximal DVT but not for distal DVT, poor specificity because of the high rate of false positives |
|
|
Term
| What is the use of d dimer when evaluating DVTs? |
|
Definition
| has a very high sensitivity (95%) but low specificity (50%) can be used to rule out DVT when combined with doppler and clinical suspicion |
|
|
Term
| What is teh most common complication of DVT? |
|
Definition
| post thrombotic syndrome (chronic venous insufficiency), occurs in half of all pts with DVT |
|
|
Term
| What is it called when DVT causes such severe leg edema that arterial supply to the limb is compromised? |
|
Definition
| phlegmasia cerulea dolens |
|
|
Term
| What is the treatment for DVT? |
|
Definition
| heparin bolus followed by a constant infusion and titrated to maintain teh PTT at 1.5 -2 X the aPTT; start warfarin once the aPTT is therapeutic and continue for 3 to 6 months; anticoagulate to INR at 2 to 3; continue heparin until the INR has been therapeutic for 48 hours |
|
|
Term
| another name for IVC filter= |
|
Definition
|
|
Term
| Who should get a greenfield filter? |
|
Definition
| pts at high risk for PE who have an absolute contraindication to otehr forms of prophylaxis |
|
|
Term
| Low molecular weight heparin vs unfractionated heparin= |
|
Definition
| low molecular weight has a longer hafl life and can be dosed once dialy, given on outpatient basis, no need to follow aPTT levels, is much more expensive than unfractionated heparin |
|
|
Term
| What are the three systems of the lower extremity venous system? |
|
Definition
| deep, superficial, and perforating systems |
|
|
Term
| In what direction does flow go in the perforating veins? |
|
Definition
|
|
Term
| How do you treat venous stasis ulcers that do not heal with the unna boot? |
|
Definition
| apply split thickness skin grafts with or without ligation of adjacent perforator veins |
|
|
Term
| superficial thrombophlebitis occurs in different locations over a short period of time= |
|
Definition
| migratory superficial thrombophlebitis (secondary to occult malignancy, often of the pancreas) |
|
|
Term
| What causes superficial thrombophlebitis? |
|
Definition
| in upper extremities, usually occurs at the site of an IV infusion; in lower extremities, usually associated with varicose veins (in the greater saphenous system) secondary to static blood flow in these veins |
|
|
Term
| How do you treat localized superficial thrombophlebitis? |
|
Definition
| no anticoagulation required; mild anagesic, continue activity |
|
|
Term
| How do you treat severe thrombophlebitis with pain and cellulitis? |
|
Definition
| bed rest, elevation and hot compresses; once symptoms resolve, ambulation with elastic stockings; antibiotics usually not necessary unless the process is suppurative in which case adequate drainage is indicated |
|
|
Term
| What percent of tumros in the heart are metastasis? What kinds of tumros metastasize to the heart |
|
Definition
| 75% (lung, breast, skin, kdiney, lymphomas, kaposi's sarcoma) |
|
|
Term
| What is the most common primary cardiac neoplasm? |
|
Definition
|
|
Term
| From where in the atria do atrial myxomas typically arise? |
|
Definition
| interatrial septum of the heart int he region of the fossa ovalis |
|
|
Term
| What are the symptoms of atrial myxoma? |
|
Definition
| fatigue, fever, syncope, palpitations, malaise, and a low pitched diastolic murmur that changes character with changing body position (diastolic plop) |
|
|
Term
| What is the pulmonary capillary wedge pressure in shock? |
|
Definition
| it is increased in cardiogenic shock; decreased in hypovolemic, septic, and neurogenic shock |
|
|
Term
| Is cardiac output increased or decreased in shock? |
|
Definition
| increased in septic shock, decreased in cardiogenic, neurogenic, and hypovolemic shock |
|
|
Term
| What are teh initial steps in evaluating shock? |
|
Definition
| two large bore venous catheters, a central line, and an arterial line; a fluid bolus; draw blood for basic labs; ECG/CXR, continuous pulse oximetry, vasopressors if the pts remains hypotensive despite fluids |
|
|
Term
| Which vasopressor do you start with for cardiogenic shock? What do you add on if that doesn't work? |
|
Definition
| dopamine, then dobutamine, then norepinephrine or phenylephrine |
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|
Term
| How much blood do you have to lose for compensatory mechanisms to fail? |
|
Definition
|
|
Term
| What are you goals for cardiac output, cardiac index and PCWP in a pt in hemodynamic shock? |
|
Definition
| cardiac output >4L/min, cardiac index >2.2 L/min/meter2, PCWP <18 mmHg |
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Term
|
Definition
| cardiac output/body surface area |
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Term
|
Definition
| hemodynamic support; causes decreased afterload, increased cardiac output and increased flow through the coronary arteries |
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|
Term
| What are the indications for IABP? |
|
Definition
| angina refractory to medical therapy, mechanical complications of MI, cardiogenic shock, low cardiac output states, and as a bridge to surgery in severe aortic stenosis |
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|
Term
|
Definition
| loss of 10-15% of blood volume; completely compensated |
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|
Term
|
Definition
| 20-30%; pulse greater than 100, mild tachypnea, anxious 20-30 mL/hr of urine |
|
|
Term
|
Definition
| 30-40% of blood is lost; pulse is >120; BP is decreased; marked tachypnea; confused; UOP= 20ML/hr |
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|
Term
|
Definition
| >40% blood volume lost; pulse >140; marked decrease in BP; marked tachypnea, lethargy/coma; negligible UOP |
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|
Term
| What are some nonhemorrhagic causes of hypovolemic shock? |
|
Definition
| voluminous vomiting, dsevere diarrhea, severe dehydration for any reason, burns, third space losses in bowel obstruction |
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Term
|
Definition
| multiple organ dysfunction syndrome; part of the SIRS spectrum; altered organ function in an acutely illpt usually leading to deaht |
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|
Term
| What is the most common cause of death in teh ICU/ |
|
Definition
|
|
Term
| What are causes of neurogenic shock? |
|
Definition
| spinal cord injury, severe head injury, spinal anesthesia, pharmacologic sympathetic blockade |
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