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Cardio Valves and arrythmias Step 3

Terms in this set (68)

All valvular dz present with what CC
SOB
Yong pt presents c valvular heart dz what should you think
MVP, HOCM, MS, bicuspid aortic valves
Valvular Heart Dz Clue: healthy young athlete
HOCM
Valvular Heart Dz Clue: immigrant, pregnant
MS
Valvular Heart Dz Clue: Turner's syn, coarctation of aorta
bicuspid aortic valves
Valvular Heart Dz Clue: palpations, atypical CP not c exertion
MVP
All valvular dz can have what findings on chest exam & lung exam
murmur, rales on lung exam, (peripheral edema, carotid pulse findings and gallops also possible)
What manuevers inc venous return to the heart
squatting and lifting legs in the air
What manuevers dec venous return to the heart
Valsalva maneuver and standing up
Which murmurs inc in intensity when squatting
AS, AR, MS, MR, VSD
Which murmurs dec in intensity when standing or valsalva
HOCM, MVP
What effect does a handgrip have on afterload
increases afterload
What is so significant about handgripping a pt
it worsens (inc the sound of certain murmurs)
Handgripping gives the opposite effect of what drugs
ACEI, ARB or amyl nitrate (which reduces afterload)
Handgriping will do what to murmurs of MVP and HOCM
it improves (lessens the murmurs when LV chamber is larger or more full)
Amyl nitrate, ARBS, ACEI will do what to murmurs of MVP and HOCM
worsen murmurs (increases obstruction and degree of prolapse)
Which murmur is not affected by handgrip or amyl nitrates
MS
Murmur locations: 2nd rt intercostal space and rad to carotid arteries
AS (crescendo-decrescendo murmur)
Murmur locations: 2nd left intercostal space
Pulmonic valve murmurs
Murmur locations: lower left sternal border
AR, tricuspid murmurs or VSD
Murmur locations: heard at apex and rad to axilla
MR
Best init test for dx of valve lesion
echo
most accurate test for valve lesion
left heart cath
What patients do you use BB for rate control in pts c Afib & Aflutter
Graves' dz, Ischemic heart dz, Migraines, Pheochromocytoma
What patients do you use CCB for rate control in pts c Afib & Aflutter
Asthma, Migraines
What patients do you use digoxin for rate control in pts c Afib & Aflutter
borderline hypotension
Once Afib/Flutter is found on EKG what are the other tests you should order
Echo, TFT, Electrolytes (K, Mg, Ca), Troponin/CK-MB
Dx of arrhythmia in hemodynamically stable outpts
EKG, if unclear then Holter monitor @ least 24hrs
Dx of arrhythmia in hemodynamically stable inpts
EKG, if unclear then telemetry monitor
Tx of Afib/Flutter in hemodynamically unstable pt
Syncronized electrical cardioverison (No Shock T)
Tx of arrhythmia in hemodynamically stable pt
Rate control with IV BB (metoprolol), IV CCB (dilitazem), or IV Digoxin
Once rate is control in Atrial arrhythmias, what should be added if AA persisted longer than 2 days
Anticoagulation c warfarin to INR target 2-3
What will an EKG show on MAT
polymorphic P waves, revealing different atrial foci for QRS complex, irregular chaotic rhythm
What drugs should you AVOID at all cost in pts c MAT
BB and Digoxin (DO NOT USE)
What will an EKG show on SVT
regular rhythm c vent rate 160-180
Dx for SVT
EKG if it does not show SVT order Holter monitor or telemetry
On CCS all dysrhythmias should undergo what test
ECHO (TTE)
Best initial mgmt for SVT in stable pts
Vagal Manuvers (carotid massage, ice immersion of face, Valsalva)
If initial mgmt for SVT in stable pts is do not work what next
IV Adenosine
Best long term mgmt for SVT or WPW
Radiofreqency catheter ablation
How does WPW present
SVT that can alternate c VT and worsening of SVT after use of CCB or Digoxin
Most accurate test of WPW or VT
electophysical studies
Tx of WPW Best initial
procainamide
How does VT presents
palpitations, syncope, CP, sudden death
Dx of VT
EKG if unclear, telemetry monitor
Tx for persistent VT in hemodynamically stable pts
Procainamide, Amiodarone, Lidocaine, Mg
Tx for Vfib is always
unsynchronized cardioversion FIRST
UNsynch cardioversion is administered as
CPR, SHOCK, IV epi/vasopressin, SHOCK, IV amiodarone/lidocaine, SHOCK, repeat several cycles of CPR btw shocks
Tx of Acute MR
Emergency sx
Causes of Acute MR
MI causing rupture of chordae tendinae; Endocarditis
When to do sx in MR pts
Symp; Asymp if EF <55% or LV end sys >45
Tx of MVP
BB
S/s of MS
dyspnea, hemoptysis, thromboembolism, hoarseness
Tx of in Asymp MS >1.5 cm
observe
Tx of Symp MS >1.5cm
exercise if pulm art press > 60 or new onset A fib = sx
Tx of in Asymp MS <1.5 cm
if assoc c pulm HTN if not observe
Tx of Symp MS <1.5cm
sx
Canon "a" waves
complete heart block
Tx of MS s MR
percutaneous mitral balloon valvuloplasty
Tx of MS c MR
valve replacement
TX of MS, symp in pregnancy
Diuretics if persist -> BB, if pt decompensates -> sx in 3rd tri
Triad of symp AS
Syncope Angina Dyspnea (SAD)
If you suspect AS what to do next
ECHO BEFORE stress test
Pt c chronic AR which meds would be helpful
Nefedipine or ACEI
Pt c chronic AR what drugs do we avoid in AR?
BB (slowing down heart will give more regurg)
Most common acyanotic congenital cardiac abnorm
VSD
Tx of VSD
most close by age of 2 if it hasn't and pt is symp then sx
Any new onset A fib what test do we run
Thyroid funct test
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