Upgrade to remove ads
Terms in this set (45)
elderly man with hx of rheumatic fever. bicuspid aortic valves common in 50%. Classic triad of: syncope, DOE and angina. systolic ejection murmur. order chest xray and echo. LV may be enlarged due to back up of blood/failure to get blood out. W/o treatment 5 year survival. 10-20% risk of sudden death. Radiates to carotids
Aortic Regurgitation/ Insufficiency
Child with strep and VSD and parents with congenital BV and IE
RF's: half of cases are from RF, rest are from IE, VSD in child, congenital bicuspid valve causing regurg. SSX: HTN, wide pulse pressure. Herd best sitting forward during expiration.
Female right after strep infection develops murmur and has quick developing HTN. Almost always a sequele of RF with 9 to 1 M to F. SSX: A-fib, PND, DOE, pulmonary edema with fatigue, ankle edema, hemoptysis. PH quick onset. worry about emboli, pulmonary edema, bacterial endocarditis
Same case as mitral stenosis but male after strep infection elderly acute pulmonary edema and pink sputum. He has many genetic diseases. (marfans, ehlers danlos, OE Imperfecta,
Half of the causes are from RF. RARE but could be from wear and tear, acute pulmonary edema. with pink sputum. Worry about A fib, emboli and cardiac failure.
Common in females that are previously healthy. present with palpitations and atypical sharp fleeting chest pain. may have hx of anxiety and panic attacks. accentuated by standing or valsalva
RARE. Person with hx of endocarditis, pulmonary htn and carcinoid syndrome (TS also). good prognosis but because it is close to pulmonary arteries you do doppler each year
RF: RHD, congenital defects, carcinoid syndrome. may be from mitral stenosis. SSX: pulmonary congestion, hepatomegaly , ascites, edema, fatigue. loudest during inspiration. requires prosthetic valve replacement.
RF's if hx of R CHF with outflwo obstruction and pulmonary htn. ASX usually. louder with inspiration. may develop into right sided HF.
4 causes of CHF
Indiscretion, infection, ischemia and infarction
Irregular QRS and P wave with >100 bpm
>100 bpm with regular QRS and P rhythm but narrow QRS
A-flutter, or supraventricular tachycardia
>100 bpm with regular QRS and P rhythm but wide QRS
PVC, PAC or ventricular tachycardia
Sinus tachycardia causes
PEACH. pain, extensive MI, anxiety, catecholamines, hypovolemia.
Heart block first degree
heart block second degree
complete heart block
no true p waves narrow QRS
early QRS with abnormal configuration could be wide, inverted or upright. most common arrhythmia
no p waves and normal shape of QRS just irregular rhythm
most idiopathic. if from cause usually viral (coxsackievirus, rocky mountain) could also be from toxins drugs. SSX: tachycardia, arrhythmias, cardiomegaly and contractile dysfunction. Worry about death dilated cardiomyopathy and arrhythmias. Many cases can respond spontaneously. but end stage 20-40% die in one year.
usually bacterial cause (staph and strep 80-90%). can result from dental infections or existing heart valve damage. Order blood cultures and echo. SSX: high fever, rapid onset and progression, night sweats, fatigue, weight loss, tachycardia, splinter nail hemorrhages, pallor. worst case heart murmur emboli, MI or lung abscess. petechiae.......CHRONIC: similar symptoms with nodules at tips of digits.
viral cause most common. echovirus or coxsackie. IT RUBS (infarct, tumor, RF, Uremia, Bacterial/Viral, SLE/ Scleroderma). SSX: acute chest pain with dyspnea better leaning forward. Order ECG (ST elevation), plain film. worst case: cardiac tamponade
Rheumatic Heart Disease
Mitral valve most commonly effected so stenosis or regurg. Mitral>aortic>tricsupid>pulmonic. Order: ECG (prolonged PR interval), CBC (leukocytosis), ESR (H), CRP (H), ASO titer (rising). main cause of murmurs world wide. 50% end up with arthritis and fever common. TX: salicylates including herbs are dramatically effective and can confirm DX.
blood pressure guidelines
>180 and/or >120 w/SSX of end organ damage
renin and urine protein levels should be ordered. high renin means inflammatory and low renin means salt sensitivity. MORE BP: MSC (CNS, lead poisoning), OCPS, Renal disease, Endocrine (adrenal, thyroid, pituitary, parathyroid), Burns and polycythemia)
focal seizure, subdural hematoma, hypoglycemia, migraines or hemorrhagic stroke.
Suspected stroke response
open airway, head and shoulders at 20 degrees, calm patient, monitor vital signs and treat for shock if necessary. IV line with saline. AMBULANCE to get streptokinase. consider aspirin.
minutes to hours. (2 min-2 hours). Carotid: unilateral with ipsilateral blindness, contralteral hemiparesis with parasthesias, aphasia, dysarthria. VB: confusion, vertigo, bilateral blindness, diplopia, bilateral or unilateral weakness. DDX: menieresm hypoglycemia and seizure. IF DX MANAGE: complete neuro and ocular every 3 months first year then yearly check ins. send to ED if it does not end in few minutes and refer for complete neuro if there has been multiple. Order carotid artery duplex scan.
hemorrhage between dura and skull.
page 99: know PAN, wegners, burgers, kawasaki, temporal arteritis and takayasu
Chronic arterial insufficiency vs chronic venous insufficiency
thrombophlebitis vs phlebothrombosis
TP: emboli are rare and it is associated with inflammation
PT: not associated with inflammation and embolism is common
imaging for ruptured aneurysm
CT not MRI (only useful days or weeks later). angiography ordered for unruptured.
SSX of emboli
FIVE Ps: pain, pulseless, pallor, parasthesia and paralysis
Imaging for vascular conditions
arterial DX US: to assess size of aorta and arterial thrombosis. ABI more than 0.85=AOD
venous DX US: to assesss DVT and competency of valves. Abdominal plain film added when assessing for AAA or renal artery aneurysm. could confirm with CT with AAA on plain film.
Lipid lowering agent effects on different lipoproteins
pharm management of CHF
first line is ACE and BB. may sub ARB for ACE. May add diuretic. 3rd line add ons are cardiac glycosides (digoxin) or vasodilators (nitroglycerin)
drugs for angina
VASODILATORS: Nitroglycerin, amlodipine (CCB)
CARDIODEPRESSENTS: BB (but not carvedilol that is nonselective and also has alpha blocking ability). CCB that do not have dihydropyridine. (verapamil)
intermittent claudication drug
pentoxifylline (PDE5 inhibitor) also works for vascular dementia, peyronies disease, fatty liver and sicke cell.
YOU MIGHT ALSO LIKE...
Cardio-Pulm Round 2, Cardio and Pulm II…
Chapter 47 care of the pt with a cardiovascular or…
NUR 614 Cardiovascular-Bates/Goolsby
Ch 19 Course Point-Patho taken from http://thepoin…
OTHER SETS BY THIS CREATOR
Opthamology and Otolaryngology