Treatment for child with coarctation of the aorta presenting in cardiogenic shock?
PGE1 (to keep ductus arteriosus open)
Acute Aortic Dissection early Tx:
Esmolol (short acting B1 easily titratable)
Do not give ____? Why? What other related condition should you not give this med?
Substernal chest pressure at rest and during activity worse in the AM and with smoking.
Dx: Transient ST Elevations on EKG
Tx: CCB, Nitrates
Do not give Propranolol. Unopposed alpha vasoconstriction can cause death. Don't give Propranolol in Intermittent Claudication (for the same reason).
EKG findings of myocardial infarction.
Sustained ST elevations (transmural)
Transient or sustained ST depressions
Q waves (Old MI)
What is it used for?
Blocks Na/K ATPase of cardiac myocytes to slow conduction through SA and AV nodes.
Digoxin Toxicity S&S.
2º AV Node Type I (Wenckebach) Block.
Tx: Digoxin Immune Fab
S&S of Left sided Heart Failure (weeks after Anterior MI.)
Most likely caused by?
↑ PCWP (> 15) and ↑ RA pressure (>6)
d/t Ventricular Aneurysm (ST elevations in V1-V4)
What is the 1st line med in all Acute Coronary Syndromes?
Aspirin. (Clopidogrel if unable to tolerate). Reduces morbidity and mortality.
Management of Symptomatic A. Fib
Dx: TEE to check for intracardiac thrombus OR
Anticoagulate for 3 wks before cardioversion
No R in V1
Tall R in V6
RSR1 "Rabbit ears"
Hypo/Hypercalcemia EKG changes?
Hypocal = "po"longed QT.
Hypercalcemia is opposite (shortened QT)
What is Kussmaul's sign?
JVP Increased with Inspiration
[Norm JVP= 6-8]
Aortic Stenosis keywords
Pulmonic Post (L 2 ICS)
Radiates to Carotids
Assoc: Turner's Syn, Heyde's angiodysplasia of colon
Mitral Regurg keywords
Radiates to Axilla
Marfan's (also seen in Aortic Regurg)
Papillary mm. rupture
Weight loss meds
Mitral Valve Prolapse keywords
Midsystolic (Think MVP of the mid-season)
Better w/ squat
Hypertrophic (Systolic) Cardiomyopathy keywords
S in V1 + R(V5/V6) > 35mm
Louder w/ Valsalva, standing, vasodilators, diuretics (anything that ↓ preload/afterload)
Tx: BB, CCB
Aortic Regurg keywords
@ LSB/Pulmonic post (L 2 ICS)
High pitched blowing
Flash pulmonary edema
(Austin Flint, Duroziez, Corrigan, DeMusset, Quincke),
Marfan's (also seen in Mitral Regurg)
Tx: Hydralazine, ACEi, CCB
Valve replace if Austin Flint
What is Austin Flint? Significance?
backward flow of blood hitting mitral valve leaflet.
Time to REPLACE the AORTIC VALVE
What is Duroziez sign?
What is Corrigan's Pulse?
Water hammer bounding pulse
What is DeMusset's sign?
What is Quincke's Pulse?
Pulsating Nail Bed
Mitral Stenosis keywords
Mid-diastolic rumble with *Opening snap*
Rheumatic Fever, Group A Strep.
Tx: Balloon Valvotomy
What can cause 1st Degree AV Block?
Stop BB, CCB, or Digoxin
Tx. for Mobitz 2, 3rd Degree AV Block, and Sick Sinus Syndrome
Pacemaker (Transcutaneous pacing)
A. Fib Tx parameters
1) Anticoagulate if CHADS2 >=2.
2) If 48 hrs, Anticoagulate,
3) If 3-6 weeks of Warfarin (INR 2-3) can cardiovert
Multifocal Atrial Tachycardia Tx
BB or CCB for rate control
Tx. for AVNRT or AVRT
1) Carotid massage, Valsalva.
3) Cardiovert if hemodynamically unstable