Cardio part 2 Flashcards

Question

Tx of MI

Answer 1

``` Oxygen ASA Nitrates Morphine STEMI- PCI If PCI can't be performed, fibrinolytics Anticoagulation as adjunct, no matter the strategy May use antiplatelet agents NSTEMI- BBs, CCBs only if contraindications to BBs, antiplatelet agents Anticoagulants ```

Answer 2

A spectrum of clinical presentations in which uncontrolled blood pressures lead to progressive or impending end-organ dysfunction

Answer 3

The most common clinical presentations are cerebral infarction, pulmonary edema, hypertensive encephalopathy, and congestive heart failure

Answer 4

``` CMP UA CBC and peripheral blood smear Tox screen Pregnancy test Endocrine testing as needed Imaging as determined by clinical presentation ```

Answer 5

``` Retinal papilledema Encephalopathy Confusion Left ventricular failure Intravascular coagulation Impaired renal function Hematuria Wt loss ```

Answer 6

Sodium nitroprusside, with constant monitoring in ICU -Avoid with hypertensive encephalopathy -Preferred in perioperative HTN Labetalol preferred in pts with acute dissection and end-stage renal dz as well as acute ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage, preeclampsia, and ACS Use diazepam, phentolamine, and nitro/nitroprusside for cocaine toxicity or pheochromocytoma Admit to ICU For adults with a compelling condition, lower SBP to <140 during the first hour and <120 in aortic dissection Without a compelling condition, reduce SBP to a max of 25% within the first hour

Answer 7

Adaptations: -Frank-Starling mechanism, where an increased preload helps to sustain cardiac performance -Alterations in myocyte regeneration and death -Myocardial hypertrophy with or without cardiac chamber dilatation, in which the mass of contractile tissue is augmented -Activation of neurohumoral systems, such as RAAS, sympathetic nervous system Angiotensin II Myocytes and myocardial remodeling Activation of atrial natriuretic peptide and B-type natriuretic peptide LV chamber stiffness

Answer 8

``` CAD DM HTN Valvular heart disease Arrhythmia Infections and inflammation Peripartum cardiomyopathy Congenital heart disease Drugs Idiopathic cardiomyopathy Rare conditions ```

Answer 9

``` CAD DM HTN Valvular heart disease HCM Restrictive cardiomyopathy Constrictive pericarditis ```

Answer 10

``` Acute valvular regurgitation MI Myocarditis Arrhythmia Drugs Sepsis ```

Answer 11

``` Exertional dyspnea Orthopnea Paroxysmal nocturnal dyspnea Dyspnea at rest Acute pulmonary edema CP/pressure Palpitations Anorexia Nausea Wt loss Bloating Fatiuge Weakness Oliguria Nocturia Cerebral sx of varying severity ```

Answer 12

May be dyspneic when lying flat without elevation of the head for more than a few minutes. Severe heart failure appear anxious and may exhibit signs of air hunger in this position. Chronic severe heart failure often malnourished and sometimes even cachectic Can have visible pulsation of the eyes and of the neck veins Severe heart failure- central cyanosis, icterus, and malar flush Dusky discoloration of the skin and diminished pulse pressure in severe Pulse may be weak, rapid, and thready Tachycardia, diaphoresis, pallor, peripheral cyanosis with pallor and coldness of extremities Rales Edema S3 gallop

Answer 13

``` CBC CMP, including Ca and Mg Renal and liver function studies Consider iron deficiency assessment BNP or NT-proBNP EKG CXR Echo for initial eval MUGA and other nuclear imaging In systolic dysfunction of unexplained cause- angiography ```

Answer 14

``` Lifestyle modifications, including sodium restriction Pharmacologic therapy: -Diuretics -ACEs/ARBs -Hydralazine and nitrates to improve sx -BBs -Aldosterone antagonists as an adjunct Acute heart failure: O2 administration for sat <90% and noninvasive positive pressure ventilation Initial IV loop diuretic Consider additional vasodilators Use inotropes for organ hypoperfusion Later on: Electrophysiologic intervention Revascularization Valve surgery ECMO Ventricular assist devices Transplant ```

Answer 15

A low-cardiac-output state secondary to extensive left ventricular infarction, development of a mechanical defect, or right ventricular infarction

Answer 16

``` Systolic dysfunction Diastolic dysfunction Valvular dysfunction Cardiac arrhythmias Coronary artery dz Mechanical complications ```

Answer 17

Can present after an MI Sinus tachycardia Low urine output Cool extremities Systemic hypotension Ashen or cyanotic with cool skin and mottled extremities Rapid and faint peripheral pulses and may be irregular if arrhythmias present JVD and crackles in lungs Distant heart sounds with some third and fourth heart sounds AMS

Answer 18

``` CMP LDH CBC Cardiac enzymes ABG Lactate BNP Echo EKG ```

Answer 19

Admission to ICU Central venous and arterial lines are often required Oxygenation and airway protection MI or ACS- ASA and heparin Vasopressors- try dopamine first IABP or other revascularization strategies

Answer 20

Pericardium usually limits the ability of the left-sided chambers to dilate This contributes to the bowing of the atrial and ventricular septums to the left, which reduces LV filling volumes and leads to a drop in cardiac output As intrapericardial pressures rise, this effect becomes pronounced

Answer 21

Idiopathic Infectious Neoplastic Postoperative/postprocedural

Answer 22

``` CP, pressure, discomfort Lightheadedness Syncope Palpitations Cough Dyspnea Hoarseness Anxiety and confusion ```

Answer 23

``` Beck's triad Pulsus paradoxus Pericardial friction rub Tachycardia Hepatojugular reflux Tachypnea Decreased breath sounds Ewart sign-dullness to percussion beneath the angle of left scapula from compression of the left lung by pericardial fluid ```

Answer 24

``` CMP CBC with diff Cardiac biomarkers ESR and CRP TSH BCx in the present of SIRS or fever RF, ANA, etc for suspected rheum cases Infectious disease testing CXR- water bottle heart Echo- imaging modality of choice EKG Pericardiocentesis ```

Answer 25

Pts with evidence of hemodynamic compromise- urgent drainage Pericardiocentesis is preferred Treat underlying causes

Cardio part 2 Flashcards

(49 cards)