Cardio Tx Flashcards
(20 cards)
ASD
Closure of defect
- age 1-3 years
- symptomatic child with a large defect
- asymptomatic kid with hemodynamic significance- cardiac cath or surgery
Patent Ductus Arteriosus
Preterm- prostaglandin inhibitor- indomethacin PO
Term infant- small to moderate just monitor, larger do a surgical closure by age 1y
VSD
monitor- small 90% close by 6y, moderate- serial echo monitoring
surgery- pts with cardiomegaly, poor growth, exercise intolerance, shunt >2:1
- repair at 3-6 mo, risk of eisenminger syndrome, synthetic or pericardial patch
Coarctation of the aora
Goal- reduce the risk of cardiac failure, correction >5yrold cat increased risk of HTN and myocardial dysfunction
surgical repair, balloon angioplasty, trans catheter stent in older patients
tetralogy of fallot
complete repair during the neonatal or infancy perior
open hear surgery
- VSD closed
- trans annular patch until pulmonary valve replacement necessary (about 10-15 yrs posted)
Transposition of the Great Arteries
early corrective surgery, before 14days old(usually at 4-7d) Arterial Switch- transect the arteries above the level of the valves and switch, separately reimplant coronary arteries, close ASD or VSD
Dialated cardiomyopathy
manage heart failure- control lipids, DM, BP, weight control, cease alcohol and smoking
all patients, regardless of etiology- Beta Blocker and ACE inhibitor
ACS+reduced LVEH- Ace or ARB and BetaBlocker, Statin
Taka Tsubo cardiomyopathy
Short term- ASA, beta blocker, ACE1 until LV recovers
long term- ACE1
Hypertrophic cardiomyopathy
slow HR to increase diastolic filling- beta blocker, maybe CCB
lower LV diastolic and LA pressure- diuretics
treat Afib, dual chamber pacing, non surgical septal ablation, implantable defib
restrictive cardiomyopathy
acute- diuretics, beta blockers
amyloidosis- difluisal or tafamidis
sarcoidosis- corticosteroids
Aortic Aneyrusm
abdominal- elective repair 5.5cm or over o.5cm growth in 6 months, impending rupture or rupture
thoracic- surgery when over 6 cm, descending- endovascular graft, aortic arch repaired by skilled team
Aortic Dissection
A- surgical intervention urgently for all
B- bypass, medical management, stent/ graft
long term- BP 120/80, serial MRI or CT at 3, 6, 12mo, annually thereafter
Giant cell/temporal areteritis
Urgent- Prednisone 60mg PO daily for a month, if vision loss on presentation start IC methylprednisone
Peripheral arterial disease
stop smoking, statins, wound care, exercise and weight loss, aspirin, surgical- angioplasty and stent, bypass graft, revascularization, amputation
Superficial thrombophlebitis
montior IV site daily, remove if sx develop, localized- NSAID and heat
anticoag prophylaxis if >5cm affected
Septic- urgent heparin treatment and Vanc + Ceftriaxone
Chronic venous insufficiancy
Compression stockings- 20-30 or higher, foot to knee
avoidance of prolonged standing, elevate LE at night
Ulceration- compression and wound care, percutaneous thermal ablation if recurrent
Venous thrombosis
LMWH, Warfarin, or oral anticoagulant
bacterial endocarditis
MRSA- Naf or Ocacillin IV or Cefazolin prosthetic valve- Nad or Oxacillin with rifampin and gentamicin, or Vanc
Viridians- penecillin G or ceftriaxone IV, can add gentamicin
enterococci- ampicillin or penecillin G IV plus gentamycin
HACEK- ceftriaxone
surgery- valve replacement if unresponsive to abs
dicontinue anticoagulant if prosthetic valve
Acute inflammatory pericarditis
activity restriction until symptom resolution, Cholchincine plus NSAID
Pericardial effusion
small- observe JVP and serial echocardiogram
Tamponade- urgent pericardiocentesis, cardiac surgery if needed
