1
Q
- Stage 1 HTN SBP <130-139 DBP <80-89
- Stage 2 HTN SBP >140 DBP >90
- B/P elevated over 3 or more separate occasions
A
Hypertension
2
Q
- SBP >220 or DBP >125 mmHg
- NO signs of end organ damage
A
HTN Urgency
3
Q
- SBP >220 or DBP >125 mmHg
- Signs of end organ damage: Mental status changes, confusion, headache, intracranial hemorrhage, ischemic stroke, proteinuria, hematuria, progressive kidney dysfunction, unstable angina, AMI, CHF, aortic dissection, pulmonary edema
A
HTN Emergency
4
Q
- Angina
- Left shoulder pain
- Indigestion
- Nausea/Vomiting
- Pale
- Diaphoresis
- New heart murmur
- Rales on pulmonary expiration
- S3, S4
- Sudden cardiac death
A
Coronary Artery Disease
5
Q
- Claudication (cramping in leg)
- Diminished femoral, popliteal, or pedal pulses
- Tissue ulceration and gangrene
- Erectile dysfunction
- Loss of hair
- Thinning and cool skin
- Muscle atrophy
- Ankle Brachial Index <0.9
A
Pulmonary Artery Disease
6
Q
- Sudden onset of extremity pain with loss or reduction of pulses
- Numbness or paralysis
- 6 P’s: Pain, Pallor, Poikolothermia, Pulselessness, Paresthesia, Paralysis
A
Acute Arterial Occlusion of a Limb
7
Q
- Neurological deficits that last over 24 hours, deficits depend upon which blood vessel the thrombus or emboli is lodged in. Can range from facial asymmetry, to paralysis of the entire upper and lower half of the body to dizziness and ataxia
- Carotid Bruits
A
Occlusive Cerebrovascular Disease
8
Q
- AMI can be the presenting symptom
- High Triglyceride level (>1000mg/dl) can cause formation of eruptive Xanthomas especially on the buttocks
- High Triglyceride level (>2000mg/dl) can cause Lipemia retinalis and can precipitate acute pancreatitis
- High LDL concentrations can lead to tendinous Xanthomas on certain tendons (Achilles, patella, and back of hand)
A
Dyslipidemia
9
Q
- HR <60 bpm
- Severe bradycardia <45 bpm may cause weakness, chest pain, lightheadedness, N/V, confusion, or syncope
A
Sinus Bradycardia
10
Q
- HR >100
- HR infrequently exceeds 150 beats/min
A
Sinus Tachycardia
11
Q
- HR 150-240
- May be asymptomatic
- Frequently associated with palpitations, mild chest pain, or SOB
- Episodes begin and end abruptly
- May cause syncope, May cause AMI
- EKG shows Regular R-R interval, Narrow QRS complex, P wave buried in the narrow QRS complex
A
Paroxysmal Supraventricular Tachycardia (PSVT)
12
Q
- HR 150-240
- Palpations, mild chest pain, or SOB
- EKG shows short PR interval (<0.12 seconds)
- Wide, slurred QRS complex called a delta wave
A
Wolf Parkinson White Syndrome (WPWS)
13
Q
- Palpitations
- Dyspnea on exertion
- Lightheadedness
- Fatigue
- Weakness
- Chest pain
- EKG shows an R-R interval that is irregularly irregular
- Atrial rate 400 bpm and presents as fibrillation waves (wavy baseline)
A
Atrial Fibrillation (A fib)
14
Q
- Palpitations
- Dyspnea on exertion
- Lightheadedness
- Fatigue
- Weakness
- Chest pain
- EKG will show saw-tooth flutter waves between QRS complexes
- Atrial rate between 250-350 bpm
A
Atrial Flutter
15
Q
- Usually asymptomatic
- Palpitations
- Dizziness
- EKG shows wide QRS complex without a preceding P wave
- Occurs before the next predicted QRS complex is set to occur
A
Premature Ventricular Contraction (PVC)
16
Q
- Asymptomatic
- Syncope
- Milder symptoms of impaired cerebral perfusion - confusion, AMS
- Common misconception that patients with VTACH always appear unstable
- EKG shows wide QRS complex (>0.12 seconds) ““TOMBSTONE””
- Absence of p waves
- Tachycardia, usually HR 160-240 bpm
- Moderately regular R-R interval
A
Ventricular Tachycardia
17
Q
- Pulseless
- Hypotensive
- Unconsciousness
- If PT is awake and responsive with this rhythm, CHECK EKG LEADS
- EKG shows fine to course zigzag pattern without p waves or QRS complexes
A
Ventricular Fibrillation
18
Q
- Palpitations
- Lightheadedness, dizziness
- Hypotension
- Syncope
- Sudden cardiac death
- EKG will show >100 bpm
- Wide QRS complex (>0.12 seconds)
- Frequent variations of the QRS axis, morphology, or both
A
Torsade de Pointes
19
Q
- Pulseless VTACH
- VFIB
- Asystole
- Pulseless Electrical Activity
- EKG will be rhythm dependent
A
Cardiopulmonary Arrest
20
Q
- Substernal chest pain
- "”Elephant”” sitting on chest
- CP radiating to left shoulder, left arm, neck, or jaw
- Diaphoresis
- Nausea and Vomiting
- Anxiety
- Intense feeling like they are going to die
- Weakness or dizziness
- Dyspnea
- LEVINE’s SIGN - anxious, diaphoretic, clinching fist over their chest
- Bradycardic or tachycardic depending on what area of heart is having the infarct
- Elevated BP or Decreased BP and in shock
- Can hear a new heart murmur
- Respiratory distress indicates heart failure
- EKG: NSTEMI may show ST segment depression, T wave inversion, or no changes at all, STEMI will show a classic ST segment elevation, T wave inversion, and finally Q wave development(which represents scar tissue)
A
Acute Coronary Syndrome (ACS) Unstable Angina/Acute MI
21
Q
- Chest pain
- RULE OUT “BIG 6”: Acute MI/Unstabe Angina, Pulmonary Embolism, Pericardial Tamponade, Esophageal Rupture, Tension Pneumothorax/Pneumothorax, Aortic Dissection/Rupture
A
Chest Pain/Angina
22
Q
- LEFT SIDED SX - Dyspnea, orthopnea, Dyspnea on exertion, Pulmonary edema, chronic non-productive cough, exercise intolerance, fatigue
- LEFT SIDED FINDINGS - crackles in base of lungs, pleural effusions, expiratory wheezing or rhonchi, enlarged sustained LV impulse, decreased S1, murmurs, S3, hypoxemia, displaced apical impulse (if LVH or dilated)
A
Left Sided Congestive Heart Failure
23
Q
- RIGHT SIDED SX - Fluid retention, peripheral edema, hepatic congestion, abdominal ascites
- RIGHT SIDED FINDINGS - JVD, elevated JVP, Hepatomegaly, Ascites, peripheral pitting edema
A
Right Sided Congestive Heart Failure
24
Q
- Sudden severe chest pain radiating to back, often described as a ripping or tearing pain
- Hypertension
- Syncope
- Paralysis of lower extremities
- Diminished or unequal peripheral pulses
- Possible diastolic murmur or Aortic Regurgitation
A
Dissecting Aortic Aneurysm
25
* Substernal chest pain which is usually pleuritic(sharp), possible radiation to neck, shoulder, or arm
* Pain is worse when supine relieved by sitting up and leaning forward
* Fever
* Pericardial friction rub is most common sign (Velcro, crunching snow)
Pericarditis
26
* Fever
* SINUS TACHYCARDIA our of proportion to TEMPERATURE
* Retrospinal chest pain
* Excessive fatigue or exercise intolerance
* S3,S4
* Pericardial friction rub if pericarditis is also present
* In severe cases signs of progressive congestive heart failure may be seen
Myocarditis
27
* Fever
* Non specific symptoms; cough, dyspnea, arthralgias, abdominal, back, or flank pain
* Characteristic peripheral lesions caused by emboli: petechia on palate, conjuctiva or beneath fingernails, splinter hemorrhages, janeway lesions, oslers nodes, roth spots
* New onset heart murmur; any new heart murmur with a fever is Endocarditis until proven otherwise
Endocarditis
28
* BECKS TRIAD - Muffled heart sounds, Jugular venous distension, Hypotension unresponsive to fluid challenge
* Tachycardia
* Chest pain
* Tachypnea
* Hypotension
* Pulsus Paradoxus: \>10mmHg fall in SBP during inspiration
Pericardial Tamponade
29
* Chest wall pain
* Broken ribs, chest wall contusion with ecchymosis
* Tachycardia disproportionate to degree of trauma
Cardiac Contusion
30
* VIRCHOW'S TRIAD - Venous Stasis, Hypercoagulable state, Injury to vessel wall
* Pain, redness, swelling, warmth, and tenderness
* Homan's sign (unreliable)
* If unilateral leg swelling, then you MUST rule out DVT, or transfer
Deep Vein Thrombosis
31
* Can be very difficult to make a clinical diagnosis
* Chest pain, tachypnea, and tachycardia
* Hypoxemia (SPO2 will be low)
* SOB
* Signs of DVT
Pulmonary Emobolism
32
* Prodromal Symptoms; blurring of vision, dizziness, pallor, nausea, vomiting, diaphoresis, seeing stars/spots
* Positive tilt test would indicate ORTHOSTATIC SYNCOPE
* Cardiac syncope; listen for murmurs, S3, S4
Cardiac Syncope
FEP MDT S/Sx's
flashcards
Decks in class (11)
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