Cardiology Flashcards
(206 cards)
1
Q
What is the most common cause of CHF
A
Coronary Artery Disease (CAD)
2
Q
What are the 3 forms of CHF
A
- Left vs. Right Sided
- Systolic vs. Diastolic
- High vs. Low Outlet
3
Q
What are common causes of left and right sided heart failure
A
Left sided: CAD and HTN
Right sided: Left HF, pulmonary disease
4
Q
What are the 3 compensatory mechanisms for HF
A
Increased preload
Increased afterload
Decreased contractility
5
Q
What happens to the kidneys in CHF
A
Decreased renal perfusion so they compensate
6
Q
How do the kidneys compensate with CHF and why
A
The kidneys aren’t getting enough blood, so they think the body is dehydrated
They stimulate the renin-angiotensin-aldosterone and ADH system
That results in fluid and sodium retention and fluid overload (central and peripheral) EDEMA
7
Q
What happens to the ventricles when preload increases (volume overload)
A
Ventricles dilate (leads to increase in BNP)
8
Q
List the steps in cycle resulting from poor cardiac function and fluid accumulation in the lung with hypoxemia
A
Acute LV systolic Dysfunction
Decreased myocardial contractility and CO
Catecholamine production (increases HR and BP)
Increase in SVR (Afterload) and BP
Increased myocardial wall tension and O2 demands
Leads to diastolic dysfunction, increased pulmonary artery and capillary hydrostatic pressures, hypoxia, and increases myocardial ischemia
9
Q
What disease processes are associated with low output HF
A
CAD Severe HTN Valvular disease Cardiomyopathy Dysrhythmias Massive PE
10
Q
What disease process are associated with high output HF
A
Increased metabolic demands
Thyroxicosis, severe anemia, AV fistula, Beriberi (thiamine deficiency), Paget’s Disease
11
Q
What symptoms are noted with Left HF
A
*Think about things that would result from fluid buildup in lungs due to increased pulmonary venous pressure**
Dyspnea, Orthopnea, paroxysmal nocturnal dyspnea, weakness, fatigue, tachycardia, basilar rales, Cheyne Stoke’s breathing
12
Q
What symptoms are noted with Right HF
A
JVSD, Peripheral edema, RUQ pain, Ascites, Hepatomegaly
13
Q
What is the most useful diagnostic test for CHF. What do you see?
A
Echo
Systolic and diastolic function, ventricular hypertrophy, wall motion abnormalities, valvular disorders
14
Q
What is the most important determinant in prognosis for CHF and how do you measure it.
A
Ejection Fraction, measured by Echo
Normal EF is 55-60
EF
15
Q
What are two other methods to Dx HF
A
CXR: Cardiomegaly, Cephalization, Kerley B lines, pleural effusions
BNP: Released due to volume overload
16
Q
What should all patients with CHF be placed on. Why?
A
Ace-I and Diuretic
17
Q
What two therapies have proven to improve OUTCOMES in CHF
A
Ace-I and Beta-Blocker
18
Q
What two therapies improve Sx in CHF
A
Nitrates and diuretics (loop or thiazide)
19
Q
What do Nitrates and diuretics do?
A
Decrease preload
20
Q
What do Ace-I do?
A
Decrease afterload and improve CO and improve renal perfusion
Decrease aldosterone production and potentiate other vasodilators
21
Q
What do Beta-Blockers do?
A
Decrease catecholamines
22
Q
What are examples of Positive Inotropes or Sympathomimetics
A
Digoxin, Dobutamine, Dopamine
23
Q
Management of CHF
think LMNOP
A
Lasix (Ace-I) Morphine Nitrates Oxygen Position (place upright to decrease venous return)
Also, Nesiritide which is a synthetic BNP and decreases RAAS activation which leads to sodium excretion
24
Q
What is the most common type of Cardiomyopathy
A
Dilated Cardiomyopathy
25
What results with dilated cardiomyopathy
Systolic dysfunction
Ventricles can't contract well so there is poor EF
Heart compensates by dilating
26
What are some causes of dilated cardiomyopathy
Idiopathic
Viral (Enterovirus like Coxsackie and Echovirus), Parvovirus
Alcohol abuse, Cocain
Pregnancy
27
What are some sx of dilated cardiomyopathy
HF sx: Weakness, SOB, peripheral edema, Crackles, S3, JVD
28
Dx of dilated cardiomyopathy
Echo: See LV dilation, reduced EF, regional or global LV hypokinesis
CXR: Cardiomegaly, curly B-lines
29
Tx of dilated cardiomyopathy
Think CHF
| Ace-I, Diuretics, Digoxin, Beta-Blockers
30
What do you do in dilated cardiomyopathy if EF
Add implantable defibrillator
31
What results in Restrictive Cardiomyopathy
Diastolic Dysfunction
Problem with filling
Fibrosis or infiltration of heart muscle, stiff, inflexible
32
What happens with EF in Restrictive Cardiomyopathy
Normal or near normal
33
What are causes of Restrictive Cardiomyopathy
Infiltrative Diseases like Amyloidosis, sarcoidosis
34
What are sx of Restrictive Cardiomyopathy
Think CHF
| Kussmaul's sign (increased JVP)
35
Dx of Restrictive Cardiomyopathy
Echo: Nondilated ventricles with normal wall thickness, some dilation of atria
CXR: Normal size heart or small
36
Tx of Restrictive Cardiomyopathy
Treat sx: Diuretics and vasodilators
37
What is happening in Hypertrophic Cardiomyopathy
```
Thickened ventricles (usually left)
Has components of both systolic and diastolic dysfunction
```
38
Sx of Hypertrophic CArdiomyopathy
Sometimes none! Could result in sudden cardiac death (due to V.fib)
Dyspnea, Angina, Syncope, Arrhythmias
39
How can you increase the sound of a murmur
Valsalva maneuver
| It decreases the volume in the LV while creating turbulent flow
40
How can you decrease the sound of a murmur
Squatting, First Clench
| Increases peripheral vascular resistance so dilates aorta and creates less turbulent flow
41
Dx of Hypertrophic Cardiomyopathy
Echo: Assymetric wall thickness, especially septal, systolic anterior motion of mitral valve
EKG: LVH
CXR: Cardiomegaly
42
Tx of Hypertrophic Cardiomyopathy
```
Avoid strenuous exercise
Beta Blockers are 1st line
CCB, Disopyramide (all 3 are negative inotropes)
Surgery: Myomectomy
Alcohol Septal Ablation
```
43
What is P-Wave
The beat goes through the atrium
44
What is the PR segment
Beat goes through the AV node
45
What is QRS
Rapid contraction through ventricle
46
What is a T wave
Ventricular Repolarization
47
What is a normal sinus rate
>60bpm
48
What is Atrial Fibrillation
Irregularly Irregular Rhythm
| No P waves seen
49
Tx for A.Fib
Rate control: Vagal maneuver, CCB or B-Blocker
| Cardioversion may be done BUT need to anticoagulate for 3-4 weeks before doing so so they don't throw a clot
50
What are the components of the CHADS2 criteria, and what is it measuring. Tx based on score.
```
Measuring stroke risk
C: CHF
H: HTN
A: Age>75
D: DM
S2: Stroke, TIA, Thrombus (2points)
High risk: >2 need to place on Warfarin
Moderate risk: 1. Warfarin or ASA
Low Risk: 0. No tx or ASA
```
51
What are the EKG findings for a 1st degree AV block
1 p for every QRS
| PR intervals are prolonged but they are constant
52
Tx for 1st degree AV block
Nothing. They're usually age related, effects of meds, myocarditis, etc.
53
What are the EKG findings for a Type I 2nd degree AV block, and what is another name for this type of block
Mobitz I, Wenkebach
P-waves are constant
PR intervals gradually increase and eventually lead to a dropped QRS complex
54
What causes a Type I 2nd degree AV block
Heightened vagal tone, normal variant, inferior wall ischemia, tends to be transient
55
Tx for Type I 2nd degree AV block
Atropine, Epinephrine, Pacer
56
What are the EKG findings for a Type II 2nd degree AV block, and what is another name for this type of block
Mobitz II
P-waves are constant
PR intervals are constant but there is a dropped QRS complex
Random drop in QRS complex
57
What causes a Type II 2nd degree AV block
MI, usually anterior MI
58
Tx for Type II 2nd degree AV block
Pacer
59
What are the EKG findings for a 3rd degree AV block, and what type of block is this
Complete heart block
P waves are not related to QRS
All P's are not followed by QRS (results in reduced CO)
PR intervals vary - no apparent association with P-waves and QRS complexes
60
What are causes of 3rd degree AV block
MI, usually inferior (narrow QRS), or anterior (wider QRS)
61
What does the QRS complex tell you in the a 3rd degree AV block regarding prognosis
Narrow QRS: Good prognosis
| Wide QRS: Worse prognosis
62
Tx for a 3rd degree AV block
Pacer
63
Summarize 1st, 2nd, and 3rd degree heart blocks
1st degree: A p-wave is being conducted but slower than we would want. This is ok because every signal is making it through at a predictable manner, so no tx.
2nd degree: Most P-waves are being conducted
2nd degree Type I: QRS is dropped due to progressive elongation of PR intervals. This is in a predictable manner, so not as concerning. Tx is Atropine and Pacer
2nd degree Type II: QRS is dropped randomly, PR intervals are all the same size. Random pacing means poor perfusion. This needs to be tx with a pacer
3rd degree heart block: No p-waves are making it through, meaning conduction system is relying on AV node or ventricles, which is too slow to perfuse appropriately. Tx is pacer
64
What is the risk with Atrial Fibrilliation
The atrial are not contracting, so blood is stagnant there and CLOTS can form
65
What is the definitive tx for A.Fib
Catheter ablation to get rid of the accessory pathways
66
What is Ventricular Fibrillation
Ventricles are not contracting
No QRS
This is incompatible with life
67
Tx for V.Fib
Shock, Cardiovert
68
What is Torsades de Pointes and how do you treat.
Sin curve seen on EKG
Precursor to V.Fib if not tx
Tx: IV magnesium
69
What can you see with Torsades de Pointes on EKG
QT Prolongation
| Sin-curve
70
What is Atrial Flutter. What do you see on EKG
When the atrium is contracting too quickly
Both Atrium and Ventricle contract
EKG: Saw-tooth waves, no P-waves
71
What is a risk with Atrial Flutter
Clots
72
TX for Atrial Flutter. Definitive Tx
Vagal maneuvers, CCB, Beta-Blockers
| Definitive: Ablation
73
What is Wolff-Parkinson-White
Accessory signal present that is not allowing appropriate repolarization before the next depolarization signal comes through
74
What do you see on EKG with WPW
Delta Waves
75
What is a risk with WPW
Arrhythmia
76
What is happening in Supraventricular Tachycardia
A signal is coming from above the ventricles, so could be the AV node or the Atria
77
What do you see in SVT
Narrow QRS
78
Tx for SVT
Valsalva
Drugs: Beta-Blockers or CCB
They shut down the parasympatehtic conduction at AV node
79
What is the difference between ischemia and infarct and how do each look on an EKG
Ischemia: Tissue Obstruction. ST depressions
Infarct: Tissue Death. ST Elevation
80
What is a RBBB and what do you see on EKG
Delay in electrical signal at right side of bundle branch
| See Wide Positive QRS in Leads V1, V2
81
What is LBBB and what do you see on EKG
Delay in electrical signal at left side of bundle branch
| See Wide Negative QRS in leads V4-V6. Also see a notch or "fork" at the top of the QRS complex in V6
82
What do you see on EKG with LVH
Large QRS Complex (tall peaks)
83
What is a murmur
An extra sound during the cardiac cycle associated with TURBULENT FLOW
84
What is happening in Aortic Stenosis and what are some problems associated with it
LV outflow obstruction
| Can lead to LVH
85
Describe the murmur heard
Systolic Ejection Crescendo-Decrescendo at the Right Upper Sternal Border
86
Where does an aortic stenosis murmur radiate to
Carotid Arteries
87
What are sx associated with Aortic Stenosis
Angina, Syncope, CHF
88
Tx for Aortic Stenosis
Surveillance if no sx
| If sx, aortic valve replacement
89
What is Mitral Regurgitation and what are complications
Backflow from the LV to LA
| Can lead to LV volume overload, so decreased CO
90
What type of murmur is heard with Mitral Regurgitation
Blowing holosystolic Murmur heard best at the Apex
91
Where does a Mitral Regurgitation murmur radiate to
Axilla
92
Sx with Mitral Regurgitation
Acute: Pulmonary Edema, Dyspnea
Chronic: A.Fib, CHF
93
What are maneuvers to increase/decrease the sound of a murmur associated with Mitral Regurgitation
Increase: Handgrip
Decrease: Amyl Nitrate
94
Tx for Mitral Regurgitation
Meds: Ace-I (vasodilators that decrease afterload and can increase forward flow)
Surgery: Valve repair
95
What is happening in Mitral Valve Prolapse
Degeneration of the mitral valve which makes it floppy
96
What type of murmur is heard with a Mitral Valve Prolapse
Missystolic Ejection Click at the Apex
97
How can you increase/decrease the sound of a murmur with Mitral Valve Prolapse
Decrease Venous Return via Valsalva, Standing, or Inspiration causes longer murmur duration
98
Sx with Mitral Valve Prolapse
Most are asymptomatic
Autonomic Dysfxn: Chest pain, Panic Attacks, Arrhythmias
If Progresses: Fatigue, dyspnea, CHF
99
What happens in Mitral Stenosis
Obstruction from LA to LV
| Leads to LA Enlargement and increases LA pressure, results in Pulmonary HTN
100
What type of murmur is heard with Mitral Stenosis
Diastolic Rumble at the Apex, may be preceded by opening snap
101
Sx with Mitral Stenosis
R-sided HF, Pulmonary HTN, A.Fib, Mitral Facies
102
Tx with Mitral Stenosis
Valvotomy in young people if rheumatic heart disease is cause
Valve repair in adults
103
What is happening with Aortic Regurgitation
Backflow from the aorta to LV
| Leads to LV volume overload
104
What murmur is heard with Aortic Regurgitation
Diastolic Decrescendo Blowing at Left Upper Sternal Border
105
What do you decrease/increase the sounds of a murmur in Aortic Regurgitation
Increase the murmur with handgrip
| Decrease the murmur with Amyl Nitrate
106
Where does an Aortic Regurgitation murmur radiate to
Left Sternal Border
107
Sx of Aortic Regurgitation
Left Sided HF (Pulmonary HTN)
108
Tx of Aortic Regurgitation
Vasodilators that will decrease afterload and increase forward flow (Ace-I)
Surgery
109
What is happening with Atrial Septal Defect
Hole in the atrial septum
110
What shunt results in ASD, is there cyanosis
Left to right shunt
| No Cyanosis
111
What type of murmur is heard with ASD
Systolic ejection crescendo-decrescendo flow at Pulmonic area (LUSB)
112
Sx of ASD
Asymptomatic until adulthood usually
Kids: Recurrent URI
Adults: Exertional dyspnea, easy fatigability, palpitations, syncope, HF
113
Tx of ASD
Surgical Correction
| Spontaneous Closure
114
Where is the area of infarct with ST elevations in V1-V4. What artery is involved
Anterior
| Left Anterior Descending
115
Where is the area of infarct with ST elevations in I, aVL, V5 and V6. What artery is involved
Lateral
| Circumflex
116
Where is the area of infarct with ST elevations in I, aVL, V4, V5, V6. What artery is involved
Anterolateral
| Mid LAD or Circumflex
117
Where is the area of infarct with ST elevations in II, III, aVF. What artery is involved
Inferior
| Right Coronary Artery
118
Where is the area of infarct with ST DEPRESSIONS in V1-V2. What artery is involved
Posterior
| RCA, Circumflex
119
What causes atherosclerosis
Lipid deposition, calcification, plaque formation in vessels
120
What are modifiable risk factors with atherosclerosis
Diabetes
Cigarette Smoking
HTN
Hyperlipidemia
121
What constitute a dx for Metabolic syndrome
```
3 or more
Abdominal obesity
Trg>150
HDL110
HTN
```
122
What falls under Acute Coronary Syndromes
Unstable Angina
NSTEMI
STEMI
123
What is Angina
Imbalance between myocardial oxygen demand and myocardial oxygen delivery
124
Sx of Angina
Subseternal chest pain, Chest tightness, Radiation to neck or Jaw, Dyspnea, Nausea/Vomiting, Diaphoresis, Levine's Sign
125
What is Stable Angina
Regular pattern of angina exacerbated by physical or emotional stress
Relieved with rest within minutes
Relieved with NTG within minutes
126
Dx of Stable Angina
History
127
Tx of Stable Angina
Modify RF, low fat low cholesterol diet
| Meds: Nitrates, Beta-Blockers, CCB
128
What is first line acute management for Stable Angina
NTG
129
What is first line chronic management for Stable Angina
Beta-Blockers
130
What is the classic regimen for someone with Angina
Daily ASA, Sublingual NTG as needed for pain, Daily Beta-Blockers, and Statin if LDL is increased
131
What causes Acute Coronary Syndrome
Ruptured coronary plaques that lead to bleeding, platelet aggregation, and thrombus formation
May slo be caused by cocain-induced or prinzmetal's variant angina
132
What is Unstable Angina
New onset of angina symptoms
Increased intensity of stable angina
Increased frequency of angina
Subtotal occlusion of vessels that lead to severe sx without infarction
133
What is an MI
Complete occlusions of vessels
| NSTEMI and STEMI
134
Sx of an MI
Pain is more prolonged, not relieved with rest or NTG
Note that 1/3 of pts don't have pain, instead only come in with dyspnea, diaphoresis, nausea, weakness (Diabetics, women, obses pts)
Tachycardia, bradycardia, CHF, Hypotension, new murmur
Post-MI Pericarditis with friction rub may occur after 24 hours
135
What are some common EKG findings with an MI
```
T-Wave Abnormalities
ST-segment depression:Ischemia
ST-Segment elevation:Infarction
Q-waves: Infarction
V1-V2: Septal or Posterior
V3-V4: Anterior
V5-V6, I, aVL: Lateral
II, III, aVF: Inferior
V1-V2 with depressions:Posterior
```
136
What are common biomarkers seen in MI
Myglobin
CPK-MB
Troponin, Troponin, Troponin!
137
When does Troponin rise, peak, and normalize
Rise: 4-6 hours
Peak: 18-24 hours
Normalizes: 7-10 days
138
What is the gold standard for an MI workup
Coronary Angiography
139
What other dx modalities can be used in MI
CXR, Echo, Stress testing
140
TX of Unstable Angina and NSTEMI
1. Antithrombotic Therapy
| 2. Adjunctive Therapy
141
Tx for STEMI
1. Reperfusion Therapy
2. Antithrombotic Therapy
3. Adjunctive Therapy
142
What is part of Antithrombotic Therapy
```
These PREVENT clots
ASA: prevents platelet aggregation
Heparine
Clopidogrel:
Glycoprotein (for people going cath lab)
```
143
What are common Adjunctive Therapies
Beta Blockers: Metoprolol
Nitrates
Morphine
CCB
144
What is a common Reperfusion Therapy in STEMI. And how soon should they be started
Primary Percutaneous Coronary Intervention - do it if it's within 90 minutes
Fibrinolytics - Do within 30 minutes
145
What are common Thrombolytic Therapies (Fibrinolytic)
These DISSOLVE clots
Tissue Plasminogen Activators: Alteplase (rTPA)
Streptokinase
146
What is common Adjunctive Therapy in STEMI
```
Beta-Blockers
Ace-I
Nitrates
Morphine
Statin therapy if high LDL
```
147
What is a complication of MI
Heart Failure
Ventricular Fibrillation
Dressler's Syndrome: Post-MI pericarditis (1-2 months after) associated with fever and pulmonary infiltrates
148
What is an anuerysm
Abnormal dilation of the aorta
149
What is the most common cause for an aneurysm
Atherosclerosis
150
What are 2 common RF for Anuerysms
Smoking and COPD
151
Sx of Anuerysm
Asymptomatic until large or rupture
Scenario: Older male with severe back pain or abdominal pain who presents with syncope or hypotension with tender pulsatile abdominal mass
Flank Ecchymosis
152
Dx of Aneurysms
Abdominal ultrasound
CT scan for thoracic
Angiography
153
What is the gold standard for dx of Anuerysms
Angiography
154
Tx of Aneurysms. What is definitive tx.
Definitive: Surgery
3-4cm: monitor every year with ultrasound
4-4.5cm: Monitor every 6 months
>4.5: Vascular surgeon referral
>5.5 or expansion in 6 months: Immediate surgery
155
What is an Aortic Dissection
Tear in the innermost layer of aorta
156
What is RF for aortic dissection
HTN, Age, Connective Tissue Disease (Marfans)
157
Sx of Aortic Dissection
Acute onset
Severe tearing ripping pain in upper chest or back
Decreased peripheral pulses: Variation in pulses between left and right arm
158
Dx of Aortic Dissection. What is the gold standard
Gold Standard: MRI Angiography
| CXR, CT with contrast
159
Tx for Type A vs. Type B
Type A: Tear in ascending and descending. Tx: Surgery
| Type B: Tear in descending only. Tx: Meds with Beta Blockers (Labetalol) with sodium nitropurisside if needed
160
What causes Peripheral Artery Disease
Atherosclerosis
161
Sx of Peripheral Artery Disease
Pain with exertion (walking), intermittent claudication, Ulcerations
162
What happens with an arterial embolism/thrombosis
Acute occlusion of an artery
163
What are common sources for emobli or thrombi
Heart and Aorta
164
Tx for emboli/thrombosis
Revascularize
165
What are sx for Acute Occlusion (6 P's)
Pain, Pallor, Pulselessness, Paresthesias, Poikilothermia, Paralysis
166
Dx for Acute Occlusion
Arterial Duplex, MRA, CTA, ABI, Angiography
167
What is Giant Cell Arteritis
Vessel Inflammation of medium/larger arteries
168
What is Giant Cell Arteritis commonly associated with
Polymyalgia Rheumatica
169
What is another name for Giant Cell Arteritis
Temporal ARteritis
170
Sx with Giant Cell Arteritis
Headache, scalp tendernes, jaw claudication, sore throat, visual loss
171
Dx of Giant Cell Arteritis
Elevated ESR/CRP
Temporal Artery Biopsy: see mononuclear lymphocyte infiltration, multinucleated giant cells
Clinical DX!
172
Tx of Giant Cell Arteritis
Steroids and referral to ENT
173
What is a complication of Giant Cell Arteritis
Blindness
174
What is Phlebitis/Thrombophlebitis
Inflammation of the superficial vein and venous occlusion/inflmmation
175
What is Phlebitis associated with
IV cath, Trauma, Pregnancy
176
Sx of Phlebitis
Pain, Tenderness, Edema, Redness, Induration, Palpable Cord
177
Dx of Phlebitis
Venous Duplex Ultrasound
178
Tx of Phelbitis
Supportive: Elevation, warm compress, NSAIDS, Compression stocking
If Septic: Abx
Vein Ligation/Excision
179
What are Varicose Veins
Dilated, Tortuous superficial veins seen with increased estrogen like OCP or pregnancy
180
Sx of Varicose Veins
Asymptomatic or mild ache
181
Tx of Varicose Veins
Stockings, Elevation, Intervention techniques
182
What is Chronic Venous Insufficiency
Vascular incompetency of either deep and/or superficial veins
183
When does Chronic Venous Insufficiency usually occur
DVT or Trauma
184
Sx of Chronic Venous Insufficiency
Leg pain worse with prolonged sitting, improved with leg elevation or walking
Edema, Stasis, Dermatitis
VENOUS STASIS ULCER: usually at MEDIAL malleolus
Atrophic Blanche
185
Dx of Chronic Venous Insufficiency
Ankle/Brachial Index
| Trendelenburg Test, Ultrasound
186
Tx of Chronic Venous Insufficiency
Compression: Leg elevation, stockings, exercise, Una boot
If ulcers: wet to dry dressings, skin grafting, hyperbaric O2
Venous valve transplant
187
What is a Venous Thrombus
DVT
188
What are RF for DVT
Virchow's Triad: Venous stasis, endothelial damage, hypercoagulability
189
Sx of DVT
Unilateral swelling/edema of lower extremity
| Calf Tenderness, Phlebitis (local warmth, erythema, palpable cord)
190
Dx of DVT
Venous Duplex Ultrasound is #1
D-Dimer
Venograph is Gold Standard
191
RF of DVT
Surgery, Travel, Genetics, Pregnancy
192
Tx of DVT
Anticoagulation Therapy: Heparin, LMWH, Warfarin for 3-6 months
193
What is a TIA
Sudden onset focal neurologic deficits, usually due to emobuls
194
Sx of TIA
Short interval of vision, speech, weakness, sensory abnormalities
Internal Carotid: Monocular visual loss, temporary "lamp shade" over one eye, weakness in contralateral hand
195
Dx of TIA
CT
| Carotid Doppler, CT Angiography, Serum Glucose
196
Tx of TIA
ASA Plavix (antiplatelet therapy), No Thrombolytics, Place supine to increase cerebral perfusion
197
What is a Stroke
Neruologic deficits due to ischemia or hemorrhage
198
Sx of Ischemic Stroke
Correlate with vessel involved (anterior vs. posterior circulation)
199
Dx of Ischemic Stroke
Noncontrast CT
MRA/MRI
CT Perfusion/CTA
CBC, Coag studies, EKG
200
Tx of Ischemic Stroke
```
Reverse Ischemia/Salvage brain tissue
Thrombolytic therapy (tPA) within 3 hours
Antiplatelet Therapy (ASA, Plavix)
```
201
Most common cuase for Hemorrhagic stroke
HTN
202
Dx of Hemorrhagic Stroke
Noncontrast CT
203
Tx of Hemorrhagic Stroke
Supportive, BP control
204
Sx of Subarachnoid Hemorrhage
Acute onset "worst headache of my life", syncope, nausea/vomiting, nuchal rigidity
205
Dx of Subarachnoid Hemorrhage
CT
| If CT negative but high suspicion do LP
206
Tx of Subarachnoid Hemorrhage
Supportive (no exertion, stool softener, anti-anxiety meds)
