Cardiovascular Flashcards
(50 cards)
side effects of procainamide
Hypotension. Other side effects include: myocardial depression, QRS/QT prolongation, V-fib, and torsade de
pointes.
side effects of lidocaine
Drowsiness, nausea, vertigo, confusion, ataxia, tinnitus, muscle twitching, respiratory depression, and psychosis.
ECG changes may be seen also.
dobutamine for CHF
Potent inotrope with some vasodilation activity, used when heart failure is not accompanied by severe hypotension.
Dobutamine decreases afterload and increases contractility.
dopamine for CHF
Vasoconstrictor and positive inotrope, is used to increase cardiac output, especially if shock is present.
tx for A flutter
Initiate A-V nodal blockade with -adrenergic or calcium channel blockers or with digoxin. If necessary, in a stable patient, attempt chemical cardioversion with a class IA agent such as procainamide or quinidine after digitalization. If such treatment fails, or if patient is unstable and requires immediate electrocardioversion, do so with 25–50 J. Sedation should be considered prior to electrical cardioversion.
tx for A fib
If patient is stable then control a fast ventricular rate with diltiazem bolus and/or IV infusion; consider digitalis, and if indicated, convert with procainamide, quinidine, or verapamil. Synchronized cardioversion at 100–200 J in an unstable patient requiring cardioversion. In a stable patient with a-fib of unclear duration, anticoagulation for 2–3 weeks should be considered prior to chemical or electrical cardioversion in order to decrease the chance of an
embolic stroke or other embolic problem.
causes of A fib
Hypertension, rheumatic heart disease, pneumonia, thyrotoxicosis, and ischemic heart disease are common causes.
Pericarditis, ETOH intoxication, PE, CHF, and COPD are other causes.
causes of SVT
digitalis toxicity (25% of digitalis induced arrhythmias), pericarditis, MI, COPD, preexcitation syndromes, mitral valve prolapse, rheumatic heart disease, pneumonia, drug and alcohol abuse.
most common cause of acute mesenteric icschemia
Arterial embolism 40–50%. Source is usually the heart, most often from a mural thrombus (recent MI often). Most
common point of obstruction is the superior mesenteric artery.
Buerger’s disease
thromboangiitis obliterans, an inflammatory, nonatheromatous occlusive condition
that causes segmental lesions and thrombus formation in medium and small arteries with less blood flow to the feet
and legs, usually in heavy smokers, males in their 20s and 30s; symptoms are usually claudication, pain, cold feet,
eventual redness or cyanosis of legs, may lead to gangrene and amputation
contraindications to beta blockers
CHF, variant angina, AV block, COPD, asthma (relative), bradycardia, hypotension, and insulin dependent diabetes mellitus (IDDM). Also, patients with recent cocaine use should not receive -blockers.
most common symptom of acute pericarditis
Sharp or stabbing retrosternal or precordial chest pain, and the pain increases when supine and decreases when
sitting-up and leaning forward. Pain may be increased with movement and deep breaths. Other symptoms include
fever, dyspnea described as pain with inspiration, and dysphagia.
physical findings of acute pericarditis
Pericardial friction rub is the most common. Rub is best heard at the left sternal border or apex in a sitting leaning
forward position. Other findings include fever and tachycardia.
s/s PE
Tachypnea (92%) Chest Pain (88%) Dyspnea (84%) Anxiety (59%) Tachycardia (44%) Fever (43%) DVT (32%) Hypotension (25%). Syncope (13%)
mitral stenosis: cause and symptom
The most common cause is rheumatic heart disease. The most common initial symptom is dyspnea.
acute mitral regurgitation
Most common cause is rupture of the chordae tendineae, rupture of the papillary muscles, or perforation of the valve leaflets. Common causes include AMI and infectious endocarditis.
aortic stenosis
Most common causes are rheumatic heart disease and congenital bicuspid valve. S/s
are syncope, angina, and left heart failure. As the disease progresses, systolic BP decreases and pulse pressure narrows.
s/s acute aortic regurgitation
Dyspnea, tachycardia, tachypnea, and chest pain. Causes include: infectious endocarditis, acute rheumatic fever,
trauma, spontaneous rupture of valve leaflets, or aortic dissection.
s/s chronic aortic regurgitation
Bobbing of the head with systole, bounding carotid pulse (water-hammer), pistol shot sound, the to-and-fro
murmur of Duroziez’s sign over the femoral arteries, and capillary pulsation of the nailbeds (Quincke’s sign).
most common cause of tricuspid stenosis
Rheumatic heart disease.
classic physical sign of endocarditis
A loud regurgitant heart murmur or a murmur that has changed in intensity or type.
what increases the risk for endocarditis
damaged or prosthetic heart valve
Janeway lesions
Purple-colored circular flat rashes (macules) on the palms or soles, due to embolic pieces of clot and infected
thrombi that break free of endocarditis and float to the distal circulation in the feet and hands. Other signs include
petechiae of the skin and mucous membranes and splinter hemorrhages under the nails.
meds used to lower BP in thoracic dissection
Sodium nitroprusside, propranolol, or labetalol. An arterial line should be considered to closely monitor the blood
pressure.
