Cardiovascular Flashcards
(183 cards)
1
Q
Dilated Cardiomyopathy
cause
A
idiopathic; viral myocarditis; alcohol toxicity; post-partum, genetics
2
Q
Dilated Cardiomyopathy
s/s
A
left congestive heart failure, dyspnea; S3 gallop, pulmonary rales, increased JVD
3
Q
Dilated Cardiomyopathy
dx
A
echocardiogram (left ventricular dilation and dysfunction, large ventricular chamber, decreased ejection fraction); CXR (cardiomegaly, pulmonary congestion); EKG (nonspecific ST/T wave changes); nuclear studies, cardiac cath
4
Q
Dilated Cardiomyopathy
tx
A
ACE, diuretics, BB, cardiac transplant, digoxin; alcohol cessation
5
Q
Hypertrophic Cardiomyopathy cause
A
genetics (asian), elderly, young athletes
6
Q
Hypertrophic Cardiomyopathy s/s
A
dyspnea, angina; syncope, arrhythmias; sudden cardiac death; sustained PMI, loud S4 gallop, variable systolic murmur, bisferiens carotid pulse, jugular venous pulsations
7
Q
Hypertrophic Cardiomyopathy dx
A
echocardiogram (LVH, asymmetric septal hypertrophy, small left ventricle, diastolic dysfunction); EKG (nonspecific ST/T wave changes, exaggerated septal Q waves, LVH)
8
Q
Hypertrophic Cardiomyopathy tx
A
BB, CBB; disopyramide; surgical ablation of septum, dual-chamber pacing
9
Q
Restrictive Cardiomyopathy cause
A
fibrosis or infiltration of ventricular wall because of collage-defect diseases (amyloidosis, radiation, post-op changes, DM, fibrosis)
10
Q
Restrictive Cardiomyopathy s/s
A
decreased exercise tolerance; right sided congestive heart failure; pulmonary HTN
11
Q
Restrictive Cardiomyopathy dx
A
echocardiogram (diagnostic); CXR (enlarged cardiac silhouette); EKG changes; Cardiac MRI; cardiac cath (reduced LV function); endomyocardial biopsy (r/o other cardiomyopathies and pericarditis)
12
Q
Restrictive Cardiomyopathy tx
A
diuretics
13
Q
Takotsubo Cardiomyopathy (broken heart syndrome) cause
A
stress-induced; major catecholamine discharge
14
Q
Takotsubo Cardiomyopathy (broken heart syndrome) s/s
A
indistinguishable from acute MI
15
Q
Takotsubo Cardiomyopathy (broken heart syndrome) dx
A
EKG changes, mild cardiac enzyme elevation suggestive of MI; cardiac cath (hypocontractility of left ventricular apex, patent coronary arteries)
16
Q
Takotsubo Cardiomyopathy (broken heart syndrome) tx
A
supportive; avoid inotropes
17
Q
Atrial Fibrillation cause
A
age; excessive alcohol use/withdrawal; structural abnormality
18
Q
Atrial Fibrillation s/s
A
palpitations, angina, fatigue, heart failure symptoms; irregularly irregular
19
Q
Atrial Fibrillation dx
A
EKG (narrow-complex irregularly irregular rhythm)
20
Q
Atrial Fibrillation tx
A
cardioversion (200 J; adenosine); anticoagulants (heparin, LMWH, warfarin, dabigatran); antiarrhythmics w/ heart failure (digoxin, amiodarone, dronedarone); w/o heart failure (metoprolol, diltiazem/verapamil)
21
Q
Atrial Flutter cause
A
COPD, heart failure, atrial septal defect, CAD
22
Q
Atrial Flutter s/s
A
palpitations, angina, fatigue, heart failure symptoms
23
Q
Atrial Flutter dx
A
○ EKG (saw tooth pattern; no P waves)
24
Q
Atrial Flutter tx
A
cardioversion (50 J; ibutilide); anticoagulants (heparin, LMWH, warfarin, dabigatran); antiarrhythmics (amiodarone, procainamide); chronic (metoprolol, diltiazem/verapamil)
25
Atrioventricular Block cause
refractory conduction of impulses from atria to ventricles through AV node or bundle of HIS
26
Atrioventricular Block s/s
asymptomatic (1st degree); weakness, fatigue, light-headedness, syncope
27
Atrioventricular Block dx
EKG
■ 1st degree block: PR interval is >0.21s
■ 2nd degree block type 1 (Wenckebach): progressive lengthening of PR interval, shortening of RR, dropped beat
■ 2nd degree block type 2: normal length PR interval, dropped beat
■ 3rd degree block: complete dissociation between P waves and QRS intervals
28
Atrioventricular Block tx
no treatment (1st degree); permanent pacing (esp type 2 and 3rd degree)
29
Bundle Branch Block cause
myocardial infarctions; CAD
30
Bundle Branch Block dx
EKG
■ RBBB: wide QRS >.12s; RsR in V1/ V2 (“m”)
■ LBBB: wide QRS >.12s; broad slurred R in V5/V6, deep S in V1; ST elevations in V1-V3
31
Sick Sinus Syndrome cause
digitalis, CCB, BB, sympathologic agents, antiarrhythmic drugs, aerosol propellant abuse; underlying collagen vascular or metastatic disease, surgical injury, coronary disease
32
Sick Sinus Syndrome s/s
asymptomatic; syncope, dizziness, confusion, heart failure, palpitations, decreased exercise tolerance
33
Sick Sinus Syndrome dx
EKG (sinus brady, sinus pause, sinus arrest)
34
Sick Sinus Syndrome tx
permanent pacing
35
Paroxysmal Supraventricular Tachycardia cause
not structural, Wolff-parkinson white syndrome
36
Paroxysmal Supraventricular Tachycardia s/s
palpitations, angina, fatigue, heart failure symptoms
37
Paroxysmal Supraventricular Tachycardia dx
EKG (regular, p wave, narrow-complex tachy)
38
Paroxysmal Supraventricular Tachycardia tx
valsalva maneuvers; adenosine IV push -> BB/CBB; synchronized cardioversion prn; catheter ablative surgery (recurrent/sustained)
39
premature beats
PAc, PJC, PVC
40
PAC's
benign; no treatment required
41
PJC
drug toxicity, electrolyte imbalance, mitral valve surgery, cold water immersion
42
PVC
benign; ischemia, electrolyte disturbance; skipped beats; BB/CBB
43
Ventricular Tachycardia cause
electrolyte abnormalities; acute MI; dilated cardiomyopathy
44
Ventricular Tachycardia s/s
palpitations; dizziness, syncope, sudden death; severe hypotension
45
Ventricular Tachycardia dx
EKG (>100bpm w/ 3 PVCs, nonsustained <30s vs sustained >30s)
46
Ventricular Tachycardia tx
cardioversion (amiodarone) vs defibrillation/CPR; lidocaine, procainamide; ICD (sustained/recurrent)
47
Ventricular Fibrillation cause
disorganized electrical impulses, no pumping action of heart
48
Ventricular Fibrillation s/s
sudden unconsciousness and death
49
Ventricular Fibrillation dx
EKG (irregular, rapid waveform of varying amplitude)
50
Ventricular Fibrillation tx
Defibrillation/CPR and cardioversion
51
Torsades de Pointes cause
spontaneous; hypokalemia, hypomagnesaemia following administration of drugs that prolong QT
52
Torsades de s/s
polymorphic Vtach; palpitations, dizziness, syncope, sudden death
53
Torsades de Pointes dx
Vtach w/ QRS twists on baseline
54
Torsades de Pointes tx
IV magnesium; correct electrolyte abnormalities; isoproterenol infusion; permanent pacemaker
55
Brugada Syndrome s/s
syncope, ventricular fibrillation, sudden death
56
Heart Failure cause
myocardial/pericardial disorders; valvular/congenital abnormalities; noncardiac (thyrotoxicosis, severe anemia)
57
Heart s/s
exertional dyspnea, cough, fatigue, orthopnea, paroxysmal nocturnal dyspnea, bibasilar rales, gallops, exercise intolerance (left-sided, exertional pulmonary congestion); JVD, nontender hepatic congestion, decreased appetite/nausea, pitting edema (right-sided, systemic pulmonary congestion); parasternal lift, enlarged displaced, hyperdynamic apical impulse, diminished S1, S3 gallop, pallor, clammy skin, nocturia, hypotension
58
Heart Failure dx
echocardiogram (decreased ejection fraction, change in size/function of chambers, valve abnormalities, etc); CXR (cardiomegaly, pulmonary effusions, Kerley B lines, venous dilation); elevated BNP; cardiac cath; anemia, renal insufficiency, hyperkalemia, hyponatremia
59
Heart Failure tx
exercise, low Na diet, stress reduction, no alcohol/smoking; ACEI/ARBs, loop/HCTZ diuretics; BB, aldosterone receptor agonists; digitalis
60
Cardiogenic Shock cause
hypovolemic shock (hemorrhage, loss of fluid/electrolytes); cardiogenic shock (MI, dysrhythmias, HF, HTN, contusion, myocarditis); obstructive shock (tension pneumo, tamponade, COPD, PE); septic/neurogenic shock (sepsis/infection, spinal cord injury, ADEs of spinal/epidural anesthesia)
61
Cardiogenic Shock s/s
hypotension, lack of hypovolemia, poor tissue perfusion; AMS (confusion, obtunded), oliguria, insulin resistance, metabolic acidosis, cool/mottled extremities, diminished cap refill, weak peripheral pulses
62
Cardiogenic Shock dx
CBC, blood type/cross match, coags, electrolytes, glucose, urinalysis, creatinine (determine cause), ABG, EKG, biomarkers, lactate levels
63
Cardiogenic Shock tx
airway, breathing, circulation; treat cause of shock; oxygen/fluid bolus; inotropes to increase cardiac output (epi, dobutamine), chronotropes to alter rate (adrenaline, digoxin), pressors to increase vascular tone (dopamine, phenylephrine); PCI
64
Orthostatic Hypotension cause
reduced cardiac output, paroxysmal cardiac dysrhythmias, low blood volume, medications, endocrine, neurologic, and metabolic disorders
65
Orthostatic Hypotension s/s
dizziness, worse with movement; headache
66
Orthostatic Hypotension dx
orthostatic vitals (>20mmHg drop in SBP or >10mmHg drop in DBP between sitting and standing, rise in pulse of >15bpm); CBC, BMP, EKG, tilt test
67
Orthostatic Hypotension tx
fluids; remove medication causes
68
Essential Hypertension cause
genetic, increased age, black ethnicity, environmental factors, tobacco, sedentary lifestyle, polycythemia, NSAID use, metabolic syndrome
69
Essential Hypertension s/s
most asymptomatic or nonspecific headache
70
Essential Hypertension dx
BP >140/>90 at 2 visits; EKG (LVH and strain); CXR (ventricular hypertrophy); dec H&H, elevated BUN, creatinine, or glucose; urinary glucose, protein, sediment, lipid profile
71
Essential Hypertension tx
DASH diet; ACE inhibitors, diuretics (loop vs HCTZ), Beta blockers, CCB (amlodipine), aldosterone receptor antagonists (spironolactone), renin inhibitor (aliskiren)
72
Secondary Hypertension cause
renal disease, renal artery stenosis, coarctation of aorta, pheochromocytoma, cushing syndrome, hyperthyroidism, chronic steroid use, NSAID use
73
Secondary Hypertension s/s
most asymptomatic; nonspecific headache
74
Secondary Hypertension dx
BP >140/>90 at 2 visit; EKG (LVH and strain); CXR (ventricular hypertrophy); dec H&H, elevated BUN, creatinine, or glucose; urinary glucose, protein, sediment, lipid profile; determine underlying disease process
75
Secondary Hypertension tx
DASH diet; ACE inhibitors, diuretics (loop vs HCTZ), Beta blockers, CCB (amlodipine), aldosterone receptor antagonists (spironolactone), renin inhibitor (aliskiren)
76
Hypertensive Emergencies cause
uncontrolled hypertension
77
Hypertensive Emergencies s/s
papilledema, encephalopathy, nephropathy, ICH, aortic dissection, preeclampsia/eclampsia, pulmonary edema, unstable angina, MI
78
Hypertensive Emergencies dx
SBP >130 with end organ damage; CT, MRI, echo, renal vessel imaging
79
Hypertensive Emergencies tx
sodium nitroprusside; labetalol, fenoldopam, nicardipine; NTG; slowly lower BP to prevent stroke 25% in MAP w/in 1st hour
80
Acute Myocardial Infarction: STEMI cause
acute coronary thrombosis; CAD, Afib, etc
81
Acute Myocardial Infarction: STEMI s/s
chest pain (pressure) radiating to neck, arm, back; lasts longer than angina; diaphoresis, N/V
82
Acute Myocardial Infarction: STEMI dx
EKG (ST elevation, reciprocal ST depression, inverted T waves)
83
Acute Myocardial Infarction: STEMI tx
aspirin, morphine, NTG; oxygen; cardiac cath; heparin/tpa prn
84
Acute Myocardial Infarction: NSTEMI cause
acute coronary thrombosis
85
Acute Myocardial Infarction: NSTEMI s/s
chest pain (pressure) radiating to neck, arm, back; lasts longer than angina; diaphoresis, N/V; asymptomatic
86
Acute Myocardial Infarction: NSTEMI dx
EKG (nonspecific ST changes, NO ST elevation); elevated cardiac enzymes
87
Acute Myocardial Infarction: NSTEM tx
aspirin, morphine, oxygen, NTG; cardiac stents
88
Stable Angina Pectoris cause
CAD, DM, hyperlipidemia, smoking, HTN, males
89
Stable Angina Pectoris s/s
chest pain, may radiate, lasts <30min; relieved with NTG or rest; dyspnea, nausea, diaphoresis, numbness, fatigue
90
Stable Angina Pectoris dx
coronary angiogram (definitive); EKG (ST depression w/ exertion, T wave inversion, poor R wave progression); Non-invasive stress test
91
Stable Angina Pectoris tx
BB, ASA; NTG prn; angioplasty, CABG
92
Unstable Angina Pectoris cause
CAD, DM, hyperlipidemia, smoking, HTN, males
93
Unstable Angina Pectoris s/s
severe and worsening from prior; chest pain, may radiate, lasts >30min; relieved with NTG or rest; dyspnea, nausea, diaphoresis, numbness, fatigue
94
Unstable Angina Pectoris dx
coronary angiogram (definitive); non elevated cardiac enzymes; EKG (ST depression w/ exertion, T wave inversion, poor R wave progression); Non-invasive stress test
95
Unstable Angina Pectoris tx
NTG, ASA, BB; (LMWH, clopidogrel); oxygen, fluids; cardiac cath
96
Prinzmetal Variant Angina cause
CAD, DM, hyperlipidemia, smoking, HTN, males
97
Prinzmetal Variant Angina s/s
occurs in morning, at rest; chest pain; not due to exertion; ventricular dysrhythmias
98
Prinzmetal Variant Angina dx
EKG (transient ST elevation); Non-invasive stress test; cardiac angiogram
99
Prinzmetal Variant Angina tx
CCB, NTG
100
Aortic Aneurysm/Dissection cause
weakness in vessel wall, atherosclerosis, congenital defects due to syphilis, trauma, vasculitis, Marfan syndrome
101
Aortic Aneurysm/Dissection s/s
asymptomatic; pulsatile abdominal mass; abdominal/back pain radiating to leg or testis, dyspnea, “ripping”/”tearing” chest pain radiating to back, hypotension, shock; BP difference of >20mmHg between upper and lower extremities
102
Aortic Aneurysm/Dissection dx
abdominal US (abdominal), CT w/ IV contrast (identifies rupture) CT/MRI (thoracic); CXR (widened mediastinum, displaced aortic notch); CBC, BMP, coag studies
103
Aortic Aneurysm/Dissection tx
endovascular/open surgical repair; manage BP w/ labetalol, nitroprusside [goal BP <150]; symptomatic will likely rupture, ruptured are fatal
104
Arterial Embolism/Thrombosis cause
hx of Afib; injury to vessel wall, increased clotting, atherosclerosis
105
Arterial Embolism/Thrombosis s/s
decreased pulses, cold extremities, lack of movement, muscle pain, numbness in fingers and hands
106
Arterial Embolism/Thrombosis dx
angiography; duplex ultrasound; PT, CBC
107
Arterial Embolism/Thrombosis tx
anticoagulant/antiplatelet; thrombolytics; pain meds
108
Giant Cell Arteritis (Temporal arteritis) cause
affects superficial temporal arteries; unknown cause (genetic, environmental, autoimmune)
109
Giant Cell Arteritis (Temporal arteritis) s/s
abrupt or insidious onset; unilateral headache, jaw claudication, fever, fatigue, malaise; neck/torso/shoulder/pelvic girdle pain
110
Giant Cell Arteritis (Temporal arteritis) dx
biopsy; elevated ESR/CRP; angiography, ultrasound, MRI/MRA
111
Giant Cell Arteritis (Temporal arteritis) tx
glucocorticoid therapy (prednisone)
112
Peripheral Arterial Disease cause
atherosclerosis; trauma, hypovolemia, inflammatory arteritis, polycythemia, dehydration, hypercoaguable states
113
Peripheral Arterial Disease s/s
intermittent claudication, foot/lower leg pain w/ exercise relieved by rest; weak/absent femoral/distal pulses; aortic/iliac/femoral bruits; loss of hair, shiny atrophic skin, and pallor with dependent rubor to skin; numbness, tingling, ischemic ulcerations
114
Peripheral Arterial Disease dx
angiography; doppler ultrasound; ankle-brachial index
115
Peripheral Arterial Disease tx
control underlying diseases (tobacco use, DM, HTN, hyperlipidemia); BB, ACEI, statins, exercise; antiplatelet therapy; revascularization
116
Phlebitis/Thrombophlebitis cause
virchow triad (stasis, vascular injury, hypercoagulability); spontaneous, following trauma, PICC line; hormone replacement, bed rest; clotting problems (factor 5 leiden, protein C, protein S); cancer
117
Phlebitis/Thrombophlebitis s/s
dull pain, erythema, tenderness, induration of involved vein (MC saphenous v); swelling, warmth, erythema to lower extremity
118
Phlebitis/Thrombophlebitis dx
duplex ultrasound; Wells score; venography; d-dimer; CT angiography (chest)
119
Phlebitis/Thrombophlebitis tx
LMWH (enoxaparin), then warfarin; bed rest, heat to area, elevation, NSAIDs; antibiotics w/ infection; frequent ambulation, compression devices
120
Varicose Veins cause
pregnancy, obesity, family history, prolonged sitting; incompetent valves
121
Varicose Veins s/s
Dilated, tortuous superficial veins; smaller blue-green, flat reticular veins, telangiectasias, spider veins; aching with fatigue; chronic distal edema, abnormal pigmentation, fibrosis, atrophy, skin ulceration
122
Varicose Veins dx
doppler sonography
123
Varicose Veins tx
elastic stockings, leg elevation, regular exercise; Laser ablation, endovenous radiofrequency, compression sclerotherapy
124
Venous Insufficiency cause
incompetent valves; thick, scarred veins, dilated veins
125
Venous Insufficiency s/s
pruritus, swelling of legs and ankles, eczema, pitting edema, fibrosis of skin, skin hyperpigmentation, stasis dermatitis, dull ache
126
Venous Insufficiency dx
duplex ultrasound
127
Venous Insufficiency tx
compression stocking, avoid long sitting/standing, elevate leg, reduce edema, pneumatic compression
128
Venous Thrombosis cause
stasis, vascular injury, hypercoagulability; OC, obesity, long-distance travel, lupus
129
Venous Thrombosis s/s
dull pain, erythema, swelling, tenderness, induration of vein
130
Venous Thrombosis dx
duplex US, venography, d-dimer and CT (pulmonary)
131
Venous Thrombosis tx
bed rest, heat, elevation, NSAIDs, anticoagulation with LMWH or UFH and warfarin
132
Aortic Stenosis cause
bicuspid AV, congenital, rheumatic heart disease, connective tissue disorders, infection, senile degeneration
133
Aortic Stenosis s/s
dyspnea, fatigue, decreased exercise tolerance, cough, rales, paroxysmal nocturnal dyspnea, hemoptysis, hoarseness; thready pulses; harsh midsystolic murmur in 2nd RICS, radiates to LSB and neck, with thrill
134
Aortic Stenosis dx
transesophageal echocardiogram and cardiac cath (definitive); CXR (left sided atrial enlargement, ventricular hypertrophy)
135
Aortic Stenosis tx
surgical repair/replacement of valve (PCI, balloon valvuloplasty); diuretics, vasodilators (pulmonary congestion); digoxin, BB (dysrhythmias)
136
Aortic Regurgitation cause
bicuspid AV, congenital, rheumatic heart disease, connective tissue disorders, infection, senile degeneration
137
Aortic Regurgitation s/s
dyspnea, fatigue, decreased exercise tolerance, cough, rales, paroxysmal nocturnal dyspnea, hemoptysis, hoarseness; bounding pulses, widened pulse pressure; soft systolic and diastolic decrescendo "blowing" murmur in 2nd/4th LICS radiating to RSB and apex
138
Aortic Regurgitation dx
transesophageal echocardiogram and cardiac cath (definitive); CXR (left sided atrial enlargement, ventricular hypertrophy)
139
Aortic Regurgitation tx
surgical repair/replacement of valve (PCI, balloon valvuloplasty); diuretics, vasodilators (pulmonary congestion); digoxin, BB (dysrhythmias)
140
Mitral Stenosis cause
bicuspid AV, congenital, rheumatic heart disease, connective tissue disorders, infection, senile degeneration
141
Mitral Stenosis s/s
dyspnea, fatigue, decreased exercise tolerance, cough, rales, paroxysmal nocturnal dyspnea, hemoptysis, hoarseness; mid-diastolic murmur in apex, snap follows S2
142
Mitral Stenosis dx
transesophageal echocardiogram and cardiac cath (definitive); CXR (atrial enlargement)
143
Mitral Stenosis tx
surgical repair/replacement of valve (PCI, balloon valvuloplasty); diuretics, vasodilators (pulmonary congestion); digoxin, BB (dysrhythmias)
144
Mitral Regurgitation cause
bicuspid AV, congenital, rheumatic heart disease, connective tissue disorders, infection, senile degeneration
145
Mitral Regurgitation s/s
dyspnea, fatigue, decreased exercise tolerance, cough, rales, paroxysmal nocturnal dyspnea, hemoptysis, hoarseness; pansystolic blowing murmur in apex, radiates to left axilla
146
Mitral Regurgitation dx
transesophageal echocardiogram and cardiac cath (definitive); CXR (atrial enlargement)
147
Mitral Regurgitation tx
surgical repair/replacement of valve (PCI, balloon valvuloplasty); diuretics, vasodilators (pulmonary congestion); digoxin, BB (dysrhythmias)
148
Mitral Valve Prolapse cause
congenital, thin females w/ minor chest wall deformities
149
Mitral Valve Prolapse s/s
asymptomatic; midsystolic clicks, late systolic murmur
150
Mitral Valve Prolapse dx
transesophageal echocardiogram and cardiac cath (definitive); CXR (atrial enlargement)
151
Mitral Valve Prolapse tx
surgical repair/replacement of valve (PCI, balloon valvuloplasty); diuretics, vasodilators (pulmonary congestion); digoxin, BB (dysrhythmias)
152
Tricuspid Stenosis cause
congenital (during infancy/childhood); rheumatic scarring, connective tissue disease, endocarditis (adults)
153
Tricuspid Stenosis s/s
exercise intolerance, JVD, peripheral edema, hepatomegaly; diastolic murmur
154
Tricuspid Stenosis dx
echocardiogram and cardiac cath (definitive); CXR (prominent right heart border w/ dilation of SVC); EKG (RAD, right atrial enlargement, RVH)
155
Tricuspid Stenosis tx
surgical repair/replacement; sodium restriction, diuretics; vasodilators, positive inotropic agents (pulmonary HTN)
156
Tricuspid Regurgitation cause
congenital (during infancy/childhood); rheumatic scarring, connective tissue disease, endocarditis (adults); intrinsic or functional
157
Tricuspid Regurgitation s/s
exercise intolerance, JVD, peripheral edema, hepatomegaly; holosystolic murmur at LLSB, radiates to right sternum and xiphoid
158
Tricuspid Regurgitation dx
echocardiogram and cardiac cath (definitive); CXR (prominent right heart border w/ dilation of SVC); EKG (RAD, right atrial enlargement, RVH)
159
Tricuspid Regurgitation tx
surgical repair/replacement; sodium restriction, diuretics; vasodilators, positive inotropic agents (pulmonary HTN)
160
Pulmonary Stenosis cause
congenital (during infancy/childhood); rheumatic scarring, connective tissue disease, endocarditis (adults)
161
Pulmonary Stenosis s/s
exercise intolerance, JVD, peripheral edema, hepatomegaly; midsystolic crescendo-decrescendo murmur in 2nd/3rd LICS, radiates to left shoulder/neck
162
Pulmonary Stenosis dx
echocardiogram and cardiac cath (definitive); CXR (prominent right heart border w/ dilation of SVC); EKG (RAD, right atrial enlargement, RVH)
163
Pulmonary Stenosis tx
surgical repair/replacement; sodium restriction, diuretics; vasodilators, positive inotropic agents (pulmonary HTN)
164
Pulmonary Regurgitation cause
congenital (during infancy/childhood); rheumatic scarring, connective tissue disease, endocarditis (adults)
165
Pulmonary Regurgitation s/s
exercise intolerance, JVD, peripheral edema, hepatomegaly; diastolic murmur
166
Pulmonary Regurgitation dx
echocardiogram and cardiac cath (definitive); CXR (prominent right heart border w/ dilation of SVC); EKG (RAD, right atrial enlargement, RVH)
167
Pulmonary Regurgitation tx
surgical repair/replacement; sodium restriction, diuretics; vasodilators, positive inotropic agents (pulmonary HTN)
168
Bacterial Endocarditis cause
staph aureus (acute); strep viridans (subacute); staph epidermidis (prosthetic)
169
Bacterial Endocarditis s/s
fever, cough, dyspnea, pallor, splenomegaly; palatal/conjunctival/subungual petechiae, splinter hemorrhages, osler nodes (painful), janeway lesions (not painful)
170
Bacterial Endocarditis dx
echocardiogram; blood cultures q1hr x3; Duke Criteria
171
Bacterial Endocarditis tx
gentamicin, cephalosporin, vancomycin (empirical); nafcillin, gentamicin (acute); PCN, gentamicin (subacute)
172
Acute Pericarditis cause
idiopathic; viral/bacterial infection; autoimmune (RA, SLE); radiation therapy, myxedema, TB, post-MI (dressler syndrome)
173
Acute Pericarditis s/s
sharp, pleuritic substernal chest pain, radiates to back/neck/shoulders; relieved by sitting upright and leaning forward, worse with inspiration; cardiac friction rub, JVD, cardiac tamponade (hypotension, tachycardia)
174
Acute Pericarditis dx
elevated WBC; EKG (diffuse ST elevation, T wave inversions, PR depression); CT/MRI
175
Acute Pericarditis tx
steroids (prednisone), NSAIDs/ASA; pericardiectomy, antibiotics, IV hydration
176
Cardiac Tamponade cause
fluid compromises cardiac filling and impairs cardiac output; MI, PE, trauma
177
Cardiac Tamponade s/s
tachycardia, tachypnea, narrow pulse pressure, JVD, pulsus paradoxus; becks triad (low BP, JVD, muffled heart sounds)
178
Cardiac Tamponade dx
CXR, echo, EKG, clinical (becks triad + pulsus paradoxus)
179
Cardiac Tamponade tx
pericardiocentesis (hemodynamic compromise), steroids/NSAIDs (inflammation), pericardiectomy
180
Pericardial Effusion cause
pericarditis, uremia, cardiac trauma
181
Pericardial Effusion s/s
painless; chest pain, cough, dyspnea
182
Pericardial Effusion dx
CXR (fluid around heart); echocardiogram; EKG (nonspecific T changes, low QRS, electrical alternans)
183
Pericardial Effusion tx
pericardiocentesis (hemodynamic compromise), steroids/NSAIDs (inflammation), pericardiectomy
