Cardiovascular And Metabolic Changes Flashcards
(209 cards)
1
Q
Dilated cardiomyopathy often leads to what type of dysfunction and physical exam.
A
Systolic HF ; both left and right
Left= Dyspnea; Cough; Wheeze
Right= Hepatomegaly; JVD; Peripheral Edema
PE= JVD and S3 gallop
2
Q
What is the most common type of cardiomyopathy
A
Dilated
3
Q
Etiologies of dilated cardiomyopathy (6)
A
Idiopathic (MC)
ETOH and Cocaine
Doxyrobicin
Infection(Cocksackie Virus)
Vitamin B1 Deficiency
4
Q
Treatment for dilated cardiomyopathy
A
“BASH”
Beta blockers
Ace-I/Arbs
Spirinolactone
Hydralyzine
-Nitrates
Sxs control = loop diuretics; digoxin
Low EF = ICD
5
Q
Restrictive cardiomyopathy explain pathophysiology
A
Stiff ventricles due to infiltration disease -> Inability to relax during diastole -> diastolic dysfunction
6
Q
3 etiologies of restrictive cardiomyopathy
A
Amyloidosis (MC)
Hemochromatosis
Sarcoidosis
7
Q
Sxs and physical exam findings restrictive cardiomyopathy
A
Hepatomegaly
Kussmauls JVD w/ inspiration
Peripheral edema
8
Q
What does the echo show for dilated cardiomyopathy
A
Ventricular dilation
Thin ventricular walls
Low EF
9
Q
What does the echo show for restrictive cardiomyopathy
A
NML to slightly thickened ventricles
Diastolic dysfunction
Atrial dilation due to ventricle resistance
10
Q
Treatment for restrictive cardiomyopathy
A
Diastolic dysfunction meds
BB; CCB; Furosemide
11
Q
HOCM pathophysiology
A
Genetic disorder of cardiac sarcomeres leading to ventricular hypertrophy
Diastolic dysfunction
+/- Outflow obstruction
12
Q
Describe HOCM murmur
A
Harsh crescendo-decrescendo HOLOSYSTOLIC murmur best heard at LLSB ; DECREASES with valsalva
+S4
13
Q
Treatment approach to HOCM
A
B-Blocker
CCB
Ablation of the septum
14
Q
What meds should be avoided in HOCM (3)
A
Nitrates Digoxin Diuretics
15
Q
What is the reason for Takotsubu
A
~ post menopausal : Catecholamine surge.
16
Q
Where are STE likely present in Takatosubu
A
Anterior Leads
17
Q
Treatment approach to takutsubu (4)
A
ASA
Nitrates
B-Blockers
Heparin
18
Q
Elevated ; Stage 1 ; Stage 2 HTN
A
Elevated—120-130 and less than 80
Stage 1—130-139 and/ or 80-90
Stage 2— 140+ and/or 90+
2 high readings on 2 different visits
19
Q
MC cause of secondary HTN
A
Renal Artery Stenosis
20
Q
4 differentials for secondary HTN
A
Cushings
Hyperaldosteronism
Pheo
Sleep apnea
21
Q
What ASCVD risk with HTN is okay to try lifestyle changes first
A
Less than 10%
22
Q
First line medication to decrease blood pressure
A
A’ CE-I/ARBS
C’ CBs
T’ hiazide diuretics
23
Q
What med should be initiated in all patients after MI to decrease mortality
A
B-Blockers
24
Q
Define resistant HTN
A
3 different classes at max doses ; persistent HTN above 130/80
25
HTN Urgency
Vs
HTN emergency
U= greater 180/110 without EOD
E= greater 180/120 with EOD
26
Examples of HTN EOD
Retinopathy
Encephalopathy
Cerebral hemmorhage
MI
HF
AKI
Aortic Dissection
27
Treatment of HTN Emergency
IV medications :
Labetalol
Nitroprusside
Nitroglycerin
Hydralazine
28
4 goals of shock management
Keep CVP greater 8 w/ IVF
Keep MAP greater than 65mmHg w/ vasopressors
Keep hematocrit greater 30%
Inotropes can augment cardiac output - Dobutamine
29
3 reasons for a hypovolemic state ; what is its effects on the heart ; TXM
Hemmorhage
Dehydration
3rd spacing
Decreased Preload ; CO
Increased SV
TXM = IVF or Blood
30
2 reasons for distributive shock
Sepsis or anaphylaxis
31
Sxs of distributive shock ; effects on the heart
Warm
Dry
Bounding pulses
Altered Body Temperature
Decreased Preload / CO
Increased SV
32
Distributive shock TXM
Vasopressors ; IVF
33
Differentials for acute hypotension (3)
Neurogenic (Barorefflex)
Chronic sympathetic efferent dysfunction decreases BP while increasing HR
Orthostatic HTN = SYS drop of 20; DIAST drop of 10
34
Reflex syncope patho ; causes
Low BP and Low HR
VV
Situational
Carotid sinus hypersensitivity
35
Tachycardic causes of cardiac syncope
WPW
V-tach
Long QT syndrome
Short QT
36
Bradycardic causes of cadiac syncope
AV Block
Sick Sinus syndrome
37
What is the murmur of atrial myxoma
Mid-Diastolic dysfunction
Crescendo Murmur
“AV valve obstruction” due to tumor in the Left Atrium
Positional - Louder when upright ; Dyspnea often improves when laid flat
38
Patho of mitral stenosis
MC : Rheumatic Fever
Decreased blood flow to the left ventricle
LLB = loudest ; and Low pitch rumble or whoosh sound
39
What 4 things can cause Dyslipidemia
Increased cholesterol
Hypothyroidism
Pregnancy
CKD
40
Triglycerides increase with: 5 [DOSEE]
DM
Obesity
Steroids
Estrogen
ETOH
41
Increased triglycerides can lead to what over what
Pancreatitis
over 500
42
What is the screening protocols for dyslipidemia
Greater than 35 y/o
Age 20-29 with ASCVD risk
43
High Intensity Statins
Atorvastatin [40-80] - Lipitor
Rosuvastatin [20-40] - Crestor [less lipophilic]
44
Moderate Intensity Statins
Atorvastatin [10-20]-Lipitor
Simvastatin [20-40] - Zocor
Rosuvastatin [5-10] -Crestor
Primvastatin [40-80] -Pravachol
45
Low Intensity Statin
Simvastatin [10]
Pravastatin [10-20]
Lovastatin [20] - Mevacor
46
MOA of statins
Contraindicated in :
Inhibit HMG COA to increase LDL receptors
Pregnancy Liver Dz Nursing
47
MOA of Fibrates
Contra
Good for decreasing Tri’s
PPAR Agonsit
-Contra = renal dz ; liver dz
48
Niacin MOA
ADE
ONLY: Fam HyperChol
Increases HDL production
ADE=Flush; Hyperglycemia
49
Who needs 1 degree prevention statin therapy
FHx of Early ASVD
Pre-eclampsia
LDL greater 160
Metabolic Synd.
CKDs
Autoimmune Diseases
TGs greater than 175
50
Who gets 2nd degree prevention?
ASCVD Equivalents = DM; HF
ACS
MI
Angina
Revascularization
TIA CVA
PAD
51
Who gets 2nd degree prevention
ASCVD Equivalents
ACS
MI
Angina
Revascularation
TIA ; CVA
PAD
52
Consider what CAC Score:
0 = No Statin
1-99 age 50 greater ; smokers ; CAD = statin
Greater 100 = statin
53
Age 40-75 ASCVD 5% = what TXM?
NONE
54
Age 40 -75; ASCVD 5-7.5% ; should get what TXM
Moderate Intensity Statin
55
Age 40-75 ; ASVD 7.5% -20% ; gets what txm?
Moderate Intensity Statin
56
ASCVD greater than20% ; Age 40-74 ; gets what txm
high intensity statin
57
What is the goal LDL for patients with more than 2 risk factors
50% reduction in LDL
58
Age 20-39 ; w/ Fam Hx Early ASCVD or LDL greater 160; gets what txm
Moderate Intensity Statin
59
LDL over 190 gets what?
High Intensity Statin
60
Main ADE’s of Statin therapy (4)
Muscle paresthesias / Atony
Liver Damage
Hyperglycemia
Neurologic Defects
61
Last resort statin therapy
PCSK-9’s [MABS]
HIS -> still over 70 LDL
Degradation of low density lipoprotein
62
Good adjunct to PCSK-9s
Ezetimibe
Inhibit small intestine absorption of cholesterol
Strongest for statins ; greater 70 LDL
63
[omega 3s]
Good for decreasing TGs
Caution = increase LDL dyspepsia
64
Risk Factors for high ASCVD
DM
Obesity
HTN
Smoking
Fam Hx
Inactive Lifestyle
Dyslipidemia
65
Definition of dyslipidemia
LDL greater 70
Tris greater 200
HDL less 40
Total Cholesterol over 200 / 240
66
Test of choice for thyroid concerns
TSH / FT4
67
What do you need to rule out if you suspect Hashimotos
Addisons Disease
68
3 drugs that can induce hypothyroidism
Amiodarone
Iodine
Lithium
69
What metabolic concerns often follow Hashimotos (4)
Low B12
Low Vit C
IDA
Low PTH
70
Hypothyroid is what on tests and what ab for Hashimotos
TSH HIGH
Low FT4
Thyroglobulin Ab +
71
Sxs of hypothyroidism (6)
Dry skin
NP edema
Decreased DTRs
Hoarse / Fatigue
Constipation
Menorrhagia
72
Ab test of choice for graves
AntiTPO Ab
73
What will a RAIU scan show in graves hyperthyroid.?
Increased uptake
74
Sxs hyperthyroid
Wt loss
Palpitations
Weak
Fine tremor
+/- AFIB
75
TXM for HYPERTHYROID
RAI ; ablation
Methimazole; best otherwise
PTU; best in preg.
R2 the gland
76
Most common type of thyroid cancer
Papillary
77
Physiologic parathyroid response
Increased PTH ; Decreased CA2+ ; Decreased Vit D = activation of Ca2+
78
HyperPTH sxs
If Ca2+ high = stones groans moans and overtones
79
4 reasons to remove the Parathyroid gland
Kidney stones
Vertical compression
Age over 50
24 hr ca 2+ urine over 400
80
What is increased commonly in hypothyriodism
Phosphate
81
Sxs of hypoPTH
If low Ca2+ = paresthesias tetany seizures Chovstek Trousseau
82
Mg effect on PTH
Sub low = increases PTH
High low = decreased PTH
83
What effectively lowers blood phosphates
Calcitonin
84
Dx of choice for pagets disease
Bone Bx
85
TXM of Paget’s disease
Bisphosphonates
Calcitonin
86
What substances/meds can induce gynecomastia (5)
ETOH
Steriods
Amiodarone
Spirinolactone
Ketoconazole
87
3 causes of unilateral gyencomastia
Cancer
Lipoma
NF
88
2 causes of bilateral gynecomastia
Obesity
Pseudo
89
6 labs to get to eval gynecomastia
PRL
HCG
LH
TEST
ESTRADIOL
TSH/FT4
90
What are good 2 ways to characterize gynecomastia
Glandular vs Fatty
91
Osteoporosis increased risk of fx if what levels
Greater -2.5 = OPO
Greater -1.5 = OSTOPE
TXM = Calcitonin / Vit D
OPO= Bisphosphonates
92
3 ADEs of Bisphosphonates
Jaw necrosis
Hoarse
HA
93
Sxs of Cushing syndrome (5)
Moon Face
Truncal obesity
DM2
HTN
Buffalo Hump
94
3 lab tests for Cushing syndrome
Dex. Suppression test = + serum cortisol over 1.7
24 hr Free urine = + greater 300
Serum ACTHa dep. = + Low ACTH ; High cortisol
95
Think Cushing disease think
Pituitary adenoma
Or ectopic ; get a CT chest
96
Hirsituism in women think
PCOS
97
3 labs for Hirsituism
Free and Total Testosterone
DHEA
17-Hydroxyurea
98
17 and 21 Hydroxy test for what
Classic = ACTH stimulation
Non Classic = High 17
-Adrenal Hyperplasia
99
MC Pituitary Adenoma manifestation
Acromegaly
HTN ; enlarged with Wt gain; vision changes ; oily skin
100
How could Hyperprolactinemia present (4)
A Pituitary Adenoma w/
Gynecomastia
Infertile
Galactorrhea
Bit. Hemaniiopsia
101
TXM Hyperprolactinemia
Cabergoline
Dopamine
Bromocritptine
R2 adenoma
102
Hemochromatosis presentation ; txm
Iron increased deposits in liver
Dark skin
Koilynychia
OPO
TXM = blood letting
103
hypoNA+ presentation ; txm
Increased water retention ; or ; Increased Salt Loss
ADH dependent or independent
Hyper/Hypo/Euvolemic
1st : Check tonicity
(Increased glucose /azotemia)
TXM= IVF HS
*Pseudo -HL*
104
HyperNA+ presentation TXM
Decreased water or increased salt retention
Aldosterone = increased salt retention
Cortisol will increase
TXM= IVF-HS o Dextrose over 48 hours
105
PAI = Primary Adrenal Insufficiency
Addisons Disease
Deceased cortisol / Increased ACTH
106
Sxs and causes of PAI
Sxs : hypovolemia ; hyponatremia ; skin pigmentation increase l hyperK+
Causes = TB ; histoplasmosis
107
Dx of PAI ; TXM
Cosyntropin stim test =+ if cortisol over 18
TXM= Prednisone or Hydrocortisone
108
4 things to do acutely to manage cardiac syncope
Get an EKG to check for arrhythmia’s
Echo to rule out structural causes
Head CT / EEG to rule out seizure
Tilt table if you suspect Vasovagal
109
What is a good test if you suspect CAD risk or LVOO/RVOO
Stress testing to r/o ischemia
110
If cardiac syncope sxs occur daily or hourly what monitoring should be done
24 hour Holter
111
Ischemia is a mismatch of what
Supply and Demand of blood
112
What is the triad of RV infarct
JVP
clear lungs
Positive Kussmaul breathing
113
What 3 populations can have atypical presentation of ACS
Women
Diabetics
Elderly
114
Characteristics of unstable angina
Sxs at rest not relieved by nitro
Negative cardiac enzymes
NO STE
= partial occlusion of vessels
115
Unstable angina or NSTEMI management
MONA
Heparin
B-Blocker
TIMI score or HEART risk assessment
116
STE = what
ST elevations > 1 mm in 2+ contiguous leads w/ reciprocal changes in opposite leads
117
Location of STE in
Anterior
Posterior
Lateral
Inferior
A = 1 AVL V2-V6
P= Depressions in V1-V3
L = 1, AVL , V4-V-6 ; depressions in Inferior Leads
I = 2 3 AVF
118
AMI protocol
a. ECG w/in 10 mins
b. Door to thrombolytics w/in 30 mins
c. Door to PCI w/in 90 mins (+/- 30 mins)
d. “MONA” → Morphine, O2, Nitrates, ASA e.
NO morphine or Nitroglycerin for inferior wall MI
119
Time frame to PCI for likely ACS chest pain
90-120 minutes PCI
OMI + MONA + BASH-C
120
What can definitive dx stable angina
Coronary angiography
121
When is nitroglycerin contraindicated (3)
if SBP < 90 mmHg, RV infarction, use of Sildenafil
122
Coronary artery spasm causing transient ST-segment elevations; not assoc. w/ clot
Prinzemetals
123
What are known triggers of Prinzmetals Angina (4)
Hyperventilation
Cocaine / Tobacco Use
Acetylcholine
Histamine/ Serotonin
(constriction of stenotic vessels)
124
2 TXM’s for printzmetals
Nitroglycerin
CCBs
125
Underlying cause for dresslers syndrome
Inflammation of the pericardium post MI
*ASA and Colchicine for 2 weeks*
126
Systolic dysfunction results in ___
Diastolic dysfunction results in ____
S = loss of contraction; S3 sounds
D = increased stiffness; decreased preload ; S4 sounds
127
Systolic HF TXM
ACE-I
B-Blocker
Loop Diuretic
128
Examples of loop diuretics
Furosemide
Bumetanide
Torsemide
129
Diastolic HF TXM
ACE-I
B-blocker
CCB
130
S/Sx: dyspnea, orthopnea, weakness, fatigue, tachycardia
iii. PE: S3, rales (indicating fluid in lungs), Cheyne-stokes breathing, cool extremities
Findings for what?
Left sided heart failure
131
MC cause = LHF, COPD ii. Acute = PE
Right Heart Failure
132
BNP values that indicate cardiac conditions
i. > 450 pg/mL if < 50 y/o
ii. > 900 pg/mL if 50 - 75 y/o
iii. > 1,800 pg/mL if > 75 y/o
133
What are good treatments for HFpEF
Lifestyle Modifications
Diuertics to decrease volume overload
SGLT-2’s [flozin]
134
Acute cold and wet management [LMNOP] ; in decompensating HF
Loop diuretics
Morphine
Nitroglycerin
Oxygen
Position upright
135
acute cold and dry management ; in decompensating HF
ICU Inotropes
136
What are 3 A-cyanotic cardiac lesions ; think what kind of shunting
VSD
ASD or PFO
PDA
L to R shunt.
137
Cyanotic cardiac lesions = what kind of shunting ; possible etiologies (3)
R to L shunt
Truncus arteriosis
Tetrology of Falot
Transposition of the great arteries
138
MC adult congenital cardiac abnormality ; they may develop what?
ASD
Severe pulmonary HTN
139
ASD TXM involves?
Diuretics
Digoxin
Surgical closure
140
Peds Decresed wt gain; tachycardia; Tachypnea think? And what murmur?
PDA
Continuous machine like murmur at the LUSB
141
TXM of PDA in infants
Indomethacin
Surgery
142
Murmurs of VSD
Pancystolic harsh murmur at LSB
143
What age gets surgical closure of VSD
2 y/o
144
upper/lower extremity systolic pressure mismatch >> 20 mmHg;
Think?
Coarctation of the aorta
Could lead to aneurysm or dissection
145
Murmurs of Tetrology? CXR shows?
Harsh systolic ejection murmur at LUSB that radiates to back
Boot shaped heart
146
TXM of tetrology
PGE-1 and surgery
147
Bubble studies can help identify what?
Intracardiac shunt
148
What should you eval for when assessing tachycardia
Wide complex or Narrow complex QRS
149
A flutter can lead to what?
High output heart failure
150
What could be underlying cause of AFIB
Hyperthyroidism
151
What drugs slow AV node conduction (4)
Metoprolol
Carvedilol
Verapamil
Diltiazem
152
Rate control is preferred in who? And What drugs?
Older patients
B-blockers and CCBs
153
Who gets rhythm control?
Less than 60 with intolerable sxs
154
If AFIB onset with sxs ; less than 48 hours ; less than 60YRS OLD what management?
anticoags and immediate electrocardioversion
Flecainimide
Amiodarone
rhythm control
155
If AFIB onset and unstable do what?
Cardioversion and IV Heparin [to prevent stroke]
156
In Torsades TXM? In V fib TXM?
T = cardioversion = good synchronization ; repair to baseline
V- fib = defibrillate = cant synchronize themselves ; create new baseline
157
Describe 2nd degree wenckebach
Some P waves are not followed by QRS 3.
“Longer, longer, longer, drop-- then you have a Wenckebach”
158
Describe 2nd degree Mobitz 2
No preceding prolongation of PR
“When there’s more P’s than Q’s consider a Mobitz 2”
159
AV blocks are often treated with what?
Pacemakers
160
Etiologies of sick sinus syndrome
SINUS NODE FIBROSIS
Can result from senescent fibrosis of sinus node or extrinsic causes including meds, hypothyroidism,
hypothermia, ↑ ICP, electrolyte abnormalities, ↑ vagal tone, ischemia, and surgical trauma
161
What two labs should you get in sick sinus syndrome
TSH and Electrolytes
162
Indications for ICD vs CRT
ICD = i. NYHA 2-3 w/ EF < 35% (> 40d after MI)
ii. NYHA 4
iii. Survivor of sudden cardiac arrest/sustained VT
iv. VT related syncope or predisposing condition
CRT = i. HF w/ EF < 35% w/ LBBB and wide QRS; after 3 mo of otherwise optimal therapy
ii. Benefits: CRT ↑ functional status and ↓ re-hospitalization
163
Adult Bradycardia with decompensation management
Atropine
And/or
Dopamine
Epinephrine
And
Transvenous pacing
164
What should you make a difference between when eval bradycardia
Wide complex or Narrow Complex
Ventricular? Atrial?
165
4 reasons for sinus tachycardia
Fever
Hypovolemia
Pulmonary disease
Anxiety/Drugs
166
First Dose of what to slow down Tachycardia greater 150, but regular/narrow/monomorphic + -(Negative) sxs
ADENOSINE = 6mg Rapid IV push with Rapid NS Flush [good for wide or narrow and regular]
Or Vagal Maneuver
2nd Dose= 12 mg
167
3 antiarrhythmic’s for wide complex tachycardia
Procainamide [20-50mg] (wide and irregular)
Amiodarone [150mg over 10 minutes] —> Mx infusion 1mg/min for first 6 hours
Sotalol [IF NO PROLONGED QT]= 100mg over 5 minutes
168
4 sxs that are concerning when in tachyarrythmia
Hypotension
AMS
Chest Pain
Signs of Shock
169
What to slow down Tachycardia greater 150, but regular and monomorphic + -(Positive) sxs
Synchronized Cardioversion
170
TACHY + Hemodynamically unstable
=CARDIOVERT
171
Narrow and Irregular with sxs and NO WPW; what can you do
BB or CCB
172
What rhythm in cardiac arrest = SHOCKABLE
VFib or Pulseless V TACH
*With CPR sandwich*
173
What rhythm is not Shockable and WHAT DO YOU DO
Asystole / PEA
GIVE : EPI [every 3-5 mins]
*With CPR sandwich*
174
Hs and T’s of cardiac arrest ; reversible! [6H/4T]
Hypovolemia
Hypoxia
Hydrogen Ion [Acidosis]
Hypo/Hyper-Kalemia
Hypothermia
Tension PTX
Tamponade
Toxins
Thrombosis ; pulmonary or coronary
175
IV drug use effects what part of the heart and what organisms common?
Tricuspid Valve
Pseudomonas and Candida
*MSSA*
176
Prosthetic valves are often effects by what organism?
Staph epidermis
177
Think Cows Sheep Goats ; with Q fever?
Coxiella Burnetti
178
Left Side vs Right Side emboli
Left = brain ischemia —> stroke
Right = pulmonary edema
179
Major (2) and Minor (5) criteria for DUKES - Endocarditis
Major =
1) Vegetations on echo
2) Positive Blood cultures from multiple sites
Minor=
1) Hx o drug injections ; cardiac lesions
2) Fever
3) Septic Emboli : Janeway Lesions ; conjunctival hemm ; pulmonary infarcts
4) Autoimmune conditions : Oslers Nodes ; Roth Spotds ; glomerulonephritis
5) Micro/serologic Evidence
180
What is considered Dx for Dukes
1 major and 3 minors
Or
5 minors
Or
2 majors
181
Rheumatic fever commonly affects what populations
5-15 yrs/old ; post strep pharyngitis
182
Acute RF Major/Minor Criteria
Major= JONES
Joint = Polyarthralgias
O= pancarditis
E= erythema marginatum
S= Sydenhams Chorea
Minor =
Arthralgia
Fever
increased ESR
Prolonged PR on EKG
Rapid Strep Positive ; ASO titer
183
3 heart effects from rheumatic heart disease
Regurge
Stenosis
Mitral Valve disease
Aortic Valve disease
184
Acute RF mangement
PCN!!
Anti-inflammatory drugs
185
1 st line TXM of endocarditis
IV ABX
Amocxicillin
Ampicillin
Cefazolin
Ceftriaxone
Cephalexin
186
Sxs of acute pericarditis ; ECG
Friction Rub worse when laying down ; improved when leaning forward
ECG: PR depressions IN AVR ; diffuse STE’s
+/-Troponin = myopericardial infvolvement
187
Dresslers syndrome
2-5 days post MI
ASA ; colchicine ; NSAID
Pregnant = Prednisone
Hx of ischemia = ASA
188
Acute pericarditis TXM
NSAIDs and Colchicine
189
Constrictive pericarditis sxs :
Increase in venous pressure
JVD
Peripheral edema
Ascites
Pericardial knock @ diastole
TXM = pericardiectomy
190
When you think increase in venous pressure think
Vs. Arterial pressure?
Venous = stasis of blood volume ; blood forced toward the heart ; AKI
Arterial = cardiac output working too hard! ; decrease elasticity ; decreased oxygenation to the heart; increased pressure on smaller vessels
191
3 causes of myocarditis
Lyme Dz
Cocksackie virus
takutsubo
192
TXM of acute myocarditis
ACE-I
B blocker
Diuretics
193
Becks triad for cardiac Tamponade
JVD
Hypotension
Muffled heart sounds
194
Leave a drain in cardiac Tamponade for how long?
Until fluid is less than 25 ml
195
Good management of peripheral vascular disease (Meds)
Cilostazol - for vasodilation ; PD inhibition
ASA
Clopidogrel if allergy
196
6. Ps of arterial occlusion
Compartment syndrome
Pain pallor paresthesia pulselesness poiklythermia paralysis
197
When you think vasculitis think what two diseases and what txm?
Takayasu
Temporal Arteritis
TXM = cc’s
198
AAA unstable #1 diagsostic ; all others?
FAST
TEE = all others (A-TAA/D-TAA)
199
Indications for urgent repair A-TAA/ D-TAA/ AAA
A = any sxs
D = greater than 5-5.5 cm
AAA= expanding more than 0.5cm per year
200
Secondary (meds) prevention for A/D TAA
Beta blockers
Statin therapy
ACE-I
201
Secondary prevention AAA
Smoking cessation
202
Describe aortic dissection chest pain
Ripping pain either retrosternal or towards the back
>20 mmHg difference blood pressure in UE
203
medical txm for distal aortic dissection
Propanolol only ;
Urgent EVAR
204
Proximal dissection management
Decrease HR and cardiac output=
Esmolol / Labetalol / Propanolol
205
Best initial dx for dissection
CXR
206
Amaurosis faugax is associated with what condition
Carotid artery dissection
207
MC location for varicose veins
= Greater saphenous veins
208
Pitting vs Non pitting edema
Pitting = CHF
Non pitting = Lymphedema ; Mxedema (thyroid) ; electrolyte distrurbance ; liver
209
TXM of pressure ulcers
Elevation
Topical ABX
Silvadene = silver sulfadiazene
Wet to dry dressing
