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Flashcards in Cardiovascular disorders Deck (41)
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1

What are the indications for cardioversion?

Indications for synchronized electrical cardioversion include the following:

--Supraventricular tachycardia

--Atrial fibrillation

--Atrial flutter

--Ventricular tachycardia

--Any patient with reentrant tachycardia with narrow or wide QRS complex who is unstable (eg, chest pain, pulmonary edema, hypotension)

Medscape

2

What are contraindications for cardioversion?

--Known digitalis toxicity–associated tachycardia

--Multifocal atrial tachycardia

--Patients with atrial fibrillation who are not anticoagulated should not undergo cardioversion without a TEE that can assess the presence of left atrial thrombus

Medscape

3

What are indications for defibrillation?

Indications for defibrillation include the following:

--Pulseless ventricular tachycardia (VT)

--Ventricular fibrillation (VF)

--Cardiac arrest due to or resulting in VF

Medscape

4

What are contraindications for defibrillation?

Awake, responsive patient

5

What is this?

Digitalis toxicity

6

What is this?

A: hypercalcemia

B: hypocalcemia

7

What is this?

Hyperkalemia

8

What is this?

Hypokalemia

9

What is this?

Wolff Parkinson White

10

What is this?

Pericarditis

--ST elevation with entire T wave above baseline

11

--IVDU

--fever

--valve vegetations seen on TTE

--septic emboli in lungs or brain seen on CT

--get blood cultures

Is this endocarditis, pericarditis, or myocarditis?

endocarditis

12

--audible rub

--pain worse supine, improves if sitting up leaning forward

--diffuse ST elevations seen on EKG

Is this endocarditis, pericarditis, or myocarditis?

pericarditis

13

--often follows URI

--need a biopsy to diagnose

--Echocardiogram documents cardiomegaly and contractile dysfunction

Is this endocarditis, pericarditis, or myocarditis?

myocarditis

14

What is the top bug that causes endocarditis?

S. aureus

 

purple book 6-12

15

After S. aureus, what is the most common bug in endocarditis for 

--native valve

--prosthetic valve

Native valve: S. viridans

Prosthetic valve: S. epidermidis

 

purple book 6-12

16

What is the treatment regimen for infective endocarditis?

Acute, native valve: vanco

Subacute, native valve: ceftriaxone

Prosthetic valve: vanco + gent + ceph

 

purple book 6-13

17

What are the etiologies of pericarditis?

--90% idiopathic (presumed to be viral)

--metastatic neoplasms

--autoimmune

--uremia

--acute STEMI

--radiation

 

purple book 1-25

18

What is the treatment of pericarditis?

NSAIDs +/- colchicine

Steroids

 

purple book 1-26

19

What are the signs and symptoms of cardiac tamponade?

1. cardiogenic shock (hypotension, fatigue) without pulmonary edema

2. pulsus paradoxus (large decrease in SBP on inspiration)

3. dyspnea

4. increased cardiac silhouette on CXR

5. effusion seen on TTE

 

purple book 1-26

20

What is the treatment regimen for cardiac tamponade?

PERICARDIOCENTESIS

But also:

1. Volume (but not too much, since that will worsen tamponade due to overfilling)

2. Positive inotropes e.g. dobutamine

3. Avoid vasoconstrictors

21

What is the NYHA Functional classification system for heart failure?

Class I (Mild)

No limitation of physical activity.

Ordinary physical activity does not cause undue fatigue, palpitation, or dyspnea.

Class II (Mild)

Slight limitation of physical activity.

Comfortable at rest, but ordinary physical activity results in fatigue, palpitation, or dyspnea.

Class III (Moderate)

Marked limitation of physical activity.

Comfortable at rest, but less than ordinary activity causes fatigue, palpitation, or dyspnea.

Class IV (Severe)

Unable to carry out any physical activity without discomfort.

Symptoms of cardiac insufficiency at rest. If any physical activity is undertaken, discomfort is increased.

 

22

What are the symptoms of congestive heart failure (right and left)?

Left: dyspnea, orthopnea, PND

Right: peripheral edema, RUQ discomfort, bloating, satiety

 

purple book 1-14

23

What are the physical exam findings of CHF?

--increased JVP

--hepatojugular reflux

--S3

--rales, dullness in lung bases 2/2 pleural effusion

--peripheral edema

 

purple book 1-14

24

What are the treatments for acute decompensated heart failure?

Warm & dry: outpatient

Warm & wet: diuresis

Cold & dry: inotropes

Cold & wet: diuresis, inotropes, +/- vasodilators

 

purple book 1-15

25

What are the pharmacologic and non-pharmacologic measures that should be taken to prevent venous thromboembolism in hospitalized patients?

Heparin, LMWH, fondaparinux, enoxaparin

NOT warfarin

NOT aspirin

~~~

YES Intermittent pneumatic compression devices

NO real evidence for compression stockings

 

UpToDate

26

What is the Wells Criteria scoring system for DVT probability?

--Paralysis, paresis or recent orthopedic casting of lower extremity (1 point)

--Recently bedridden (more than 3 days) or major surgery within past 4 weeks (1 point)

--Localized tenderness in deep vein system (1 point)

--Swelling of entire leg (1 point)

--Calf swelling 3 cm greater than other leg (measured 10 cm below the tibial tuberosity) (1 point)

--Pitting edema greater in the symptomatic leg (1 point)

--Collateral non varicose superficial veins (1 point)

--Active cancer or cancer treated within 6 months (1 point)

--Alternative diagnosis more likely than DVT (Baker's cyst, cellulitis, muscle damage, superficial venous thrombosis, post phlebitic syndrome, inguinal lymphadenopathy, external venous compression) (-2 points)

 

Scoring:

3-8 Points: High probability of DVT

1-2 Points: Moderate probability

-2-0 Points: Low Probability

UpToDate

 

27

What are the diagnostic steps for suspected DVT?

1. Wells score

2. D-dimer (sensitive, not specific - rules out if neg but if pos, don't know why, need more testing)

3. Ultrasound

28

How do you best prevent development of pressure ulcers in hospitalized patients?

1. Identify patients at risk

2. Turn Q2 hours

3. Position properly (elevate HOB, use pillows between knees, etc.)

4. Choose proper surface (mattress, pneumatic mattress, etc.)

5. Minimize moisture (i.e. from incontinence)

6. Proper nutrition

7. Proper skin care (moisturizing, etc.)

8. Minimize immobility

9. Educate staff, have protocols in place

29

What are the 3 main classifications of cardiomyopathy?

Dilated

Hypertrophic

Restricted

(plus Takotsubo)

30

72 yo woman whose husband passed away suddenly last week presents with s/s of acute anterior MI but  upon cardiac catheterization/imaging only LV apical ballooning is found. 

What is it?

Takotsubo, or stress cardiomyopathy

Usually complete recovery

--postmenopausal women

--after major catecholamine discharge