Chapter 3 MDT Flashcards
(241 cards)
1
Q
What is regulated by the relaxing or contracting of the smooth muscle around arterioles?
A
Blood pressure
2
Q
Compared to veins, what do arteries have?
A
Larger layer of smooth muscle & more dense outer layer
3
Q
When taking BP, how much more do you inflate the cuff after the auscultatory sound disappears?
A
20 to 30 mm Hg
4
Q
When taking BP how slow do you deflate the cuff in order to hear the Korotkoff sounds?
A
2 mm Hg per second
5
Q
Normal BP
A
SBP: <120
DBP <80
6
Q
SBP: 120-129
DBP: <80
A
Elevated BP
7
Q
SBP: 130-139
DBP: 80-89
A
Stage I Hypertension
8
Q
SBP: >140
DBP: >90
A
Stage II Hypertension
9
Q
Essential hypertension is applied to what percentage of patients?
A
95%
10
Q
Hypertension occurs in what percentage of white patients?
A
10-15%
11
Q
Hypertension occurs in what percentage of black patients?
A
20-30%
12
Q
What is the onset age of hypertension?
A
25-55
13
Q
Hypertension that has an identifiable cause and should be suspected with HTN at an early age, when symptoms first appear at 50 years old, or when there is difficulty controlling HTN with medication
A
Secondary Hypertension
14
Q
What age would you calculate a 10-year atherosclerotic cardiovascular disease risk
A
40+
15
Q
Lifestyle modifications for HTN Patients
A
1) Diets rich in fruits and vegetables and low in saturated fats
2) Weight reduction (10 kg can lower SBP by 5-20 mm Hg)
3) Reduced alcohol consumption (no more than 2 drinks a day)
4) Increase physical activity
16
Q
What is the goal BP for HTN in most patients?
A
<140/90
<130/80 in patients with diabetes or kidney disease
17
Q
First line treatment for HTN
A
1) Diuretic: Hydrochlorothiazide
2) ACE Inhibitor: Lisinopril (-pril)
18
Q
What would you prescribe to a patient when an ACE inhibitor is working well, but they develop a cough?
A
ARB: Losartan
19
Q
ACEi’s work well on what types of patients?
A
Younger white patients, relatively less effective in black patients
20
Q
What HTN medication works well in older and in black patients?
A
Calcium Channel Blockers: Diltiazem or Amlodipine
21
Q
Primarily used for benign prostate hyperplasia, but when used as an anti-hypertensive, it is usually used in conjunction with another medication
A
Alpha Blocker: Terazosin
22
Q
1) SBP >220 or DBP >125
2) NO signs of end organ damage
3) Reduce BP within a few hours
A
Hypertensive Urgency
23
Q
1) Blood pressure elevated (DBP > 130)
2) Signs of end organ damage
3) Need to reduce blood pressure by 25% within 1-2 hours, then < 160/110 in 24 hours
A
Hypertensive Emergency
24
Q
What is the goal to reduce patients in a hypertensive urgency?
A
Use PO medications with the goal of reducing DBP <110 in 24 hours
25
If the patient is in a HTN Urgency and not currently on medication, what can you give them?
1) Alpha Blocker: Clonidine (Primary treatment for HTN Urgency)
2) Beta blocker: Metoprolol or Labetalol
26
HTN Emergency, BP reduction goal
25% within 1 to 2 hours, then slowly decrease to 160/110 within the next 24 hours
27
HTN Emergency medication treatment
1) Labetalol 20mg IV (over 10 minutes), then 40-80 mg IV q10 minutes PRN (max 300mg)
2) Once stable start Metoprolol 25-50mg PO twice daily
28
Atherosclerotic Disease primarily affects what part of the artery?
Arterial endothelium
29
Plays a critical role in the development of atherosclerosis
Dyslipidemia and abnormal lipids
30
Number one killer in the United States
Atherosclerotic Coronary Artery Disease (CAD)
31
Metabolic syndrome, a combination of what medical disorders that when occurring together, increase the risk of developing cardiovascular disease and diabetes?
1) Abnormal obesity
2) Triglycerides > 150mg/dL
3) HDL <40 mg/dL for men; <50 mg/dL for women
4) Fasting glucose > 110 mg/dL
5) Hypertension
32
Bad cholesterol
LDL
33
Good cholesterol
HDL
34
Most important non-pharmacological change for patients with CAD
Smoking Cessation
35
Medications for CAD
1) Atorvastatin
| 2) Aspirin
36
Primary prevention dose of Aspirin in patients with ASCVD?
81 mg daily
37
CAD Surgeries
1) Coronary Artery Bypass Grafting (CABG)
2) Stenting
3) Primary percutaneous coronary intervention
38
Occlusive atherosclerotic lesions that develop in the legs, and less commonly, the arms causing decreased perfusion of the extremities
Atherosclerotic Peripheral Vascular Disease (PAD)
39
PAD has a high correlation with what types of patients?
Diabetic and smokers
40
Cramping pain or tiredness in the thigh, calf, or foot with walking or exercise and relieved by rest
Claudication
41
Pharmacological treatment for PAD
Phosphodiesterase inhibitor: Cilostazol
42
Emboli large enough to occlude proximal arteries are almost always from what part of the body?
The heart
43
What is one of the most common causes for an acute arterial occlusion of a limb?
Atrial Fibrillation
44
1) Pain
2) Pallor (mottled with delayed cap refill)
3) Poikilothermic (coolness)
4) Pulselessness
5) Paresthesia
6) Paralysis
Six P's of severe arterial ischemia
45
Pharmacological treatment for Acute Arterial Occlusion of a Limb
Anticoagulants:
1) Enoxaparin (1mg/kg SC q 12 hrs)
2) Heparin Sulfate (5,000-10,000 Units IV Stat)
46
Immediate revascularization must be done within how many hours to decrease potential irreversible tissue damage?
3 hours
47
Acute Arterial Occlusion of a limb % risk of amputation and mortality rate
10-25% risk of amputation; 25% hospital mortality rate
48
Causes strokes or TIA's
Symptoms: Neurological deficits and Carotid Bruits
Occlusive Cerebrovascular Disease
49
Imaging modality of choice for carotid stenosis
Duplex ultrasonography
50
Patients with carotid stenosis who had a TIA or small stroke and have had no treatment, are at what risk of having a stroke in 1 year?
25%
51
Elevated total Low-density (LDL) cholesterol levels and low levels of high-density lipoprotein (HDL) cholesterol
Dyslipidemia
52
Most triglyceride molecules are found in what particles?
VLDL
53
Transports cholesterol to your liver to be expelled from your body
HDL
54
Treatment for a 40–79 year-old that is >5% risk of ASCVD in 10 years
Statins
55
Treatment for a 40–79 year old that is >10% risk for ASCVD in 10 years
Aspirin
56
High triglyceride level (>1000 mg/dL) can cause what symptom?
Xanthomas (red/yellow papules, especially on the butt)
57
High triglyceride level (>2000 mg/dL) can cause what symptom?
Lipemia Retinalis (cream-colored vessels in the fundus of the eye)
58
What can cause tendinous Xanthomas?
High LDL concentrations
59
What can precipitate acute pancreatitis?
High triglycerides
60
Diets to help treat Dyslipidemia
1) Low fat diet (reduce total fat to 25-30% of your diet)
2) Mediterranean Diet
3) High Fiber Diet (40-45 grams a day)
61
Pharmacological treatment for dyslipidemia
Simvastatin (Statins)
62
Treatment for 20-39 y/o with a ASCVD risk of >10% in 10 years
Statin therapy
63
How many leads are there for an EKG?
12
64
Placement of Right/Left Arm EKG lead
Anywhere between wrist and shoulder
65
Placement of Right/Left leg EKG lead
Anywhere between ankle and torso
66
EKG V1 placement
4th ICS to the right of sternum
67
EKG V2 placement
4th ICS to the left of sternum
68
EKG V3 placement
Midway between V2 and V4
69
EKG V4 placement
5th ICS at the midclavicular line
70
EKG V5 placement
Anterior axillary line at the same level as V4 (5th ICS)
71
EKG V6 placement
Midaxillary line at the same level as V4 & V5 (5th ICS)
72
EKG wave
Represents the right and left atrium depolarization
P wave
73
The time between the start of the P wave and the start of the QRS complex
PR interval (normal: 0.12-0.2 seconds)
74
EKG wave
Depolarization of the ventricles
QRS complex (normal duration: 0.12 seconds)
75
EKG wave
Represents the repolarization of the ventricles
T wave
76
Interval that starts at the QRS complex and ends at the end of the T-wave.
It represents the time of ventricular activity including both depolarization and repolarization.
QT interval (normal: 0.36-0.44 seconds)
77
Segment between the end of the QRS complex and the start of the T-wave.
It should be at the same level on the EKG tracing as the PR interval.
ST segment
78
If the ST dips and does not come back to the same level as the PR interval, this indicates:
ST Depression (start of myocardial ischemia)
79
If the ST elevates and does not come back to the same level as the PR interval, this indicates:
ST elevation (represents full thickness myocardial infarction)
80
T-wave inversion could indicate:
Ischemia
81
Identified by having a wide QRS complex (greater than 0.12 seconds) along with a broad S wave in lead V1 and wide R wave in lead V5/V6
Left Bundle Branch Block
82
What is the gold standard for monitoring and diagnosing cardiac arrhythmias?
ECG
83
Severe bradycardia
<45 beats/min
84
Bradycardia treatment
Atropine (inhibits vagal input to SA node)
85
What would indicate someone is unstable if tachycardic or bradycardic?
1) Changes in mental status
2) Ischemic chest discomfort
3) Hypotension
4) Signs of shock
5) Acute heart failure
86
Mechanical measures to treat Paroxysmal Supraventricular Tachycardia (PSVT)
1) Valsalva
2) Dunk face in bowl of ice water
3) Carotid sinus massage (gentle pressure 10-20 seconds)
87
Pharmacological treatment for PSVT
Adenosine (antiarrhythmic ) - FIRST LINE
Metoprolol or Diltiazem - SECOND LINE
88
Hemodynamically unstable SVT cardioversion rate:
50-150 J
89
Most common, chronic arrhythmia, and prevalence increases with age
Atrial Fibrillation
90
"Holiday Heart"
Alcohol excess or withdrawal
91
Patients with A-Fib greater than 48 hours should have elective cardioversion after how many weeks on anti-coagulants?
3 weeks
92
2/3 of patients experiencing their first A-Fib event will revert back to normal sinus within?
24 hours
93
EKG:
1) Short PR interval (<0.12 seconds)
2) Wide, slurred QRS complex
Symptoms: Same as PSVT
Wolf Parkinson White Syndrome
94
EKG:
1) R-R interval is irregularly irregular
2) Atrial Rate: 400 beats/min (wavy baseline)
Atrial Fibrillation
95
When would you cardiovert an A-Fib or an A-Flutter patient before they have been anticoagulated for the 3 week period?
If they're UNSTABLE
Cardiovert at 100-200 J
96
What medications would you give an A-Fib patient?
1) Metoprolol (Beta-blocker)
2) Diltiazem (CCB)
3) Enoxaparin (anticoagulant)
97
What EKG rhythm is:
Usually associated with pulmonary disease.
Originates from a localized area in the atria.
Predisposes patients to thromboembolic events.
Atrial Flutter
98
EKG:
1) Saw tooth flutter waves between QRS complexes
2) Atrial rate between 250-350 beats/min
3) AV block 2:1, 3:1, 4:1
Atrial Flutter
99
Medication treatment for A-Flutter
1) Metoprolol (Beta-blocker)
| 2) Diltiazem (CCB)
100
3 or more consecutive ventricular premature beats lasting < 30 seconds and terminating spontaneously
Non-sustained V-Tach
101
What are the most common causes for V-Tach?
1) AMI
2) Ischemic heart disease
3) Electrolyte imbalance
102
Why is V-Tach life threatening?
It can lead to pulseless V-tach, V-fib, and death
103
EKG:
1) Wide QRS complex (longer than 0.12 seconds)
2) Absence of P waves
3) Tachycardia, usually HR 160-240 beats/min
4) Moderately regular R-R
V-Tach
104
Symptoms of an unstable patient:
1) Change in mental status
2) Ischemic chest discomfort
3) Hypotensive
4) Signs of shock
5) Acute heart failure
105
Medications to treat V-Tach
1) Lidocaine
| 2) Amiodarone (CCB)
106
Medications to treat V-Tach if you suspect patient has low magnesium levels from diuretic therapy, alcoholism, diarrhea, acute pancreatitis
Magnesium 2g IV
107
Treatment for stable V-Tach with narrow complex
1) Vagal maneuvers (1st line)
2) Adenosine (2nd line)
3) Betablocker or CCB (3rd line)
108
Digoxin toxicity, caffeine use, and hyperthyroidism can cause what type of heart arrythmia?
Premature Ventricular Contraction (PVC)
109
EKG:
1) Wide QRS complex without a preceding P-wave
2) Occurs before the next predicted QRS complex is set to occur
Premature Ventricular Contraction (PVC)
110
Pharmacological treatment for frequent PVCs in patients with underlying structural heart disease
Metoprolol
111
1) Totally disorganized depolarization of small areas of the ventricular myocardium
2) No effective ventricular pumping and thus no cardiac output
Ventricular Fibrillation
112
EKG:
| Fine to course zigzag pattern without P waves or QRS complexes
Ventricular Fibrillation
113
Symptoms of Ventricular Fibrillation
1) Pulseless
2) Hypotensive
3) Unconscious
114
Treatment for V-Fib
Initiate ACLS Protocol for cardiac arrest
115
1) Acquired or congenital QT interval prolongation
2) Can be triggered by hypomagnesemia, hypocalcemia, hypokalemia, starvation, anorexia nervosa, liquid protein diets, and hypothyroidism
3) Type of ventricular tachycardia
Torsades de Pointes
116
EKG:
1) HR greater than 100
2) Wide QRS complex (> 0.12 seconds)
3) Frequent variations of the QRS axis, morphology, or both
Torsades de Pointes
117
Symptoms of Torsades de Pointes
1) Palpitations
2) Lightheadedness, dizziness
3) Hypotension
4) Syncope
5) Sudden cardiac death
118
Treatment for stable Torsades de Pointes
Vitals every 5 minutes
2 grams of Magnesium Sulfate IV
Check electrolyte panel and EKG
119
Treatment for unstable Torsades de Pointes
Synchronized cardioversion at 100 J then give 2 grams of Magnesium Sulfate IV
120
Delayed or blocked conduction from the atrium to the ventricles
Atrioventricular (AV) Block
121
How many degrees of AV heart blocks are there?
Three
122
1) Delayed AV conduction manifested by a prolonged PR interval
2) Delayed conduction between the SA node and the AV node, not truly a heart block
3) Benign finding
1st Degree AV Block
123
EKG:
| Prolonged PR interval >0.2 seconds is the only finding
1st Degree AV Block
124
1) Progressive prolongation of AV conduction until impulse is completely blocked
2) In this rhythm the block is above the AV node
3) PR interval will become longer and longer until the QRS complex is dropped off completely
2nd Degree AV block I
125
Wenckebach block
2nd Degree AV Block I
126
EKG:
1) Progressive PR interval prolongation until QRS complex is not conducted
2) Represents a failure of a conducted atrial beat to reach the ventricle
3) QRS is narrow (because the disease is above the AV node)
2nd Degree AV Block I
127
Treatment for unstable 2nd Degree AV Block I
1) Atropine (first line)
| 2) If atropine does not work, Transcutaneous Pacing
128
What heart block usually implies structural heart damage to the nodal conduction system and are usually permanent?
2nd degree AV block TYPE II
129
1) Block is just below the AV node in the Bundle of His
| 2) Has a high potential to progress into a 3rd degree AV block
2nd Degree AV Block Type II
130
EKG:
1) PR interval remains unchanged prior to a P wave that fails to conduct the ventricles
2) Disease is below the AV node, the QRS complex tends to be more prolonged (>0.10 seconds)
2nd Degree Heart Block Type II
131
Treatment for unstable 2nd Degree AV Block Type II
1) Atropine & Transcutaneous pacing (FIRST LINE)
2) Dopamine (2nd-line)
If Signs of Heart Failure use: Dobutamine or Epinephrine
132
1) Also known as Complete Heart Block due to no AV conduction
2) Complete Disassociation of P waves and QRS complexes
3) Usually leads to inadequate cardiac output to maintain perfusion to vital organs and patients present unstable with periods of ventricular asystole
3rd Degree AV Block
133
EKG:
1) No relationship between P and R waves
2) Patients with have P and QRS complex activity independent of each other
3) Disease in 2/3 of patients is at the AV node which leads to narrow QRS
3rd Degree Heart Block
134
Treatment for 3rd Degree AV Block
1) Atropine & Transcutaneous pacing
2) Dopamine (2nd-line)
* Signs of Heart Failure use: Dobutamine or Epinephrine
135
Organized electrical rhythm, but absence of mechanical ventricular activity sufficient to generate a pulse
Pulseless Electrical Activity (PEA)
136
What are the Four Rhythms that can cause Cardiac Arrest?
1) Pulseless Ventricular Tachycardia
2) Ventricular Fibrillation
3) Asystole
4) Pulseless Electrical Activity (PEA)
137
What are Shockable Rhythms?
1) Pulseless V-Tach
| 2) Pulseless V-Fib
138
What are Non-shockable Rhythms?
1) Pulseless Electrical Activity
| 2) Asystole
139
Ventilation rate during CPR with bag valve mask
2 breaths every 30 compressions
140
Ventilation rate during CPR with an advanced airway
1 breath every 6-8 seconds and maintain continuous CPR
141
Carbon dioxide physiological levels
ETCO2: 35-40 mmHg
PaCO2: 40-45 mmHg
142
SBP goal from Return of Spontaneous Circulation (ROSC)
>90
143
What would you do if SBP is under 90 mmHg from RSOC?
1) IV Fluid Bolus (1-2 Liters of NS or LR)
| 2) Vasopressor infusion (Epinephrine, Norepinephrine, or Dopamine)
144
Treatment of STEMI patient that is able to follow commands
Admit to a critical care unit for ongoing care and monitoring
145
Treatment of a STEMI Patient that is not able to follow commands
Initiate Targeting Temperature Management (TTM):
-Maintain core body temperature of 32-36 degrees Celsius for 24 hours
146
What are the coronary arteries?
1) Left Anterior Descending Artery (LAD)
2) Left Circumflex Artery (LCx)
3) Right Coronary Artery (RCA)
147
How much oxygen does myocardium tissue extract?
65%
| Normal tissue will only extract about 25%
148
Chest pain with exertion and relieved by rest
Stable Angina
149
Chest pain while resting:
Unstable Angina
150
Rare, caused by coronary vasospasm often without any CAD
Prinzmetal's Angina
151
Coronary blood flow occurs only during what phase of the heart pump?
Ventricular Diastole
152
Disease that comprises the spectrum of unstable cardiac ischemia, unstable angina, acute myocardial infarction
Acute Coronary Syndrome (ACS)
153
Presents with positive cardiac enzymes and non-specific EKG changes (represents partial muscle thickness infarct)
Non-ST segment elevation (NSTEMI)
154
Results from an occlusive coronary thrombus at the site of preexisting atherosclerotic plaque
STEMI or Acute myocardial infarction
155
What do you need to consider when treating young individuals without any risk factors that have a NSTEMI or STEMI?
Cocaine use
156
Levine's Sign
Clinching fist over chest
157
Right coronary artery lesions will present with what symptoms?
Bradycardia, due to it supplying blood to SA node
158
Left coronary artery lesions will present with what symptoms?
Tachycardia and CHF symptoms
159
Troponin levels rise and peak how long after injury?
Rise 4-8 hours after injury
Peak at 12-24 hours after injury
160
Troponin T and I will stay elevated for how long?
T: 2 weeks
I: 5-7 days
161
What elevated cardiac enzymes indicate a myocardial infarction?
Troponin and CK-MB
162
How would an NSTEMI look on an EKG?
ST segment depression, T wave inversion, or no changes at all
163
How would a STEMI look on an EKG?
ST segment elevation, T wave inversion, Q wave development (which represents scar tissue)
164
How can you tell which area of the heart, and which coronary vessel is blocked in a STEMI?
Based on which EKG leads have the ST elevation
165
What is the #1 goal for treatment in an MI?
Prevent further cardiac tissue damage
166
Treatment for Myocardial Infarctions
MONA:
- Morphine
- Oxygen (4L NC if <94%)
- Nitroglycerine
- Aspirin
167
What percentage of MI patients have an LV wall rupture?
1%, 2-7 days post MI
168
What percentage of ER visits account for chest pain?
5%
169
What are:
1) Acute Myocardial Infarction/Unstable Angina
2) Pulmonary Embolism
3) Pericardial Tamponade
4) Esophageal Rupture
5) Tension Pneumothorax/Pneumothorax
6) Aortic Dissection/Rupture
"BIG 6"
6 life threatening causes of acute onset chest pain
170
What labs/interventions would you order to rule out life-threatening causes of acute chest pain?
1) EKG
2) Cardiac enzymes
3) Chest X-ray
4) CT chest for Aortic dissection & PE
5) FAST exam for tamponade
171
Muscles located in the ventricles, attach to the cusps of the valves via chordae tendineae
Papillary muscles
172
Another name for leaking heart valve
Regurgitation
173
Term for a valve that doesn't open properly. The flaps of the valve thicken, stiffen, or fuse together.
Stenosis
174
What is one of the most important congenital heart issues, that can lead to aortic aneurysm formation?
Congenital Bicuspid Aortic valve.
175
Back flow of blood from the left ventricle back into the left atrium during systole
Mitral Regurgitation
176
Valves protruding back into the left atrium during ventricular systole
Mitral Valve Prolapse ("Floppy mitral valve")
177
Mid-Systolic click would indicate:
Mitral Valve Prolapse
178
Low pitched diastolic murmur (rumbling murmur) would indicate:
Mitral stenosis
179
What ages is aortic stenosis more common?
>65
180
Physical examination:
1) Systolic crescendo-decrescendo murmur through systole with radiation to the right carotid
2) Parasternal heave (upward push of your hand, suggest ventricular hypertrophy)
3) Thrill (vibratory sensation on your hand) at the aortic position
Aortic Stenosis
181
Blood flow from the Aorta back to the left ventricle during diastole
Aortic Regurgitation
182
Physical exam:
1) Soft Aortic Diastolic murmur
2) Wide pulse pressure
3) Pulmonary edema
Aortic Regurgitation
183
What is the definitive treatment for valvular heart disease?
Surgical repair, tissue or mechanical valve replacement
184
Hearts inability to pump enough blood throughout the body
Congestive Heart Failure
185
Percentage of CHF patients that >65
75%
186
In CHF what does your body first signal to increase Cardiac Output?
Renin-Angiotensin-Aldosterone system to retain fluid in the kidneys
187
The most common type of CHF:
Left Ventricular systolic failure
188
The most common cause of right heart failure is:
Left Heart Failure
189
CHF
What side of the heart is affected if the patient has dyspnea, pulmonary edema, chronic cough, fatigue?
Left side
190
CHF
What side of the heart affected if the patient has fluid retention, peripheral edema, hepatic congestion, abdominal ascites, and JVD?
Right side
191
Released from the myocardial tissue in response to increased heart distention which signals the kidneys to start removing more fluid
B type Natriuretic Peptide (BNP)
192
Acute Treatment for CHF
Furosemide or Bumetanide
193
In a CHF patient, when would you want to check their Potassium and Magnesium levels?
If they produce >1 liter of urine
194
What is considered a low sodium diet?
<2 grams per day
195
Chronic Treatment for CHF
1) Lifestyle changes
2) ACE inhibitors
3) Diuretics
4) Nitroglycerine
196
What would you give a CHF patient with pulmonary edema?
Furosemide (Lasix)
197
Mortality rate of CHF with pulmonary edema
50% within the next year
198
CHF mortality rate with no pulmonary edema
35% in 2 years
| 80% in 6 years
199
3 layers of the Aorta
1) Intima
2) Media
3) Adventitia
200
What type is:
Aortic Dissection involving the arch
Type A
201
What type is:
Aortic Dissection involving the descending Aorta
Type B
202
Spontaneous Aortic Dissections are commonly associated with:
1) HTN
2) Connective tissue disorders (Marfan Syndrome)
3) Bicuspid Aortic Valve
4) Pregnancy
5) Coarctation of the Aorta (narrowing)
203
Symptoms:
1) Sudden severe chest pain radiating to the back ("ripping" or "tearing")
2) HTN
3) Syncope
4) Paralysis of lower extremities
5) Diminished or unequal peripheral pulses
6) Possible diastolic murmur of Aortic Regurgitation
Aortic Dissection
204
What type of aortic dissection requires immediate surgery?
Type A
205
Goal BP for Aortic Dissection
SBP of 100-120 and lower HR to <80
206
Mainstay pharmacological treatment for Aortic Dissections
Beta Blockers:
-Metoprolol & Labetalol
Morphine for pain
207
Mortality rates for Type A Aortic Dissections if unrepaired
1% at 72 hours
90% in 3 months
208
Inflammation of the pericardium
Pericarditis
209
What is the most common cause of pericarditis?
Viral infections in males <50 years old
210
What is the most common organism that causes pericarditis?
Coxsackieviruses and Echovirus
211
Symptoms:
1) Fever
2) Sharp pain, worse when lying down
3) Chest is positive for Friction rib (sounds like Velcro or crunching snow)
Pericarditis
212
Treatment for pericarditis
Aspirin and NSAIDS
213
Non-infectious causes of Myocarditis
1) Alcohol
2) Cocaine
3) Medications
4) Insect Bites
5) Snake Bites
6) Inflammatory bowel disease
7) Celiac Disease
8) Sarcoidosis (rashes)
214
Symptoms:
1) S3/S4
2) Sinus Tachycardia with a Fever
3) Retrosternal chest pain
Myocarditis
215
What distinguishes myocarditis from pericarditis?
Myocarditis will have positive cardiac enzymes (troponin/CK-MB)
216
What medication do you want to avoid, which can worsen myocarditis?
NSAIDS
217
What bacteria usually causes native valve endocarditis?
Staph Aureus or Streptococci
218
What accounts for 60% of endocarditis cases?
IV drug users with Staph Aureus infections
219
What side of the heart in endocarditis cases do IV drug users typically present?
Right Sided
220
Any new onset of heart murmur with a fever is what until proven otherwise?
Endocarditis
221
Treatment for endocarditis after blood cultures
Ertapenem OR Vancomycin, with Ceftriaxone
222
Initial care of endocarditis
IV, O2 if <94%
THREE sets of blood cultures
Antibiotic Treatment
Transfer to higher level of care
223
Accumulation of fluid in the pericardium preventing venous return and ventricular filling
Pericardial Tamponade
224
1) Muffle heart sounds
2) JVD
3) Hypotensive unresponsive to fluid change
Beck's Triad (positive for pericardial tamponade)
225
Patient drops >10mmHg SBP during inspiration
Pulsus Paradoxus (Pericardial Tamponade)
226
How would pericardial tamponade look on an EKG?
1) Sinus Tachycardia
| 2) Electrical Alternans (Alternates strength in every other QRS)
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Treatment for pericardial tamponade
1) IV Fluid bolus to correct hypotension
| 2) Pericardiocentesis (Needle aspiration of fluid around heart)
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1) Swelling occurs, which decreases blood flow and can lead to necrosis
2) Commonly caused by high speed MVA, Steering wheel in motor vehicle accidents and other blunt force trauma
Cardiac Contusion
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Treatment for cardiac contusion
1) Pain control with analgesics
2) Monitor for 4-6 hours, repeat EKG in 24 hours
3) Transfer
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1) Venous Stasis (inflammation of skin)
2) Hypercoagulable state
3) Injury to vessel wall
Virchow's triad (Presence of just one can cause Deep Vein Thrombosis)
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Most common life-threatening consequence of a DVT?
Pulmonary Embolism (PE)
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THROMBOSIS
1) Trauma, Travel
2) Hypercoagulable, Hormones
3) Recreational IV Drugs
4) Over 60 y/o
5) Malignancy
6) Birth control
7) Obesity
8) Surgery, Smoking
9) Immobilization
10) Sickness
Risk factors for developing Deep Vein Thrombosis (DVT)
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What lab do you want to get in a patient with suspected DVT?
D-Dimer
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All patients with signs or symptoms of DVT need to undergo:
Ultrasound
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DVT treatment
Anticoagulants: Lovenox or Heparin (for 3-6 months minimum)
Pain Control: Tylenol or Morphine
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If you suspect DVT what should you do right away before MEDEVAC?
Anticoagulants
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What percentage of PE patients with have lower extremity DVT?
50-70%
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3rd leading cause of death in hospitalized patients
Pulmonary Embolism
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Symptoms:
1) Chest pain, tachypnea, and tachycardia
2) Hypoxemia
3) Shortness of breath
4) Signs of DVT (unilateral leg swelling, pain, redness)
Pulmonary Embolism
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What is the imaging of choice to look for Pulmonary Embolism?
Helical CT pulmonary angiography
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Treatment of Pulmonary Embolism
Aggressive anticoagulation with Heparin or Lovenox
