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Cardiology > Chapter 3 MDT > Flashcards

Chapter 3 MDT Flashcards

1
Q

What is regulated by the relaxing or contracting of the smooth muscle around arterioles?

A

Blood pressure

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2
Q

Compared to veins, what do arteries have?

A

Larger layer of smooth muscle & more dense outer layer

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3
Q

When taking BP, how much more do you inflate the cuff after the auscultatory sound disappears?

A

20 to 30 mm Hg

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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

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5
Q

Normal BP

A

SBP: <120

DBP <80

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6
Q

SBP: 120-129
DBP: <80

A

Elevated BP

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7
Q

SBP: 130-139
DBP: 80-89

A

Stage I Hypertension

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8
Q

SBP: >140
DBP: >90

A

Stage II Hypertension

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9
Q

Essential hypertension is applied to what percentage of patients?

A

95%

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10
Q

Hypertension occurs in what percentage of white patients?

A

10-15%

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11
Q

Hypertension occurs in what percentage of black patients?

A

20-30%

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12
Q

What is the onset age of hypertension?

A

25-55

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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

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14
Q

What age would you calculate a 10-year atherosclerotic cardiovascular disease risk

A

40+

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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

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16
Q

What is the goal BP for HTN in most patients?

A

<140/90

<130/80 in patients with diabetes or kidney disease

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17
Q

First line treatment for HTN

A

1) Diuretic: Hydrochlorothiazide

2) ACE Inhibitor: Lisinopril (-pril)

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18
Q

What would you prescribe to a patient when an ACE inhibitor is working well, but they develop a cough?

A

ARB: Losartan

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19
Q

ACEi’s work well on what types of patients?

A

Younger white patients, relatively less effective in black patients

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20
Q

What HTN medication works well in older and in black patients?

A

Calcium Channel Blockers: Diltiazem or Amlodipine

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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

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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

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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

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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

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25
Q

If the patient is in a HTN Urgency and not currently on medication, what can you give them?

A

1) Alpha Blocker: Clonidine (Primary treatment for HTN Urgency)
2) Beta blocker: Metoprolol or Labetalol

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26
Q

HTN Emergency, BP reduction goal

A

25% within 1 to 2 hours, then slowly decrease to 160/110 within the next 24 hours

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27
Q

HTN Emergency medication treatment

A

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

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28
Q

Atherosclerotic Disease primarily affects what part of the artery?

A

Arterial endothelium

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29
Q

Plays a critical role in the development of atherosclerosis

A

Dyslipidemia and abnormal lipids

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30
Q

Number one killer in the United States

A

Atherosclerotic Coronary Artery Disease (CAD)

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31
Q

Metabolic syndrome, a combination of what medical disorders that when occurring together, increase the risk of developing cardiovascular disease and diabetes?

A

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

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32
Q

Bad cholesterol

A

LDL

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33
Q

Good cholesterol

A

HDL

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34
Q

Most important non-pharmacological change for patients with CAD

A

Smoking Cessation

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35
Q

Medications for CAD

A

1) Atorvastatin

2) Aspirin

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36
Q

Primary prevention dose of Aspirin in patients with ASCVD?

A

81 mg daily

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37
Q

CAD Surgeries

A

1) Coronary Artery Bypass Grafting (CABG)
2) Stenting
3) Primary percutaneous coronary intervention

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38
Q

Occlusive atherosclerotic lesions that develop in the legs, and less commonly, the arms causing decreased perfusion of the extremities

A

Atherosclerotic Peripheral Vascular Disease (PAD)

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39
Q

PAD has a high correlation with what types of patients?

A

Diabetic and smokers

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40
Q

Cramping pain or tiredness in the thigh, calf, or foot with walking or exercise and relieved by rest

A

Claudication

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41
Q

Pharmacological treatment for PAD

A

Phosphodiesterase inhibitor: Cilostazol

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42
Q

Emboli large enough to occlude proximal arteries are almost always from what part of the body?

A

The heart

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43
Q

What is one of the most common causes for an acute arterial occlusion of a limb?

A

Atrial Fibrillation

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44
Q

1) Pain
2) Pallor (mottled with delayed cap refill)
3) Poikilothermic (coolness)
4) Pulselessness
5) Paresthesia
6) Paralysis

A

Six P’s of severe arterial ischemia

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45
Q

Pharmacological treatment for Acute Arterial Occlusion of a Limb

A

Anticoagulants:

1) Enoxaparin (1mg/kg SC q 12 hrs)
2) Heparin Sulfate (5,000-10,000 Units IV Stat)

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46
Q

Immediate revascularization must be done within how many hours to decrease potential irreversible tissue damage?

A

3 hours

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47
Q

Acute Arterial Occlusion of a limb % risk of amputation and mortality rate

A

10-25% risk of amputation; 25% hospital mortality rate

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48
Q

Causes strokes or TIA’s

Symptoms: Neurological deficits and Carotid Bruits

A

Occlusive Cerebrovascular Disease

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49
Q

Imaging modality of choice for carotid stenosis

A

Duplex ultrasonography

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50
Q

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?

A

25%

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51
Q

Elevated total Low-density (LDL) cholesterol levels and low levels of high-density lipoprotein (HDL) cholesterol

A

Dyslipidemia

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52
Q

Most triglyceride molecules are found in what particles?

A

VLDL

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53
Q

Transports cholesterol to your liver to be expelled from your body

A

HDL

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54
Q

Treatment for a 40–79 year-old that is >5% risk of ASCVD in 10 years

A

Statins

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55
Q

Treatment for a 40–79 year old that is >10% risk for ASCVD in 10 years

A

Aspirin

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56
Q

High triglyceride level (>1000 mg/dL) can cause what symptom?

A

Xanthomas (red/yellow papules, especially on the butt)

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57
Q

High triglyceride level (>2000 mg/dL) can cause what symptom?

A

Lipemia Retinalis (cream-colored vessels in the fundus of the eye)

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58
Q

What can cause tendinous Xanthomas?

A

High LDL concentrations

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59
Q

What can precipitate acute pancreatitis?

A

High triglycerides

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60
Q

Diets to help treat Dyslipidemia

A

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)

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61
Q

Pharmacological treatment for dyslipidemia

A

Simvastatin (Statins)

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62
Q

Treatment for 20-39 y/o with a ASCVD risk of >10% in 10 years

A

Statin therapy

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63
Q

How many leads are there for an EKG?

A

12

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64
Q

Placement of Right/Left Arm EKG lead

A

Anywhere between wrist and shoulder

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65
Q

Placement of Right/Left leg EKG lead

A

Anywhere between ankle and torso

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66
Q

EKG V1 placement

A

4th ICS to the right of sternum

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67
Q

EKG V2 placement

A

4th ICS to the left of sternum

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68
Q

EKG V3 placement

A

Midway between V2 and V4

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69
Q

EKG V4 placement

A

5th ICS at the midclavicular line

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70
Q

EKG V5 placement

A

Anterior axillary line at the same level as V4 (5th ICS)

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71
Q

EKG V6 placement

A

Midaxillary line at the same level as V4 & V5 (5th ICS)

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72
Q

EKG wave

Represents the right and left atrium depolarization

A

P wave

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73
Q

The time between the start of the P wave and the start of the QRS complex

A

PR interval (normal: 0.12-0.2 seconds)

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74
Q

EKG wave

Depolarization of the ventricles

A

QRS complex (normal duration: 0.12 seconds)

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75
Q

EKG wave

Represents the repolarization of the ventricles

A

T wave

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76
Q

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.

A

QT interval (normal: 0.36-0.44 seconds)

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77
Q

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.

A

ST segment

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78
Q

If the ST dips and does not come back to the same level as the PR interval, this indicates:

A

ST Depression (start of myocardial ischemia)

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79
Q

If the ST elevates and does not come back to the same level as the PR interval, this indicates:

A

ST elevation (represents full thickness myocardial infarction)

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80
Q

T-wave inversion could indicate:

A

Ischemia

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81
Q

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

A

Left Bundle Branch Block

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82
Q

What is the gold standard for monitoring and diagnosing cardiac arrhythmias?

A

ECG

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83
Q

Severe bradycardia

A

<45 beats/min

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84
Q

Bradycardia treatment

A

Atropine (inhibits vagal input to SA node)

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85
Q

What would indicate someone is unstable if tachycardic or bradycardic?

A

1) Changes in mental status
2) Ischemic chest discomfort
3) Hypotension
4) Signs of shock
5) Acute heart failure

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86
Q

Mechanical measures to treat Paroxysmal Supraventricular Tachycardia (PSVT)

A

1) Valsalva
2) Dunk face in bowl of ice water
3) Carotid sinus massage (gentle pressure 10-20 seconds)

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87
Q

Pharmacological treatment for PSVT

A

Adenosine (antiarrhythmic ) - FIRST LINE

Metoprolol or Diltiazem - SECOND LINE

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88
Q

Hemodynamically unstable SVT cardioversion rate:

A

50-150 J

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89
Q

Most common, chronic arrhythmia, and prevalence increases with age

A

Atrial Fibrillation

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90
Q

“Holiday Heart”

A

Alcohol excess or withdrawal

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91
Q

Patients with A-Fib greater than 48 hours should have elective cardioversion after how many weeks on anti-coagulants?

A

3 weeks

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92
Q

2/3 of patients experiencing their first A-Fib event will revert back to normal sinus within?

A

24 hours

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93
Q

EKG:

1) Short PR interval (<0.12 seconds)
2) Wide, slurred QRS complex

Symptoms: Same as PSVT

A

Wolf Parkinson White Syndrome

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94
Q

EKG:

1) R-R interval is irregularly irregular
2) Atrial Rate: 400 beats/min (wavy baseline)

A

Atrial Fibrillation

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95
Q

When would you cardiovert an A-Fib or an A-Flutter patient before they have been anticoagulated for the 3 week period?

A

If they’re UNSTABLE

Cardiovert at 100-200 J

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96
Q

What medications would you give an A-Fib patient?

A

1) Metoprolol (Beta-blocker)
2) Diltiazem (CCB)
3) Enoxaparin (anticoagulant)

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97
Q

What EKG rhythm is:

Usually associated with pulmonary disease.

Originates from a localized area in the atria.

Predisposes patients to thromboembolic events.

A

Atrial Flutter

98
Q

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

A

Atrial Flutter

99
Q

Medication treatment for A-Flutter

A

1) Metoprolol (Beta-blocker)

2) Diltiazem (CCB)

100
Q

3 or more consecutive ventricular premature beats lasting < 30 seconds and terminating spontaneously

A

Non-sustained V-Tach

101
Q

What are the most common causes for V-Tach?

A

1) AMI
2) Ischemic heart disease
3) Electrolyte imbalance

102
Q

Why is V-Tach life threatening?

A

It can lead to pulseless V-tach, V-fib, and death

103
Q

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

A

V-Tach

104
Q

Symptoms of an unstable patient:

A

1) Change in mental status
2) Ischemic chest discomfort
3) Hypotensive
4) Signs of shock
5) Acute heart failure

105
Q

Medications to treat V-Tach

A

1) Lidocaine

2) Amiodarone (CCB)

106
Q

Medications to treat V-Tach if you suspect patient has low magnesium levels from diuretic therapy, alcoholism, diarrhea, acute pancreatitis

A

Magnesium 2g IV

107
Q

Treatment for stable V-Tach with narrow complex

A

1) Vagal maneuvers (1st line)
2) Adenosine (2nd line)
3) Betablocker or CCB (3rd line)

108
Q

Digoxin toxicity, caffeine use, and hyperthyroidism can cause what type of heart arrythmia?

A

Premature Ventricular Contraction (PVC)

109
Q

EKG:

1) Wide QRS complex without a preceding P-wave
2) Occurs before the next predicted QRS complex is set to occur

A

Premature Ventricular Contraction (PVC)

110
Q

Pharmacological treatment for frequent PVCs in patients with underlying structural heart disease

A

Metoprolol

111
Q

1) Totally disorganized depolarization of small areas of the ventricular myocardium
2) No effective ventricular pumping and thus no cardiac output

A

Ventricular Fibrillation

112
Q

EKG:

Fine to course zigzag pattern without P waves or QRS complexes

A

Ventricular Fibrillation

113
Q

Symptoms of Ventricular Fibrillation

A

1) Pulseless
2) Hypotensive
3) Unconscious

114
Q

Treatment for V-Fib

A

Initiate ACLS Protocol for cardiac arrest

115
Q

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

A

Torsades de Pointes

116
Q

EKG:
1) HR greater than 100

2) Wide QRS complex (> 0.12 seconds)
3) Frequent variations of the QRS axis, morphology, or both

A

Torsades de Pointes

117
Q

Symptoms of Torsades de Pointes

A

1) Palpitations
2) Lightheadedness, dizziness
3) Hypotension
4) Syncope
5) Sudden cardiac death

118
Q

Treatment for stable Torsades de Pointes

A

Vitals every 5 minutes

2 grams of Magnesium Sulfate IV

Check electrolyte panel and EKG

119
Q

Treatment for unstable Torsades de Pointes

A

Synchronized cardioversion at 100 J then give 2 grams of Magnesium Sulfate IV

120
Q

Delayed or blocked conduction from the atrium to the ventricles

A

Atrioventricular (AV) Block

121
Q

How many degrees of AV heart blocks are there?

A

Three

122
Q

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

A

1st Degree AV Block

123
Q

EKG:

Prolonged PR interval >0.2 seconds is the only finding

A

1st Degree AV Block

124
Q

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

A

2nd Degree AV block I

125
Q

Wenckebach block

A

2nd Degree AV Block I

126
Q

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)

A

2nd Degree AV Block I

127
Q

Treatment for unstable 2nd Degree AV Block I

A

1) Atropine (first line)

2) If atropine does not work, Transcutaneous Pacing

128
Q

What heart block usually implies structural heart damage to the nodal conduction system and are usually permanent?

A

2nd degree AV block TYPE II

129
Q

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

A

2nd Degree AV Block Type II

130
Q

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)

A

2nd Degree Heart Block Type II

131
Q

Treatment for unstable 2nd Degree AV Block Type II

A

1) Atropine & Transcutaneous pacing (FIRST LINE)
2) Dopamine (2nd-line)

If Signs of Heart Failure use: Dobutamine or Epinephrine

132
Q

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

A

3rd Degree AV Block

133
Q

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

A

3rd Degree Heart Block

134
Q

Treatment for 3rd Degree AV Block

A

1) Atropine & Transcutaneous pacing
2) Dopamine (2nd-line)
* Signs of Heart Failure use: Dobutamine or Epinephrine

135
Q

Organized electrical rhythm, but absence of mechanical ventricular activity sufficient to generate a pulse

A

Pulseless Electrical Activity (PEA)

136
Q

What are the Four Rhythms that can cause Cardiac Arrest?

A

1) Pulseless Ventricular Tachycardia
2) Ventricular Fibrillation
3) Asystole
4) Pulseless Electrical Activity (PEA)

137
Q

What are Shockable Rhythms?

A

1) Pulseless V-Tach

2) Pulseless V-Fib

138
Q

What are Non-shockable Rhythms?

A

1) Pulseless Electrical Activity

2) Asystole

139
Q

Ventilation rate during CPR with bag valve mask

A

2 breaths every 30 compressions

140
Q

Ventilation rate during CPR with an advanced airway

A

1 breath every 6-8 seconds and maintain continuous CPR

141
Q

Carbon dioxide physiological levels

A

ETCO2: 35-40 mmHg

PaCO2: 40-45 mmHg

142
Q

SBP goal from Return of Spontaneous Circulation (ROSC)

A

> 90

143
Q

What would you do if SBP is under 90 mmHg from RSOC?

A

1) IV Fluid Bolus (1-2 Liters of NS or LR)

2) Vasopressor infusion (Epinephrine, Norepinephrine, or Dopamine)

144
Q

Treatment of STEMI patient that is able to follow commands

A

Admit to a critical care unit for ongoing care and monitoring

145
Q

Treatment of a STEMI Patient that is not able to follow commands

A

Initiate Targeting Temperature Management (TTM):

-Maintain core body temperature of 32-36 degrees Celsius for 24 hours

146
Q

What are the coronary arteries?

A

1) Left Anterior Descending Artery (LAD)
2) Left Circumflex Artery (LCx)
3) Right Coronary Artery (RCA)

147
Q

How much oxygen does myocardium tissue extract?

A

65%

Normal tissue will only extract about 25%

148
Q

Chest pain with exertion and relieved by rest

A

Stable Angina

149
Q

Chest pain while resting:

A

Unstable Angina

150
Q

Rare, caused by coronary vasospasm often without any CAD

A

Prinzmetal’s Angina

151
Q

Coronary blood flow occurs only during what phase of the heart pump?

A

Ventricular Diastole

152
Q

Disease that comprises the spectrum of unstable cardiac ischemia, unstable angina, acute myocardial infarction

A

Acute Coronary Syndrome (ACS)

153
Q

Presents with positive cardiac enzymes and non-specific EKG changes (represents partial muscle thickness infarct)

A

Non-ST segment elevation (NSTEMI)

154
Q

Results from an occlusive coronary thrombus at the site of preexisting atherosclerotic plaque

A

STEMI or Acute myocardial infarction

155
Q

What do you need to consider when treating young individuals without any risk factors that have a NSTEMI or STEMI?

A

Cocaine use

156
Q

Levine’s Sign

A

Clinching fist over chest

157
Q

Right coronary artery lesions will present with what symptoms?

A

Bradycardia, due to it supplying blood to SA node

158
Q

Left coronary artery lesions will present with what symptoms?

A

Tachycardia and CHF symptoms

159
Q

Troponin levels rise and peak how long after injury?

A

Rise 4-8 hours after injury

Peak at 12-24 hours after injury

160
Q

Troponin T and I will stay elevated for how long?

A

T: 2 weeks

I: 5-7 days

161
Q

What elevated cardiac enzymes indicate a myocardial infarction?

A

Troponin and CK-MB

162
Q

How would an NSTEMI look on an EKG?

A

ST segment depression, T wave inversion, or no changes at all

163
Q

How would a STEMI look on an EKG?

A

ST segment elevation, T wave inversion, Q wave development (which represents scar tissue)

164
Q

How can you tell which area of the heart, and which coronary vessel is blocked in a STEMI?

A

Based on which EKG leads have the ST elevation

165
Q

What is the #1 goal for treatment in an MI?

A

Prevent further cardiac tissue damage

166
Q

Treatment for Myocardial Infarctions

A

MONA:

  • Morphine
  • Oxygen (4L NC if <94%)
  • Nitroglycerine
  • Aspirin
167
Q

What percentage of MI patients have an LV wall rupture?

A

1%, 2-7 days post MI

168
Q

What percentage of ER visits account for chest pain?

A

5%

169
Q

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

A

“BIG 6”

6 life threatening causes of acute onset chest pain

170
Q

What labs/interventions would you order to rule out life-threatening causes of acute chest pain?

A

1) EKG
2) Cardiac enzymes
3) Chest X-ray
4) CT chest for Aortic dissection & PE
5) FAST exam for tamponade

171
Q

Muscles located in the ventricles, attach to the cusps of the valves via chordae tendineae

A

Papillary muscles

172
Q

Another name for leaking heart valve

A

Regurgitation

173
Q

Term for a valve that doesn’t open properly. The flaps of the valve thicken, stiffen, or fuse together.

A

Stenosis

174
Q

What is one of the most important congenital heart issues, that can lead to aortic aneurysm formation?

A

Congenital Bicuspid Aortic valve.

175
Q

Back flow of blood from the left ventricle back into the left atrium during systole

A

Mitral Regurgitation

176
Q

Valves protruding back into the left atrium during ventricular systole

A

Mitral Valve Prolapse (“Floppy mitral valve”)

177
Q

Mid-Systolic click would indicate:

A

Mitral Valve Prolapse

178
Q

Low pitched diastolic murmur (rumbling murmur) would indicate:

A

Mitral stenosis

179
Q

What ages is aortic stenosis more common?

A

> 65

180
Q

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

A

Aortic Stenosis

181
Q

Blood flow from the Aorta back to the left ventricle during diastole

A

Aortic Regurgitation

182
Q

Physical exam:

1) Soft Aortic Diastolic murmur
2) Wide pulse pressure
3) Pulmonary edema

A

Aortic Regurgitation

183
Q

What is the definitive treatment for valvular heart disease?

A

Surgical repair, tissue or mechanical valve replacement

184
Q

Hearts inability to pump enough blood throughout the body

A

Congestive Heart Failure

185
Q

Percentage of CHF patients that >65

A

75%

186
Q

In CHF what does your body first signal to increase Cardiac Output?

A

Renin-Angiotensin-Aldosterone system to retain fluid in the kidneys

187
Q

The most common type of CHF:

A

Left Ventricular systolic failure

188
Q

The most common cause of right heart failure is:

A

Left Heart Failure

189
Q

CHF

What side of the heart is affected if the patient has dyspnea, pulmonary edema, chronic cough, fatigue?

A

Left side

190
Q

CHF

What side of the heart affected if the patient has fluid retention, peripheral edema, hepatic congestion, abdominal ascites, and JVD?

A

Right side

191
Q

Released from the myocardial tissue in response to increased heart distention which signals the kidneys to start removing more fluid

A

B type Natriuretic Peptide (BNP)

192
Q

Acute Treatment for CHF

A

Furosemide or Bumetanide

193
Q

In a CHF patient, when would you want to check their Potassium and Magnesium levels?

A

If they produce >1 liter of urine

194
Q

What is considered a low sodium diet?

A

<2 grams per day

195
Q

Chronic Treatment for CHF

A

1) Lifestyle changes
2) ACE inhibitors
3) Diuretics
4) Nitroglycerine

196
Q

What would you give a CHF patient with pulmonary edema?

A

Furosemide (Lasix)

197
Q

Mortality rate of CHF with pulmonary edema

A

50% within the next year

198
Q

CHF mortality rate with no pulmonary edema

A

35% in 2 years

80% in 6 years

199
Q

3 layers of the Aorta

A

1) Intima
2) Media
3) Adventitia

200
Q

What type is:

Aortic Dissection involving the arch

A

Type A

201
Q

What type is:

Aortic Dissection involving the descending Aorta

A

Type B

202
Q

Spontaneous Aortic Dissections are commonly associated with:

A

1) HTN
2) Connective tissue disorders (Marfan Syndrome)
3) Bicuspid Aortic Valve
4) Pregnancy
5) Coarctation of the Aorta (narrowing)

203
Q

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

A

Aortic Dissection

204
Q

What type of aortic dissection requires immediate surgery?

A

Type A

205
Q

Goal BP for Aortic Dissection

A

SBP of 100-120 and lower HR to <80

206
Q

Mainstay pharmacological treatment for Aortic Dissections

A

Beta Blockers:
-Metoprolol & Labetalol

Morphine for pain

207
Q

Mortality rates for Type A Aortic Dissections if unrepaired

A

1% at 72 hours

90% in 3 months

208
Q

Inflammation of the pericardium

A

Pericarditis

209
Q

What is the most common cause of pericarditis?

A

Viral infections in males <50 years old

210
Q

What is the most common organism that causes pericarditis?

A

Coxsackieviruses and Echovirus

211
Q

Symptoms:

1) Fever
2) Sharp pain, worse when lying down
3) Chest is positive for Friction rib (sounds like Velcro or crunching snow)

A

Pericarditis

212
Q

Treatment for pericarditis

A

Aspirin and NSAIDS

213
Q

Non-infectious causes of Myocarditis

A

1) Alcohol
2) Cocaine
3) Medications
4) Insect Bites
5) Snake Bites
6) Inflammatory bowel disease
7) Celiac Disease
8) Sarcoidosis (rashes)

214
Q

Symptoms:

1) S3/S4
2) Sinus Tachycardia with a Fever
3) Retrosternal chest pain

A

Myocarditis

215
Q

What distinguishes myocarditis from pericarditis?

A

Myocarditis will have positive cardiac enzymes (troponin/CK-MB)

216
Q

What medication do you want to avoid, which can worsen myocarditis?

A

NSAIDS

217
Q

What bacteria usually causes native valve endocarditis?

A

Staph Aureus or Streptococci

218
Q

What accounts for 60% of endocarditis cases?

A

IV drug users with Staph Aureus infections

219
Q

What side of the heart in endocarditis cases do IV drug users typically present?

A

Right Sided

220
Q

Any new onset of heart murmur with a fever is what until proven otherwise?

A

Endocarditis

221
Q

Treatment for endocarditis after blood cultures

A

Ertapenem OR Vancomycin, with Ceftriaxone

222
Q

Initial care of endocarditis

A

IV, O2 if <94%

THREE sets of blood cultures

Antibiotic Treatment

Transfer to higher level of care

223
Q

Accumulation of fluid in the pericardium preventing venous return and ventricular filling

A

Pericardial Tamponade

224
Q

1) Muffle heart sounds
2) JVD
3) Hypotensive unresponsive to fluid change

A

Beck’s Triad (positive for pericardial tamponade)

225
Q

Patient drops >10mmHg SBP during inspiration

A

Pulsus Paradoxus (Pericardial Tamponade)

226
Q

How would pericardial tamponade look on an EKG?

A

1) Sinus Tachycardia

2) Electrical Alternans (Alternates strength in every other QRS)

227
Q

Treatment for pericardial tamponade

A

1) IV Fluid bolus to correct hypotension

2) Pericardiocentesis (Needle aspiration of fluid around heart)

228
Q

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

A

Cardiac Contusion

229
Q

Treatment for cardiac contusion

A

1) Pain control with analgesics
2) Monitor for 4-6 hours, repeat EKG in 24 hours
3) Transfer

230
Q

1) Venous Stasis (inflammation of skin)
2) Hypercoagulable state
3) Injury to vessel wall

A

Virchow’s triad (Presence of just one can cause Deep Vein Thrombosis)

231
Q

Most common life-threatening consequence of a DVT?

A

Pulmonary Embolism (PE)

232
Q

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

A

Risk factors for developing Deep Vein Thrombosis (DVT)

233
Q

What lab do you want to get in a patient with suspected DVT?

A

D-Dimer

234
Q

All patients with signs or symptoms of DVT need to undergo:

A

Ultrasound

235
Q

DVT treatment

A

Anticoagulants: Lovenox or Heparin (for 3-6 months minimum)

Pain Control: Tylenol or Morphine

236
Q

If you suspect DVT what should you do right away before MEDEVAC?

A

Anticoagulants

237
Q

What percentage of PE patients with have lower extremity DVT?

A

50-70%

238
Q

3rd leading cause of death in hospitalized patients

A

Pulmonary Embolism

239
Q

Symptoms:

1) Chest pain, tachypnea, and tachycardia
2) Hypoxemia
3) Shortness of breath
4) Signs of DVT (unilateral leg swelling, pain, redness)

A

Pulmonary Embolism

240
Q

What is the imaging of choice to look for Pulmonary Embolism?

A

Helical CT pulmonary angiography

241
Q

Treatment of Pulmonary Embolism

A

Aggressive anticoagulation with Heparin or Lovenox

Cardiology (5 decks)

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