CV Disease Pt 2 Flashcards by Caroline Chesser Young

“Pulseless Disease”- inflammation/thickening of aortic arch and/or proximal great vessels, causing weak pulse

Takayasu arteritis

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Symptoms of Takayasu arteritis

Upper extremity claudication, angina, CHF, absent pulses, arterial bruits, BP difference b/w 2 arms

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Symptoms d/t ischemia of vessels in the carotid artery region including unilateral headache, visual disturbance (impairment of ophthalmic artery) and jaw claudication

Temporal arteritis

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Tx for temporal arteritis

Start steroids IMMEDIATELY to prevent blindness

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Inflammation of small & medium sized arteries. Smoker’s dz. Foot claudication, leg pain, ulceration, skin necrosis

Buerger’s Disease “Thromboangiitis Obliterans”

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Triad of upper & lower airway disease and renal disease (glomerulonephritis). Sx: Sinusitis & hematuria

Wegener’s granulomatosis

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Dx and Tx for Wegener’s granulomatosis

Dx: ANCA (antineutrophilic cytoplasmic antibodies);
Tx: Cyclophosphamide, steroid and/or methotrexate

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Involves medium-sized arteries in kidneys, gut, & skin.
S/Sx: fever, weight loss, malaise, abd pain, Melina, HA, myalgia, HTN, & cutaneous eruption.
Microaneurysms on angiography.
Tx: cyclophosphamide, steroid

Polyarteritis nodosa

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Acute, self-limiting necrotizing vasculitis in infants & children. (Asian population)
Fever, conjunctivitis, changes in lips/oral mucosa “strawberry tongue”, lymphadenitis, desqumative rash.

Kawasaki disease

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Tx for Kawasaki disease

Aspirin, immunoglobulins

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Bad sign that shows global ischemia

Third heart sound

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EKG is gold standard in first \_\_\_\_ 
Myoglobin \_\_\_\_\_
CK-MB test of choice in first \_\_\_\_ post MI
Troponin-I \_\_\_\_
LDH1 is elevated \_\_\_\_\_ post MI

EKG= 6hrs;
Myoglobin= < 2hrs
CK-MB = 24hrs
Troponin-I = 4hrs to 7-10 days
LDH1 = 2-7 days

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Angina pectoris = CAD narrowing > ___

75%

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Most ominous sign of CAD

Unstable angina- pain that occurs at rest or w/out a provoking cause

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CP occurring more and more frequently with less and less exertion

Crescendo angina

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EKG with unstable angina

ST depression or T wave inversion (must distinguish from non-Q wave MI)

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Angina at rest a/w ST elevation (hallmark) secondary to coronary artery spasm.

Prinzmetal’s angina

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Tx for Prinzmetal’s angina

Nitrates and CCB to tx vasospasm

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How do nitrates relive angina

Venodilation which decreases cardiac wall tension

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How do CCB relieve angina?

Most potent to least potent?

By decreasing afterload, HR, and contractility;

Verapamil > Diltiazem > Nifedipine

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Avoid ____ in bronchial spasm, CHF, or bradycardia

beta blockers

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MCC of acute MI

Chronic coronary atherosclerosis

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Acute MI most often occurs in which arteries greatest to least?

LAD > RCA > circ

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What does persistent elevation of CK-MB indicate?

Post infarct ischemia- do cath, give heparin and nitro

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Acute management of MI

BOOMAR | Bed rest, Oxygen, Opiate, Monitoring, Anticoagulation, Reduce clot size

Post infarct ischemia is most common after what type of MI?

Non-Q wave MI

Poor prognostic signs a/w pump failure post MI:

``` Pulmonary edema (crackles) & HR increase to maintain CO ```

Interventricular septum (L -> R) 4-10 days post MI -> SHOCK and cardiac tamponade

Rupture of ventricular free wall

Friction rub 3-5 days post MI. | PR depression, diffuse ST elevation

Fibrinous pericarditis

Autoimmune phenomenon resulting fibrinous pericarditis (2-6 wks post MI). Low grade fever. Tx: NSAID

Dressler’s syndrome

Occurs w/ inferior wall MI (d/t occlusion of RCA). Hypotensive, raised JVP, clear lungs Tx: fluids to maintain right-sided filling pressures

Right ventricular infarction

Most common cause of decreased contractility a/w CHF

Ischemia and MI

MCC of right-sided heart failure

Left-sided heart failure

Signs of RHF

Tachycardia, S3 (ventricular gallop), S4 (atrial gallop), rales, cardiomegaly, ascites, hepatic congestion (increased CVP)

Reduced EF, increased EDV, decreased contractility often secondary to ischemia/MI or dilated CM

Systolic dysfunction

Preserved EF, normal EDV, decreased compliance (Increased EDP) often secondary to myocardial hypertrophy

Diastolic dysfunction

Tx for diminished contractility

Digoxin, beta agonist- dopamine, Amrinone (PDE inhibitor)

Tx for high afterload in CHF

ACE inhibitors or ARBs

Beware of ________ with hypokalemia (w/ diuretics) elderly and renal insufficiency

Dig toxicity

EKG findings in dig toxicity

PVC’s, ST depression ”dig effect”, paroxysmal atrial tach w/ varying block

Anesthesia concerns for CHF

1. Slightly elevated head; 2. Watch fluid status closely (SWAN); 3. Risk of overdose d/t slow circulation; 4. Watch UO; 5. Sensitive to anesthetic gases; 6. Avoid nitrous oxide in sever CHF; 7. Watch for arrhythmia

Tx of Heart Failure (ABCDE)

``` ACE inhibitors Beta blockers CCB Diuretics Endothelin receptor blocker (decreased PVR) ```

Pressure-volume loop for systolic heart failure

Increase in LVEDV; Decreased SV; Increased LVEDP (bc LV volume is increased) Diastolic portion has to shift RIGHT

Pressure-volume loop for diastolic failure

P-V loop has to shift UP

Alcohol acutely diminished LV function “holiday heart syndrome” 5-10 yrs of heavy drinking

Alcoholic cardiomyopathy (dilated CM)

Usually develops just before and 3 months after delivery. Autoimmune. Most cases are reversible

Peripartum cardiomyopathy (dilated CM)

MCC of dilated CM

Ischemia

Symptoms result form stiff ventricle, which restrict ventricular filling. “Hall mark” = diastolic dysfuntion. Cardiac size & systolic functions are normal

Restrictive cardiomyopathy

_______ increase diastolic relaxation and allow better filling in restrictive CM

CCB

Pressure-volume loop in IHSS (hypertrophic CM)

Shifted to smaller volumes and larger pressure (d/t outflow tract obstruction)

Asymmetric ventricular concentric hypertrophy with outflow obstruction (b/w hypertrophic septum & anterior MV leaflet) Autosomal dominant. Cause of sudden death in young athletes

Idiopathic hypertrophic subaortic stenosis (hypertrophic cardiomyopathy)

_______ d/t hypertrophied and stiff ventricles in IHSS

Diastolic dysfunctions

Conditions that enlarge the LV (increase in preload & afterload) separate the septum and anterior leaflet of the mitral valve and ________ (IHSS)

Decrease the obstruction

Conditions that make the ventricle smaller or increase the velocity of blood flow (dehydration, + inotropes) ________ (IHSS)

Increase the obstruction

Factors increasing outflow obstruction

Increased contractility; Increased HR; Decreased preload (volume) or decreased afterload

TX for IHSS (hypertrophic CM)

Beta blockers and CCB

Anesthetic concerns with IHSS:

1. Increase preload “full full full” 2. Increase afterload/SVR (Phenylephrine b/c does not increase contractility “up up up” 3. BB to decrease contractility 4. NO spinal or epidural (reduces SVR)

Drugs that worsen outflow obstruction

1. Vasodilators 2. Positive inotropes 3. B agonist 4. Diuretics (Fentanyl does not depress myocardium or increase SVR so is of no use)

Loss of circulating volume % a/w skin changes, normal BP, thirsty, cold, awake & alert

< 20%

Loss of circulating volume % a/w oliguria (20ml/hr), restlessness, decreased BP, weak pulse > 120, confusion

20% - 40%

Loss of circulating volume % a/w very low BP, pulse > 140, ekg changes, lethargic, coma, no UO

> 40%

Septic causes

Gram negative rods

S/s of septic shock

``` Severe decreases in SVR; Fever; Low UO; Hyperventilation/ resp alkalosis; High cardiac index; DIC ```

TX for septic shock

Fluid resuscitate to increase MAP; IV abx; Surgical drainage; Vasopressors (dopamine & NorEpi)

S/s of Neurogenic Shock

Warm well perfused skin; Low to normal UO; Bradycardia & hypotension; Normal CO, low SVR, low to normal PCWP

Tx for neurogenic shock

IV fluid; Vasoconstrictors; Supine or trendelenburg; Maintain body temp

S/sx of cardiogenic shock

Elevated neck veins; | High cardiac filling pressure (increased PCWP);

Tx for cardiogenic shock

``` Abcs; Treat arrhythmias; Optimize HR; Inotropic agents; Vasopressors (dopamine); Fluids HARMFUL if increased PCWP ```

Best indicator of peripheral perfusion and adequate resuscitation

Urine output

ALL _____ and _____ depress CVS except _____

Volatile agents; induction agents; Ketamine

CV Disease Pt 2 Flashcards

(70 cards)