Exam 3, CIS Pales, Heart Failure Flashcards Preview

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Flashcards in Exam 3, CIS Pales, Heart Failure Deck (31):
1

63 female with SOB mid sternal chest pain, sudden onset, constant 10/10 to L arm
dyspnea is moderately severe with cough
+HTN, PAD, HLD
+hysterectomy and aorto-femoral bypass
20 pack year Hx smoking
PMI 7th ICS, tachy, b/l crackles, trace edema
Ddx?

AMI
Unstable angina
CHF
PE
aortic dissection
pleuritis, pneumonia
myocarditis
pyscho somatic
takotsubo
pneumothorax
GERD

2

Why is PMI displaced

L ventricular hypertrophy

3

63 female with SOB mid sternal chest pain, sudden onset, constant 10/10 to L arm
dyspnea is moderately severe with cough
+HTN, PAD, HLD
+hysterectomy and aorto-femoral bypass
20 pack year Hx smoking
PMI 7th ICS, tachy, b/l crackles, trace edema
What tests to order

echo
EKG
troponins
CXR
CBC and CMP

4

63 female with SOB mid sternal chest pain, sudden onset, constant 10/10 to L arm
dyspnea is moderately severe with cough
+HTN, PAD, HLD
+hysterectomy and aorto-femoral bypass
20 pack year Hx smoking
PMI 7th ICS, tachy, b/l crackles, trace edema
echo shows left sided dilated cardiomypathy

AMI causing Acute CHF

5

63 female with SOB mid sternal chest pain, sudden onset, constant 10/10 to L arm
dyspnea is moderately severe with cough
+HTN, PAD, HLD
+hysterectomy and aorto-femoral bypass
20 pack year Hx smoking
PMI 7th ICS, tachy, b/l crackles, trace edema
what medications are appropriate for use at this time

aspirin, morphine, oxygen, NTG(monitor because BP is low)
betablocker ACEI etc..

6

COPD patient getting worse
paroxsymal dyspnea, LE edema, abdominal distention, +COPD, DM, HTN, HLD, CAD
+appendectomy, cholescystectomy, heart cath
85% O2 on O2, JVD, S4, tachy, dec breath sounds b/l with bibasilar crackels
shifting dullness positive, extremities 2+ edema b/l
Ddx dyspnea?

CHF
COPD excacerbation
R sided HF
PE

7

COPD patient getting worse
paroxsymal dyspnea, LE edema, abdominal distention, +COPD, DM, HTN, HLD, CAD
+appendectomy, cholescystectomy, heart cath
85% O2 on O2, JVD, S4, tachy, dec breath sounds b/l with bibasilar crackels
shifting dullness positive, extremities 2+ edema b/l
Ddx LE swelling?

Venous insufficiency****
lymph obstruction
nephrotic syndrome
CHF

8

most common cause lower extremity edema

venous insufficiency

9

COPD patient getting worse
paroxsymal dyspnea, LE edema, abdominal distention, +COPD, DM, HTN, HLD, CAD
+appendectomy, cholescystectomy, heart cath
85% O2 on O2, JVD, S4, tachy, dec breath sounds b/l with bibasilar crackels
shifting dullness positive, extremities 2+ edema b/l
Ddx for cough?

pneumonia
pulm edema
CHF

10

3 most common causes of cough

post nasal drip
GERD
asthma

11

most common cause abdominal distention

obesity

12

what is significance of precordial heave

Large R ventricle

13

COPD patient getting worse
paroxsymal dyspnea, LE edema, abdominal distention, +COPD, DM, HTN, HLD, CAD
+appendectomy, cholescystectomy, heart cath
85% O2 on O2, JVD, S4, tachy, dec breath sounds b/l with bibasilar crackels
shifting dullness positive, extremities 2+ edema b/l
What tests do you order

EKG
CXR
ECHO

14

positive deflection in V1 could mean what on EKG

RAD, posterior MI, R ventricular hypertrophy

15

COPD patient getting worse
paroxsymal dyspnea, LE edema, abdominal distention, +COPD, DM, HTN, HLD, CAD
+appendectomy, cholescystectomy, heart cath
85% O2 on O2, JVD, S4, tachy, dec breath sounds b/l with bibasilar crackels
shifting dullness positive, extremities 2+ edema b/l
what medications should be used or not used in patient

DIURETIC
probably not beta blocker. but has preivous MI so do want.

16

Patient with swollen legs

Lymphedema - Filariasis

17

22 y.o male cold Sx malaise and extreme fatigue. b/l leg swelling and SOB, gain 25 Lb, rash on back. no PMH, mom has lupus
BP100/50 HR 135 pulse 89
O2 RA 90%
JVD, PMI displaced, 2/6 systolic murmur tachy
dec lung sounds and b/l basilar crackles
3+ pitting edema b/l, erythematoud macular papular rash
Why is there a difference between HR and pulse (pulse deficit)?

HR too fast for ventricle to fill so cannot propel wave to extremities

18

what could cause 2/6 systolic murmur

infectious myocarditis dilating the heart
stretches annulus around valve
mitral regurg

19

22 y.o male cold Sx malaise and extreme fatigue. b/l leg swelling and SOB, gain 25 Lb, rash on back. no PMH, mom has lupus
BP100/50 HR 135 pulse 89
O2 RA 90%
JVD, PMI displaced, 2/6 systolic murmur tachy
dec lung sounds and b/l basilar crackles
3+ pitting edema b/l, erythematoud macular papular rash
how could rash connect to CHF syndrome

systemic viral infection
could be rheumatic fever
lupus

20

22 y.o male cold Sx malaise and extreme fatigue. b/l leg swelling and SOB, gain 25 Lb, rash on back. no PMH, mom has lupus
BP100/50 HR 135 pulse 89
O2 RA 90%
JVD, PMI displaced, 2/6 systolic murmur tachy
dec lung sounds and b/l basilar crackles
3+ pitting edema b/l, erythematoud macular papular rash
What test would you order

TSH, CBC, CMP
ECHO
EKG
CXR

21

22 y.o male cold Sx malaise and extreme fatigue. b/l leg swelling and SOB, gain 25 Lb, rash on back. no PMH, mom has lupus
BP100/50 HR 135 pulse 89
O2 RA 90%
JVD, PMI displaced, 2/6 systolic murmur tachy
dec lung sounds and b/l basilar crackles
3+ pitting edema b/l, erythematoud macular papular rash
Echo results: EF 37%, dilation atria and ventricle, moderate mitral regurg
most likely Dx

infectious myocarditis
coul dbe lupus myocarditis-- need to biopsy rash

22

infectious myocarditis
could be lupus myocarditis-- need to biopsy rash
What medications should we use?

ACEI
Beta blocker
Aldosterone antagonist

23

45 female with passing out, SOB, chest pain, LE edema
few weeks ago normal exercise stress test
NTG caused syncope
BP 110/80 4/6 holosystolic crescendo decrescendo murmur dec with valsalva
Ddx?

aortic stenosis

24

what does normal exercise stress test indicate

no CAD

25

what does a 4/6 holosystolic crescendo decrescendo murmur dec with valsalva suggest

aortic stenosis

26

what is pulses parvus et tardus and what is it a sign of?

weak begining of pulse
later in pulse is normal
aortic stenosis

27

45 female with passing out, SOB, chest pain, LE edema
few weeks ago normal exercise stress test
NTG caused syncope
BP 110/80 4/6 holosystolic crescendo decrescendo murmur dec with valsalva
does she have CHF?

no because it is a syndrome, does not have Sx of it

28

45 female with passing out, SOB, chest pain, LE edema
few weeks ago normal exercise stress test
NTG caused syncope
BP 110/80 4/6 holosystolic crescendo decrescendo murmur dec with valsalva
What Tx?

heart surgery
NOT NTG

29

give NTG have syncope, what is it

aortic stenosis

30

32 y.o female to ER with SOB
over last 1-2 weeks had increasing dyspnea, extreme anxiety, swelling of legs, HA, b/l eye pain
heart palpuations, lost 30 LB gained 15
sweating, hot, shaky hands, hair loss, lump in neck, servere Resp distress, intubation
P 160, HR 160 RR 46 75% O2 on RA
+shifting dullness(ascites), extremity 4+ edema, jaundice
Ddx?

hyperthyroidism
thyrotoxicosis- high output failure
HTN causing HF

31

32 y.o female to ER with SOB
over last 1-2 weeks had increasing dyspnea, extreme anxiety, swelling of legs, HA, b/l eye pain
heart palpuations, lost 30 LB gained 15
sweating, hot, shaky hands, hair loss, lump in neck, servere Resp distress, intubation
P 160, HR 160 RR 46 75% O2 on RA
+shifting dullness(ascites), extremity 4+ edema, jaundice
why is their hepatomegaly and elevated liver enzymes?

congestive hepatopathy
back up from heart