Test 1 Flashcards
(168 cards)
1
Q
EOD Occlusive aorta & iliac arteries
A
- Claudication in calf, thigh or hip
- Diminished femoral pulses
- Tissue loss (ulceration, gangrene) or rest pain
2
Q
EOD superficial & common femoral & popliteal arteries
A
- Cramping pain or tiredness in calf w/ exercise
- Reduced popliteal or pedal pulses
- Foot pain at rest, relieved by dependency
- Foot gangrene/ulceration
3
Q
EOD lower leg & foot arterial occlusion
A
- Severe pain of the forefoot relieved by dependency
- Pain/numbness of the foot w/ walking
- Ulceration or gangrene of the foot or toes
- Pallor when the foot is elevated
4
Q
What is the most common cause of cardiac thrombus formation?
A
Afib
5
Q
In acute arterial occlusion of a limb, what should you do ASAP?
A
- Revascularization
- IV heperin
from thrombus/emboli
6
Q
EOD acute arterial occlusion of a limb
A
- Sudden pain in extremity
- Generally assoc. w/ some element of neurologic dysfunction w/ numbness, weakness or complete paralysis
- Absent extremity pulses
7
Q
Where do emboli come from in occlusive cerebrovascular disease w/o stroke?
A
proximal internal carotid artery
8
Q
Unilateral blindness from occlusive cerebrovascular disease is called?
A
amaurosis fugax
9
Q
EOD occlusive cerebrovascular disease
A
- Sudden onset weakness & numbness of an extremity, aphasia, dysarthria or unilateral blindness (amaurosis fugax)
- Bruit heard loudest in the neck
10
Q
What is chronic syndrome of intestinal angina?
A
adequate perfusion for the viscera at rest but ischemia occurs w/ severe abdominal pain when flow demands inc. w/ feeding
11
Q
EOD visceral artery insufficiency
A
- Severe postprandial abdominal pain
- Wt loss w/ a fear of eating
- Acute mesenteric ischemia - severe abdominal pain yet minimal findings on physical exam
may also be acute mesenteric vein occlusion but rare
12
Q
Which vessels are usually affected w/ thromboangiitis obliterans (Buerger disease)?
A
plantar & digital vessels of foot & lower leg
13
Q
What are the DDx w/ Buerger disease?
A
- Atherosclerotic peripheral vascular disease
- Raynaud disease
- Atheroemboli
14
Q
EOD thromboangiitis obliterans (Buerger disease)
A
- Typically male cigarette smokers
- Distal extremities involved w/ severe ischemia, progressing to tissue loss
- Thrombosis of the superficial veins may occur
- Amputation required unless stop smoking
15
Q
How big is an abdominal aortic aneurysm?
A
3 cm
usually ruptures >5cm
16
Q
What is the ratio of men:female w/ abdominal aortic aneurysm?
A
4:1
17
Q
Which vessels are usually involved in abdominal atherosclerotic aneursyms?
A
aortic bifurcation or common iliac arteries
18
Q
When do you screen for abdominal aortic aneurysms?
A
US for 65-75 y/o men w/ Hx of smoking
19
Q
EOD abdominal aortic aneurysm
A
- Most asymptomatic until rupture
- AAA 5cm are palpable in 80% of Pts
- Back or abdominal pain w/ aneurysmal tenderness may precede rupture
- Rupture is catastrophic (HOTN, excruciating abdominal pain that radiates to the back)
20
Q
What is 1st line if suspected thoracic aneursym?
A
CT scanning
shows anatomy & size
excludes lesions that can mimic aneurysms (ex. neoplasm, goiter)
21
Q
EOD thoracic aneurysm
A
- Widened mediastinum on CXR
2. w/ rupture, sudden onset CP radiating to back
22
Q
What are the Sx of peripheral artery aneurysms due to?
A
peripheral embolization & thrombosis
silent until critically symptomatic
23
Q
What is the most common peripheral artery aneurysm?
A
popliteal
does not cause ischemia due to parallel arterial supply to foot
24
Q
EOD peripheral artery aneurysm
A
- Widened, prominent pulses
2. Acute leg or foot pain & paresthias w/ loss of distal pulses
25
Type A vs. Type B aortic dissection
A - arch proximal to L subclavian
worse prognosis, surgery!
B - proximal descending thoracic aorta usually just beyond the L subclavian
26
What is absolutely necessary w/ aortic dissection?
control BP!
systolic to 100-120 mmHg
DO NOT GIVE ASPIRIN!
27
What are the DDx for aortic dissection?
1. MI
| 2. Pulmonary embolism
28
EOD aortic dissection
1. Sudden searing CP w/ radiation to the back, abdomen, or neck in a HTN Pt
2. Widened mediastinum on CXR
3. Pulse discrepancy in extremities
4. Acute aortic regurgitation may develop
29
What is the biggest risk factor for varicose veins?
women after pregnancy
30
Which veins are usually affected w/ varicose veins?
greater saphenous veins
31
EOD varicose veins
1. Dilated, tortuous superficial veins in lower extremities
2. May be asymptomatic or assoc. w/ aching discomfort or pain
3. Often hereditary
4. Inc. frequency after pregnancy
32
What are the causes of superficial venous thrombophelbitis?
1. Cath
2. PICC lines
spontaneously in
1. Pregnant/postpartum women
2. Varicose veins
3. Thromboangiitis obliterans
4. Trauma, systematic hypercoagulability secondary to abdominal CA
5. Assoc w/ DVT in 20% of cases
33
What are the DDx of superficial venous thrombophlebitis?
1. Cellulitis
2. Erythema nodosum
3. Erythema induratum
4. Panniculitis
5. Fibrositis
6. Lymphangitis & Deep thrombophlebitis
34
How do you treat simple superficial venous thrombophlebitis?
Local heat
| NSAIDS
35
EOD superficial venous thrombophlebitis
1. Induration, redness & tenderness along a superficial vein (usually the saphenous vein)
2. Induration, redness & tenderness at the site of a recent IV line
Significant swelling of the extremity may NOT be seen
36
EOD chronic venous insufficiency
1. Hx of prior DVT/leg injury
2. Edema, stasis (brawny) skin pigmentation, subQ liposclerosis in the lower leg
3. Large ulcerations at or above the ankle common (stasis ulcers)
37
What are the common causes of superior vena cava obstruction?
1. Neoplasms
2. Chronic fibrotic mediastinitis
3. DVT
4. Aneurysm of aortic arch
5. Constrictive pericarditis
38
EOD superior vena cava obstruction
1. Swelling of the neck, face & upper extremities
| 2. Dilated veins over the upper chest & neck
39
What bacteria commonly cause lymphangitis/lynphadenitis?
Hemolytic streptococci
| S aureus
40
DDx of lymphangitis/lynphadenitis
1. Superficial thrombophlebitis
2. Cat-scratch fever (Bartonella henselae)
3. Strep hemolytic gangrene
4. Necrotizing fasciitis
41
EOD lymphangitis/lynphadenitis
1. Red streak from wound or area of cellulitis toward regional lymph nodes, which are usually enlarged & tender
2. Chills, fever & malaise may be present
42
Primary vs. secondary lymphedema
1 - congenital
2 - Inflammatory or mechanical
43
EOD lymphedema
1. Painless persistent edema of one or both lower extremities
2. Primarily in young women
3. Pitting edema w/o ulceration, varicosities or stasis pigmentation
4. May be episodes of lymphangitis & cellulitis
44
What is syndrome X?
angina w/ normal coronary arteries w/o other identifiable causes
most likely due to inadequate flow in microvasculature
45
ECG & angina
Neg cardiac enzymes
horizontal or downsloping ST-segment depression
reverses after ischemia disappears
46
What is the definitive diagnostic procedure for CAD?
coronary angiography
LV function is a major determinant of prognosis in coronary heart disease
47
What is the drug Tx for angina?
nitroglycerin
if pain not relieved/improving after 5 mins call 911
48
EOD angina
1. Precordial CP, usually pptd by stress or exertion, relieved rapidly by rest or nitrates
2. ECG or scintigraphic evidence of ischemia during pain or stress testing
3. Angiographic demonstration of significant obstruction of major coronary vessels
49
Describe ECG & characteristics of Prinzmetal's angina
spasm
ST-segment elevation
women <50 y/o
usually occurs in am, awakening Pts from sleep
assoc. w/ arrythmias or conduction defects
50
EOD angina w/o CAD (ex. Prinzmetal's angina)
1. Precordial CP, often occuring at rest during stress or w/o known precipitant, relieved rapidly by nitrates
2. ECG of ischemia during pain, sometimes w/ ST-segment elevation
3. Angiographic demonstration of no significant obstruction of major coronary vessels, coronary spasm that responds to intra-coronary nitroglycerin or CCBs
51
TIMI risk score
1. >65 y/o
2. 3 or + cardiac risk factors
3. Prior coronary stenosis 50%
4. ST-segment deviation
5. 2 anginal events in prior 24 hours
6. ASA in prior 7 days
7. Elevated cardiac markers
52
EOD NSTEMI
1. Distinction in acute coronary syndrome btwn Pts w/ & w/o ST-segment elevation at presentation is essential to determine need for reperfusion therapy
2. Fibrinolytic therapy is harmful in acute coronary syndrome w/o ST-segment elevation
3. Antiplatelet & anticoagulation therapies & coronary intervention are mainstays of Tx
53
What should you avoid w/ STEMI?
NSAIDS
54
EOD STEMI
1. Sudden but not instantaneous development of prolonged (>30 mins) anterior chest discomfort (sometimes felt as "gas" or pressure
2. Seomtimes painless, masquerading as acute HF, syncope, stroke or shock
3. ECG: ST-segment elevation or LBBB
4. Immediate reperfusion Tx w
5. Primary PCI w/in 90 mins of 1st medical contact is the goal & superior to thrombolysis
6. Thrombolysis w/in 30 mins of hosptial presentation & 6-12 hrs of onset of Sx reduces mortality
55
A high morning BP is a sign of???
inc. risk of cerebral hemorrhage
56
HTN risk factors
1. Age/gender
2. Race (blacks)
3. FH
4. Obesity
5. Sedentary lifestyle
6. Low K diet
7. High salt diet
8. Tobacco use
9. Alcohol
10. Stress
11. Sleep apnea
12. Endocrine diseases
13. Kidney disease
57
HTN Sx
Mostly asymptomatic
1. HA
2. Fatigue
3. End organ damage
58
HTN Pts at risk for?
1. Stroke
2. MI
3. Peripheral arterial disease
4. CHF
5. LV hypertrophy
59
When should you start BP meds?
if 20S/10D higher from the target
if >140/90 start to get concerned
60
Work up w/ HTN Dx
1. Renal function
2. Glucose
3. Lipid panel
4. EKG
5. UA
6. Electrolytes
7. CBC
8. ECHO
must have 2 high BP readings at two diff. times
61
Causes of secondary HTN
Renal artery stenosis - #1!
1. Abdominal bruits
2. Primary hyperaldosteronism
3. Pheochromocytoma
4. Cushing's
5. Sleep apnea
6. Coarctation of aorta
7. Meds
62
May have secondary HTN if?
1. Severe or resistant to Tx
2. Acute rise in BP
3. <30 y/o, nonobese, no FH, no other risk factors
4. Malignant or accelerated w/ end organ damage
63
Work up of secondary HTN
1. Renal imaging
2. Plasma renin activity
3. Plasma & urine catecholamines
4. MRA, duplex US
5. CTA
64
What is the most underestimated cause of secondary HTN?
sleep apnea
65
What is a HTN urgency?
>180 >120
no Sx or just HA
common causes - not taking meds, too much salt
gradual reduction to 160/100
66
What is a HTN emergency?
>180 >120 w/ end organ damage
1. Encephalopathy
2. Retinal hemorrhage
3. Papilledema
4. Acute renal failure
5. CP, EKG changes
67
Genetic disorders of secondary HTN
1. Glucocorticoid remediable aldosteronism - dominant
2. Syndrome of apparent mineralocorticoid excess - recessive
3. HTN exacerbated in pregnancy - dominant
4. Liddle syndrome - dominant
68
When is renal vascular HTN suspected?
1. Onset before 20/after 50
2. HTN resistant to 3 or more drugs
3. Epigastric or renal artery bruits present
4. Atherosclerotic disease of the aorta or peripheral arteries
5. Abrupt inc. in level of serum creatinine after administration of ACEi
6. Episodes of pulmonary edema are assoc. w/ abrupt surges in BP
69
BP HTN
140-159, 90-99
70
BP Stage 2 HTN
>160 , >100
71
AB vs CD drugs
ACEi/ARBs -& beta-blockers - interrupt the renin angiotensin system
more effective in young, white people where renin is usually higher
CCBs & diuretics - more effective in old or black people
72
Risk factors of orthostatic HOTN
autonomic reflexes are impaired or intravascular volume is depleted
1. Old people
2. Meds
3. Diabetic neuropathy
4. Autonomic dysfunction
5. Parkinoson
6. Paraneoplastic
7. FH
73
DDx orthostatic HOTN
1. Aortic stenosis
2. Arrhythmia
3. Postural tachycardia syndrome
4. Postprandial HOTN
74
Dx of orthostatic HOTN
Fall 20S or 10D 2-5 mins after supine position
75
Work up of orthostatic HOTN
1. CBC
2. Renal function
3. Glucose
76
Tx of orthostatic HOTN
1. Avoid/treat primary reason
2. Fluids
3. Arise slowly
4. Avoid long standing
5. Avoid coughing, hot weather, straining
6. Elastic stocking extended to the waist
7. Tensing legs
8. Inc. salt water
9. Avoid large meals
77
Meds for orthostatic HOTN
1. Fludrocortisone
2. Midodrine alpha-1 adrenergic
3. Caffeine
78
Risk factors of CAD & peripheral artery disease
1. Smoking!!!!!!!!
2. Dyslipidemia
3. HTN
4. Diabetes
5. Abdominal obesity
6. Psychosocial factors
7. Physical activity
8. FH
9. Age >50
10. Gender - men (women after menopause 55+)
11. Collagen vascular disease
12. Infections
13. Sleep apnea
14. Homocysteine
15. Cocaine
16. Meth
17. Takotsubo stress cardiomyopathy
79
Sx of MI
1. CP
2. SOB
3. GI
4. Diaphoresis
5. Dizziness
6. Fatique
7. Sudden death
8. Inc. HR
9. Change in BP
10. New murmurs/heart sounds
11. Chest congestion
12. Irregular heart beat
80
Dx MI
1. EKG
2. Cardiac enzymes
3. CXR
4. CBC
5. Renal function
6. Electrolytes
7. Transthoracic echo
8. Stress test/coronary angiogram
81
Anterior leads
V1-V6
LAD - worst!
82
Anterioseptal leads
V1 & V3
83
Lateral leads
V4, V6, aVL, I
84
Inferior leads
II, III, aVF
R coronary occlusion
85
Immediate mgmt for MI
1. Monitor
2. O2
3. IV access
4. Chew ASA
5. Nitrate/morphine
6. EKG
7. Airways
8. Quick H&P
86
Complications of MI
1. Arrhythmias
2. CHF
3. Rupture
4. Aneurysm
5. Acute pulmonary edema
6. Mitral regurgitation
87
Risk factors of aortic aneurysm
1. Old age
2. Male (women rupture more)
3. Caucasian
4. FH
5. Smoking
6. Presence of other large aneurysm
88
Clinical findings of thoracic aortic aneurysm
Pressure on
1. Trachea
2. Esophagus
3. Superior vena cava
89
Clinical findings of abdominal aortic aneurysm
Most Pts have no Sx
1. Pulsatile mass
2. Abdominal, back pain
3. Limb ischemia w/ embolization
4. Fever/malaise due to inflammation, infection
5. Discovered by imaging studies as a coincidental findings
90
Risk factors of aortic dissection
1. HTN!!!
2. Inflammatory changes
3. Marfan syndrome, Ehler-Danlos syndrome
4. Aortic coarcation
5. Turner syndrome
6. CABG (coronary artery bypass grafting)
7. Cardiac cath
8. High intensity wt lifting
91
Sx of aortic dissection
1. Syncope
2. CVA
3. MI
Painless in cases like diabetes
92
Imaging for aortic dissection
1. CXR
2. CT scan
3. MRI
4. Aortogram
5. TTE
93
What is erectile dysfunction common with?
common iliac disease
94
Risk factors of chronic venous insufficiency
1. Trauma
2. DVT
3. Obstruction
95
Risk factors of DVT
1. CA
2. Immobilization
3. Coagulopathy
4. Birth control
5. Major surgery
96
Dx of DVT
1. Duplex US
2. D-Dimer
3. Venogram
4. Serial US
97
Pulsus Paradoxus
Dec. in systolic BP upon inspiration >10mmHg
seen in pericarditis
98
Electrical alternans
alternation of QRS amplitude or axis
seen in pericarditis
99
HACEK organisms
```
Haemophilus
Actinobacillus
Cardiobacterium hominis
Eikenella corrodens
Kingella
```
infective endocarditis
100
What is the most common bacteria & location of infective endocarditis w/ IV drug users?
S. Aureus
Tricuspid valve
101
EOD Myocarditis
1. Often follows a URI
2. May present w/ CP (pleuritic or nonspecific) or signs of heart failure
3. Echo documents cardiomegaly & contractile dysfunction
4. Myocardial Bx may reveal a characteristic inflammatory pattern
102
EOD Rheumatic fever
1. Uncommon in US, more common in developing countries
| 2. Diagnosis based on Jones criteria & confirmation of streptococcal infection
103
EOD Acute inflammatory pericarditis
1. Anterior pleuritic CP that is worse supine than upright
2. Pericardial rub
3. ESR usually elevated
4. ECG shows diffuse ST segment elevation w/ PR depression
104
EOD constrictive pericarditis
1. Evidence of R heart failure w/ an elevated JVP, edema, hepatomegaly & ascites
2. No fall or an elevation of the JVP w/ inspiration (Kussmaul sign)
3. Echo shows septal bounce & reduced mitral inflow velocities w/ inspiration
4. Cath shows RV-LV interaction, a square-root sign, equalization of diastolic pressures, normal PA pressure & discordance of RV/LV systolic pressures w/ inspiration (RV systolic rises, LV systolic falls)
5. Area of RV/LV pressure tracing ratio that dec. w/ inspiration
105
EOD infective endocarditis
1. Fever
2. Preexisting organic heart lesion
3. Positive blood cultures
4. Evidence of vegetation on echo
5. New or changing heart murmur
6. Evidence of systemic emboli
106
Virulence vs. Pathogenicity
V - magnitude of the infection by virulence factors
P - ability to cause infection
107
What are the ways infection can be established?
1. Direct inoculatin
2. Inhalation or respiratory droplets/aerosols
3. Contiguous spread
4. Hematogenous dissemination
5. Mucosal barriers
6. Disruption of normal flora (C. diff)
108
What bacteria causes Rheumatic Fever & who commonly gets it?
Strep pyogenes - group A beta-hemolytic strep
gram + bacilli in pairs & chains
usually happens 2 weeks after strep pharyngitis infection
uncommon in US, most common in 5-15 y/o
109
Which valve is usually infected w/ Rheumatic Fever?
mitral valve
then aortic, tricuspid & pulmonary
110
How is Rheumatic Fever diagnosed?
Jones criteria
2 major/1 major & 2 minor
Major
1. Carditis
2. Erythema Marginatum
3. Sydenham chorea
4. Polyarthritis (symmetric & migratory)
Minor
1. Polyarthralgias
2. Elevated CRP
3. Prolonged PR interval
4. +throat culture
5. ASO titer
111
DDx of Rheumatic Fever
1. Endocarditis
2. Myocarditis
3. Juvenile rheumatoid arthritis
4. Lupus
5. Lyme's disease
6. Kawasaki's disease
7. Osteomyelitis
8. Disseminated Gonococcal Disease
112
Tx of Rheumatic Fever
1. Bedrest until fever goes away
2. Salicylates - ASA
3. PCN Benzathine 1.2 mil units IM once
Maybe corticosteroids
PCN IM monthly until 21 y/o
113
What are the causes of pericarditis?
1. Coxsackie
2. Echovirus
3. EBV
4. Influenza
5. HIV
6. Varicella
7. Mumps
8. Hepatitis
9. B burgdoferi, pneumococci
10. TB
11. Uremic/severe hypothyroidism
12. CA
13. Dressler's syndrome, SLE
14. Radiation, drugs
114
S/S pericarditis
1. Pleuritic CP relieved w/ leaning forward
2. Dyspnea, cough, weakness, fatigue
3. Triphasic friction rub
4. +/- fever if infectious
5. R sided CHF if severe
6. Pulsus Paradoxus
115
Dx pericarditis
1. Leukocytosis if infectious
2. Elevated ESR & CRP
3. EKG findings
- diffuse ST-segment elevation
- PR depression
- Low QRS amplitude
- Electrical alternans
4. Echo - pericardial fluid
5. Pericardiocentesis
116
Tx pericarditis
Depends on underlying cause
1. Viral - NSAIDS/ASA
2. Dressler's - ASA
3. Uremic - dialysis
4. Neoplastic - pericardiocentesis/pericardial window
5. Antibiotics
117
Who most commonly gets pericarditis?
males under 50 y/o
inflammation of pericardial sac
118
What commonly causes constrictive pericarditis?
1. Radiation therapy
2. Cardiac surgery
3. Histoplasmosis infection
4. Chronic viral pericarditis
119
What is constrictive pericarditis?
Chronic inflammatory process leading to thickened, fibrotic & adherent pericardium
Restricts diastolic filling leading to elevated venous back pressure
120
S/S constrictive pericarditis
1. Progressive dyspnea
2. Weakness
3. Edema
4. Hepatomegaly
5. Elevated JVP
6. Kussmaul sign
121
What is Kussmaul sign?
failure of JVP to fall w/ inspiration
122
Dx constrictive pericarditis
1. CXR - occasional calcifications around pericardium
2. Echo - may reveal septal bounce
3. Cardiac CT - need 4 mm pericardial thickening to be diagnostic
4. Cardiac cath
- evidence of RV-LV interaction
- square root sign
123
What are the ECG changes associated w/ pericarditis?
1. Diffuse ST-segment elevation
2. PR depression
3. Low QRS amplitude
4. Electrical alternans
124
Tx constrictive pericarditis
1. Aggressive diuresis w/ attention to electrolyte balance
| 2. Pericardiectomy if diuresis fails
125
What are the causes of myocarditis & what is it?
Cardiac dysfunction due to acute viral infection & post viral immune response, leading to chronic myocyte injury
Many causes - mostly viral in US but can be autoimmune, drugs, venom, systemic diseases, other
126
S/S myocarditis
1. Pleuritic CP
2. Dyspnea
3. PVC/VTach
4. Edema
5. Sudden hemodynamic compromise
may mimic STEMI w/ normal coronaries
Microaneurysm may lead to Vtach
shows few days/weeks after acute febrile illness
127
What should you suspect in a Pt w/ new CHF, arrhythmia, or conduction block w/o previous heart disease?
Myocarditis
128
Dx myocarditis
1. Cardiac MRI w/ Gadolinium
- areas of spotty enhancement throughout the myocardium indicating injury & necrosis
2. Endomyocardial Bx
- histology
if no virus/bacteria present, may want to start immunosuppression
129
Tx acute myocarditis
1. Correct hemodynamic compromise
| 2. IV pressors, IABP, LVAD, ECMO, IVIG
130
Tx chronic myocarditis
1. Treat EF <40% as you would for CHF
2. BB, ACEi
w/ severe dilated cardiomyopathy
Consider long-term LVAD/heart transplantation
131
What is contained in the mediastinum?
1. Great vessels
2. Heart
3. Vagus & Phrenic nerves
4. Lymph nodes
5. Trachea
6. Esophagus
132
What are the common causes of mediastinitis?
Cardiac surgery is main cause
Spreads from deep neck space facial planes from untreated retropharyngeal abscess
Others:
1. Esophageal rupture
2. Contiguous spread from oropharyngeal, lung
133
What risk factors inc. your chances of mediastinitis during cardiac surgery?
1. Morbidity prior to surgery
2. Length of the procedure
3. Artificial materials used
4. Previous sternotomy
134
What bacteria most commonly cause mediastinitis?
Often polymicrobial & bacteria from the mouth
1. Viridans group strep
2. Peptococci
3. Peptostreptococci
4. Bacteroides
5. Fusobacterium
135
S/S mediastinitis
1. Primary infection - odontogenic signs
2. CP, SOB, dysphagia
3. PE, tachycardia, crepitus over the chest wall, Hamman's sign, precordial crepitus
4. Sepsis
5. Cardiothoracic surgery - abnormal wound appearance, bubbling from the site, abnormal pain, wound or sternotomy dehiscence
usually 2 wks out or sooner if gram -
136
Dx mediastinitis
1, CT scan of thorax - soft tissue swelling, pleural effusion, air collection, sternal errosion
2. Cultures
epicardial wires, purulent material, blood, aspirate
3. May do Indium 111 tagged WBCs
137
Hammon's sign
crunching sound synchronous with heartbeat
seen w/ mediastinitis
138
Tx mediastinitis
1. Most require surgical drainage & debridement
2. Broad-spectrum antibiotics
Duration may be months
139
Which valve is most commonly infected w/ infective endocarditis?
Mitral valve
then AV, TV, PV
140
What are the risk factors for native valve endocarditis?
1. Rheumatic Heart Disease
2. Congenital heart disease
3. IVDU - TV
4. Poor dental hygiene
5. On hemodialysis
6. Diabetes
141
What are the risk factors for prosthetic valve endocarditis?
1. Mechanical valve
2. Bioprosthetic valve if <6 mo of surgery
3. Bacteremia/fungemia from lines
142
What are the causes of infective endocarditis?
1. Strep sp. Viridans group
2. S. aureus
3. CoNS
4. Enterococci
5. Gram neg bacillis
6. HACEK organisms
7. Diptheroids
8. Polymicrobial
9. Or from previous abx exposure - Bartonella sp, meitensis, Legionella pneumophila, Chlamydia psittaci, Tropheryma whippeli, Coxiella burnetii
143
S/S infectious endocarditis
1. Fever
2. Murmur
3. Emboli
4. Splenomegaly
5. Metastatic focus of infection
6. Retinal lesion
7. Petechiae
8. Splinters
9. Osler's node
10. Janesway lesions
144
What are Osler's nodes?
painful nodes on finger pads from immune complexes
characteristic of infectious endocarditis
145
What are Janesway lesions?
painless red lesions of the palms or soles
characteristic of infectious endocarditis
146
How do you diagnose infective endocarditis?
Duke criteria
+histopath/cultures from tissue
2 major
1 major & 3 minor
5 minor
Possible
1 major & 1 minor
3 minor
Rejected
Firm alternative Dx
Resolution of illnes <4 days w/ abx therapy
No supportive pathology
147
What are the components of the Duke criteria?
Major
1. Pathogens from 2 cultures
2. Antibody titer IgG >1:800
3. New valvular regurgitation
4. Positive echo
Minor
5. Predisposing conditions (ex. IVDU)
6. Fever
7. Vascular phenomena (emboli, infarct, mycotic aneurysm, hemorrhage)
8. Immunologic phenomena (glomerulonephritis, Osler's nodes, Roth's spots, RF)
148
What are the complications of infective endocarditis?
1. Systemic embolic (greater w/in first 2-4 wks of abx therapy)
2. Periannular extension: abscess, fistula
3. Splenic abscess
4. Mycotic aneurysms
149
Tx infective endocarditis
1. ID & surgical consult
2. PICC line - vanco +/-gentamicin
Test of Cure - blood cultures
150
What is the problem w/ VAD?
induced CD4 T cells to induce apoptosis leading to immunocompromise
common infection in drive line
must get transplant
151
What is chronic Rheumatic Heart Disease?
from single/repeat attacks of RF that produce rigidity & deformity of valve cusps, fusion of the commisures or shortening & fusion of the chordae tendinae
valvular stenosis or regurgitation can occur
152
What should you use to treat recurrent/refractory cases of pericarditis?
colchicine
153
What should you look for if a Pt has enterococci endocarditis?
Gastric CA
154
What is the best test for endocarditis?
TEE
155
Who & when should receive prophylaxis Tx to prevent endocarditis?
Pts w/ predisposing congenital/valvular anomalies
Select dental procedures, operations w/ respiratory tract, infected skin, skin structure or musculoskeletal tissue
156
Which heart sound is present during active MI?
S4
due to the lack of ATP production impairing left ventricular relaxation
157
Killip Classification
Used to predict mortality in STEMI
I - No evidence of heart failure
II - Mild to moderate heart failure (S3 gallop, rales 1/2-way up lung fields of elevated jugular venous pressure)
III - Pulmonary edema
IV - Cardiogenic shock (Systolic BP <90 mmHg & signs of hypoperfusion such as oliguria, cyanosis & sweating)
158
What is Carey Coombs?
murmur suggestive of valvulitis
seen with Rheumatic Fever
159
What is the most common cause of pericarditis?
Coxsackie virus
160
What is Dressler's syndrome?
inflammatory process 2-5 days after an MI causing pericarditis
treat w/ ASA
161
What is effusive-constrictive pericarditis?
pericardial tamponade + constrictive pericarditis
162
What is metabolic syndrome & what is it associated with?
HTN, coronary heart disease
1. Truncal obesity
2. Hyperinsulinemia & insulin resistance
3. Hypertriglyceridemia
163
What HTN meds are commonly used in men w/ BPH?
alpha - adrenergic antagonists
164
What is Levine's sign?
a clenched fist over the sternum & clenched teeth when describing chest pain
165
What is commonly used to measure the extent of an MI?
MRI w/ gadolinium contrast
also used to Dx myocarditis
166
What is seen w/ a perivascular granuloma w/ vasculitis?
Rheumatic fever
167
What is the most common cause of aortic dissection?
atherosclerosis
most occur in the abdomen
168
What cholesterol level significantly inc. your risk of CAD?
>200 mg/dL
