Term
|
Definition
| coronary arteries fill in diastole and systemic arteries fill in systole |
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Term
|
Definition
| = CO x TPR = diastolic + 1/3 PP = 2/3 diastolic + 1/3 systolic |
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Term
|
Definition
|
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Term
|
Definition
| CO = SV x HR = (rate O2 used / arterial-venous O2) |
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Term
|
Definition
| brain increases SV before starting, increased HR maintains increased CO |
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Term
|
Definition
| cholesterol in cornea, seen in hyperlipidemia |
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Term
| what is homocysteine a marker for |
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Definition
| high in hyperlipidemia, increases risk of CAD, lower it with folic acid, B6, or B12 but does not decrease CAD risk so just marker |
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Term
| when do you start hyperlipidemia meds |
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Definition
>160 everyone
>130 if CAD >2 risk factors
>100 if CAD, DM, PVD, AAA |
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Term
| when do you start hyperlipidemia lifestyle modifications |
|
Definition
>160 everyone
>130 if any CAD risk factors or comorbidities |
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Term
| why do we lower TG, what med |
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Definition
| causes acute pancreatitis, fibrates, nicotonic acid, fish oil, statins |
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Term
|
Definition
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Term
|
Definition
smoking
HTN
HDL <35 (minus point if >60)
female >45yo or male >55yo
Male
MI/sudden death in familial male <55 or female <65yo |
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Term
| treatment for athlerosclerosis |
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Definition
reduce risk factors
statins - reduce inflammation and LDL |
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Term
| when is a cardiac stress test done |
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Definition
| when they reach 85% of 220-age, chest pain, arrhythmia, ST changes on EKG |
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Term
| treatment of stable angina |
|
Definition
aspirin, BB, nitrates PRN
risk factor modification (exercise) |
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Term
| Treatment of acute myocardial event (unstable, NSTEMI, STEMI) |
|
Definition
MONA plus 5: morphine, O2, nitro, aspirin, statin, BB, copidogrel, heparin, maintain Mg/K
NEVER GIVE NITRO TO INFERIOR MI
thrombolytic if STEMI <12h |
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|
Term
| diagnosis of varient angina |
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Definition
| st elevation, transmural, without blockage on angio. IV ergonovine to provoke CP on angio is definitive |
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Term
| leads and vessel for inferior, lateral, septal, anterior, and posterior MI |
|
Definition
inferior: posterior descending of right main (II, III, AVF)
lateral: LAD or circumflux (V5, V6, I, AVL)
septal: branch of LAD (V1-3)
anteiror: LAD main (V2-4)
posterior: ST depression in V1-2 |
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Term
| myoglobin, CKMB, troponin, LDH onset, peak, duration |
|
Definition
myoglobin: onset 1h
ckmb: onset 406h, peak 24h, duration 3d
troponin: onswt 4-6h, peak 24-48h, duration 10d
LDH: peak 48-72h, duration 10d |
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|
Term
| drugs that decrease mortality post MI |
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Definition
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|
Term
| dressler syndrome symptoms and tx |
|
Definition
fevere, malaise, pericarditis, leukocytosis, pleuritic pain, increased ESR, 2-4wk post MI
DOC colchicine, alt steroids |
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Term
|
Definition
young man, laos, thiland, ST elevations V1-3, RBBB, possible terminal S waves in lateral leads
Risk of sudden death |
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|
Term
|
Definition
LV failure
MV stenosis
lymphangitis caranomatosis
lymphatic obstruction
asbestos
sarcoidosis |
|
|
Term
|
Definition
1) symptoms with vigorous activity: diuretic PRN, ACEI
2) symptoms with moderate activity: add BB
3) symptoms with daily activity: add spironolactone
4) symptoms at rest: at digitalis short term |
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|
Term
| treat acute CHF exacerbation |
|
Definition
nitrates remove pulmonary blood
oxygen
loops
inotropes (dobutamine)
position with legs off bed |
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|
Term
|
Definition
| megaesophagus, enlarged salivary glands, romana sign (swollen eye on side of infection), dilated cardiomyopathy |
|
|
Term
| dilated cardiomyopathy signs and treatment |
|
Definition
S3, balloon heart, murmurs, fatigue, dyspnea
diuretics, ACEI |
|
|
Term
| hypertrophic cardiomyopathy signs and treatment |
|
Definition
SOB, CP, syncope, sudden death young athlete
S4, boot heart
bisferous pulse, systolic ejection murmur worse with valsalva
TX: BB, myomectomy if severe |
|
|
Term
| restrictive cardiomyopathy signs |
|
Definition
|
|
Term
|
Definition
| CP, dyspnea, S3, S4, diastolic murmur, friction rub, ST/T elevations, cardiomeagly |
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|
Term
| acute pericarditis signs and treatment |
|
Definition
pleuritic CP, plusus paradoxus, pericardial riction rub, diffuse ST elevations, globular canteen heart
TX: NSAIDs for symptoms self limited |
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|
Term
| constrictive pericarditis signs and treatment |
|
Definition
kussmauls sign (JVD increases with inspiration), edema, ascites, dyspnea, pericardial thickening, square root sign equal diastolic pressures in all chambers
tx: NSAIDs, cholchine, steroids, pericardial excision |
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|
Term
| pericardial effusion signs and treatment |
|
Definition
low QRS voltage, electrical alterans, muffled heart sounds, water bottle heart, soft PMI
pericardiocentesis if risk of tamponade |
|
|
Term
| cardiac tamponade signs and treatment |
|
Definition
beck's triad (JVD, muffled heart sounds, hypotension), pulsus paradoxus, electrical alterans, diffuse low voltage
tx: pericardiocentesis, if hemorrhagic surgical repair |
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|
Term
| aortic regurgitation: increase, decrease, timing, sound, cause, signs |
|
Definition
increase: expiration, handgrip
decrease: valsalva, inspiration
timing: early diastolic
sound: beat beat blow
cause: endocarditis, rheumatic, HTN, CT disease, aortic dissection (syphilis)
sx: SOB, palpitations, worse lying down, de musst, wide PP, quinke
tx: if acute emergent valve replacement, if chronic meds until LV dilation then replace |
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|
Term
| pulmonic regurgitation: increase, decrease, timing, sound |
|
Definition
increase: inspiration
decrease: valsalva, expiration
timing: early diastolic
sound: beat beat blow |
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Term
| mitral stenosis: increase, decrease, timing, sound, cause, signs |
|
Definition
increase: expiration, lateral decubitus, valsalva
decrease: inspiration, squat
timing: late diastolic
sound: opening snap
cause: rheumatic
signs: CP, SOB, HSM, edema, AFib, hemoptysis, kearly B lines |
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Term
| aortic stenosis: increase, decrease, timing, sound, cause, signs, treatment |
|
Definition
increase: expiration
decrease: valsalva, inspiration
timing: systolic ejection
sound: beat and blow at same time, ejection click
cause: congenital bicuspid, calcification, syphilis, rheumatic
sx: CP, angina, dyspnea, CHF, parvus, tardus, precordal thrill
tx: replace when >50mmHg or symptomatic |
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|
Term
| pulmonic stenosis: increase, decrease, timing, sound |
|
Definition
increase: inspiration
decrease: valsalva, expiration
timing: systolic ejection
sound: beat and blow at same time, ejection click |
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|
Term
| mitral regurgitation: increase, decrease, timing, sound, cause, signs |
|
Definition
increase: expiration, lateral decubitus, squat
decrease: inspiration, valsalva
timing: holosystolic
sound: long blow overlapping beats
cause: endocarditis, papillary rupture, MVP, marfans, rheumatic
sx: CP, SOB, palpitations, pulmonary edema, radiation to axilla and back, lateral PMI |
|
|
Term
| tricuspid regurgitation: increase, decrease, timing, sound, cause, treatment |
|
Definition
increase: inspiration
decrease: valsalva, expiration
timing: holosystolic
sound: long blow overlapping beats
cause: LV failure, inferior MI, endocarditis, rheumatic, cor pulmonale
sx: asymptomatic until R heart failure, AFib
tx: replacement if no pulmonary HTN |
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Term
| mitral valve prolapse: increase, decrease, timing, sound, cause, symptoms, treatment |
|
Definition
increase: expiration, lateral decubitus, valsalva
decrease: inspiration, squat
timing: late systolic
sound: click
cause: CT disease, thrombi, ruptured papillary, endocarditis
sx: palpitations, CP, TIA, endocarditis
tx: BB for CP |
|
|
Term
|
Definition
split S1
split S2 on inspiration
S3 if <40 yo
early quiet systolic murmur |
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|
Term
| who gets prophylactic antibiotics before dental or other procedures |
|
Definition
prosthetic valve or any prosthetic in heart
previous endocarditis
unrepaired congenital defect
cardiac transplant with valvuloplasty
(1-2g amoxicillin 30-60 min before procedure) |
|
|
Term
|
Definition
<5cm and asymptomatic: periodic imaging, risk factor reduction
>5cm or symptomatic or >0.5cm increase in 6mo: endovascular graft placement |
|
|
Term
|
Definition
normal 0.9-1
>1.3 non-compressible vessels, calcification in severe disease
<0.7 intermittent claudication
<0.3 rest pain |
|
|
Term
| signs of cholesterol emboli |
|
Definition
| black toes, renal insufficiency, abdominal bleeding and pain, CVA, fever, ARDS, livdeo reticularis, eosinophilia |
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|
Term
| superificial thrombophlebitis signs and treatment |
|
Definition
pain, tenderness, induration, erythema, tender palpable cord
localized: aspirin for analgesia, continue activity and recheck in 7-10d
control symptoms: bed rest, elevation, hot compresses, ambulation, elastic stockings
if septic, infected, or >5cm: anticoagulate and if infected give IV antibiotics |
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|
Term
| most effective way to reduce blood pressure |
|
Definition
|
|
Term
| when do we start blood pressure emds |
|
Definition
3 readings at least 2wks apart of >140/90
if has DM, kidney disease, end organ damage, or CV disease start at >130/80
if >60yo can go up to 150/90 |
|
|
Term
| definition and treatment of hypertensive urgency |
|
Definition
BP >180/120 without symptoms
lower BP over 24h with oral meds |
|
|
Term
| definition and treatment of hypertensive emergency |
|
Definition
BP >180/130 with evidence of end organ damage
reduce diastolic to 100 or 25% of presenting diastolic (which ever is less) with IV anti-HTN over 2h
begin maintenance BB |
|
|
Term
| cardiogenic shock: TPR, MAP, HR, CO, PWCP, skin, JVD, TX |
|
Definition
TPR up
MAP down
HR up
CO down
PCWP up
skin cool
JVD up
NO FLUIDS, dopamine, dobutamine, nitro |
|
|
Term
| hypovolemic shock: TPR, MAP, HR, CO, PWCP, skin, JVD, TX |
|
Definition
TPR up
MAP down
HR up
CO down
PCWO down
skin cool
JVD down
crystalloid, fluids, RBC, monitor urine |
|
|
Term
| neurogenic shock: TPR, MAP, HR, CO, PWCP, skin, TX |
|
Definition
TPR down
MAP down
HR down
CO down
PCWP unchanged
skin warm
some fluids, atropine, vasopressors, casoconstrictors, T bird |
|
|
Term
| septic shock: TPR, MAP, HR, CO, PWCP, skin, JVD, TX |
|
Definition
TPR down
MAP down
HR up CO up
PCWP unchanged
skin warm
JVD down
lots of fluids, norepinepherine, antibiotics |
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|
Term
| anaphylactic shock: TPR, MAP, HR, CO, PWCP, TX |
|
Definition
TPR down
MAP down
HR up
CO up
PCWP down
fluids, epinepherine, H1/2 blockers, steroid |
|
|
Term
| define SIRS, sepsis, severe sepsis, septic shock |
|
Definition
SIRS (2 minimum): temp <38/<36, HR >90, RR >20, PaCO2 <32, WBC >12/<4/>10% bands
sepsis: SIRS with source of infection
severe sepsis: sepsis with organ dysfunction, hypoperfusion, or hypotension
septic shock: severe sepsis with hypotension despite fluid recussitation |
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|
Term
|
Definition
1) placenta > umbilical vein > ductus venosus (bypasses liver, mix point with nonO2 blood from LE) > IVC > RA
2) could go to foramen ovale and into LA/LV and to aorta or go through RV/PA and through PDA into aorta
3) oxygenates the body and returns to placenta via umbilical artery |
|
|
Term
|
Definition
| stridor, crowing respiration, hyperextended neck, dysphagia, bronchoscopy showing tracheal compression, barium swallow showing compression from abnormal vessels |
|
|
Term
| signs of williams syndrome |
|
Definition
| elfin facies, MR, hypercalcemia, supravalvular aortic stenosis (dyphragmatic hour glass narrowing) |
|
|
Term
| associations with aortic coarctation |
|
Definition
turner syndrome
bicuspid aorta |
|
|
Term
|
Definition
|
|
Term
|
Definition
ostium secondum (80%): none, #1 defect in adults
ostium primum: down syndrome
deep sea diving and high altutide sickness |
|
|
Term
|
Definition
#1 congenital heart disease
fetal alcohol syndrome **
downs
cri du chat
trisomies |
|
|
Term
| when do we fix a septal defect |
|
Definition
| 1.5:1 pulmonary to systemic or symptomatic |
|
|
Term
|
Definition
| maternal rubella, high altutide, premature birth, maternal PGE, female baby |
|
|
Term
| signs of tertalogy of fallot |
|
Definition
tet spells, cyanosis, clubbing, crescendo decrescendo murmur
boot heart
sudden cardiac death |
|
|
Term
| association with truncus arteriosis |
|
Definition
|
|
Term
| association with transposition of the great vessels |
|
Definition
| apert syndrome, downs, cri du chat, trisomies |
|
|
Term
| signs of transposition of the great vessels |
|
Definition
| cyanosis, loud S2, CXR with egg on string appearance, pulmonary markings, narrow heart base |
|
|
Term
| gold standard for diagnosis of thoracic aortic aneurysm |
|
Definition
|
|
Term
| gold standard for diagnosis of thoracic aortic aneurysm |
|
Definition
| CT of chest with contrast |
|
|
Term
| gold standard for diagnosis of AAA |
|
Definition
|
|
Term
| treatment of thoracic aortic aneurysm |
|
Definition
>5cm or symptomatic: surgery
<5cm: CT in 6mo, in no change CT again in 12mo |
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|
