cardio #3
Terms
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- CHF
- heart failure resulting b/c of myocardial dysfunction that impairs the heart's ability to circulate blood at a rate suffiecient to maintain the metabolic needs of peripheral tissue and various organs
- right sided heart failure
-
JVD
peripheral edema
hepatomegaly
ascities
hepatojugular reflux
jaundice - left sided heart failure
-
S3 (very diagnostic)
pulmonary congestion
tachycardia
Cheyne-Stokes respirations
mental status changes
decreased urine output
pallor
cyanosis
cold extremeties - pericarditis
- results from the inflammation of pericardium and in some cases the development of an effusion b/w the myocardium and pericardium
- cardiac tamponade
- exists when increased intrapericardial pressure from the accumulation of fluids compromise the filling of the heart and therby impairs ccardiac output
-
triphasic friction rub
3 components -
during:
atrial contraction
ventricular systole (mose consistant)
early diastole - restrictive cardiomyopathy
-
-signs and symp. of HF with frequent dominant right sided findings
-diastolic ventricular f(x)al abnormalities suggestive of reduced vent. compliance
-normal-to-small size ventricles
-atria dilated on echo - hypertrophic cardiomyopathy
-
-dyspnea
-systolic ejection murmur (sounds like aortic stenosis)
-left ventricular hypertrophy
-hyperkinetic left vent. systolic funtion - Dilated cardiomyopathy
-
end result of HTDZ of any type with a generalized 4 chamber cardiac enlargement
decreased right and left vent. systolic performance which can lead to stasis in any cardiac chamber (thromo/emboli) risk for clots -
Systolic Ejection Murmur
DDX= - aortic stenosis and hypertrophic cardiomyopathy
- General treatment of CHF
-
-treat underline prob (revasculature, HTN, DM)
-ensure O2/ gas exchange (O2& ASA)
-avoid over diuresis (low NA+ diet, fluid restrictions, K+ supplaments, Is & Os, monitor electrolytes)
-diuretics (preload)
-+ve inotropic agents (digitalis-CHF & a. fib)
-vasodilators (if still symptomatic after dig and diuretics)
-IV sympathomimetics
-Nitrates (venodilators/ afterload)
-ACE(afterload/ neurohumoral antagonist) - Treatment of CHF
-
O2, diuretics, nitrates, morphine
mechanical ventilation
IV sympathomimetics
rule-out reversible causes - teatment of pericarditis
-
-treat the underline causes
-NSAIDS (if doesn't work- steroids or colchicine (prophalaxis of recurrent))
-pericardiocentesis (take fluid out but would 1st confirm with an echo or MRI) - treatment of resstrictive cardiomyopathy
-
diuretics (preload)
nitrates (afterload-venodilators)
coumadin (prevent clots)
transplant - treatment of hypertrophic cardiomyopathy
-
-beta blockers and CCB = for dypnea and angina (not working= digitalis for a-fib)
nitro-contra and diuretics- cautioned
-surgery (remove band)
-pacemaker implantation (pt's develope BBB)
-transplant - Treatment of Dilated cardiomyopathy
-
heart treansplant
(anticoagulants?) - Aortic Stenosis (AS)
-
-heard best in the 2nd R ICS
-radiates to carotids; crescendo-decres
-S2 (A2) is decreased
-S3 often heard
-most common cause in a bicuspid valve (congenital)
-senile calcific and rheumatic fever - Pulmonic Stenosis (PS)
-
-crescendo-decrescendo
-heard best over pulmonic area 2nd LICS
-increases with inspiration
-widely split S2
-congenital - Mitral Regurg (MR)
-
-holosystolic
-loudest at mitral area and radiates into the axilla
-caused by HTN, rheumatic fever, MI - Tricuspid Regurg (TR)
-
holosystolic
radiates into the R chest
increases with inspiration - Aortic insufficiency (AI)
-
-best heard over aortic area radiating to LSB and apex
-decrescendo
-S3
-caused by rheumatic fever, Marfans, aortitis, HTN - Pulmonic Insufficiency (PI)
-
-decrescendo
-heard best in pulmonic area (COPD) - Mitral Stenosis (MS)
-
-DIASTOLIC RUMBLE with presystolic accentuation if in NSR
-Loud P2 (pulmonary HTN)
-Opening snap and soft S1
-rheumatic fever almost exclusively
-Austin-Flint murmur - Tricuspid STenosis (TS)
-
diastolic
heard best in tricuspid area
congenital -
Patent ductus arteriosus,
coarctation of aorta - 2nd L ICS (loudest)
- Ventricular septal defect
-
doesn't radiate
much louder (post MI, infants) at the LSB - Acrocyanosis
- bluish tinge (cyano) to the tips (acro) of the extremities
- Blood Pressure
- pressure of the blood against the inner walls of the blood vessels. top # indicates the pressure during contraction of the heart, or systole; the bottom # indicates the pressure during relaxation, or diastole
- Bruit
-
abnormal heart sound heard by listening with a stethoscope
turbulence (murmur) heard anywhere else but the heart - Ecchymosis
- condition (osis) in which there is an outpouring of fluid (chym) that is blood under the skin resulting in a purple spot
- Extrasystole
- the heart contracts (systole) more often (extra) that it should: the heart does not get an opportunity to relax before the next contraction starts. sometimes referred to as premature contraction of the heart
- Circulatory collapse
- sudden failure (collapse) of the circulatory system and repiratory system resulting ina profound degree of shock
-
AV Block treatment:
(Pharmacologic)
acute situation
neurovascular syncope -
-atropine and isoproterenol: useful in increasing HR and decreasing symptoms in pt's with sinus bradycardia or AV block localized to the AV node
-beta blockers and disopyramide to depress left ventricular function and decrease mechanoreceptor- related reflexes -
AV Blocks treatment:
Long-term therapy for bradyarrhythmias -
best accomplished by pacemakers
(esp. 3 degree AV block) -
Atrial dysrhythmias treatment:
PAC - remove precipitating factors (coffee, stress, etc)
-
atrial dysrhythmia treatment:
Atrial Flutter -
the most effective treatment is direct-current cardioversion (shock)
(worry about clots so treat with coumadin) -
atrial dysrhythmia treatment:
Atrial Fibrillation
(acute situations, in absece of severe cardiovascular compromise, prior to cardioversion, and pt's should always take) -
-treatment of precitpitating factors 1st
(fever, throtoxicosis, etc)
-elctrical cardioversion is treatment of choice (shock)
-slowing of ventricular rate becomes the initial therapeutic goal (with bb or ccb)
-precautions must be taken to reduce the risk of systemic embolization
-pt's should be anticoagulated -
atrial dysrhythmia treatment:
SVT (atrial tachycardia):
in pt's w/o hypotensiion and w/ it -
-vagal maneuvers, particularly carotid sinus massage, can terminate the arrhythmia in 80% of cases
-raising the BP will eliminate the abnormal rhythm -
ventricular dysrhythmia treatment:
PVC: asympto
symptomatic (w/HD) -
(asympto): no treatment if causative agents/ heart dis. has been ruled out)
(sympto): beta blockers -
ventricular dysrhythmia treatment:
V-Tach: if tolerating rhythm
if symptomatic -
- lidocaine, procainamide, amiodarone
-cardioversion -
ventricular dysrhythmia treatment:
V-flutter - cardioversion (shock)
-
ventricular dysrhythmia treatment:
V-fibrilllation - cardioversion (shock)
- Hemangioma
- tumor (oma) consisting of blood (hem) vessels (angi). also called an angioma
- Hemorrhoid
- dilated vein filled with blood (hemo) in the area of the anal sphincter