Cardiology 1
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- Systemic conditions that increase transvalvular flow (ie. benign ejection or diastolic murmur) include:
- fever, anemia, thyrotoxicosis, and pregnancy
- Causes of Pansystolic murmur:
-
tricuspid/mitral regurge, VSD
mitral: heard best at apex- has uniform intensity through out systole. S1-S2. radiates to the axilla
the smaller the VSD the louder, also may have a thrill - Late systolic murmur, continues to A2, think....
- often regurgitant mitral due to prolapse... note mid systolic click.
- DDx for diastolic murmurs...
- early decrescendo due to incompetent A or P; mid/late "rumbling" murmurs turbulent flow past T or M
- continuous murmur
- patent ductus arteriosus
- EKG abnormalities with transmural infarct.
- ST segment elevation, T wave inversion, and Q waves in injured region.
- EKG abnormalities with epicardial infarct.
- ST segment depression, and T wave inversion in injured region.
- Condidtions confused with acute MI.
- Aortic dissection, pericariditis (diffuse ST elevation), pulmonary embolism, esophogeal spasm/reflux, pneumothorax
- Serum BioMarkers in MI, temporal sequences:
-
Myoglobin - CK-MB - Troponins
Myo- 2-4 hrs, rapidly cleared in Kidney, not specific, non Dxstic
CK-MB- rise 3-12 hours following, delyed 24hr peak; N after 48, Use reletive index vs total.
Troponins- GOLD STD, absent in health pts. Must get sample to Lab STAT, TnT in heart vs TnI in skeletal muscle (i think). - Define Cardiac Shock
- Severely decreased cardiac output and hypotension (systolic <90); greator than 40% of ventricular mass is infacted. Mortality 70%