-
identify as many causes of 2' HTN as you can
- renal (renal parenchymal dz - glomerulonephritis, polycistic dz, diabetic nephropathy)
- endocrine (hypo or hyperthyroid, pheo, cushing's, conn's, hyperparathyroid, hypercalcemia)
- neurologic (tumour, SC trauma, sleep apnea, porphyria)
- toxic (EtOH, coke, Pb poisoning, OCP, HRT, NSAIDs, corticosteroids...)
- other (aortic coarctation, pregnancy, carcinoid syndrome, pain, anxiety, hypoglycemia, EtOH or drug withdrawal)
-
list routine investigations for a pt newly dx w HTN
- urinalysis
- CBC
- lytes
- BUN/Cr
- fasting glucose and lipids
- EKG
-
list conservative mg't for HTN
- reduce BMI to between 18-25
- limit EtOH
- exercise 3-4 x/wk
- restrict salt
- stop smoking
- stress management
-
define accelerated HTN
- asymptomatic
- systolic BP >200 +/- diastolic BP > 120
needs immediate tx to prevent potential complications of a malignant HTN crisis
-
define malignant HTN
- symptomatic accelerated HTN
- papilledema, bulging discs, retinal hemorrhages
- mental status changes
- elevated Cr
-
complications of malignant hypertensive emergency include
- confusion
- seizures
- h/a
- visual changes
- cerebral thrombosis
- intracerebral or subarachnoid hemorrhage
- unstable angina
- acute pulmonary edema
- dissecting aortic aneurysm
- sever pre-eclampsia and eclampsi
- acute renal failure
- pheo
-
Which investigations should you order to investigate heart palpitations
- lytes (Na, K, Mg)
- CBC
- BUN, Cr
- LDH, CK
- TSH, T4
- cardiac enzymes
- ECG, Echo, CXR
-
list important management issues concerning a fib
- rate control - managed with beta blockers, CaCBs or digoxin
- Anticoagulation
- Rhythm conversion
- determine etiology
-
DDx for bradyarrhythmias
- sinus brady
- sick sinus syndrome
- junctional rhythm
- ventricular escape rhythm
-
DDx or conduction delay
- 1', 2' or 3' AV nodal block
- fascicular block
- bundle branch block
-
DDx for irregular tachy
- a fib
- a flutter w variable block
- atrial or ventricular premature beats
- ventricular fibrillation
-
DDx for regular tachy (narrow complex)
- SVT
- a flutter
- WPW syndrome
- AV node re-entry
-
DDx for regular tachy (wide complex)
- SVT w aberrance or BBB
- ventricular tachy
- torsades de pointes
-
when is a rhythm unstable?
unstable arrhythmia = pt has hypotension, dyspnea, chest pain, presyncope or syncope
definitively treat with direct current cardioversion
-
Define syncope
the sudden transient loss of consciousness w loss of postural tone
-
define palpitations
sensations of an unduly rapid or irregular heartbeat
-
S&S if part of LAD was occluded
i.e. left sided heart failure
- dyspnea
- orthopnea
- basal crackles in the lungs
- cough
- hemoptysis
- fatigue
- syncope
- systemic hypotension
- cool extremities
- peripheral cyanosis
- enlarged apical impulse
-
S&S if part of RCA was occluded
i.e. right sided heart failure
- peripheral edema
- hepatic tenderness
- hepatomegaly
- pulsatile liver
- elevated JVP
- positive hepatojugular reflux
-
DDx for chest pain
- CV - CAD, angina, MI, aortic aneurysm/dissection
- Resp - pnuemo, pleurisy, PE, pneumonia
- GI - esophagitis, hiatus hernia, peptic ulcer, pancreatitis, cholecystitis
- MSK - costochondrodynia, muscle spasm, chest wall pain NYD
- Other - anxiety, shingles
-
6 steps of tx for pts with acute CAD
- ABCs
- telemetry
- EKG
- cardiac enzymes
- IV access
- drug tx (o2, ASA, nitro, BBlocker)
- reassess pt
-
define pulsus paradoxus
inspiratory fall in systemic BP > 10 mmHg
-
explain the pathogenesis of pulsus paradoxus
- high negative intrapleural pressure draws blood back into vena cava
- increases venous return to RA and RV --> increased filling of right heart
- interventricular septum bulges into the LV outflow tract
- SV decreases
- BP decreases
-
under what conditions would you see pulsus paradoxus
- CVS: cardiac tamponade, pericardial effusions, constrictive pericarditis
- Resp: asthma, emphysema, increased effort in ventilation
-
define JVP
- pressure of the internal jugular system
- direct assessment of the pressure in the right atrium of the heart
-
how do we differentiate JVP from carotid waveforms
JVP - not palpable, multiple waveforms, soft quality, compressible, height changes w inspiration, sitting up and valsalva manoevre
-
why do we prefer to read right sided pulsations rather than left sided JVP
left sided may be falsely elevated b/c of kinknig of the innominate vein
-
what features of JVP need to be described to the examiner
- height
- character of waveform
- results of abdominojugular reflux
-
what is a normal range for JVP
4-5 cm above sternal angle
-
when is the abdominojugular reflux considered abnormal
when there is a sustained rise in JVP > 4cm after applying abdominal pressure for a min 15-30 sec
-
what is Kussmaul's sign and why does it occur
- paradoxical increase in JVP on inspiration
- heart is unable to accomodate the increase in the venous return that accompanies the inspiratory fall in intrathoracic pressure
-
in which conditions would you expect to see Kussmaul's
- severe right sided heart failure
- constrictive pericarditis
- restrictive cardiomyopathy
|
|
