Cardio review

• Symptomatic
• >5.5 cm in diameter
• Rapid growth

• US immediate
• CT for visualization of arteries prior to surgical repair

Pregnancy, Bicuspid aortic valve, Marfans, Hypertension

• IV labetalo
• lAdd morphine for pain
• Add IV nitroprusside for further BP control
• In a pt with asthma- add  Esmolol or verapamil/diltiazem

• A- occurs proximal to the L subclavian artery and therefore may lead to aortic regurgitation, bleeding into the pericardial sac and cardiac tamponade. This is referred to as ascending dissection and has a worse prognosis
• B- occurs in the thoracic aorta beyond the L subclavian artery. (Descending)

• Intestinal ischemia
• Renal insufficiency

Regurgitation of flow increases the LV end systolic volume. The heart tries to compensate by hypertrophying of the muscle. This allows for a normalized cardiac output. Eventually the ventricle cannot maintain the output and heart failure ensues

High pitched diastolic decrescendo murmur heard at the LUSB with the patient sitting up, leaning forward and exhaling.

• 1-Hill signc (upper extremity and lower extremity BP difference)
• 2- Traube sign (Pistol shots heard over femoral artery)
• 3- Quinckne (pulsations in capillary nailbed)
• 4- Muller (uvular pulsations)
• 5- Corrigan pulse (Brisk carotid pulse)

Harsh systolic ejection murmur heard best at the RUSB with radiation to the carotids.

• Delayed carotid upstroke
• precordial thrill
• narrow pulse pressure
• strong PMI

• 1- Parasternal RV heave (w/ pulmonary hypertension)
• 2- Palpable S1 at precordium
• 3- diastolic thrill in left lateral decubitus position at apex
• 4- low pitched diastolic rumble heard with bell at apex in LLDP
• 5- Opening snap after s2 at apex

• AS is lower pitched compared to MR
• AS radiates to carotid, MR radiates to axilla
• AS does not increase with handgripping, MR increases
• AS increases with amyl nitrate, MR does not.

• HOCM does not increase with handgripping, MR does
• HOCM increases with valsalva, MR decreases

• Abdominal discomfort
• jaundice
• aninition
• wasting

• holosystolic at midsternal border
• no thrill, no radiation
• increases with inspiration

• diastolic rumble at lower left sternal border
• increases with inspiration
• highpitched and scratchy
• +/- hepatic pulsations

• Found in patients with pulmonic regurgitation and pulmonary hypertension.
• It is a high pitched decrescendo diastolic murmur at LUSB that also increases with inspiration

• 1- fixed split of S2
• 2- Palpable pulmonary artery
• 3- prominent RV impulse
• 4- systolic ejection murmur

• 1- systolic thrill
• 2- holosystolic murmur at LLSB that radiates to right parasternal area
• 3-displaced LV impulse
• 4- S3 gallop from increased flow across mitral valve

• 1- continuous machinery murmur heard best under left clavicle
• 2- bounding pulses
• 3- thrill
• 4- displaced apical impulse

• high frequency systolic click at LUSB that DECREASEs with inspiration
• with or without thrill and RV impulse

• 1- >2 + BC taken prior to abx
• 2- evidence of valvular involvement (echo or murmur)

• Fever
• immunologic phenomena (GN, osler's nodes, roth spot)
• vascular phenomena (emboli, janeway, conjunctival hemorrahge)
• history of IVDU

• 1- active bleeding
• 2- spinal neoplasm
• 3- aortic dissection
• 4- hemorrhagic stroke
• 5- facial trauma within the past 3 months

• 1- elevated INR
• 2- Ischemic stroke
• 3- HTN >180/110
• 4- recent CPR or internal bleeding
• 5- PUD
• 6- PRIOR STREPTOKINASE

Boot shaped heart on xray

• conduction abnormalities including 2nd and 3rd degree AV block.
• Sick sinus syndrome
• severe heart failure

• 1- COPD
• 2- Pericardial tamponade
• 3- Pericarditis

Decrease > 10 in systolic pressure on inspiration

Oral sulfadiazine

heightened vagal tone

peaked t waves

Nifedipine because it causes peripheral vasodilation, which may result in decreased left ventricular filling and worsening of outflow tract obstruction.

Transposition of the great arteries

• 1- papillary muscle rupture (MR)
• 2- ventricular septal rupture
• 3- ventricular free wall rupture

opening snap is the sound of a stenotic mitral valve opening. In progressive MS the valve may be completely calcified and not open as much, thus an absent snap.

Isoniazid, chemotherapy, phenytoin, hydralazine

beta blockers

Regular, monomorphic tachycardic rhythms, PSVT.

120-139 / 80-89

renal parenchymal disease

Blacks, elderly, obese, smokers

• precipitation of gout
• ed
• rash
• photosensitivity
• hypokalemia
• mild increases in glucose, LDL and triglycerides

• gynecomastia
• hyperkalemia
• metabolic acidosis

Diuretics or calcium channel blockers

spironolactone

ace-inhibitors

• lithium -> toxicity
• potassium sparing diuretics -> hyperkalemia

beta blockerss

• 1- cardiogenic
• 2- distributive
• 3- hypovolemic
• 4- obstructive

Evidence of tissue hypoxia due to low cardiac output in the presence of adequate intravascular volume

Dobutamine- increases contractility (inotropic) and decreases afterload

• Norepinephrine
• phenylephrine
• vasopressin

(Any drug that will maintain systemic vascular resistance to give adequate tissue perfusion)

When alpha receptors in smooth muscler are blocked, total peripheral resistance decreases.

smooth muscle, pupil, bladder and prostate

Any receptor that responds to norepinephrine

• alpha
• beta
• dopamine

Eye- Mydriasis, ciliary muscle contaction (increased outflow to treat glaucoma)

prostate contractions

contracts smooth muscle, increases cardiac contraction

• increases force of contraction
• increases rate of contraction
• increases renin release

smooth muscle relaxation

alpha agonist, to treat orthostatic hypotension by causing smooth muscle contraction

• 1- soft/distant heart sounds
• 2-hypotension
• 3- JVD
• CARDIAC TAMPONADE

• acute cholangitis
• 1- fever
• 2- jaundice
• 3- pain

• stasis
• endothelial injury
• hypercoagulability