What medication is started with suspicion of aortic dissection? What can be added? What if the pt has a CI to the first drug of choice? What are those CI?
lAdd morphine for pain
Add IV nitroprusside for further BP control
In a pt with asthma- add Esmolol or verapamil/diltiazem
What is the difference between the 2 types of aortic dissections? Which has a worse prognosis?
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)
What are complications of aortic dissections?
How does chronic aortic regurgitation develop?
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
Describe the murmur of aortic regurgitation
High pitched diastolic decrescendo murmur heard at the LUSB with the patient sitting up, leaning forward and exhaling.
What are the 5 peripheral signs of aortic regurgitation?
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)
Describe the murmur of aortic stenosis
Harsh systolic ejection murmur heard best at the RUSB with radiation to the carotids.
What physical exam findings may be present in aortic stenosis?
Delayed carotid upstroke
narrow pulse pressure
What 5 physical exam findings may be present in mitral stenosis?