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89 Cards in this Set
- Front
- Back
Congenital disorder predisposing one to ventricular tacharrhythmias
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Long QT syndrome (QTc > 440msec)
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JVD
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> 7cm above sternal angle.
Suggests: Right CHF Pulmonary HTN Volume overload Tricuspid regurgitation Pericardial disease |
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Kussmaul's sign
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Increased JVD with inspiration
Suggests: R ventricular infarction Postoperative cardiac tamponade Tricuspid regugitation Constrictive pericarditis |
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Harsh systolic ejection murmur, radiating to carotids
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Aortic Stenosis
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Holosystolic murmur, radiating to axillae or carotids
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Mitral regugitation
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Midsystolic or late-systolic click
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Mitral valve prolapse
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Systolic murmurs (4)
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Aortic stenosis
Mitral regurgitation Mitral valve prolapse Flow murmur : no disease |
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Diastolic murmurs (2)
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ALWAYS ABNORMAL:
Aortic regurgitation Mitral stenosis |
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Early decrescendo murmur
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Aortic regurgitation
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Mid-late low-pitched murmur
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Mitral stenosis
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S3 gallop
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Dilated cardiomyopathy (floppy ventricle), mitral valve disease, or normal in younger patients in high output states (pregnancy)
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S4 gallop
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HTN, diastolic dysfunction (stiff ventricle), aortic stenosis, normal in younger athletes
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Peripheral edema DDX (10)
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R heart failure
Biventricular failure Peripheral venous disease Constrictive pericarditis Tricuspid regurgitation Hepatic disease Lyphedema Nephrotic syndrome Hypoalbuminemia Drugs |
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Peripheral pulses greater in the arms than legs
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Coarcation
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Heart problem with increased peripheral pulses (2)
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Compensated aortic regurgitation
Patent ductus arteriosus |
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Pulses alternans
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Alternating weak and strong pulses. Seen in : cardiac tamponade, impaired LV systolic function. Poor prognosis
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Pulsus parvus et tardus
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Weak and delayed pulse. Seen in aortic stenosis
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Management of A-fib: ABCD
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Anticoagulate
BBs Cardiovert/CCBs Digoxin |
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DDX for CHF: HEART FAILED
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HTN
Endocrine Anemia Rheumatic heart disease Toxins Failure to take meds Arrhythmia Infection Lung (PE) Electrolytes Diet (Excess Na+) |
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Treatment for symptomatic bradycardia
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Atropine or pacemaker
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PR interval > 200 msec
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1st Degree AV block. No treatment necessary
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Causes of 2nd Degree AV block MobitzI/Wenckebach) 6
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Digoxin
BBs CCBs Increased Vagal Tone Sinoatrial conduction disease R coronary inscemia or infarction |
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Treatment for 2nd Degree AV block MobitzI/Wenckebach)
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Stop offending drug
Atropine Pacemaker |
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2nd Degree AV block Mobitz II DDX and TX
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Fibrotic disease, acute, subacute or prior infarct
Treat with pacemaker |
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Progressive PR lengthening until a dropped beat occurs
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2nd degree AV block Mobitz I/Wenckebach
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Unexpected dropped beats without a change in PR interval
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2nd Degree AV block, Mobitz II
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3rd degree AV block (Complete) cause and treatment
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No commincation between atria and ventricles. Cannon A waves. Treat with pacemaker
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Disorder consisting of abnormalities in supraventricular impulse generation and conduction that lead to SVT and bradyarrhythmias
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Sick Sinus Syndrome (SSS)
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Most common indication for pacemaker placement
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Sick sinus syndrome (SSS)
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Acute A-fib DDX (PIRATES)
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Pulmonary disease
Ischemia Rheumatic heart disease Anemia/Atrial myxoma Thyrotoxicosis Ethanol Sepsis |
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No discernible P waves, with variable and irregular QRS response
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A-fib
Treat with CCBs, BBs, amiodarone. Coumadin might be necessary. |
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Regular rhythm, sawtooth appearance of P waves, rate 240 - 300 bpm with varying degree of blockade
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Atrial flutter
Treat with anticoagulation, rate control. Cardiovert if necessary |
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3 or more unique P-wave morphologies rate > 100 bpm
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Multifocal atrial thacycardia
Treat underlying disorder (COPD, hypoxemia), cerapamil, BBs |
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Ectopic beats from ventricular foci. Associated with hypoxia, hyperthyroidism, electrolyte abnormalities
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Premature ventricular contraction (PVC)
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3 or more consecutive PVCs with wide QRS complexes in a regular rapid rhythm. AV dissociation. Associated with MI, CAD, and structural heart disease
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Ventricular tachycardia
Treat with cardioversion and antiarrhythmics (amiodarone, lidocaine, procainamide) |
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Totally eratic wide-complex tracing associated with CAD, structural heart disease and cardiac arrest
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Ventricular fibrilation
Treat with immediate electrical cardioversion and ACLS protocol |
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Polymorphous QRS; VT with rates 150 - 250 associated with long QT syndrome, proarrhythmic response to meds, hypokalemia, and congenital deafness
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Torsades de pointes
Treat with correcting cause. Give magnesium and cardiovert if unstable |
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Stage A of CHF
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Have risk factors but no signs or symptoms
Manage risk factors, ACEIs for those with HTN, PAD, and DM |
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Stage B of CHF
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Structural heart disease (prior MI, valvular disease, etc.) without symptoms
Treat: ACEIs and BBs |
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Stage C of CHF
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Structural heart disease with symptoms of CHF
Treat: ACEIs, BBs, digitalis, and low Na+ diet |
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Stage D of CHF
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Marked symptoms at rest despite maximal medical therapy
Treat: mechanical assist devises, heart transplant, continuous IV inotropic drugs, and hospice |
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Diuretic that can cause hyperglycemia and hyperlipidemia
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Thiazide
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Diuretic that can cause hyperkalemia
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K+ sparing, Spironolactone, triamterene, amiloride
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Treatment for acute pulmonary congestion in CHF (PLOMN)
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Position upright
Lasix (Furosemide) Oxygen Morphine Nitrates |
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Indication for an implantable biventricular cardiac defibrillator (ICD)
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EF < 30%
and CAD |
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2 Most common causes of secondary dilated cardiomyopathy
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Ischemia
Long-standing HTN others: Chagas, wet beri beri, thyroid dysfunction, acromegaly, pheo, cocaine, myocarditis, post-partum, coxackievirus, HIV, etc. |
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Gradual development of CHF symptoms, displacement of left ventricular impulse, JVD, S3/S4 gallop, LBBB, sinus tachycardia, low-voltage QRS
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Dilated cardiomyopathy
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Most common cause of sudden death in young healthy athletes
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Hypertrophic obstructive cardiomyopathy. Autosomal dominant in 50%
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Syncope, dyspnea, palplitations, angina, sustained apical impulse, S4 gallop, systolic ejection crescendo-decrescendo murmur that increases with decreased preload (valsalva).
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Hypertrophic obstructive cardiomyopathy
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Asymmetrically thickened left ventricular wall and dynamic obstruction of blood flow, LVH, mitral regurgitation, left atrial enlargement
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Hypertrophic obstructive cardiomyopathy
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Treatment for hypertrophic obstructive cardiomyopathy
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BBs
CCBs 2nd line |
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Causes of restrictive cardiomyopathy (4)
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Sarcoidosis
Amyloidosis Hemochromatosis Scarring and fibrosis (radiation or doxorubicin) |
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Rapid early filling with a normal EF, LBBB, fibrosis or infiltration on biopsy
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Restrictive cardiomyopathy
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Young women at rest in the early morning, sharp pain in chest with pressure, ST-segment elevation in absence of cardiac enzyme elevation
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Prinzmetal's (variant) angina. Caused by vasospasm of coronary vessels.
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New onset chest pain, occurs with less exertion or a rest, ST-changes, no elevation in cardiac enzymes
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Unstable angina, possible impending infarction.
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Medications that have a mortality benefit in treating angina (2)
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BBs
ASA |
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Indication for heparin, angiography and possible percutaneous coronary intervention (PCI) or CABG
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Chest pain refractory to meds
TIMI score >3 Troponin elevation ST changes > 1mm |
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Treatment for STEMI (6 meds)
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ASA
BBs (not if also CHF, instead use ACEIs) Clopidogrel (plavix) Morphine Nitrates O2 |
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Non-pharmacologic tx for STEMI
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Angiography and PCI
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Hypercholesterolemia (4)
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Total cholesterol > 200
LDL >130 HDL < 40 Triglycerides > 500 |
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Drug therapy for stage 1 HTN (BP 140/90)
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Thiazide diuretic - first line
ACEIs BBs CCBs or combo |
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Drug therapy for stage 2 HTN (BP 160/100)
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2 drug combo
Usually thiazie + ACEIs, BB, or CCB |
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HTN
Unexplained hypokalemia Metabolic alkalosis |
Conn's syndrome (Hyperaldosteronism)
Usually due to an aldosterone-producing adrenal adenoma. Remove tumor. |
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Tumors causing HTN (4)
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Pheo (adrenal gland tumor)
Aldosterone-producing adrenal adenoma (Conn's syndrome) ACTH-producing pituitary tumor (Cushing's disease) Ectopic ACTH-producing tumor (Cushing's syndome) |
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HTN
Progressive renal failure Encephalopathy with papilledema |
Malignant HTN
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Treatment for HTN urgencies
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Oral BBs, clonidine, ACEIs
Gradually lower BP over 24 - 48 hours |
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Treatment for hypertensive emergencies
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IV labetalol, nitroprusside, nicardipine. Gradually lower mean arterial pressure by no more than 25% over first 2 hours
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Signs of pericarditis (PERIC)
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Pulsus paraodxus
ECG changes Rub Increased JVP Chest pain |
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Causes of pericarditis CARDIAC RIND
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Collagen vascular disease
Aortic dissection Radiation Drugs Infections Acute renal failure Cardiac (MI) Rhematic fever Injury Neoplasms Dressler's syndrome |
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Pleuritic chest pain, dyspnea, cough, fever. Pain worsens in supine position with inspiration. Pericardial friction rub.
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Pericarditis
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Excess fluid in pericardial sac leading to compromised ventricular filling and decreased cardiac output.
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Cardiac tamponade
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JVD
Hypotension Distant heart sounds |
Beck's triad for acute cardiac tamponade
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Kussmaul's sign
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JVD on inspiration
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Electrical alternans on ECG
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Diagnostic for cardiac tamponade
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Treatment for cardiac tamponade
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Volume expansion with IV fluids
Pericardiocentesis Possible balloon pericardiotomy and pericardial window |
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Aortic aneurysms most common association and location
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Atherosclerosis
Below renal arteries |
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Indication for surgical repair of aortic aneurysm
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Abdominal > 5.5 cm
Thoracic > 6 cm or rapidly enlarging |
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Aortic dissection association and location
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HTN, males, 40 - 60
Above aortic valve and distal to left subclavian artery |
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Pulsus parvus et tardus, single or paradoxically split S2 sound, systolic murmur radiating to carotids
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Aortic stenosis
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Blowing diastolic murmur at L sternal border, mid-diastolic rumble (Austin Flint murmur), widened pulse pressure, Musset's sign (head bob with heart beat), Corrigan's sign (water-hammer pulse), Duroziez's sign (femoral bruit)
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Aortic regurgitation
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Causes of aortic regurgitation CREAM
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Congenital
Rheumatic damage Endocarditis Aortic dissection/aortic root dilation Marfan's syndrome |
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Opening snap and mid-diastolic murmur at apex, pulmonary edema
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Mitral valve stenosis. Rhematic fever most common cause.
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Holosystolic murmur radiating to axillae
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Mitral valve regurgitation. Rheumatic fever or chordae tendineae rupture after MI
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DeBakey classification for aortic dissections
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I: Both ascending and descending
II: Only ascending III: Only descending (can be treated medically) |
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Stanford classification for aortic dissections
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A: Ascending aorta
B: All other types |
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Virchow's Triad
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Hemostasis
Endothelial damage Hypercoagulability |
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6 P's of acute ischemia
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Pain
Pallor Pulselessness Paralysis Paresthesia Poikilothermia |
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Immigrant presenting with progressive swelling of lower extremities bilaterally with no cardiac abnormalities
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Filariasis
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Treatment for lymphedema
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Exercise
Massage therapy Pressure garments Diuretics are relatively contraindicated |