cardiology(Govender)Vid one

• sudden onset chest pain is caused by PE and heart attact
• some sign of cardiac failure include: orthopnea, paroxysmal nocturnal dyspnea and no chest pain
• low bp and congestive cardiac failure are cardiogenic shock
• if the pulse is regular,then there is no arrhythmia
• if patient is in shock, they are at high risk of cardiac failure
• holosystolic murmur/pansystolic is a systolic murmur caused by mitral regurgitation, tricuspid regurgitation, aortic stenosis and pulmonary stenosis
• lead ii, iii, avf are inferior part of the heart supplied by branch of RCA-posterior descending artery
• prednisone is a corticosteroids.
• hydroxycloroquine is an antimalarials
• patient experiencing chest pain during exersion and the pain goes away, think about angina
• no crackles meaning no congestive heart failure, no rash-exclude rheumatic heart disease
• remember HTN patients needs to be on life style modification first before we can increase medication dose
• always give diuretic for congestive heart failure,
• severe edema in heart failure, give spironolactone
• severe hypertension is associated with >180/110 but asymptomatic
• hypertension urgency is associated with: >180/110 plus headache and epistaxis(nose bleed) OR retinopathy grade1-artery thickening, grade 2-vein constriction where they meet arteries
• hypertension emergency/hypertension crisis/malignant hypertension is associated with >180/110 plus signs of end-organ damage e.g Brain damage- seizures,confusion,CVA-there is subarachnoid hemorrhage. management is to slowly decrease bp over 48hrs. give hydralazine and labetolol
• signs of unstable patient include: low bp, lightheadness/dizziness, chest pain, unconscious,SOB
• If patient has MI, but there is ST depression on ecg, this is NSTEMI.
• patients with acute MI can develop mitral regurgitation 2-7 days after having infarction.And mitral regurgitation lead to diastolic overload of ventricles meaning there is an in increase in left ventricular filling pressure.
• positive stress test is associated with st depression and t-wave inversion, next test will be echocardiogram or coronary angiogram
• for hypertension patients we check compliance, their lifestyle, then we can maximize dose then they can comeback after a week
• in wet-cardiac failure(congestive heart failure) do not give beta blocker
• retinopathy grade3- retinal ischaemia and grade4- papilloedema
• ACE-inhibitor side effect is angioedema, which is swelling of the face, lips, tongue, and throat
• respiratory distress signs include: wheezes, grunting(niosy breathing sound),retractions(area between ribs and neck deepens/sink in when they inhale),nasal flaring(nostrils widen while breathing),cyanosis, tachypnea, sweating
• pleural disease is associated with pleural chest pain that gets worse on inhalation and become better when patient leans forward.
• pulmonary hypertension signs include: palpable and loud second heart sound(P2),parasternal heave (heart pulse palpable) plus cardiac failure
• differential diagnosis of chest pain include: coronary artery disease, pulmonary or pleuritic(pleurizy,pneumonia,pericarditis,PE), aortic(dissection,intramural hematoma), gastrointestinal/esophageal, chest wall/musculoskeletal.
• chest pain coronary artery disease is: 1)substernal pain, 2)pain radiate to arm-shoulder or jaw,3)pain gets worse with exertion and relieved by rest or nitroglycerine.
• pulmonary/pleuritic chest pain: 1) sharp/stabbing pain, 2)pain gets worse with inhalation,3)pericarditis chest pain gets worse when lying flat,4)PE and pneumothorax they have hypoxia and respiratory distress
• aortic dissection or intramural hematoma chest pain is: 1)sudden severe(tearing)pain,2)radiates to the back,3)common in elderly men,4)patient have hypertension and risk factors for atherosclerosis
• gastrointestinal/esophageal chest pain is: 1)nonexertional and pain is relieved by antacids, 2)pain is substernal or upper abdominal, 3)pain is associated with regurgitation,nausea,dysphagia(difficulty swallowing), 4)nocturnal pain
• chest wall/musculoskeletal chest pain is: 1)persistent prolong pain, 2)pain gets worse with movement
• antiplatelets include: prasugrel and clopidogrel
• patients with ventricular tachycardia but they are unstable, we take them straight to sychronized cardioversion(electrical cardioversion).
• if the patient with ventricular tachycardia is stable,we need to do conservative management; 1) carotid massage-if is not effective, 2) do valsalva maneuver-if not effective,3) medication-give antiarrhythmic(Adenosine or Amiodarone)-if not effective,4) synchronized cardioversion
• panic attack= tachycardia
• if patient is unstable and there is no pulse, we take the patient to unsynchronized cardioversion(defibrillation)
• COPD plus cardiac failure cause core pulmonale which is pulmonary hypertension