cards 1 HTN HLD CAD

cyanosis

clubbing

edema

papilledema

cotton wool spots

xanthomas

xanthelasma

S1 sound

lub

S1 actions

mitral and tricuspid valves close

aortic and pulmonic valves open

S2 sound

dub

S3 sound meaning

CHF, ventricular gallop

S2 actions

aortic and pulmonic valves close

mitral and tricuspid valves open

S4 action

aortic valve closes

S4 pathology

acute MI, LV stiff, severe HTN

aortic valve auscultation

2nd R ICS

pulmonic valve auscultation

2nd L ICS and 3rd R ICS

tricuspid valve auscultation

4-5th L ICS sternal border

mitral valve auscultation

5th L ICS at apex at MCL

narrow pulse pressure pathologies

shock and hypotension

widened pulse pressure pathologies

hypertension, severe aortic regurg, arteriovenous shunting, elderly

primary HTN

HTN d/t unidentified cause

primary HTN RF

fhx, smoking, EtOH, obesity

secondary HTN

HTN d/t identifiable cause

secondary HTN causes

medications, endocrine, neuro, kidneys, cardiac

HTN sx

HA, blurred vision, “heartbeat in my ear,” fatigue, flushing

HTN PE

papilledema, cotton wool spots, retinopathy, displacement of PMI, renal artery bruit

HTN EKG

possible LVH

hypertensive urgency

no end organ damage

hypertensive emergency

acute end organ damage

hypertensive emergency management

decrease MAP by no more than 25% w/in first hour and titrate meds to 160/110 w/in 2-6h

hypertensive emergency sx

CP, HA, blurred vision, palpitations, dizziness

hypertensive emergency PE

papilledema, AV nicking, cotton wool spots, S4, displaced PMI, heaves

hypertensive emergency RF

smoking, CAD

orthostatic hypotension

decrease in SBP of 20 or DBP of 10 w/in 1-2 min of moving supine to standing

meds causing orthostatic hypotension

thiazides, loop diuretics, alpha blockers, CCB, hydralazine

orthostatic hypotension non med causes

dehydration, GI blood loss, neurological illness

orthostatic hypotension sx

dizziness, weakness, fatigue, near syncope, syncope

hyperlipidemia hx/RF

fhx, smoking, diabetes, EtOH, thyroid

hyperlipidemia PE

xanthoma, xanthelasma, abdominal obesity

CP skin do not miss dx

herpes zoster

CP MSK do not miss dx

costochondritis, pectoral strain, rib fracture, cervical/thoracic spondylosis

CP esophageal do not miss dx

spasm, rupture, GERD, esophagitis

CP GI do not miss dx

PUD, GB disease, pancreatitis

CP pulmonary do not miss dx

pleural effusion, pneumonia, neoplasm, viral infection, PE

CP cards do not miss dx

ACS, MI, pericarditis, myocarditis, stable angina, arrhythmias

CP vascular do not miss dx

aortic dissection

angina

clinical syndrome with chest discomfort caused by transient ischemia

coronary artery disease

atherosclerotic plaque buildup in coronary arteries leading to narrowing or blockage that reduces blood flow to heart muscle

stable angina

chest discomfort or pressure that occurs predictably with exertion or emotional distress and is relieved with rest or nitro

acute coronary syndrome

medical emergency that refers to a spectrum of conditions caused by sudden, reduced blood flow to the heart muscle due to partial or complete blockage of a coronary artery

stable angina diagnostic

plain treadmill stress test

unstable angina

ischemia without cardiac muscle death (no elevated trop)

NSTEMI

partial blockage with myocardial necrosis

NSTEMI diagnostics

elevated trop, no ST elevation on EKG

STEMI

complete blockage with myocardial necrosis

STEMI diagnostics

elevated trop, ST elevation on EKG in 2-3 leads

stable angina HPI

gradual, dull aching/pressure/tightness/squeezing, intermittent, subsides in 5-20 min, lasts <20 min,

stable angina location

substernal, left precordium, radiation to throat, arm, or jaw

stable angina exacerbation cause

activity, cold, anxiety

stable angina alleviating factors

nitro, rest

stable angina associated sx

nausea, SOB

unstable angina HPI

sudden and severe onset, dull aching/pressure/tightness/squeezing, constant and severe, lasts >20 min

unstable angina location

substernal, left precordium, radiates to throat, arm, or jaw

unstable angina exacerbating factors

anything, occurs at rest, with minimal exertion, or progressively worsens

unstable angina alleviating factors

none - not relieved with rest or nitro

unstable angina associated sx

nausea, vomiting, SOB, diaphoresis

angina relevant pmhx/fhx/RF

DM, HTN, HLD, fhx CAD, smoking, EtOH, diet, exercise

CAD PE

S4, murmur, xanthomas or xanthelasma (HLD), irregular HR/arrhythmia, HTN, diabetic retinopathy, levine’s sign

levine’s sign

patient clenches their fist over their chest to describe the sensation of chest pain

acute coronary syndrome

unstable angina and NSTEMI

ACS HPI

unstable angina sx

ACS management

inpatient/ER, trop, EKG monitoring

STEMI HPI

unstable angina sx

STEMI management

cath lab within 90 min (“time is tissue”)

STEMI meds tx

plavix, heparin, beta blocker, statin

anterior STEMI artery

LAD

anterior STEMI EKG ST elevation

V1-V4

anterior STEMI EKG ST depression

inferior leads II, III, aVF

anteroseptal STEMI artery

proximal LAD

anteroseptal STEMI EKG ST elevation

V1-V3 maybe V4

anteroseptal STEMI EKG ST depression

inferior leads II, III, aVF

anterolateral STEMI artery

LAD or left circumflex

anterolateral STEMI EKG ST elevation

V3-V6, I, aVL

anterolateral STEMI EKG ST depression

inferior leads II, III, aVF

lateral STEMI artery

left circumflex

lateral STEMI EKG ST elevation

I, aVL, V5-V6

lateral STEMI EKG ST depression

inferior leads II, III, aVF

inferior STEMI artery

right coronary artery (80%) or left circumflex (20%)

inferior STEMI EKG ST elevation

II, III, aVF

inferior STEMI EKG ST depression

lateral leads I, aVL

sometimes anterior leads V1-V3

posterior STEMI artery

right coronary artery posterior descending or left circumflex artery

posterior STEMI EKG ST elevation

posterior leads V7-V9

posterior STEMI EKG ST depression

V1-V3

unstable angina tx

antiplatelet/anticoagulation

NSTEMI tx

antiplatelet/anticoagulation, cardiac cath