Aortic valve replacement indications:
- Symptomatic (SAD) - syncope, angina, dyspnea
- Severe AS in pts undergoing CABG or other valvular surgery
- A symptomatic pts with severe AS and either poor LV systolic fx, LV hypertrophy >15mm, valve area
Phase 1a ventricular arrhythmias
within 10 mins of coronary occlusion; acute ischemia causes heterogeneity in conduction, delayed conduction increases the chance of re-entry.
Phase 1b ventricular arrhythmias
10-60 mins after MI; due to abnormal automaticity
Mitral regurgitation
seen in dilated and ischemic cardiomyopathy; holosystolic murmur at apex with radiation to the axilla
Causes of outflow obstruction in hypertrophic cardiomyopathy
- Bulging of the interventricular septum
2. systolic anterior motion (SAM) of mitral valve leaflets
Bronchiectasis appearance on CT and potential complication
tubular airways with thickened walls; hemoptysis
Treatment for infective endocarditis due to strep mutans
IV antibiotics (aqueous pencillin G or IV ceftriaxone) for 4 wks
Myasthenia gravis (paraneoplastic syndrome) involved site and clinical features:
acetylcholine receptor in postsynaptic membrane; fluctuating muscle weakness - ocular (ptosis and diplopia), bulbar (dysphagia, dysarthria) and facial, neck, and limb muscles
Lambert-Eaton syndrome (paraneoplastic syndrome) involved site and clinical features:
presynaptic membrane voltage-gated calcium channels; proximal muscle weakness, autonomic dysfunction (dry mouth), cranial nerve involvement (ptosis), diminished or absent DTRs
Dermatomyositis/polymyositis (paraneoplatic syndrome) involved sites and clinical features:
muscle fiber injury; symmetrical and proximal muscle weakness, interstitial lung disease, Raynaud’s, and esophageal dysmotility, polyarthritis, skin findings (Gottron’s papules and heliotrope rash)
Female athlete triad
- decreased caloric intake
- oligo-amenorrhea
- osteoporosis
Morton’s neuroma
pain btwn the 3rd and 4th toes on the plantar surface w/ clicking sensation (Mulder’s sign)
Tarsal tunnel syndrome
compression of the tibial nerve that causes numbness, burning, and aching of the distal plantar surface of the foot and toes
Isolated systolic hypertension (ISH)
decreased compliance of the arteries with age that causes isolated systolic pressure increase and widened pulse pressure; treat with thiazides, CCBs, or ACE inhbitor
Pulmonary HTN
pulmonary artery pressure >25 mm at rest or >30 mm w/ exercise
Causes of pulmonary HTN
- Disorders of the respiratory system, hypoxemia
- Pulmonary venous HTN (LV disease, mitral valve disease, pulmonary veno-occlusive disease)
- chronic thromboembolic disease
- Pulmonary arterial HTN (primary or associated with vasculopathy)
- Pulmonary capillary hemangiomatosis
Modified Wells criteria for pretest probability of PE
- Clinical signs of DVT (+3)
- Alternate diagnosis less likely (+3)
- Previous PE or DVT (+1.5)
- HR >100 (+1.5)
- Recent surgery or immobilization (+1.5)
- Hemoptysis (+1)
- Cancer (+1)
Total score: > or = to 4, PE likely
Cardiac index
CO/body surface area
Normal hemodynamic measurements
Right atrial pressure (preload) - 4mmHg
Pulmonary capillary wedge pressure (preload) - 9mmHg
Cardiac index (pump function) - 2.8 to 4.2 L/min/m2
Systemic vascular resistance (after load) - 1150 dynes*sec/cm5
Mixed venous oxygen saturation - 60-80%
Hypovolemic shock
Decreased right atrial pressure, pulmonary capillary wedge pressure, cardiac index, and mixed venous O2 saturation
Increased systemic vascular resistance
Cardiogenic shock
Increased right atrial pressure, pulmonary capillary wedge pressure, systemic vascular resistance
Decreased cardiac index and mixed venous O2 saturation
Septic shock
Normal to decreased right atrial pressure and pulmonary capillary wedge pressure
Increased cardiac index and mixed venous O2 saturation
Decreased systemic vascular resistance
Avascular necrosis
Progressive hip pain w/o restriction of ROM or abnormality of radiographs.
MRI is diagnostic.
Ertapenem
Doesn’t cover pseudomonas
