-cardiac tamponade
1. tx {{Ans- 1. nonhemorrhagic and stable - monitor with echo/CXR/ECG, dialysis (for uremia)
hemorrhagic - emergent surgery*,
... [Show More] pericardiocentesis-mitral stenosis
1. patho
2. clinical pres/PE {{Ans- 1. rheumatic heart dz*** --> cross reactivity between streptococcal antigen and
valve--> scarring, inc. LA pressure, pulm HTN, Afib***
2. DOE, orthopnea, PND, palpitations, CX pain, hemoptysis (bronchial vein rupture), thromboembolism
murmur - S2 followed by OS (closer = mores severe) followed by diastolic rumble, loud S1 in LLD position
with bell
LATE: JVD, hepatomegaly, ascites, right vent. heave, loud P2 (pulm HTN)
-mitral stenosis
1. dx
2. tx {{Ans- 1. CXR - left atrial enlargement
echo - left atrial enlargement, thick mitral valve, fish mouth orifice
2. diuretics for pulm congestion/edema
beta blockers - lower CO/HR
endocarditis prophylaxis
anticoagulation with warfarin
percutaneous balloon valvuloplasty
open commissurotomy/mitral replacement
-aortic stenosis
1. patho
2. clinical pres
25% 3 year survival w/o treatment @ time of presentation with symptoms {{Ans- 1. senile aortic
calcification, bicuspid aortic valve, rheumatic fever --> LV outflow obs, LVH, mitral regurg
2. angina (3 yr surv), syncope (2 yr surv), dyspnea/heart failure (1.5 yr surv.)* murmur - harsh crescendo-decrescendo systolic murmur, @ right 2nd ICS, radiates to carotids, soft S2
parvus et tardus - delayed carotid upstrokes
sustained PMI, precordial thrill
-aortic stenosis
1. dx
2. tx {{Ans- 1. CXR - calcified aortic valve, dilatation of proximal ascending aorta, enlarged LV/LA
ECG - LVH, LA abnormalities
Echocardiogram - immobile thickened aortic valve, dilated aortic root, LVH
2. no sx = no tx
sx = aortic valve replacement
-aortic regurgitation
1. causes/patho
2. symptoms {{Ans- 1. infective endocarditis, trauma, dissection, iatrogenic
rheumatic fever, bicuspid, marfans, ehlers, syphilis. OI, behcets, reiters--> inadequate closure of aortic
valve leaflets--> LV dilation/hypertrophy--> elevated pulmonary pressures
2. DOE, PND, angina orthopnea, palpitations worse with lying down, cy [Show Less]