Cardiology
|
Causative organisms
Staph. aureus, group D strep, enterococci, HACEKs
|
|
Organism in IVDA
Staph. aureus (tricuspid valve*)
|
|
Organisms prosthetic valve endocarditis
Staph, gram-, fungi (first 2 months) and staph/strep after that
|
|
Regurgant valve defect
Seen in most endocarditis pts, makes them more susceptible
|
|
How infections occur
Direct intravascular contamination or from bacteremia from surgeries
|
|
Classic features
Osler nodes, Janewar lesions, Roth spots, petechiae, splinter hemorrhages
|
|
Duke Criteria
Used to establish diagnosis
|
|
Treatment
Vancomycin + Ceftriaxone
|
|
Indications for Abx Prophylaxis
If pts. with prosthetic valves, congenital heart disease, valve disorder, transplants are going to get dental work or surgery
|
|
Prophylactic abx
Amoxicillin
|
|
Definition
|
Weakness and subsequent dilation of the vessel wall, usually from a genetic defect or atherosclerotic damage to the intima
|
|
Most common cause
|
Atherosclerosis (can see in Marfan's or Ehlers-Danlos though)
|
|
Classic clinical scenario
|
Elderly male smoker with CAD, emphysema, and renal impairment
|
|
Where are they found
|
90% abdominal, 10% thoracic
|
|
Clinical features
|
Pulsatile abdominal mass +/- abdominal or back pain
|
|
Symptoms of AAA rupture
|
Severe back, abdominal, or flank pain. Hypotension + shock
|
|
Lab Studies
|
Abdominal U/S followed by CT w/ contrast
|
|
Treatment
|
Endovascular or open surgical repair
|
|
Definition
Systemic inflammatory condition of medium & large vessels, pts. >50yo, often coexists with PMR
|
|
Most commonly-affected arteries
Temporal artery
|
|
Consequence of not treating aggressively
Blindness
|
|
Clinical Features
Headache, scalp tenderness, jaw claudication, throat pain, visual abnormalities
|
|
Lab Studies
ESR + CRP both elevated
|
|
Definitive diagnostic
Temporal artery bx
|
|
Treatment
High-dose prednisone x few months + ASA
|
|
Rheumatic Fever
A systemic immune response occurring 2-3 weeks after a Beta-hemolytic strep. pharyngitis
|
|
Valve most commonly involved
Mitral valve (75-80%), then aortic valve (30%)
|
|
Jones Criteria
Diagnostic criteria to establish diagnosis
|
|
Treatment
Bedrest, salicylates, IM penicillin, and early treatment of strep pharyngitis for prevention*
|
|
Definition
Loss of wall tension in veins, resulting ins tasks of venous blood and often assoc. with a hx of DVT, leg injury, or varicose veins
|
|
Clinical Features
Progressive edema starting at ankle, skin changes, itching, dull pain with standing and ulceration, skin is shiny/thin/atrophic with dark pigmentary change and subcutaneous induration, stasis ulcers above ankle
|
|
General Treatment
General: leg elevation, avoidance of sitting/standing, compression hose.
|
|
Treatment for Stasis Dermatitis
Wet compresses, HC cream, Zinc oxide, anti fungal cream (ulcerations may need graft)
|
|
Etiology
Superficial venous insufficiency and valvular incompetance
|
|
Clinical features
Dilated, tortuous veins, esp. long saphenous vein
|
|
Treatment
Compression stockings, leg elevation, exercise, laser ablation, endovenous radiofrequency, compression sclerotherapy
|
|
Etiology
Atherosclerosis or thromboembolism (trauma, hyper coagulable states, etc.)
|
|
Clinical features
lower leg pain with exercise which is relieved by rest (AKA intermittent claudication), progresses later to pain at rest, numbness, tingling, ischemic ulcerations, gangrene
|
|
The "Ps" of extremity occlusion
Pain, pallor, pulselessness, paresthesias, paralysis, poikilothermia
|
|
Lab studies/diagnostics
Doppler flow studies, ABI,
|
|
Treatment
Cilostazol + antiplatelet rx + lifestyle (NO smoking, more exercise), surgery and revascularization
|
|
Thrombophlebitis
Involves occlusion of a vein + inflammatory changes
|
|
Virchow's Triad
Stasis + vascular injury + hyper-coagulability (predispose veins)
|
|
Most common place to find a DVT
Lower extremities and pelvis
|
|
Risk factors for DVT
Major surgery (total hip), long plane ride, hormone/contraceptive therapy, prolonged bed rest
|
|
Features of superficial thrombophlebitis
Dull pain, erythema, tenderness, induration. Most common in long saphenous vein.
|
|
Class findings of DVT
Swelling of the involved area and redness
|
|
Diagnostic Studies
Duplex U/S
|
|
D-Dimer
Highly sensitive, if <500 then negative, can r/o DVT
|
|
Treatment
Anticoagulation with LMWH (Lovenox), or heparin then warfarin
|
Cheatography n. The art of mapping complex subjects into clear, instantly navigable reference guides.
