Venous Thromboembolism
What is the test of choice for VTE?
Venous Ultrasonography
What are the two main symptoms of peripheral artery disease?
intermitent claudication and pain at rest
healthy athlete or elderly adult, usually benign and require no treatment
What is the number 1 cause of pericarditis?
Viral Cox1 and Cox2 are the responsible strains
45 yo female pt. presents to the ED of south asian decent and a murmur with an "opening snap", dyspnea and chest pain. What are you thinking is the cause of this murmur and what is your treatment of choice?
Rheumatic disease is the cause
MS is the diagnosis
Tx: Balloon Valvuloplasty
What is treatment of choice for superficial venous thrombosis?
NSAIDS
What is the treatment of choice for acute arterial occlusion?
Heparin
What is the treatment of choice for a patient with unstable Mobitz 2 arrythmia?
Tx: dobutamine, dopamine or Epi
This is more severe than mobitz 1 as it is a sign of ischemia in the heart
Your patient CXR comes back with a "waterbottle shaped heart" what would you expect to find on physical exam and what is your final diagnosis?
Px: muffled heart sounds, EWARTS SIGN (dull percusion)
S/S: dysphagia, hoarseness, cough, dyspnea
Dx: pericardial effusion
An 85 yo male presents to the ED and c/o episodes of syncope, dyspnea, and angina. On physical exam you note a murmur that radiates to the carotids and is worse on inspiration. What is the diagnosis and treatment of choice?
DX: Aortic stenosis
TX: TAVR
Note: Echo/Ekg may reveal LVH
Why would we use Heparin in PE treatment?
reversible and easy to monitor
What is the telling sign of atheroembolism?
painful fingers and toes
What are three major risk factors for third degree AV block and what is your treatment of choice in an unstable patient
RF: past MI, recent heart procedures, lymes disease
Tx: atropine
Your patients EKG shows "Fox ear" like ST elevation. What signs and symptoms are you looking for to confirm diagnosis and what is going to be your treatment of choice?
S/S: FEVER, pleuritic chest pain, and friction rub
TX: NSAIDS 2-4wks. F/u with colchisine for 3 months to prevent reoccurance
Pt. presents to the ED with a history of right sided heart failure. EKG shows right atrial enlargement. Murmur is heard best at the T post. What is your diagnosis and treatment?
Dx: TS
Tx: treat the CHF and insert a prosthetic valve
What is the treatment of choice for anticoagulation therapy in a pregnant patient?
Heparin
Warfarin is teratogenic
What is the major risk factor and signs/symptoms of thromboangitis obliterans?
RF: SMOKING, s/s: necrosis of the fingers and toes
Your patients EKG shows M like elevation in V1-V3 and W like elevation in V5-V6 what is the arrythmia and what are risk factors that may have caused this block?
RBBB
RF: PE, MI, HTN
DX: Constrictive pericarditis
TX: Pericardial stripping (pericardiectomy)
Your patient has an EKG that reveals peaked P-waves and has symptoms of dyspnea on exertion, angina and syncope. What is your diagnosis and treatment of choice?
Dx: pulmonary stenosis
Tx: balloon dilation of valve
Describe the genetic risk factor for VTE?
V leiden gene or prothrombin gene
What is the screeing test of choice for 1. atheroembolism 2. Raynauds phenomenon
atheroembolism: skin and muscle biopsy
Raynauds: Digital pulse volume
Your patient has W like waves in V1 and M like waves in V6 they have a histroy of HTN and currently are unstable. What is the block and what are you going to do to treat it?
LBBB, tx: Pacemaker
Pt. presents to the ED with a BP of 85/60mmHg, confused and agitated. Physical exam reveals pulsus paradoxus. What is your diagnosis and what is your course of treatment?
DX: Cardiac Tamponade
TX: Pericardiocentesis or Pericardial Window
Pt. presents to the ED with an "austin flint murmur" EKG reveals LVH. What test are your going to order to determine the severity of the patient's murmur and what is going to be your treatment plan?
Pt. has severe aortic regurg. order a aortography to determine the severity and set up surgery to replace the valve asap for this patient.