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Med Surg ReviewsLeft sided Mitral & aortic valvesSimilar Sx as HFEchocardiographCan see valves & blood flow through themMurmur is heard with valvular disordersStenosis – narrowing of the valveRegurgitation – back flow of bloodTreatmentReplace with mechanical valveLasts a life-timeHave to be on anticoagulants (coumadin)Check PT & INR (3.5 is normal for them) (normal is Biologic valvesHumans, cadaversCows & pics (bovine & porcine)Don’t need anticoagulants but don’t last as longStenosis Symptoms:AnginaSyncopeExertions dyspnea EndocarditisClinical manifestationMurmursAcute heart failureBacterial infection feverEmbolization: symptoms: splinter hemorrhages (blue toes), petechia Roth spots, Osler’s node, Janeway lesionsDiagnosisProcedures in the last 3 to 6 monthsCulture & sensitivities 2 blood cultures, before antibiotics We do two to rule out false positiveAntibiotics IV for 3 to 6 monthsAcute pericarditisInflammation Give NSAIDSSymptoms: Pericardial friction rub (indicative sign)Chest pain relieved when leaning forward, putting less pressure on the chestConcerned about cardiac tamponadePericardiocentesis is done if they have cardiac tamponade Antibiotics Peripheral Arterial DiseaseDifficult to get blood to the peripheryIntermittent pain in lower extremitiesGive pentoxaphilin, Trental (slide 7)Signs/SymptomsPale, shiny skin, no hair growth, poor cap refillDiagnosis:ABI – ankle brachial index Treatment:Anticoagulant – Aspirin, PlavixPeripheral or arterial bypassEndarterectomy or stentCMS checkC – Pulse & cap refilM –Move foot up and downNumbness? Tingling? 6 P’sPainPallorPulselessnessParesthesiaParalysisPoikilothermiaAortic AneurismPulsatile mass DON’T TOUCHGreatest risk factor hypertensionWorried about RUPTURE! EMERGENCY!Noticed jugular vein distention, bruising, back, abdomen, flank painBP plummet & increase in HR until it can’t anymoreMonitor BP because we don’t want it to be too high to cause it to ruptureRUPTURE CODE & call doctor to get them to surgery ASAPBruit whooshing sound heard over AA“blue toes”Emboli are seen first in the legsCTMRICoronary artery diseaseRisk factors:ModifiableSmokingDiabetesObesityDrinking Non-modifiableFamily historyLeads to anginaStable goes away with rest (happens on exertion)Unstable does NOT go away with rest (unpredictable)DiagnosisECGCRP (C-reactive protein)– inflammationStress test chest pain STOPChemical stress testStable AnginaNitro – sublingualAirtight container AWAY from the SUNNO VIAGRA!Acute Coronary SyndromeUnstable angina No elevated cardiac enzymes & STEMI cardiac enzymes elevated & ST depressionNSTEMI ST depression & cardiac enzymes elevatedLonger than 20 -30 minutes indicates more of an MIMONA!!Morphine (check BP)Oxygen Nitrates (check BP)Aspirin or Plavix or HeparinCan give beta blockers or ace inhibitors GET THEM TO CATH LABIntervene – Angioplasty & StentCABG coronary artery bypass graph (arteries are almost completely occluded)Saphenous vein (used for multiple)Mammary artery (lasts longer)Need a bypass machinePost CABG:Chest tubesAssess pain: give meds, don’t uses more than 10-15 lbs of weight (don’t use your arms to lift yourself)COUGH! & BREATHE ................
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