Line 12: |
Line 12: |
| **H&P: palpitations, syncope | | **H&P: palpitations, syncope |
| **DDx: Sinus tach, Afib, Aflutter, Vtach, Vfib, Vflutter, AVNRT, AVRT, WPW | | **DDx: Sinus tach, Afib, Aflutter, Vtach, Vfib, Vflutter, AVNRT, AVRT, WPW |
− | **Tx: Stable vs. Unstable. Synchronized cardioversion vs DCCV. Vagal maneuvers, atropine, beta blockers, amiodarone, digoxin, diltiazem. Rate control superior to rhythm control most of the time. Calculate a CHAD2S2VASc for Afib patients. Consider cardioablation vs. watchman. Always get a TEE/cardioversion for chronic Afib. The most effective AC is warfarin. Best AC is usually DOAC because of once daily oral dosing. LMWH is an alternative if they can't have a DOAC. Aflutter can be 2:1, 3:1, or 4:1 with fixed rates of 150, 100, and 75 respectively. | + | **Tx: Stable vs. Unstable. Synchronized cardioversion vs DCCV. Vagal maneuvers, atropine, beta blockers, amiodarone, digoxin, diltiazem. Rate control superior to rhythm control most of the time. Calculate a CHAD2S2VASc for Afib patients. Consider cardioablation vs. Watchman. Always get a TEE/cardioversion for chronic Afib. The most effective [[AC]] is warfarin. Best AC is usually DOAC because of once daily oral dosing. LMWH is an alternative if they can't have a DOAC. Aflutter can be 2:1, 3:1, or 4:1 with fixed rates of 150, 100, and 75 respectively. Do NOT shock sinus tach. |
| | | |
| =Congestive Heart Failure= | | =Congestive Heart Failure= |
Line 33: |
Line 33: |
| | | |
| =Dyslipidemia= | | =Dyslipidemia= |
| + | * Age 45-74, LDL > 190 |
| + | * Age 45-74, LDL 70-190 ASCVD > 10% |
| + | * Age 45-74, LDL 70-190 ASCVD > 7.5% |
| + | * Age 45-74, Diabetes |
| + | * ACS = HD |
| + | * > 75 = MD |
| | | |
| =Hypertension= | | =Hypertension= |
− | * Primary Hypertension | + | * Primary/Essential Hypertension |
− | * Secondary Hypertension | + | ** Dx: Rule out secondary causes, BP > 130/90 on two separate occasions. |
− | ** RAS, Hypo/Hyper(para)thyroidism, Conn syndrome, Cushing's syndrome, Pheochromocytoma | + | ** DDx: Secondary HTN--RAS, Hypo/Hyper(para)thyroidism, Conn syndrome, Cushing's syndrome, Pheochromocytoma |
− | * Hypertensive Crisis | + | ** Tx: Can start with 1 or 2 agents depending on severity. First line: ACEI/ARB (good for kidney protection), (Non)Dihydropyridine CCB, Beta Blockers (cardiac selective, non-selective), Thiazide/Non-Thiazide Type Diuretics (second line) |
| + | * Hypertensive Urgency BP > 180 |
| + | * Hypertensive Emergency BP > 180 + symptoms |
| | | |
| =Pericardial Disease= | | =Pericardial Disease= |
| * Pericarditis | | * Pericarditis |
− | * Cardiac Tamponade | + | * Cardiac Tamponade (Beck's triad) |
| | | |
| =Valvular Heart Disease= | | =Valvular Heart Disease= |
| + | {| class="wikitable sortable" |
| + | |+ Cardiac Murmur Descriptions and Maneuvers |
| + | |- |
| + | ! Murmur !! Description !! Provocative Maneuvers |
| + | |- |
| + | | AR || Diastolic, M || Example |
| + | |- |
| + | | AS || Systolic, A || Example |
| + | |- |
| + | | MR || Systolic, A || Example |
| + | |- |
| + | | MS || Diastolic, Blowing, M || Example |
| + | |- |
| + | | MP || Systolic, Click, A || Example |
| + | |- |
| + | | TR || Systolic || Example |
| + | |- |
| + | | PDA || Continuous, Machine-like || Example |
| + | |} |
| + | * Maneuvers increase afterload (hand grip, standing), preload (passive leg raise, lying down), or both (vagal). |
| + | |
| + | * Endocarditis: Janeway lesions, Osler nodes, Splinter hemorrhages |
| | | |
| =Vascular Diseases= | | =Vascular Diseases= |
− | * Aortic Aneurism | + | * Aortic Aneurism: Different types of repair (open vs endovascular), when to intervene (> 5.5 cm or rapidly enlarging), one time screening abd US in ever smokers at age 50 |
− | * Aortic Dissection | + | * Aortic Dissection: Stanford classification: type B (post arch and descending aorta) is medically managed; type A (ascending or arch) is surgical emergency. |
− | * Deep Venous Thrombosis | + | * Deep Venous Thrombosis: Virchow's triad |
− | * Peripheral Arterial Disease | + | * Peripheral Arterial Disease: ABI |
| * Lymphedema | | * Lymphedema |
| | | |
| =Syncope= | | =Syncope= |