NUR 511 EXAM 1, NUR 511 EXAM 2, NUR511
ISM:gkFinitegkM Chaptergk12:gkDifferencegkEquationsgkandgkMathematicalgkM
ath odels
EXAM 3, NUR511 EXAM 4 Q AND A
S/SnjHeartnjfailurenj-njanswer--
Fatigue,njangina,njanxiety,njoliguria,njdecreasednjGInjmotility,njpalenjcoolnjskin,njweightnjgainnj(2njlbnjinnjanjday
3-5njlbnjinnjanjweek),njrestlessness,njedema
LeftnjHFnj-njanswer--
Backsnjupnjtonjlungs,njpulmonarynjedema.njPleuralnjeffusion.njCracklesnjinnjlungs.njMorenjcommonnjthannjrig
njDOE,njSOB,njPND,njnonproductivenjcough,njpinknjfrothynjsputum,njorthopnea,njpulmonarynjcrackles,njfanjIg
njweakness,njactivitynjintolerance,njdrynjcough,njnocturnalnjcough,njS3njandnjS4,njdizzinessnjsyncope,njpalpi
ions/njtachycardia,njnocturia,njpale/cyanosis,njdisplacednjPMI,njanxiety,njdepression.
RightnjHFnjornjCornjpulmonalenj-njanswer--
ResultnjofnjeithernjleftnjventricularnjfailurenjornjCoPDnjandnjpulmonarynjhypertension.njPeripheralnjedema.njA
ites.njJVD.njAnorexia,njnausea,njabdominalnjdistinction,njRUQnjpainnj(livernjdistention),njmurmurs,njanasarc
jtachycardia,njhepatomegaly,njsplenomegaly,njanxiety,njdepression.
Strokenjvolumenj-njanswer--Madenjupnjofnjpreload,njcontractility,njafterload.
Compensatorynjmechanismsnj-njanswer--SNSnjactivation-
njcatacholaminenjreleasenj(increasenjHR,njBP,njvasoconstrictionnjinnjperiphery,njworkloadnjonnjheart)
RAAS-njholdnjontonjwaternjandnjsalt,njincreasenjvolumenjandnjvasoconstriction
ADH-njholdnjontonjwaternjandnjsalt
Natriureticnjpeptide-njdiureticnjandnjvasodilationnjproperties=njBNP=njspecificnjmarkernjfornjHF.
Hypertrophic-njcan'tnjfill
Dilation-njcan'tnjsqueeze
HFnjclassificationsnj-njanswer--Lownjnumbersnjgood,njhighnjbad.njAnjisnjgood,njDnjisnjbad.
HFnjdiagnosisnj-njanswer--BNPnjelevated,njBUNnjandnjcreatininenjelevated,
Ejectionnjfractionnj-njanswer--Greaternjthannj60njisnjnormal
40-60njmoderatenjHF
20-40njmodnjtonjseverenjHF
Lessnjthannj20njseverenjHF
SerumnjBUNnj-njanswer--Kidneynjfunction
Normalnjisnj10-20njmg/dL
Serumnjcreatininenj-njanswer--Kidneynjfunctionnj
Normalnjisnj0.5-1.2
Hyperkalemianj-njanswer--Potassiumnjgreaternjthannj5.1
Causes:njrenalnjfailure,njexcessivenjKCl,njexcessivenjusenjofnjsaltnjsubstitutes.
Hyponatremianj-njanswer--Sodiumnjlevelnj135njmEq/Lnjornjless
Causes:njinadequatenjsodiumnjintake,njpotentnjdiuretics,njretentionnjofnjfluidsnj(heartnjornjkidneynjfailure).
, Chaptergk12:gkDifferencegkEquationsgkandgkMathematicalgkM ISM:gkFinitegkM
odels
Hypernatremia nj-njanswer--Sodiumnjlevelnjgreaternjthannj145njmEq/L
ath
Causes:njdecreasednjwaternjintakenjornjexcessivenjlossnjofnjwater.
BNPnj-njanswer--Levelsnjovernj700pg/mLnjindicatenjdecompensatednjHF.
LFTsnj-njanswer--AST,njALT,njLDH,njAlkalinenjphosphatase,njGammanjGT.
SPO2nj-njanswer--Shouldnjbenj90%njornjgreater.njLessnjthannj85njisnjserious.njLessnjthannj70njisnjdeadly.
Edemanjscalenj-njanswer--+1njisnjslight:njrapidlynjreturnsnjtonjnormal
+2nj:njnormalnjinnj10-15njsec
+3:njnormalnjinnj1-2njmin
+4:njnormalnjinnj2-5njmin
ACEsnj-njanswer--
Endnjinnj"pril".njUsednjtonjpreventnjkidneynjdamage,njpreventnjremodelingnjofnjheart,njandnjreducenjBP.
BetanjblockersnjfornjHFnj-njanswer--Carvedilol,njmetoprololnjXL,njzebeta.njBlocknjcatacholamines.
Natrecornj-njanswer--
SyntheticnjBNP.njProfoundnjvasodilator.njUsednjfornjdecompensatednjHF,njwatchnjBP,njIVnjinfusionnjonly,njB
Pnjwillnjbenjelevatednjobviously...
Digoxinnjtoxicitynj-njanswer--
Nausea,njvomiting,njanorexia,njdysrhythmias,njbradycardia,njtachycardia,njheadache,njfatigue,njblurrednjvis
n,njcolorednjvision.
Primarynjcardiomyopathynj-njanswer--Idiopathicnjcardiomyopathy
Secondarynjcardiomyopathynj-njanswer--Cardiomyopathynjcausednjbynjanothernjdisease.
Dilatednjcardiomyopathynj-njanswer--
Can'tnjsqueeze,njmostnjcommonnjtype,njcausenjofnjsuddennjcardiacnjdeath,njbignjboggynjheart.
Causednjbynjcardiotoxicnjagentsnj(alcohol),njinfections,njdiseases,njpregnancy.
HFnjsymptoms,njS3njandnjS4,njatnjrisknjfornjbloodnjclots!
Bloodnjclotnjrightnjside-njpulmonarynjembolism
Bloodnjclotnjleftnjside-njbrainnj(stroke),njlegs,njkidneys
Treatnjbynjstoppingnjalcohol/drugs,njsamenjmessnjasnjHF,njanticoagulants
Avoidnjalcohol,njinfections/crowds,njfamilynjshouldnjlearnnjCPR.
Hypertrophicnjcardiomyopathynj-njanswer--Can'tnjfill,njsupernjthicknjwalled.njOccursnjinnjyoungnjadultnjmen!n
Causednjbynjgeneticnjlink,njchronicnjhypertension,njaorticnjstenosis.
S/
S:njsomenjasymptomatic,njexertionnjallnjdyspnea,njangina,njexertionnjallnjsyncope,njfatigue,njdizziness,njpalp
ations,njdysrhythmias,njlaterallynjdisplacednjPMInj(lownjandnjtonjthenjleft),njmurmur,njcrackles,njS4.
Echonjisnjprimarynjdiagnosticnjtool.
,Treatment njisnj
ISM:gkFinite gk to
Mnjdecreasenjcontractility,njrelaxChapter
njheart:gk beta
nj12: njblockers,
gkDifference njcalcium
gkEquations njchannel
gkand njblockers,
gkMathematical gkM njDigox
ath
njanticoagulants.njNonjinotropes!njNonjnitro!
odels
Limitnjstrenuousnjactivity!njActivitynjrestriction.
Elevatenjfootnjofnjbed
Infectivenjendocarditisnj-njanswer--Infectionnjinsidenjthenjheart,njusuallynjofnjthenjheartnjvalves.nj
IVnjdrugnjusersnjcommon!nj
Flunjlikenjsymptoms,njlownjgradenjfevernj(101-102).
Vegetationsnjcannjbreaknjoffnjtonjformnjemboli!
Leftnjheartnjvalves-njclogsnjinnjbrainnj(stroke),njkidneynj(flanknjpain),njspleennj(sharpnjLUQnjpain).nj
Bloodnjthinnernjwon'tnjhelp.
S/
S:njflunjsymptoms,njarthralgias,njmurmurs,njsplinternjhemorrhages,njpetechiae,njosler'snjnodes,njJanenjway'
sions.nj
Neednjantibioticsnjbeforenjdental/njsurgicalnjprocedures!
NotifynjMDnjifnjtempnjelevatednj(101.5)
Drugnjtherapy:njIVnjantibiotics,njantipyretic,njanalgesics,njrest/njfluids.
Pericarditisnj-njanswer--Inflammationnjofnjpericardialnjsac.njOftennjidiopathicnjcause.nj
Peoplenjoftennjhavenjseverenjpain,njthinknjtheynjarenjhavingnjheartnjattacknj(lastsnj2-3njdays).nj
Acute:njmaynjoccurnj48-72njhrnjafternjMI
Dressernjsyndrome:njoccursnj4-6njweeksnjafternjMI
Intensenjradiatingnjchestnjpain.njAggregatednjbynjlying,njdeepnjinspiration,njswallowing!
njEasednjbynjsittingnjupnjandnjleaningnjforward.njBreathsnjshortnjandnjshallownjtonjreducenjpain.nj
Pericardialnjfrictionnjrubnj(patientnjholdnjbreathnjwhilenjlistening).nj
Pericardialnjeffusion:njcannjcompressnjlungs,njphrenicnjnerve,njlaryngealnjnerve.
Treatment:njtreatnjunderlyingnjproblem,njantibioticsnjifnjbacterial,njNSAIDsnjfornjinflammation,njopioidsnjfornjp
n,njcorticosteroidsnjifnjautoimmune,njcolchicinenjifnjrecurrent.njPericardialnjwindownjornjpericardiocentesis.
Cardiacnjtamponadenj-njanswer--Compressionnjofnjheartnjfromnjfluidnjbuiltnjupnjinnjpericardialnjsac.nj
Seenjsignificantnjpulsesnjparadoxusnj(deepnjbreathnjlosenjpulse),njconfusion,njagitation,njrestlessness,njtach
cardia,njtachypnea,njdyspnea,njchestnjpain,njlownjCOnjstate,njJVDnj(PROFOUND!),njnarrowednjpulsenjpress
e,njmufflednjheartnjsounds,njmottlednjskin.
Mitralnjvalvenjprolapsenj-njanswer--AlsonjcallednjBarlow'snjsyndromenjornjfloppynjvalvenjsyndrome.
MostnjcommonnjvalvenjdiseasenjinnjUS.nj
BothnjmitralnjcuspsnjbulgenjintonjLAnjduringnjventricularnjsystole.
SomenjLVnjbloodnjmaynjflownjbacknjintonjLAnjbynjlimitednjamount.
Frequentlynjasymptomatic.nj
SOBnjornjatypicalnjchestnjpain,njmurmur,nj
Tachydysrhythmiasnjand/njornjpalpitationsnjwithnjlightheadednessnjandnjsyncope.nj
Treatment:njhealthynjlifestyle,njbetanjblockers,njweightnjandnjBPnjmanagement,njvisitnjdentist.
Mitralnjstenosisnj-njanswer--
Tightening,njthickening,njnarrowing,njshorteningnjofnjmitralnjvalve.njPushingnjagainstnjextranjpressure.nj
ObstructsnjbloodnjflownjfromnjLAnjtonjLVnjduringnjdiastole,njimpairednjLVnjfilling.nj
ReducesnjLVnjvolumenjandnjpressure...causesnjLVnjhypertrophynjandnjLAnjdilation.
Bloodnjbacksnjupnjtonjpulmonarynjvasculature,njcausingnjs/snjofnjleftnjHF,njcannjleadnjtonjrightnjHF.nj
, High njrisknjgk
Chapter for njdeveloping
12: gkDifferencegknj anjFib,njhigh
Equations gkand risk
njgk njofnjblood
Mathematical Mclots!nj
gknj ISM:gkFinitegkM
odels ath
Earlynjsymptoms:njDOE,njmurmurnj(lownjpitchednjdiastolicnjatnjapex),njanjfib,njfatigue,njcough,njpulmonarynjin
ctions.
Laternjsymptoms:njs/snjHF,njpalpitations,njdizziness,snjsyncope.
RisknjfornjSTROKE!
Treatmentnjofnjchoicenjisnjtransluminalnjvalvuloplasty
Mitralnjregurgitationnj-njanswer--Bloodnjflowsnjbacknjintonjleftnjatrium/
lungsnjduringnjsystole,njleaking.njIncreasednjLAnjvolumenjcausesnjchambernjdilation.
DecreasednjCOnjandnjejectionnjfraction.
DOE,njorthopnea,njparoxysmalnjnocturnalnjdyspnea,njcoughnj(espnjatnjnight),njdizziness/
syncope,njloudnjholosystolicnjmurmur,njheartnjpalpitations,njS3.
RisknjfornjSTROKE.
Aorticnjstenosisnj-njanswer--
ObstructsnjbloodnjflownjfromnjLVnjtonjaortanjduringnjsystole.njLVnjhasnjtonjworknjharder,njhypertrophies.
Increasednjworkload,njcausesnjischemia.
Pressurenjbacksnjupnjcausingnjpulmonarynjcongestion/edema.
LeftnjsidednjHF.
Symptoms:njDOE,njangina,njExertionalnjsyncope!nj(Knownjthese)
Narrowednjpulsenjpressure,njharshnjsystolicnjmurmur,njdiminishenjfornjabsentnjS2,njs3njandnjs4,
Aorticnjregurgitationnj-njanswer--
BackflownjofnjbloodnjfromnjascendingnjaortanjintonjLVnjduringnjdiastole.njLVnjvolumenjoverload,njincreasednjL
jpressure,njpulmonarynjcongestion/hypertension,njresultsnjinnjrightnjsidenjfailure.
Acute:njcardiovascularnjcollapsenj(severenjhypotension,njCP,njdyspnea)
Chronic:njs/
snjHF,njthrobbingnjpulsenjinnjneck,njdeMisset'snjsignnj(headnjbob),njdiastolicnjmurmur,njs3njandnjs4,njwidened
ulsenjpressure,njunresponsivenjangina.
Nonjnitro!!!
Treatments:njsamenjasnjHFnjwithnjadditionnjofnjanticoagulantsnjandnjprophylacticnjantibiotics.
Valvenjreplacementnj-njanswer--
Biological:njlessnjdurable,njincreasednjrisknjfornjendocarditis,njshortnjtermnjanticoagulation.
Mechanical:njgreaternjdurability,njlifelongnjanticoagulation,njinfectionsnjhardernjtonjtreat,njaudiblenjclick.
Oldernjtendnjtonjgonjmechanical.njYoungernjtendnjtonjgonjbiological.
Starvation-njrelatednjmalnutritionnj(primarynjprotein-calorienjmalnutrition)nj-njanswer--
Chronicnjstarvationnjwithoutnjinflammation
Chronicnjdiseasenjrelatednjmalnutritionnj(secondarynjPCM)nj-njanswer--
Sustainednjinflammationnjofnjmildnjmodnjdegree.njTissuenjneedsnjnotnjmetnjevennjwhennjdietarynjintakenjwou
njnormallynjbenjadequate.nj(Chronic/longnjtermnjconditions)
Acutenjdiseasenjornjinjurynjrelatednjmalnutritionnj-njanswer--
Markednjinflammatorynjresponse.njAssociatednjwithnjacutenjdiseasenjornjinjurynj(burns,njtrauma,njmajornjinfe
ion).
ISM:gkFinitegkM Chaptergk12:gkDifferencegkEquationsgkandgkMathematicalgkM
ath odels
EXAM 3, NUR511 EXAM 4 Q AND A
S/SnjHeartnjfailurenj-njanswer--
Fatigue,njangina,njanxiety,njoliguria,njdecreasednjGInjmotility,njpalenjcoolnjskin,njweightnjgainnj(2njlbnjinnjanjday
3-5njlbnjinnjanjweek),njrestlessness,njedema
LeftnjHFnj-njanswer--
Backsnjupnjtonjlungs,njpulmonarynjedema.njPleuralnjeffusion.njCracklesnjinnjlungs.njMorenjcommonnjthannjrig
njDOE,njSOB,njPND,njnonproductivenjcough,njpinknjfrothynjsputum,njorthopnea,njpulmonarynjcrackles,njfanjIg
njweakness,njactivitynjintolerance,njdrynjcough,njnocturnalnjcough,njS3njandnjS4,njdizzinessnjsyncope,njpalpi
ions/njtachycardia,njnocturia,njpale/cyanosis,njdisplacednjPMI,njanxiety,njdepression.
RightnjHFnjornjCornjpulmonalenj-njanswer--
ResultnjofnjeithernjleftnjventricularnjfailurenjornjCoPDnjandnjpulmonarynjhypertension.njPeripheralnjedema.njA
ites.njJVD.njAnorexia,njnausea,njabdominalnjdistinction,njRUQnjpainnj(livernjdistention),njmurmurs,njanasarc
jtachycardia,njhepatomegaly,njsplenomegaly,njanxiety,njdepression.
Strokenjvolumenj-njanswer--Madenjupnjofnjpreload,njcontractility,njafterload.
Compensatorynjmechanismsnj-njanswer--SNSnjactivation-
njcatacholaminenjreleasenj(increasenjHR,njBP,njvasoconstrictionnjinnjperiphery,njworkloadnjonnjheart)
RAAS-njholdnjontonjwaternjandnjsalt,njincreasenjvolumenjandnjvasoconstriction
ADH-njholdnjontonjwaternjandnjsalt
Natriureticnjpeptide-njdiureticnjandnjvasodilationnjproperties=njBNP=njspecificnjmarkernjfornjHF.
Hypertrophic-njcan'tnjfill
Dilation-njcan'tnjsqueeze
HFnjclassificationsnj-njanswer--Lownjnumbersnjgood,njhighnjbad.njAnjisnjgood,njDnjisnjbad.
HFnjdiagnosisnj-njanswer--BNPnjelevated,njBUNnjandnjcreatininenjelevated,
Ejectionnjfractionnj-njanswer--Greaternjthannj60njisnjnormal
40-60njmoderatenjHF
20-40njmodnjtonjseverenjHF
Lessnjthannj20njseverenjHF
SerumnjBUNnj-njanswer--Kidneynjfunction
Normalnjisnj10-20njmg/dL
Serumnjcreatininenj-njanswer--Kidneynjfunctionnj
Normalnjisnj0.5-1.2
Hyperkalemianj-njanswer--Potassiumnjgreaternjthannj5.1
Causes:njrenalnjfailure,njexcessivenjKCl,njexcessivenjusenjofnjsaltnjsubstitutes.
Hyponatremianj-njanswer--Sodiumnjlevelnj135njmEq/Lnjornjless
Causes:njinadequatenjsodiumnjintake,njpotentnjdiuretics,njretentionnjofnjfluidsnj(heartnjornjkidneynjfailure).
, Chaptergk12:gkDifferencegkEquationsgkandgkMathematicalgkM ISM:gkFinitegkM
odels
Hypernatremia nj-njanswer--Sodiumnjlevelnjgreaternjthannj145njmEq/L
ath
Causes:njdecreasednjwaternjintakenjornjexcessivenjlossnjofnjwater.
BNPnj-njanswer--Levelsnjovernj700pg/mLnjindicatenjdecompensatednjHF.
LFTsnj-njanswer--AST,njALT,njLDH,njAlkalinenjphosphatase,njGammanjGT.
SPO2nj-njanswer--Shouldnjbenj90%njornjgreater.njLessnjthannj85njisnjserious.njLessnjthannj70njisnjdeadly.
Edemanjscalenj-njanswer--+1njisnjslight:njrapidlynjreturnsnjtonjnormal
+2nj:njnormalnjinnj10-15njsec
+3:njnormalnjinnj1-2njmin
+4:njnormalnjinnj2-5njmin
ACEsnj-njanswer--
Endnjinnj"pril".njUsednjtonjpreventnjkidneynjdamage,njpreventnjremodelingnjofnjheart,njandnjreducenjBP.
BetanjblockersnjfornjHFnj-njanswer--Carvedilol,njmetoprololnjXL,njzebeta.njBlocknjcatacholamines.
Natrecornj-njanswer--
SyntheticnjBNP.njProfoundnjvasodilator.njUsednjfornjdecompensatednjHF,njwatchnjBP,njIVnjinfusionnjonly,njB
Pnjwillnjbenjelevatednjobviously...
Digoxinnjtoxicitynj-njanswer--
Nausea,njvomiting,njanorexia,njdysrhythmias,njbradycardia,njtachycardia,njheadache,njfatigue,njblurrednjvis
n,njcolorednjvision.
Primarynjcardiomyopathynj-njanswer--Idiopathicnjcardiomyopathy
Secondarynjcardiomyopathynj-njanswer--Cardiomyopathynjcausednjbynjanothernjdisease.
Dilatednjcardiomyopathynj-njanswer--
Can'tnjsqueeze,njmostnjcommonnjtype,njcausenjofnjsuddennjcardiacnjdeath,njbignjboggynjheart.
Causednjbynjcardiotoxicnjagentsnj(alcohol),njinfections,njdiseases,njpregnancy.
HFnjsymptoms,njS3njandnjS4,njatnjrisknjfornjbloodnjclots!
Bloodnjclotnjrightnjside-njpulmonarynjembolism
Bloodnjclotnjleftnjside-njbrainnj(stroke),njlegs,njkidneys
Treatnjbynjstoppingnjalcohol/drugs,njsamenjmessnjasnjHF,njanticoagulants
Avoidnjalcohol,njinfections/crowds,njfamilynjshouldnjlearnnjCPR.
Hypertrophicnjcardiomyopathynj-njanswer--Can'tnjfill,njsupernjthicknjwalled.njOccursnjinnjyoungnjadultnjmen!n
Causednjbynjgeneticnjlink,njchronicnjhypertension,njaorticnjstenosis.
S/
S:njsomenjasymptomatic,njexertionnjallnjdyspnea,njangina,njexertionnjallnjsyncope,njfatigue,njdizziness,njpalp
ations,njdysrhythmias,njlaterallynjdisplacednjPMInj(lownjandnjtonjthenjleft),njmurmur,njcrackles,njS4.
Echonjisnjprimarynjdiagnosticnjtool.
,Treatment njisnj
ISM:gkFinite gk to
Mnjdecreasenjcontractility,njrelaxChapter
njheart:gk beta
nj12: njblockers,
gkDifference njcalcium
gkEquations njchannel
gkand njblockers,
gkMathematical gkM njDigox
ath
njanticoagulants.njNonjinotropes!njNonjnitro!
odels
Limitnjstrenuousnjactivity!njActivitynjrestriction.
Elevatenjfootnjofnjbed
Infectivenjendocarditisnj-njanswer--Infectionnjinsidenjthenjheart,njusuallynjofnjthenjheartnjvalves.nj
IVnjdrugnjusersnjcommon!nj
Flunjlikenjsymptoms,njlownjgradenjfevernj(101-102).
Vegetationsnjcannjbreaknjoffnjtonjformnjemboli!
Leftnjheartnjvalves-njclogsnjinnjbrainnj(stroke),njkidneynj(flanknjpain),njspleennj(sharpnjLUQnjpain).nj
Bloodnjthinnernjwon'tnjhelp.
S/
S:njflunjsymptoms,njarthralgias,njmurmurs,njsplinternjhemorrhages,njpetechiae,njosler'snjnodes,njJanenjway'
sions.nj
Neednjantibioticsnjbeforenjdental/njsurgicalnjprocedures!
NotifynjMDnjifnjtempnjelevatednj(101.5)
Drugnjtherapy:njIVnjantibiotics,njantipyretic,njanalgesics,njrest/njfluids.
Pericarditisnj-njanswer--Inflammationnjofnjpericardialnjsac.njOftennjidiopathicnjcause.nj
Peoplenjoftennjhavenjseverenjpain,njthinknjtheynjarenjhavingnjheartnjattacknj(lastsnj2-3njdays).nj
Acute:njmaynjoccurnj48-72njhrnjafternjMI
Dressernjsyndrome:njoccursnj4-6njweeksnjafternjMI
Intensenjradiatingnjchestnjpain.njAggregatednjbynjlying,njdeepnjinspiration,njswallowing!
njEasednjbynjsittingnjupnjandnjleaningnjforward.njBreathsnjshortnjandnjshallownjtonjreducenjpain.nj
Pericardialnjfrictionnjrubnj(patientnjholdnjbreathnjwhilenjlistening).nj
Pericardialnjeffusion:njcannjcompressnjlungs,njphrenicnjnerve,njlaryngealnjnerve.
Treatment:njtreatnjunderlyingnjproblem,njantibioticsnjifnjbacterial,njNSAIDsnjfornjinflammation,njopioidsnjfornjp
n,njcorticosteroidsnjifnjautoimmune,njcolchicinenjifnjrecurrent.njPericardialnjwindownjornjpericardiocentesis.
Cardiacnjtamponadenj-njanswer--Compressionnjofnjheartnjfromnjfluidnjbuiltnjupnjinnjpericardialnjsac.nj
Seenjsignificantnjpulsesnjparadoxusnj(deepnjbreathnjlosenjpulse),njconfusion,njagitation,njrestlessness,njtach
cardia,njtachypnea,njdyspnea,njchestnjpain,njlownjCOnjstate,njJVDnj(PROFOUND!),njnarrowednjpulsenjpress
e,njmufflednjheartnjsounds,njmottlednjskin.
Mitralnjvalvenjprolapsenj-njanswer--AlsonjcallednjBarlow'snjsyndromenjornjfloppynjvalvenjsyndrome.
MostnjcommonnjvalvenjdiseasenjinnjUS.nj
BothnjmitralnjcuspsnjbulgenjintonjLAnjduringnjventricularnjsystole.
SomenjLVnjbloodnjmaynjflownjbacknjintonjLAnjbynjlimitednjamount.
Frequentlynjasymptomatic.nj
SOBnjornjatypicalnjchestnjpain,njmurmur,nj
Tachydysrhythmiasnjand/njornjpalpitationsnjwithnjlightheadednessnjandnjsyncope.nj
Treatment:njhealthynjlifestyle,njbetanjblockers,njweightnjandnjBPnjmanagement,njvisitnjdentist.
Mitralnjstenosisnj-njanswer--
Tightening,njthickening,njnarrowing,njshorteningnjofnjmitralnjvalve.njPushingnjagainstnjextranjpressure.nj
ObstructsnjbloodnjflownjfromnjLAnjtonjLVnjduringnjdiastole,njimpairednjLVnjfilling.nj
ReducesnjLVnjvolumenjandnjpressure...causesnjLVnjhypertrophynjandnjLAnjdilation.
Bloodnjbacksnjupnjtonjpulmonarynjvasculature,njcausingnjs/snjofnjleftnjHF,njcannjleadnjtonjrightnjHF.nj
, High njrisknjgk
Chapter for njdeveloping
12: gkDifferencegknj anjFib,njhigh
Equations gkand risk
njgk njofnjblood
Mathematical Mclots!nj
gknj ISM:gkFinitegkM
odels ath
Earlynjsymptoms:njDOE,njmurmurnj(lownjpitchednjdiastolicnjatnjapex),njanjfib,njfatigue,njcough,njpulmonarynjin
ctions.
Laternjsymptoms:njs/snjHF,njpalpitations,njdizziness,snjsyncope.
RisknjfornjSTROKE!
Treatmentnjofnjchoicenjisnjtransluminalnjvalvuloplasty
Mitralnjregurgitationnj-njanswer--Bloodnjflowsnjbacknjintonjleftnjatrium/
lungsnjduringnjsystole,njleaking.njIncreasednjLAnjvolumenjcausesnjchambernjdilation.
DecreasednjCOnjandnjejectionnjfraction.
DOE,njorthopnea,njparoxysmalnjnocturnalnjdyspnea,njcoughnj(espnjatnjnight),njdizziness/
syncope,njloudnjholosystolicnjmurmur,njheartnjpalpitations,njS3.
RisknjfornjSTROKE.
Aorticnjstenosisnj-njanswer--
ObstructsnjbloodnjflownjfromnjLVnjtonjaortanjduringnjsystole.njLVnjhasnjtonjworknjharder,njhypertrophies.
Increasednjworkload,njcausesnjischemia.
Pressurenjbacksnjupnjcausingnjpulmonarynjcongestion/edema.
LeftnjsidednjHF.
Symptoms:njDOE,njangina,njExertionalnjsyncope!nj(Knownjthese)
Narrowednjpulsenjpressure,njharshnjsystolicnjmurmur,njdiminishenjfornjabsentnjS2,njs3njandnjs4,
Aorticnjregurgitationnj-njanswer--
BackflownjofnjbloodnjfromnjascendingnjaortanjintonjLVnjduringnjdiastole.njLVnjvolumenjoverload,njincreasednjL
jpressure,njpulmonarynjcongestion/hypertension,njresultsnjinnjrightnjsidenjfailure.
Acute:njcardiovascularnjcollapsenj(severenjhypotension,njCP,njdyspnea)
Chronic:njs/
snjHF,njthrobbingnjpulsenjinnjneck,njdeMisset'snjsignnj(headnjbob),njdiastolicnjmurmur,njs3njandnjs4,njwidened
ulsenjpressure,njunresponsivenjangina.
Nonjnitro!!!
Treatments:njsamenjasnjHFnjwithnjadditionnjofnjanticoagulantsnjandnjprophylacticnjantibiotics.
Valvenjreplacementnj-njanswer--
Biological:njlessnjdurable,njincreasednjrisknjfornjendocarditis,njshortnjtermnjanticoagulation.
Mechanical:njgreaternjdurability,njlifelongnjanticoagulation,njinfectionsnjhardernjtonjtreat,njaudiblenjclick.
Oldernjtendnjtonjgonjmechanical.njYoungernjtendnjtonjgonjbiological.
Starvation-njrelatednjmalnutritionnj(primarynjprotein-calorienjmalnutrition)nj-njanswer--
Chronicnjstarvationnjwithoutnjinflammation
Chronicnjdiseasenjrelatednjmalnutritionnj(secondarynjPCM)nj-njanswer--
Sustainednjinflammationnjofnjmildnjmodnjdegree.njTissuenjneedsnjnotnjmetnjevennjwhennjdietarynjintakenjwou
njnormallynjbenjadequate.nj(Chronic/longnjtermnjconditions)
Acutenjdiseasenjornjinjurynjrelatednjmalnutritionnj-njanswer--
Markednjinflammatorynjresponse.njAssociatednjwithnjacutenjdiseasenjornjinjurynj(burns,njtrauma,njmajornjinfe
ion).
