Chemicals SCD Alcohol use Nosocomial infections Chest radiation Endocarditis Recent dental sx Fever Mild elevation of WBC in IE Illegal drug use Chills, Night sweats Elevated Erythrocyte Acute: rapid onset, Weakened valves Tachycardia Sedimentation Rate (ESR) in virulent Previous hx Fatigue IE PNA Malaise Elevated CRP in IE Subacute: low virulent Valve dysfunction Anorexia Elevated CK-MB, Troponin organism Nosocomial infections Weight loss Conduction delay, ST changes Chest trauma Headache CHF symptoms of ECG Septal defects Arthralgias CXR – septic pulmonary Bleeding gums Myalgias emboli Long-term central line Back pain Prosthetic valves Abdominal discomfort Congenital heart disease Clubbing Cellulitis Splinter hemorrhages on nails Rheumatic fever Petechiae Marfan’s syndrome Osler’s nodes (painful lesions)) HIV Janeway’s lesions Roth’s spots on retina Cardiac tamponade Pericarditis Chest pain worsened by deep Elevated venous pressure Pericardiocentesis Thoracic surgery breathing or coughing Decreased CO Hemodynamic monitoring Trauma Difficulty breathing Decreased BP ECG monitoring Discomfort, sometimes relieved Loss of tissue perfusion Fluid replacement by sitting upright or leaning Narrowed pulse pressure Pericardiectomy or forward <30 mmHg pericardial window Pale, gray, or blue skin - Beck’s triad – low BP, Surgical resection cyanosis muffled heart sounds, JVD Palpitations - tachycardia Weak peripheral pulses Rapid breathing Pulsus paradoxus - >10 drop Dizziness in SBP during inspiration Drowsiness ECG – low QRS Weak or absent pulse Anxiety Decreased LOC Mitral valve disease Pulmonary hypertension Regurgitation: Murmurs ECG monitoring for a-fib Decreased CO Dyspnea, weakness, fatigue Echocardiogram Monitor for cardiomegaly Increased pulse pressure Orthopnea, paroxysmal Transesophageal Maintain CO and activity Stenosis: nocturnal dyspnea, peripheral echocardiography (TEE) tolerance
Chemicals Alcohol use Nosocomial infections Chest radiation SCD Endocarditis Acute: rapid onset, virulent Subacute: low virulent organism Recent dental sx Illegal drug use Weakened valves Previous hx PNA Valve dysfunction Nosocomial infections Chest trauma Septal defects Bleeding gums Long-term central line Prosthetic valves Congenital heart disease Cellulitis Rheumatic fever Marfan’s syndrome HIV Fever Chills, Night sweats Tachycardia Fatigue Malaise Anorexia Weight loss Headache Arthralgias Myalgias Back pain Abdominal discomfort Clubbing Splinter hemorrhages on nails Petechiae Osler’s nodes (painful lesions)) Janeway’s lesions Roth’s spots on retina Mild elevation of WBC in IE Elevated Erythrocyte Sedimentation Rate (ESR) in IE Elevated CRP in IE Elevated CK-MB, Troponin Conduction delay, ST changes CHF symptoms of ECG CXR – septic pulmonary emboli Cardiac tamponade Pericarditis Thoracic surgery Trauma Chest pain worsened by deep breathing or coughing Difficulty breathing Discomfort, sometimes relieved by sitting upright or leaning forward Pale, gray, or blue skin - cyanosis Palpitations - tachycardia Rapid breathing Dizziness Drowsiness Weak or absent pulse Anxiety Decreased LOC Elevated venous pressure Decreased CO Decreased BP Loss of tissue perfusion Narrowed pulse pressure <30 mmHg Beck’s triad – low BP, muffled heart sounds, JVD Weak peripheral pulses Pulsus paradoxus - >10 drop in SBP during inspiration ECG – low QRS Pericardiocentesis Hemodynamic monitoring ECG monitoring Fluid replacement Pericardiectomy or pericardial window Surgical resection Mitral valve disease Pulmonary hypertension Decreased CO Increased pulse pressure Stenosis: Regurgitation: Dyspnea, weakness, fatigue Orthopnea, paroxysmal nocturnal dyspnea, peripheral Murmurs Echocardiogram Transesophageal echocardiography (TEE) ECG monitoring for a-fib Monitor for cardiomegaly Maintain CO and activity tolerance
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