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Cardiology > 10.3 Clinical Care of the Cardiovascular System > Flashcards

10.3 Clinical Care of the Cardiovascular System Flashcards

1
Q

What is normal blood pressure?

A

SBP: <120
DBP: <80

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2
Q

What is Stage 1 Hypertension?

A

SBP: 130-139
DBP: 80-89

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3
Q

When you are deflating the blood pressure cuff what sound are you listening for to determine your SBP and DBP?

A

Korotkoff Sounds

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4
Q

What happens if you try to take a patients blood pressure with a cuff that is too small?

A

Artificially high reading

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5
Q

What Rythmn is this?

A

A-Fib

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6
Q

What is Stage 2 Hypertension

A

SBP: >=140
DBP: >=90

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7
Q

What is the term applied to 95% of hypertensive patients when no single cause can be identified?

A

Essential Hypertension

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8
Q

Secondary HTN should be considered when what?

A
  1. Patients with HTN at an early age
  2. When first symptoms appear after 50
  3. difficulty controlling with multiple meds
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9
Q

What are some physical findings in patients with long term uncontrolled HTN?

A

Can hear mitral valve murmurs
Can hear S4
Can have displaced PMI

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10
Q

To evaluate a new diagnosis of HTN, what labs do you need?

A 
Fasting glucose
UA for proteinuria, hematuria, casts
CBC
Chemistry
TSH
Lipid Panel
EKG
Calculate 10 yr atherosclerotic CVD risk
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11
Q

Patients must have elevated BP recordings for how many visits to be considered for HTN?

A

3-5 separate visits

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12
Q

What rhythm is this?

A

V-Tach

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13
Q

What treatment for HTN yields modest results?

A

Lifestyle Modifications

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14
Q

What lifestyle modifications are used as treatment for HTN?

A
  1. Diet rich in fruits and vegetables, low in sat fat
  2. Weight reduction
  3. Reduce alcohol
  4. Increase physical activity
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15
Q

What is the pharmacological goal in treating HTN?

A

<140-90 bp in most patients

<130-80 in patients with diabetes or kidney disease

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16
Q

What 2 drug classes are considered FIRST LINE treatment for HTN?

A

Diuretics

ACEi

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17
Q

What is the medication and dosing for treatment of HTN with a diuretic?

A

Hydrochlorothiazide

12.5-25mg daily can titrate to 50mg/day maximum

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18
Q

In what patients would a Calcium Channel Blocker be a more effective pharmacological option for treating HTN?

A

African American and Older Patients

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19
Q

When prescribing and ACEi for treatment of HTN, what medication and dosing would you use?

A

Lisinopril (most common but any of the -pril drugs)

5-10mg/day maximum of 40mg/day

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20
Q

How often should a patient have follow up blood work to check for kidney function during HTN treatment?

A

yearly

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21
Q

What denotes hypertensive urgency

A

SBP >220 mm Hg or DBP >125 mm Hg
+/- optic disc edema
NO END ORGAN DAMAGE
BP must be reduced within a few hours

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22
Q

What is this an example of?

A

Wolff-Parkinson White Syndrome (WPW)

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23
Q

What is the main difference between HTN urgency and emergency?

A

SIGNS OF END ORGAN DAMAGE

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24
Q

What are signs of END ORGAN DAMAGE?

A 
Hypertensive encephalopathy
Intercranial Hemorrhage
Ischemic stroke
Hypertensive nephropathy
Ustable angina, AMI, CHF or Aortic dissection
Pulmonary Edema
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25
Q

During a HTN emergnecy, you need to reduce the BP by ________ within __________, then ____________ in ___________

A

25% within 1-2 hours, then <160/110 in 24 hours.

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26
Q

What is the main goal of your physical examination during a HTN emergency?

A

evaluate for signs of END ORGAN DAMAGE

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27
Q

What are some differential diagnosis for HTN Emergency?

A 
Aortic dissection
Ischemic Stroke
Drug withdraw
NSAID use
Thyroid Storm
Heavy Alcohol use
Meds/drugs
Pre-eclampsia
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28
Q

What are the pharmacological options to treat Hypertensive Urgency?

A

Clonidine (primary)
0.1-0.2 mg oral, then 0.1 mg every hour up to 0.8 mg
Metoprolol - Initial 50mg 2x daily, titrate up to max 200 mg daily
or
Labetalol - Initial 100mg 2x daily, titrate up to max 1200mg 2x day

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29
Q

What is the Pharmacological option for treatment of Hypertensive emergency?

A

Labetalol 20mg IV (over 10 minutes) then 40-80mg IV q10 min PRN, max 300 mg.

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30
Q

What plays a critical role in the development of atherosclerosis?

A

Dyslipidemia and abnormal lipids

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31
Q

Risk factors for atherosclerotic disease include:

A

1) Hypercholesterolemia
2) Hypertension
3) Diabetes Mellitus
4) Male gender
5) Smoking
6) Family history

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32
Q

What is the number one killer in the US?

A

Atherosclerotic Coronary Artery Disease (CAD)

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33
Q

What are some physical findings of Atherosclerotic Coronary Artery Disease (CAD)?

A 
Chest pain            Left shoulder pain
Indigestion           Nausea/Vomiting
Pale                       Diaphoresis
New heart murmur
Rales on pulmonary examination
S3 / S4
Sudden cardiac death
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34
Q

What Lab Studies would you get for CAD?

A

Lipids Panel
EKG
Fasting Glucose
Troponin

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35
Q

The most important non pharmacological treatment for CAD is:

A

SMOKING CESSATION

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36
Q

Pharmacological Treatment for CAD is:

A

Atorvastatin - Initial dose 10 mg before bedtime, titrate to a maximum dose of 80mg before bed.

Aspirin 81mg daily

37
Q

During monitoring how often do we check LFTs and why?

A

Check initial LFTs, then repeat in 3-6 months to

monitor for any hepatotoxicity

38
Q

What are the surgical treatments for CAD?

A

1) Coronary Artery Bypass Grafting (CABG)
2) Stenting
3) Primary percutaneous coronary intervention

39
Q

Occlusive atherosclerotic lesions that develop in the legs, and
less commonly, the arms causing decreased perfusion of the extremities is called what?

A

Atherosclerotic Peripheral Vascular Disease (PAD)

40
Q

Symptoms/Physical Exam findings that correlate to a diagnosis of Peripheral Vascular Disease (PAD) are what?

A 
Claudication
Diminished femoral, popliteal, or pedal pulses
Tissue Ulceration and gangrene 
Erectile Dysfunction
Loss of Hair
Atrophy of skin and muscles
Thinning and cool skin
Patients with pain unrelieved by rest are at high risk for amputation
41
Q

What are signs of severe arterial ischemia?

A 
Remember the  6 P's
     Pain
     Pallor
     Poikilothermia
     Pulselessness
     Paresthesia
     Paralysis
42
Q

Thrombus or plaque that breaks off an starts to travel in the body is called a ___________?

A

Emboli

43
Q

What is a blood clot that forms as a plaque ruptures and platelets start to adhere and aggregate to the rupture site?

A

Thrombus

44
Q

What are surgical treatments for PAD?

A

1) Surgical Bypass
2) Endovascular angioplasty/stenting
3) Amputation

45
Q

What rhythm is displayed?

A

Normal Sinus Rhythm

46
Q

Cilostazol 100mg PO PID is the treatment for what?

A

Peripheral Vascular Disease (PAD)

47
Q

What areas would you cover if you were counseling a patient on a Non Pharmacological ways to treat/prevent Peripheral Vascular Disease(PAD)

A

1) SMOKING Cessation
2) Risk factor reduction
3) Weight loss
4) Consistent moderate exercise

48
Q

In Occlusive Cerebrovascular Disease, emboli are predominantly due to emboli from the _______?

A

proximal internal Carotid artery

49
Q

Atherosclerotic Disease breaks down into what different diagnosis?

A

Atherosclerotic Disease
Atherosclerotic Coronary Artery Disease (CAD)
Atherosclerotic Peripheral Vascular Disease (PAD)
Acute Arterial Occlusion of a Limb
Occlusive Cerebrovascular Disease

50
Q

What is the doing for Enoxaparin?

A

1mg/kg SC q12

51
Q

___________ is defined as an elevated total or low-density (LDL) cholesterol levels, or low levels of high-density lipoprotein (HDL) cholesterol.

A

Dyslipidemia

52
Q

__________ refers to an abnormally high concentration of fats or lipids in the blood and interchangeable with dyslipidemia.

A

Hyperlipidemia

53
Q

What is considered “bad” cholesterol?

A

low-density (LDL) cholesterol

54
Q

Use the _____________ to determine 10 year risk of having a MI which will help you determine if treatment is warranted or not.

A

ASCVD Risk Calculator

55
Q

What treatment is indicated in a 40-79 yr old patient with a 10 yr risk >5%?

A

Use of a STATIN

56
Q

If a 40-79 yr old patient has an ASVCD Risk of >10% 10 yr risk, what initiation is warranted?

A

Aspirin Therapy

57
Q

What follow up lab studies are needed at what frequency?

A

Yearly Lipid panels and ASCVD risk

Yearly LFTs if using a STATIN

58
Q

What wave represents depolarization of the left and right atrium?

A

P Wave

59
Q

What is the normal PR interval?

A

0.12-0.2 seconds

60
Q

What is the QRS Complex? Where is it, what does it represent and how long is it typically?

A
  • Combo of 3 graphical deflections seen in typical EKG
  • Central and most visible part of the EKG
  • Representing ventricular depolarization
  • Normal duration less than 0.12 seconds
61
Q

What is the wave that represents ventricular repolarization called?

A

T Wave

62
Q

The time of ventricular activity including both depolarization and repolarization is represented how?

A

QT interval

63
Q

True/False.

PR interval and ST segments should be at the same level on an EKG tracing.

A

True

64
Q

If the ST segment dips does not come back to the same level as the PR interval line and it is below the PR interval line then it is termed _________?

A

ST Depression

64
Q

ST depression represents what?

A

Start of myocardial ischemia

65
Q

Identify the rhythm.

A

Sinus Bradycardia

66
Q

IF the ST segment elevates and stays elevated above the PR interval line then it is termed ___________.

A

ST Elevation

67
Q

Full thickness myocardial infarction is represented by:

A

ST Elevation

68
Q

When looking at a 12 lead EKG, ____________ represents the lateral aspect of the heart.

A

Leads I, aVL, V5-V6

69
Q

When looking at a 12 lead EKG, ____________ represents the inferior aspect of the heart.

A

Leads II, III, aVF

70
Q

When looking at a 12 lead EKG, _____________ represents the septal area of the heart

A

Leads V1-V2

71
Q

When looking at a 12 lead EKG, ___________ represents the anterior area of the heart (in particular the LV)

A

Leads V3-4

72
Q

A wide QRS complex along with a broad S wave in V1 and a wide R wave in V5 or V6 is indicative of what?

A

Left Branch Bundle Block

73
Q

What are abnormalities in cardiac rhythm and conduction?

A

Cardiac Arrhythmias

74
Q

What rhythm does this patient have?

A

V-Fib

75
Q

What rhythm is displayed below?

A

Asystole

76
Q

What is the below strip an example of?

A

Wolff-Parkinson White Syndrome

77
Q

What signs on an EKG indicate Wolff-Parkinson White Syndrome?

A

1) Short PR interval ( < 0.12 seconds).

2) Wide, slurred QRS complex called a delta wave.

78
Q

What rhythm is displayed?

A

Sinus Bradycardia

79
Q

Name the Rhythm

A

Paroxysmal Supraventricular Tachycardia (PSVT)

80
Q

How are cardiac arrhythmias normally detected?

A

During a routine screening
or
Patients present with symptoms

81
Q

What 3 things constitute a normal sinus rhythm?

A

1) PR interval remains constant.
2) R-R interval is regular and constant.
3) P-P interval is constant.

82
Q

What is considered a normal finding in healthy individuals in excellent physical condition.

A

Sinus bradycardia to rates of 50 beats/min

83
Q

For treatment of Bradyarrhythmia, what must be determined in order to treat?

A

Stable or unstable

84
Q

What does this strip show?

A

Premature Ventricular Contraction (PVC)

85
Q

What rhythm is being displayed?

A

Torsades de Pointes

86
Q

What is Torsades de Pointes?

A

A polymorphic Ventricular Tachycardia

87
Q

What are unshockable rhythms?

A

Asystole

Pulseless Electrical Activity

88
Q

What rhythms can be potentially corrected with defibrillation?

A

Ventricular Tachycardia

Ventricular Fibrillation

Cardiology (3 decks)

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