10.3 Clinical Care of the Cardiovascular System Flashcards
1
Q
What is normal blood pressure?
A
SBP: <120
DBP: <80
2
Q
What is Stage 1 Hypertension?
A
SBP: 130-139
DBP: 80-89
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
4
Q
What happens if you try to take a patients blood pressure with a cuff that is too small?
A
Artificially high reading
5
Q
What Rythmn is this?
A
A-Fib
6
Q
What is Stage 2 Hypertension
A
SBP: >=140
DBP: >=90
7
Q
What is the term applied to 95% of hypertensive patients when no single cause can be identified?
A
Essential Hypertension
8
Q
Secondary HTN should be considered when what?
A
- Patients with HTN at an early age
- When first symptoms appear after 50
- difficulty controlling with multiple meds
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
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
11
Q
Patients must have elevated BP recordings for how many visits to be considered for HTN?
A
3-5 separate visits
12
Q
What rhythm is this?
A
V-Tach
13
Q
What treatment for HTN yields modest results?
A
Lifestyle Modifications
14
Q
What lifestyle modifications are used as treatment for HTN?
A
- Diet rich in fruits and vegetables, low in sat fat
- Weight reduction
- Reduce alcohol
- Increase physical activity
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
16
Q
What 2 drug classes are considered FIRST LINE treatment for HTN?
A
Diuretics
ACEi
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
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
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
20
Q
How often should a patient have follow up blood work to check for kidney function during HTN treatment?
A
yearly
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
22
Q
What is this an example of?
A
Wolff-Parkinson White Syndrome (WPW)
23
Q
What is the main difference between HTN urgency and emergency?
A
SIGNS OF END ORGAN DAMAGE
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
25
During a HTN emergnecy, you need to reduce the BP by ________ within __________, then ____________ in ___________
25% within 1-2 hours, then <160/110 in 24 hours.
26
What is the main goal of your physical examination during a HTN emergency?
evaluate for signs of END ORGAN DAMAGE
27
What are some differential diagnosis for HTN Emergency?
```
Aortic dissection
Ischemic Stroke
Drug withdraw
NSAID use
Thyroid Storm
Heavy Alcohol use
Meds/drugs
Pre-eclampsia
```
28
What are the pharmacological options to treat Hypertensive Urgency?
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
29
What is the Pharmacological option for treatment of Hypertensive emergency?
Labetalol 20mg IV (over 10 minutes) then 40-80mg IV q10 min PRN, max 300 mg.
30
What plays a critical role in the development of atherosclerosis?
Dyslipidemia and abnormal lipids
31
Risk factors for atherosclerotic disease include:
1) Hypercholesterolemia
2) Hypertension
3) Diabetes Mellitus
4) Male gender
5) Smoking
6) Family history
32
What is the number one killer in the US?
Atherosclerotic Coronary Artery Disease (CAD)
33
What are some physical findings of Atherosclerotic Coronary Artery Disease (CAD)?
```
Chest pain Left shoulder pain
Indigestion Nausea/Vomiting
Pale Diaphoresis
New heart murmur
Rales on pulmonary examination
S3 / S4
Sudden cardiac death
```
34
What Lab Studies would you get for CAD?
Lipids Panel
EKG
Fasting Glucose
Troponin
35
The most important non pharmacological treatment for CAD is:
SMOKING CESSATION
36
Pharmacological Treatment for CAD is:
Atorvastatin - Initial dose 10 mg before bedtime, titrate to a maximum dose of 80mg before bed.
Aspirin 81mg daily
37
During monitoring how often do we check LFTs and why?
Check initial LFTs, then repeat in 3-6 months to
| monitor for any hepatotoxicity
38
What are the surgical treatments for CAD?
1) Coronary Artery Bypass Grafting (CABG)
2) Stenting
3) Primary percutaneous coronary intervention
39
Occlusive atherosclerotic lesions that develop in the legs, and
less commonly, the arms causing decreased perfusion of the extremities is called what?
Atherosclerotic Peripheral Vascular Disease (PAD)
40
Symptoms/Physical Exam findings that correlate to a diagnosis of Peripheral Vascular Disease (PAD) are what?
```
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
What are signs of severe arterial ischemia?
```
Remember the 6 P's
Pain
Pallor
Poikilothermia
Pulselessness
Paresthesia
Paralysis
```
42
Thrombus or plaque that breaks off an starts to travel in the body is called a ___________?
Emboli
43
What is a blood clot that forms as a plaque ruptures and platelets start to adhere and aggregate to the rupture site?
Thrombus
44
What are surgical treatments for PAD?
1) Surgical Bypass
2) Endovascular angioplasty/stenting
3) Amputation
45
What rhythm is displayed?
Normal Sinus Rhythm
46
Cilostazol 100mg PO PID is the treatment for what?
Peripheral Vascular Disease (PAD)
47
What areas would you cover if you were counseling a patient on a Non Pharmacological ways to treat/prevent Peripheral Vascular Disease(PAD)
1) SMOKING Cessation
2) Risk factor reduction
3) Weight loss
4) Consistent moderate exercise
48
In Occlusive Cerebrovascular Disease, emboli are predominantly due to emboli from the _______?
proximal internal Carotid artery
49
Atherosclerotic Disease breaks down into what different diagnosis?
Atherosclerotic Disease
Atherosclerotic Coronary Artery Disease (CAD)
Atherosclerotic Peripheral Vascular Disease (PAD)
Acute Arterial Occlusion of a Limb
Occlusive Cerebrovascular Disease
50
What is the doing for Enoxaparin?
1mg/kg SC q12
51
___________ is defined as an elevated total or low-density (LDL) cholesterol levels, or low levels of high-density lipoprotein (HDL) cholesterol.
Dyslipidemia
52
__________ refers to an abnormally high concentration of fats or lipids in the blood and interchangeable with dyslipidemia.
Hyperlipidemia
53
What is considered "bad" cholesterol?
low-density (LDL) cholesterol
54
Use the _____________ to determine 10 year risk of having a MI which will help you determine if treatment is warranted or not.
ASCVD Risk Calculator
55
What treatment is indicated in a 40-79 yr old patient with a 10 yr risk >5%?
Use of a STATIN
56
If a 40-79 yr old patient has an ASVCD Risk of >10% 10 yr risk, what initiation is warranted?
Aspirin Therapy
57
What follow up lab studies are needed at what frequency?
Yearly Lipid panels and ASCVD risk
| Yearly LFTs if using a STATIN
58
What wave represents depolarization of the left and right atrium?
P Wave
59
What is the normal PR interval?
0.12-0.2 seconds
60
What is the QRS Complex? Where is it, what does it represent and how long is it typically?
- 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
What is the wave that represents ventricular repolarization called?
T Wave
62
The time of ventricular activity including both depolarization and repolarization is represented how?
QT interval
63
True/False.
| PR interval and ST segments should be at the same level on an EKG tracing.
True
64
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 _________?
ST Depression
64
ST depression represents what?
Start of myocardial ischemia
65
Identify the rhythm.
Sinus Bradycardia
66
IF the ST segment elevates and stays elevated above the PR interval line then it is termed ___________.
ST Elevation
67
Full thickness myocardial infarction is represented by:
ST Elevation
68
When looking at a 12 lead EKG, ____________ represents the lateral aspect of the heart.
Leads I, aVL, V5-V6
69
When looking at a 12 lead EKG, ____________ represents the inferior aspect of the heart.
Leads II, III, aVF
70
When looking at a 12 lead EKG, _____________ represents the septal area of the heart
Leads V1-V2
71
When looking at a 12 lead EKG, ___________ represents the anterior area of the heart (in particular the LV)
Leads V3-4
72
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?
Left Branch Bundle Block
73
What are abnormalities in cardiac rhythm and conduction?
Cardiac Arrhythmias
74
What rhythm does this patient have?
V-Fib
75
What rhythm is displayed below?
Asystole
76
What is the below strip an example of?
Wolff-Parkinson White Syndrome
77
What signs on an EKG indicate Wolff-Parkinson White Syndrome?
1) Short PR interval ( < 0.12 seconds).
| 2) Wide, slurred QRS complex called a delta wave.
78
What rhythm is displayed?
Sinus Bradycardia
79
Name the Rhythm
Paroxysmal Supraventricular Tachycardia (PSVT)
80
How are cardiac arrhythmias normally detected?
During a routine screening
or
Patients present with symptoms
81
What 3 things constitute a normal sinus rhythm?
1) PR interval remains constant.
2) R-R interval is regular and constant.
3) P-P interval is constant.
82
What is considered a normal finding in healthy individuals in excellent physical condition.
Sinus bradycardia to rates of 50 beats/min
83
For treatment of Bradyarrhythmia, what must be determined in order to treat?
Stable or unstable
84
What does this strip show?
Premature Ventricular Contraction (PVC)
85
What rhythm is being displayed?
Torsades de Pointes
86
What is Torsades de Pointes?
A polymorphic Ventricular Tachycardia
87
What are unshockable rhythms?
Asystole
| Pulseless Electrical Activity
88
What rhythms can be potentially corrected with defibrillation?
Ventricular Tachycardia
| Ventricular Fibrillation
