Cardiac Flashcards
what produces loud, low pitched, S1 murmur, mid-diastolic, apical crescendo rumble
Mitral stenosis
What produces systolic murmur at 5th ICS MCL, blowing or high pitched, may include S3
Mitral regurgitation
What produces systolic murmur, harsh blowing 2nd R ICS, radiating to neck
aortic stenosis
what produces diastolic blowing murmur at 2nd L ICS
aortic regurgitation
what are the systolic murmurs?
mitral regurgitation and aortic stenosis
what are the diastolic murmurs?
mitral stenosis, aortic regurgitation
when does S3 occur?
after S2, increased fluid states- heart failure, pregnancy
when does S4 occur ?
before S1, stiff ventricular wall- MI, L ventricular hypertrophy, chronic hypertension
what are symptoms of Right sided heart failure?
JVD, PND, dependent edema, hepatomegaly, splenomegaly, displaced PMI, S3/4, fatigue, abdominal fullness
describe NYHA Functional Classification of Heart Failure
I- no limitations
II- slight limitation, but comfortable at rest
III- marked limitations of physical activity, but comfortable at rest
IV- severe; inability to carry out any physical activity without discomfort
when does AV nicking occur?
uncontrolled chronic hypertension
seen on retinal exam
pharmacological hypertension management for Non-African American vs African American population
Non-AA- thiazide diuretic (HCTZ), ACEI (lisinopril), ARB (losartan), CCB (amlodipine)
AA- Thiazide diuretic (HCTZ), CCB (amlodipine)
what HTN meds are indicated for diabetic and renal patients?
ACEI or ARB
What conditions is hypertensive emergency cutoff reduced lower than 180/120
ICH, unstable angina, acute MI, acute HF, AAA dissection, eclampsia, malignant hypertension, hypertensive encephalopathy
what is timeframe for BP reduction in hypertensive emergency
reduce by 25% within 1st hour, then if stable, to 160/100 within next 2-6 hours, then cautiously to normal during following 24-48 hours
what is Levine’s sign
clenched fist sign- hand held over chest- indicates patient experiencing chest pain
what are lipid goals
vs. lipid goals for DM or CAD patients
cholesterol < 200
VLDL < 150
LDL < 100
HDL 40-60
DM/ CAD/ HLD triad
LDL < 70
HDL> 40
triglyceride < 150
what risk scores indicate statin therapy?
w/o ASCVD or DM with LDL 70-189, with estimated 10 year risk ASCVD >7.5%
what level of statin therapy gives what level of LDL reduction?
high intensity - 50% or greater LDL reduction
moderate intesity- 30-50% LDL reduction
low intensity- 30% LDL reduction, or less
what drug doses are for high, moderate and low intensity statin therapy?
High- atorvastatin 40-80, rosuvastatin 20-40
Med- atorvastatin 10-20, rosuvastatin 5-10, simvastatin 20-40
Low- simvastatin 10mg
what are other lipid lowering agents? (4)
- bile acid sequestrants- cholestyramine, colesevelam, colestipol
- fibrates - gemfibrozil, fenofibrate
- Cholesterol absorption inhibitor- Ezetimibe (Zetia)
- Niacin- high doses may cause flushing sensation- be careful of immediate vs extended release preparations
anterior MI leads
V 1-V4
lateral MI leads
I, aVL, V5, V6
inferior MI leads
II, III, aVF
what are therapeutic levels for coagulation labs for MI anticoagulation treatment?
INR 2.5-3.5
APTT, PT, PTT- 1.5-2.5x normal time
what are contraindications for pharmacological revascularization?
prior ICH or SAH, structural cerebral vascular lesion or malignant intracranial neoplasm
ischemic stroke within 3 months
suspected aortic dissection
active bleeding
significant closed head trauma or facial trauma within 3 months
intracranial or intraspinal surgery within 3 months
severe uncontrolled hypertension > 185/110
active bleeding or risk of active bleeding- abnormal coagulation values (INR > 1.7) normal INR 0.8-1.2
what’s the difference between pathophysiology of peripheral vascular disease and chronic venous insufficiency? what’s the difference in presentation??
PVD- patho- narrowing of arteries resulting in decreased blood supply to extremities- calf pain, cold or numb extremities
CVI- impaired venous return due to destruction of valves, changes due to deep thrombophlebitis, leg trauma, sustained elevation of venous pressure. aching lower extremities relieved by elevation, edema with standing, night cramps
endocarditis vs pericarditis
pericarditis- inflammation of heart wall- thorough history essential to make the diagnosis
endocarditis- infection of endothelial surface of heart- affects valves- consider in all patients with heart murmur and fever of unknown origin
pericarditis causes
viral.
post- MI
renal failure, endocarditis, septicemia, drug induced
endocarditis
commonly bacterial
recent dental surgery
IVDU
pericarditis physical finding
friction rub- pain relieved by sitting forward
SOB, pain on deep inspiration and coughing
pericarditis EKG changes
ST elevation in all leads
what is empiric treatment for endocarditis ?
S. aureus most common, therefore vancomycin is the empiric treatment before cultures come back
