Cardiac Flashcards by Kasey May

Risk factors for CVD

HTN
DM
HKD
Smoking

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HTN

SBP tends to increase gradually with age while DBP plateau

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ACS

Unstable angina plus NSTEMI or STEMI
SOB, AMS, confusion, dizziness, syncope
ASS 160-325
O2 maintain sats above 92%
Nitro and morphine
Anti thrombosis-LMWH, fondaparinux (factor X inhibitor)
Bivalirudin (direct thrombin inhibitor)
Cangrelor (P2Y12 platelet inhibitor)
PCI
Post ACS- start BB, ASA, ACEI/ARB, statin, clopidogrel or prasugrel for less than 75 years old for at least 9-12 months
Cardiac rehab

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Chronic CAD

Exertional fatigue or SOB more likely in older patients
May have MVD or LV dysfunction
Stress test!

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Controlling risk factors

LDL less than 100 with high risk CAD less than 70
Smoking cessation
Low saturated fat and cholesterol
Fruits and veggies
Exercise 150 minutes per week
ASA 81 mg
Statin regardless of LDL
CCB can be used in BB intolerant individuals or in combo with BB and nitrates

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Paroxysmal - terminates spontaneously with or without intervention, episodes vary
Persistent-sustain past 7 days
Long standing- greater than 12 months
Permanent- physician and pt make decision to stop further attempts to restore SR
Non valvular- absence of valve disease or disorder or replacement
Factors: HTN, obesity, OSA, hyperthyroid, alcohol and drugs, remodeling, generics, oxidative stress, RAAS
Symptoms-variable, palps, SOB, impaired exercise intolerance
Anticoagulants, ablation, drugs

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CHAD VASC score

Identifies risk for stroke
Greater than 2 need anticoagulants
Age-65-74 1 point, greater than 75 2 pts
Sex- female 1 pt
CHF- 1 pt
HTN- 1 pt
VTE HX- 1 pt if yes
Vascular disease- 1 pt if yes
DM- 1 pt if yes
Xarelto 20 mg daily with meal
Eliquis 2.5-5 mg twice a a day
Coumadin 2-3 INR

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HAS BLED score

Risk of bleeding with anticoagulant
1 pt
HTN
renal disease cr greater than 2.5
Liver disease
Stroke hx
Major bleed
Label INR
Age greater than 65
Alcohol greater than 8 drinks per week
Meds with predisposed factors to bleed
Greater than 3 high risk
Correct modifiable risk factors
Should not be used as a way to exclude OAC therapy

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Ventricular arrhythmias

Beta blocker first choice
ICD if recurrent or CHF less than 35%% and life expectancy greater than 1 yr even without presence of arrhythmia

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Brady arrhythmias

May have fatigue, lightheadedness, reduced exercise intolerance
Pre syncope or syncope
Loop, event monitor, DC meds, manage conditions causing
Pacer if needed

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Cardiomyopathy WHO classification

1-5
1 dilated- enlarged systolic dysfunction
2-hypertrophic- thickened, diastolic dysfunction
3- restrictive- diastolic dysfunction
4-arrhthmogenic RV dysplasia-fibroelastosis replacement
5-unclassified-fibreoclastosis, LV non compaction

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CM etiologies

Ischemic
Valvular
HTN
inflammatory
Metabolic
Inherited
Toxic reactions
Peripartum

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Dilated CM

Reduced systolic function with or without CHF
Myocyte damage
Can lead to valvular issues or arrhythmia
AKA alcoholic CM, congestive CM, diabetic CM, familial dilates CM, idiopathic CM, ischemic CM, peripartum CM, primary CM
fatigue, DOE, SOB, orthopnea, edema, weight gain or abdominal girth

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Hypertrophic CM

Genetics
Can cause sudden cardiac death in young adults
Avoid high dose diuretics or vasodilators
BB

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Amyloid CM

Sarcoidosis
Endomyocardial fibrosis
Right greater than left CHF
Steroids for sarcoidosis

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Takotsubo CM

Mimics ACS symptoms
Stress CM
Acute illness, emotional stressor, surgical procedure, exogenous catecholamines
Can see STEMI
Usually return to normal 3 months post

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Aortic stenosis

Transaortic gradient greater than 40
Impaired forward flow
Pressure on LV can cause dysfunction
Usually degenerative or calcification of valve or bicuspid
Angina, DOE, CHF, syncope*
Mid to late systolic ejection murmur radiates to carotids, S4 gallop, left ventricular heave, EKG with LVH
TAVR or AVRzz a

Aortic regurgitation

LV overload can cause dysfunction
Higher than normal EF
Due to calcification, combo with AS, endocarditis, rheumatic fever, marfans, aortic dissection, syphilis
DOE, CHF, angina, high pulse pressure, bounding and collapsing pulses, early diastolic decresendo murmur systolic ejection murmur in acute severe AR, LVH on EKG
AVR

Mitral stenosis

Obstruction of blood flow to LA from LV
Strain on left atrium and cause pulmonary congestion, can cause atrial fibrillation
Cause by rheumatic disease, congenital, prosthetic valve, mitral annular calcification, left atrial myxoma, combined with MR
DOE, orthopnea, leg edema, decreased exercise capacity
Early diastolic opening snap low pitched, diastolic murmur at apex, pulmonary HTN, right heart failure
Valvuloplasty, MVR

Mitral regurgitation

More complete left ventricular emptying eventually left ventricular will volume overload and right heart failure occurs
Caused by infective endocarditis, ischemic heart disease, MVP, trauma, CM
SOB, orthopnea, pulmonary rales, tachycardia, narrow pulse pressure, S3, short harsh systolic murmur, blowing sound, holosystolic murmur radiating to axils, thrill
MVR, miraclip, M TEER

Murmurs

Systolic- aortic stenosis, mitral regurgitation, pulmonary stenosis, tricuspid regurgitation
Diastolic-aortic regurgitation, mitral stenosis, pulmonary regurgitation. Tricuspid stenosis
Grade by sound-1-6, 6 can be heard without stethoscope and associated with thrill

Mitral stenosis

Diastolic rumble early-late
No radiation
Increase S1

Tricuspid regurgitation

Holosystolic blowing with increase intensity on inspiration.
Thrill at LLSB with RVH

Mitral valve prolapse

Late systolic preceded by mid systolic clock
Holosystolic if severe

Tricuspid stenosis

Diastolic rumble Increase in early and late diastole Increase with inspiration Rare May have thrill, increased JVD,

The valve closure that is best heard at the bases of the heart are

Aortic and pulmonic

Which of the following statements is true about S1

S1 coincides with carotid pulse pressure

You are auscultating the heart of an older adult at the 2nd right intercostal space. You hear a 2/6 murmur, the murmur is louder with squatting. There is a small carotid pulse delay with upstroke. The patients history is benign. His activity tolerance is normal. The NP would interpret this murmur as

Aortic stenosis-squatting increases preload and systolic murmur

The NP is examining a women with a known history of mitral valve disease what type of murmur will be heard on auscultation that supports a history of mitral stenosis

Diastolic murmur heard best at the apex with the patient on her left side

The vital signs of a 70 year old patients with HTN are 180/100, HR 90 you hear an extra heart sound at the apex before S1, you can only hear it with the bell while the patient is in a left lateral position with these findings and patients history this extra heart sound is likely

Atrial gallop S4 occurred with decreased compliance of the ventricles and fluid overload

Indicates decreased compliance of ventricles like in CHF

Cycle

Diastole S1- Tricuspid and mitral open Systole S2-aortic and pulmonic open Diastole

A thin young adult comes into the ER with a sudden onset of chest pain and SOB after run what do you suspect

Myocardial infarction or spontaneous pneumothorax

When a patient with cardiac disease is following the DASH first as part of their lifestyle modification the total fat should compromise of what prevent of the diet

27%

Which drug is used for the treatment of CAS should be avoided in patients with asthma

Metoprolol

A women has had stable angina for 4 years with pain resolving within 3-4 minutes with rest and SLNG but the patients reports a sudden change where the pain is more intense, last longer, occurs at rest and is unrelieved by nitro the NP should

Refer to the ER for cardiac care

Pharmaceutical therapy for mitral valve disease in adults includes

Treatment of dyspnea with diuretics to relieve congestion

Which would be the last suggestion you would consider in a patients with long term chronic ischemic heart disease

Coronary angiogram

Which of the following is true about aortic stenosis

Cardinal symptoms include dyspnea, angina and syncope

You are managing a client with CHF The patient takes Coreg 12.5 mg BID, lisinopril 2.5 mg daily, lasix 80 mg daily, aldactone 25 mg daily, he is in the price to see for you a 2 week follow up and he shares that he has gained 7 pounds in the last week: he states he has been faithful to his fluid and dietary restrictions and his urinary output is slightly less. What medication would you add to help the loop diuretic

Metolazone

Sandra says she wants to know more about the pooled cohort equation to determine her 10 year risk of ASCVD you tell her the variable include which of the following

Cholesterol-total and HDL Systolic BP diabetes Current smoking status