Cardiac Flashcards
Systolic BP 140-159 and Diastolic BP 90-99 is what stage of hypertension
Stage I Hypertension
Risk factors for Coronary Heart Disease (CHD) includes:
- Hypertension
- High/Elevated LDL
- Cigarette Smoking
- Low HDL
- Family Hx of premature CHD
Medications that has proven efficacy in reducing elevated lipids
- Statins (HMG Co-A reduc Inhib)
Patients with dyslipidemia should be screened for what?
- Diabetes (BG)
- Renal Disease (BUN and Cre)
- Hypothyroidsim (TSH)
The primary effect eating has on a lipid profile is the:
- Triglycerides - Triglyceride levels occurs 3-4 hours after eating, but may peak during a 12 hour period.
CHD risk equivalents include:
- Diabetes
- Symptomatic C.A.D
- P.A.D
- Abdominal Aortic Aneurysm
- Multiple risk factors that confer a 10 year risk of CHD > 20 percent
Stage II Hypertension is diagnosed when?
- Systolic BP > 160
* Diastolic BP > 100
Statins are most beneficial when taken:
- In conjunction with diet and exercise
1st line treatment for hypertension is:
- Weight loss
* Lifestyle Modifications
If a patient, taking a statin drugs, complains of muscle or joint pains, which labs should be drawn?
- CPK or…
- CK or…
- CK-MG
- ** Any lab that will show that a breakdown in muscle tissue has occurred***
Treatment for stage II hypertension includes:
- Dual Therapy - usually a:
- Thiazide Diuretic and…
- CCB, ACE-I, or ARB
- ACE-I and ARB cannot be a combo*
Systole/S1, which is the lub sound, is considered the closure of which valves
- Mitral and…
* Tricuspid
A holosystlic or pansystolic murmur, best heard at the apex, and can possibly radiate to the axillae, is suggestive of ____
- Mitral Regurgitation
An audible S3 sound heard in middle age and elderly adults is suggestive of
- Systolic Dysfunction (CHF)
The “GOLD STANDARD” for diagnosing hypertension is:
- An elevated SBP or DBP on 3 different occasions (days)
* An extremely elevated (>200 SBP & >110 DBP, with symptoms)
- An acute or sudden onset of “Tearing” severe low back/abdominal pain.
- Presents with abdominal bruit with abdominal pulsation.
- Dissecting Aortic Anyeursm
1st line pharmacological treatment for Stage I hypertension includes:
- Thiazide Diuretics (1st choice)
- CCB
- ACE-I
- Beta-blockers
A midsystolic murmur heard at the 2nd intercostal space, on the right side of the sternum, that can radiate to the neck is suggestive of _____
- Aortic Stenosis
In Diastole/S2, which is the “Dub” sound, which valves are closing?
- Aortic, and…
* Pulmonic
Symptoms of “DECREASED” cardiac output includes:
- Dypsnea on exertion
- Chest Pain
- Orthopnea
- Syncope
- Near Syncope
The main cause of “Mitral Stenosis” is:
- Rheumatic Infection (Strep Infection)
In diabetics, at what BP should pharmacological treatment begin
- 140/80 or greater
How often should a fasting lipid profile be done in diabetic patients
- Annually
* For patients with levels at or under goal, every 2 years is fine.
Diabetics with increased for Cardiovascular Disease (CVD), should be placed on _______, as primary prevention.
- Aspirin (75mg-162mg/day)
* Plavix 75mg/day (for Aspirin Allergy)
Primary cause of hyper/dyslipidemia
- Familial genetic defect
How does “Mitral Regurgitation” effect cardiac output
- “DECREASES” cardiac output
When starting on an ACE-I, what is lab is most important to monitor?
- Potassium (K+)
- ACE-I can impair renal excretion of K+ with normal kidney function, and can increase the risk of hyperkalemia with impaired renal function.
Secondary causes of hyper/dyslipidemia include:
- ↑ intake of cholesterol, trans, and saturated fats (do lipid profile)
- Diabetes (do BG check)
- Hypothyroidism (do TSH, or thyroid panel)
Medications that is frequently used to improve long-term outcomes in patients with “SYSTOLIC DYSFUNCTION”
- ACE- Inhibitors
The initial evaluation of intermittent claudication would include:
- Ankle and Brachial BP checks before and after exercise
When heart block is present, which hypertensive medications are contraindicated
- Alpha-blockers
- Beta-blockers
- Calcium-blockers
Which class of medications affects smooth muscle
- Calcium Channel blockers
* Examples: Amlodipine (Norvasc), Nifedipine (Procardia), Verapamil
- A condition in which the two valve flaps of the mitral valve do not close smoothly or evenly.
- Also known as “Click-Murmur Syndrome”, “Barlow’s Syndrome” or “Floppy Valve Syndrome”.
- Mitral Valve Prolapse
Treatment for mild pre-eclampsia includes:
- Bedrest with bathroom privileges
- Close monitoring of weight and BP
- Monitor of urine protein, creatinine, and platelets counts
- Antihypertensive medication that can exacerbate COPD and CHF
- Beta-blockers
A cough noted with heart failure is usually described as:
- Wet
- Worse when lying down (recumbent)
- Worse at night
Which hypertensive medication has a sulfa ring attached to it
- Hydrochlorothiazide
Patient with long standing poorly controlled hypertension, will have a PMI located where?
- 5th intercostal space, to the left
This is of greatest value when evaluating heart valves, chamber size, cardiac output, and overall function of the myocardium
- Echocardiogram
The most common arrhythmia from valvular heart disease is:
- Atrial Fibrillation
Systolic Murmurs include:
- Aortic Stenosis
- Mitral Regurgitation
- Pulmonic Stenosis
- Tricuspid Regurgitation
- This arrhythmia is considered intermittent or self-terminating.
- Episodes usually terminate within 7 days.
- It is usually asymptomatic
- Paroxysmal Atrial Fibrillation
Secondary Hypertension causes include:
- Renal (Renal Stenosis, Renal Failure)
* Endocrine (Adrenal Tumors, Hyperthyroidism)
Medication that helps HTN and BPH
- Alpha 1 - Blockers
* Example (Tarazosin, Tamsulosin)
What symptoms are found in Hypertensive retinopathy
- AV nicking
* Copper and Silver wire arterioles
Side effects of Thiazide diuretics include:
- Hyperglycemia
- Hyperuricemia
- Hypertriglyceremia
Treatment for Isolated Systolic Hypertension in the Elderly includes:
- Thiazide diuretic (1st choice)
* If needed, add CCB (Amlodipine, Nifedipine)
Women with hypertension and osteopenia/osteoporosis should receive _____ because they help bone loss by slowing down calcium loss
- Calcium Channel blockers (1st choice)
* Thiazide Diuretics
- Jugular vein distention
- Enlarged spleen and liver
- Lower extremity edema
The above signs and symptoms are indicative of:
- Right-sided Heart Failure
Abrupt discontinuation of beta-blockers could cause what?
- Rebound Hypertension
- Palpitations
- Chest Pain (Angina Pectoris)
S3 heart sound can be benign in which populations
- Athletes
- Youth
- Pregnancy
Side Effects of Calcium Channel Blockers
- Edema of the Ankle
- Dizziness
- Headaches
- Flushing
- Weakness
Pulse deficit is the difference between _____ and ______
Apical and Radial pulse, which is taken at the same time (subtract radial from the apical)
What grade of murmur can be felt during palpating
Grade 4 or higher
In hypertensive target organ damage, the organs commonly affected include:
- Kidneys (Renal failure and Proteinuria)
- Eyes (Retinopathy, AV Nicking, Bleeding, and Blindness)
- Heart (Heart Disease, CHF, LVH, and MI)
- Brain (Stroke, TIA)
Signs and Symptoms are this disorder include:
- Shortness of breath especially during activities of daily living or when lying down
- Fatigue during times of exercise,
- Coughing especially when lying down
- Palpitations and Pedal edema
- Heart murmurs,
- Polyuria
- Syncope, dizziness, chest pain, angina type like squeezing, crushing, and pressure tightness.
AORTIC STENOSIS
- Types of QT syndrome in which the heart cardiac muscle takes longer than normal to recharge between heart beats.
- Jervell and Lange Neilson Syndromes
In Bacterial Endocarditis, skin finding are mostly found where?
- Fingers, hands, toes, and feet
- Subhungual heomorrages (splinter hemorrhages)
- Petechiae on the palate
- Pain violet-colored nodes on the fingers or feet (Osler Nodes)
- Tender red spots on the palms/soles (Janeway Lesions)
Low tone heart sounds (S3 or S4) or Mitral Stenosis can be heard with which side of the stethoscope?
Bell Side
Mid and High pitch heart sounds and Lung Sounds, along with Mitral Regurgitation and Aortic Stenosis can be heard with which side of the stethascope
Diaphragm Side
Diastolic Murmurs are ALWAYS indicative of:
Heart Disease
- Described by the location of “on the apex” or “apical area” of the heart, or…
- On the 5th ICS on the left side of the sternum, medial to the midclavicular line
- Mitral Murmurs
What is the “CHADS2” Scoring system used for?
- To determine if treatment for atrial fibrillation is needed (2 CHADS2 factors required anticoagulation)
Causes of Paroxysmal Atrial Tachycardia (Paroxysmal Supratachycarida) include:
- Digoxin Toxicity
- Alcohol
- Hyperthyroidism
- Caffeine Intake
- Illegal Drugs
How can Paroxysmal Atrial Tachycardia/Paroxysmal Supratachycardia be interrupted or stopped
- Valsalva maneuver
What action is to be taken with an INR of 3.0 to 5.0
- Skip 1 dose. ↓ maintenance dose. Check INR in 1 to 2 days until normal.
- This is when the apical pulse can still be heard, even thought he radial pulse is no longer palpable.
- It is measured by using a BP cuff and stethoscope
- Pulsus Paradoxus (Paradoxical Pulse)
Causes of Pulsus Paradoxus/Paradoxical Pulse include:
- Asthma and Emphysema (↑ positive pressure)
* Cardiac Tamponade, Pericarditis, Cardiac Effusion (↓ movement of the LV)
What action is to be take with an INR of 5.0 to 9.0
- Omit a dose and give a small dose of Vitamin K, or…
- Omit next 1 to 2 doses
- Decrease maintenance dose
- Daily INR monitoring until normal
The INR for Atrial Fibrillation should be
- 2.0 to 3.0
The INR for Prosthetic Heart Valve should be
- 2.5 to 3.5
- A person age 60 or older with a systolic BP of 160 or higher, but has a normal diastolic B/P
- It is due to reduced vascular compromise in large arteries (stiffened vessels as we age)
- It is a significant predictor of cardiovascular events in the elderly (↑ risk of strokes and M.I’s)
- Isolated Systolic Hypertension
Treatment for Isolated Systolic Hypertension includes:
- Thiazide (1st line)
* May add a D-CCB (Amlodipine, Nifedipine, or ACE-I
Side effects of Aldosterone Receptor Agonists Diurectics (Spironolactone/Aldactone)
- Gynecomastia
- Hyperkalemia
- GI irritation (Nausea/Vomiting, Diarrhea, Cramping)
- Post menopausal bleeding
- Erectile Dysfunction
Gold standard for diagnosis for of DVT
- Venography/B-Mode ultrasound with Doppler flow, or MRI
Gold standard for diagnosis of PVD or PAD
- Angiography
What is the most sensitive marker for “Myocardial Damage”
Troponin-I (cTnI)
Absolute Contraindications for Fibrinolysis are:
- Any prior history of intracranial hemorrhage
- Known structural cerebral vascular lesion (AV Malformation)
- Known Malignant Neoplasm (Primary or Metastatic)
- Ischemic Stroke within 3 months “EXCEPT” acute ischemic strokes within 3 hours
- Suspected Aortic Dissection
- Active bleeding or bleeding Diathesis
- Significant closed-head or facial trauma within 3 months
- Which lifestyle modification has the greatest reduction effect on blood pressure?
- Weight Reduction (Reduces it by 5-20mmHg/per 10Kg)
- Which population of people are Mitral Valve Prolapse commonly found in?
- People with Thoracic Disorders or Scoliosis
* Women in their “Child-Bearing” Years (Age 18-35)
- 1st line pharmacological therapy for hypertension patients with diabetes includes:
- ACE-I or A.R.Bs (they ↓ progression of renal damage)
- How much can weight reduction reduce B/P?
- 5-20mmgHg per 10kg
- How much can diet reduce B/P?
- 8-14mmHg
- In patient with bilateral renal artery stenosis, which medications with precipitate/cause “Acute Renal Failure”
- ACE-I (Ace-Inhibitors)
- What physical assessment can be done to assess for a DVT?
- Homan’s Sign (If +, very highly of DVT)
