Cardiac Flashcards
What does an S3 sound indcate?
CHF or pregnancy
What is S4 a sign of? Sounds like Tennessee.
LVH or elderly with stiff arteries
Murmur heard moderately loud with stethoscope plus a thrill.
Grade 4 murmur
A loud murmur heard without a stethoscope.
Grade 6 murmur.
Aortic stenosis is a _____ murmur that radiates to the ____.
systolic, neck
Mitral regurgitation is a _____ murmur that radiates to the ______.
systolic, axilla
best heard at apex during S1
What is the gold standard to rule out AAA in 65 and older who smokes.
Ultrasound.
What do you prescribe for HTN in someone who also has osteoporosis.
thiazide
HTN drug for a diabetic with neuropathy
ACE or ARB
AV nicking is a sign of ______.
hypertension
Elderly patient with an isolated systolic hypertension BP log. What medication do you start?
CCB.
What test is used for PAD?
brachial index
Edema, thick and discolored lower extremities describes what?
Chronic venous insufficiency.
What test is used for stable angina?
Stress test.
Moderately loud with stethoscope. No thrill. Is what grade murmur?
grade III murmur.
Patient with gradual onset fever, hemorrhages on nail beds (subungual hemorrhages), painful red raised nodules on fingers/feet (Osler nodes), tender, red spots on soles/palms (Janeway lesions).
Bacterial endocarditis.
A carotid bruit signifies what?
narrowing of the carotid.
amlodipine
CCB
diltiazem (Cardizem)
CCB
verapamil
CCB
nifedipine (Procardia)
CCB
chlorthalidone
thiazide diuretic
hydrocholorthiazide
thiazide diuretic
atenolol labetalol metoprolol bisoprolol carvedilol propranolol Beta Blocker or Alpha-Beta blocker?
atenolol- BB labetalol- Alpha metoprolol- BB bisoprolol- BB carvedilol- Alpha propranolol- BB
enalapril
Ace inhibitor
lisinopril
Ace Inhibitor
captopril
Ace Inhibitor
losartan
ARB
valsartan
ARB
candesartan
ARB
hydralazine
vasodilator
What hypertension medication can cause a dry, hacking cough?
Ace inhibitors
What HTN medication class is avoided in CHF?
CCB
What HTN med class is avoided in asthma or COPD patients?
Beta Blockers
What does a positive Homan’s sign indicate?
DVT
(+) test with lower leg pain with dorsiflexion of foot
pain worse on ambulation (intermittent claudication), pain relieved by rest, shiny and hyperpigmented ankles that are hairless and cool, decreased pedal pulse
venous insufficiency or arterial insufficiency?
Peripheral arterial disease symptoms
S2 click with late systolic murmur
mitral valve prolapse (MVP)
normal LDL levels
< 100
normal HDL level
> 50
normal triglyceride level
<150
When to start Niacin or Fibrate?
when triglycerides over 500
Start statin if ASCVD risk over _____%
LDL > _____
diabetic with LDL ____-_____.
ASCVD risk over 7.5%
LDL > 190
DM + LDL 70-189
definition of coarctation of aorta
congenital defect, aorta is narrower than usual
DX: echo
symptoms of coarctation of aorta
HTN, lower extremities pulses are weak compared to upper pulses, murmur present
where do you best hear a split S2 sound?
pulmonic area
2nd ICS, left sternal border
What BP med should you wean off to avoid rebound HTN?
Beta blockers
Xanthelasma
lesions of the eyelids assoc. with high cholesterol
What is an abnormal ankle-brachial index score? And what does it screen for?
less than 1.0
Peripheral artery disease
What two HTN meds would you choose to start an 90 year old woman on?
CCB or thiazide diuretics
Pulsus paradoxus is the _______ in _______ pressure during __spiration.
decrease in systolic pressure during inspiration
closing of the semilunar valves is S1 or S2?
S2
S1 is atrioventricular valves closing
HTN meds preferred for Af Americans
CCB or thiazides
BP goal for all races/ages under 60?
Or if they’re over 60 with DM or CKD.
140/90
BP goal for over 60 y.o.
150/90
Arteriovenous nicking– on examination of the eye, a small ______ is seen crossing a small ______, which results in the compression of the _____ with bulging on either side of the crossing.
artery, vein, vein
What HTN med would you prescribe a person with HTN and osteoporosis?
thiazide diuretic
What is there an increased risk of when triglycerides are over 500?
pancreatitis
A carotid bruit is cause by carotid ______.
stenosis (plaque accumulation)
Where do you hear aortic stenosis best?
2nd ICS, R side
Rule out ______ ________ in females with mitral valve prolapse.
Marfan’s Syndrome
What grade murmur is the first time a thrill is felt?
Grade 4
T/F:
Do not mix statins with grapefruit juice.
true
Which two are high intensity statins? Rosuvastatin Simvastatin Atorvastatin Pravastatin
Rosuvastatin
Atorvastatin
What labs should be monitored while on statins?
LFTs
What effects do thiazides have on…
- blood sugar
- triglycerides
- potassium
- gout
elevates sugar
elevates triglycerides
lowers potassium
elevates uric acid
what can pulses paradoxus lead to?
asthma, emphysema, pericarditis, cardiac effusion
What are the starting doses of warfarin (Coumadin) for Afib in people under and over age 70?
under age 70 start at 5mg
over age 70 start at 2.5mg
When do give Vitamin K?
INR over 5.0
Goal INR for Afib?
Goal INR for prosthetic valves?
2-3
2.5-3.5
What is the gold standard for diagnosis of PAD?
angiography
low ext. edema, ruddy colored, dull and achy, ulcers, warm to the touch, with pedal pulses present is PAD or PVD?
PVD
test for PVD?
ultrasound
Who and what do you screen for AAA?
- men aged 65-75 who have ever smoked
- abdominal ultrasound
Heart block as a prolonged _____ interval.
PR interval
HTN meds ok for 1st degree heart block
BB and CCB
only for 1st degree though
Is right or left side HF caused by pulmonary hypertension and results in edema and/or ascites?
Right HF
Which side HF (R or L) has symptoms of SOB, fatigue, weakness, rapid or irregular heartbeat, reduced ability to exercise, persistent cough or wheezing with white or pink blood-tinged phlegm?
Left HF (left = lung)
treatment for Left heart failure?
ACEi & Lasix
What med is used for CAD prevention in the elderly?
aspirin
