cardiac SM Flashcards by Kimber Heard

When ASCVD risk is >____, start a stain

7.5%

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What is normal total cholesterol level? Triglycerides? HDL? LDL

<200
<150
40-60
<100

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What are 2 high intensity statins?

Atorvastatin 40-80

Rosuvastatin 20-40

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What are expected findings of a patient with high cholesterol levels?

arcus senilus

xanthelasma - younger (benign in elderly)

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Go to treatment before medication?

lifestyle modifications

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If you suspect rhabdomyolysis in a patient that is on a statin, what lab should you order? If you do not discontinue the statin, what may happen?

CK level
5x normal limit
acute renal failure

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If a patient on a statin develops new jaundice, what do you suspect? What lab should you order?

acute drug induced hepatitis

liver function tests

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What should a patient not ingest if they are taking a statin?

grapefruit juice

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What differentiates rhabdomyolysis from acute drug-induced hepatitis?

rhabdo - MUSCLE PAIN

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Triglycerides are >500, what should you start this patient on? What are we trying to prevent?

Fenofibrate

pancreatitis (>500 high risk)

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What are 2 possible signs of necrotizing pancreatitis?

cullens and turners sign

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When should you initiate treatment with JNC 8 guidelines? (>60 years, <60 or CKD, DM) Goal BP?

> 60 years >150/90
<60 years CKD, DM>140/90

Goal: <140/90

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When should you initiate treatment with AHA/ACC guidelines?

<130/80

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What herbal supplement is good for the heart?

Coenzyme 10 - CoQ10

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What is our initial plan of attack for any new

hypertension patients?

lifestyle modifications

consider at home monitoring and follow up

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What labs should be monitored for a patient taking ACE inhibitors?

renal function - BUN, creatinine, potassium

risk of hyperkalemia

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What medication should be substituted for the patient that experienced angioedmea with ACE inhibitors?

ARB -sartan

ACE first - decrease CV events and mortality

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Who should NOT be put on a thiazide diuretic? Who benefits the most from this medication?

Hyperglycemia
Uric acid
Hypertriglyceridemia

good - Osteoporosis

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Who should NOT be put on a beta blocker?

not first line! (given after a MI)

NO COPD, asthma

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Who should NOT be put on a calcium channel blocker?

GERD

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What are common complaints of calcium channel blockers?

ankle edema

headaches

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What 3 medications are SAFE for pregnancy?

New Little Momma

Nifedipine
Labetalol
Methyldopa

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What are category X medications for pregnancy?

Statins
ACEi, ARBS
Dmards - methotrexate

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Initiate blood pressure medications if a patient has an ASCVD risk of :

> 10%

hyperTENsion

A "go-to" blood pressure medication for a patient with hypertension and diabetes? What should NOT be given to this patient?

ACE inhibitors and ARBs kidney protection Thiazides (increase glucose)

What is isolated systolic hypertension? What is the preferred BP medication?

ISH - elderly, elevated systolic, normal diastolic, stiffened arteries Calcium channel blockers

__________ occurs when there are variances in heart rate upon inspiration and expiration. Who do you see this most commonly in? Do you need to intervene/treat?

Respiratory sinus arrhythmia young and healthy athlete NO

Describe pulsus paradoxus. What is suspected with this?

There is a 10 point drop in systolic BP upon expiration cardiac tamponade, status asthmaticus, etc

What are initial diagnostic tests to determine if a patient has heart failure?

BNP EKG ECHO - ejection fraction is 40-50 <40% = HF

What medications should a patient with heart failure be on?

diuretic | ACE or ARB

What extra heart sound is heard with fluid overload?

S3 pregnancy is also S3 heart sound

What OTC medications should a patient with heart failure avoid?

NSAIDS!!!! increases sodium and fluid retention = exacerbation

A patient with diabetes, heart failure, and hypertension. What medication would be good for this patient?

ACE inhibitor | maybe beta blocker

When should a heart failure patient call you based on weight gain amount?

2Kg in one day

What diabetic medication should be AVOIDED in the heart failure patient?

TZDs

What 2 medications are atrial fibrillation patients on?

anticoagulant - aspirin, warfarin | Rate control - Metoprolol

What is the goal INR for the patient on warfarin with atrial fibrillation? A patient with a stent?

Afib, DVT 2-3 | stent: 2-2.5 or 2.5-3.5

What is the antidote to Warfarin?

vitamin K

The only heart sound heart at the base of the heart?

When is hearing a split S2 normal? When is it not normal? Where do you auscultate for a split S2?

split S2 during inspiration ONLY = normal heard during inspiration and expiration = ABNORMAL base

When do you hear the S1 heart sound?

AV valves | closure of mitral and tricuspid

When do you heart the S2 heart sound?

Semilunar valves | closure of aortic and pulmonic

When do you hear S3 heart sound?

fluid overload

When do you hear S4 heart sound?

uncontrolled HTN | LV hypertrophy

What are the only murmurs that radiate?

systolic murmurs

What is the mnemonic for diastolic murmurs?

MS. ARD mitral stenosis aortic regurgitation

what is the mnemonic for systolic murmurs?

MR.PASS MVP mitral regurgitation aortic stenosis mitral valve prolapse

What murmur radiates to the axilla?

mitral Regurgitation | aRmpit

What murmur radiates to the neck?

aortic stenosis | closer to the neck

When is MVP common with a click sound?

Marfan syndrome

What grade murmur do we feel a palpable thrill?

grade IV

What are expected findings of peripheral arterial disease?

intermittent claudication (pain with walking) shiny, purple shins without hair decreased blood flow ulcers on feet/toes

What score of ABI indicates PAD?

<0.9 | dividing BP in artery of ankle by BP in artery in arm

What is the biggest risk factor of PAD?

smoking!

What are expected signs and symptoms of chronic venous insufficiency?

reddish-brown discoloration of skin varicose veins Swelling/heaviness

What are peoeple with Chronic venous insufficiency at risk for?

clots - DVT

what are s/s of DVT? What is a diagnostic sign? What should be ordered?

Localized swelling with tenderness and warmth Pain in calf, foot, or leg Homan's sign - not considered accurate anymore DX: doppler

What is raynaud's phenomenon? Triggers? Treatment?

decreased blood flow to fingers cold, stress Tx: calcium channel blockers, avoid triggers