cardiac SM Flashcards
When ASCVD risk is >____, start a stain
7.5%
What is normal total cholesterol level? Triglycerides? HDL? LDL
<200
<150
40-60
<100
What are 2 high intensity statins?
Atorvastatin 40-80
Rosuvastatin 20-40
What are expected findings of a patient with high cholesterol levels?
arcus senilus
xanthelasma - younger (benign in elderly)
Go to treatment before medication?
lifestyle modifications
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
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
What should a patient not ingest if they are taking a statin?
grapefruit juice
What differentiates rhabdomyolysis from acute drug-induced hepatitis?
rhabdo - MUSCLE PAIN
Triglycerides are >500, what should you start this patient on? What are we trying to prevent?
Fenofibrate
pancreatitis (>500 high risk)
What are 2 possible signs of necrotizing pancreatitis?
cullens and turners sign
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
When should you initiate treatment with AHA/ACC guidelines?
<130/80
What herbal supplement is good for the heart?
Coenzyme 10 - CoQ10
What is our initial plan of attack for any new
hypertension patients?
lifestyle modifications
consider at home monitoring and follow up
What labs should be monitored for a patient taking ACE inhibitors?
renal function - BUN, creatinine, potassium
risk of hyperkalemia
What medication should be substituted for the patient that experienced angioedmea with ACE inhibitors?
ARB -sartan
ACE first - decrease CV events and mortality
Who should NOT be put on a thiazide diuretic? Who benefits the most from this medication?
Hyperglycemia
Uric acid
Hypertriglyceridemia
good - Osteoporosis
Who should NOT be put on a beta blocker?
not first line! (given after a MI)
NO COPD, asthma
Who should NOT be put on a calcium channel blocker?
GERD
What are common complaints of calcium channel blockers?
ankle edema
headaches
What 3 medications are SAFE for pregnancy?
New Little Momma
Nifedipine
Labetalol
Methyldopa
What are category X medications for pregnancy?
Statins
ACEi, ARBS
Dmards - methotrexate
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?
S2
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
