Cardiac system Flashcards
Types of murmur
Murmurs
I/VI – Barely audible
II/VI – Audible but faint
III/VI- loud, associated with a thrill
V/VI – Very loud; heard with one corner of the stethoscope off the chest wall
VI/VI – Loudest
Patient with CKD and hypertension, which drugs should they receive?
ACE inhibitor or ARB as initial or add-on therapy, because it improves kidney function
Patient with chronic kidney disease, and diabetes, the target bp is systolic __________ and diastolic ____________
140
90
What is the name of initial antihypertensive medication?
Initial treatment:
Thiazide diuretic, calcium channel blocker, ACE inhibitor, or ARB in the general nonblack population
Thiazide diuretic or calcium channel blocker in the general black population.
General black population, including those with diabetes, initial treatment should
thiazide diuretic or calcium channel blocker.
Anatomical position and their sound
S1
Mitral/tricuspids (AV)valves closure
S2
Aortic/pulmonic (semilunar) valves closure
Systole
Period between S1 and S2
Diastole
Period between S2 and S1
S3
“Ken-tuck’ y” increased fluid states (CHF, pregnancy, etc) heard in the pulmonic area also known as the “ventricular gallop”
S4
“Ten-ne-ssee” stiff ventricular wall (MI, left ventricular hypertrophy, chronic hypertension, etc).
Treatment does not need to be adjusted if it results in a systolic pressure lower than ____________as long as it is not associated with adverse effects on health or quality of life
140
For age less than 60 years, The target systolic pressure in this population is less than___________and the target diastolic pressure is less than ___________mm Hg
140
90
Even after adding second drug ( ace, arbs, calcium channel blockers, thiazide dieuretics), target bloodc pressure is not achieved, what should you do?
Drugs from other class should be used such as
beta blockers
aldosterone antagonist
referal is needed.
Why you should not combine an ACE inhibitor with an ARB)
ARBs should not be combined with ACE inhibitors because such combinations increase the risk of hypotension, hyperkalemia, and renal impairmen
Nonblack population who have hypertension and diabetes, initial antihypertensive treatment should include ________________________________________.
thiazide diuretic, calcium channel blocker, angiotensin-converting enzyme (ACE) inhibitor, or angiotensin receptor blocker (ARB).
If the target blood pressure is not reached within one month after initiating therapy, what should provider do?
the dosage of the initial medication should be increased,
or a second medication should be added.
_____________________one of the most important preventable contributors to disease and death in the United States, leading to myocardial infarction, stroke, and renal failure when it is not detected early and treated appropriately
Hypertension
When should provider start antihypertensive medication? Age and disease specific recommendation
150/90 mm Hg or higher in adults 60 years and older,
140/90 mm Hg or higher in adults younger than 60 years.
In patients with hypertension and diabetes, pharmacologic treatment should be initiated when blood pressure is 140/90 mm Hg or higher, regardless of age.
For age more than 60 years, Patients should be treated to a target systolic pressure of less than __________mm Hg and a target diastolic pressure of less than ___________mm Hg.
150
90
.
first line diagnostic test for coronary artery disorder- ischemia or stenosis
Duplex ultrasound
Treatment for corotid stenosis or ishcemia
Carotid angioplasty and stent
carotid endartectomy
aspirn and statin
Where do you hear kentucky and tenesse sound?
Apex
during left decubiti position
S3 is ______—–
kentucky
S4 _________–
Tenesse
Physical exam what do you find for AAA?
Aus- BRUIT
Palpation- mass in the abdomen
Ct scan/mri/usg
Who needs screening for AAA?
USG screening and PE- 60 years and older, whose offspring/siblings have AAA
60 to 75 years old who have ever smoked
Abdominal aortic aneurysm define?
Diameter of more than 3 cm, 50% increase in diameter.
Risk of rupture?
Diameter of more than 5 mm
sign of ruptured aaa?
hypotension
pulsatile abdomen mass
abdomen pain
back pain, groin pain, leg pain, chest pain
vomiting
dyspnea
Aortic stenosis
2nd RT intercostal space
rough harsh murmur
radiate to the neck
Aortic regurgitation
2nd Left ICS
diastolic blowing murmur
mitral valve prolapse
Split s2 heart sound
heard at the apex
mitral regurgitation
5 th ics
