cardio Flashcards
What causes S1 “lub”
The mitral and tricuspid valves closing (AV valve closure)
What causes S2 “dub”
The aortic and pulmonic valves closing (semilunar valve closure)
When might we hear S3
CHF, pregnancy, sometimes normal in children
What is the antidote to Heparin
Protamine sulfate
Systolic murmurs
MR PASS MVP (mitral regurg radiates to armpit) Physiological, Aortic Stenosis (radiates to neck) Systolic Mitral Valve Prolapse
the nurse practitioner notes a crescendo-decrescendo systolic murmur that radiates to the carotid artery. Which of the following is the most likely diagnosis?
Aortic stenosis. This type of murmur is best heard at the second intercostal space, right sternal border, and will radiate towards the neck. If the murmur had been described as a click and does not radiate, mitral valve prolapse is most likely. Aortic regurgitation would be described as a high pitch, blowing diastolic murmur while mitral regurgitation would best be described as a pansystolic or holosystolic murmur.
For an elderly patient who is presenting with isolated systolic hypertension, the best treatment is ….
a dihydropyridine (DHP) calcium channel blocker like Amlodipine (Norvasc).
Statin therapy should be initiated for prevention in
(1) patients with clinical atherosclerotic cardiovascular disease (ASCVD) such as a history of a myocardial infarction, (2) patients with LDL levels of 190 mg/dL or higher, (3) adults age 40-75 (without diabetes) with LDL 70-189 mg/dL with ASCVD risk score of 7.5% or greater, and (4) adults age 40-75 with diabetes and LDL 70-189 mg/dL regardless of ASCVD risk score.
An S4 sound is heard in patients with uncontrolled hypertension or left ventricular hypertrophy. The S4 sound is best heard at
5th ICS, left midclavicular line, heard during diastole (the apex of the heart).
Best heard when the patient is laying on their left side with arms raised. An S4 sound can also be heard in the elderly and be a normal finding.
What murmurs would be the most likely for the nurse practitioner to be able to palpate a thrill?
Diastolic!
Mitral regurgitation is a systolic murmur that radiates to the axilla. Where can it be heard?
Only systolic murmurs radiate, and all mitral murmurs (diastolic or systolic) can be heard at the apex of the heart.
ABI can be calculated by …
dividing the highest pressure in the right foot by the highest pressure in both arms.
A score of less than 0.9 indicates peripheral arterial disease. A normal result on an ABI ranges from 1.0-1.4.
Verapamil, a nondihydropyridine calcium channel blocker, is not the antihypertensive of choice when a patient presents with a heart block.
High intensity statins, like rosuvastatin 20-40mg/d, or atorvastatin 40-80mg/d should be initiated in patients with LDL >190, high risk conditions such as cardiovascular diseases, diabetes, or CKD. Patients over 65 years old should also be considered for high intensity statins. Lifestyle modifications are important in any case of hyperlipidemia.
Amiodarone is used for rhythm control, but is contraindicated in patients with
thyroid disorders.
