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3P > Cardio > Flashcards

Cardio Flashcards

1
Q

Treatment for HTN (general drug classess)

A

think “CAT”

Calcium channel blockers
Ace/Arbs
Thiazide diuretics

**Remember – BB not first line, unless another more prominent indications such as afib/angina

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2
Q

White coat hypertension vs Masked HTN

A

WC - BP elevated in presence of medical professional but normal at home

Masked - High BP at home but normal at office

**Ambulatory BP x3months at home, base tx off that

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3
Q

what medication class is chlorthalidone?

A

thiazide diuretic

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4
Q

What is a good 1st choice medication class for HTN?

A

Ace/Arbs

** Unless African American with CKD, then no Ace/Arb since HTN not as driven by RAAS system

** any population = good start low dose amlodipine –> can cause feet swelling

*** can start on thiazide diuretic (chlorthalidone or HCTZ) then if needed can add ace/arb on pill

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5
Q

What are the ABCDs of HTN?

A 
A = Ace/Arbs
B = Beta blockers 
C = Calcium Channel blockers
D = Diuretics
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6
Q

What do we use ace inhibitors for?

A

DM /scleroderma –> protects kidneys

CHF/p MI –> caridoprotective

Young pts (caucasian) w/ HTN

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7
Q

Beta blockers used for what DDx?

A

CHF/p MI –> improves survival (carvedilol/metoprolol for CHF)

young pts (Caucasian) w/ HTN

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8
Q

Calcium Channel blockers used in…

A

meds do not improve survival

Useful in AA & elderly

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9
Q

SE of Ace/Arbs

A

Angioedema –> emergency

Cough (Ace) –> switch to Arb
Hyperkalemia
Hyponatremia

Creatine increased in renal artery stenosis (contra)

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10
Q

SE of Beta blockers

A

bradycardia

Increase lipids/cholesterol
increase depression

worsen asthma/copd –> bronchospasm (contra)

Hyperkalemia

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11
Q

SE of calcium channel blockers

A

based on category

Dihydropyridines (-pine) nifedipine, amlodipine

  • peripheral vasodilation
  • HR Increases/stays the same (except for amlodipine which decreases HR)

Non-dihydropyridines; diltiazem, verapamil
-reduction in inotrope (reduces contractility of heart) –> decreased HR
usefull in afib RVR

Other SE
edema, constipation, HF (d/t negative inotrope effects)

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12
Q

SE of Diuretics (loop vs HCTZ)

A

Loop:

  • decreases Ca, K, Na
  • Increase Creatine –> AKI

HCTZ: ascending limb
increases: Ca level serum but decreases Ca excretion, uric acid (worsens gout), lipids, glucose
Decreases: K

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13
Q

Ace & Arb MOA

A

MOA: block conversion of angiotensin I -> II

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14
Q

What is the typical medication suffix for the medication classes ACE/ARBs

A

Ace: “-pril”

ARB: “-sartan”

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15
Q

What is the first choice medication for tx of HTN in pts with DM or renal disease?

A

Ace/Arbs —> Unless in black pts (then 1st line is diuretic)

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16
Q

Side effects for Ace/Arbs

A

Ace — Dry hacking cough 1-2 weeks after tx start –> switch pt to Arb

  • First dose hypotension
  • Hyperkalemia
  • Acute renal failure
  • Angioedema

***Do not combine both ACE/ARBS –> increased AE

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17
Q

When should you avoid the use of ACE/ARB ?

A

Pregnancy
Renal artery stenosis
Acute renal insufficiency

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18
Q

What is the definition of a murmur?

A

sound detected when there is turbulent blood flow through the great vessels or across a heart

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19
Q

What 2 vavles cause nearly all of the trouble in adults?

A

Aortic and mitral

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20
Q

Amelies 3 rules for murmurs

A
  1. Stenosis vs Regurgitation (where is it heard / check pulse)
  2. Where is it heard the loudest?
  3. Are there associated findings (CP, SOB, cyanosis, exercise intolerance, palpitations, BP, thrill, changes with positioning)
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21
Q

Systolic murmurs

Mr. Peyton Manning AS MVP

A

Mr. = Mitral Regurgitation (SOB/ fatigue, HF)

Peyton Manning = Physiologic Murmur (Asymptomatic, can be normal. Kids & young adults)

AS = Aortic stenosis (angina, syncope, HF) 
MVP = Mitral valve prolapse (palpitatiosn, CP, "click"
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22
Q

Diastolic Murmurs

Mnemonic: ARMS!

A

All diastolic murmurs are abnormal!

AR = Aortic regurgitation (Angina, syncope, HF) 
MS = Mitral stenosis (Dyspnea, Afib) - can be caused by rheumatic heart disease from strept throat
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23
Q

what are associated findings with aortic stenosis?

A

“ASC” (Aortic stenosis Complications)

Angina, Synocpe, CHF

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24
Q

1 choice for HTN in pregnancy?

A

Methyldopa

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25
Q

Heart failure (patho)

A

Not enough forward flow in the heart –> leads to back up and congestion
-Kidney function decreases (reduced perfusion) -> activates RAAS & ADH system -> increased fluid retention –> symptoms

  • Pulm system- congestion affects lungs first –> pulm edema
  • Liver congestion –> Increased AST/ALT = “nutmeg liver”
  • Elevated pulm artery pressures
  • Pedal edema
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26
Q

Systole

A

“Lub”
active contraction –> blood pumped to systemic circulation

closure of AV valves (3-leaf)

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27
Q

Diastole

A

“dub”

Relaxation - blood enters into the heart and fills

-minimum arterial pressure exerted during relaxation and dilation of the ventricles

Closure of semilunar valves (2-leaf)

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28
Q

systolic dysfunction

A

heart cant contract

EF will decrease

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29
Q

Diastolic dysfunction (HFpEF)

A

heart can relax
unchanged EF

Normal EF -> blood cant get in –> Blood cant get pumped out which preserves EF

-Causes: Prolonged HTN –> muscles to thicken preventing relaxation of heart (L ventricular hypertrophy)

30
Q

What is the most important aspect in controlling CVD?

A 
Controling LDL (bad cholesterol) 
VLDL (very bad )

*HDL = good cholesterol

31
Q

what medication class is used to treat hyperlipidemia?

examples of “big guns”

A

HMG-CoA reductase inhibitors

Atorvastatin (Lipitor) 40-80mg
Rosuvastatin (Crestor) 20-40mg

** these decrease LDL by 50%

32
Q

What is the #1 of pathogen of endocarditis?

What are the most common causes?

A

Staph Aureus

Causes: skin lesions, IV drug use, Dental work

33
Q

what is endocarditis?

A

inflammation of the endocardium (inner lining of the heart)

affects heart valves - most often Mitral

34
Q

What are Janeway Lesions? what do they indicate?

A

non-tender small erythematous lesions (macular, papular, or nodular) on the palms

indicate infective endocarditis!

35
Q

Pt has chest pain that is relieved by leaning forward… what is a possible DDx?

A

Endocarditis

36
Q

What is the mechanism of action of Prostaglandin in a pt with transposition of the great vessel?

A

to produce vasodilation and provide adequate oxygenation

**prostaglandin slows down the closing of ductus arteriosus and PFO allowing O2 blood to cross from pulm circulation to systemic circulation through congenital pathway

37
Q

What causes Afib?

A

Heart failure, Electricity issue, pMI, valve issues

38
Q

how do we treat afib?

A

ventricular rate control : Betablocker or non-dihydropyridine calcium channel blocker

rhythm control with antiarrhythmic drug

anticoagulation: warfarin

39
Q

how long does it take proximal afib to terminate?

A

7 days

40
Q

How is peripheral artery disease (PAD) defined?

A

Ankle-brachial index (ABI) of <0.90

compare BP of lower extremity and upper extremity

41
Q

Assessment finding for PAD

A
  • Most asymptomatic
  • Intermittent Claudication - earliest manifestation. pain in legs with exercise relieves with rest (2-5 mins) . only 10% of pts
  • pain, ache, cramp of feeling tired in extremity foot, calf, thigh or buttocks with exercise
  • narrow lumen produces characteristic pain distal to site
  • lack of hair growth
  • thickened toenails
  • diminished pulses
  • pale, cool extremities
  • dependent rubor
  • prolonged cap refill
  • bruit in abd, fem or popiteal
42
Q

Gold standard for PAD diagnosis

A

Contrast angiography - highly sensitive

also do duplex Us & doppler, ABI

43
Q

Treatment for PAD

A

Antiplatelet: Petal, Plavix, ASA

Pentoxifylline - decreases blood viscosity

High intensity statin - atorvastatin, rosuvastatin

44
Q

Varicose Veins physical assessment

A

Assess by having pt STAND

Trendelenburg Maneuver - assess valves of peripheral veins

supine leg 90degrees
occlude greater saphenous
Have pts stand continuing to occlude saphenous for 20 seconds
then have pt stand to “map” veins ?

45
Q

Tx for varicose veins

A

cosmetic

laser therapy/abaltion
sclerotherapy
surgery

46
Q

when starting coumadin, when should you get your first INR based off of known half life?

A

3 days

47
Q

Missed dose for warfarin…. what are next steps?

A

<12 hours –> take dose and continue on. INR in 1 week

> 12 hours = take next dose at time due. Notify MD. INR in 3-7 days

48
Q

What is the antidote for warfarin?

A

Vitamin K

49
Q

Reversal agents for DOACs (direct oral anticoagulants)

A

(becoming more prevalent then warfarin, less interaction, but equal therapeutic effect)

  1. Andexanet alfa (Andexxa) –> reverses effect of Rivaroxabn (xeralot) & Apixaban (Elliquis)

Idarucizumab (Praxbind) –> reverses Dabigatran (Pradaxa)

50
Q

What is the reversal agent of Dabigatran (Pradaxa)

A

Med is a Direct oral anticoagulant (DOAC)

Reversal = Idarucizumab (Praxbind)

51
Q

Normal CV changes in pregnancy

A
  • Systemic Vasodilation (Decrease SVR/BP)
  • Renal vasodilation
  • increased CO – may causes systolic flow murmur
  • Increased total RBC production / Blood volume
  • Increased HR
52
Q

Stenotic vs Regurgitant valves

A

stenotic = valves dont OPEN properly

Regurgitation = valves dont CLOSE properly

53
Q

Sick sinus syndrome (patho)

A

destruction of the SA node and changes in the nerves and ganglia

SA node doesn’t fire to initiate a heartbeat

54
Q

what type of angina involves nocturnal symptoms?

A

unstable angina

symptoms at rest and at night!

55
Q

What causes Prinzmetals angina? aka Variant angina

A

coronary artery vasospasm

occurs in atypical patterns

can cause ST elevation

56
Q

Pt experiences chest pressure, heaviness on exertion. what type of angina is this?

A

Classic/Stable Angina

relieved by rest

57
Q

What bacteria is responsible for rheumatic fever

A

Group A streptococcus

58
Q

What regulates MAP?

A

Caridac output
Systemic vascular resistance
central venous pressure (pressure exerted by heart)

59
Q

what are the four defects of tetralogy of Fallot

A
  1. large ventricular septal defect
  2. pulmonary stenosis
  3. Right ventricular hypertrophy
  4. overriding aorta
60
Q

which can cause both a systolic and diastolic timed murmur?

A

Tricuspid regurgitation

  • causes blood to flow backward into R atrium when ventricles contract
  • murmur increases intensity with inspiration
61
Q

Which cardiac rhythm has prolonged QT interval?

A

Torsades de pointes

62
Q

what organ synthesized triglycerides?

A

Liver

63
Q

pts with ventricular septal defect have which type of murmur?

A

Holosystolic

heard throughout systole, usually asymptomatic

64
Q

What peptide hormone causes vasoconstriction and increases blood pressure

A

Angiotensin

65
Q

T/F Does Raynaud phenomenon cause reactive hyperemia?

A

True.

occurs when blood vessel is constricted for a prolonged period then dilates suddenly producing substantially increased blood flow to the area.

66
Q

What is the name of a condition that is acute, febrile, immune-mediate disease characterized by vasculitis leading to coronary artery aneurysm ?

A

Kawasaki syndrome

67
Q

when does the ducus arteriosus close?

A

1-2 days after birth

68
Q

which congenital heart defects result in RIght to LEFT shunting and requires emergency surgical intervention?

A

Tetralogy of Fallot

Pulmonary Atresia

69
Q

What differentiates unstable angina vs NSTEMI?

A

elevated troponins

NSTEMI - elevated trops present

Unstable angina - same symptoms but trops negative

70
Q

what is a cyanotic mixed defect with increased pulm flood flow?

A

transposition of the great arteries

3P (16 decks)

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