CARDIO Flashcards
What is our goal BP in an elderly pt with HTN without CKD or DM?
<150/90
What is our goal BP in an elderly pt with HTN and/or CKD?
<140/90
What does the initial eval involve for HTN?
2 or more reading at 2 or more visits
CBC, UA, electrolytes, Cr, HbA1c, total cholesterol, HDL cholesterol, and ECG
What are some aggravating factors for HTN?
stress, lack of exercise, nicotine, excessive alcohol or sodium intake, low potassium or calcium intake
Is the goal of <120/80 recommended in the elderly?
NO
What are non-pharm treatments for HTN?
lots of fruits/veggies, aerobic exercise MOST days of week, Na intake (<2.4g/day; optimal <1.5g), SMOKING CESSATION, and weight reduction
Where do we start for treating HTN with meds?
HCTZ - ACE/ARBS - CCB
What are some ACE’s?
Lisinopril, Captopril, Enalopril
What are some ARBS?
Losartan or Valsartan
If a pt has angina, how do we treat their HTN?
BB, CA (Calcium agonists AKA CCB)
If a pt has Afib and HTN how do we treat them?
BB & NDCA
What are 2 examples of non-dihydropyradine calcium channel blockers?
Diltiazem & Verapamil
If a patient has bronchospasm and HTN what should we avoid?
BB
Besides metoprolol, what are 2 other beta-blockers?
Atenolol & Propranolol
In diabetics, CKD, and HF how do we treat their HTN?
ACEI, ARB’s
How does ischemic heart disease present in a young person vs. the elderly?
Young = CP & heaviness
Elderly = vague – dyspnea, abdominal pain, fatigue, confusion or malaise
How do we tell the difference between a STEMI & NSTEMI?
BOTH have elevated cardiac markers
NSTEMI has NONELEVATED ST segments
In the presence of a STEMI how do we treat?
door to balloon in 90 minutes
Give NTG, morphine, and BB
: In the presence of NSTEMI how do we treat?
ASA, BB, and full anti-coag
If everything is normal after 24 hours do stress testing
If you heard a crescendo-decrescendo systolic murmur that radiates to the carotids and is heard best over the right 2nd intercostal space – dx?
Aortic stenosis
If a pt with Afib is unstable – how do we treat?
Cardioversion
What is rate control for Afib?
CCB (non-dihydros)
What is rhythm control for Afib?
Cardioversion – if longer than 48 hours must anticoagulated x3-4 weeks or get TEE to show no atrial thrombi
What is the one murmur that gets louder with standing from a squat or Valsalva?
mitral valve prolapse
What are our 2 diastolic murmurs?
Mitral stenosis & Aortic regurg
Which 3 murmurs cause holosystolic murmurs?
Mitral regurg, tricuspid regurg, and VSD
What murmur is associated with rheumatic fever or HF?
Mitral regurg
What murmur has an opening snap followed by a low diastolic rumble heard best in the left lateral decubitis position?
Mitral stenosis
What murmur is blowing holosystolic heard radiating from the apex to the axilla?
Mitral regurg
What murmur is blowing holosystolic heard best at the left sternal border and on inspiration?
Tricuspid regurg
What murmur has a diastolic blowing decrescendo heard best over the left sternal border while sitting, leaning forward and exhaling & holding breath?
Aortic regurg
What diagnosis causes lower extremity exertional pain/fatigue (aka claudication)?
Peripheral vascular disease
What are the 5 aspects of controlling vascular disease?
Quit smoking BP control DM control Lipid lowering agents ASA
What are some common sxs of HF in the elderly?
confusion, irritability, sleep disturbance, anorexia, N/d
Cough, orthopnea, dependent edema
How do we diagnose HF?
- BNP! Most useful test, but specificity declines with age
- XR for increase heart size
- Echo & EKG (Q waves or LVH)
What are the two main components of HF we treat?
Reduce preload & afterload
How do we reduce preload?
Diuretics
What must we always check before/after prescribing diuretics?
K levels!
How do we reduce afterload?
ACE inhibitors
What must we watch before/after prescribing Lisinopril?
Cough & K levels
If a pt experiences a cough with Lisinopril, what can we change to?
ARB (losartan)
