Cardio Final Flashcards
1
Q
whats normal bp
A
less than 120/80
2
Q
whats prehypertension
A
130-140 / 80-90
3
Q
whats hypertension stage 1
A
140-160 / 90-100
4
Q
whats hypertension stage 2
A
160+ / 100
5
Q
how often do we screen for BP in people with normal BP?
A
every 2 years
6
Q
how often do we screen for BP in people with prehypertension?
A
every year
7
Q
how do we handle white coat syndrome?
A
do ambulatory BP’s, or have nurse or tech take the bp in the office
8
Q
in what % of patients experience white coat syndrome?
A
20 - 25%
9
Q
what are the risk factors for essential (primary) HTN?
A
sodium, alcohol, obesity, immobility, dyslipidemia, type A personality, Vitamin D deficiency, OTC meds (NSAIDS, decongestants,e tc), Family Hx, African American, Age
10
Q
what class of BP meds slows av conduction and HR
A
Beta Blockers and non-dihydropirine CCB’s (like verapamil and diltiazem)
11
Q
common side effects in diuretics?
K+ sparing, thiazides, loops
A
hypokalemia, hypovolemia
K sparing = gynecomastia
12
Q
A patient coming in complaining of a fatigue and unable to maintain an erection, shows a slow heart. He is likely on what medication?
A
Beta Blockers
13
Q
This class of drugs drops Peripheral vascular resistance and dilates coronary arteries?
A
Calcium Channel Blockers
14
Q
do dihydropiridines or non-dihydropiridines affect the heart?
A
non-dihydropiridines
15
Q
drugs that end in ‘-il’ are from what class?
A
Ace inhibitors
16
Q
A patient complains to you of dizziness, you notice swelling in his lips, and complains of a dry cough, he is likely on what medication?
A
An ACE
if no S/E of the cough he would be on an ARB
17
Q
Can you give an ACE or ARB to a pregnant woman?
A
NO
18
Q
What HTN drug class is best for BPH
A
Alpha Blockers
19
Q
HCTZ and chlorthalidone are what medications?
A
thiazide diuretics
20
Q
furosemide and bumetadine are what medications?
A
loop diuretics
21
Q
what is our favorite K+ sparing diuretic?
A
spironolactone (aldactone)
22
Q
HTN med for Africans?
A
CCB’s and Diuretics
23
Q
HTN med for Diabetics
A
ACE/ARB
24
Q
HTN med for CHF
A
BB, Diuretics (Ace in LV dysfunction)
25
HTN med for CAD
BB, CCB
26
HTN for CKD
ACE/ARB
27
what is the selection of HTN meds based on?
CLARC
| Comorbidities, Lifestyle, Age, Race, Cost
28
what is considered diagnosable hypertensive emergency?
> 180 / 120 with associated end-organ damage
29
in what situations does this HTN crisis usually occur?
abrupt d/c of meds, cocaine, RAS
30
what is the primary cause of resistant HTN?
Renal Artery Stenosis
31
cardiac output corrected for body size is?
cardiac index
32
normal cardiac output value?
5l/min
33
normal stroke volume?
70ml/beat
34
normal EF range?
55-65%
35
pulmonary wedge pressure measures what chamber?
LAP, and subsequently LVEDP
36
normal Pulmonary capillary wedge pressure is?
12mmhg
37
a large MI, acute MR, ventricular free wall rupture, perciardial tamponade, myocarditis, and end stage cardiomyopathy can all cause what?
Cardiogenic shock
38
indications for Swan Ganz catheters?
to differentiate between cardiogenic and septic shock, monitor hemodynamics, assesing pulmonary HTN, managing post-op open heart patients
39
values of PCWP, CO, PVR in Cardiogenic shock
PCWP = high
CO = low
PVR - high
40
values of PCWP, CO, PVR in septic shock
```
PCWP = low
CO = high
PVR = low
```
41
autonomic dysfunction resulting in inadeqate release of norepi from sympathetic neurons can cause what?
orthostatic hypotension
42
what meds can cause orthostatic hypotension
TCA's, alpha blockers
43
can post-prandialism cause ortho hypotension
oh yea
44
what particular patient type can get a Tetralogy of Fallot?
Down syndrome
45
What is the most common congential heart lesions requiring intervention in the first year of life?
Tetralogy of Fallot
46
What does TOF cause?
cyanosis (right to left shunting)
47
what do we call the heart shape in TOF?
boot shaped heart
48
what is the most definitive exam for TOF?
echo
49
what is the heart sound for TOF?
crescendo-decrescendo systolic murmur
50
Sex, age, family hx, htn, hyperlipidemia, insulin resistance, smoker, obese, alcohol, ckd, diet, lvh, hyperuricemia, cocaine, type A personality can all cause what condition?
Ischemic heart disease
51
Treatment for Acute Coronary Syndrome
o2 2-4 nc
aspirin 325
nitro .4mg
morphine (if pain not relieved w/ nitro)
52
in unstable angine, what else can we give?
IV heparin, Beta Blockers, DP IIb/IIIa inhibitor (like asa)
53
if treatment of unstable angina does not improve consider....
thrombolytics w/in 3hr onset, or 6 hours of no cath lab. (must be no contraindication for bleeding)
54
EKG criteria for a STEMI
St elevation > 1mm in 2 or more contiguous leads
55
Drug class for Prinzmetals angina
CCB Non-Dihydropiridinese
| Diltiazem and verapamil
56
a patient presents to your ER with fever, and sharp pleuritic chest pain and leaning forward in the chair. You hear a pericardial friction rub on exam and see diffuse ST elevations with PR depressions. On echo you see pericardial effusion. He likely has...?
Acute Pericarditis
57
the majority of pericardial effusions are due to?
idiopathic, viral, iatrogenic (hydralazine)
58
types of pericardial effusion
transudative (CHF, uremia)
Exudative (TB, infection)
Hemorrhagic (trauma, aortic dissection)
Malignant
59
1. what the most confirmatory test to diagnose pericardial effusion?
2. what is the common EKG finding?
1. echocardiogram
(and a water bottle configuration on CXR)
2. low voltage EKG (and/or) electrical alternans
60
What three symptoms are classic for tamponade
hypotension, muffled heart sounds, JVD
61
what is that group of symptoms called in tamponade?
Beck's triad
62
cardiac enlargement of 1 or both ventricles without thickening, showing an EF<40% and maybe s3 or s4 with regurg.
dilated cardiomyopathy
63
hypertrophy of the left ventricle with wall thickening often causing septal obstruction near the aortic valve.
HOCM
64
a normal thickness and size of heart but with rigid walls, causing diastolic dysfunction and atrial enlargment
restrictive cardiomyopathy
65
the three types of restrictive cardiomyopathy
amyloidosis: speckled granular apperarance on echo
sarcoidosis: chronic granuloma nodules
hemochromatosis: increased iron uptake
66
Transient systolic dysfunction apical or mid sections of the left ventricle mimicking an MI, with clear coronaries (CP like prinzmetal) showing "apical ballooning" or "octopus" heart on imaging.
Stress Induced (Takotsubo) Cardiomyopathy
67
what are some triggers of takotsubo
death of loved one, severe stress.
(catecholamine surge)
(supportive care)
68
backward failure of the left ventricle leads to congestion in the pulmonary vasculature, this is called?
left sided heart failure
69
what does LSHF cause?
pulmonary edema, orthopnea, PND
70
backward failure of the right ventricle leads to congestion of the systemic capillaries
right sided heart failure
71
what does RSHF cause?
peripheral edema, ascites, JVD, Hepatosplenomegaly, etc.
72
TRUE OR FALSE: patients usually present with a combination of both right and left sided heart failure.
TRUE
73
someone is diagnosed with CH and an EF<40%, they have no limits to their physical activity, and no symptoms with activity, what CHF class are they?
Class I
74
someone is diagnosed with CH and an EF<40%, they have MODERATE/MARKED limitations, and symptoms with less than ordinary activities, what CHF class are they?
Class III
75
someone is diagnosed with CH and an EF<40%, they have MILD/SLIGHT limitation, and symptoms with ordinary activity, what CHF class are they?
Class II
76
someone is diagnosed with CH and an EF<40%, they are unable to get out of the chair or bed, what CHF class are they?
Class IV
77
what is first line for CHF?
lifestyle mods
78
what is second line for CHF?
diuretics, ACE/ARB, BB, Digoxin, Ionotropes
79
what is thirst line for CHF?
ICD, single or biventricular
80
what is last line for CHF?
transplant or LVAD
81
what is hypotension?
less than 90 systolic
82
Staph aureus, MRSA, and Rheumatic Heart Disease all contribute to what pathology?
also the HACEK group
Infective endocarditis
83
What is infective endocards?
bacterial vegetation with fibrin and platelets in it on valvular structures causing turbulence and valvular incompetence.
84
what valve is most affected
mitral...followed by aortic
85
this type of infective endocarditis is a severe illness that occurs over days to weeks and is usually due to staph aureus, often leading to an embolic event
ACUTE bacterial endocarditis
86
this type of infective endocarditis is a more mild-moderate illness that progresses slowly over weeks to months and is usually due to strep
SUBACUTE bacterial endocarditis
87
What are 4 classic derm findings from infective endocards?
osler nodes
janeway lesions
splinter hemmorages
roth spots
88
what else does infective endocards cause?
FEVER OF UNKNOWN ORIGIN,
night sweats/chills, new or worsening murmur.
CHF, conduction abnormalities, renal failure, embolic event to vital organs
89
what is the criteria used to diagnose infective endocards?
duke criteria
(definitive, possible, rejected)
(+ culture, ESR up, WBC, up, anemia)
90
what type of conditions warrant endocarditis prophylaxis?
any type of valve work, unrepaired heart defects, transplant, HOCM, MV prolapse w/ regurg.
91
which patients with infective endocarditis need surgery?
```
heart failure - valve dysfunction
severe mitral or aortic regurg
fungal endocarditis
pervalvular abscess or fistula
vegetation > 10mm
Continued bacteremia post max. abx therapy
Relapse of prosthetic valve endocarditis
```
92
what does the ankle brachial index assess
degree of PVR
93
what is the formula for the ankle brachial index?
ankle systolic / arm systolic = x
| If X < .9 = Positive result
94
what are risk factors for aneurysms?
HTN (60%), male, trauma, infection, intrinsic defect like marfans
95
What does the Debakey Classification measure indicate?
the location of the aortic aneurysm
96
This Debakey type aneurysm originates in the ascending and propogates to at least the aortic arch and often beyond
Type I
97
This Debakey type aneurysm originates IN and IS CONFINED to the ascending aorta
Type II
98
This Debakey type aneurysm originates in the descending aorta and extends distally and proximally
Type III
99
In the Stanford classification of aneurysm locations, type A includes...
anything proximal in origin to the left subclavian
100
In the Stanford classification of aneurysm locations, type B includes...
anything distal in origin to the left subclavian
101
this type of aneurysm involves all three layers of the aorta
true aneurysm
102
this type of aneurysm results from leakage of arterial blood from an artery into the surrounding tissue with patent communication between the two areas.
false (pseudo) aneurysm
103
age, obesity, infection, oral contraception, smoking, travel, malignancy, hypercoaguability, trauma, pregnancy, are all risk factors for...?
DVT
104
what does wells score evaluate?
the likelihood of getting a DVT.
105
```
a person with a wells score of
<1
1-2
3+
has what risk?
```
<1 low risk (5% chance)
1-2 medium risk (17& chance)
2+ high risk (53% chance)
106
a chronic inflammatory disease of large/medium arteries and aorta, mostly involving the cranial branches. old women, and you should suspect aortic aneurysm
Giant cell arteritis
107
what are the manifestation of GCA?
fever, h/a, vision changes, aortic regurg murmur, aortic dissection.
108
what is the gold standard to dx GCA?
tissue biopsy
109
what is the gold treatment for GCA?
corticosteroids
