cardio flash-cards Flashcards
1
Q
what is a hypertensive urgency?
A
over 220 systolic or 125 diastolic
2
Q
what is a hypertensive emergency
A
diastolic >130
3
Q
spironolactone
A
aldosterone receptor antagonists, increasingly used in refractory HTN; 2nd line for acute pulm edema or CHF
4
Q
left sided failure
A
exertional dyspnea, nonprod cough, fatique, orthopnea, paroxsymal nocturnal dyspnea, basilar rales, gallops, exercise intolerance
5
Q
right sided failure
A
distended neck veins, tender or nontender hepatic congestion, nausea, dependent pitting edema
6
Q
diastolic failure cardiac sign
A
S4 gallop/hepatomegaly, ascites, JVD
7
Q
kerley B lines
A
CHF CXR
8
Q
nocturia, hypotension, narrow pulse pressure
A
CHF
9
Q
CHF treatment and associated angina
A
loop or thiazide diuretic. Add an ACE. CCB(amlodipine) only to treat associated angina and HTN; LMNOP for pulm congestions
10
Q
Levine’s sign
A
clenched fist over sternum and clenched teeth: ischemia
11
Q
angina pectoris
A
midsternal but may radiate to jaw, shoulders, arms, wrists, back of the neck; usually on the left. lasts for 3 min
12
Q
important marker in atherosclerosis
A
c reactive protein
13
Q
how to control atherosclerosis
A
manage blood glucose and BP
14
Q
what if angina pectoris lasts more than 30 min
A
unstable angina, MI, or another dx
15
Q
EKG in angina
A
horizontal or downsloping ST segment depression. exercise testing will have a depression of 1 mm
16
Q
definitive diagnostic test in angina
A
coronary angiography
17
Q
SE of nitrates
A
HA, nausea, lightheadedness, hypoTN
18
Q
medication for chronic angina
A
Beta blockers first line therapy. it prolongs life of pts with coronary disease
19
Q
ranolazine
A
prolongs exercise duration and time to angina
20
Q
CCB does what
A
decrease cardiac muscle oxygen demand but are third line agents
21
Q
aortic stenosis
A
harsh systolic ejection murmur that radiates to the carotids; narrows the valve opening, impeding the ejection function of the left side of the heart
22
Q
aortic insuffiency(regurge)
A
early decresendo DIASTOLIC murmur;results in volume overloading of the left ventricle
23
Q
mitral stenosis
A
mid to late low pitch DIASTOLIC murmur; impedes blood flow between the left atrium and ventricle
24
Q
mitral insufficiency
A
holosystolic;causes backflow and volume overload of the left atrium
25
MVP
asymptomatic, but it may cause mitral regurge
26
What does valve related progressive heart failure lead to?
pulmonary HTN and congestion
27
sx in valvular disorder
cough, dyspnea, fatigue, decreased exercise tolerance
28
thready carotid pulses
aortic stenosis
29
widenen pulse pressures
aortic insuffiency
30
MVP characteristics
thin females with minor chest wall deformities, midsystolic clicks and late systolic murmur
31
CXR of aortic valve disorders
left sided atrial enlargement and ventricular hypertrophy
32
CXR in mitral valve disorders
atrial enlargement alone
33
how to check pressure gradient assessment
doppler ultrasound
34
systemic venous congestion sx
JVD, peripheral edema, hepatomegaly
35
Aflutter occurs in what kind of pts
COPD, CAD, CHF, atrial septal defect
36
junctional rhythms occur in what pts
nml hearts, mycocarditis, CAD, digitalis toxicity
37
non pharm tx of PSVT
ablation, *synchronized cardioversion(not in dig toxicity)
38
medicine to treat PSVT
IV adenosine, PO verapamil.
39
pharmacological prevention of PSVT
diltiazem verapmil beta blocker
40
acute A-Fib tx and etio
cardiovert. PIRATES
41
chronic AFIB tx
rate control and prevention of thromoembolism
42
atrial flutter tx/ final
chemical conversion with ibutilide or electric cardioversion
43
chronic atrial flutter tx
amiodarone or dofetilide
44
what is V tach
3 or more consecutive ventricular premature beats; sustained/unsustained, frequent complication of acute MI and dilated cardiomyopathy
45
torsades be pointes
Vtach in which QRS complex twists aound the baseline; can happen with hypokalemia, hypomagnesemia, or following drugs that prolong QT
46
ventricular premature beats tx
beta blockers or class I and II
47
Vfib
no effective pumping action; sudden death; occurs in early morning
48
tx of Vtach with severe hypotension or loss of consciousness
synchronized cardioversion if unstable
49
medication tx of Vtach
lidocaine, procainimide, amiodarone. empiric magnesim
50
brugadas symdrome
occurs in asians and males. causes syncope, ventricular fib and sudden death. tx is implantable defibrillator
51
when is sick sinus syndrome reversible
if caused by digitalis, quinidine, beta blockers or aerosols
52
Describe "silent" MIs
1/3 of pts. most likely older people, women, DM
53
inferior changes will occur in what leads
II III aVF
54
posterior changes occur in what leads
V1 V2
55
anteroseptal changes occur in what leads
V1 V2
56
anteior changes occur in what leads
V1 V2 V3
57
anterolateral changes occur in what leads
V4 V5 V6
58
Cardio PE in ACS
nml or JVD, soft heart sounds, mitral regurge, S4 gallop
59
dresslers syndrome
post MI syndrome; pericarditis, fever, leukocytosis, pleural/percaridal effusion; usually 1-2 wks after
60
ECG changes in MI
progression from peaked T waves to ST elevation/depression to Q waves to T wave inversions that occur over hrs to days
61
doppler studies in MI
postinfarction ventricular septal defect or mitral regurge
62
CXR in MI
congestive failure or signs of aortic dissection
63
most sensitive test to quantify the extent of an infarction
MRI with gadolinium
64
Total CK
initial elevation at 3-5 h, peaks at 24h, and returns to normal with 28-72hr
65
LDH
initial elevation at 10h, peaks at 24-28h, and returns to normal with 10-14 days
66
what should u give ACS pts with ST elevation
antiplatelet therapy and anticoagulants
67
med tx in ACS
beta blocker(if not in hrt failure, bradycardic, heart block), CCB(if cannot take bblocker or nitrates )
68
what does cyanotic heart anomalies involve
right to left shunts
69
tetralogy of fallot description
subaortic septal defect, right ventricular outflow obstruction, overriding aorta, right ventricular hypertrophy
70
tetralogy of fallot murmur
crescendo-decrescendo, holosystolic at LSB, radiating to back
71
pulmonary atresia definition
pulmonary valve is closed, atrial septal opening and patent ductus arteriosus are present; emergency tx!
72
cyanosis, clubbing, increased RV impulse at LLSB, loud S2
tetralogy of fallot
73
cyanosis with tachypnea at birth, hyperdyamic apical impulse, single S1 and S2
pulm atresia
74
TET spells
cyanosis, hyperpnea, agitation
75
what is hypoplastic left heart sydrome
group of defects with a small left ventricle
76
transposition of great vessels PE
*cyanosis in newborn; loud S2 if large VSD
77
most common type of ASD
ostium secundum
78
atrial septal defect murmur
systolic ejection murmur second LICS; wide fixed split S2
79
what does right sided overload lead to
right sided cardiomegaly, systemic venous congestion, and rt sided heart failure
80
sx of tricuspid/pulmonic valve d/o
JVD, hepatomegaly, peripheral edema
81
CXR of tricuspid/pulmonic valve d/o
prominent rt heart border with dilation of SVC
82
ECG of tricuspid/pulmonic valve d/o
right axis deviation, P wave abnormality associated with right atrial enlargement; or prominent R and deep S waves of right ventricular hypertrophy
83
Tx of tricuspid/pulmonic valve d/o
Na restriction and diuretics to decrease volume filling and right atrial pressure. **surgery
84
how to treat pulm HTN
arterial vasodilators or positive inotrophic agents
85
aortic stenosis murmur characterisitics
2ICS; rad to neck and LSB; loud; best if pt sitting and leaning forward
86
aortic regurge murmur characteristics
2nd-4th LICS; rad to apex and RSB; Loud pitch; best heard sitting, leaning forward, full exhalation
87
austin flint murmur
midsystolic aortic regurge; suggests large flow nad arterial pulses large and bounding
88
mitral stenosis murmur characteristics
heard at apex, no rad, low pitch, heard best in left lateral position with full exhalation.
89
S1 accenuated; opening snap follows S2
mitral stenosis
90
mitral regurge murmur characteristics
heard at apex, rad to left axilla, med to high pitch.
91
S2 often decreased; apical impulse prolonged
mitral regurge
92
tricuspid regurge murmur characteristics
LLSB; holosystolic, rad to rt sternum and xiphoid; increased with inspiration. JVP elevated
93
2 murmurs with pansystolic timing
mitral regurge and tricuspic regurge
94
murmur with midsystolic timing
aortic stenosis
95
pulm stenosis murmur characteristics
2nd-3rd LICS; midsystoic crescendo-decrescendo; rad to left shoulder and neck; medium pitch.
96
early pulmonary ejection sound
pulm stenosis
97
medication for ventricular premature beats
beta blocker(class I and II) if pt is symptomatic
98
tx for severe V tach with severe hypoTN or loss of consciousness
synchronized cardioversion and maybe pacing
99
medications for Vtach
lidocaine, procainamide, amiodarone. empiric magnesium
100
what to do if in a ventricular arrhythmia with a pt with an identifiable site of arrhythmic origin
radiofrequency ablation
101
what to do in a recurrent sustained Vtach, for congenital long QT syndrome, brugadas syndrome
implantable defibrillator
102
torsades medication tx
beta blockers, magnesium, temporary atrial or ventricular pacing.
103
AV block sx
weakness, fatigue, light headedness, syncope
104
wenckebach
mobitz type II 2nd degree heart block
105
sick sinus sydrome tx
most require permanent pacing
106
AV conduction tx
cardiac pacing
107
common type of cardiomyopathy
dilated (affecting left ventricle)
108
causes of dilated cardiomyopathy
excessive ETOH, postpartum state, chemo toxicitiy, endocrinopathies, myocarditis, idiopathic
109
Takotsubo cardiomyopathy
occurs after a major catecholamine discharge; apical left ventricular ballooning with sx of acute MI
110
major cause of hypertrophic cardiomyopathy
genetic; usually asian descent or elderly
111
what is hypertrophic cardiomyopathy
4%; usually of the septum, small left ventricle, systolic anterior mitral motion, diastolic dysfunction
112
Sx for dilated cardiomyopathy
*dyspnea. S3 gallop, rales, increased JV pressure
113
Sx of hypertrophic cardiomyopathy
*dyspnea and angina. also maybe asymptomatic or sudden death
114
PE for hypertrophic cardiomyopathy
sustained point of maximal impulse or triple apical impulse, loud S4 gallop, variable systolic murmur, bisferens carotid pulse, JV pulsations with a prominent "a" wave
115
bisferens carotid pulse, JV pulsations with a prominent "a" wave
hypertrophic cardiomyopathy
116
restrictive cardiomyopathy Sx
decreased exercise tolerance; pulmonary HTN; in advanced disease will have right sided congestive failure
117
ECG in dilated cardiomyopathy
nonspecific ST and T wave changes, PVC(vent ectopy)
118
ECG in hypertrophic cardiomyopathy
nonspecific ST and T wave changes, exagerated Q waves, LVH
119
CXR in dilated cardiomyopathy
pulmonary congestion and cardiomegaly
120
CXR in hypertrophic cardiomyopathy
not remarkable
121
hrt studies show high diastolic pressures and low cardiac output
dilated hypertrophy
122
cardiac studies show LVH, asymmetric septal hypertrophy, small left ventricle, diastolic dysfunction
hypertrophic cardiomyopathy
123
Key test for restrictive cardiomyopathy
echocardiography! cardiac MRI is distinctive, cath shows reduced mildly left ventricular function.
124
tx for the cardiomyopathies
dilated(no ETOH, treat underlying cause, CHF); hypertrophic(beta blockers, CCB; disopyramide for negative inotrophic effects, ablation of hypertrophic septum); restrictive(diuretics)
125
percarditis common in who
men and those under 50 yrs old
126
what is cardiac tamponade
fluid compromises cardiac filling and impairs cardiac output
127
Sx of acute pericarditis
pleuritic substernal radiating chest pain relieved by sitting upright and leaning forward. *friction rub
128
sx of constrictive pericarditis
slowly progressing dyspnea, fatigue, weakness, accompanied by edema, hepatomegaly, ascites
129
sx of cardiac tamponade
tachycardia, narrow pulse pressure, pulsus paradoxus
130
ECG changes in pericardial disorders
nonspecific T wave changes and low QRS voltage.
131
what is pathognomonic for a pericardial effusion
electrical alternans
132
organism in prosthetic valve endocarditis
staph, gm neg, fungi in first 2 months; strep or staph later on
133
a changing murmur
rare but diagnostically significant in endocarditis
134
sx in endocarditis
none in elderly; fever and nonspecific sx
135
classic features on endocarditis
25% pts have this. palatal, conjunctival, subungal petechiae, splinter hemorrages, osler nodes, janeway lesions, and roth spots
136
roth spots
exudative lesions in the retina
137
common sx in endocarditis
pallor and splenomegaly; strokes and emboli may occur
138
pulm infiltrates on CXR
right side of hrt has endocarditis
139
antibiotic choice for endocarditis prophylaxis
amoxicillin
140
empiric antibiotic for endocarditis
vanco ply ceftriaxone
141
surgery for endocarditis?
maybe necessary, especially aortic valve
142
what is rheumatic fever
a systemic immune response occurring usually 2-3 wks following a beta hemolytic streptococcal pharyngitis
143
common people rheumatic hrt disease occurs in
recent immigrants; kids 5-15 years of age
144
perivascular granuloma lesion with vasculitis
rheumatic valve disease
145
valve most commonly involved in rheumatic heart disease
mitral(75-80%) then aortic(30%). aortic and tricuspid rarely occurs in isolation
146
medication tx for rheumatic heart disease
IM PCN, if allergic then emycin
147
Leriche's syndrome
ED occurring with iliac artery disease
148
ankle brachia index for PAD
less than 0.9 indicates significant disease
149
tests to order for PAD
CT or magnetic resonance angiography
150
drug for PAD
cilostazol; sildenafil for ED.
151
brodie-trendelenburg test
differentiates saphenofemoral valve incompetence from perforator vein incompetence
152
Virchows triad
stasis, vascular injury, and hypercoagulability
153
what is thrombophlebitis
involve partial or complete occlusion of a vein and inflammatory changes. virchows triad
154
palpable cord in long saphenous vein
thrombophlebitis
155
what is d-dimer
fibrin degradation product that is elevated in presence of thrombus
156
skin changes in chronic venous insufficiency
shiny, thin, itchy, atrophic with dark pigment and subcutaneous induration
157
how to treat stasis dermatitis
wet compresses, hydrocortisone cream. chronic forms may also need zinc oxide with ichthammol and antifungal cream
158
1st degree AV block
PR interval constant and >200/asymptomatic/no treatment; can occur with increased vagal tone or with a bb or ccb
159
mobitz 1
PR progressively lengthens until QRS drops; asymptomatic or palp/no tx; can be from bb or ccb or increased vagal tone or coronary ischemia/infarction
160
mobitz 2
from fibrotic disease of the conduction system from an MI/occasional syncopeQRS beats are intermittently dropped w/out PR prolongation/asymp or palp/tx: pacemaker
161
3rd degree AV block
dissociation of P and QRS/no electrical communication between atria and ventricles/syncope,dizziness,hrt fail,hypoTN/ tx: pacemaker
162
L BBB
QRS >120;deep S wave and no R wave in V1;wide, tall R waves in 1, V5, V6
163
R BBB
QRS >120; RSR complex;wide R wave in V1, QRS pattern with wide S wave in 1, V5, V6
164
BBB causes and sx
CAD, Cardiomyopathy, valve disease/asymp, syncope, presyncope
165
q wave
septal depolarization
166
r wave
apical and early depolarization
167
s wave
late ventricular depolarization
168
t wave
ventricular repolarization;
corresponds to the period when the lower heart muscle chambers are relaxing and preparing for the next muscle contraction
169
p wave
atrial depolarization/record of movement of electrical activity through atria and recorded when they contract
170
qrs complex
record of movement of electrical impulses through ventricles and recorded when they contract
171
ST segment
elevated or lowered means heart muscle damaged or not receiving enough blood
172
T wave
corresponds to the period when the lower heart muscle chambers are relaxing and preparing for the next muscle contraction
173
inferior leads and arteries
I, II, avF/ rt coronary arter circumflex branch, and post descending branch
174
posterior leads and arteries
V1 and V2/ LCA to circumflex branch and RCA to post descending branch
175
anteroseptal leads and artery
V1 and V2 / LAD plus septal branch
176
anterior leads and artery
V1 V2 V3; Lt Ant Descending
177
anterolateral leads and lateral arteries
V4 V5 V6/ lt coronary artery, circumflex branch
178
PSVT causes and risks
dig too high, WPW/ risks: etoh,caffeine,drugs, smoking
179
test for aortic dissection
CT angiography
180
secondary HTN causes
CHAPS: cushing, hyperaldosterone, aortic coarctation, pheochromocytoma, stenosis renal artheries
181
orthostatic hypoTN
greater than 20 mm Hg drop in systolic or 10 diastolic. if pulse increase by 15 beats, depleting circlulating blood volume
182
pericarditis sx, PE,
pleuritic CP, dyspnea, cough, FEVER; CP worsens in supine and inspiration(sits and leans); friction rup, inc JVP, pulsus paroxus
183
pericarditis imaging and tx
ekg: diffuse st seg elev and PR seg dep followed by t wave inv; tx: underlying cause; asa/NSAIDS for viral;no corticosteroids
184
pulsus paroxus
decreased systolic BP > than 10 mm hg inspiration
185
beck triad
jvd, hypoTN, distant heart sounds: cardiac tamponade
186
acute cardiac tamponade
beck triad, pulsus paradoxus, kussmaul, electrical alternans, (water bottle heart), EKG: rt atrial and rt vent diastolic collapse
187
WPW EKG and tx
DELTA WAVE; procainamide or arrhythmics
188
S3
early sign of heart failure; ventricular gallop, fluid overload, disappears when pt gets up
189
S4
atrial gallp, decreased compliance- HTN, diastolic dysfunction
190
Pulsus parvus et tardus
weak, delayed carotid up stroke, split S2, aortic stenosis
191
blowing diastolic murmur and tx
aortic regurge; tx: vasodilators
192
opening snap and mid diastolic murmur at apex an tx
mitral stenosis; rheumatic fever; antiarhythmics
193
under 65 y/o, EF under 50%, *exertional dyspnea, parasternal lift, S3 S4, JVD, BNP >500
systolic CHF- do loop. no ccb
194
tx for pulm congestion
LMNOP: lasix, morphine, nitrates, O2, position
195
murmur heard best in left lateral position in full exhalation
mitral stenosis
196
high pitch, blowing murmur; heard best sitting and leaning forward, full exhalation
aortic regurge
197
harsh and medium pitch murmur, heard best sitting and leaning forward
AS
198
murmur radiation
1)axilla 2)rt sternum/xyphoid 3)lt shoulder/neck
1) AR 2) TR 3) PS
199
anti-arrhythmic class 2 drugs
beta blockers slow AV conduction for SV tachycardia, may prevent vent fibrillation
200
anti-arrhythmic class 3 drugs
K++ channel blockers:prolong action potential; for refractory V tach, SV tach; amiodarone,sotalol,dofetilide,ibutilide
201
anti-arrhythmic drugs class IV
slow CCB for SV tachycardia
202
anti-arrhythmic class V drugs
Adenosine and Digoxin for SV tachycardia
203
Sodium channel blockers
Class 1 drugs; Quinidine, procainamide, disopyramide,lidocaine
204
med for variant/atypical/prinzmental angina
CCB
205
how do nitrates work
venodilation to decrease preload and O2. also coronary artery dilation to increase blood flow.
206
how do Beta blockers work
decrease O2 demand. watch out for hypoglycemia
207
which CCB causes flushing and which ones cause constipation
nifedipine. diltiazam and verapamil
208
which CCB can cause worsening angina
nifedipine
209
anteroseptal leads
V1 V2. LAD
210
MONA
ACS tx. Morphine/merperadine O2 Nitrates, asa
211
post ACS complications mneumonic
PFARTS. pericarditis, failure, arrhythmia/aneursym, ruptrue, thromboembolism, septal perf
212
marker for heart failure
BNP
213
EKG changes in pericarditis
ST segment elevation in 2 or 3 limb leads
214
acute occlusion S/S
paresthias, pallor, pulseless, pain, paralysis
215
heart sounds locations
A then P, below is T. to the right is M
216
sternal lift
RVH
217
enlarged, displaced PMI
LVH
218
systole valves
A/P open
219
diastole valves
M/T open
220
S1 is what valves
M/T close
221
S3
early diastolic sound. think heart failure
222
S4
think chr HTN. its late diastolic
223
high pitched murmur
M/T valve
224
cresendo
think A/P
225
inspiration does what to a murmur
increase venous return
226
left lateral decubitus affects murmurs how
makes mitral valve murmurs easier to hear
227
sitting and leaning forward
increases AR murmur
228
valsalva/standing
decrease venous return
229
squatting
increases venous return
230
wide pulse pressure
AR
231
narrow pulse pressure
AS
232
marfans
AR
233
tachycardia
with infections
234
bradycardia
with AV blocks
235
JVP
reflects RA pressure.
236
large A wave
TS
237
large V wave
TR
238
bounding pulses
AR
239
pulsus alternans
with left ventricular failure
240
slow and delayed carotid pulse
severe AS
241
roth spots on retina
endocarditis
242
clubbing
hypoxia
243
petechiae, splinter hemorrhages
endocarditis
244
S4
AS
245
rheumatic fever
MS
246
radiate to left neck
PS
247
rt sided S3 S4
PS
248
murmur with inspiration
PS
249
heard at aortic region, no radiation. softer with squatting, louder with valsalva/standing
IHSS
250
how to hear hypertrophic cardiomyopathy
over lower sternum; louder with standing/valsalva; softer with squatting
251
3 holosytolic murmurs
MR, TR, VSD
252
MR heard best at
apex
253
TR heard best at
LLSB
254
MR
LL deb positiion. radiates to left axilla. blowing
255
TR
inspiration decreases intensity. blowing
256
diastolic murmurs: nml flow through valves
mitral and tricuspid stenosis
257
diastolic murmurs: backward flow through valves
aortic and pulmonic regurge
258
MS
decresendo-cresendo. heard best at apex. rumbling, S2 accentuated. think rheumatic fever
259
AR
decresendo. S4, PMI enlarged. head bobbing. increase intensity with leaning forward with expiration.
260
machine like murmur
PDA
261
continuous murmur
venous hum. stops with compression of jugular vein
262
systolic murmurs
AS, PS, MR, TR, VSD, MVP
263
IV drug use affects
right heart valves
264
murmur heard best at pulmonic area and increases with inspiration
likely PS
265
hypoxia, electrolyte abnormalities, HYPERthyroidism; dx and tx
PVC, give BB
266
systolic dysfunction: defintion, age, EF, cardiomyopathy, PMI, gallop, CXR, ekg
inadequate vent contractility, under 65 y.o, EF under 40%, dilated CM, PMI displaced, S3, Cardiomegaly on CXR, q waves
267
non systolic dysfunction: definition, age, EF, cardiomyopathy, PMI, gallop, CXR, ekg
impaired relaxation- cannot fill; over 65 y.o, EF over 55%, Hypertrophic and restrictive CM, PMI sustained, S4, CXR pulm htn, LVH
268
tx for systolic and non systolic dysfunction CHF.
avoid what in each. (3)
Systolic: 1) acute: loop with ACE (avoid BB)
2) chronic: loop, ACE, BB. (avoid CCB)
Diastolic: diuretics first line(avoid digoxin)
269
loop
1) effects
2) use in what
3) SE
4)disadvantage
1) hypokalemia, hypocalcemia,hypomagnesium,hyperruricemia.
2) 1st line for CHF, also can use in acute pulm edema
3) dehydration, gout, ototoxicity
4) short acting
270
SE for K sparing agents
hypokalemia, gynecomastia, sexual dysfunction
271
most common cause of young healthy athletes in US; etio
hypertrophic obstructive CM; inherited as an autosomal dominant trait
272
echo shows rapid early filling and normal EF; EKG LBBB. which CM?
restrictive
273
7 major risk factors in CAD
male, inc LDL, dec HDL, smoking, HTN, FH, age(male over 45 and woman over 55),
274
tx for chronic stable angina
BB, aspirin, and nitro
275
Xanthelasma, xanthomas, lipemia retinalis; indicates what
yellow deposits in skin around eyes, eruptive nodules in skin over tendons, creamy appearance of retinal vessels; think dyslipidemia
276
When to conduct a fasting lipid profile
pts over 35 y.o or over 20 y.o with CAD risk factors; repeat every 5 years.
277
dyslipidemia dx
LDL over 130 or HDL under 40
278
mnemonic for HTN tx
ace/arb, bb, ccb, diuretics
279
tests for end organ complications(kidney and heart)- HTN
creatinine, BUN, urine protein to creatinine ratio, EKG to look for hypertrophy
280
primary renal disease HTN tx
ace
281
diuretic SE
hypokalemina; HYPER glycemia, lipemia, uricemia; azotemia
282
BB SE
bronchospasm, bradycardia, CHF exacerbation, impotence, fatigue, depression
283
ACE SE
angiodema, rash, leukopenia, HYPERkalemia
284
ARB SE
leukopenia, rash, HYPERkalemia
285
screening in aortic aneurysm
screen all men 65-75 with hx of smoking once by ultrasound.
286
when to repair and when to monitor a AAA
under 5 cm -monitor
over 5 cm- surgery
287
what is a AAA and origination
greater than 50% dilatation of all 3 layers of the aortic wall; most are abdominal and over 90% below renal arteries
288
AAA commonly associated with what
atherosclerosis
289
what is aortic dissection
transverse tear in the intima of a vessel that results with blood entering the media, creating a false lumen and leading to a propagating hematoma
290
aortic dissection commonly linked to what
HTN
291
common site for aortic dissection; age, gender
above aortic valve and distal to left subclavian artery. age 40-60 and greater in females
292
imaging of AAA and aortic dissection
AAA: abd ultrasound; aortic dissection is CT angiography
293
BP classification
(3)
over 60 y/o: 150/90(no CKD, DM,or HTN)
under 60 y/o: 140/90
over 18 y/o with CKD or DM: 140/90
294
spironolactone SE and uses
hyperkalemia, gynecomastia
2nd line for acute pulm edema and CHF
295
meds to reduce mortality in CHF
BB with ACE
296
first test to order for CHF.
echo. look at EF
297
medication for CHF to add if angina present
amlodipine
298
most specific and sensitive cardiac enzyme
troponon 1
299
wide split S2 can be what 2 things
ASD or PS
300
harsh systolic murmur can be what 2 things
AS(heard best at LSB) or COA
301
S2 S3 S4 with
AS, AR, PS, MR, MS,
AS and AR S4
PS S3 and S4
MR S2 and S3
MS S2
302
S2 S3 S4 with
AS, AR, PS, MR, MS,
AS and AR S4
PS S3 and S4
MR S2 and S3
MS S2
303
pansystolic murmur heard best at apex and rad to left axilla
MR
304
rib notching or 3 sign
COA
