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Physician Assistant > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Define the measurements of orthostatic vitals that define orthostasis/postural hypotension

A

Between supine and sitting and/or standing

  • >20 mmHg decrease in systolic BP
    ​OR
  • >10 mmHg decrease in diastolic BP

>15 bpm HR increase suggests depleted circulating blood volume

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2
Q

Primary (essential) HTN casues ____% of elevated BP cases

A

95%

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3
Q

What are the BP ranges for:

  • Normal
  • Elevated
  • HTN Stage I
  • HTN Stage II
  • HTN Crisis
A
  • Normal
    • <120 AND <80
  • Elevated
    • 120-129 AND <80
  • HTN Stage I
    • 130-139 OR 80-90
  • HTN Stage II
    • >140 OR >90
  • HTN Crisis
    • >180 AND/OR >120
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4
Q

List some causes of secondary HTN

A
  • Renal
    • renal disease
    • renal artery stenosis
  • Endocrine
    • pheochromocytoma
    • cushing syndrome
    • hyperthyroidism
    • primary hyperaldosteronism
  • Pharmacology
    • NSAIDs
    • Estrogens
  • Obstructive
    • Sleep apnea
    • coarctation of the aorta
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5
Q

Nonpharmacologic therapies for essential HTN

A

Dietary Approaches to Stop Hypertension (DASH) diet

weight loss

aerobic exercise

cessation of smoking

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6
Q

What 3 HTN medications are safe during pregnancy?

A

Methyldopa

Nifedipine

Labetalol

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7
Q

2 major factors that affect BP

A

CO and PVR

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8
Q

? x ? = Cardiac Output (CO)

A

HR x SV = CO

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9
Q

HR x SV = CO

What 3 things affect stroke volume (SV)?

A

Preload

Afterload

Contractility

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10
Q

“-prils” drug class

A

ACE Inhibitors

Captopril

Enalapril

Lisinopril

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11
Q

“-sartans” drug class

A

ARBs (Angiotensin II Receptor Blockers)

Losartan

Valsartan

Candesartan

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12
Q

Spironolactone drug class

A

Aldosterone Antagonist

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13
Q

HTN first line drug for pts with DM and/or CKD

A

ACEI

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14
Q

ACEI Contraindications

A

Bilateral renal stenosis

Pregnancy

H/O angioedema

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15
Q

Avoid combining ACEI with what other medications/supplements? Why?

A
  • Avoid combining with
    • other RAAS inhibitors
    • K sparing diuretics
    • K supplements
    • Salt substitutes (KCl)

ACEI decrease amount of aldosterone. Aldosterone holds the Na and spits out the K. With decreased levels, less K is spit out and puts pt at risk of hyperkalemia.

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16
Q

Side effects of ACEI

A

hypotension

renal dysfunction

hyperkalemia

cough

angioedema

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17
Q

ACEI and ARBs relax the _____ arterioles of the nephrons

A

efferent arterioles

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18
Q

HTN in Special Populations - Which drug(s) would you prescribe?

  • Elderly
  • Black
A

Thiazide

Thiazide-like diuretics

CCB

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19
Q

HTN in Special Populations - Which drug(s) would you prescribe?

  • DM
A

ACEI/ARBs

Thiazide-like diuretics

CCB

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20
Q

HTN in Special Populations - Which drug(s) would you prescribe?

  • CAD
A

BB

Non-DHP CCB

ACEI/ARB

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21
Q

HTN in Special Populations - Which drug(s) would you prescribe?

  • HF
A

ACEI/ARBs

Diuretics

BB

Aldosterone Antagonist

22
Q

HTN in Special Populations - Which drug(s) would you prescribe?

  • CKD
A

ACEI/ARB

CCB

23
Q

HTN in Special Populations - Which drug(s) would you prescribe?

  • PVD
A

CCB

alpha-blockers

24
Q

HTN in Special Populations - Which drug(s) would you prescribe?

  • BPH
A

alpha-blockers

25
Q

HTN in Special Populations - Which drug(s) would you prescribe?

  • Afib/flutter
A

BB

Non-DHP CCB

26
Q

HTN in Special Populations - Which drug(s) would you prescribe?

  • Pregnancy
A

Labetolol

Methyldopa

Nifedipine

27
Q

BP = ? x ?

A

BP = CO x PVR

28
Q

CCBs mechanism of action in treating HTN

A

BP= CO x PVR

  1. Decr PVR (potent vasodilators)
    • DHP
    • Non-DHP
  2. Decr CO by decr contractility (negative inotropes)
    • Non-DHP
29
Q

DHP vs Non-DHP CCBs

  • MOA
  • List 2 drugs in each class
A
  • DHP CCB
    • ​DECREASE PVR
      • Nifedipine
      • Amlodipine
      • Nicardipine
  • NON-DHP CCB
    • ​Decrease PVR
    • NEGATIVE INOTROPE
      • Diltiazem
      • Verapamil
30
Q

Beta Blocker Classification

What receptors does each BB class target?

  1. Noncardioselective BB
  2. Cardioselective BB
  3. Vasodilating nonselective BB
  4. Vasodilating selective BB
A
  1. Noncardioselective BB
    • B1, B2
  2. Cardioselective BB
    • B1
  3. Vasodilating nonselective BB
    • B1, B2, a
  4. Vasodilating selective BB
    • B1
31
Q

“-zosin” is what class of drugs

A

Alpha-1 Blockers

Daxazosin

Prazosin

Terazosin

32
Q

Name the heart sound/what you hear

A

Normal Heart Sound

S1 and S2

33
Q

Name the heart sound/what you hear

A

Aortic Stenosis

  • systolic murmur
  • Diamond <> sound
  • mid-systolic
34
Q

Name the heart sound/what you hear

A

Mitral Regurgitation OR Mitral Valve Prolapse

  • Systolic murmur
  • Holosystolic
  • “Blowing”
35
Q

Name the heart sound/what you hear

A

Aortic Regurgitation

  • Diastolic
  • early diastolic
  • Decrescendo >, high-pitched, blowing
36
Q

Name the heart sound/what you hear

A

Mitral Stenosis

  • Diastolic
  • Opening snap
  • low-pitched, rumbling
37
Q

Name the heart sound/what you hear

A

Atrial Septal Defect (ASD)

  • Systolic murmur
  • Fixed S2 split (mitral b4 tricuspid)
  • soft
38
Q

Name the heart sound/what you hear

A

Ventricular Septal Defect (VSD)

  • Pansystolic
  • high freq and intensity
39
Q

Name the heart sound/what you hear

A

Splitting of S2

40
Q

Name the heart sound/what you hear

A

S3

41
Q

Name the heart sound/what you hear

A

S4

42
Q

Rheumatic heart disease can result in what heart murmur?

A

Mitral Regurgitation/Insuffiency

43
Q

Mitral Insufficiency

  • systolic or diastolic
  • stethoscope placement/position of pt
  • sound
  • what makes the murmur incr/decr
A
  • systolic or diastolic
  • L. axilla, L. lateral position
  • Holosystolic, “Blowing”
  • what makes the murmur incr/decr
    • Incr: squatting
    • Decr: valsalva and standing
44
Q

Mitral Valve Prolapse

  • systolic or diastolic
  • stethoscope placement/position of pt
  • sound
  • what makes the murmur incr/decr
A
  • systolic or diastolic
  • L. axilla
  • sometimes mid-systolic click
  • what makes the murmur incr/decr
    • Incr: standing
    • Decr: Squatting

Sounds like mitral valve insufficiency but acts OPPOSITE

45
Q

Aortic Stenosis

  • systolic or diastolic
  • stethoscope placement/position of pt
  • sound
  • what makes the murmur incr/decr
  • symptoms
A
  • systolic or diastolic
  • Right ICS, Pt sit up and lean fwd
  • Diamond <> mid systolic
  • what makes the murmur incr/decr
    • Decr: isometric hand grip/ incr resistance, valsalva
  • Angina, dyspnea/syncope c exertion
  • NARROW pulse pressure
  • Do NOT do stress test –> Death
46
Q

Pathophysiology of S4

A

Atrial contraction injecting blood into stiff/noncompliant ventricle

47
Q

Pathophysiology of S3

A

Increased ventricular (diastolic) volume

Decreased ventricular compliance

Can be normal- kids, young adults, pregnancy

48
Q

Mitral Stenosis

  • systolic or diastolic
  • stethoscope placement/position of pt
  • sound
  • what makes the murmur incr/decr
A
  • Diastolic
  • Apex c Bell, Pt in LLD position
  • Opening snap, low pitched, rumbling
  • what makes the murmur incr/decr
    • Incr: inspiration and squatting
49
Q

Aortic Regurgitation

  • systolic or diastolic
  • stethoscope placement/position of pt
  • sound
  • what makes the murmur incr/decr
A
  • Diastolic
  • Right ICS, Pt lean fwd and exhale
  • Decrescendo >, high pitched, blowing
  • What makes the murmur incr/decr
    • Incr: hand grip
    • Decr: amyl nitrate
  • WATER HAMMER PULSE
  • WIDE PULSE PRESSURE
50
Q

Kerley B lines seen on CRX indicate what?

A

Interstitial edema

51
Q

Clenched fist over the sternum and clenched teeth when presenting with chest pain is known as _____ sign

A

Levine sign

52
Q
A

Physician Assistant (11 decks)

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