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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
HTN in Special Populations - Which drug(s) would you prescribe? * Afib/flutter
BB Non-DHP CCB
26
HTN in Special Populations - Which drug(s) would you prescribe? * Pregnancy
Labetolol Methyldopa Nifedipine
27
BP = ? x ?
BP = CO x PVR
28
CCBs mechanism of action in treating HTN
BP= CO x PVR 1. Decr PVR (potent **vasodilators**) * DHP * Non-DHP 2. Decr CO by decr contractility (**negative inotropes**) * Non-DHP
29
DHP vs Non-DHP CCBs * MOA * List 2 drugs in each class
* **DHP CCB** * **​**DECREASE PVR * *Nifedipine* * *Amlodipine* * *Nicardipine* * **NON-DHP CCB** * **​**Decrease PVR * NEGATIVE INOTROPE * *Diltiazem* * *Verapamil*
30
Beta Blocker Classification What receptors does each BB class target? 1. Noncardioselective BB 2. Cardioselective BB 3. Vasodilating nonselective BB 4. Vasodilating selective BB
1. Noncardioselective BB * B1, B2 2. Cardioselective BB * B1 3. Vasodilating nonselective BB * B1, B2, a 4. Vasodilating selective BB * B1
31
"-zosin" is what class of drugs
Alpha-1 Blockers ## Footnote Daxazosin Prazosin Terazosin
32
Name the heart sound/what you hear
Normal Heart Sound S1 and S2
33
Name the heart sound/what you hear
Aortic Stenosis * systolic murmur * Diamond \<\> sound * mid-systolic
34
Name the heart sound/what you hear
Mitral Regurgitation OR Mitral Valve Prolapse * Systolic murmur * Holosystolic * "Blowing"
35
Name the heart sound/what you hear
Aortic Regurgitation * Diastolic * early diastolic * Decrescendo \>, high-pitched, blowing
36
Name the heart sound/what you hear
Mitral Stenosis * Diastolic * Opening snap * low-pitched, rumbling
37
Name the heart sound/what you hear
Atrial Septal Defect (ASD) * Systolic murmur * Fixed S2 split (mitral b4 tricuspid) * soft
38
Name the heart sound/what you hear
Ventricular Septal Defect (VSD) * Pansystolic * high freq and intensity
39
Name the heart sound/what you hear
Splitting of S2
40
Name the heart sound/what you hear
S3
41
Name the heart sound/what you hear
S4
42
Rheumatic heart disease can result in what heart murmur?
Mitral Regurgitation/Insuffiency
43
Mitral Insufficiency * systolic or diastolic * stethoscope placement/position of pt * sound * what makes the murmur incr/decr
* **systolic** or diastolic * **L. axilla, L. lateral position** * **Holosystolic, "Blowing"** * what makes the murmur incr/decr * **Incr: squatting** * **Decr: valsalva and standing**
44
Mitral Valve Prolapse * systolic or diastolic * stethoscope placement/position of pt * sound * what makes the murmur incr/decr
* **systolic** or diastolic * **L. axilla** * sometimes **mid-systolic click** * what makes the murmur incr/decr * **Incr: standing** * **Decr: Squatting** ## Footnote **Sounds like mitral valve insufficiency but acts OPPOSITE**
45
Aortic Stenosis * systolic or diastolic * stethoscope placement/position of pt * sound * what makes the murmur incr/decr * symptoms
* **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
Pathophysiology of S4
Atrial contraction injecting blood into **stiff/noncompliant** ventricle
47
Pathophysiology of S3
Increased ventricular (diastolic) volume Decreased ventricular compliance Can be normal- kids, young adults, pregnancy
48
Mitral Stenosis * systolic or diastolic * stethoscope placement/position of pt * sound * what makes the murmur incr/decr
* **Diastolic** * **Apex c Bell, Pt in LLD position** * **Opening snap, low pitched, rumbling** * what makes the murmur incr/decr * **Incr: inspiration and squatting**
49
Aortic Regurgitation * systolic or diastolic * stethoscope placement/position of pt * sound * what makes the murmur incr/decr
* **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
Kerley B lines seen on CRX indicate what?
Interstitial edema
51
**Clenched fist over the sternum** and clenched teeth when presenting with chest pain is known as _____ sign
Levine sign
52

Physician Assistant (11 decks)

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