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AGACNP Board Review > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Where is the S1 auscultated?

A

Mitral/Tricuspid close
Aortic/Pulmonic open

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2
Q

Where is S2 auscultated?

A

Aortic/Pulmonic closure
Mitral/Tricuspid open

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3
Q

What is Systole?

A

Period between S1 and S2

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4
Q

What is Diastole?

A

Period between S2 and S1

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5
Q

When is S3 auscultated?

A

Auscultated when there is increased fluid in the heart

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6
Q

When is S4 auscultated?

A

Auscultated when the heart is stiff

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7
Q

Murmur grading

A

I/IV: Barely auscultated
II/IV: Faintly heard
III/IV: Loud
IV/VI: Loud with thrill
V/VI: Auscultated with part of the stethescope
VI/VI: Loudest

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8
Q

Mitral Stenosis Murmur

A

Loud S1, low pitched, mid distolic

Mitral Opening Snap and Diastolic Murmur

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9
Q

Mitral Regurgitation

A

Systolic murmur at the 5th ICS MCL

Early Systolic Murmur

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10
Q

Aortic Stenosis

A

Systolic, rough, harsh murmur

Systolic Murmur with Absent S2

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11
Q

Aortic Regurgitation

A

Diastolic, blowing murmur at the 2nd left ICS

Early Diastolic Murmur

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12
Q

Where is a Mitral Murmur?

A

In the apex of the heart located in the 5th ICS

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13
Q

Where is a Aortic Murmur?

A

In the base of the heart located between the 2nd and 3rd ICS

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14
Q

What valvular diseases can be auscultated during diastole?

A

Mitral
Stenosis
Aortic
Regurgitation
Diastolic

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15
Q

What valvular disease can be auscultated during systole?

A

Mitral
Regurgitation
Aortic
Stenosis
Systolic

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16
Q

What is Heart Failure?

A

A condition that lowers cardiac output leaving it unable to meet the needs of the body

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17
Q

What are the types of of Heart Failure?

A

HFrEF
HEmEF
HFpEF
Acute
Chronic

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18
Q

What is HFrEF?

A

EF less than 40%
Inability to contract

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19
Q

What is HFmEF?

A

EF between 40-50%

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20
Q

What is HFpEF?

A

EF greater than 50%
Inability to relax and fill

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21
Q

What is AHF?

A

Abrupt onset of heart failure usually because of MI or valve rupture

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22
Q

What is CHF?

A

Develops as a result of inadequate compensation that have been used over a period of time to improve cardiac output

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23
Q

Clinical manifesations of acute left sided heart failure

A

Dyspnea
Coarse rales
Wheezing
Frothy cough
S3
Mitral regurgitation murmur

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24
Q

Clinical manifestations of chronic right sided heart failure

A

JVD
Hepatomegaly
Splenomegaly
Dependent edema
Paroxysmal nocturnal dyspnea
Appears chronically ill
Diffuse chest wall heave
Displaced PMI
Abdominal Fullness
Fatigue
S3 and/or S4

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25
Q

NYHA Class One

A

No limitation of physical activity

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26
Q

NYHA Class Two

A

Slight limitation of physical activity, but comfortable at rest

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27
Q

NYHA Class Three

A

Moderate limitation of physical activity, but comfortable at rest

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28
Q

NYHA Class Four

A

Unable to carry out physical activity and symptoms do not go away with rest

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29
Q

Laboratory/Diagnostics

A
  1. ABG: Hypoxemia and Hypocapnia
  2. Elevated BNP
  3. CXR has Pulmonary Edema and Effusion
  4. Echo
  5. ECG may show deviation or underlying problem
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30
Q

Nonpharmacologic intervention for heart failure

A
  1. Sodium restriction
  2. Rest/activity balance
  3. Weight reduction
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31
Q

What are the pharmacologic interventions for congestive heart failure?

A
  1. Diuretic.
  2. Angiotensin, converting enzyme inhibitor, or angiotensin II receptor blocker
  3. Beta blocker.
  4. Entresto
  5. Digoxin
  6. Anticoagulation therapy for atrial fibrillation
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32
Q

What is a cardiomyopathy?

A

A cardiomyopathy is any disorder that affects the heart muscle

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33
Q

What are the different types of cardiomyopathies?

A
  1. Dilated cardiomyopathy
  2. Hypertrophic cardiomyopathy
  3. Restrictive cardiomyopathy
  4. Arrhythmogenic right ventricular dysplasia 
  5. Transthyretin amyloid cardiomyopathy
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34
Q

What is dilated cardiomyopathy?

A

Dilated cardiomyopathy is dilation of the heart muscle

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35
Q

What is hypertrophic cardiomyopathy?

A

Hypertrophic cardiomyopathy he is hypertrophy of the left, and sometimes the right ventricle

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36
Q

What is restrictive cardiomyopathy?

A

Restrictive cardiomyopathy is scarring and stiffening of the heart muscle

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37
Q

What are the signs and symptoms of cardiomyopathy?

A

Signs and symptoms of cardiomyopathy is similar to congestive heart failure

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38
Q

Acute management of heart failure

A
  1. Manage ABC’s
  2. Preload and afterload reduction with vasodilators
  3. Inhibition of neurohormonal activation
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39
Q

Routine management of heart failure

A
  1. Start beta blockers once euvolemic
  2. Diuretic.
  3. ACEi/ARB
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40
Q

Inpatient management of pulmonary edema

A
  1. Oxygen at 1 to 2 L
  2. Please patient and sitting or semi-Fowlers
  3. Morphine 2 to 4 mg IV push
  4. Furosemide 40 mg IV up to 80 mg over 20 minutes
  5. If cardio index is low, use dobutamine
  6. If SBP is low, use dopamine.
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41
Q

What are the two types of hypertension?

A
  1. Primary is in 95% of all cases.
  2. Secondary is in 5% of all cases, and due to estrogen, renal disease, pregnancy, endocrine disorder, renal artery stenosis
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42
Q

What modifiable risk factors increase blood pressure?

A
  1. Smoking
  2. Obesity
  3. Excessive alcohol intake.
  4. NSAIDS
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43
Q

What are the signs and symptoms of hypertension?

A
  1. Often silent or none
  2. Elevated blood pressure
  3. Headache.
  4. Epistaxis
  5. Dizziness.
  6. Lightheadedness
  7. S4
  8. Chest pain
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44
Q

Laboratory and diagnostic test for hypertension

A
  1. BMP
  2. Chest x-ray
  3. Plasma aldosterone
  4. Cortisol level
  5. Urinalysis
  6. Complete blood count.
  7. Calcium (Hypercalcemia causes increased vascular resistance)
  8. Phosphorus (Hyperphosphotemia causes increased vascular resistance)
  9. Uric acid
  10. Cholesterol
  11. Triglycerides
  12. ECG 
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45
Q

What is a normal blood pressure?

A

SBP <120 and DBP <80

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46
Q

What is stage one hypertension?

A

Stage one hypertension is a systolic blood pressure of 130-139 and diastolic blood pressure of 80-89

47
Q

What is the stage two hypertension?

A

Stage two hypertension is a systolic blood pressure of >140 and diastolic blood pressure of >90

48
Q

What what are some nonpharmacologic therapies for hypertension?

A
  1. Restrict dietary sodium.
  2. Weight loss
  3. Dash diet
  4. Exercise.
  5. Stress management planning
  6. Reduction or elimination of alcohol
  7. Smoking cessation
  8. Appropriate nutritional intake
49
Q

Pharmacologic management for non-African-American for hypertension

A

Thiazide diuretic
Angiotensin-converting enzyme inhibitor
Angiotensin-receptor blocker
Calcium channel blocker

50
Q

Pharmacological management for African-Americans for hypertension

A

Thiazide Diurtic
Calcium Channel Blockers

51
Q

Pharmacological management for diabetics with hypertension

A

ACEi
ARB

52
Q

Pharmacological management of hypertension in chronic kidney disease

A

ACEi

53
Q

What medication is the first line therapy for hypertension?

A

Thiazide Diuretics followed ACE/ARB and CCB

54
Q

What blood pressure is a hypertensive urgency?

A

180/110

55
Q

What is the treatment for hypertensive urgency?

A

Clonidine

56
Q

What blood pressure is considered hypertensive emergency?

A

180/120

57
Q

Name five conditions associated with hypertensive emergencies

A
  1. Malignant hypertension
  2. Hypertensive cephalopathy
  3. Intracranial hemorrhage
  4. Unstable angina
  5. Acute MI
  6. Acute HF
  7. Dissecting aortic aneurysm
  8. Eclampsia
58
Q

What is the management of hypertensive emergency?

A

ICU admission and administration of nicardipine, sodium nitroprusside, labetalol, esmolol, and hydralazine

59
Q

What is angina?

A

Decreased blood flow through the vessel resulting in tissue ischemia causing cardiovascular pain

60
Q

What are the four types of angina?

A
  1. Stable.
  2. Prinzmetal.
  3. Unstable.
  4. Microvascular.
61
Q

What is stable angina?

A

Stable angina is chest pain associated with exertion that may be acute or chronic

62
Q

What is Prinzmetal angina?

A

Prinzmetal angina is associated with vasospasms, occurs at various times, and even at rest

63
Q

What is unstable angina?

A

Unstable angina is chest pain associated with coronary syndrome that does not resolve at rest

64
Q

What are the clinical manifestations of angina?

A
  1. Chest discomfort that last for several minutes.
  2. Chest pain associated with exertion
  3. Use of nitroglycerin.
  4. Signs of peripheral artery disease.
  5. Levine sign (clenched fist)
  6. Presence of S4
65
Q

What are the EKG readings during angina?

A
  1. EKG may be normal
  2. May have depressed ST segment
  3. May have peaked T-waves of inverted T-waves
66
Q

What are four diagnostic tools for angina?

A
  1. ECG
  2. Exercise ECG
  3. Serum lipid panel
  4. Coronary angiography
67
Q

What risk factors are associated with Angina?

A
  1. Age (>40)
  2. Sex (Male)
  3. Race (African American)
  4. Total cholesterol (High)
  5. HDL cholesterol (Low)
  6. SBP (High)
  7. Diabetic
  8. Current or history of smoking
68
Q

What are common pharmacological therapies for angina?

A
  1. ASA 81 mg
  2. Nitrates
  3. Beta-Blockers
  4. Calcium Channel Blockers
69
Q

What makes a patient qualify for statin therapy?

A
  1. Clinical evidence of ASCVD
  2. LDL-C greater than 190mg/dl
  3. Patients with diabetics and have a LDL-C between 70-189 without clinical evidence of ASCVD
  4. Individuals without ASCVD or diabetes with LDL-C between 70-189 with an estimated 10-years risk ASCVD >7.5%
70
Q

What is High-Intensity statin therapy?

A

Lowers LDL-C by an average of 50%

  1. Atorvastatin 40-80mg
  2. Rosuvastatin 20-40mg
71
Q

What is Moderate-Intensity Statin Therapy?

A

Lowers LDL-C 30-50%
1. Atorvastatin 10-20 mg
2. Rosuvastatin 5-10 mg
3. Simvastatin 20-40 mg
4. Pravaststin 40-80 mg
5. Fluvastatin 80 mg
6. Pitavastatin 2-4 mg

72
Q

What is Low-Intensity Statin Therapy?

A

Lowers LDL-C by 30%
1. Simvastatin 10 mg
2. Pravastatin 10-20 mg
3. Lovastatin 20 mg
4. Fluvastatin 20-40 mg
5. Pitavaststatin 1 mg

73
Q

Other agents used for cholesterol reduction

A
  1. Cholestyramine (Questran)
  2. Colesevelam (Welchol)
  3. Colestipol (Colestid)
  4. Gemfibrozil (Lopid)
  5. Fenofibrate (Tricor)
  6. Fenofibric Acid (Trillpix)
  7. Ezetimbe (Zetia)
  8. Niacin (Vitamin B3)
74
Q

What is MI and ACS?

A

Sudden cardiac death due to coronary artery disease and cardiomyopathy

75
Q

What are 5 clinical manifestations of AMI?

A
  1. Alteration in typical anginal pain
  2. NTG has little effect
  3. Diaphoresis
  4. Weakness
  5. Impending doom
  6. Apprehension
  7. Light-headedness
  8. Syncope
  9. Dyspnea
  10. Cough
  11. Nausea
  12. Vomiting
76
Q

Physical Exam findings for AMI

A
  1. Dysrhythmia
  2. Presence of S4
  3. Wheezing
  4. Pulmonary crackles
  5. Low-grade fever
  6. Tachycardia
77
Q

Laboratory and Diagnostic findings for AMI

A
  1. Peaked T waves
  2. ST elevation
  3. Cardiac enzyme elevation
  4. Leukocytosis
  5. Heart Block
78
Q

Management for AMI

A
  1. ASA 325
  2. NTG x3 every 5 minutes
  3. Oxygen and IV
  4. ECG
  5. Morphine 2-4 mg
  6. Furosemide 40 mg IVP
  7. Heparin or Lovenox
  8. Coagulation monitoring
79
Q

Therapeutic value for MI

A

INR 2.5-3.5 times the normal
APTT, PT, PTT 1.5-2.5 times the normal

80
Q

Indications for pharmacologic revascularization in MI

A
  1. Unrelieved chest pain between 30 minutes and up to six hours with ST elevation in 2 or more leads
  2. Medications used for MI is alteplase and tenectaplase
81
Q

Contraindications for Pharmacologic Revascularizatrion

A
  1. Prior ICH
  2. Cerebral neoplasm
  3. Ischemic stroke within 3 months
  4. Suspected aortic dissection
  5. Actively bleeding or risk of active bleeding
  6. Closed head/facial trauma within 3 months
  7. Intracranial or Intraspinal surgery within 2 months
  8. Uncontrolled Hypertension
82
Q

What is PVD?

A

Peripheral vascular disease is arteriosclerotic narrowing of the lumen of the arteries resulting in decreased blood supply to the extremities

83
Q

What are common causes of PVD?

A
  1. Atherosclerosis
  2. Age: 40-70
  3. Hyperlipidemia
  4. Smoking
  5. Diabeties Mellitus
84
Q

What are signs and symptoms of PVD?

A
  1. Claudication
  2. Cold/numb extremities
  3. Pain at rest
85
Q

Physical exam findings indicative of PVD

A
  1. Shiny/hairless skin
  2. Digital rubor
  3. Pallor
  4. Cyanosis
  5. Ulcerations
  6. Reduced pulses
86
Q

Labs/Diagnostics for PVD

A
  1. Doppler U/S
  2. ABI
  3. XRAY
  4. Arteriography
87
Q

Management for PVD

A
  1. Smoking Cessation
  2. Exercise
  3. Pletal
  4. Weight reduction
  5. Diabeties and cholesterol management
  6. Angioplasty
  7. Bypass Surgery
  8. Amputation
88
Q

What is CVI?

A

Chronic Venous Insufficiency is impaired venous return due to destruction of the valave, a dvt, leg trauma, or sustained venous pressure seen in heart failure

89
Q

What are the common etiologies of CVI?

A
  1. Female
  2. Genetics
  3. History of leg trauma
90
Q

Signs and symptoms of CVI

A
  1. Aching of lower extremities relieved by elevation
  2. Edema after prolonged standing
  3. Night cramps of the lower extremities
91
Q

Physical exam findings in CVI

A
  1. Trophic changes with brownish discolaraion
  2. Stasis leg ulcers
  3. Edema of lower extremities
  4. Dermatitis
  5. Cool to touch
92
Q

Laboratory and diagnostic findings in CVI

A

Rule-out other causes of edema like CHF, DVT, and May-Thurner syndrome

93
Q

CVI Management

A
  1. Bed rest with legs elevated to diminish chronic edema
  2. Use of heavy-duty elastic support stockings
  3. Weight reduction
  4. Treat dermatitis and ulcers as indicated
94
Q

Acute weeping dermatitis management

A

Tap water compresses
Hydrocolloid dressings
Hydrocortisone cream

95
Q

What is Pericarditis?

A

Inflammation of the pericardium

96
Q

What the common etiologies of Pericarditis?

A
  1. Virus (most common cause)
  2. MI
  3. Renal failure
  4. Endocarditis
  5. Drug/Trauma
  6. Idiopathic
97
Q

Signs and symptoms of Pericarditis

A
  1. Chest pain
  2. Pain increased with deep inspiration, coughing, or swallowing
  3. Pain relieved by sitting forward
  4. Dyspnea related to pain with inspiration
98
Q

Physical exam finding for Pericarditis

A
  1. Pericardial friction rub
  2. Plural friction rub
  3. Fever
99
Q

Laboratory/Diagnostic findings in Pericarditis

A
  1. ST elevation in all leads
  2. Depression of PR segment
  3. ESR elevation
  4. Positive blood cultures
  5. CBC positive for infection
  6. Echocardiogram reveals pericardial fluid
  7. BMP at patients baseline
100
Q

Management of Pericarditis

A
  1. NSAIDS
    Indomethacin
    Ketoralac
    Ibuprofen
  2. Corticosteroids
  3. Antibiotics
  4. Monitor for tamponade
101
Q

Exam findings indicitive of tamponade

A
  1. Hypotension
  2. JVD
  3. Muffled/Distant heart sounds
  4. Pulsus paradoxus
102
Q

What is Endocarditis?

A

Endoarditis is an infection of the endothelial surface of the heart that usually affects the valves

103
Q

Common causes of endocarditis

A
  1. Bacteria
  2. Rheumatic disease
  3. Aortic/Mitral valve prolaspe
  4. Recent dental/oropharyngeal surgery
  5. GU or Resp. surgery
  6. Congenital heart disease
  7. Prolonged use of TPN
  8. Burn patients
  9. Hemodialysis
104
Q

Signs and symptoms of Endocarditis

A
  1. Fever
  2. Malaise
  3. Night sweats
  4. Weight loss
  5. Generally feels sick
105
Q

Physical exam findings for endocarditis

A
  1. Murmur
  2. Fever
  3. Osler nodes
  4. Petechiae, purpura, pallor
  5. Splinter hemorrhages
  6. Janeway lesions
  7. Roth spots
106
Q

What are Oslers nodes?

A

Painful red nodules in the distal phalanges

107
Q

What are splinter hemorrhages?

A

Linear, subungal, splinter-appearing in the nail bed

108
Q

What are Janeway lesions

A

Small painless macules on palm and soles

109
Q

What are Roth spots?

A

Small retinal infarcts, white in color, encircled by areas of hemorrhage

110
Q

Lab/Diagnositic findings for endocarditis

A
  1. Leukocytosis
  2. Left shift bands
  3. Valvular damage
  4. Blood culture x3
  5. ESR elevation
111
Q

Management of Endocarditis

A

Empiric therapy with Vancomycin until culture results are available

112
Q

Gerontological cardiovascular changes

A
  1. Aterial wall thicken reducing compliance
  2. The heart hypertophies
  3. Sclerosis of veins
  4. Maximum HR decreases
  5. Barorecptors are less sensitive to blood pressure hanges
  6. Circulatory changes with decreased blood flow
  7. Arterosclerosis and atherosclerosis
113
Q
A

AGACNP Board Review (5 decks)

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