Cardiology Flashcards
ejection fraction will remain normal in _____ heart failure Decreased ejection fraction usually less than 50% in ____ heart failure
diastolic systolic
most common etiology of heart fialure is ____
coronary artery disease.
MC presenting sxs of heart failure are ____ and ____
fatigue, SOB
dx exams for heart failure
ECG: arrhythmia, Q waves, ischemia, LVH stress test: assess exercise tolerance and risk stratification.
When do you order a CXR for a pt with heart failure?
to evaluation of dyspnea & rule out other etiologies of SOB (not to diagnose CHF).
what meds lower mortility in pts with HF?
ACE/ARBs (Ivabradine and Sacubitril-valsartan) BBs (carvedilol, bisoprolol, and metoprolol succinate)
What medications can you give to reduce sxs in heart failure?
Diuretics: fluid overload Digoxin: SOB
___ is used when the ejection fraction is below 35% in a pt with HF, those with sustained VT, and/or those with un-explained syncope to prevent a fatal arrhythmia.
ICD
Work up for pt in acute exacerbation of HF
ECHO ECG: arrhythmias, MI. BNP: distinguish btCHF exacerbation and COPD exacerbation as the cause of dyspnea. Cardiac enzymes: rule out MI
Treatment for acute exacerbation of CHF
LMNOP Loop diuretics Morphine Nitrates Oxygen Position (head up)/positive pressure
____ is a disease of the heart muscle associated with cardiac dysfunction that usually has no etiology
cardiomyopathy
what are the 3 types of cardiomyopathy
Dilated Restrictive Hypertrophic
what dx test is used to differentiate bt Dilated, Restrictive, Hypertrophic cardiomyopathy
echocardiogram
what is the only way to definitively dx restrictive cardiomyopathy?
biopsy
what is the tx of dilated cardiomyopathy?
same as CHF
what is the tx of hypertrophic cardiomyopathy?
BB, CCB ** no diuretics!
This heart defect is described as a systolic ejection murmur with a fixed wide splitting of S2
atrial septal defect
What may cause the The ductus arteriosus is kept open?
low oxygen environment prostaglandins.
machine like continuous murmur describes what heart defect?
PATENT DUCTUS ARTERIOSUS
what are the 4 components of tetralogy of fallot?
Right ventricular hypertrophy VSD Overriding aorta Right ventricular outflow obstruction
___ is a heart defect that sounds like a holosystolic murmur is heard that does not increase with respiration.
VSD
how do you dx HTN?
elevated BP >140/90 on two separate occasions
MC cause of secondary HTN
renal disease
what labs should be ordered upon HTN dx
urine analysis urine micro albumin EKG CBC BMP lipid panel
What PE findings should you look for in a pt newly dx with HTN?
fundoscopy (hemorrhage or papilledema) thyroid assessment carotid bruit size and rhythm of heart crackles in lungs renal bruit pedal edema confusion or weak-ness
HTN tx for a pt w/ DM
ACE/ARB
HTN tx for a pt w/ CHF/Ischemia/CAD?
Beta blocker or ACE/ARB
HTN tx for a pt w/ Angina
Beta blocker or calcium channel blocker
HTN tx for a pt w/ BPH
Alpha blocker
HTN tx for a pt w/ Hyperthyroid
Beta blocker
HTN tx for a pt w/ CKD?
ACE/ARB
HTN tx for a pt w/ Raynaud’s syndrome?
Calcium channel blocker
HTN tx for a pt w/ Migraine?
Beta blocker or calcium channel blocker
____ is hypertension that is not responsive to at least three medications, one of which must include a diuretic.
Resistant hypertension
Common causes of secondary HTN?
Renal artery stenosis Hyperaldosteronism Primary kidney disease Pheochromocytoma Cushing’s disease Sleep apnea Coarctation of aorta
___ is Severely elevated HTN is considered to occur when the systolic is over 180 and/or when the diastolic is over 120, patient is asymptomatic and no end organ damage.
HYPERTENSIVE URGENCY
as a rule of thumb, how much should you drop BP by in hypertensive urgency?
lower pressure no more than 30% in the first few hours reduce over 1-2 days
__ is Severely elevated hypertension usually over 180/120 with end organ damage
HYPERTENSIVE EMERGENCY
what are two main consequences of hypertensive emergency?
malignant hypertension hypertensive encephalopathy
what are s/s of Malignant hypertension due to hypertensive emergency?
papilledema exudates retinal hemorrhage acute kidney injury (hematuria or proteinuria) and/or focal neurological findings.
what are s/s of Encephalopathy due to hypertensive emergency?
cerebral edema: Headache, N/V, confusion, seizure, coma.
dx tests of pts w/ hypertensive emergency?
EKG, CXR, UA, serum creatinine, and cardiac enzymes (is MI suspected)
____ is a state characterized by decreased perfusion and decreased oxygenation of tissues.
Shock
___ shock stems from the heart not being able to pump normally.
Cardiogenic
MC cause of Cardiogenic shock?
MI
Tx of cardiogenic shock
aggressive fluid resuscitation (careful!) pressors (norepinephrine or dopamine) balloon-tipped pulmonary artery (Swan-Ganz) catheter
Common etiology of orthostatic hypothension
Medications hypovolemia anemia heart disease diabetes Parkinson’s disease.
how is orthostatic hypothension dx?
The diagnosis is made if the systolic blood pressure falls 20mmHg or if the diastolic falls 10mmHg or more when going from laying to stanging positions
tx for orthostatic hypotension
- Treat the underlying etiology. 2. Arise slowly from supine to seated to standing 3. increase fluid and sodium intake. 4. If no response, give fludrocortisone (mineralo-corticoid) as first line medical therapy.
