cardiology II Flashcards
what are the characteristics of typical angina/
o Typical angina: substernal chest discomfort with the following features
• Oppressive quality (described as “squeezing, pressure, heaviness”) not sharp or stabbing, minute(s)duration
• Provoked by exertion or emotional stress
• Relieved by rest and nitroglycerin (within several minutes)
what are the ischemic causes of angina/
CAD, critical aortic stenosis, severe HTN, coronary spasm, hypertrophic cardiomyopathy, severe pulmonary HTN,
what are the extra cardiac causes of angina/?
Anemia, hypoxia, hyperthyroidism, hyperviscosity,
what are the non cardiac causes of angina/?
GI, pulmonary, musculoskeletal psych
what are the MC causes of acute chest pain?
are acute cardiac ischemia=MI, Unstable angina, stable angina
what is the best way to understand a pts CP?
have them describe it in their own words
what are the close ended questions to ask after a patient describes CP in their own words and what is its significance?
chest pain right now? (acute or chronic) does the chest pain prevent you from doing things you would normally do? (impact on physical activity–stable or unstable)
when evluating someone with angina, what RFs should you consider?
• Check RFs for DM, smoking, HTN, hyperlipidemia, FH of premature CAD, postmenopausal status, PVD, cocaine abuse
these sx of CP reduce the likelihood of what? o Pleuritic chest pain, chest pain reproduced by palpation, sharp or stabbing chest pain, positional chest pain also 1) very brief pain
reduce the likelihood of MI
what are some alarm sx of palpitations and their significance?
syncope or presyncope (if in SVT its fast enough to reduce CO), FH of sudden cardiac death or known arrhythmia, meds that prolong QT (may have started an arrhythmia by landing on QT interval) , hx of heart disease, valvular or hypertrophic or dilated cardiomyopathy
how should you get a detailed description of a pts heart palpitations?
have them tap it out, have them describe the circumstances eliciting it, ask about associated sx, ask about meds, sx: a pounding neck is a “frog sign’ meaning the atria and ventricles are contracting at the same time. a sensation of a skipped beat or flip flopping usually means a premature systole and a compensatory pause.and forceful contraction afterwards.
how often should risk factors for CVD be checked in people over 20?
FH: regularly; smoking, diet, alcohol, activity, BMI, BP, waist circumference, pulse (for afib) at each routine visit (q 2 years or so)
HTN accounts for •
____ of all Mis and strokes
_____ of all episodes of heart failure
_____ of all premature deaths
35%; 49%, 24%
what are some risk factors for HTN?
physical inactivity
microalbuminuria or estimated GFR less than 60 mL/min
family history of premature CVD (
what are the recommended lifestyle modifications for preventing cardiovascular disease and stroke? (hint: they are the same for preventing or managing HTN)
o Optimal weight, or BMI of 18.5-24.9
o Salt intake of less than 6 Gm NaCl or 2.4 Gm of Na/day
o Vigorous exercise at least 30 min/day, 3 days/wk.
o Limit alcohol consumption to
when can s1 be accentuated?
• S1 can be accentuated in tachycardia, rhythms with a short PR (the ventricles contract and close the valve before it can on its own) or in high cardiac output states like exercise, anemia, hyperthyroidism because they have a lot of blood and close it quickly
when can s1 be diminished?
• S1 can be diminished in first degree heart block (delayed conduction to ventricles causes valve to close on its own a little bit already) or if the mitral valve is calcified and relatively immobile like in mitral regurgitation or when left ventricular contractility is markedly reduced like in CHF or coronary artery disease
when is the pulse felt relative to s1?
the pulse is felt right after s1 is heard, because s1 is caused by the ventricles contracting the blood out that causes the pulse
when do you hear s3?
o Occurs after the mitral valve opens and the ventricle fills rapidly causing stretching of the chordae tendinae or possibly from blood decelerating and hitting the ventricular wall.
o Can be normal or physiologic in people under age 40 and is common in the third trimester of pregnancy
• Because there is increased blood volume
• If they are not super athletic or pregnant its probably pathologic
• Think about volume overload
o Past age 40, it is pathologic and indicates volume overload or heart failure.
why/when will the s4 heart sound be heard?
o Occurs just before s1.
o Sound made by the contraction of the atria and blood being forced into a stiff or hypertrophic ventricle.
o Thought to be due to stiff myocardium with decreased compliance.
• You actually hear the blood going into the ventricle because the ventricle can’t stretch
o May be normal in athletes and the elderly.
o Usually heard best at the PMI in the left lateral position.
o Usually is pathologic and causes include:
• Hypertensive heart disease
Need to manage our pts with HTN
Causes ventricles to toughen up
• Coronary artery disease
• Aortic stenosis
Can’t get blood as easily through aortic valve
• cardiopmyopathy
o Will sound like “tennessee”
when will you hear a varying s1?
• S1 will vary in 3rd degree heart block because atria and ventricles are contracting independlty of each other; or heard in irregular rhythms like fib
what are the rep’s for exercise for a 5-10 yo?
- 5 - 10 y Moderate to vigorous physical activity every day (Grade A) Strongly Recommend
- 5 - 10 y (cont) Limit daily leisure screen time (TV/video/computer)(Grade B)Strongly Recommend
- 5 - 10 y (cont)Supportive actions: Prescribe moderate to vigorous activity 1 h/d with vigorous intensity physical activity on 3 d/wk
- Limit total media time to no more than 1-2 hours of quality programming per day
- No TV in child’s bedroom
- Take activity and screen time history from child once a year
- Match physical activity recommendations with energy intake
- Recommend appropriate safety equipment relative to each sport
- Support recommendations for daily physical education in schools
what are the rep’s for exercise for a 11-17 yo?
• 11 -17 y Moderate to vigorous physical activity every day (Grade A)Strongly Recommend
• 11 -17 y (cont.)Limit leisure time TV/video/computer use (Grade B)Strongly Recommend
• 11 -17 y (cont.)Supportive actions:
Encourage adolescents to aim for 1 h/d of moderate to vigorous daily activity, with vigorous intense physical activity on 3 d/wk
• Encourage no TV in bedroom
• Limit total media time to no more than 1-2 hours of quality programming per day
• Match activity recommendations with energy intake
• Take activity and screen time history from adolescent at health supervision visits
• Encourage involvement in year-round, physical activities
• Support continued family activity once a week and/or family support of adolescent’s physical activity program
• Endorse appropriate safety equipment relative to each sport.
what are the rep’s for exercise for a 18-21 yo?
• 18 - 21 y Moderate to vigorous physical activity* every day. (Grade A)Strongly Recommend
• 18 -21 y (cont)Limit leisure time TV/video/computer. (Grade B)Strongly Recommend
• 18 -21 y (cont)Supportive actions:
Support goal of 1 h/d of moderate to vigorous daily activity with vigorous intense physical activity on 3 d/wk
• Recommend that combined leisure screen time not exceed 2 h/d
• Activity and screen time history at health supervision visits
• Encourage involvement in year-round, lifelong physical activities