Cardiovascular

Question 1

What is Apical pulse used to determine?

Answer 1

size of the heart

Question 2

find areas of ischemia in the heart muscle (do not show blockage). >70% blockage shows ischemia

Answer 2

Nuclear studies

Question 3

dye in arteries, shows blockages

Answer 3

Heart catheterization

Question 4

substance produced by liver in response to inflammation. High= general marker of inflammation (including infections and rheumatoid; not specific for CV disease) >10mg/L is high. <10 normal → increase risk, control RF

Answer 4

CRP

Question 5

amount of calcium in the arteries; useful if pt his high risk but has no symptoms

Answer 5

Coronary artery calcium score (CAC)

Question 6

How to do in office Ankle-Brachial Index (ABI)

Answer 6

(divide highest BP at ankle by highest BP in either arm given as a ratio). Decrease of ABI with exercise is a significant indicator of PAD. Normal is 1- 1.1 (ankle about the same as arm). The lower the ABI the worse the PAD
<0.95 indicates possible PAD

Question 7

What does an ABI of <0.95 indicate?

Answer 7

possible PAD

Question 8

How to confirm Unstable angina/ NSTEMI?

Answer 8

cardiac enzymes

Question 9

meds to manage Past STEMI?

Answer 9

Management= Antiplatelet (aspirin or plavix), beta blocker (olol drugs), statin, ACE or ARB, nitro

Past STEMI= Q-wave

Question 10

do not show blockages. Can have up to 70% blocked before _____ study is affected. Shows blood flow only.

Answer 10

Nuclear studies

Question 11

Heaviness, tightness, burning, crushing, squeezing, discomfort often in the chest area (also in back, jaw, shoulder, neck, epigastric). Usually resolves with rest.
Women present with atypical symptoms (don’t feel right, lightheaded, SOB, fatigability)

NOT ____: sharp, jabbing
Usual age: 50s-70s

Answer 11

Angina

Question 12

how to tx angina?

Answer 12

nitroglycerin (vasodilates, decreases afterload) beta blockers (decrease contractility and HR= decreased demand) apply oxygen

Question 13

Predictable; occurs with exertion. Resolves with rest and/or SL Nitro

Answer 13

Stable angina

Question 14

new onset, worsening, or unpredictable. Occurs at rest, unrelieved with rest and SL NTG.
This is a form of ACS, could lead to MI → ED

Answer 14

unstable angina

Question 15

d/t vasospasm. Occurs spontaneously at rest, often at night. F>M; smokers
May have ST depression; clean coronaries on heart cath
Tx: CCBs (relax walls of arteries) and Nitrates

Answer 15

Prinzmetal/Vasospastic Angina

Question 16

d/t microvascular dysfunction or spasm. No epicardial obstruction. Occurs with exertion and rest. Diagnosed with PET or CMR

Answer 16

Microvascular Angina

Question 17

narrowing of the arterial lumen that can lead to cardiac ischemia through thrombus formation, coronary vasospasm, endothelial cell dysfunction. 70% blockage can cause ischemia

Answer 17

Coronary Artery Disease/ASCVD

Question 18

gold standard diagnostic for Coronary Artery Disease/ASCVD

Answer 18

coronary angiography (heart cath) GOLD STANDARD;

stress test (less effective, less invasive), CRP (high CRP → increased inflammation) → not CVD indicator, coronary artery calcium

Question 19

What to do if CAD suspected ?

Answer 19

refer to cardiology!

Question 20

diagnosed with Cardiac enzymes

No EKG changes (same with unstable angina)

Answer 20

NSTEMI

Question 21

(most specific) detectable within hours, peak at 10-24 hours, can be detected for 10-14 days. Usually not ordered outpatient

Answer 21

Troponin

Question 22

claudication (heaviness, tightness, tired, sore, necrotic toe). Pain worse with activity, relieved by rest and if leg is in dependent position, which maximizes blood flow. Pain worse with elevation

Answer 22

Peripheral arterial disease

Question 23

Findings: diminished pulses, hair loss, pallor, rubor, gangrene, ulcers
dx: In office ABI/ Arterial ultrasound

Answer 23

Peripheral arterial disease

Question 24

Tx for PAD?

Answer 24

depends on severity of sx. Lifestyle modifications. Want them to walk to the point of pain daily.
Rx: antiplatelets (low dose ASA), statins
Angioplasty or bypass surgery if severe.

Question 25

increased pressure (d/t obesity, pregnancy, standing all day) damages valves and disrupts one way flow back to heart
PE: swelling, worse at end of the day (dependent edema); chronic skin changes (ruddy discoloration), potentially ulcerations. Discomfort worse when standing, relieved with elevation. Warm extremities with normal pulses

• clinical diagnosis
  Tx: compression stockings and periodic leg elevation

Answer 25

Peripheral Venous insufficiency

Question 26

pathologic distension and proliferation of superficial veins

Answer 26

varicose veins

Question 27

familial (cannot have a hx of DVT for this classification) usually occur during pregnancy

Answer 27

primary varicose veins

Question 28

result from previous DVT. Incompetent valves after recannulation therapy.

Answer 28

Secondary varicose veins

Question 29

result from increased pressure in superficial veins

Answer 29

Telangiectasia

Question 30

how to dx varicose veins?

Answer 30

clinical, based on inspection. See veins fill while pt standing. Venous duplex to r/o DVT.

Question 31

(usu affects 2-5th costochondral junction)

Sharp pain, worse with movement or deep breathing
Recent physical exercise, illness with cough
Pain often one-sided; palpation elicits tenderness
Tx: heat, ice, NSAIDs

Answer 31

costochondritis

Question 32

involves single cartilage (usu. 2nd rib)
Sharp pain, worse with movement or deep breathing
Recent physical exercise, illness with cough
Pain often one-sided; palpation elicits tenderness
Tx: heat, ice, NSAIDs

Answer 32

Tietze syndrome

Question 33

Heartburn, cough, sore throat, atypical chest pain

Tx: PPI (omeprazole, pantoprazole)ss

Answer 33

GERD

Question 34

Acute onset. Sharp burning pain with inspiration
Increases with inspiration or reclining
lessens when leaning forward
PE: pericardial friction rub. EKG diffuse ST elevation and PR depression
Cause: virus (RSV, coxsackie, flu, mumps, adenovirus, CMV, EBV)
DDx: PE, Pna

Answer 34

Pleuritic CP