Cardiovascular Flashcards
What is Apical pulse used to determine?
size of the heart
find areas of ischemia in the heart muscle (do not show blockage). >70% blockage shows ischemia
Nuclear studies
dye in arteries, shows blockages
Heart catheterization
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
CRP
amount of calcium in the arteries; useful if pt his high risk but has no symptoms
Coronary artery calcium score (CAC)
How to do in office Ankle-Brachial Index (ABI)
(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
What does an ABI of <0.95 indicate?
possible PAD
How to confirm Unstable angina/ NSTEMI?
cardiac enzymes
meds to manage Past STEMI?
Management= Antiplatelet (aspirin or plavix), beta blocker (olol drugs), statin, ACE or ARB, nitro
Past STEMI= Q-wave
do not show blockages. Can have up to 70% blocked before _____ study is affected. Shows blood flow only.
Nuclear studies
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
Angina
how to tx angina?
nitroglycerin (vasodilates, decreases afterload) beta blockers (decrease contractility and HR= decreased demand) apply oxygen
Predictable; occurs with exertion. Resolves with rest and/or SL Nitro
Stable angina
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
unstable angina
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
Prinzmetal/Vasospastic Angina
d/t microvascular dysfunction or spasm. No epicardial obstruction. Occurs with exertion and rest. Diagnosed with PET or CMR
Microvascular Angina
narrowing of the arterial lumen that can lead to cardiac ischemia through thrombus formation, coronary vasospasm, endothelial cell dysfunction. 70% blockage can cause ischemia
Coronary Artery Disease/ASCVD
gold standard diagnostic for Coronary Artery Disease/ASCVD
coronary angiography (heart cath) GOLD STANDARD;
stress test (less effective, less invasive), CRP (high CRP → increased inflammation) → not CVD indicator, coronary artery calcium
What to do if CAD suspected ?
refer to cardiology!
diagnosed with Cardiac enzymes
No EKG changes (same with unstable angina)
NSTEMI
(most specific) detectable within hours, peak at 10-24 hours, can be detected for 10-14 days. Usually not ordered outpatient
Troponin
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
Peripheral arterial disease
Findings: diminished pulses, hair loss, pallor, rubor, gangrene, ulcers
dx: In office ABI/ Arterial ultrasound
Peripheral arterial disease
Tx for PAD?
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.
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
Peripheral Venous insufficiency
pathologic distension and proliferation of superficial veins
varicose veins
familial (cannot have a hx of DVT for this classification) usually occur during pregnancy
primary varicose veins
result from previous DVT. Incompetent valves after recannulation therapy.
Secondary varicose veins
result from increased pressure in superficial veins
Telangiectasia
how to dx varicose veins?
clinical, based on inspection. See veins fill while pt standing. Venous duplex to r/o DVT.
(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
costochondritis
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
Tietze syndrome
Heartburn, cough, sore throat, atypical chest pain
Tx: PPI (omeprazole, pantoprazole)ss
GERD
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
Pleuritic CP
