Cardiovascular Flashcards
Arrhythmias, Chest pain, CHF, CAD, Endocarditis, Hyperlipidemia, Hypertension, Hypertensive Emergencies, Hypertriglyceridemia, PVD, Valvular Disease
coronary artery vasospasms causing transient ST-segment elevations, not associated with a clot
prinzmetal variant angina
characterized as narrow, complex tachycardia without discernible P waves
paroxysmal supraventricular tachycardia
normal, minimal variations in the SA node’s pacing rate in association with the phases of respiration. Heart rate frequently increases with inspiration and decreases with expiration.
sinus arrhythmia
patient presents with edema, cheyne-stokes breathing, S3 sound, crackles on auscultation, jugular venous distention, and hepatomegaly ascites. what should be ordered (4)? Dx? Treatment (3)?
BNP
EKG
Chest xray
echocardiogram
systolic heart failure
ACEI + Beta blocker + loop diuretic
patient presents with edema, cheyne-stokes breathing, S4 sound, crackles on auscultation, jugular venous distention, and hepatomegaly ascites. what should be ordered (4)? Dx? Treatment (2)?
BNP
EKG
Chest xray
echocardiogram
diastolic heart failure
ACEI + Beta blocker/ CCB
patient presents with elevated jugular venous distension, lower extremity edema, crackles, bruits, ischemic ulcers and diminished pulses. what should be ordered (5)? Dx? Treatment?
cardiac catheterization
CXR
cardiac biomarkers
EKG
stress test
coronary artery disease
Morphine
Oxygen
Nitroglycerin
Aspirin / clopidogrel
ACEI
what class of drugs DOES NOT improve post-MI mortality rates?
calcium channel blockers
a 45-year-old female with a long history of a heart murmur presents with one week of increasing fatigue and low-grade fevers. She had a dental cleaning two weeks ago. She denies hematuria, neurological symptoms, or changes in the appearance of her hands and fingernails. On physical exam, her temperature is 100.6 F, heart rate is 92/min, blood pressure is 118/67, and respiratory rate is 16/min. She appears fatigued but in no acute distress. Cardiac auscultation reveals a grade III/VI holosystolic murmur heard best at the cardiac apex in the left lateral decubitus position. what should we order? Dx? treatment options (2)?
echocardiogram
endocarditis
IV vancomycin OR ampicillin/sulbactam + aminoglycoside
what are 4 classic signs of infective endocardiits?
Osler’s nodes on feet
Janeway painless lesions on palms and soles
Roth spots in retina
splinter hemorrhages on nails
a 55-year-old obese Caucasian gentleman who arrives at your clinic for a routine check-up after having some blood work done during a routine workplace health screening. He complains of calf pain while walking to the convenience store, which resolves with rest. Additionally, you notice that he has well-demarcated yellow deposits around his eyes. Dx?
hyperlipidemia
patients with primary LDL of ____ or greater would benefit from high intensity statin therapy
190
patients with _____, 40-75 years of age, with LDL levels of ____-_____ would benefit from moderate intensity statin therapy
diabetes
70-189
patients without diabetes, 40-75 years of age, with an estimated 10-year ASCVD risk of ____% or more would benefit from moderate-high intensity statin therapy
10
high intensity statins lower LDL by at least ____% on average
50
moderate intensity statins lower LDL by ____% to ____% on average
30 - 50
low intensity statins lower LDL by ____% on average
30
how is primary hypertension defined?
resting systolic BP 30 or more, or diastolic BP 80 or more, on at least 2 readings at 2 separate visits with no cause
what is considered elevated BP?
120-129 and < 80
what is considered stage 1 hypertension?
130-139 or 80-89
what is considered stage 2 hypertension?
140 or more, or 90 or more
what are the treatment guidelines for normal BP?
evaluate yearly + encourage health lifestyle
what are the treatment guidelines for elevated BP? (2)
healthy lifestyle changes
reassess in 3-6 months
what are the treatment guidelines for stage 1 hypertension if 10 year risk is <10%? (2)
health lifestyle changes
reassess in 3-6 months
what are the treatment guidelines for stage 1 hypertension if 10 year risk is >10%? (3)
healthy lifestyle changes
1 medication
reassess in 1 month
what are the treatment guidelines for stage 2 hypertension? (2)
lifestyle changes
2 medications
what are the initial 3 medication options for hypertension in non-black patients, including those with diabetes?
ACEI or ARB
CCB (amlodipine)
thiazide-like diuretic (chlothalidone)
what is the recommended treatment for stage 2 hypertension?
2 BP lowering meds of different classes
which 2 medications are recommended to treat hypertension in black adults?
thiazide-type diuretics and/or CCB
which antihypertensives are used for angina pectoris?
CCB (vasodilator)
which 2 antihypertensives are used for diabetes with proteinuria?
ACEI or ARB
which antihypertensives are CI in pregnancy?
ACEI
which antihypertensive is CI in asthma?
BB
how is severe hypertension in adults defined?
systolic BP > 180 and diastolic BP over 120
what are the 2 clinical syndromes that are caused by hypertensive emergencies?
hypertensive retinopathy
hypertensive encephalopathy
what is the drug of choice for hypertensive urgency?
clonidine
what is the drug of choice for hypertensive emergency?
sodium nitroprusside
what is the drug of choice for hypertensive retinopathy?
clevidipine / sodium nitroprusside
what is the recommendation for a fasting lipid panel in healthy asymptomatic patients without risk factors?
begin at age 20 and repeat q 5 years
what is the recommendation for a fasting lipid panel in patients with CHD?
fasting lipid panel yearly
what level should triglycerides be reduce to prevent pancreatitis?
<500
what are 2 treatment options for isolated triglycerides?
fibrates (gemfibrozil / fenofibrate)
niacin
for the treatment of hypertriglyceridemia, which medication should be used cautiously in diabetic patients? why?
niacin
causes hyperglycemia
patient presents with dull, aching pain in the calf that is worse with walking and exercise, and relieved with rest. They are experiencing cramping, weakness, and numbness. Diagnostic? Dx? medical treatment (4)?
angiography
intermittent claudication (PVD)
graduated exercise
aspirin
clopidogrel
cilostazol (vasodilator)
a patient presents with pain in lower extremities, cramping of calves with diminished/absent pulses. diagnostic? Dx? medical treatment (3)?
arteriography
PAD/PVD
aspirin
clopidogrel
cilostazol
what is the surgical treatment for claudication or PVD/PAD?
angioplasty
a 59 yo male presents with chest pain, dyspnea, and presyncope which occurred after climbing a flight of stairs. He has a late systolic-ejection murmur in the 2nd intercostal space at the right sternal border with radiation to the carotids and the apex. The murmur is decreased with Valsalva maneuver and EKG suggests LVH. Dx?
aortic stenosis
