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Board Review > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

ACE inhibitor (function and examples)

A

Stops conversion of angiotensin 1 to angiotensin 2

Lisniopril
Elanapril

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2
Q

ARBs

A

Angiotensin II receptor blockers (ARBs)

Losartan
Irbestartan

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3
Q

Calcium Channel Blockers - Dihydropyridines

A

Relax blood vessels, which decreases vascular resistance and blood pressure

Potent vasodilator – used for reducing heart rate and reducing heart irritability)
- Amlodipine
- Nifedipine
- Nicardipine

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4
Q

Calcium Channel Blockers - Non-Dihydropyridines

A

Less potent vasodilator, depressive effect on cardiac conduction and contractility

 Cardizem
 Diltiazem
 verapamil

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5
Q

Side effects of CCBs

A

Constipation and peripheral edema

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6
Q

Beta blockers

A

Used for heart rate control

Coreg (alpha and beta blocker, good for HF. Reduces contractility and relaxes blood vessels

Metoprolol: Beta one selective

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7
Q

Loop diuretics

A

Most potent, cause loss of all electrolytes.
Furosemide

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8
Q

Thiazide diuretics

A

Weaker than loop diuretics but retain calcium and loss of other electrolytes.

Hydrochlorothiazide

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9
Q

Potassium sparing diuretics

A

Increase potassium levels in serum, decrease sodium.

Spironolactone

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10
Q

Hypertension according to JNCB

A

140/90

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11
Q

Normal BP

A

120/80

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12
Q

Elevated BP

A

120-129/80

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13
Q

Stage 1 hypertension

A

130-139/80-90

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14
Q

Stage 2 Hypertension

A

140/90 or above

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15
Q

Systolic heart failure

A

Failure of the myocardium to effectively contract

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16
Q

Diastolic heart failure

A

Failure of the heart to effectively relax

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17
Q

HFrEF

A

Ejection fraction <40%

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18
Q

NY Heart Association Subjective Heart Failure levels

A
  1. No symptoms
  2. Symptoms with exertion but not ADLs
  3. Symptoms with ADLs
  4. Feel terrible (rales, edema, weight gain, fluid overload, pulmonary congestion)
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19
Q

HFpEF

A

Ejection fraction >40%

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20
Q

Symptoms of HF

A

SOB
Fatigue
Exertional dyspnea
Diependent and pulmonary edema
Low activity tolerance
Abdominal bleeding
Orthopnea

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21
Q

Causes of HF

A

Ischemic heart disease
Valve disease
MI
Cardiomyopathy

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22
Q

Treatment for HF

A
  • ACE/ARB
  • ARB/ARNI
  • Beta blocker
  • Nitrites plus hydralazine
  • Fluid and salt restriction
  • Daily weights
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23
Q

Goal of HF treatment

A
  • Minimize exacerbation/hospitalization
  • Maintain/optimize current functional status and medication regimen
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24
Q

Gold standard treatment for ASCVD

A

Statins

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25
Q

High intensity statins include..

A

Atorvastatin - 40-80mg
Rosuvastatin 20-40mg

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26
Q

Most common side effect of statins

A

Myalgia

CoQ10 can help reduce achiness

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27
Q

Most severe and life threatening complication of statins

A

Rhabdomylosis

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28
Q

Therapy track for statins

A

Statins (can’t get to goal) –> ezetimibe (zetia) –> proven angiographic disease then refer to cardiology for higher level of medication injectable biweekly highly expensive medication (PCSK9 medication – or for familial homozygous hyperlipidemia

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29
Q

Aortic Stenosis - s/s

A

Blood can’t get out of heart.

  • Syncope or near syncope (due to reduced flow to the brain)
  • HF symptoms (SOB, fatigue, orthopnea,)
  • Echo and carotid US
  • High frequency murmur (during systole – trying to get through a small hole)

Systolic, harsh, blowing murmur at the second right intercostal space that radiates to the neck

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30
Q

Aortic Regurgitation

A

Causes backflow

  • HF symptoms (SOB, fatigue, orthopnea,)
  • diastole
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31
Q

Mitral stenosis

A

Blood can’t get out

  • HF symptoms (SOB, fatigue, orthopnea,)
  • Radiate laterally, left chest wall
  • Low frequency murmur (diastolic while the heart is relaxed and trying to fill back up)
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32
Q

Mitral regurgitation

A

Causes backflow

  • HF symptoms (SOB, fatigue, orthopnea,)
  • Heard during systole
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33
Q

What does aortic stenosis sound like?

A

a high-pitched, rough, and low-pitched systolic murmur that has a crescendo-decrescendo configuration, or “diamond shape”.

It’s usually heard best at the second intercostal space in the right upper sternal border, and it can radiate to the neck and carotid arteries.

SYSTOLIC

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34
Q

What does aortic regurgitation sound like?

A

a blowing, high-pitched diastolic murmur that is decrescendo in nature.

It is best heard at the left lower sternal border, and is most audible when the patient leans forward and holds their breath at the end of an exhalation

DIASTOLIC

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35
Q

Sound of mitral regurgitation

A

high-pitched and “blowing,” and is best heard at the apex of the heart with the patient in a left lateral decubitus position.

SYSTOLIC

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36
Q

Sound of mitral stenosis

A

A sharp click or snap that occurs after the second heart sound (S2) when the mitral valve opens forcefully

A decrescendo-crescendo murmur that occurs after the opening snap and lasts until mid-diastole.

DIASTOLIC

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37
Q

Acute triad of ruptured AAA

A

acute abdominal pain, abdominal distention and hemodynamic instability.

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38
Q

Cause of AAA

A

HTN, smoking, congenital disorder

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39
Q

Chest aortic aneurysms

A

Stanford A (ascending before the left subclavian branch)
* Very dangerous, if dissects near cardiac arteries then death

Stanford B (descending after the left subclavian)
* Less dangerous, more chronic management

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40
Q

How many months of therapy minimum for DVT/PE?

A

3 months

For idiopathic with recurrence may need lifelong therapy

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41
Q

Virchow’s triad

A

High risk for a thrombotic event.

o Venous statis
o Hypercoagulability
o Endothelial injury

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42
Q

Clinical findings for PAD

A

o Pale, waxy, hairless less, achiness, intermittent claudication (work throught e pain to help encourage angiogenesis – development of new blood vessels)
o Pain with ambulation that improves with rest

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43
Q

How is PAD diagnosed?

A

Diagnose in clinic with ankle brachial index (BP arm vs BP ankle, less than .9 is diagnostic for PAD)

Diagnosis must be confirmed with angiography.

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44
Q

Treatment for PAD

A
  • Stents or bypass of occluded vessels
  • Antiplatelets (clopidogrel, aspirin…)
  • Statins for lipid management
  • Smoking cessation
  • Management of comorbid conditions (DM)
  • Daily ambulation/exercise therapy
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45
Q

Pericardial effusion

A

Fluid around the heart inside the pericardium
o Limits compression and filling
o Echo to diagnose

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46
Q

S/S of pericardial effusion

A
  • Narrowed pulse pressure
  • Tachycardia
  • JVD
  • Muffled heart tones
  • Atrial fibrillation/aflutter/sinus tach
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47
Q

Causes of pericardial effusion

A
  • Viral pericarditis
  • Post trauma
  • Dressler syndrome (after cardiac surgery, stent, surgery)
  • Thyroid dysfunction (myxedema coma)
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48
Q

Treatment for pericardial effusion

A

Address underlying cause (malignancy, hypothyroidism, hypocoagulable state, trauma)

 Pericardiocentesis
 Medications
* Colchicine
* NSAIDS
* Steroids may be considered by not first line

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49
Q

What does AF look like on an EKG?

A

o Irregularly irregular rhythm w/o P waves

50
Q

Treatment for AF

A

rate and rhythm control

51
Q

What does Atrial Flutter look like on an EKG?

A

Sawtooth pattern

52
Q

S/s of A flutter and Afib

A

Acute onset fatigue, dizziness, nausea, palpitations, rapid irregular pulse

53
Q

Anticoagulation bridging

A

Needed for 5-6 days after starting warfarin until the dose becomes therapeutic. Usually done with lovenox or heparin. Stop when INR is over 2.

54
Q

STEMI

A
  • EKG changes plus enzyme elevation
  • Exposure of tunica media which attracts platelets which builds a clot (increasing thrombus) that blocks the artery
  • 90 minutes or less into the ED
55
Q

Non-STEMI

A
  • No EKG changes only enzyme elevation
  • Elevated troponin (4-6 hours)
  • Elevated creatinine kinase
56
Q

EKG changes with an MI

A
  • ST elevation –> acute injury
  • T wave inversion –> ischemia
  • Pathological q wave –> old irreversible MI (with ST elevation then current MI)
  • Wide QRS complex – contractions not at same time, may need pacer
57
Q

EKG leads with MI

A

I SEE ALL LEADS

Lead changes can tell you where the infarct is
- Inferior (2,3 AVF)
- Septal (V1-2)
- Anterior (V3-4)
- Lateral (v5-6)

58
Q

MONA for chest pain

A

Morphine
Oxygen
Nitroglycerin
Aspirin

59
Q

Catelcholamines

A

Catecholamines increase heart rate, blood pressure, breathing rate, muscle strength, and mental alertness.

  • Dopamine
  • Dobutamine
  • Norepinephrine
  • Epinephrine
60
Q

Vasodilators

A
  • Nitroglycerine
  • Nicardipine
  • Nitroprusside
61
Q

Coronary angiogram

A
  • Direct vascular access with visualization of the endovascular anatomy
  • May include angioplasty and stenting (primary coronary intervention)
62
Q

What pathogen causes bacterial endocarditis most often? What is it treated with?

A

Stapholoccoal aureus

Treat with amoxicillin

63
Q

S/S of bacterial endocarditis

A

Fever
Chills
New murmur
anorexia
weight loss
splinter hemorrhage to nail beds
petechate on palate
non-tender spots to hands and soles

64
Q

Systolic Heart Sounds (S1)

A

MOTIVATED

M - mitral
T - tricuspid
AV - atrioventricular

65
Q

Diastolic Heart Sounds (S2)

A

APPLES

A - aortic
P - pulmonic
S - semilunar

66
Q

S3 gallop

A

Indicative of HF or CHF

Sounds like “kentucky”

Always abnormal after age 40

67
Q

S4 gallop

A

Indicative of increased resistance due to stiff left ventricle

Best heard at apex

Sounds like “tenessee”

68
Q

S2 split

A

Splitting of aortic and pulmonic components

69
Q

How to assess murmurs?

A
  1. Is it happening during systole or diastole?
  2. What is the location of the murmur (aortic, pulmonic, erbs point…)
70
Q

Systolic Murmurs

A

MR PASS

Mitral regurgitation
Physiologic
Aortic Stenosis

71
Q

Diastolic murmurs

A

MS ARD

Mitral stenosis
Aortic regurgitation

Usually indicates heart disease

72
Q

What does mitral regurgitation sound like?

A

Soft low pitched decrescendo

Best heart at apex

73
Q

What does aortic stenosis sound like?

A

Harsh and noisy.

Best heard at 2nd ICS L sternum

74
Q

What does aortic regurgitation sound like?

A

High pitched diastolic murmur. Best heard at 2nd intercostal space L sternum.

75
Q

What does mitral stenosis sound like?

A

Low pitched and rumbling. Best heard at apex.

76
Q

Grading of heart murmurs

A

1 - very soft, only heard in optimal conditions
2 - mild-moderately loud
3 - Loud, easily heard
4 - Loud with THRILL present (first hear thrill)
5 - Very loud heard with edge of stethoscope off the chest
6 - can be heard with stethoscope off the chest, palpable thrill

77
Q

Treatment for endocarditis

A

Amoxicillin (2g PO x1 for prophylaxis)

78
Q

Irregularly irregular rhythm with no visible P waves on EKG is what diagnosis?

A

AF

79
Q

ST elevation in V2-4 with tombstone pattern on EKG is what diagnosis?

A

Anterior wall MI

80
Q

Jagged irregular QRS complex on EKG is what diagnosis?

A

Ventricular tachycardia

81
Q

Variation in the P-P interval, which is the time between consecutive P waves. In sinus arrhythmia, the P-P interval varies by more than 120 milliseconds, increasing and decreasing with breathing is what diagnosis if seen on EKG?

A

Sinus arrhythmia

82
Q

First line therapy for non-valvular arrhythmias?

A

DOACs

83
Q

How to start a patient on warfarin

A
  1. 5mg (or 2.5 if patient over 70)
  2. Check INR every 2-3 days until therapeutic twice, then monitor every 4 weeks
  3. Bridge with lovenox or low molecular weight heparin
84
Q

First line therapy for patients with prosthetic heart valves?

A

Warfarin

85
Q

INR goal for patient with AF

A

2-3

86
Q

INR goal for patient with synthetic heart valves

A

2.5-3.5

87
Q

Screening guidelines for individuals at high risk for hyperlipidemia

A

Screen males age 25-35, screen females age 30-35

88
Q

Screening for individuals at low risk of hyperlipidemia

A

Screen males starting age 35 and females starting age 45

89
Q

Total cholesterol

A

<200

90
Q

Borderline high cholesterol level

A

201-239

91
Q

High cholesterol level

A

> 240

92
Q

HDL

A

> 40 in men
50 in women

93
Q

LDL

A

<100

94
Q

LDL goal for patients with heart disease or diabetes

A

<70

95
Q

Triglycerids

A

<150

96
Q

What medications increase triglycerides?

A

Estrogen
Diuretics
Isotrentinoin
Beta blockers

97
Q

Lifestyle modifications for high triglycerides

A

Decrease sugar and carb intake, avoid alcohol, low fat diet, fist with omega 3, exercise

98
Q

Triglycerides over what level are high risk for developing acute pancreatitis?

A

500

Focus on reducing LDL which will bring triglycerides down as well.

99
Q

Diets that improve cholesterol levels

A

Mediterranean diet and DASH diet

100
Q

Hypertensive crisis

A

BP 180+/120+ with end organ damage

101
Q

Retinal findings with hypertensive retinopathy

A
  • AV nicking
  • Copper/silver wire arterioles
102
Q

Retinal findings for diabetic retinopathy

A

Neovascularization
Cotton wool spots
Microaneurysms

103
Q

Pappiledema

A

Swelling of the optic disc due to elevated intracranial pressure (ICP).

104
Q

Thiazide diuretics and side effects

A

Inhibit NaCl reabsorption in the kidneys.

Side effects:
- hyperglycemia, hyperuricemia, hypertryglyceridemia, hypercholesterolemia
- hypo K, Mg, Na

105
Q

Loop diuretics

A

Inhibit Na, Cl and K pump in the loop of henle.

Loss of K, Na, and Mg.

106
Q

Aldosterone receptor agonists side effects

A

Spironolactone

Gynecomastia, galactorrhea, hyperkalemia, erectile dysfunction, GI effects

107
Q

Thiazide diuretics and osteoporosis

A

Slow calcium loss from bone. Prescribe for patients with hypertension and osteopenia or osteoporosis.

108
Q

Cardioselective beta blockers

A

Atenolol, metroprolol, bisoprolol

109
Q

Non-cardioselective beta blockers

A

Propranolol, timolol pindalol

110
Q

Meds that are both alpha and beta blockers

A

Coreg and labetalol

111
Q

Alpha blockers

A

Used for HTN and BPH only

  • terazosin
  • doxazosin
  • tamsulosin
112
Q

Sound of mitral valve prolapse

A

Midsystolic, non-ejection click with late systolic or holosystolic murmur

113
Q

preferred treatment for HFrEF

A

Carvedilol

114
Q

Best place to hear s3 heart sound

A

mitral area

115
Q

most common causes of infective endocarditis are…

A

staphylococci, streptococci, and enterococci.

116
Q

Diagnostics for AAA

A
  1. Asymptomatic - US
  2. Symptomatic but stable - CT
  3. Symptomatic unstable - FAST
117
Q

First action for a patient with newly discovered AF

A

Order a stat transthoracic (2D) echocardiogram and prepare the patient for trasnport to the closest appropriate hospital for inpatient evaluation

118
Q

An example of secondary prevention for a diagnosis of coronary artery disease includes what?

A

Coronary artery bypass grafting

119
Q

Treatment for stage C heart failure

A

Furosemide (Lasix), lisinopril (Zestril), carvedilol (Coreg)

120
Q

Which of the following agents would NOT be useful in reducing pulmonary edema in a patient with cardiogenic shock?

A

Phenylephrine

Phenylephrine is an afterload increasing agent and would likely exacerbate worsening of pulmonary edema in a heart with cardiogenic shock.

121
Q

Your patient presents with bradycardia, severe nausea, and substernal pain. STEMI was identified on the EKG. Which region of the heart is most likely involved?

A

Inferior Wall

The inferior wall, fed by the right coronary artery is commonly associated with these symptoms. Remember right equals rate as it is the blood supply for the SA and AV nodes in most patients.

Dyspepsia is common in RCA territory injury due to vagal stimulation not typical of other areas.

Board Review (25 decks)

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