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Family Medicine > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

Most common cause of secondary HTN in young women

A

Birth control pills

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2
Q

Meds causing secondary HTN

Endocrine causes

A 
OCP, 
decongestants, 
estrogen, 
TCAs, 
NSAIDs
Hyperaldo
Thyroid or pth dz
Cushings
Pheo
Acromegaly
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3
Q

Goals in evaluating pt with HTN

A

Look for secondary causes

Assess damage to target organs heart, kidneys, eyes, CNS

Assess overall cardio risk

Therapy decisions based on above

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4
Q

What kind of cuff falsely elevated BP?

A

Cuff that is too small

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5
Q

BP categories

A

Normal: < 120/80

PreHTN: 120-139 or 80-89
–tx w lifestyle mod

Stage I HTN: 140-159 or 90-99
–tx w lifestyle mod or med

Stage II HTN: >=160 or >=100
–tx w lifestyle mod + 2 meds

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6
Q

Dx HTN

A

2 elevated readings at different times within 4 wks

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7
Q

HTN tx that decreases risk of new onset diabetes

A

ACEi

ARBs

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8
Q

Categories of anti HTN meds

A 
Thiazides
Beta blocker
ACEi
ARBs
CCBs

Alpha blockers
Vasodilators (hydralazine, minoxidil)

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9
Q

Thiazides side effects

A

HYPO K, Mg

Hyper GLUC

  • glucose
  • lipid
  • uric acid
  • calcium
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10
Q

ACEi side effects

A

“CHATS”

Cough
HYPER K
Altered taste
Teratogen
Skin rash
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11
Q

Beta blocker side effects

A 
Bradycardia
Bronchospasm
Insomnia
Mask hypoglycemia in insulin diabetics
Impotence
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12
Q

Initial mono therapy drugs for HTN

A

Thiazides
CCBACEi or ARB

Best to start with ace or CCB since trial showed ace and CCB was better than ace and diuretic at controlling HTN

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13
Q

Meds causing elevated lipids or LDL

A 
Thiazides 
B blockers
Estrogens
Steroids
HIV protease inhibitors
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14
Q

Best for dec TGs

What drug for hld increases TGs?

A

Fibrates (gemfibrozil) to dec TGs

Bile acid resins (cholestyramine) increases TGs

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15
Q

Secondary causes of hyperlipidemia

A 
Chronic liver dz
diabetes mellitus, 
hypothyroidism, 
obstructive liver disease, 
chronic renal failure, 
some medications.
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16
Q

What HLD drugs work well together

A

Statins

Bile acid resins

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17
Q

HLD drug with lft issues

A

Statins

Fibrates

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18
Q

HLD not good for diabetics

A

Niacin

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19
Q

Tx peripheral vascular disease

A

EXERCISE

Antiplatelet to reduce risk of stroke (no effect on claudication)
- aspirin

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20
Q

Of the dietary factors recommended for the prevention and treatment of cardiovascular disease, which one has been shown to decrease the rate of sudden death

A

Omega 3 fatty acids

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21
Q

Tx aortic dissections

A

Acute dissection of the ascending aorta is a surgical emergency, dissections confined to the descending aorta are managed medically unless the patient demonstrates progression or continued hemorrhage into the retroperitoneal space or pleura, rupture, or occlusion of major branch A.

  • Initial management” reduce the systolic blood pressure to 100-120 mm Hg
  • —β-blocker such as propranolol or labetalol is 1st line

—-If SBP > 100 still, IV nitroprusside

——–Without prior beta-blocade, vasodilation from the nitroprusside will induce reflex activation of the sympathetic nervous system, causing increased ventricular contraction and increased shear stress on the aorta.

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22
Q

Tx supraventricular tachy

A

Tx underlying cause

If trying to find…
1) adenosine –> 2) IV verapamil or beta blocker if adenosine doesn’t work3) IV propanefone or Flecanide if 2 doesn’t work

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23
Q

Monotherapy for hypertension in African-American patients is more likely to consist of

A

diuretics or calcium channel blockers NOT β-blockers or ACE inhibitors.

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24
Q 
Peds pt
Systolic heart murmur
low, short tone
no radiation
decreases with inspiration
asymptomatic

What is it?

A

Stills murmurcan be due to vibrations in chordae tendinae, semilunar valves or ventricular wall

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25
Q

Venous hum

A

continuous low-pitched murmur caused by the collapse of the jugular veins and their subsequent fluttering, it worsens with inspiration or diastole

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26
Q

Enoxaparin elimination

A

Renal

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27
Q

Initial eval of palpitations

A

EKG

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28
Q

When do you give thrombolytics for acute MI?

A

new LBBBsuggests occlusion of LAD

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29
Q

MI dx

A

Myocardial infarction is diagnosed by ST elevation ≥1 mm in two or more limb leads and ≥2 mm in two or more contiguous precordial leads.

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30
Q

Antihypertensives that can worsen depression

A

B-blockersClonidine

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31
Q

axillosubclavian vein thrombosis (ASVT)

A

more frequent with the increased use of indwelling subclavian vein catheters. Spontaneous ASVT (not catheter related) is seen most commonly in young, healthy individuals. - The most common associated etiologic factor is the presence of a compressive anomaly in the thoracic outlet.

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32
Q

Tx 1st episode of unprovoked DVT

A

Warfarin at least 3 mo

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33
Q

Give for acute MI

A

Mona

Morphine
Oxygen
Nitrates
ASA

Beta blocker
ACEi

Statins a few days later

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34
Q

New onset angina. What drug is contraindicated?

A

Nifedipine

Can increase mortality

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35
Q

Symptoms of congestive heart failure in infants are often related to

A

feedings. Only small feedings may be tolerated, and dyspnea may develop with feedings. Profuse perspiration with feedings, is characteristic, and related to adrenergic drive.

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36
Q

Best med for HTN + diabetes

A

ACEi

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37
Q

When to tx aortic stenosis

A

mean aortic-valve gradient exceeds 50 mm Hg

aortic-valve area is not larger than 1 cm2

Symptomatic from AS

Valve replacement is tx. Not valvuloplasty

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38
Q

Contraindications to beta-blocker use include

A

hemodynamic instability, heart block, bradycardia, severe asthma.

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39
Q

How can you ppx for surgery-related cardiac complications in pts w/ CV risk factors?

A

Beta blockers

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40
Q

Exercise in elderly…considerations

A

Initial exercise routines for the elderly can be as short as 6 minutes in duration. A target heart rate of 60%–75% of the predicted maximum should be set as a ceiling.

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41
Q

What should any person with HLD undergo before starting lipid lowering therapy?

A

Investigate secondary causes of HLD

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42
Q

NOT ok for WPW

A

Intravenous and oral digoxin can shorten the refractory period of the accessory pathway, and increase the ventricular rate, causing ventricular fibrillation. Beta-blockers will not control the ventricular response during atrial fibrillation when conduction proceeds over the bypass tract

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43
Q

Contraindicated in CHF

A

NSAIDs
High dose ASA
—-They cause sodium and water retention, as well as an increase in systemic vascular resistance which may lead to cardiac decompensation

Cilostazol

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44
Q

Best to control what for afib first?

A

Rate

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45
Q

Patients with long QT syndrome that have sudden arrhythmia death syndrome usually have

A

either torsades de pointes or ventricular fibrillation.

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46
Q

1st line for HTN, including in elderly!

A

thiazide diuretics and long-acting calcium channel blockers as first-line therapy.

47
Q

Clinical trials support the treatment of systolic hypertension in the older person with a systolic blood pressure of at least

A

160 mm Hg.

48
Q

The INITIAL treatment of choice in the management of severe hypertension during pregnancy is

A

IV hydralazine, IV labetalol, or oral nifedipine

49
Q

what have been found to decrease mortality late after myocardial infarction

A

Beta-blockers and ACE inhibitors

50
Q

Preferred drugs for congestive heart failure due to left ventricular systolic dysfunction,

A

ACEi because they are associated with the lowest mortality. The combination of hydralazine/isosorbide dinitrate is a reasonable alternative

51
Q

Clinical predictors of increased perioperative cardiovascular risk for elderly patients include major risk factors such as

A

unstable coronary syndrome (acute or recent myocardial infarction, unstable angina),
decompensated congestive heart failure,
significant arrhythmia (high-grade AV block,
symptomatic ventricular arrhythmia,
supraventricular arrhythmias with uncontrolled ventricular rate),
severe valvular disease.

52
Q

Intermediate predictors of increased perioperative cardiovascular risk for elderly patients include

A 
mild angina, 
previous myocardial infarction, 
compensated congestive heart failure, 
diabetes mellitus, 
renal insufficiency.
53
Q

Minor predictors of increased perioperative cardiovascular risk for elderly patients include

A

advanced age, an abnormal EKG, left ventricular hypertrophy, left bundle-branch block, ST and T-wave abnormalities, rhythm other than sinus, low functional capacity, history of stroke, uncontrolled hypertension.

54
Q

Tx WPW

A

Amiodarone

Procainamide

55
Q

The primary treatment for symptomatic mitral valve prolapse is

A

β-blockers.

56
Q

Natural tx for varicose veins

A

Horse chestnut seed extract has been shown to have some effect when used orally for symptomatic treatment of chronic venous insufficiency, such as varicose veins.

57
Q

greatest risk factor for AAA

A

cigarette smoking

58
Q

For patients with a history of previous stroke, JNC-7 recommends using what for HTN control?

A

combination therapy with a diuretic and an ACE inhibitor to treat the hypertension, as this combination has been clinically shown to reduce the risk of recurrent stroke.

59
Q

Tx UE DVT

A

heparin should be given for 5 days, and an oral vitamin-K antagonist for at least 3 months.

60
Q

Tx acute pulmonary edema 2/2 CHF

A

FurosemideNItro if BP is increasedMorphine as adjunct

61
Q

Tx CHF- what reduces mortality?- what reduces hospitalizations?

A

Reduce mortality:

  • ACEi/ARB
  • beta blockers (for NYHA 2&3

Reduce hospitalizations

  • Digoxin
  • Diuretics

FOr NYHA 3&4:
- aldosterone blockers

62
Q

What tx is NOT ok for systolic heart failure

A

CCB

  • will increase mortality
  • only exception is amlodipine

CCB, diuretics, ARBs for diastolic failure

63
Q

Tx for acute exacerbation of CHF

A

ACEi
Diuretics (furosemide)

NOT beta blockers

64
Q

Tx NYHA class 3/4 CHF

A

Aldo blockers
Cardiac resynchroniation tx if maxed out drug therapy
- will decrease mortality adn hospitalization in symptomatic ppl

65
Q

How does HCM murmur change with valsalva? supine position?

A

valsalva - increases

supine - decreases

66
Q

Common triggers of CHF

A

Anemia (because increased CO needed –> heart failure sx)

Infection

67
Q

CHF CXR

A

Cardiomegaly > 50% heart: thorax ratio

Cephalization of pulmonary vasculature

Pleural effusions

68
Q

In patients with a drug-eluting stent, what meds should a person be on as well?

A

combined therapy with clopidrogel and aspirin is recommended for 12 months because of the increased risk of late stent thrombosis

69
Q

A 60-year-old male is recovering from a non–Q-wave myocardial infarction. He has a 40-pack-year smoking history, currently smokes a pack of cigarettes per day, and has a strong family history of coronary artery disease. Studies ordered by the cardiologist showed no indication for any coronary artery procedures. His BMI is 27.5 kg/m 2 and his blood pressure is 130/70 mm Hg. Laboratory tests reveal a fasting blood glucose level of 85 mg/dL, a total cholesterol level of 195 mg/dL, and an LDL-cholesterol level of 95 mg/dL.Which one of the following secondary prevention measures would be LEAST likely to improve this patient’s cardiovascular outcome? (check one)

A. A weight reduction diet

B. A β-blocker

C. A statin

D. An antiplatelet agent

E. Smoking cessation

A

A

Although dietary management may be appropriate, a weight reduction diet is not likely to improve this patient’s cardiovascular outcome. In fact, even if this person were obese, there is insufficient evidence that weight reduction would decrease his cardiovascular mortality (SOR C). There is good evidence that the other options, even β-blockers in a patient with normal blood pressure, are indicated. All of these measures have evidence to support their usefulness for secondary prevention of coronary artery disease

70
Q

Diet to reduce BP

A

High K

High Ca

71
Q

Isolated systolic HTN in elderly responds best to

A

Diuretics

72
Q

Most common cause of HTN in kids

A

Renal parynchymal dz

Get a UA, urine cx, and renal US for all kids with HTN

73
Q

Postural orthostatic tachycardia syndrome (POTS)

A

is manifested by a rise in heart rate >30 beats/min or by a heart rate >120 beats/min within 10 minutes of being in the upright position. Symptoms usually include position-dependent headaches, abdominal pain, lightheadedness, palpitations, sweating, and nausea. Most patients will not actually pass out, but some will if they are unable to lie down quickly enoughcondition is thought to have a genetic predisposition, is often incited after a prolonged viral illness, and has a component of deconditioning. The recommended initial management is encouraging adequate fluid and salt intake, followed by the initiation of regular aerobic exercise combined with lower-extremity strength training, and then the use of β-blockers

74
Q

The cardiac toxicity of methadone is primarily related to

A

QT prolongation and torsades de pointes.

75
Q

CHADS 2 score

A

Congestive heart failure,

Hypertension,

Age >75,

Diabetes mellitus,

previous Stroke or transient ischemic attack.

> 4 = high risk
2-3 = moderate risk
1 or less = low risk

Tx:

  • low risk = ASA 81-325mg
  • mod-high risk = warfarin
76
Q

What we the factors used to determine optimal LDL levels?

A
  • Cigarette smoking
  • Hypertension (blood pressure ≥140/90 mm Hg or on antihypertensive med-ication)
  • Low HDL
  • Age (
77
Q

When should you send a kid here for sports eval to cardiologist?

A

Diastolic murmur 3/6 or louder
HOCM suggestive murmur
Marfans

78
Q

What is a CHD risk equivalent?

A

peripheral arterial disease,
cerebrovascular disease, abdominal aortic aneurysm
type 2 diabetes
multiple risk factors that together raise the risk of CHD to greater than or equal to 20% in 10 years

79
Q

Effective tx for venous ulcers

A

Pentoxifylline is effective when used with compression therapy for venous ulcers

80
Q

Sick sinus syndrome

A

usually involves a dysfunction of the SA node that leads to bradycardia and can cause fatigue and syncope.

Patients, however, can also have a tachycardia-bradycardia variety of sick sinus syndrome in which they also experience supraventricular tachycardia with its associated symptoms of palpitations and angina pectoris.

81
Q

Brugada syndrome

A

is an ion channel disorder that is most common in Asian males. On an ECG, it presents as ST-segment elevation in leads V1 to V3, and it too can cause dangerous arrhythmias that result in death.

82
Q

multifocal atrial tachycardia (MAT) classically found in presence of

A

COPD

83
Q

Long QT syndrome

A

is caused by mutations in multiple genes and can have an autosomal dominant pattern. It is seen more commonly in females. Prolonged QT interval is defined as QT 470 msec in men or greater than 480 msec in women

84
Q

Meds prolonging QT

A

quinidine, procainamide, sotalol, amiodarone, and tricyclic antidepressants

85
Q

Tx primary supraventricular tachy

Tx symptomatic SVT

A

β-blockers
calcium channel blockers
Digoxin

Symptomatic (SVT): self-treated by patients with recurrent episodes by several vagal stimulation techniques. Carotid sinus massage, Valsalva maneuver, and cold applications to the face (diver’s reflex) can trigger vagus nerve stimulation, which may break an episode of SVT. If unsuccessful, IV adenosine

  • if works, then the arrhythmia is most likely a reentry SVT.
  • If it does not, then the rate may be slowed down with β-blockers or calcium channel blockers. At that point, consultation with a cardiologist should be sought.
86
Q

the most common cause of palpitations

A

Primary rhythm disturbances

87
Q

Tx Ventricular fibrillation

A

Patients with ventricular tachycardia, who are unstable, need to be electrically cardioverted. Amiodarone should be given to a patient with stable ventricular tachycardia and in patients who were converted back into a sinus rhythm through cardioversion. Can give lidocaine if allergic to iodine

88
Q

Causes of secondary HTN

A 
Pheo
hyper PTH
thyroid dz
renal artery stenosis
Obesity
89
Q

Tx PAD refractory to lifestyle changes + exercise

A

Cilostazol

90
Q

all children suspected of ingesting a calcium channel blocker should be

A

admitted to a pediatric intensive-care unit for monitoring and management.

91
Q

Specific criteria for the diagnosis of polycythemia vera

A

include an elevated red cell mass, a normal arterial oxygen saturation (>92%), the presence of splenomegaly. In addition, patients usually exhibit thrombocytosis (platelet count >400,000/mm3 ), leukocytosis (WBC>12,000/mm3 ), a low serum erythropoietin level, and an elevated leukocyte alkaline phosphatase score

92
Q

Goal HTN in chronic renal failure

A

<130/80 mm Hg

93
Q

What is the most effective imaging study for the diagnosis of pericardial effusion

A

Echocardiography

94
Q

A well-known use of intravenous magnesium is for

A

correcting torsades de pointes.

95
Q

When should you change statins because of side effects?

A

Research has proven that up to a threefold increase above the upper limit of normal in liver enzymes is acceptable for patients on statins.

96
Q

For persistent ventricular fibrillation (VF), in addition to electrical defibrillation and CPR, patients should be given

A

a vasopressor, which can be either epinephrine or vasopressin. Amiodarone should be considered for treatment of VF unresponsive to shock delivery, CPR, and a vasopressor

97
Q

Adenosine is used for…

A

narrow complex, regular tachycardias

98
Q

Amiodarone to tx…

A

WPW

acute management of sustained ventricular tachyarrhythmias, regardless of hemodynamic stability.

afib only in symptomatic patients with left ventricular dysfunction and heart failure

99
Q

Secondary prevention of cardiac events in high risk pts or those who had MI already

A

aspirin, β-blockers after myocardial infarction, ACE inhibitors in patients at high risk after myocardial infarction, angiotensin II receptor blockers in those with coronary artery disease, amiodarone in patients who have had a myocardial infarction and have a high risk of death from cardiac arrhythmias

100
Q

Tx STEMI

A

STEMI is defined as an ST-segment elevation of greater than 0.1 mV in at least two contiguous precordial or adjacent limb leads. The most important goal is to begin fibrinolysis less than 30 minutes after the first contact with the health system. The patient should be given oral clopidogrel, and should also chew 162–325 mg of aspirin.

101
Q

S/E Anticholinesterase meds

A

significant increased risk of bradycardia, syncope, and pacemaker therapy with cholinesterase inhibitor therapy. (Eg donepezil)

102
Q

Circumflex occlusion causes changes in

A

I, AVL, and possibly V5 and V6 as well.

103
Q

Left anterior descending coronary artery occlusion causes changes in

A

V1 to V6.

104
Q

Right coronary occlusion causes changes in

A

II, III, and AVF.

105
Q

Tx pericarditis

A

NSAIDs, such as aspirin and ibuprofen.

Recent studies demonstrate that adding colchicine to aspirin may be beneficial in reducing the persistence and recurrence of symptoms

106
Q

Intensive management of hyperglycemia also has a beneficial effect on cardiovascular disease in patients with DM 1 or 2 or both?

A

type 1 diabetes mellitus but, unfortunately, not in patients with type 2 diabetes mellitus.

107
Q

A 58-year-old male complains of leg claudication. Subsequent tests reveal that he has significant bilateral peripheral arterial disease. His current medications include atenolol (Tenormin), 50 mg/day, and aspirin, 325 mg/day. His blood pressure is 128/68 mm Hg, and his pulse rate is 64 beats/min. His LDL-cholesterol level is 123 mg/dL.

The addition of which one of the following could reduce this patient’s symptoms?
(check one)
A. Epoetin alfa (Epogen)
B. Nifedipine (Procardia)
C. Simvastatin (Zocor)
D. Testosterone supplementation
E. Warfarin (Coumadin) titrated to an INR of 2.0–3.0

A

Peripheral arterial disease (PAD) is a common malady that has several proven treatments. The outcomes of these treatments can be separated into two primary categories: reducing PAD symptoms and preventing death due to systemic cardiovascular events (CVEs), especially myocardial infarction. Routine exercise up to near-maximal pain on a regular basis has been shown to be one of the most effective treatments for symptoms of PAD. Smoking cessation and aspirin are also standard recommendations, and can both prevent CVEs and slow the rate of progression of PAD symptoms.

Statin drugs (specifically simvastatin and atorvastatin) have been shown to be beneficial for treatment of PAD symptoms and prevention of CVEs through the reduction of cholesterol, but they also appear to have other properties that help reduce leg pain in patients with PAD. Although lowering abnormally high blood pressure is recommended in PAD patients, only ACE inhibitors have been shown to reduce symptoms of PAD directly. Furthermore, the combination of atenolol and nifedipine has actually been shown to worsen symptoms of PAD. The addition of warfarin to aspirin has no additional benefit in either reduction of PAD symptoms or prevention of CVEs, but it may have a role in preventing clots in patients who have undergone revascularization.

108
Q

causes of fetal bradycardia

A

Epidural anesthesia, post-dates pregnancy, and umbilical cord prolapse

109
Q

Causes of fetal tachycardia include

A

maternal fever, fetal hypoxia, hyperthyroidism, maternal or fetal anemia, medication effects of parasympatholytic or sympathomimetic drugs, chorioamnionitis, fetal tachyarrhythmia, and prematurity

110
Q

First-line therapy for proteinuric kidney disease with HTN includes

A

an ACEI or an ARB.

Because these drugs can cause elevations in creatinine and potassium, these levels should be monitored.

A serum creatinine level as much as 35% above baseline is acceptable in patients taking these agents and is not a reason to withhold treatment unless hyperkalemia develops.

111
Q

Tx s/p MI depression

A

Several studies have demonstrated that SSRIs are safe and effective in treating depression in patients with coronary disease

112
Q

Kawasaki disease

A

usually self-limited, with fever and acute inflammation lasting 12 days on average without therapy.

if untreated, this illness can result in heart failure, coronary artery aneurysm, myocardial infarction, arrhythmias, or occlusion of peripheral arteries.

Dx:

  • fever must be present for 5 days or more with no other explanation + 4/5 of following:
  • 1) nonexudative conjunctivitis that spares the limbus;
  • 2) changes in the oral membranes such as diffuse erythema, injected or fissured lips, or “strawberry tongue”;
  • 3) erythema of palms and soles, and/or edema of the hands or feet followed by periungual desquamation;
  • 4) cervical adenopathy in the anterior cervical triangle with at least one node larger than 1.5 cm in diameter; and,
  • 5) an erythematous polymorphous rash, which may be targetoid or purpuric in 20% of cases.

Tx:

  • IV Ig
  • ASA

DO NOT USE PREDNISONE as can cause coronary

113
Q 
The presence of nonthrombocytopenic palpable purpura, colicky abdominal pain, and arthritis is most consistent with which one of the following?  (check one)
 A. Kawasaki disease 
 B. Takayasu arteritis 
 C. Wegener granulomatosis 
 D. Polyarteritis nodosa 
 E. Henoch-Schonlein purpura
A

The most common pediatric vasculitis is Henoch-Schonlein purpura. It is an IgA-mediated small-vessel vasculitis that classically presents with the triad of nonthrombocytopenic palpable purpura, colicky abdominal pain, and arthritis. Kawasaki disease is manifested by conjunctival injection, mucosal erythema, rash, and lymphadenopathy. Takayasu arteritis has numerous manifestations, including night sweats, fatigue, weight loss, myalgia, and arthritis. Later findings may include hypertension, skin lesions, and cardiac disorders. Wegener granulomatosis causes constitutional symptoms also, including weight loss and fatigue, with later findings including respiratory problems, ophthalmologic lesions, neuropathies, glomerulonephritis, and skin lesions. Polyarteritis nodosa is another disease that causes constitutional symptoms such as fatigue, fever, and myalgias. It also causes skin lesions, gastrointestinal symptoms such as postprandial abdominal pain, and cardiac lesions.

114
Q

Dx rheumatic criteria

A

JONES criteria

Two major criteria, or one major criterion and two minor criteria, plus evidence of a preceding streptococcal infection, indicate a high probability of the disease.

Major:
Joints (migrathory polyarthritis)
O = pancarditis
N = SubQ nodules
E = erythema marginatum
S = syndeham chorea
Minor criteria:
F = fever
A = arthralgia
C = high CRP level
E = high ESR
P =  prolonged pulse rate interval on EKG.

Family Medicine (11 decks)

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