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AANP FNP: Adult > Cardiovascular > Flashcards

Cardiovascular Flashcards

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1
Q

What is the sound of S2?

A

The sound of the semilunar valves (aortic/pulmonic) closing

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2
Q

S3 heart sound

A

“Ken-tuck-y”

Increased fluid states: pregnancy, CHF

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3
Q

S4 heart sound

A

“Ten-nes-see”
Stiff ventricular wall
(HTN, MI, young athletes)

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4
Q

Grading of murmurs

A 
1- barely audible
2- faint but audible
3- easily heard
4- associated with a thrill
5- heard with one corner of stethoscope off the chest
6- loudest
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5
Q

Name that murmur: diastolic, 5th intercostal space

A

mitral stenosis

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6
Q

Name that murmur: systolic, 5th intercostal space

A

mitral regurgitation (also known as mitral valve prolapse)

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7
Q

Name that murmur: 2nd intercostal space radiating to neck, systolic

A

aortic stenosis

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8
Q

Name that murmur: diastolic, 2nd ICS

A

aortic regurgitation

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9
Q

What side heart failure is acute heart failure?

A

Left sided heart failure

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10
Q

What side heart failure is chronic heart failure?

A

Right sided heart failure

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11
Q

Symptoms of left sided heart failure

A

Acute
dyspnea
crackles
frothy cough

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12
Q

Symptoms of right sided heart failure

A

Chronic
Jugular vein distention
Edema
fatigue on exertion

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13
Q

What is the most common cause of right sided heart failure?

A
  • Left side heart failure

- Cor pulmonale (result of pulmonary hypertension)

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14
Q

Management of heart failure

A
  1. Lifestyle- low sodium, rest/activity balance, weight loss

2. Medications- ACE inhibitors, diuretics

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15
Q

New York Heart Association Functional Classifications of Heart Failure

A

I- no activity limitations
II- slight activity limitations, comfortable at rest
III- marked activity limitations, comfortable at rest
IV- severe activity limitations, symptoms while at rest

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16
Q

What kind of headache may hypertension cause?

A

Suboccipital pulsating headache, occurring early in the morning and resolving throughout the day

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17
Q

What are some s/sx of hypertension, if any occur?

A

headache
dizziness/lightheadedness
epistaxis (worse in afternoon)
S4 heart sound

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18
Q

What tests could you do for new hypertension to rule out secondary cause?

A

Renal studies
Chest x-ray (if cardiomegaly is suspected)
Plasma aldosterone level (to rule out aldosteronism)
AM/PM cortisol levels (to rule out Cushing’s)
EKG
Labs: UA, CBC, BMP, Lipid panel

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19
Q

What is normal BP according to JNC 7?

A
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20
Q

What is prehypertension according to JNC 7?

A

120-139/80-89

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21
Q

What is stage 1 hypertension according to JNC 7?

A

140-159/90-99

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22
Q

What is stage 2 hypertension according to JNC 7?

A

≥ 160/≥100

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23
Q

When do you start treating hypertension according to JNC 8?

A
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24
Q

What antihypertensives are recommended for non-African-American patients?

A

Thiazide diuretics
Calcium Channel blockers
ACE/ARB

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25
Q

What antihypertensives are recommended for African Americans?

A

Thiazide diuretics

Calcium channel blockers

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26
Q

What antihypertensives are recommended for adults with chronic kidney disease?

A

ACE/ARB regardless of race or other medical conditions

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27
Q

How long do you wait to reassess hypertension after new intervention?

A

One month, and continue to assess monthly until goal is reached

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28
Q

What two types of antihypertensive drug can you not use together?

A

ACE and ARB

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29
Q

At what point do you refer for hypertension?

A

If it requires 3 or more drugs to manage

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30
Q

MOA of thiazide diuretics? Special considerations?

A

increase excretion of sodium and water
screen for sulfa allergy before administering
can decrease potassium

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31
Q

MOA of ACE inhibitors? Special considerations?

A

cause vasodilation, block sodium and water retention
do not use with renal artery stenosis
contraindicated in pregnancy
may cause dry cough, angioedema

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32
Q

MOA of ARBs? Special considerations?

A

cause vasodilation and block sodium and water retention
reserved for patients intolerant to ACE inhibitors
contraindicated in pregnancy

33
Q

What is the sound of S1?

A

Sound of the AV valves closing (mitral, tricuspid)

34
Q

MOA of beta blockers? Special considerations?

A

directly relax the heart
monitor heart rate
may cause fatigue

35
Q

MOA of peripheral alpha-1 antagonists? Examples of meds? Special considerations?

A

cause vasodilation
examples: prazosin, terazosin, doxazosin
take at bedtime, may cause orthostasis

36
Q

MOA of central alpha-2 antagonists? Examples? Special considerations?

A

prevent vasoconstriction, cause vasodilation, slow the heart rate
Examples: clonidine, methyldopa
do not discontinue abruptly

37
Q

MOA of arterial vasodilators? Examples? Special considerations?

A

directly relax the vascular smooth muscle resulting in arterial dilation
Examples: hydralazine
reduce frequency in renal dysfunction
may cause reflex tachycardia

38
Q

MOA of renin inhibitors? Examples? Special considerations?

A

inhibits renin, which inhibits conversion of angiotensin I to II
Examples: aliskiren (Tekturna)
expensive
teratogenic

39
Q

Hypertensive urgency

A

≥180/110
may or may not be symptomatic
treat with oral clonidine

40
Q

Hypertensive emergency

A

≥180/120
require decrease in BP within 1 hour
examples: malignant hypertension, hypertensive encephalopathy, intracranial hemorrhage, unstable angina, acute MI, dissecting aortic aneurysm, eclampsia
Tx: refer to ER/ICU

41
Q

What does dissecting aortic aneurysm present with?

A

Back pain

BP different on right and left sides

42
Q

Stable angina

A

Exertional, subsides with rest

43
Q

Prinzmetal’s angina (variant angina)

A

caused by coronary vasospasm

causes ST elevation, typically find out diagnosis in cath lab

44
Q

Unstable angina

A

MI/ACS, pre-infarction

not relieved with rest

45
Q

Microvascular angina

A

related to Metabolic Syndrome

46
Q

Levine’s sign

A

“clenched fist sign”
90 percent diagnostic for angina
“Feel like something is squeezing my chest”

47
Q

Dx for angina

A

EKG
Exercise EKG/stress test
Check lipid panel

48
Q

Normal lipid panel values

A

Cholesterol:

49
Q

What is a lipid panel value that is a NEGATIVE cardiac risk factor?

A

HDL ≥ 62

50
Q

Management of hyperlipidemia/angina/cardiac risk

A

Low fat diet
Baby ASA daily
Statin if indicated by ASCVD (esp. diabetics, smokers)

51
Q

What are the “strongest” and “weakest” statins?

A

Strongest: atorvastatin, rosuvastatin
Weakest: pravastatin, fluvastatin

52
Q

How much does LDL decrease on average with high-intensity statin therapy?

A

greater than 50 percent

53
Q

How much does LDL decrease on average with moderate intensity statins?

A

30-50 percent

54
Q

How much does LDL decrease on average with low-intensity statin therapy?

A

Less than 30 percent

55
Q

What to do if high-dose statin therapy is not enough to get patient within goal?

A
  1. Add Niacin

2. Add fenofibrate (like gemfibrozil)

56
Q

Examples of bile acid sequestrants? What do they lower?

A

Mostly LDL; may increase triglycerides

Examples: cholestyramine, colesevelam (Welchol), colestipol

57
Q

Examples of fibrates? What do they lower?

A

Decrease triglycerides, slightly lower LDL, possibly increase HDL
Examples: gemfibrozil, fenofibrate

58
Q

Examples of cholesterol absorption inhibitor? What do they lower?

A

Used in conjunction with statin to lower LDL

Example: ezetimibe

59
Q

What does niacin lower?

A

LDL and triglycerides, and increases HDL

60
Q

What causes MI/ACS?

A

“clot on plaque”

61
Q

Diagnosis of MI/ACS?

A

EKG- up to 30 percent without any initial EKG changes
Peaked T waves, ST elevation, Q wave development
Cardiac enzyme- elevations within 4 to 6 hours and remain high for 3 days to 3 weeks

62
Q

Which EKG leads indicate lateral MI?

A

I, aVL

63
Q

What EKG leads indicate inferior MI?

A

II, III, aVF

64
Q

What EKG leads indicate anterior MI?

A

V leads (precordial) or V3 and V4

65
Q

Treatment of acute MI?

A

Activate EMS, then…

  1. Aspirin 325mg
  2. Nitroglycerin
  3. Oxygen
66
Q

Which cardiac markers are true to cardiac problem only?

A

TNI and CKMB

67
Q

INR normal

A

0.8 to 1.2

68
Q

APTT normal

A

28 to 38 seconds

69
Q

PT normal

A

11-16 seconds

70
Q

PTT

A

60 to 90

71
Q

Indications for TPA for MI

A

Unrelieved chest pain >30 minutes and

72
Q

Risk factors for DVT

A 
immobility
female
post operative period
use of oral contraceptives (especially with smokers)
clotting disorder
73
Q

Signs and symptoms DVT

A

Pain especially while walking
Dull ache or “tight” feeling
Edema, skin may be cool to touch

74
Q

Diagnosis and management of DVT

A

Ultrasound, D Dimer, Venography

Tx: Bed rest 7-14 days, Lovenox 1mg/kg every 12 hours, Coumadin therapy for 12 weeks, referral

75
Q

Peripheral vascular disease: symptoms

A

arterial disease
Sx: claudication, cold/numb extremities, shiny/hairless skin, dependent rubor and pallor with elevation, ulcerations, reduced pulses

76
Q

PVD: Diagnosis, management

A

Dx: Doppler US, ABI, arteriography
Tx: Stop smoking, exercise (to grown collateral circulation), weight loss, angioplasty, bypass surgery, amputation
Meds: pentoxifylline or cilostazol (Trental/pletal)

77
Q

Chronic venous insufficiency: symptoms

A

venous disease
Sx: women > men, history of leg trauma, varicose veins, aching of BLE alleviated by elevation of legs, edema with prolonged standing, night cramps of BLE, brownish discoloration, ulcers, edema, dermatitis, cool to touch

78
Q

Chronic venous insufficiency: Diagnosis and management

A

Dx: rule out other causes of edema
Tx: elevate legs, TEDS stockings, weight loss

79
Q

Treatment of acute weeping dermatitis

A

Wet compresses

0.5% hydrocortisone cream after compresses

AANP FNP: Adult (14 decks)

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