Cardiovascular Flashcards
MI s/s
male: heavy chest, left shoulder/jaw pain, clammy
women: unusual fatigue, back pain, n/v
AAA (dissecting abd aortic aneurysm)
elderly white male
pulsating sensation in abdomen or low back
impending rupture- “sudden” sharp pain to chest/low back.
high risk: HTN/smoker
CHF
elderly pt c/o sob, “dry cough”, swollen ankles, increase weight
crackles
s3 heart sound
hx: cad, prior MI
bacterial endocarditis s/s
check their fingers/toes
janeway lesions- tender red spots on the palms/soles
splinter hemorrhage- splinter hemorrhage on nailbed
pregnant PMI
located upward on the left side
Deoxygenated blood
SVC, right atrium, tricuspid, right ventricle, PULMONIC VALVE, lungs, alveoli (RBC pick p02 and release co2)
oxygenated blood
left atria, mitral valve, left ventricle, , AORTIC VALVE, aorta, general circulation
s1 sound
s2 sound
closure of mitral/tricuspid valve
3 leaflets
s2- aortic/pulmonic valves
semilunar valves- 2 leaflets
s3
CHF! or heart failure occurs during "early diastole" aka" ventricular gallop" alway abnormal if >35yo normal in young children and athletes if no other s/s
In older individuals it indicates the presence of congestive heart failure. The third heart sound is caused by a sudden deceleration of blood flow into the left ventricle from the left atrium.
s4
LVH
stiff left ventricle
The fourth heart sound (S4), when audible, is caused by vibration of the ventricular wall during atrial contraction. This sound is usually associated with a stiffened ventricle (low ventricular compliance), and therefore is heard in patients with ventricular hypertrophy, myocardial ischemia, or in older adults.
aka “atrial gallop” or “atrial kick”
summation gallop
s1-s4 heart
benign split s2
best heard over pulmonaic area (left sternum). normal finding if it occurs during inspiration, disappears expiration
bengin s4 in elderly
if no s/s of heart/valvular disease it is normal
MR ASS
mitral regur- best heart apex. axilla, high pitched (use diaphragm to listen)
aortic stenosis- radiates to neck
noisy murmur- use bell
systolic murmurs- loud, radiate to neck or axilla
MS. ARD
mitral stenosis- use diaphragm
aortic regurg- use bell
diastolic
heart murmur grading
I-VI
IV- louder murmur, first time a thrill is present “palpable mur mur”
ALL diastolic (MS AR)= abnormal
all benign mumurs occurring during systole (s1)
benign murmur do NOT have a thrill
true
Mitral valve location
apex of the heart
apical area
5th ICS on the left side of the sternum medial to the midlclavicular line
only systolic murmur radiate
mitral regurg- axilla
aortic stenosis- neck
s3 is a sign of what
CHF
s4 is a sign of what
LVH
s2 split heard best heard where
pulmonic area
afib tx
use CHADs2 score (2 or more requires anticoag) C (CHF) H (HTN) A (>75yo) D (DM) S (hx Stroke/TIA) 2 (2 or more)
classic case: pt c/o heart palpitations, sob, chest pain, syncope.
tx: ecg, tsh, electrolytes, 24 hr holder, digoxin level, echo (r/o vavular pathology)
lifestyle: avoid stimulants and alcohol
afib medications
rate: CCB, BB or dig
rhythm: amiodaron (cordarone) . black box: pulmonary and liver damage
**SIMVASTATIN with AMIODARONE”= rhabdo
anticoag with warfarin, baseline INR and CBC
patient education -eat Vit K in food
paroxysmal atrial tachy
peaked qrs.
ie: abrupt onset palpitations, sob, anxiety, HR 150-250
management: hold one’s breath, carotid massage, splash ice cold water (valsalva maneuvers)
pulsus parodoxus (paradoxical pulse)
pericarditis
cardio effusion
apical pulse heard, radial pulse no longer palpable
jnc 8 blood pressure
> 60 yo, 18 yo with CKD or DM
HTN medications for blacks
CCB or thiazaide (BB cause angioedema)
HTN medications with CKD
ace/arb
rule out organ damage in HTN
eyes: silver/copper wire arterioles, AV junction nicking, flame shaped hemorrhages, papilledema
kidneys: microalbumin, proteinuria
elevated creatine, gfr, edema
heart: s3 (CHF), s4 (LVH)
carotid vruits
CCB medications
"pine" nifedipine ( procardia) amlodipine (norvac) verapamil (calan) dilt (cardizem)
thiazide diuretics
good for osteoporosis hyperglycemia hyperuricemia hypokalemia hyper triglyceriemia ( check lipids)
don’t use if allergic to sulfa
side effects of spironolactone
gynecomastia
left ventricular failure
Left = L (lungs)
crackles, cough, sob
right ventricular failure
GI
JVD (normal mvd is 4cm or less)
enlarged spleen, enlarged liver, lower extremity edema
tx for CHF
lasix 20mg, nitro, ace/arb
DVT assessment
positve humans sign (pain with dorsiflexion of the foot)
gold standard- contract venography
PVD or PAD gold standard dsg
angiography
low tech- ankle/brachial BP before and after exercise
raynauds tx
CCB (vasodilate)- nifedepine, amlodipine
avoid BB, vasoconstriction drugs (decongestants, amphetamines), smoking cesession
- think american flag, red/white/blue
if triglicerides >500
priority before lowering LDL dt risk of acute pancreatitis
tx with niacin or vibrate
low fat dient (
statin interactions
increase risk for rhabdo:
grapefruit juice fibrates ( except fenofibrate) antifungals! (intraconazole, ketonazole) macrolide amiodarone CCB (dilt, amloidipine, verapamil)
tx plan for high cholesterol
lifestyle (weight loss, exercise most days, smoking cession ), dash (low salt, low sat fat)
soluble fiber (inulin, guar gum, fruit, veges)
beneficial stanols and sterols (benecol, smart balance margarine)
** If not changes 6 months of lifestyle, consider anti lipid drugs if more than 2 risk factors
risk factors for heart disease (CHD)
htn family hx of premature heart disease (women with MI 45, women>55) smoking BMI>30 microalbuminuria CAD, PVD
albuminuria values
ln a single urine specimen, a level of more than 30 mg of albumin per gram of creatinine is considered positive.
For a 24-hour urine collection, 30 to 300 mg of albumin means albuminuria.
CA: >1:30
agents to HDL (no impact on LDL)
nicotinic acid (niacin) OTC, niaspan
fibrates: fenofibrate (tricor)
alternate: bile acide séquestrants
high trig- avoid junk food
low HDL- exercise
rhabo labs
> CK: 10,000-25,000
proteinuria in up to 45% LFT
pain, weakness, dark urine
advice if low HDL
aerobics
niacin OTC
or tx niacin (niaspan) or fibrates
waist circumference in obese
females: >35 inches or 88cm
males: >40 or 102cm
metabolic syndrome critieria
3 must be present;
abdominal obesity (>40 male, >35 females)
HTN
hyerlipidemia
hypertension: fasting glucose >100, triglerides >150,
trigleride level normal
less than 150
increase triglerceride level can cause
fatty liver (steatosis) aka nonalcoholid fatty liver disease
look for >ast/alt, negative hep a, b, c.
educate: decrease simple carbs
bmi calculations
weight divided by height
PEF calculations
hag,
height, age, gender
