Cardiovascular Flashcards
s/s of MI in women
dyspnea, fatigue, back pain, nausea
s/s of AAA
pulsating-type sensation in abd or lower back
risk factors for AAA
elderly white male, hx of HTN, smoker
s/s of CHF
dyspnea, fatigue, swollen feet/ankles, lung crackles, S3 heart sound
painful violet-colored nodes on the fingers or feet in those with bacterial endocarditis
Osler nodes
tender red spots on the palms/soles in those with bacterial endocarditis
Janeway lesions
where is the apical pulse
5th intercostal space at midclavicular line
flow of blood in the heart
vena cava–> right ventricle –> tricuspid valve –> right ventricle –> AV valve –> pulmonary artery –> the lungs –> pulmonary veins –> left atrium –> mitral valve –> left ventricle –> aorta
S1 is the
closure of the mitral and tricuspid valves
S2 is the
closure of the pulmonic and aortic valves
mneumonic to remember type of valves
MOTIVATED APPLES:
Mitral
Tricuscpid
AV valves (3 leaflets)
Aortic
Pulmonic
Semilunar valves (2 leaflets)
S3 sounds like
KENTUCKY
S3 is only abnormal in those
greater than 35
S4 is caused by
stiff left ventricle
Sign of left ventricular hypertrophy
S4
atrial gallop or atrial kick
S4
ventricular gallop
S3
S4 sounds like
Tennessee
the bell of the stethoscope is to hear for
extra heart sounds (S3 or S4), mitral stenosis
heart sound that can be normal in the elderly
S4
Mnemonic for systolic murmurs
Mr. Peyton Manning AS MVP (Mitral regurgitation, Physiologic murmurs, aortic stenosis, mitral valve prolapse)
Mnemonic for diastolic murmurs
ARMS (aortic regurgitation, mitral stenosis)
These murmurs are ALWAYS indicative of heart disease
diastolic murmur
Also called the “opening snap” and is best heard with ___
mitral stenosis; bell of stethescope
murmur grade where a thrill is first heard
grade IV
____ murmurs are always abnormal; whereas ____ murmurs are usually benign
diastolic; systolic
mitral regurgitation murmur radiates to the
axilla
aortic stenosis murmur radiates to the
neck
A split S2 is best heard at the
pulmonic area
When afib is intermittent and terminates in 7 days or less; asymptomatic
paroxysmal afib
amiodarone has a black box warning for
pulmonary and liver damage
simvastatin and amiodarone together can cause
rhabdomyolysis
INR for those with prosthetic valves
2.5-3.5
diet teaching for those on coumadin
only one serving per day of foods high in vitamin K (“greens”: kale, collards, mustard, turnip, spinach, romaine lettuce, brussel sprouts)
treatment for paroxysmal atrial tachycardia (PSVT)
Valsalva, carotid massage, splashing cold water on face
what is paradoxical pulse
when the apical pulse is still heard but no radial pulse can be palpated
If INR is between 3-5, then
skip one dose, may need to decrease maintenance dose, recheck every 1-2 days until normal
If INR is between 5-9, then
hold dose and give either small dose of oral vitamin K OR skip the next 1-2 doses. Recheck INR daily until normal.
screening in BP for those with normal BP
every 2 years
screening in BP for those with prehypertension
every year
Prehypertension
SBP 120-139, DBP 80-89
Stage I HTN
SBP 140-159, DBP 90-99
Stage II HTN
SBP greater than 160, DBP greater than 100
eye changes in those with HTN
copper and silver arterioles; AV nicking; papilledema
can cause HTN in young adults
renal artery stenosis
how to check for coarctation of the aorta
check radial and femoral pulse at same time
Goal BP for those greater than 60 without hx of DM or CKD
less than 150/90
Goal BP for those less than 60 without hx of DM or CKD
less than 140/90
Goal BP for those with DM or CKD
less than 140/90
first line of trx in those with HTN and CAD
ACE or ARB
first line of trx in those with HTN post-MI
beta blocker
first line of trx in those with HTN with hx of heart failure or CHF
thiazide
dietary source of magnesium
dried beans, whole grains, nuts
where loop diuretics have effect
Loop of Henle
ex of loop diuretics
furosemide (Lasix), bumetanide (Bumex)
ex of aldosterone receptor antagonist diuretics
spironolactone
MOA of spironolactone
antagonizes effect of aldosterone –> increase water elimination and conserves potassium
Side effect of spironolactone
gynecomastia, hyperkalemia, vomiting/diarrhea
contraindications to spironolactone
high K+, renal insufficiency, DM with microalbuminuria
avoid abrupt discontinuation of this BP med
beta blockers: can cause rebound HTN
Beta1 receptors are specific to the ____ ; and beta2 receptors are specific to the ____
heart; lungs and peripheral vasculature
contraindications to beta blocker use
asthma, COPD, second/third degree block
Do not use this beta blocker to treat HTN as it has a short half-life
propranolol (Inderal)
side effects of CCB
headaches, ankle edema, bradycardia
one side of effect of nifedipine is
reflex tachycardia
The nondihydropyridine CCBs MOA
Decrease HR, a little BP
The dihydropyridine CCBs MOA
Decrease BP, doesn’t hurt pulse
ex of nondihydropyridine CCB
verapamil and diltiazem
ex of dihydropyridine CCB
nifedipine and amlodipine
MOA of ACEI and ARBS
block conversion of angiotensin I to II (a potent vasoconstrictor)
BP med that is contraindicated in pregnancy
ACEI and ARB
side effects of ACEI and ARB
dry hacking cough, hyperkalemia, angioedema
This med is contraindicated in renal artery stenosis
ACEI or ARB
ex of ARB
losartan
MOA of alpha-adrenergic blockers
vasodilation
common side effects of alpha-adrenergic blockers
dizziness and hypotension
first dose orthostatic hypotension is common in this medication
alpha-adrenergic blocker
administration of alpha-adrenergic blockers
give a bedtime, start at low doses and titrate slowly
first choice medication for a male with HTN and BPH
alpha-adrenergic blockers
MOA of diuretics
decrease volume and preload
This BP medication has a sulfa component and should be avoided in patients with sulfa allergy
thiazide diuretics
Has a favorable effect for those with HTN and osteopenia/osteoporosis
thiazide diuretics
side effects of thiazide diuretics
hyperglycemia, hyperuricemia, high cholesterol, hypokalemia, hyponatremia
examples of thiazide diuretics
HCTZ, chlorthalidone
these two BP med combinations can increase risk of hyperkalemia
ACEI and spironolactone
CHF is an EF less than
40%
normal JVD is less than
4 cm
If a patient with CHF has no limitations of physical activity, they are classified as
Class I
If a patient with CHF has ordinary physical activity that results in fatigue, and exertional dyspnea, then they are classified as
Class II
If a patient with CHF has marked limitation in physical activity, then they are classified as
Class III
If a patient with CHF has symptoms at rest with or without physical activity, then they are classified as
Class IV
risk factors of DVT
oral contraception use, inactivity for more than 3 hours, CHF, pregnancy, bone fx in long bones, trauma, recent surgery
s/s of DVT
swelling of extremity that is painful, red, and warm.
gold standard to diagnose DVT/PE
contrast venography
Trx for DVT/PE
heparin IV, then warfarin PO for at least 3-6 mo
risk factors for superficial thrombophlebitis
catheter, IV potassium, Staph aureus infection
s/s of superficial thrombophlebitis
indurated, cordlike vein that is warm, red, and tender to touch
trx for superficial thrombophlebitis
NSAIDS (ibuprofen, Anaprox DS/naproxen), warm compresses
intermittent claudication
worsening pain on ambulation that is relieved by rest
golden standard for dx of peripheral vascular/arterial disease
angiography
Pentoxifylline (Trental) is indicated for
peripheral vascular/arterial disease
reversible vasospasm of the peripheral arterioles on fingers and toes
Raynaud’s
s/s of Raynaud’s
color changes that occur symmetrically in hands and feet, numbness/tingling with cold temperatures.
treatment for Raynaud’s
nifedipine or amlodipine
important not to use these drugs in those with Raynaud’s
Imitrex, decongestants, amphetamines
subungual hemorrhages
splinter hemorrhages on nailbed
s/s of endocarditis
subungual hemorrhages, Osler nodes, Janeway lesions, fever/chills
endocarditis prophylaxis is given to those with
prosthetic valves, heart transplant, invasive dental procedures
endocarditis prophylaxis is NO longer given to those with
mitral valve prolapse, GU/GI invasive procedures
endocarditis prophylaxis medication
amoxicillin 2 g PO x 1 (adults); amox 50 mg/kg (children) one hour before procedure;
treatment for MVP with symptoms
beta blockers, avoid caffeine/alcohol/smoking
normal cholesterol is less than
200
normal HDL is
greater than 40
normal triglycerides
less than 150
high risk of pancreatitis
triglycerides greater than 500
simvastatin drug interactions
grapefruit juice, antifungals, macrolides, amiodarone
serious complication of statins
rhabdomyolosis and drug-induced hepatitits
MOA of statins
decrease LDL and raise HDL
MOA of fibrates and nicotinic acid
reduces triglycerides and increases HDL
SE of fibrates
dyspepsia, gallstones
patient education for those with high triglycerides
reduce simple carbs, “junk food” and fried foods
patient education for those with low HDL
increase exercise, trial of OTC niacin
gemfibrozil (Lopid), Tricor
fibrate
Cholestyramine (Questran)
bile acid sequestrant
work on the small intestine and interfere with fat absorption (including fat-soluble vitamins A, D, E, and K).
bile acid sequestrant
side effects of bile acid sequestrant
bloating, gas, abd pain
labs for cholesterol meds
baseline LFTs
triad of rhabdomyolosis
muscle pain, weakness, red-brown urine
labs in rhabdomyolosis
high CK, proteinuria
high waist circumference in males
greater than 40 in
high waist circumference in females
greater than 35
criteria for metabolic syndrome
abdominal obesity, HTN, HLD
fatty liver or nonalcoholic fatty liver disease is caused by
triglyceride deposits in the liver
labs for fatty liver
elevated ALT and AST; Hep A, B, and C negative
treatment for fatty liver
weight loss, avoid hepatotoxic drugs (statins, tylenol), vaccination for Hep A&B
BMI calculation
weight/height2
when to screen for lipid disorders
men: 35, women: 45
normal BP in children
both systolic and diastolic are less than 90th percentile for gender, age, and height
when should BP meds be started in children
if lifestyle modifications fail in 6 months
management for statin therapy
baseline LFTs, CK does not need to be routinely measured
normal cholesterol in children is
below 75th percentile
abnormal cholesterol values in children
above 95th percentile
when to screen for dyslipidemia in children
age 9-11 and again at 17-21
systemic inflammatory illness that particularly affects medium-sized arteries, especially the coronary arteries
Kawasaki disease
s/s of Kawasaki disease
fever, conjunctivitis, strawberry tongue, rash, swelling of hands and feet
diagnostic for kawasaki disease
high ESR/CRP, thrombocytosis, leukocytosis.
screening for AAA
one time screening for all men 65-75 who have smoked
outpatient trx for DVT
LMWH then add warfarin for at least 5 days, can d/c LMWH once INR is therapeutic for at least 2 consecutive days
management of DVT
compression stockings after anticoagulant therapy initiated; early ambulation
s/s of arterial ulcers
painful; mostly on toes; necrotic
abnormal ABI
less than 0.90
s/s of venous ulcers
located between knee and ankle; mild pain; scaling, weeping, erythema
aortic regurgitation is best heard when
leaning forward or during Valsalva
location best heard for venous hum
under right clavicle
quality of venous hum
continuous murmur
location best heard for stills murmur
2-4th left ICS
quality of stills murmur
musical
characteristic of hypertropic cardiomyopathy
systolic murmur that gets louder when the patient stands
therapeutic range for digoxin
0.5-2.0
s/s of digoxin overdose
anorexia, N/V, abd pain, confusion, visual changes
examples of potassium sparing diuretics
triamterene, amiloride
adverse effects of beta blockers
bronchospasm, blunts hypoglycemic response, depression
med choices for african american with HTN
thiazide or CCB
med choices for non-black person with HTN
thiazide, CCB, ACEI, ARB
thiazide diuretic is good to treat
mild HTN
these people are known to have high renin states causing HTN
young white males
First line treatment for isolated systolic HTN
CCB
Side effect of HCTZ
erectile dysfunction
-pine drugs are
DHP CCB
DHP Calcium channel blockers decrease ____ and not the _____.
BP; pulse (Don’t Hurt Pulse)
These people should be placed on a moderate to high statin
Hx of CHD or stroke;
LDL greater than 190;
DM, age 40-75;
10-year risk score greater than 7.5%
High potency statins
atorvastatin (Lipitor), rosuvastatin (Crestor)
Moderate potency statins
simvastatin (Zocor), pravastatin (Pravachol)
med contraindicated to give in heart failure
TZDs, CCB, naproxen
Areas of heart valves
Aortic;
Pulmonic;
Tricuspid;
Mitral
These valves don’t open properly
stenotic valves
these valves don’t close properly
regurgitant valves
s/s of aortic stenosis
syncope, angina, HF
murmur with an audible “click”
mitral valve prolapse
mitral valve prolapse can be common in
pregnant women; women 15-30.
causes of peripheral artery disease
diabetic, smoker, dyslipidemia, no exercise
trx for kawasaki disease
aspirin daily x 2 months to prevent MI
innocent murmur clues
less than grade II, softer when sitting than lying, musical quality
pathologic murmur clues
grade III or higher, harsh quality, increased intensity when standing
foods high in folic acid
spinach, liver, whole wheat bread
this BP med can increase blood sugars
thiazide diuretics
