Cardiovascular Flashcards
Hypertensive urgency
Moderate: greater than 200/120
Severe: greater than 200/130
Tx: lower BP 25% in 24-48 hours with PO meds
Meds: Captopril, Clonidine, Labetalol, Nicardipine
Hypertensive emergency
BP: greater than 220/120
Plus end organ damage
Treatment for hypertensive emergency
Decrease BP by 10% in the first hour, additional 15% in next 2-3hours
Drugs: sodium nitroprusside, nitroglycerin, labetalol, nicardipine, hydralazine, enalapril
Malignant hypertension
Older term that was used for moderate to severe hypertension
Peripheral artery disease (PAD)
of the lower extremities
Femoral and popliteal arteries: occluded by atherosclerosis
tibial and pedal arteries: more common in diabetics
Sx: intermittent claudication, dependent rubor, blanching w/ elevation, atrophic changes (hair loss etc.), reduced popliteal and pedal pulses
MANAGEMENT: conservative: diet, exercise, smoking ces. Surgery if loss of function
Occlusive cerebrovascular dz:
Eti: Symptoms due to emboli, TIAs from small emboli
- 90% of emboli originate in proximal internal carotid artery
SX: sudden onset of weakness/numbness of extremity, aphasia, dysarthria, unilateral blindness, bruit heard loudest in mid neck
WORK UP: carotid U/s, MRA and CTA
Occlusive disease of the aorta and iliac
Eti: atherosclerotic lesions of distal aorta and proximal iliacs, may be 1st sign of systemic atherosclerosis. Think white male smokers age 50-60.
SX: claudication in calf muscles/thigh and hip, diminished femoral and distal pulses, ABI less than 0.9(ankle-brachial index) ratio of ankle bp to arm bp.
Mesenteric insufficiency
Aka: gut angina
Eti: embolus from the heart, thrombosis, non-occlusive ischemia from dehydration, hypotension, HF which causees insufficient perfusion to intestine.
SX: Severe postprandial abd pain, wt. loss, fear of eating, N/V, transient diarrhea, peritonitis, epigastric and periumbilical pain
DDx for chest pain?
Don’t miss: MI; pericarditis, aortic dissection, PE, tension pneumothorax, esophageal rupture.
Pulmonary: pneumonia, etc.
GI: GERD, Mallory-Weiss, PUD, etc.
MSK: arthritis, costochondritis, subacromial bursitis
Other: anxiety, thoracic outlet syndrome,
Nitrates (nitroglyceerin)
MOA, etc.
MOA: smooth muscle relaxation: vasodilation
AE: bracdycardia, flushing, hypotension
Indications: angina
CI: PDE-5 inhibitors (sildenafil), inferior MI, hypotension
Interactions: antihypertensives, vasodilators
Rx: 0.3-0.6mg sublingual tab at onset, can repeat in 5 minutes, max three tabs in 15 mintues. Avoid regular use to minimize tolerance
Beta Blockers
Metoprolol, atenolol
MOA: Selectively block beta 1 receptors in the heart, these don’t effect beta 2 in the lungs. Decrease sympathetic drive in the heart decreasing contractility and provide rate control.
Indications: angina, HF, HTN, post-MI
CI: severe bradycardia, heart block, sick sinus syndrome
Pt Ed: orthostatic hypo, may mask hypoglycemia
CCB
(non-dihydropine):diltiazem, verapamil;
MOA: block Ca++ ions: coronary vasodilation: slow AV nodal conduction
(dihydropine)Nifedipine
MOA: same as above: no effect on conduction through AV node, may increase HR.
AEs: edema, HA, bradyC, hypoT, flushing
INDICATIONS: vasospastic angina, HTN, CAD,CKD
Aortic Stenosis: ETI and S/sx
Eti: congenital bicuspid valve - rheumatic heart disease - calcification of normal valve - obstruction of valve: LV hyperT S/sx: angina, sycope, CHF - Symptoms often exertional - Lower extremity edema
Aortic stenosis: murmur type
Diamond shaped: crescendo-decrescendo systolic murmur between S1 and S2
- loudest in aortic area (right 2nd ICS), radiates toward carotids
- S4 atrial kick with LV hyperT
- S gallop with LV failure
Aortic insufficiency
aka aortic regurgitation
Eti: any disease with aortic leaflet incompetency
S/sx: fatigue with activity, SOB with exertion or lying down, angina, syncope, arrhythmia
Murmur: Diastolic (early and decrescendo), heard best in LSB (sitting forward)
Mitral stenosis
Eti: narrowing of mitral valve, backup of blood into pulmonary arteries and R heart.
Sx: SOB, hemoptysis, orthopnea
MURMUR: Opening snap follow by a diastolic rumble. heard best: mitral area
Mitral insufficiency (mitral regurg)
Eti: MC from mitral prolapse, CAD
S/sx: Chronic develops over time: dyspnea, fatigue, palpitations, pulmonary edema will eventually develop.
MURMUR: Pan-systolic heard best at apex and radiates to axilla
Mitral valve prolapse
Most common valve disorder “typically in thin females”
S/sx: minor chest pain, palpitations, often asymptomatic
MURMUR: Mid systolic click, with late systolic murmur
Tricuspid stenosis
Eti: R ventricular hypertrophy
S/sx: mainly asymptomatic, but can have fatigue or weakness
Signs: R heart failure
MURMUR: Loud S1 with diastolic rumble along the left sternal border (increases with inspiration)
Tricuspid regurg
Eti: R ventricle dilation, commonly seen due to left heart failure
S/sx: mainly asymp, can have fatigue and weakness…
MURMUR: Holosystolic best heard at 4th ICS, increases with inhalation.
Pulmonary stenosis
Eti: congenital
S/sx: asymtomatic, may have exertional dyspnea and fatigue
MURMUR: Crescendo-decrescendo, best heard at left 2nd ICS, not heard at carotid, decreases with inspiration
Superficial thrombophlebitis
Eti: Partial or complete obstruction of a superficial vein by a thrombus
- Virchow’s triad: stasis, hypercoagulability, vessel damage.
- precipitating events: pregnancy, OCP use, varicose veins, local injury, IV site (MC)
S/sx: Dull pain, induration and erythema alog pattern of superficial vein (great saphenous is MC), firm cord like vein may remain after inflammation resolves.
- If erythema and induration seen at IV site + fever and chills: suspect septic phlebitis
DVT
Eti: Thrombus formation in deep veins of lower leg and pelivs, 80% originate in calf (these usually don’t break off)
S/sx: 1/2 patients asymp in early stages, dull ache, limb edema, distention of superficical collaterals, fever due to inflammation, tachycardia + SOB, homans sign.
Manage: diagnostic study: US
Varicose veins
Eti: venous valve incompetence
S/sx: Dull aching pain in legs, may be worse when standing
Prevention: body weight, exercise, sometimes just genetic
Tx: compression hosiery
Chronic venous insufficiency
AKA post-phebetic syndrome
Eti: High venous pressure in LE causes capillary leakage of fluid and RBCs
S/sx: itchy, scaly rash around medial malleolus. Edema progresses from pitting to induration. Brawny discoloration. inflammation and stasis of blood leads to tissue hypoxia and ulcers on the ankles.
