cardiovascular Flashcards
1
Q
AV valves
A
tricuspid and mitral
2
Q
S1 Atria Ventria valves are
A
closed
3
Q
S2 semilur valves
A
pulmonic and
4
Q
S3 leading abnormal heart sound in
A
heart failure, normal in pregnancy kentucky
5
Q
S4 tennesse
A
stiff ventricular wall (MI, LVent hypertrohy) uncontrolled HTN
6
Q
Mitral stenosis
A
loud S1 murmur, low pitched a
7
Q
Aortic stenosis radiates to neck
A
systolic blowing
8
Q
Acute heart faillure is
A
L sided
9
Q
chronic heart failure is
A
R sided
10
Q
left failure look for problems in the
A
Lungs
11
Q
Order of R heart failure
A
JVD-hepatosplnomeegaly- peripheral edema
12
Q
outpatient managment of heart failure
A
na and water restriction
rest and activity balance
weight reduction
13
Q
pharma management of heart failure
A
ace inhibitors (prils) and diuretics
14
Q
manageent of acute plum edema
A
O2
morphine and lasix 40 repete q20 or 30
15
Q
definition of HTN
A
sustained elevation of sys BP >140 or diastolic BP >90
3times on two different occasions
16
Q
primary HTN
A
95% onset usually less than the age of 55
17
Q
secondary HTN
A
classic presentations- estrogen use, renal disease, pregnancy, endocrine disorders RENAL ARTERY STENOSIS
18
Q
HTN exacerbates
A
smoking, oeisity, too much booze, nsaids
19
Q
suboccipital HA HTN
A
HTN gets better over the course of the day
20
Q
S and S of HT
A
often silent EPISTAXIS elevatedBP dizzy light headed S4related to left ventricular hypertrophy
21
Q
HTN labs and diagnostic
A
primary HTN is a diagnosis of exclusion
22
Q
Normal BP
A
less than 120 and less than 80
23
Q
pre hypertension
A
120-139/or 80-89
24
Q
HTN stage 1
A
140-159/or 90-99
25
HTN stage 2
more than 160 or more than 100
26
patients over 60yo
less than 150 less than 90
27
patients less than 60yo
less than 140 less than 90
28
non pharma management HNT
```
low salt
weight loss if overweight
exercise 30mins most days
dash diet
streee reduction
low booze
```
29
pharma management of of HTN thiazide diruetics
screen for sulfa allergy, pee sowatch lytes
30
jnc 7
stage 1 thiazide diuretics
| stage 2 thiazide diuretic and another agent
31
no BB for dm or
asthma or copd
32
ace inhibitors
prils - contraindicated in pregnancy
| not with an arb watch for cough
33
angiotensisin II ARB
reserved for patients intolerant to ACE I
34
lasix particularly effective in
african americans and elderly with isolated systoic hypertension 162/74 kind of thing
35
hypertensive urgency
180/110 w/o target organ dysfunction
po clonadine(alpha 2 agonist)/catopril(ace I)
may have ha
rarely
36
hypertensive emergency
```
>180/120 with nd organ dysfunciton
malignant hypertension with changes in the eyes
htn
pappilidema, swelling of potic disc and blurred lid margins.
unstable angina
acute MI
acute LV failure with edema
dissecting aneurysm
```
37
hypertensive emergency
nitro gtt, unit admission, and a line
38
hypertensive emergency
cardne gtt, unit admission, and a line
39
hypertensive emergency
shoot for 160-180 or less than 105diastolic - no more than 25% withing 2hrs
40
angina at rest
prinzmetals vs unstable
41
levines sign
clinched fist sign (sqeezing my heart=angina)
42
angina ecg
downsloping of ST or T wave peak inversion
ST depression +ischemia
ST elevation is infarction
43
angina after exercis ecg
serum lipid levels
44
angina desired serum lipid levels
total less than 200
trigs less than 150
ldl less than 100
hld over 40
45
lipid goals for DM or CAD
LDL less than 70
HDL over 40
TRI less than 150
46
angina angiography
coranary angioagraphy is definitive but not indicated soley for diagnosis
47
angina meds
```
low dose asa 81enteric coated
then
nitrates
BB
CCB 3 classes of meds
```
48
optomizing lipids who gets a statin
clinical evidence of athlerosclerotic CVD
elevated LDL-C over 190
diabetics 40-70 with LDL between 70-189 but with an estiated athlersclrotic rsik of 7.5% or higher
49
statin goal
try and get 50% LDL reduction after you max statin dos u can try and non statin adjunct
50
mi
alteration intypical anginal pain, most occur at rest, pain is like angina
s4 is common
51
mi ecg
30% have nothing on ECG
peaked T
ST elevation
maybe Qwave
52
1-avl
lateral mi
53
2-3-avf
inferior MI
54
V 3-4
anterior mi
55
troponin I and CKMB are
100% cardioslective
56
leukocytosis after mi
10-20k on the second day
57
mobtz II
regulr A and PR interval but vent rythm is irregular and complexes are droped
58
III block
no relationship between p and qrs complexes. PR interval varies with no regularity
59
MI mangemnt
```
ASA 325 to chew
NItro s q5x3
02
IV kvo 3
12 lead
morphine 2-4
lasix 40 for pulm edema
BB if not contraindicated
ACE I for failure or large infarction to prevent ventricular remodeling
hep
```
60
INR mormal vs
0.8 -1.2
61
INR goal in MI
2.5-3.5 of normal 2-2.8---4.2 (2-3)
62
door to fibriniltyics is
30 mins
63
door to cath lab is
90 ins
64
lovenox dose in MI
1mg/kg
65
indications for pharmacologic recascularization
unreleived chest pain more than thirty mins and less than six hours with st seg elevation of greater than .1 in two or more contiguous leads
66
contraindications for pharmacologic therapy ie TPA
```
Prior ICH
malignant neoplasm of brain or cerebral vascualr lesion
ischemic stroke within 3 months
suspected aortic discetion
active bleeding
closed head or facial trauma within 3 months
spinal or brian sx wihting 2 months
uncontrolled htn over 185/110
abnormal coags
```
67
DVT management
```
bed rest for 7-14days with leg elevated
gradually re-introduce walking
lovonox 1mg/kg q12
heparin for 7-10 days
coumadin for 12 weeks
consult when antigoag is needed
```
68
DVT while walking and distal edema
DVT
69
PVD
40-70years of age
high lipids
smoker
dm
70
PVD s and s
claudication
cold or numb to extremities
progress to pain at rest
71
PVD physical findings
shiny hairless skin
dependant rubor
elevational white feet or pallor
72
PVD lab dx
doppler us, ABI ateriography is most definitive test
73
PVD treatment
```
stop smoking
walk 1hr per day stop on pain
resume when it stops to develo colateral circ
trental
pletal
angioplasty or bipass
```
74
CVI
womman greater than men,
may be genetic
history of leg trauma or vericosities
75
cvi symptoms
aching of LE releived by elevation, edema after stadnign, night cramps in LE
76
CVI findings
```
trophic changes iwth brownish redish hue
stasis leg ulcers
dermatitis
cool to tocuh
LE
```
77
CVI dx
non specific, R/O HF
78
CIV management
bed rest with legs up
support stockings
weight reduction
79
CVI treatment of acute weeping dermtis
wet compress
0.5 hydrocortisone cream after comress
systemic abx only if central infection is suspected
80
heart murmur with fever
must rule out endocarditis
81
pericarditis vs endo
peri is virus endo is bacterial
82
pericarditis
pain is localized and retrosternal
rub is present
hurts on ispiration releived when leaning forward
may not have fevers
ST ELEVATION IN ALL LEADS IWTH DEPRESSION OF PR SEGMENT
83
pricarditis
hihg dose nsads advil 400-600 q 6
steroids only on total failure of nsaids
monitor for tampanod
84
endocarditis
fever malaise, night sweats and weight loss
85
endocarditis blood cultures
3 cultures at three sperate sites in one hour
86
endocarditis oslar nodes
painful red nodules in the distal phalanges
87
endocarditis janewa lesion
small not painful macul on palm and sole
88
endocarditis abx 1
penicillin g 2million units IV q4 in combo with gnetimycin
89
endocarditis
nafcillinn (unipen) 2g q4
90
endocarditis mrsa
vanc
