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Cardiovascular > Cardiovascular Exam 1 Cards > Flashcards

Cardiovascular Exam 1 Cards Flashcards

1
Q

Diagnostic criteria for hypertension

A

Two or more accurate seated BP readings during two or more outpatient visits
UNLESS there is a hypertensive emergency (end organ damage)

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2
Q

Normal blood pressure

A

Under 120 AND under 80

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3
Q

Elevated blood pressure

A

120-129 AND under 80

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4
Q

Stage 1 hypertension

A

130-139 OR 80-89

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5
Q

Stage 2 hypertension

A

Over 140 OR over 90

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6
Q

Primary/Essential hypertension

A

Multifactorial or uncertain etiology

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7
Q

Secondary hypertension

A

Definable cause to HTN

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8
Q

Coarctation of the aorta

A

Aorta is pinched after leaving the heart

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9
Q

Hypertensive patterns in patients under 50

A

Systolic and diastolic rise
Hormonal or sleep apnea

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10
Q

Hypertensive patterns in patients over 60

A

Systolic rises without diastolic rise due to arterial stiffness

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11
Q

Isolated systolic hypertension

A

SBP over 140 with DBP under 90
Older patients or young athletic males

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12
Q

Which blood pressure number tends to be more important

A

Systolic for older patients
Diastolic for younger patients

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13
Q

White coat hypertension

A

over 140/90 in office but normal at home
Use long term monitoring and ensure they are getting accurate home measurements

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14
Q

Which is more concerning, narrow or wide pulse pressure?

A

Narrow pulse pressure

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15
Q

Masked hypertension

A

Normal in office but abnormal at home
Often a result of alcohol, tobacco or caffeine consumption

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16
Q

Pseudohypertension

A

Calcification of blood vessels in the elderly results in a false elevation
Reason for caution in treating hypertension in the elderly
May present with high reading and hypotensive sx

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17
Q

Blood pressure equation

A

Cardiac output X Systemic vascular resistance

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18
Q

5 things that can cause HTN

A

Hyperactive SNS
RAAS defect
Defective natriuresis
Abnormal CV or renal development
Elevated intracellular calcium or sodium

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19
Q

3 goals in evaluating a hypertensive patient

A

Look for end-organ damage (bruits, etc)
Determine presence of CV risk factors (lipids, lifestyle, etc.)
Evaluate for underlying secondary causes of HTN

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20
Q

6 parameters of an IDEAL blood pressure

A

CAUSED
Cuff on bear arm
Arm at heart level
Uncrossed legs
Support feet and back
Empty bladder
Don’t talk

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21
Q

Ideal method for taking BP

A

both arms, two times, spaced 1-2 minutes apart
Automatic may not work in A fib patients

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22
Q

Ambulatory BP monitoring

A

Monitor checks BP automatically at intervals - must be worn

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23
Q

4 meds that can cause hypertension

A

Contraceptives
NSAIDs
Amphetamines
Licorice

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24
Q

Historical findings that suggest end organ damage

A

Neuro dysfunction
Heart failure
CAD
PAD

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25
Q

Optic signs of HTN damage

A

Hemorrhages, exudates, papilledema

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26
Q

Significance of abdominal bruits with HTN

A

Renal artery stenosis

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27
Q

Signs of aortic coarctation

A

Diminished pulses, rib bruits

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28
Q

5 labs to consider with hypertension

A

UA, BMP, EKG, Lipids, TSH

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29
Q

Cardiac sign of hypertensive pathology on an EKG

A

Left ventricular hypertrophy
Can improve with BP management
May also see heaves or gallops

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30
Q

2 vascular complications of HTN

A

Atherosclerosis and aortic aneurism/disection

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31
Q

Weight reduction effect of HTM

A

5-20mmHg reduction per 10kg weight loss

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32
Q

DASH diet effect on HTN

A

8-14 mmHg reduction

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33
Q

3 other lifestyle modifications for HTN

A

Alcohol reduction 2-4mmHg
Physical activity 4-9mmHg
Sodium restriction 1-8mmHg

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34
Q

Management recommendations for prehypertensive

A

Non-pharm therapy with reevaluation in 3-6 months

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35
Q

Management recommendation for Stage 1 hypertension

A

Begin pharm is 10 year ASCVD risk is abov 10%

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36
Q

Management recommendation for stage 2 hypertension

A

Begin pharm and non-pharm treatment

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37
Q

Target BP for all HTN patients

A

Under 130/80

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38
Q

Best HTN meds for african americans

A

CCB or Thiazides

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39
Q

2 compelling indications for aldosterone agonists

A

Heart failure and post MI

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40
Q

2 compelling indications for CCBs

A

High coronary disease risk
DM

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41
Q

3 compelling indications for ARB use

A

Heart failure
DM
CKD

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42
Q

2 situations where beta blocker might not be advised

A

CKD
Stroke prevention

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43
Q

2 situations where a diuretic for HTN might not be advised

A

Post MI
CKD

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44
Q

2 medication classes that interact with BP meds

A

SNRIs - elevate BP
NSAIDs - Compete for receptors

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45
Q

When should meds be taken in relation to BP readings and why

A

Before because we need to know if the med is making a difference

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46
Q

Non-DHP CCBs

A

Verapamil and Diltaezem - act on heart

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47
Q

DHP CCBs

A

Work on periphery and can cause edema

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48
Q

Pharmacologic BP reduction rule of thumb

A

10mmHg reduction per agent used

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49
Q

Electrolyte to watch with ACEI/ARB therapy

A

Potassium

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50
Q

Difference between hypertensive urgency and emergency

A

Urgency has no symptoms of organ failure

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51
Q

Threshold for hypertensive urgency/emergency

A

Over 180/ and or over 120

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52
Q

Imaging for renal artery stenosis

A

Duplex venous ultrasound

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53
Q

2 non biological etiologies to consider for hypertensive crises

A

Non-compliance with meds
Illicit drugs

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54
Q

Management for hypertensive urgency

A

Treat PO in office
Can give - Clonidine, Captopril, Metoprolol tartrate, Hydralazine to stabilize short term

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55
Q

MOA of clonidine

A

Central sympatholytic

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56
Q

What does a drastic shift in kidney function after ACEI/ARB induction mean

A

Renal artery stenosis

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57
Q

Why might a beta blocker be useful to include for hypertensive urgency

A

Prevention of reflex tachycardia

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58
Q

Management of hypertensive emergency (180/120+ with end organ damage)

A

IV and inpatient treatment
Lower BP by no more than 25% in first two hours
Target BP is 160/100 over next 2-6 hours

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59
Q

Management of hypertensive emergency with ischemic stroke

A

SBP 180-200 with slow reduction

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60
Q

Management of hypertensive emergency with hemmorhagic stroke

A

Target SBP under 140

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61
Q

Management of hypertensive emergency with aortic dissection

A

Goal SBP under 120

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62
Q

Management of hypertensive emergency with MI

A

Anticoagulation and nitroglycerin - no BP goal

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63
Q

First two agents usually used in hypertensive emergency

A

Beta blockers and CCBs

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64
Q

5 first line drugs for a hypertensive emergency

A

Nicardipine - May percipitate MI
Clevidipine - Contraindicated in soy/egg allergies
Labetolol - Avoid in LV systolic dysfunction
Esmolol - Avoid in LV systolic dysfunction
Fenoldopam - May protect kidneys

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65
Q

4 second line hypertensive emergency treatment options

A

Enalaprilat - ACEI can cause hypotension
Furosemide - Loop diuretic, use with vasodilator
Nitroglycerin - Used with MI, can become tolerant
Nitroprusside - Not commonly used due to cyanide toxicity potential

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66
Q

Abnormal blood pressure for pregnancy

A

Greater than 140/90

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67
Q

Diagnostic for HTN during pregnancy

A

2 elevated reading four ours apart

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68
Q

3 acute BP meds used for hypertension management in pregnancy

A

NEVER USE AN ACEI or ARB
Labetolol, Hydralazine, Nifedipine

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69
Q

3 chronic HTN meds used in pregnancy

A

Labetolol, Nifedipine, Methyldopa

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70
Q

Target pregnancy BP

A

130-150/80-100

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71
Q

Definition of resistant hypertension

A

Does not respond to a 3 drug regimen that includes a diuretic
Often due to non-compliance

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72
Q

Treatment for resistant hypertension

A

Referral to nephrology is often the best choice

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73
Q

Hypotension

A

Usually a BP under 90/60
Treat the symptoms not the number

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74
Q

BP reading of too small cuff

A

HIGH

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75
Q

BP reading of too large cuff

A

LOW

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76
Q

Three things that determine arterial pressure

A

Cardiac output
Venous pressure
Systemic vascular resistance

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77
Q

4 skin signs of hypotension

A

Pallor, DIaphoresis, Cool and Clammy, Prolonged capillary refill

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78
Q

2 potential etiologies of orthostatic hypotension

A

Impairment of autonomic reflexes
Volume depletion

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79
Q

Systolic and diastolic drop of orthostatic hypotension

A

20mmHg SBP
10mmHg DPB

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80
Q

6 medications that can cause orthostatic hypotension

A

Alpha 1 agonists (-zosin)
Antihypertensives
Diuretics
PD-5 inhibitors (-fil)
Antidepressants (TCA, MAOI)
Opiods

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81
Q

Test for orthostatic hypotension

A

Bedside tilt or table tilt test
Strat to table, tilt, take BP
Can give nitroglycerin if no symptoms

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82
Q

When might we see symptoms for orthostatic hypotension

A

Either immediately or within 2-5 minutes

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83
Q

Non-pharm interventions for orthostatic hypotension

A

Compression stockings
Hydration
Tensing leg muscles when standing
Avoid exertion in hot weather
Getting up slowly

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84
Q

2 pharmalogical treatments for orthostatic hypotension

A

Fludricortisone
Midodrine

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85
Q

Side effect of hypotension medications

A

Supine hypertension - elevate HOB

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86
Q

Class of midodrine

A

Alpha-1 adrenergic agonist

87
Q

Postural orthostatic tachycardia syndrome

A

Form of orthostatic intolerance where the resonse to standing is an increased heart rate MC in young females

88
Q

Diagnostic criteria for POTS

A

Correlation of symptoms (syncope, brain fog, etc.) with HR increase of 30-40 bpm or 120+ within ten minutes of standing

NO DROP IN BP

89
Q

Gold standard diagnostic for POTS

A

Table Tilt test

90
Q

Non-pharm treatment for POTS

A

Increased salt and water intake
Avoidance of exacerbating factors
Lower extremity exercise and compression stockings

91
Q

Pharm treatment for POTS

A

Fludricortisone, Midodrine
Beta Blockers
May use SSRI or SNRI but rare
Improved sx after 1-2 years

92
Q

3 potential triggers for POTS

A

Large heavy meals, Heat, Alcohol

93
Q

MCC of cardiogenic shock

A

Acute MI, 50% mortality

94
Q

Classic presentation of cardiogenic shock

A

Peripheral vasoconstriction and tachycardia

95
Q

5 step vicious cycle of cardiac injury

A

Ischemia of coronary artery
Myocardial injury/death
Decreased CO
Hypotension
Decreased coronary perfusion

96
Q

S1

A

MV and TV closing

97
Q

S2

A

Aortic and Pulmonic valves closing

98
Q

Aortic post

A

Second intercostal space right sternal border

99
Q

Pulmonic post

A

Second intercostal space, left sternal border

100
Q

Erb’s point

A

third intercostal space, left sternal border

101
Q

Tricuspid post

A

Fourth/Fifth intercostal space left stenal border

102
Q

Mitral post

A

Fifth intercostal space, mid clavicular line

103
Q

Proper heart listening position

A

HOB at 30 degrees, if they are straight up and it’s quiet - sit up and breath OUT

104
Q

Changes in heart sounds with expiration

A

More blood in the left heart

105
Q

Difference in heart standing v. squatting

A

Harsher noise with standing because heart has to work harder. Decrease intensity of AS

106
Q

Ejection click

A

Hear the opening of an AV valve - immediately follows S1

107
Q

Opening snap

A

Opening of mitral valve

108
Q

S3

A

Kentucky gallup
Early diastole (dull)
Physiologic in kids pathologic in older
We hear the ventricle FILLING

109
Q

S4

A

Tennessee gallop
Late diastole
Due to increased resistance to filling of ventricle

110
Q

Comparison of S1 to S2

A

S1 is softer at the base but louder at the apex

111
Q

Split S1

A

May be normal if mitral and tricuspid
Abnormal in RBBB or PVC

112
Q

Physiologic splitting

A

Breathing in increases a split b/c more pressure in the right heart

113
Q

Holosystolic

A

All of systole

114
Q

Holosystolic

A

High to low pressure chamber through a valve that should be closed
Regurgitation/ VSD

115
Q

Midsystolic murmur

A

Not always pathologic
Innocent if it disappears during systole
Pathologic - harsh with stenotic valves
mid systolic click w/ hyperthyroidism

116
Q

Diastolic murmers

A

Usually pathologic
May not hear a closing sound

117
Q

Venous hum

A

Louder in diastole than systole
Humming above the clavicle
Pressure on vein decreases hum

118
Q

Pericardial friction rub sound

A

Rubbing noise

119
Q

PDA sound

A

Harsh radiating to the clavicle less loud in diastole

120
Q

Transesophageal echo

A

Better view of posterior side of the heart
Use if a TT Echo is not working well enough

121
Q

Stenosis sound

A

Harder click

122
Q

Regurgitation sound

A

Whoosh (may not hear the valve close)

123
Q

6 stages of valvular heart disease

A

A-C - Murmer with NO symnptoms
C2 - LV dysfunction
D-Symptomatic

124
Q

Mid - Systolic murmur with LVH
Radiating to the carotids
Harsh Sound
May also hear some regurgitation

A

Aortic stenosis

125
Q

Symptoms of aortic stenosis

A

Exertional chest pain
Syncope

(Can’t get enough blood out - also dilates blood vessels)

126
Q

Source of displaced PMI in aortic stenosis

A

LVH

127
Q

Meds for a mechanical heart valve

A

Warfarin and 81mg ASA - lifelong
Plavix 6 months and ASA forever for TAVI

128
Q

Cause of aortic regrugitation

A

Can be marfans syndrome or a cause of Aortic stenosis

129
Q

Symptoms of Aortic regurgitation

A

Chest pain etc. from blood backing upp and not getting to the body

130
Q

Holo-diastolic murmur
With S3 and S4 gallops
2nd and 4th left intercostal spaces

A

Aortic regurgitation murmur

131
Q

Why widened pulse pressure with Aortic regurgitation

A

Heart tries really hard to get that blood out to the system

132
Q

Austin flint murmur

A

With Aortic regurg

133
Q

Acute aortic regurgitation

A

Trauma etc.
Sudden
EMERGENT because hemodynamic instability

134
Q

S/S of cardiogenic shock

A

Weak
Pale
Cold extremities
Low pitched early diastolic murmur

135
Q

Treatment for Acute aortic regrug

A

Echo
Beta blockers
Diuretics
Vasodilators

136
Q

Mitral stenosis

A

Most common in women who have had rheumatic fever
Left atrial enlargement

137
Q

s/s of mitral stenosis

A

A fib
Hockey stick deformity
Irregular pulse
Hemoptysis from pulm edema
Hoarse voice (atrium compressing

138
Q

Low pitched diastolic murmur at the apex of the heart
S2 Opening snap with mid diastolic murmur

A

Mitral stenosis
Bell in left lateral decubitus

139
Q

Mid systolic click meaning

A

Mitral valve prolapse

140
Q

Indication for percutaneous baloon valvuloplasty

A

No emboli, or not needed to last for very long

141
Q

MI that leads to mitral regurg

A

Posteior wall MI

142
Q

Holosystolic murmur radiating to the axilla and back
May hear mid-systolic click

A

Mitral regurg murmur

143
Q

Why does acute regurg cause cardiogenic shock

A

The atria don’t have time to dilate to compensate for the back flow - blood goes to the lungs!!

144
Q

Mitral valve prolapse

A

Usually in young women
Valves don’t line up
May cause regurg

145
Q

Standing vs. Squatting and murmurs

A

Standing makes the heart work harder, hear MVP click sooner

146
Q

Valves of S1

A

Aortic and pulmonic

147
Q

Valves of S2

A

Tricuspid and Mitral

148
Q

Expected s/s of tricuspid stenosis

A

Diastolic murmur w/ opening snap
JVD
Ascites with liver pulsation with atrial contraction

149
Q

Difference between mitral and tricuspid stenosis

A

Tricuspid should present with increased sound with inspiration

150
Q

Management of tricuspid stenosis

A

Loop diuretics are best
Add an aldosterone antagonist of liver congestion and ascites are present

151
Q

MCC of tricuspid regurgitation/RV dilation

A

Pulmonary hypertension

152
Q

How can tricuspid stenosis lead to LVH

A

Left ventricle tries harder because it is not getting enough blood

153
Q

Management of tricuspid regurgitation

A

Repair or replacement - only need anticoagulation if a-fib is present

154
Q

Presentation of tricuspid regurg

A

Signs of right heart failure (JVD, ascites, etc.)
High pitched pansystolic murmur to the left sternal border
Accentuated by inspiration

155
Q

Pulmonic stenosis

A

Usually a congenital defect
Noonan and Trisomy 13
Results in RVH

156
Q

Presentation of pulmonic stenosis

A

Systolic ejection murmur at the left upper sternal border (pulmonic post) radiating to the left shoulder
RV lift of precordium
Louder with expiration

157
Q

Management of pulmonic stenosis

A

Valvuloplasty or surgery if 36-64mmHg with symptoms or 64+ with or without for the gradient

158
Q

Cause of pulmonic regurg

A

Typically due to dilation of the PV annulus secondary to pulmonary hypertension

159
Q

Presentation of pulmonic regurg

A

Diastolic murmur with ahigh pitched blowing quality at the second left intercostal space

160
Q

MCC of pulmonary HTN

A

Left heart failure

161
Q

Non-echo diagnostics for pulmonic regurg

A

MRI or CT to give an idea of the size of the pulmonary artery - excludes other causes of pulmonary hypertension

162
Q

Mechanical valve warfarin therapy requirement

A

INR of 2.5-3.5

163
Q

Non-mechanical heart valve therapy requirement

A

ASA 81 mg may be sufficient

164
Q

Pathophysiology of rheumatic heart disease

A

Starts with a group A beta hemolytic strep infection followed by pancarditis

165
Q

Hostologic finding of rheumatic fever

A

Aschoff bodies with verrucous lesions on the leaflet edge

166
Q

JONES criteria for rheumatic fever - MAJOR

A

Joints - polyarthritis
Carditis (heart looks like an O)
Nodules
Erythema marginatum
Sydenham chorea (S looks like it’s dancing)

167
Q

Minor JONES criteria for rheumatic fever

A

Arthralgia
Prolonged PR
Fever
Elevated ESR/CRP

168
Q

Diagnostic criteria for rheumatic heart disease

A

2 major JONES crit
or 1 Major and 2 minor with evidence of recent strep infection
Needs to be a documented case

169
Q

Erythema marginatum

A

Bulls eye rashes but all over body

170
Q

What qualifies as a documented case of strep for RHD

A

Throat culture growing GABHS
OR
Elevated anti-streptolysin O titers

171
Q

Treatment for RHD

A

Salicylates for fever/arthritis
PCN for strep infection
PCN or erythromycin for 10 year prophylaxis (be mindful of compliance

172
Q

Something that must happen for endocaritis

A

Valve must be damaged, and bacteria must be introduced into blood stream

173
Q

Aspect of personal hygeine related to infective endocarditis

A

ORAL Hygeine

174
Q

cardiac vulnerability in IV drug users

A

Right heart because bacteria goes there first from blood stream

175
Q

Most common organism for native valve endocarditis

A

S. aureus

176
Q

Risk factors for infectious endocarditis

A

any malformation of the valve etc.

177
Q

MC causitive organisms for prosthetic valve infection

A

Staph and strep and enterococci later on

178
Q

Clinical presentation of infectious endocarditis

A

CHF
Fever
Septic emboli
Petechiae
Splinter hemmorhages from emboli

179
Q

Janeway lesions

A

PAINLESS - caused by vasculitis of endocarditis

180
Q

Osler nodes

A

Painful - vasculitis of endocarditis
Peas under skin feel

181
Q

Eye presentation of endocarditis infectious

A

Roth spots -like a bulls eye

182
Q

Major DUKES criteria for infectious endocarditis

A

Positive blood culture
Evidence of involvement on an echo
New regurgitant murmur

183
Q

Minor dukes criteria for infectious endocarditis

A

Predisposing heart condition
Vascular embolic phenomena (Janeway, etc.)
Single positive blood culture or evidence of active infection with a common organism

184
Q

Definitive diagnosis of IE

A

2 major, 1 major 3 minor, or all 5 minor

185
Q

Possible diagnosis of IE

A

1 major 1 minor or 3 minor

186
Q

Management of infectious endocarditis

A

Antibiotic (PCN-G or Gentamycin or Vanc)
CHF management
Involve cardio and ID

187
Q

Treatment for fungal IE

A

Amphotericin B - have to have surgery to CURE

188
Q

Surgery for IE

A

Don’t delay surgery to prolong abx therapy
Must if fungal
Chronic CHF
Spreading/Not improving

189
Q

Dental care and IE

A

Will need dental care prophylaxis - get dentist on board

190
Q

Prophylaxis for IE

A

In those with risk factors:
Amoxacillin first line or IV Ampicillin
Clinda or Keflex if allergic or Cephazolin IV

191
Q

Patients who are at risk for IE from procedures

A

Prosthetic heart valves
Prior endocarditis
Cyanotic congenital heart disease
Cardiac transplant

192
Q

Procedures for endocarditis prophylaxis

A

Dental procedures and cleanings
Respiratory tract procedures
Skin procedures - ie. abcess

NOT for GI procedures

193
Q

Initial lab orders for IE

A

CBC and blood cultures

194
Q

Most common etiology of pericarditis

A

Viral - cocksackie, flu, etc.

Can be from CKD, Hypothyroidism as well

Drug induced (chemo agents like doxyrubicin) also possible

195
Q

Four principle diagnostic features of pericarditis

A

Chest pain
Pericardial friction rub
EKG changes
Pericardial effusion

196
Q

EKG signs of pericarditis

A

Diffuse EKG changes - ST elevation and PR depression

197
Q

Pleuritic chest pain

A

Worse with breathing and laying down; better with leaning forward

198
Q

Diagnosis of Pericarditis

A

Viral panel
Cardiac enzymes
Echo
CBC, BMP, Thyroid
Inflammatory markers

Usually a clinical diagnosis though

199
Q

Management of pericarditis

A

NSAIDs for pain and inflammation - ibuprofen (ASA if heart attack)

Corticosteroids to prevent recurrence

200
Q

Admission criteria for pericarditis

A

Fever
Immune compromised
Tamponade
Subacute
Trauma
Myopericarditis

201
Q

Pathognomic sign of cardiac tamponade

A

Alternations on an EKG

202
Q

Kussmaul’s sign

A

Indicative of cardiac tamponade - Increase in JVP on inspiration

203
Q

Pulsus paradoxus

A

Sign of cardiac tamponade systolic BP falls 12+ mmHg during breathing

204
Q

Cause of EKG variations in tamponade and what it is called

A

Heart is swinging in fluid - Electrical alternans

205
Q

Initial test of choice for diagnosing a pericardial effusion

A

Echo -shows collapsed chambers

206
Q

CXR of cardiac tamponade

A

May be normal, may have enlarged heart

207
Q

Management for cardiac tamponade

A

Pericardiocentesis (diagnostic and therapeutic)

208
Q

Analysis of pericardial fluid

A

RBCs
Protein,
Gram stain
LDH

209
Q

Pericardial diodesis

A

Sclerosing of pericardium with chemicals to prevent fluid from re-accumulating

210
Q

Pericardiotomy

A

Incise a window for drainage

211
Q

Restrictive pericarditis

A

Caused by TB, radiation, surgeries
Inflammation leads to pericardial fibrosis
Fibrotic tissue makes it hard for heart to relax etc.
Like tamponade but more gradual

212
Q

Presentation of restrictive pericarditis

A

Right heart failure (ascited/JVD)
Atrial fibrilation

213
Q

Diagnosis of restrictive pericarditis

A

Imaging may show an enlarged pericardium
Cardiac catheterization is confirmatory

214
Q

Management of restrictive pericarditis

A

Loop diuretics or aldosterone antagonist
May need a surgical incision for drainage

Cardiovascular (5 decks)

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