cards Flashcards
S4 gallop
diastolic HF (ejection fraction is usually normal). sounds made when LA trying to push blood into an hypertrophic LV
S3
Systolic HF (reduced EF) with volume overload - tachycardia, tachypnea. the sound of blood splashing into the a dilated ventrile
what are the classifications for the NYH failure?
Class I: No limitations, no sxs with activity
Class II: comfortable at rest but slight limitation with normal activity.
Class III: marked limitation. only comfortable at rest. sxs with less than normal activities.
Class IV: sxs at rest unable to perform normal activities.
findings of pulmonary congestion on Chest-X ray?
Cephalization of pulmonary vessels & Kerley B lines
Most common causes of left-side heart failure?
CAD and HTN
What is the EF of systolic heart failure?
HFrEF: EF <40%
What is the EF of diastolic heart failure?
HFpEF: EF >50%
What is the long-term treatment for Heart failure
1) Diuretic
2) ARNI (sacubitril-valsartan). ARB or ACE-I
3) Beta Blocker
Lifestyle modifications for heart failure
Decrease sodium to 2 grams per day
Fluid <2 L per day
What is the treatment for acute HF exacerbation? (LMNOP)
Laxis
Morphine (reduce preload)
NTG (reduce preload + pulmonary congestion)
Oxygen
Position (upright position reduce venous return)
What is the primary cause of coronary artery disease?
Atherosclerotic occlusion of the coronary arteries
What disease is considered a CAD equivalent?
Diabetes mellitus
What is stable angina?
predictable; presents with a consistent amount of exertion
the patient can achieve relief with rest or nitroglycerin
Who should routinely get Aspirin for primary prevention of CVD?
10yr risk >20% in nondiabetics
10yr CVD risk >10% in DM pts
What is endocarditis?
Inflammation of the lining or valves of the heart caused by the presence of bacteria in the bloodstream
What is acute endocarditis?
Infection of normal valves with a highly virulent organism, Staph Aureus
Risk factor reduction of CAD
Smoking cessation
HTN goal <140/90
LDL goal <70
A1c goal <7.0%
ASA
Most common valves affected in Endocarditis?
Mitral valve
Subacute Bacterial Endocarditis
Infection of abnormal valves w a less virulent organism, strep viridans
Presentation of endocarditis
FROM JANE
FEVER
Roth spot(round retinal hemorrhages w pale centers)
Osler nodes (ouch)
MURMUR (new or change murmur)
Janeway lesions (non tender)
Anemia
Nailbed hemorrhage
Embolic (strokes, glomerulonephritis)
Duke’s Criteria
Definite: 2 major or 1 major & 3 minor or 5 minor
Possible: 1 major + 1 minor or 3 minor
Duke’s Major Criteria
1) pos x2 blood cultures
2) Echocardiogram: vegetations seen (tricuspid IV drug users, mitral valve non-drug users), abscess, new murmur
Duke’s minor criteria
1)predisposition (IVDU, prosthetic valve, regurgitation)
2) Fever 100.5
3) Vascular phenomena (septic emboli, Janeway lesion, conjunctival hemorrhage)
4) immunologic phenomena Glomerulonephritis, Osler nose, Roth spots
5) + blood cultures not meeting major criteria
treatment of endocarditis
IV vancomycin or ampicillin/sulbactam PLUS aminoglycoside
add rifampin if prosthetic valve.
Four groups most likely to benefit from statin therapy
Patients with any form of clinical atherosclerotic cardiovascular disease (ASCVD)
Patients with primary LDL-C levels of 190 mg per dL or greater
Patients WITH diabetes mellitus, 40 to 75 years of age, with LDL-C levels of 70 to 189 mg per dL
Patients WITHOUT diabetes, 40 to 75 years of age, with an estimated 10-year ASCVD risk ≥ 7.5%
High intensity Statin
Atorvastation 40-80 mg
Rosuvastatin 20-40 mg
Moderate intensity statin
Atorvastatin 10-20mg
Rosuvastatin 5-10 mg
Hypertensive retinopathy (formerly called malignant HTN)
Characterized by retinal hemorrhages, exudates, and papilledema
Treatment: Hypertensive urgency
clonidine (drug of choice)
Treatment: Hypertensive emergency
sodium nitroprusside (drug of choice)
Diagnosis of Peripheral Arterial disease.
Ankle-brachial index
*ABI </=0.9 pos for PAD
> 1.4 = incompressible calcified
normal 1-1.4
PAD treatment
1st line: structured exercise therapy, smoking cessation & aspirin
Cilostazol is 1st line medication tx.
PAD physcial exam findings
hair loss, shiny skin, muscle atrophy, brittle nails
PAD ulcers
punched-out appearance located on the lateral malleolus
symptoms of chronic venous disease
LE heavines, aching, cramping ot edema associated with prolonged standing, sitting w feet dependent & relieved with ambulation & leg elevation
Chronic venosu disease physical exam
varicose veins, brown/blue gray hyperpigmentation, statsis dermatitis (itching, eczematic rash)
Chronic venous ulcer
shallow w irregular borders w exudation located above the medial malleolus
