Caridovascular Flashcards
What is Levine sign?
90% diagnostic for angina
“Clenched fist sign” aka squeezing
Diagnostic for angina
What is HTN urgency?
BP >/= 180/110
May or may not be associated wtih:
severe HA,
SOB,
epistaxis,
severe anxiety
Tx for HTN urgency
Clonidine or Catapress
pure Alpha AGONIST
What is HTN EMERGENCY?
BP >/= 180/120
Requires immediate (w/in 1 hr) BP reduction to prevent or limit target organ damage
BP maybe < 180/120 for the following:
- Malignant hypertension
- hypertensive encephalopathy
- intracranial hemorrhage
- USA
- Acute MI
- Dissecting Ao Aneursym
- Eclampsia
Tx for HTN EMERGENCY
ICU admission for continuous monitoring of BP and target organ damage and for parenteral administration of an appropriate agent, i.e. CARDENE or Nipride
For compelling conditions, e.g. severe preeclampsia or eclampsia, or pheochromocytoma crisis.
SBP < 140 w/in 1st hour
Ao dissection: <120 SBP w/in 1st hour
For non-compelling conditions:
SBP reduced by 25% w/in the 1st hour;
then if stable to 160/100 w/int 2 - 6 hours
then cautiously to normal during the following 24 - 48 hours.
What is Prinzmetal’s angina?
Vasospastic
Occurs at various times including rest
Cause by sudden influx of intracellular Ca++
Tx of Prinzmetal angina?
CCB
What are the EKG changes w/ Prinzmetal angina
ST elevation but dx by exclusion
Coronary arteries are clean/open
What is the desirable total cholesterol value?
<200 mg/dL
What is the VLDL (triglycerides) value?
NL </= 150 mg/dL
What is the optimal value for LDL?
< 100 mg/dL
< 70 mg/dL in diabetics & CAD
What are the values for HDL?
low </= 40 mg/dL
high >/= 60 mg/dL
What are the serum lipid level goals for pt’s with DM or known CAD?
HDL > 40 mg/dL
LDL < 70 mg/dL
TG < 150 mg/dL
Which drug is used in conjunction w/ a statin to lower LDL, if statin is maxed?
Ezetimibe (Zetia) a cholesterol absorption inhibitor.
What is the mainstay or DOC for the management of pericarditis?
NSAIDS
Ibuprofen 400 - 600 mg/6-8 hrs
possibly Indomethacin
or Toradol
What is the 2nd DOC of management of pericarditis and why is it 2nd?
Corticosteroids ONLY if there if failure of high dose NSAIDS over several weeks w/ relapsing of pericarditis
Dexamethasone over prednisone
Not 1st line because it can cause viral replication
What should you r/o with patients w/ fever of unknow origin and/or heart murmur?
endocarditis
What is the cause of pericarditis vs. endocarditis?
Pericarditis = viral cause
Endocarditis = bacterial cause
Name 5 causes of NIGHT SWEATS in adults.
- Endocarditis
- TB
- Menopause
- HIV or more like AIDS
- Leukemia
When will you NOT hear a murmur with endocarditis?
Right sided endocarditis, appx 30%
What are the physical findings of endocarditis?
Skin changes:
- Osler nodes (DIP) painful red noduels
- petechiae, pupura, pallor
splinter hemorrhages:
- linear, subungual splinter appearing lesions
Jane way lesions:
- rare. small and NOT painful macules on the palms and soles.
Roth spots:
- small retinal infarcts, white in color, encircled by areas of hemorrhage.
What are the characteristics of mitral regurgitation or mitral valve prolapse?
Holosystolic murmur
opening snap
What is the characteristic of Ao stenosis?
S4 d/t narrowing of the valve outflow
Systolic murmur
Gallop
Click
Name sx for Beck’s triad.
Muffled or distant heart tones
Elevated jugular venous pressures or CVP
hypotension
Why can’t Entresto be administered with ACE?
High risk of ANGIOEDEMA because Entresto contains neprilysin inhibitor (sacubitril).
What EKG changes are seen with pulmonary embolism?
RBBB
T-wave INVERSION
What HMG-co reductase, aka statins are recommended for HIV-+ and on protease inhibitors and why?
Rosuvastatin (Crestor) because it is mediated by CYP2C9, < potential for myopathy in pts on PI.