Caridovascular

Question 1

What is Levine sign?

Answer 1

90% diagnostic for angina

“Clenched fist sign” aka squeezing

Diagnostic for angina

Question 2

What is HTN urgency?

Answer 2

BP >/= 180/110

May or may not be associated wtih:
severe HA,
SOB,
epistaxis,
severe anxiety

Question 3

Tx for HTN urgency

Answer 3

Clonidine or Catapress

pure Alpha AGONIST

Question 4

What is HTN EMERGENCY?

Answer 4

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

Question 5

Tx for HTN EMERGENCY

Answer 5

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.

Question 6

What is Prinzmetal’s angina?

Answer 6

Vasospastic

Occurs at various times including rest

Cause by sudden influx of intracellular Ca++

Question 7

Tx of Prinzmetal angina?

Answer 7

CCB

Question 8

What are the EKG changes w/ Prinzmetal angina

Answer 8

ST elevation but dx by exclusion

Coronary arteries are clean/open

Question 9

What is the desirable total cholesterol value?

Answer 9

<200 mg/dL

Question 10

What is the VLDL (triglycerides) value?

Answer 10

NL </= 150 mg/dL

Question 11

What is the optimal value for LDL?

Answer 11

< 100 mg/dL

< 70 mg/dL in diabetics & CAD

Question 12

What are the values for HDL?

Answer 12

low </= 40 mg/dL

high >/= 60 mg/dL

Question 13

What are the serum lipid level goals for pt’s with DM or known CAD?

Answer 13

HDL > 40 mg/dL

LDL < 70 mg/dL

TG < 150 mg/dL

Question 14

Which drug is used in conjunction w/ a statin to lower LDL, if statin is maxed?

Answer 14

Ezetimibe (Zetia) a cholesterol absorption inhibitor.

Question 15

What is the mainstay or DOC for the management of pericarditis?

Answer 15

NSAIDS
Ibuprofen 400 - 600 mg/6-8 hrs

possibly Indomethacin
or Toradol

Question 16

What is the 2nd DOC of management of pericarditis and why is it 2nd?

Answer 16

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

Question 17

What should you r/o with patients w/ fever of unknow origin and/or heart murmur?

Answer 17

endocarditis

Question 18

What is the cause of pericarditis vs. endocarditis?

Answer 18

Pericarditis = viral cause

Endocarditis = bacterial cause

Question 19

Name 5 causes of NIGHT SWEATS in adults.

Answer 19

1. Endocarditis
2. TB
3. Menopause
4. HIV or more like AIDS
5. Leukemia

Question 20

When will you NOT hear a murmur with endocarditis?

Answer 20

Right sided endocarditis, appx 30%

Question 21

What are the physical findings of endocarditis?

Answer 21

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.

Question 22

What are the characteristics of mitral regurgitation or mitral valve prolapse?

Answer 22

Holosystolic murmur

opening snap

Question 23

What is the characteristic of Ao stenosis?

Answer 23

S4 d/t narrowing of the valve outflow

Systolic murmur

Gallop

Click

Question 24

Name sx for Beck’s triad.

Answer 24

Muffled or distant heart tones

Elevated jugular venous pressures or CVP

hypotension

Question 25

Why can’t Entresto be administered with ACE?

Answer 25

High risk of ANGIOEDEMA because Entresto contains neprilysin inhibitor (sacubitril).

Question 26

What EKG changes are seen with pulmonary embolism?

Answer 26

RBBB

T-wave INVERSION

Question 27

What HMG-co reductase, aka statins are recommended for HIV-+ and on protease inhibitors and why?

Answer 27

Rosuvastatin (Crestor) because it is mediated by CYP2C9, < potential for myopathy in pts on PI.