CASES-CARDIO Flashcards
Mr. Astaire is 72 yo male c/o CP when walking up 3 flights of stairs; his pain is consistent and reproducible. His BP is well controlled on anti-hypertensive medications. His EKG is normal. What is the next step in the evaluation of this patient?
DX- stable angina
Workup. Cardiac stress test
Mr. Holley is 48 yo diabetic male presents for a routine visit; his Hgb A1c is 9%. A fasting lipid profile shows triglycerides 400, HDL 30, LDL unable to calculate. What is the most appropriate management of this patient’s lipid abnormality?
fibrate will lower his triglycerides and lower risk of pancreatitis
5.
Mrs. Knowles 53 yo female has BP 138/84. Her parents and brother all have HTN. What is the best management of her BP?
Stage 1 HTN; begin lifestyle modifications and do CV risk assessment, if risk >10% begin BP med; if risk lower then reassess in 3-6 months
Mr. Jones 63 yo male who quit smoking 3 yrs ago with a 30 pk-yr smoking history has BP 150/92, HR 62; EKG shows mild LVH. He takes no meds, no PMH, neg ROS. What is the best medication class to control his BP?
Stage 2 HTN start a BP med (thiazide is no longer 1st line, an ACEI or other class of medication would also be appropriate)
Mr. Jones above returns in 1 week to recheck his BP and you review his lab results, which show total cholesterol 250, TG 120, HDL 45, LDL 180. What is the best management of his lipid abnormality?
statin would be best to lower LDL cholesterol and cardiac risk
Mr. Harries 70 yo male with a recent syncopal episode presents with a harsh systolic murmur loudest at the right sternal border, radiating to the right carotid area. What is the pathophysiology of this problem?
Aortic valve stenosis
elderly patients d/t atherosclerosis of the valve leaflets, increased resistance to ejection of blood from the left ventricle into the aorta;
results in narrowed valve opening,
turbulent blood flow heard as a systolic murmur
loudest at the right sternal border
Mrs. Jones 63 yo female c/o pain in her right calf when walking 5 blocks that resolves when she stops walking. She has diminished pulses in her right foot, her right popliteal pulse is intact. What is the most likely diagnosis?
Peripheral artery disease
Ms. Hart 76 yo female with known CAD s/p 4-vessel CABG 3 years ago presents with fatigue, DOE and swelling in her legs for the past week. She has an 8 pound weight gain and bibasilar crackles on PE, along with 2+ pitting edema to her knees. EKG shows NSR @ 80 bpm with no new ischemia/infarction. Echocardiogram shows a reduced ejection fraction. What is the pathophysiology of her current condition?
Congestive heart failure Systolic dysfunction
pumping ability of the heart is impaired.
Systolic dfx caused by a decrease in cardiac contractility and ejection fraction from impaired contractility (in ischemic heart disease),
volume overload or pressure overload (from HTN).
- A 66 yo male with HTN, CAD with stable angina is taking a beta-blocker, ACE inhibitor, statin, ASA and NTG PRN; his BP is well controlled. For the past 4 days he notes angina at rest. What is the pathophysiology of his unstable angina?
Transient occlusion of a coronary artery causing ischemia
- A 66 yo male with HTN, CAD with stable angina is taking a beta-blocker, ACE inhibitor, statin, ASA and NTG PRN; his BP is well controlled. What is the next step in the management of the above patient?
Cardiac stress testing
cardiac catheterization based on stress test results and/or progression of symptoms;
TX-start platelet inhibitor (clopidogrel)
cardiac risks managed aggressively to prevent a cardiac event
Ms. Eileen 82 yo female with HTN, CAD presents with palpitations x 3 days; on PE you hear an irregularly irregular heart rhythm with a loud S1, opening snap and a new diastolic murmur. On EKG you note new onset of atrial fibrillation. You send her for an echocardiogram, which shows fused mitral valve leaflets. What is the diagnosis?
Mitral valve stenosis
Mrs. Dentin healthy 41 yo female with mitral valve prolapse is scheduled for an invasive dental procedure. Her dentist wants you to prescribe antibiotic prophylaxis to prevent infectious endocarditis. Is this indicated in this patient?
No;
prophylaxis include: prosthetic heart valve, history of infectious endocarditis, congenital heart disease
Mr. MacDonald 44 yo diabetic male presents with BP 200/110; he is asymptomatic. He takes no medications for his BP. BMP is normal. What should you prescribe to lower his BP today?
Stage 2 HTN
TX-thiazide diuretic and an ACE inhibitor would be the best drugs to start today; two drugs,
ACEI for his diabetes.
- A 68 yo female with treatment resistant HTN is on the maximum dose of 4 medications for her BP, which is 150/92 today. PE is unremarkable. Her BMP shows a serum creatinine of 1.8. What diagnostic study would you order at this time?
Renal artery US to evaluate for renal artery stenosis
Mrs. Sunny 73 yo female with atrial fibrillation and HTN has a syncopal episode and is brought in by her son for evaluation. She is asymptomatic at the time of the visit. BP 138/78, HR 82 and irregular; EKG shows atrial fibrillation with a normal rate, no ischemia/infarction. What is the pathophysiology of her syncopal event?
Atrial fibrillation
1. chaotic impulses from multiple foci in the atria cause fibrillation because the atrial cells cannot repolarize in time for the next incoming stimulus;
- ventricular response is completely irregular because of the disorganized stimuli coming through the AV node.
- changes in stroke volumes resulting from varying periods of diastolic filling
- not all ventricular beats produce needed cardiac output, which can cause cerebral hypoperfusion and result in syncope.
