chronic CV pt 2 Flashcards
left sided HF symptoms
dyspnea
cough
crackles
respiratory distress
A fib
S3
murmurs
pulm congestion on CXR
right sided HF
edema
fluid retention
hepatic congestion
nausea
increased CVP
JVD
ascites
S3/S4
HF cardinal features
parasternal lift
displaced PMI
diminished S1
S3 gallop
S4 gallop (diastolic HF)
BNP indicative of HF
> 400
HFrEF meds
vasodilators - ACE/arb
diuretics - loop
B-blockers (later)
non-pharm mgmt for HFrEF
na restriction <2300
case mgmt
palliative care
ICD/pacer if EF <35
LVAD/RVAD
coronary revascularization
transplant
HFpEF mgmt
correct reversible causes
manage BP, A fib
SGLT2, diuretics, ACE/ARB
murmur grading
I - barely audible
II - audible but faint
III - moderately loud; easily heard
IV - loud, associated with a thrill
V - loudest (off chest)
diastolic murmurs
mitral stenosis
aortic regurg
systolic murmurs
mitral regurg
aortic stenosisi
MRASS
mitral regurg
s3 with systolic murmur at apex (5th ICS MCL)
may radiate to base or left axilla
musical, blowing, high pitched
decreased with standing, valsalva, increased with squatting
aortic stenosis
2nd right ICS
usually radiates to neck
blowing, rough, harsh
mitral stenosisi
5th ICS, MCL
loud s1, mid-diastolic, low-pitched, crescendo rumble
increased in L lateral, squatting, valsalva
aortic regurg
2nd L ICS, RSB
blowing
basic principles for valvular HD
manage RF! HTN, HLD, DM
lifestyle
oral health
vaccinations
mitral stenosis mgmt
anticoagulation (warfarin) if A fib, or embolic event
HR control
valve replacement/repair or balloon valvotomy
diagnostic for valvular disorders
TTE
aortic stenosis mgmt
diuretics
AVR - definitive
aortic regurg mgmt
htn mgmt - CCB, ACEI/ARB
AVR - definitive
mitral regurg mgmt
control HF symptoms and HTN
MV repair if severe (primary)
Pulm HTN diagnosis
mean PAP >25 mg Hg at rest
pulm HTN initial treatment
vasoreactivity testing at time of RHC
positive following nitric oxide admin - give high dose calcium channel blocker
negative - treatment determined by risk:
high risk - combo therapy w IV prostacyclin
low/intermediate -oral endothelin receptor antagonist and PED5 inhibitor
triple therapy: epoprostenol, bosentan, sildenafil
PAD symptomatology
claudication
cold extremities
numbness
pain exacerbated by activity, relieved by rest
skin ulcerations - punched out edges, well-defined, pale/necrotic, low exudative, PAINFUL
ABI interpretation
normal 1-1.4
noncompressible >1.4 (calcified vessel)
borderline 0.91-0.99
abnormal <0.9 duplex US
PAD gold standard diagnosis
ABIs, then
CTA
PAD mgmt
lifestyle modifications (smoking cessation, exercise, glycemic control)
HLD - statin
HTN - ACEI or ARB
antiplatelets (aspirin, clopidogrel)
revascularization surgery
venous insufficiency s/s
dull, achy legs
leg swelling
itching, tingling, burning, cramping, heaviness
dependent edema
trophic changes
chronic cellulitis
irregular edges, slough
minimal pain in ulcers
venous insufficiency dx
duplex U/S
venous insufficiency mgmt
supportive measures - elevation & compression
weight reduction, exercise
stenting/reconstructive
commonly affected organs of HTN
heart - LVH, angina, MI, HF
brain - stroke, TIA, dementia
eyes - retinopathy
kidney - CKD
peripheral artery disease
HTN symptomatology/exam findings
asymptomatic
pulsating HA
epistaxis
lightheadedness
visual disturbances
LHF symptoms
S4
end organ damage
HTN screening guideliens
annually for adults >40 or risk factors
every 3-5 years for adults with normal BP and no RF
HTN stages
normal <120 and <80
elevated 120-129 and <80
stage 1 130-139 or 80/89
stage 2 140 or >90
HTN first line agents
- ACEI/ARB & CCB
- ACEI/ARB & CCB & thiazide
- ACEI/ARB & CCB & thiazide & spironoactone
2nd line HTN agents
diuretics - loop, K sparing, aldosterone antagonists
B-blockers
Alpha-blockers
alpha 2 agonists
vasodilators
renin inhibitors
HTN dx
140>90, goal <130/80 in special populations
HTN tx for HF
HFrEF - ACEI/ARB, diuretics, B-blockers, NO NONDIHYDROPYROIDINE CCBS
HFpEF - diuretics, ACEI/ARB, beta blockers
HTN tx for CKD
stage 1-2 w albuminuria or stage 3 - ACEI (or ARB if not tolerated)
HTN tx for DM
all first line agents
consider ACEI/ARB in presence of albuminuria
HTN tx for blacks
thiazide or CCB first line
HTN tx in pregnancy
methyldopa, nifedipine, labetalol
NO ACEI, ARB, or direct renin inhibitors
geriatric HTN tx
<140/90
NYHA HF classes
I - no limitation of physical activity, ordinary activity does not cause fatigue, dyspnea, or angina
II - slight limitation of physical activity. ordinary physical activity results in symptoms
III - marked limitation on physical activity. comfortable at rest, but less than ordinary activity causes symptoms
IV - unable to engage in any physical activity without discomfort, symptoms may be present even at rest
V - used by some experts to describe symptoms that are typical and can occur either at rest or with exertion
cha2d2s vasc score
used to predict thromboembolic events in patients with nonvalvular A fib
ischemic stroke greatest risk
Congestive HF
Hypertension
Age>75
DM
Stroke/TIA/TE -2
Vascular disease
Age 64-74
Sex category (female)
