Clinical Appraoch (Lecture 3) Flashcards
“knifelike” pain may describe aortic dissection or pericarditis? How do you differentiate?
AD = sudden, unrelenting
Pericarditis = Lasts hours to days, may wax/wane
In cardiovascular conditions, chronic dyspnea usually is caused by increases in pulmonary venous pressure as a result of left ventricular failure or valvular heart disease . Orthopnea, which is an exacerbation of dyspnea when the patient is recumbent, is caused by increased
work of breathing because of either increased venous return to the pulmonary vasculature or loss of gravitational assistance in diaphragmatic effort. ____ is severe dyspnea that awakens a patient at night and forces the assumption of a sitting or standing position to achieve gravitational redistribution of fluid.
Paroxysmal nocturnal dyspnea
Old lady with fatigue?
Be concerned with MI
Hemoptysis is a classic presenting finding in patients with pulmonary embolism, but it is also common in patients with _____, pulmonary edema, pulmonary infections, and malignant neoplasms
mitral stenosis
If a patient has an MI, 5 days later they’ve developed a holosystolic murmur. What’s it most likely?
Mitral valve regurgitation (heard at apex)
other holosystolic murmurs include Tricuspid regurge and VSD…
Pulmonary HTN… EKG characteristic?
Large p-waves in lead 2
Most COMMON symptom in heart disease?
Dyspnea
What will you NOT see in AFIB?
S4 heart sound
ORder of prevalence of cardiomyopathies…?
- Dilated
- Hypertrophic
- Restrictive
Hyperthyroidism presents w/ what type of HTN?
isolated systolic
What type of edema is more attributable to CVD?
dependent “pitting” edema
“non-pitting” = lymphedema
What are the 5 modifiable TRADITIONAL risk factors for atherosclerosis
Tobacco smoking HTN Dyslipidemia Diabetes/metabolic syndrome Lack of physical activity/obesity
What are the 3 non-modifiable TRADITIONAL risk factors for atherosclerosis?
Advanced age
Male sex
Family Hx
Diabetes has how much a fold increase in risk of coronary events?
3-5 fold increase
What are the 4 risk factors that comprise metabolic syndrome?
HTN, hypertriglyceridemia, reduced HDL, insulin resistance, visceral obesity
(notice that LDL is NOT a part of this cluster)
Traditional risk factors include an age of > 45 for men and >55 for women.
However, the FamHx component of the risk factors have different numbers for their relatives… which are?
Male first degree relative with diagnosis of CAD before age 55
• Female first degree relative with diagnosis of CAD before age 65
What are the 8(9) non-traditional risk factors for CAD?
Homocysteine Lipoprotein A Small LDL size (smaller = worser) Pro-inflammatory markers (CRP) Coronary-artery calcification (assessed w/ EBCT) Pro-thrombotic factors ESRD, chronic inflammatory diseases, HIV
Homocysteine requires B12/Folate…
Patients w/ enzyme deficiences related to homocysteine metabolism have higher risk of premature atherosclerosis
Circulating lipoprotein similar to LDL with a unique glycoprotein (apo(a)) bound to apo B100
Lipoprotein (a) levels are genetic. Levels > ___ mg/dL appear to be associated w/ an independent increased risk of CVD
20
When is it appropriate to screen with CRP?
INTERMEDIATE ONLY!
High risk you already know…
Low risk not necessary becuase it’s expensive
How do you screen for coronary artery calcification?
EBCT (electron beam CT)
Gives you a Calcium score (>100, you’re posotive for calcium)
Once calcium is deposited… it’s there fo lyfe
What type of heart sound would you see with ASD?
fixed/wise S2
____ have increased mortality with ischemic coronary disease, which is why these agents are not considered first-line agents. At best, ___ are second-line agents.
calcium channel blockers
Which of the following EKG abnormalities is most likely to be seen in the setting of atrial septal defect?
RBBB
Diaphoresis and substernal chest pain longer than __ minutes are the physical examination signs that are most
consistent with MI.
30
____ occur from abnormal ballooning of mitral valve into the left atrium as the mitral valve prolapses. Decrease in venous return bring the click closer to S1 and increase in venous return move the click closer to S2.
Mid-systolic clicks
a non-ejection click
____ occurs in mitral and tricuspid stenosis (MS and TS). The earlier the ___, the worse the disease, because it indicates that the atrial pressure must have been very high to open the valve fast. Later, in diastole the OS, better the prognosis.
Opening snap (OS)
Ejection click occurs shortly after S1 (i.e., early) and typically accompanies the murmur of _____
aortic stenosis
can also occur in pulmonic stenosis… but obviously the location will be different
