CV

Question 1

shirley, 52, diabetes for seven years, her bp today is 132/84, what medication would you put her on?

Answer 1

Add an ACE inhibitor

Question 2

why treat HTN?

Answer 2

to prevent end organ hypertensive disease damage to eyes, brain, kidneys, heart

Question 3

1 cause of death in women:

Answer 3

heart dx

Question 4

proper position to take BP:

Answer 4

sitting, feet level on the ground, arm level with the heart, sit quietly for 5 min, take the mean of 2 measurements,

Question 5

for younger, otherwise healthy pts with HTN:

Answer 5

start with ace- inhibitor; if they develop cough, give ARB ( labetalol)

Question 6

when beginning HTN therapy:

Answer 6

go low, go slow

start one drug, titrate to maximum dose, and then add a second drug

Question 7

first line HTN therapy for black/elderly:

Answer 7

CCB’s

Question 8

max dose for thiazide:

Answer 8

25 mg

Question 9

Major side effect of CCB

amlodipine

Answer 9

peripheral edema, specifically the foot

Question 10

spiralactone, a aldosterone antagonist selective, is great for :

Answer 10

HF

Question 11

major SE of spiralactone:

Answer 11

Gyneomastia, hi K, impotence

Question 12

TIA is defined as a syndrome of acute neurologic dysfunction referable to the distribution of a ______ _____ ______ and characterized by symptoms that last ___ ___ ___ _____.

Answer 12

single brain artery

less than 24 hours

Question 13

Ischemic stroke involves a neurologic deficit that persists ___ ___ ___ ___ and is associated with _______ _______.

Answer 13

longer than 24 hrs

permanent infarction

Question 14

Potential damage of HTN to the brain:

Answer 14

stroke, vascular ( multi infarct dementia)

Question 15

Potential damage of HTN to the CV system:

Answer 15

atherosclerosis, MI, left- ventricular hypertrophy, heart failure

Question 16

Potential damage of HTN to the kidney:

Answer 16

HTN nephropathy, renal failure

Question 17

Potential damage of HTN to the eye:

Answer 17

HTN retinopathy with risk for blindness

Question 18

HTN med for HF:

Answer 18

aldosterone antagonist
spironolactone
watch potassium and renal function for hyperkalemia

Question 19

diabetics 40-75 with hyperlipidemia should be put on:

Answer 19

high intensity statin

Question 20

for patients who do not achieve an adequate response to therapy with a maximally tolerated statin, may consider adding this first line NON- statin therapy to lower LDL -c:

Answer 20

Zetia

Question 21

A fib is usually related to underlying heart disease but can be precipitated by:

Answer 21

Hyperthyroidism; acute illness; sleep apnea; lung disease

Question 22

most common arrhythmia:

Answer 22

Afib

Question 23

a 40 y/o has a ___ % chance of developing Afib

Answer 23

25%

Question 24

rate control goals for AFib

Answer 24

Goal < 110 bpm if assymptomatic; 60-80 if symptomatic or cardiomyopathy

Question 25

first line drugs for Afib:

Answer 25

Beta-blocker or Ca Channel Blocker (non-dihydropyridine)

Question 26

Stop warfarin _____ before a procedure for patients at low risk of thromboembolism

Answer 26

4 days

Question 27

mitral valve prolapse is a _____ murmur

Answer 27

systolic murmur

Question 28

Patients with MVP are at risk for:

Answer 28

systolic heart failure( SOB, BLEE).

Question 29

What is HF?

Answer 29

a clinical syndrome caused by altered cardiac function - not a diagnosis

Question 30

In HF, ___ or ____ conditions cause altered ______ or _____ of blood

Answer 30

structural or functional ,

filling or ejection

Question 31

SCD VT/Vfib, Arrythmias: Afib, bradycardia, Hemodynamic compromise - shock, CVA/PE/DVT, REsp failure, kidney/liver failure are all complications of:

Answer 31

HF

Question 32

In ____________ HF the heart muscle’s are __ and ____

Answer 32

diastolic HF

thick and stiff

Question 33

in __________ HF the heart muscles are ____ and _____

Answer 33

systolic HF

thin and weak

Question 34

HFpEF AKA _____

Answer 34

diastolic dysfunction

Question 35

In HFpEF, EF>___%, but ____ left ventricle = ____ filling

Answer 35

50%

stiff

poor

Question 36

In HFrEF, EF

Answer 36

40%

LV

Question 37

which has poorer prognosis: HFpEF or HFrEF

Answer 37

HFrEF

Question 38

two most specific S/S of HF:

Answer 38

JVD; S3

Question 39

HF HYHA stage 1:

Answer 39

no limitations, asymptomatic

Question 40

HF HYHA stage 2:

Answer 40

slightly limited with ordinary physical activity, no S/S at rest

Question 41

HF HYHA stage 3:

Answer 41

Very limited with less than ordinary physical activity

no S/S at rest

Question 42

HF HYHA stage 4:

Answer 42

S/S at rest

Question 43

tx basics for all types of HF:

Answer 43

diuretics; HTN control; NA restriction and daily weight; fluid restriction (HFrEF); Avoidance of meds: NSAIDs, TZDs( ACTOS- oral diabetes med), CCB( nondiphenhydramines - dil/verapamil); certain chemo agents,

Question 44

diuretics are a mainstay to treat edema and pulmonary congestion by ______ ______

Answer 44

decreasing preload