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cv leik Flashcards

1
Q

incidental finding on CXR, may show widend mediastinam and obliteration of the aortic knob

A

thoracic aortic dissection

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2
Q

apical impulse

A

5th ics mid clavicular line left sternal border

LVH (severe) and cardiomyopathy can displace more than 3cm, it is larger and more prominent

3rd trimester preggers S3 during preggers is OK, located slightly up on the left side of the chest

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3
Q

de ox blood path

sean is a total victor passes prominantly

A 
Superiror vena cava
Inferior vena cava
Atrium
Tricuspid
Vent
Pulmonic 
Pulm artery
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4
Q

ox blood path

after my vistory aspireing always

A

pulm veins from lungs then

Atrium 
Mitral 
Vent
Aortic valve 
Aorta
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5
Q

motivated apples

A

Mitral Aortic
Tricuspid pulmonic
AV valves semilunar

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6
Q

S1 systole Motivated

A

lub
closure of mitral and tricuspid valves
(AV valves have 3 leaflets

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7
Q

S2 diastole apples

A

dub
closure of aortic and pulmonic valves
two leafs

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8
Q

S3 sound

A

equals heart failure
early diastole also called ventricular gallup or
S3 gallup
kentuky
always abnormal if after 35 cept preggers, can be normal in kids

The third heart sound is caused by a sudden deceleration of blood flow into the left ventricle from the left atrium

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9
Q

s4 heart sound

A

increased resistance from stiff left ventricle usually indicates LVH
can be normal in some elderly
late diastole
atrial gallop
sounds like tennessee
BEST HEARD AT THE APEX OR APICAL AREA USING THE BELL OF THE STETHESCOPE

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10
Q

bell is for

A

low tones like extra heart sounds

mitral stenosis

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11
Q

diaphragm is for

A

mid to high pitich such as lung sounds
Mitral regurg
aortic stenosis

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12
Q

benign variants

A

split S2- PULMONIC AREA 2nd ICS appears at inspiration dissapears at experiation

s4 in elderly- if no S and S of heart or valve disease, it can be normal

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13
Q

Systolic murmurs

A

Mitral Regurg

Aortic Stenosis
Systolic murmurs

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14
Q

diastolic murmurs

A

Mitral
Stenosis

Aortic
Regurg
Diastole

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15
Q

mitral area

A

lower anatomically
apex, or apical area
5 ICS 8-9 cm form the midsternal line slightly medial to the midclavicular line
PMI or apical pulse is here

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16
Q

Aortic area

A

up top

2nd ACS at the BASE (anatomically higher)

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17
Q

S1 murmurs MR Ass

A

holosystolic, pan systolic, early mid or late systolic,

louder and radiate up to the neck

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18
Q

Mitral regurg

A

pan or holosystolic murmur
HEARD at the APEX 5th ICS
Radiates to axillia
LOUD BLOWING and high pithced (use diaphragm)

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19
Q

Aortic Stenosis

A

midsystolic ejection murmur
2nd ics R sternal border (careful with this one)
HARSH NOISY MURMUR, diaphragm

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20
Q

MS ard Diasotlic
diastolic murmurs are always bad

S2 MS-

A

low pitched- bell
heard best at apex 5th ics
also called “opening snap”

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21
Q

MS ARD

aortic regurg

A

high pitched diastolic
2nd ics RSB
high pitched blowing murmur - diaphragm

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22
Q

murmur grade
1
2
3

A

1 barely able to hear, can do only under p=optimal conditions

  1. mild to mod loud murmur
  2. loud murmur easily heard once the stethiscope is placed on chest
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23
Q

murmur grade
4
5
6

A

4 louder than three FIRST TIME THRILL IS PRESENT (think palpable murmur)

5 very loud murmur more obvious thrill, can hear with edge of scope off chest

  1. thrill is easily palpated, can hear with scope off chest
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24
Q

radiats to axila

A

mitral regurg

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25
Q

radiats to the neck

A

aortic stenosis

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26
Q

parox AF

A

terminates within 7 days but usually less than 24 hours, generally asymoptomatic

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27
Q

AF CC and treatment

A

fluttering heart, hypotension, pre or near syncopy,

tx is based on pt type and risk factors for stroke

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28
Q

CHADS VASC

A 
0 is low 2 or more needs AC
C-CHF
H-HTN
A age over 75
D- DM
S- stroke or tia
V- vascular disease
A- 65-74 years 
S- female gender (higher risk)
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29
Q

AF labs after EKG

A

TSH, lytes, rena panel, BNP to R/O HF dig level if on digoxin 0.5-2 digibind for elevated

eccho to evaluate for valve problems that increase risk of stroke

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30
Q

if parox consider

A

24hr holter monitor

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31
Q

lifestyle for afib

A

avoid stims, caffeine, nicotine, decongestants and booze in some pts

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32
Q

AF - new

A

refer to cards
can cardiovert if stable in first 48 hours
or seek rate control

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33
Q

Rate control meds AF

A

BB
calcium channel blockers

Norvasc (amlodipine)
Plendil (felodipine)
DynaCirc (isradipine)
Cardene (nicardipine)
Procardia XL, Adalat (nifedipine)
Cardizem, Dilacor, Tiazac, Diltia XL (diltiazem)
Sular (Nisoldipine)
Isoptin, Calan, Verelan, Covera-HS (verapamil)

or dig cardiac glycosides.

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34
Q

AF antiarythmics

A

amiodarone (cordarone) black box for pulmonary or liver damage, simvastatin with amio can cause rhabdo

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35
Q

Af anticoagulation

A

coumadin- vitamin K agonist only one reccomend for liver failure pt

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36
Q

baseline labs for coumadin

A

prothrombin time is 9.5-13.5 seconds.
INR below 1.1
aptt 30-40sec
platelet count 150,000 to 450,000

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37
Q

initial dose for coum-

A

5mg but frail or elderly above 70 take 2.5
full effect takes a few days 2-3
check INR- every 2-3 days untill theraputic for 2 consecutive checks
then weekly untill stable at between 2-3
then every 4 weeks when stable

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38
Q

for non vavlular AF consider

A

direct thrombin inibitors - xarelto, eliquis, no INR or diet restrictions

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39
Q

90% of warafin deaths are caused by

A

intracerebral hemmorhage

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40
Q

INR goal with a prostetic valve

A

2.5-3.5

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41
Q

INR less than 5 or 5-9 with no bleed

A

5-no vitamin K , sip next dose/adjust baseline dose, recheck once or twice a week while adjusting

5-9 hold one or 2 doses with 1 to 2.5mg of vitamin K monitor INR and lower maintnece dose of coum

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42
Q

WPW (more common in kids) delta wave Paroxsysmal SVT- peaked QRS with P waves CC and TX

A

like a-fib but with p waves, HR like 150 or 250
can be caused by dig tox, etoh, hyperthyroid, caffeine, drugs

EKG, if unstable may need cardioversion
vagal maneuvers

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43
Q

pulsus paradoxus

A

apical pulse can be heard but radial pulse cant be palpated, mesured with BP cuff and sterthoscope, imapired diastolic filling cause drop of sustolic pressure of more than 10mmhg
pulm cause- asthma or emphysema- increased positive pressure
cardiac- tamponade, pericarditis, effusion

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44
Q

anterior wall mi

A

Reciprocal ST segment depression in the inferior leads (II, III and aVF

st elevation in 3-4

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45
Q

BP measurement

A

manual is preferred- 2 or ore readings seperated by at least 2 mins should be averaged per visit

higher number determins BP stage
any change in PVR or CO has corrosponding effect on BP

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46
Q

Primary or essential HTN

A

most often asymptomatic

47
Q

Normal
pre
1
2

A

normal less then 120 and 80
pre less than 120-139 and 80-89
1 less than 140-159 and 90-99
2 less than 160 or 100

48
Q

angiotensin 1 to angiotensin 2

A

increases vasoconstriction and BP

younger pts have higher renin levels than elderly

49
Q

Sympathetic Stim

A

epinephrin secretion causes tacchy and vasoconstriction

50
Q

preggers and BP

A

SVR is LOWER from hormones, sys and diastolic decrease during 1st and 2nd trimester

51
Q

secondary HTN, 3 types

A

Renal: renal artery stenosis- polycystic kidney, or CKD (more common in young)
Endocrine: HYPERthyroid, HYPERaldosteronism, Pheocromocytoma (middle age)
Other- OSA, coarctation of aorta,

52
Q

Malignant HTN

A

severe HTN iwth end organ damage, retinal hemmorhage, pailledema, acute renal failure and sever HA

53
Q

coartation of Aorta

A

BP in arms is higher than legs

check fem and radial at same time, fem is delayed

54
Q

Avoid ace (prils) and arb (sartan) with epigastric bruit or flank bruit indicating renal artery stenosis

A

with chronic kidney disease

55
Q

main BP goal 60 and under

A

less than 140 and 90

56
Q

main BP goal over 60 no DM or CKD

A

150/90

57
Q

AA treatment to get to less than 140/90

A

thiazide diurtetic and CCB’s or “PINE” drugs alone or in combo

58
Q

non AA to get to less than 140/90

A

thiazide dirutic and acei (prils) (except DM or CKD)

59
Q

CKD 18 years and older- less than 140/90

A

ACEI (prils) or ARB (sartans)

60
Q

DM 18 years and older less than 140 and 90

A

ACEI (prils) or ARB (sartans)

61
Q

HTN emergency

A

diastolic BP greater than 120, with end organ damage, NV think increased ICP,

62
Q

isolated systolic HTN in elderly

A

loss of recoil in artery- increasing PVR
wide pulse pressure
for frail or with sever orthostatic hypotension if older than 60 its ok to be up to 150 systolic

low dose hctc
and long acting ccb-

63
Q

orthostatic hypo

A

less active autonomic nervous system activity

slower drug metabolism in liver ‘

64
Q

first line therapy for HTN, lipids, and type 2 dm

A 
lifestyle changes 
stop smoking, 
lose weight
sodium below 2.4 g less than 2,400 mg 
fatty fish 3 times a week
less than 10z and 05 oz of booze per day
65
Q

normal BMI

A

18.5-24.9

66
Q

DASH diet

A

for pre and HTN, high K, Mg, CA, low red meat and processed food, more whole grain and legume, more fish and poultry

67
Q

calcium

A

low fat dairy

68
Q

K

A

potatoes, most fruits and veggies,

69
Q

mag

A

dried beans, whole grains and nuts

70
Q

omega 3

A

anchovy, krill, salmon, flax seed

71
Q

exercise lowers

A

LD overll cholesterol and BP

72
Q

exercise plan

A

4 session per week

40 mins

73
Q

thiazides work by

chlortalidone- hygrotin
indpamide- lozil

A

changin how kidneys handle sodium, upping urine output

favorable efffect on osteopenia perosis- slow demineralization

all contain sulfa, avoid in allergy

SE are HYPER-
glycemia
uricemia- wathc for gout
cholesterol check panel

HYPO
K watch iwth dig
na
mag

74
Q

Loop diuretics work by

A

inhibiting the sodium, potassium, chloride pump of the kidney in the loop of henley

possibly alter excretion of lithium and saliclyates

75
Q

K sparring Aldosterone receptor antagonist diuretics

spironolactone aldactone
epelrenone inspira

A

increase elimination of water,
used in hirstuism, precosious puberty and htn
avoid with Ace-i (prils)

avoid in
DM 2with microalbuminemia
serum creat greater than 2
serum K over 5.5

76
Q

BB

A

avoid abrupt discontinue with chronic use
works by decreasing vasomotor activity
inhibits renin and norepinephrine realease

contraindicated in asthma, COPD, emphysema,
2nd degree block weinkie and mobits II ( normal but extra pr)
3rd degree block

77
Q

b1 receptors are

A

cardiac

78
Q

b2 receptors are

A

lungs and peripheral vasculature

79
Q

dont use propanalol for HTN because of

A

short half life

80
Q

CCBs pine endings

A

blocks voltage gated CA in cardiac smooth muscle, and the nlood vessels, resutls in systemic vasodialation

81
Q

nondihydropyridines
verapimil- calan sr
caridzem

A

depress the muscle of the heart (inotropic effect

82
Q

dihydropyridines
nefidipin- procardia
amlodipine norvasc
felodipine plendil

A

slow the rate (chronotropic effect

83
Q

drug of choice in DM or CKD

A

ACEI (pril) ARB (sartan) prevent conversion of angiotensin less vasoconstriction

84
Q

ACEI (pril) ARB (sartan) dont use

A

mod to sever kidney disease especially renal artery stenosis

High K side effect of this class so effect will be worse

85
Q

Alpha 1 blockers- alph adrenergic (zosin)

teraosin (hytrin) htn and BPH use in this group
tamulosin (flomax) htn only

A

potent vasodilarors - cause dizzyness, give at bedtime and titrate up

1st dose orthostasis is common
with ARBS (sartan) severe hypotension and tacchy
86
Q

CHF cutoff

A

systolic is less than 40 HFrEF

diastolic EF is over 40 HFpEF

87
Q

CHF left ventricular failure

A

crackles, dull to precussion, rales on lower lobes

R and L failure- paroxysmal nocturnal dypsnea, orthopnea, nocturnal non productive cough, wheezing (cardiac asthma) HTN

88
Q

CHF R ventricular failure

A

JVD- normal is 4cm or less
large spleen, liver, anorexia, nausea, and ab pain,
LE edema, cool skin

R and L failure- paroxysmal nocturnal dypsnea, orthopnea, nocturnal non productive cough, wheezing (cardiac asthma) HTN

89
Q

CHF CXR

A

increased heart size, interstitial or alveolar edema
Kerley B lines

BNP

echo with doppler flow for ef
daily weights

90
Q

CHF diruetic

A

20 or up to 320 of lasix initially

91
Q

CHF stable HF with reduced EF and HTN

A 
Start ACEI (prils) or ARB (sartans) plus BB, and others 
limit salt
92
Q

CHF stage

A

1 no limitations
2 ordinary activity results in fatigue- exertional dypsnea
3 MARKED LIMITATION in activity
4 PRESENT AT REST, with or without activity

93
Q

CHF lifestyle mod

A

weight loss, smokingg cessation, no ETOH
Restrict sodium 2-3g daily
fluid restrict 1.5-2L daily

94
Q

DVT 3 categories

A

stasis: travel, more than 3hours of inactivity
inherited coag disorders: factor C or leiden
increased coag due to external factors: oral contraceptivs or bone frx etc

95
Q

DVT classic case

A

gradual onset of LE swelling painful swollen LE that is red and warm.

hep gtt then coum for 3-6 months first episode
recurrant dvt or elderly may have lifelong anticoag

96
Q

superficial vs DVT

A

no swelling in superficial
treatment is nsaid
warm compress, elevate

97
Q

PAD cc

A

older, smoking, HLD, worsoning pain on ambulation instantly relieved by rest atrophic skin changes, may get gangrene

98
Q

ABI score

A

0.9-1.3 is normal, less than 0.9 is PAD

Systolic BP of arm (brachial) and ankle with cuff and ultrasound after supine for 10mins,

done for each leg
SBP of foot is divided by arm

99
Q

PAD treatment

A

pentoxifylline pletal- watch fro grapefruit juice, dig, and priolosec if taken together,

bypass

100
Q

reynauds

A

females mostly

avoid caffine, stop smoking
do not use vasoconstrictors and non selective beta blockers

101
Q

endo

A

tender red spots on the hands -janes

tender violet colored nodules on fingers or toes (oslers)

102
Q

Give amox 2g po one hour before for (or clinda with allergy

A

dental procedures that (previous history of infective endo)

valve- any time u are screwing with the resprityoy tract

103
Q

MVP, cc

treat

A

S2 click” followed by systolic murmur, female, fatigue palpitations, orthostatic hypo made worse by excertion
can have sunken chest or marfans,

asymtomatic- no treatment
mvp with palp- BB avoide cafinne and
holter monitor for detecting significan arrythmias

104
Q

HLD screen at age then
over 40 screen
preexisting HLD

A

start at 20 then Q5
over 40 its Q2-3
preexisting HLD is annually

105
Q

total cholesterol ranges

A

normal: less than 200
borderline- 200-239
High over 240

106
Q

HDL C goals

A

men over 40 women over 50

statin or niacin are good at increasing HDL

107
Q

LDL goals

A

optimal is less than 100
Less than 130for pts with fewer than 2 risk factors
greater than 190 is Very high

108
Q

Triglycerides

A

less than 150 is normal

pancretitis concenr over 1000

109
Q

treatment plan for lipids

A

lifestyle
reduce salt
lower LDL first

110
Q

21-75 with ASCVD

A

lower LDL by 50%
lipitor atorvastatin
rosuvastatin crestor

111
Q

21 with LDL over 190 but no ASCVD

A

lower LDL by 50%
lipitor atorvastatin
rosuvastatin crestor

112
Q

over 75 with ASCVD

A

moderated lower LDL by 30-50
zocor-simvastatin
pravastatin- pravachol
lovastatin-mevacor

113
Q

rhabdo triad

A

muscle pain, weakness, and dark urne

CK is at least 500K
urine has myoglobin and protein up to 45%

issues and policy (22 decks)

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