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Review > CVD > Flashcards

CVD Flashcards

1
Q

Acute MI aka

A

STEMI

ACS

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2
Q

S3 heart sound may indicate

A

Heart failure

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3
Q

Infective endocarditis can present with

A

new murmur

  • subungal hemorrhages
  • Osler nodes
  • Janeway lesions
  • Roth spots or retinal hemorrhages
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4
Q

Osler nodes

A

painful violet-colored nodes on fingers or feet

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5
Q

Janeway lesions

A

-nontender red spots on palms/soles

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6
Q

AAA presentation

A
  • elderly white male
  • sudden severe, sharp, excruciating pain in abdomen, flank, and/or back
  • distended abdomen
  • abnormal vitals
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7
Q

Which ventricle is closest to sternum

A

right ventricle

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8
Q

Displacement of the PMI can occur due to

A
  • severe LVH

- pregnancy in third trimester

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9
Q

S3 heart sound during pregnancy is normal

A

true

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10
Q

S1 valves

A
  • Systole
  • MoTiVAted
  • Mitral, tricuspid closure
  • these are AV valves
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11
Q

S2 valves

A
  • diastole
  • APpleS
  • Aortic, pulmonic closure
  • these are semilunar valves
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12
Q

S3 heart sounds are also called

A
  • ventricular gallop

- S3 gallop

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13
Q

What does S3 sound like

A

kentucky

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14
Q

When is S3 normal

A
  • children
  • pregnant
  • some athletes
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15
Q

When is S3 never normal

A

-if it occurs after age 35-40

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16
Q

What does S4 indicate

A

LVH

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17
Q

When is S4 normal

A

-normal in some elderly due to stiffened left ventricle

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18
Q

When does S4 happen

A

-late diastole

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19
Q

What is S4 also called

A
  • atrial gallop

- atrial kick

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20
Q

What does S4 sound like

A

-Tennessee

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21
Q

What is the bell of the stethoscope used for

A
  • low tones such as S3 S4 sounds

- Mitral stenosis

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22
Q

What is the diaphragm used for

A
  • mid to high pitched tones like lung sounds
  • mitral regurg
  • aortic stenosis
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23
Q

Physiologic S2 benign or pathologic

A

-benign

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24
Q

Where is split S2 best heard

A

-pulmonic area

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25
Q

When is split S2 normal

A

-appears during inspiration and disappears at expiration

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26
Q

Erb’s point

A

-third to fourth ICS on the left sternal border

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27
Q

Mitral regurg description

A
  • pansystolic or holosystolic
  • loud blowing and high-pitched
  • use diaphragm
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28
Q

Where is mitral regurg best heard

A

-apex

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29
Q

Where can mitral regurg radiate to

A

-axillae

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30
Q

Aortic stenosis description

A
  • midsystolic ejection murmur
  • harsh noisy murmur
  • use diaphragm
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31
Q

Aortic stenosis location

A
  • second ICS at right side of sternum

- aortic region

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32
Q

Where can aortic stenosis murmur radiate to

A

-neck

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33
Q

Plan for patients with aortic stenosis

A
  • avoid physical overexertion

- refer to cardiologist

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34
Q

Mitral stenosis description

A
  • low-pitched diastolic rumbling murmur
  • aka opening snap
  • use bell
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35
Q

Mitral stenosis location

A

-apex

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36
Q

Aortic regurg description

A
  • high-pitched diastolic murmur

- use diaphragm

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37
Q

Aortic regurg location

A

-Located at Erb’s point

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38
Q

Grade I murmur

A

-very soft only heard under optimal conditions

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39
Q

Grade 2 murmur

A

-mild to moderately loud

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40
Q

Grade 3 murmur

A

-loud murmur easily heard with stethoscope on chest

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41
Q

Grade 4 murmur

A
  • louder murmur

- first time a thrill is present

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42
Q

Grade 5 murmur

A
  • very loud
  • heard with edge of stethoscope off chest
  • thrill more obvious
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43
Q

Grade 6 murmur

A
  • murmur so loud, can be heard with stethoscope off chest

- thrill easily palpated

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44
Q

Stenotic valves don’t ___ properly

A

open

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45
Q

Regurgitant valves don’t ___ properly

A

close

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46
Q

Identifying murmurs

A
  1. where in the cardiac cycle is it audible
  2. where is it the loudest
  3. any associated findings
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47
Q

Second most common cause of aortic stenosis

A

-rheumatic fever

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48
Q

Rheumatic fever can cause what

A
  • aortic stenosis

- mitral stenosis

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49
Q

Aortic regurg findings

A
  • PMI displacement
  • dilated left ventricle
  • X-ray shows evidence of LVH
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50
Q

How many stages of mitral stenosis

A

4

1: asymptomatic, then gradual reduction in exercise tolerance
2: onset of pulmonary congestion
3: pulmonary HTN
4: severe state of low CO

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51
Q

MVP associated findings

A
  • palpitations
  • CP
  • CLICK
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52
Q

MVP is most common in which population

A

women 14-30 years old

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53
Q

MVP findings

A

-midsystolic click best at apex and left sternal border

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54
Q

S3 is a sign of

A

CHF

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55
Q

S4 is a sign of

A

LVH

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56
Q

Which grade of murmur is a thrill palpated for the first time

A

4

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57
Q

What to do if a man has a pulsatile abdominal mass >3 cm in width

A

order abdominal US and CT

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58
Q

Most common arrhythmia in US

A

afib

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59
Q

Class of afib

A

supraventricular tachyarrhythmia

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60
Q

Paroxysmal afib

A
  • episodes terminate within 7 days

- usually asymptomatic

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61
Q

Afib treatment tool

A

-CHADS VASc score

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62
Q

New onset afib treatment plan

A
  • EKG
  • TSH
  • electrolytes
  • renal function
  • BNP
  • troponin
  • refer to cardio
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63
Q

Lifestyle modifications for afib

A
  • avoid caffeine

- avoid alcohol

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64
Q

afib medications

A
  • rate control: BB, CCB, digoxin
  • antiarrhythmics: amiodarone BBW pulmonary and liver damage
  • Simvastatin with amiodarone: rhabdomyolysis
  • anticoagulation: warfarin
  • nonvalvular afib: direct thrombin inhibitor or factor Xa inhibitors
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65
Q

Reversal agent for clopidogrel (Plavix)

A

Pradaxa

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66
Q

INR for syntheithic and prosthetic valves

A

2.5-3.5

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67
Q

INR < 5.0

A
  • skip next dose
  • or reduce slightly the maintenance dose
  • check INR once or twice a week when adjusting dose
  • no vitamin K
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68
Q

INR >5.0

A
  • hold one or two doses
  • with or without vitamin K
  • monitor INR every 2-3 days until stable
  • decrease maintenance dose
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69
Q

Paroxysmal SVT EKG

A
  • tachycardia with peaked QRS with P waves

- more common in children

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70
Q

PVST presentation

A
  • acute onset of palpitations
  • rapid pulse
  • lightheadedness
  • SOB
  • anxiety
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71
Q

PVST treatment

A
  • cardio referral
  • if hemodynamically unstable, call 911
  • Vagal maneuvers
  • hold breath and strain hard, or splashing cold water on face
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72
Q

Pulsus paradoxus

A
  • aka paradoxical pulse .
  • apical pulse can be heard even though radial pulse no longer palpable
  • status asthmaticus
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73
Q

Pulmonary cause of pulsus paradoxus

A
  • asthma

- emphysema

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74
Q

Cardiac cause of pulsus paradoxus

A
  • tamponade
  • pericarditis
  • cardiac effusion
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75
Q

Anterior wall MI EKG

A
  • Wide QRS, ST segment elevation

- wide QRS looks like tombstones

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76
Q

Afib causes

A
  • alcohol intoxication
  • CAD
  • CHF
  • history of MI
  • older age
  • HTN
  • stimulants
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77
Q

Suspected bleeding with warfarin, what to order

A
  • INR

- PT, PTT

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78
Q

How long can it take to see changes in INR with warfarin dose change

A

-3 days

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79
Q

PVR x CO

A

BP

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80
Q

Sodium and BP

A

increased: water retention increases vascular volume, increase CO

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81
Q

Normal BP

A

<120/80

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82
Q

Prehypertension

A
  • 120-139

- 80-89

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83
Q

Stage 1 HTN

A
  • 140-159

- 90-99

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84
Q

Stage 2 HTN

A
  • > 160

- >100

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85
Q

Angiotensin I to angiotensin II

A
  • increased vasoconstriction will increase PVR

- younger patients have higher renin than elderly

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86
Q

Sympathetic system stimulation

A

-epinephrine causes tachycardia and vasoconstriction

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87
Q

Alpha blockers, beta blockers, CCB

A

-decrease PVR through vasodilation

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88
Q

Pregnancy and BP

A

-Systemic vascular resistance lower due to hormones

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89
Q

HTN and microvascular damage

A
  • eyes

- kidneys

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90
Q

Eye exam with HTN

A
  • silver, copper wire arterioles
  • AV junction nicking
  • Flamed shaped hemorrhages
  • papilledema
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91
Q

Kidney exam with HTN

A
  • microalbuminuria and proteinuria
  • elevated serum creatinine and eGFR
  • peripheral or generalized edema
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92
Q

Macrovascular damage with HTN

A
  • Cardiac: S3, S4, bruits, CAD, acute MI, PAD

- Brain: TIA, strokes

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93
Q

Classes of secondary HTN

A
  • renal
  • endocrine
  • other
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94
Q

Renal causes of secondary HTN

A
  • renal artery stenosis
  • PCOS
  • CKD
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95
Q

Endocrine causes of secondary HTN

A
  • hyperthyroidism
  • hyperaldosteronism
  • pheochromocytoma
96
Q

Other causes of secondary HTN

A
  • obstructive sleep apnea

- coarctation of aorta

97
Q

Primary hyperaldosteronism labs

A
  • HTN with hypokalemia

- normal to elevated sodium

98
Q

Hyperthyroidism labs and presentation

A
  • weight loss, tachycardia, fine tremor, moist skin, anxiety
  • new onset afib
  • check TSH
99
Q

Pheochromocytoma presentation

A
  • excessive secretion of catecholamines
  • labile increase in BP with palpitations
  • sudden onset anxiety, sweating, severe headache
100
Q

Diagnosing HTN

A
  • confirm with subsequent visit 1-4 weeks later
  • check BP at home with diary
  • If home BP lower –> white coat HTN
101
Q

BP goal for everyone

102
Q

BP goal for <60

A

<150/90

only if without DM or CKD

103
Q

BP goal for CKD >18 years old

104
Q

BP goal for DM >18 years old

105
Q

Hypertensive emergency

A

-diastolic >120 with findings of target organ damage

106
Q

Isolated systolic HTN in elderly

A
  • loss of recoil in arteries (atherosclerosis)

- Pulse pressure increased

107
Q

HTN, HLD, T2DM lifestyle recommendations

A
  • weight loss
  • stop smoking
  • reduce stress
  • reduce sodium <2.4g
  • adequate K, Ca, Mg
  • limit alcohol
  • eat fatty cold-water fish three times a week
108
Q

DASH diet is recommended for

A

-prehypertension, HTN, weight loss

109
Q

DASH goal

A
  • eat more K, Mg, Ca
  • reduce red meat and processed foods
  • eat more whole grains legumes
  • eat more fish and poultry
110
Q

What kind of exercise reduces LDL and BP

A

aerobic
3-4x/week
at least 40 minutes

111
Q

Thiazide diuretics

A
  • increase urine output
  • monitor K
  • avoid with sulfa allergy
112
Q

Side effects of diuretics

A
  • hyperglycemia
  • hyperuricemia
  • hyperTG and cholesterol
  • hypokalemia
  • hypnatremia
  • hypomag
113
Q

Aldosterone receptor antagonist diuretics action

A
  • antagonizes aldosterone

- increase water elimination while sparing K

114
Q

Aldosterone receptor antagonist diuretics indications

A
  • HTN
  • HF
  • hirsutism
  • precocious puberty
115
Q

Aldosterone receptor antagonist diuretics side effects

A
  • gynecomastia
  • galactorrhea
  • hyperkalemia
  • GI
  • postmenopausal bleeding
  • ED
116
Q

Aldosterone receptor antagonist diuretics examples

A

spironolactone

-Eplerenone (Inspra)

117
Q

BB action

A

-decrease vasomotor activity, CO, inhibit renin and norepinephrine release

118
Q

BB contraindications

A 
-asthma
COPD
-chronic bronchitis
-emphysema
--2nd, 3rd degree heart block
-sinus brady
119
Q

BB and post-MI

A

decreases mortality

120
Q

CCB action

A
  • blocks calcium channels in cardiac smooth muscle
  • systemic vasodilation
  • nondihydropyridines: depress muscles of heart (inotropic)
  • dihydropyridines: slow down HR (chronotrope)
121
Q

Nondihydropyridines

A

depress heart muscle

inotropic

122
Q

Dihydropyridines

A

decrease HR

chronotrope

123
Q

CCB side effects

A

HA
ankle edema
heart block or bradycardia
reflex tachycardia

124
Q

CCB contraindications

A
  • 2nd, 3rd degree HB
  • Bradycardia
  • CHF
125
Q

Dihydropyridine examples

A

-Pine
-nifedipine
amlodipine
felodipine

126
Q

Nondihydropyridine examples

A

verapamil

diltiazem

127
Q

Pregnancy category for ACE/ARB

128
Q

ACEI and ARB contraindications

A
  • mod to severe CKD

- renal artery stenosis

129
Q

ACEI ends with

130
Q

ARBs end with

131
Q

Alpha-1 blockers suffix

132
Q

Alpha-1 blockers side effects

A
  • dizziness
  • hypotension
  • give at HS and titrate up
133
Q

Used for both HTN and BPH

A
  • Terazosin (Hytrin)

- Doxazosin (Cardura)

134
Q

Alpha-1 blockers used ONLY for BPH

A

Tamsulosin (Flomax)

135
Q

Diabetic retinopathy findings

A
  • neovascularization
  • cotton wool spots
  • microaneurysms
136
Q

Preferred meds for isolated systolic HTN in elderly

A

-low dose thiazide or CCB

137
Q

COmbining ACEI with K-sparing duretic

A

watch for hyperkalemia

138
Q

Which antihypertensive helps females with HTN and osteopenia/osteoporosis

A

Thiazide diuretic

slows calcium loss by stimulating osteoclasts

139
Q

Systolic heart failure EF

A

<40%

HFrEF

140
Q

Diastolic heart failure EF

A

> 40%

HFpEF

141
Q

Left ventricular failure findings

A
  • crackles, bibasilar rales, cough, dyspnea, decreased breath sounds, dullness
  • paroxysmal nocturnal dyspnea, orthopnea, nocturnal nonproductive cough, HTN, fatigue
142
Q

Right ventricular failure findings

A
  • JVD (normal <4 cm)
  • enlarged spleen, enlarged liver
  • LE edema with cool skin
143
Q

Paroxysmal nocturnal dyspnea may indicate left or right HF

144
Q

Other findings with HF

A
  • S3 gallop

- anasarca: generalized edema

145
Q

Treatment for stable HF with HTn

A

-start ACEI/ARB, add BB
limit sodium
-refer to cardiologist
-ED if in distress

146
Q

NYHA class I

A

-no limitations on physical activity

147
Q

NYHA class II

A

ordinary physical activity results in fatigue, exertional dyspnea

148
Q

NYHA class III

A

marked limitation in physical activity

149
Q

NYHA class IV

A

symptoms present at rest

150
Q

DVT stasis etiology

A
  • prolonged travel
  • prolonged inactivity >3 hours
  • bed rest
  • CHF
151
Q

DVT inherited coagulation disorder etiology

A
  • Factor C deficiency

- Factor V Leiden

152
Q

DVT increased coagulation due to external factors

A
  • OC
  • pregnancy
  • bone fractures of long bones, trauma, recent surgery, malignancy
153
Q

DVT Homan’s sign

A
  • lower leg pain on dorsiflexion of foot

- low sensitivity

154
Q

DVT labs

A
  • CBC
  • platelets
  • clotting time
  • D-dimer level
  • CXR
  • EKG
  • US
  • hospital admission for IV heparin and PO coumadin for 3-6 months
155
Q

Superficial thrombus patho

A
  • inflammation of superficial vein due to local trauma

- higher risk with indwelling catheters, IV drugs, secondary bacterial infection

156
Q

Superficial thrombophlebitis findings

A
  • indurated cord-like vein
  • warm and tender
  • surrounding area with erythema
  • should be no swelling or edema of entire limb –> DVT
157
Q

Superficial thrombophlebitis treatment

A
  • NSAIDs
  • warm compress
  • elevate limb
  • If septic cause –> ED
158
Q

Peripheral arterial disease patho

A
  • gradual narrowing and/or occulsion of medium to large arteries in LE
  • blood flow decreases over time
  • permanent ischemic damage
159
Q

Risk for PAD

A
  • HTN
  • smoking
  • DM
  • HLD
  • previously known PVD
160
Q

PAD presentation

A
  • worsening pain on ambulation (intermittent claudication)
  • instantly relived by rest
  • atrophic skin changes
  • gangrene on toes
161
Q

Ankle-Brachial Index (ABI) diagnosis for PAD

162
Q

Normal ABI

163
Q

ABI procedure

A
  • systolic BP of ankle and arm checked after being supine for 10 minutes
  • ABI done for each leg
  • ABI=SBP of eat foot divided by SBP of both arms
164
Q

PAD skin findings

A
  • atrophic
  • shiny and hyperpigmented ankles
  • hairless and cool
165
Q

PAD CVD findings

A
  • decreased to absent dorsal pedal pulse
  • increased capillary refill time
  • bruits over partially blocked arteries
166
Q

PAD treatmnet

A
  • smoking cessation –> vasoconstriction
  • daily ambulation exercise
  • Cilostazol (Pletal): phosphodiesterase inhibitor, direct vasodilator
  • Percutaneous angioplasty or surgery for severe cases
167
Q

Raynaud’s association

A

increased risk of autoimmune disorders

168
Q

Raynaud’s presntation

A
  • women
  • chronic and recurrent episodes of color changes on fintertips in symmetric pattern
  • white, blue, and red
  • numbness and tingling
  • attacks last for hours
169
Q

Raynaud’s treatment

A
  • avoid cold
  • avoid stimulants
  • smoking cessation
  • CCB: nifedipine, amlodipine
  • check distal pulses and ischemic signs
  • no vasoconstricting drugs
  • avoid nonselective BB
170
Q

ASCVD score to start statin

A

> 7.5%

if diabetic, start immediately

171
Q

Statin recommendation for history of CHD or stroke

A

high potency statin

172
Q

Statin recommendation for LDL >190 (familial)

A

High potency statin

173
Q

Statin recommendation for DM

A

Mod potency statin

174
Q

Statin recommendation for global 10-year risk score >7.5

A

mod potency statin

primary prevention

175
Q

High potency statins

A
  • rosuvastatin 20, 40

- atorvastatin: 40, 80

176
Q

Bacterial pathogens for bacterial endocarditis

A
  • viridans streptococcus
  • s. aureus
  • usually gram +
177
Q

Bacterial endocarditis treatment plan

A

-stat referral to ED for IV abx

178
Q

Bacterial endocarditis prophylaxis is recommended for

A
  • previous history of IE
  • prosthetic valves
  • certain congenital heart disease
  • cardiac transplant

for

  • dental procedures of mucosa, gingiva, periapical area
  • invasive procedures of respiratory tract
179
Q

IE prophylaxis medication

A
  • Amoxicillin 2 G PO x 1 does (adults)

- amoxicillin 50 mg/kg 1 hour before produce x one dose (children)

180
Q

MVP is at higher risk for

A
  • thromboemboli
  • TIA
  • afib
  • ruptured chorade tendinae
181
Q

Treatment for MVP

A
  • asymptomatic does not need treatment
  • MVP with palpitations: BB, avoid caffeine, alcohol, cigarettes
  • Holtor monitor
182
Q

When to start screening for HLD

A

20

every 5 years

183
Q

HLD screening for <40

A

every 2-3 years

184
Q

Screening for preexisting HLD

A

every year

185
Q

Normal total cholesterol

186
Q

Borderline total cholesterol

187
Q

High total cholesterol

188
Q

HDL in men

189
Q

HDL in women

190
Q

Low HDL is associated with

A

increased risk of CAD even with normal LDL

191
Q

What diet is associated with low HDL

A

high carb and low-fat diets

smoking

192
Q

Optimal LDL

193
Q

LDL for low-risk patients and <2 risk factors

194
Q

Very high LDL

195
Q

LDL level for heart disease or DM

196
Q

Normal TG

197
Q

High risk of acute pancreatitis

198
Q

Treatment plan for TG >500

A
  • treat TG with fibrate (fenofibrate or niacin), OTC niacin, or high-dose fish oil
  • prescription fish oil: Lovaza 4f/day
  • once TG under control, switch to LDL lowering
199
Q

HLD treatment

A
  • lifestyle changes
  • DASH diet
  • increase soluble fiber
  • treat LDL or TG first
200
Q

HLD treatment for >75 with ASCVD

A

-mod intensity statin

201
Q

Best at reducing LDL

A

-HMG COA reductase inhibitors

statins

202
Q

Niacin should not be combined with

203
Q

Fibrates should not be used with

A

severe renal disease

204
Q

Good agents for lowering TG and elevating HDl

A

nicotinic acid and fibrates

205
Q

Bile acid sequestrant mechanism

A

works in small intestine, interfere with fat absorption, including fat soluble vitamins

206
Q

fat soluble vitamins

A

A, D, E, K

207
Q

When are bile acid sequestrants used

A

-when patients cannot tolerate statins, fibrates, and niacin

208
Q

Bile acid sequestrant examples

A

-Cholestyramine, colestipol, colesevelam

209
Q

Combination regiment for lipid-lowering

A

should be avoided

210
Q

Rhabdomyolysis labs

A 
-creatine kinase if markedly elevated 
at least 5x upper limited of normal
-urine will be reddish-brown 
proteinuria
LFTs elevated
211
Q

Acute drug induced hepatitis presentation

A
  • nausea
  • anorexia
  • dark urine
  • jaundice
  • fatigue
  • flu like symptoms
212
Q

Acute drug-induced hepatitis labs

A

-elevated ALT and AST

213
Q

Any adult with history of ASCVD must be treated with

A

high dose statin

214
Q

Any adult with LDL> 190 without ASCVD or DM must be treated with

A

high dose statin

215
Q

Patient with ASCVD risk score 5-7.5% initial treatment

A

lifestyle modifications

216
Q

Statins may cause which neurologic symptoms

A

memory loss
confusion
d/c statin

217
Q

Which statins should not be mixed with macrolides

A

simvastatin

lovastatin

218
Q

Which body types are at risk for metabolic syndrome

A

apple body more at risk than pear shaped body

219
Q

Obesity waist circumference in males

A

> 40 inches

220
Q

Obesity WC in females

A

> 35 inches

221
Q

Waist to hip ratio obesity males

222
Q

Waist to hip ratio obesity females

223
Q

Metabolic syndrome increases risk for

A

DM and CVD

224
Q

Criteria for metabolic syndrome

A
  • abdominal obesity
  • HTN
  • HLD: FPG(>100), elevated TG (>150), decreased HDL (<40)
225
Q

NAFLD patho

A
  • TG fat deposits in hepatocytes

- most asymptomatic

226
Q

NAFLD labs

A
  • LFTs

- hepatitis panel

227
Q

NAFLD treatment

A
  • lose weight, exercise
  • d/c alcohol permanently
  • avoid hepatotoxic drugs
  • vaccine for hepatitis A and B
228
Q

BMI

A

ratio of weight (kg) to height (Meters^2)

229
Q

Overweight BMI

230
Q

AAA screening

A
  • men aged 65-75 who have ever smoked

- one time with US

231
Q

Physiologic split S2

A

split increases on inspiration
found in most adults <30
benign
best heard in pulmonic region

232
Q

Heart sound found in poorly controlled HTN or recurrent MI

233
Q

High-dose statin therapy can reduce LDL by how much

234
Q

What is pulsus paradoxis

A
  • decrease in systolic BP on inspiration
  • systolic pressure drops due to increased pressure
  • asthma, emphysema
235
Q

What is ankle brachial index used to measure

A

severity of arterial blockage in LE

-Peripheral arterial disease

236
Q

Normal ABI score

237
Q

ABI score for severe PAD

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