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AANP Leik and Fitzgerald > CVS > Flashcards

CVS Flashcards

1
Q

S3 is usually heard in ______

A

S3: usually in HF, early diastole “ventricular gallop” - Kentucky
• Can be normal in kids, pregnancy, some athletes

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2
Q

S4 is usually heard in ______

A

S4: usually in LVH, stiff L ventricle, late diastole “atrial gallop”, “atrial kick” - Tennessee
• Can be normal in elderly
Best heard at apex with bell

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3
Q

what grade of murmur do you first feel a thrill?

A

grade 4

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4
Q

3 diagnostic tests for afib?

A

12 lead ECG
Echo
Bloodwork: CBC, lytes, Ca, Mg, INR/PTT, Cr/eGFR, LFT, TSH, fasting lipids, fasting glucose, A1C
Leik also adds BNP to r/o HF, troponin to r/o MI

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5
Q

black box warning for amiodarone?

A

Amiodarone black box of pulmonary toxicity, hepatic injury, hyper/hypothyroidism, visual impairment, peripheral neuropathy, worsening arrhythmia

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6
Q

warfarin

what is the therapeutic range?

A
  1. 0-3.0

2. 5-3.5 for synthetic valves

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7
Q

initiating warfarin

Frequency of INR?

A

check q2-4 days until 2 consecutive therapeutic values, then weekly

every 4 weeks when stable

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8
Q

how is pulsus paradoxus defined?

A

• Fall in SBP of > 10 mm during inspiration

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9
Q

pulmonary causes of pulsus paradoxus?

A

asthma

emphysema

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10
Q

cardiac causes of pulsus paradoxus?

A

cardiac tamponade
cardiac effusion
pericarditis

*anything that decreases movement of L ventricle

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11
Q

AHA definition of stage 1 and stage 2 hypertension?

A

Stage 1 hypertension as a blood pressure at or above 130/80 mmHg.

Stage 2 hypertension is defined as a blood pressure at or above 140/90 mmHg

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12
Q

physical exam finding of coarctation of aorta?

A

SBP higher in ARMS (normal to be higher in legs) with bounding pulse.
Delayed/decreased femoral pulses when radial and femoral pulses palpated together

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13
Q

when to suspect secondary hypertension?

A

Consider secondary hypertension if:
• Age <30
• Severe HTN or acute rise in BP in previously stable person
• Resistant HTN despite 3 meds
• HTN (severe HTN with end-organ damage)

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14
Q

examples of causes of secondary hypertension?

A

Renal (renal artery stenosis, polycystic kidneys, CKD)

Endo (hyperthyroid, hyperaldosteronism, pheochromocytoma)

Other (OSA, aortic coarctation)

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15
Q

what class of antihypertensive is contraindicated in bilateral renal artery stenosis?

A

ACE-I or ARB –> will precipitate renal failure

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16
Q

HTN

what is the dietary Na and K recommendations?

A

Sodium <1.5 g/day

Potassium >3.5 g/day if normal kidney function

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17
Q

HTN

what is the alcohol recommendation?

A

men 1 oz, 2 or less/day

women 0.5 oz 1 or less per day

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18
Q

what is considered normal BMI range

A

18.5 to 24.9

19
Q

what are the “hyper” side effects for thiazide diuretics?

A

“Hyper”

  • glycemia: caution DM
  • uricemia: CI gout
  • TG and cholesteremia
20
Q

what are the “hypo” side effects for thiazide diuretics?

A

“Hypo”

  • K: potentiates digoxin
  • Na: hold, restrict water
  • Mg
21
Q

name 3 contraindications to thiazide diuretics

A
  • hypokalemia
  • gout
  • renal failure
  • lithium
  • allergy to sulfa
22
Q

3 examples of cardioselective beta blockers?

A
  • bisoprolol
  • atenolol
  • metoprolol
23
Q

where are beta 1 and beta 2 receptors located?

A

B1 receptors: cardiac

B2 receptors: lungs, vascular smooth muscle

24
Q

which blood pressure medication class is contraindicated in DM II with microalbuminuria

A

mineralocorticoid receptor antagonist

eg spironolactone

25
Q

contraindications to beta blockers?

A
  • LUNG: asthma, COPD, emphysema
  • HEART: second and third degree heart block
  • sinus bradycardia
26
Q

which class of HTN medications is contraindicated in heart failure?

A

CCB

27
Q

side effects of ACE-I and ARB?

A
  • dry cough (10% ACE-I)
  • hyperK
  • serious angioedema
28
Q

contraindications to ACE-I and ARB?

A
  • renal disease
  • renal stenosis
  • pregnancy
29
Q

first line HTN medication for DM?

A

ACE-I/ARB

30
Q

first line HTN medication for CKD?

A

ACE-I or ARB

31
Q

African American may be less sensitive to _____ (BP med class) –> try _______ instead

A

less sensitive to ACE-I and ARB

try thiazides or CCB

32
Q

what class of HTN medications are recommended after acute MI?

A

BB
ACE-I
MRA (spiro)

33
Q

what medications can increase BP?

A

NSAIDs, steroids, decongestants, oral contraceptives

34
Q

what are the retinopathy findings in hypertension?

A

copper and silver wire arterioles

AV nicking

35
Q

what are the retinopathy finding in diabetic retinopathy?

A

neovascularization
cotton-wool spots
microaneurysms

36
Q

what is a side effect of spironolactone?

A

gynecomastia
galactorrhea
hyperkalemia

37
Q

HFrEF vs HFpEF

LV ejection fraction

A

HFrEF: LVEF <40%

HFpEF: LVEF >50%

38
Q

what is the ABI cut-off for PAD?

A

0.9 or less

39
Q

what is the prophylaxis rx for endocarditis?

A

HIGH RISK ONLY

  • hx of bacterial endocarditis
  • prosthetic valve
  • congenital heart disease
  • cardiac transplant with valve disease

AMOX 2 g po x 1 dose one hour before invsive procedure

PROCEDURES include dental cleaning, extraction, abscess drainage

40
Q

what are the best medications for lowering triglycerides?

A

Niacin and fibrates

41
Q

two examples of high intensity statin?

A

atorvstatin 40-80 mg/d

rosuvastatin 20-40 mg/d

42
Q

what is the Waist-to-hip ratio definition of obesity?

A

Males: 1.0 or higher
Females: 0.8 or higher

43
Q

ECG changes seen on patient who is on therapeutic level of digoxin?

A

prolonged PR interval

curved / cupping of ST

AANP Leik and Fitzgerald (14 decks)

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