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
contraindications to beta blockers?
- LUNG: asthma, COPD, emphysema - HEART: second and third degree heart block - sinus bradycardia
26
which class of HTN medications is contraindicated in heart failure?
CCB
27
side effects of ACE-I and ARB?
- dry cough (10% ACE-I) - hyperK - serious angioedema
28
contraindications to ACE-I and ARB?
- renal disease - renal stenosis - pregnancy
29
first line HTN medication for DM?
ACE-I/ARB
30
first line HTN medication for CKD?
ACE-I or ARB
31
African American may be less sensitive to _____ (BP med class) --> try _______ instead
less sensitive to ACE-I and ARB | try thiazides or CCB
32
what class of HTN medications are recommended after acute MI?
BB ACE-I MRA (spiro)
33
what medications can increase BP?
NSAIDs, steroids, decongestants, oral contraceptives
34
what are the retinopathy findings in hypertension?
copper and silver wire arterioles | AV nicking
35
what are the retinopathy finding in diabetic retinopathy?
neovascularization cotton-wool spots microaneurysms
36
what is a side effect of spironolactone?
gynecomastia galactorrhea hyperkalemia
37
HFrEF vs HFpEF LV ejection fraction
HFrEF: LVEF <40% HFpEF: LVEF >50%
38
what is the ABI cut-off for PAD?
0.9 or less
39
what is the prophylaxis rx for endocarditis?
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
what are the best medications for lowering triglycerides?
Niacin and fibrates
41
two examples of high intensity statin?
atorvstatin 40-80 mg/d | rosuvastatin 20-40 mg/d
42
what is the Waist-to-hip ratio definition of obesity?
Males: 1.0 or higher Females: 0.8 or higher
43
ECG changes seen on patient who is on therapeutic level of digoxin?
prolonged PR interval | curved / cupping of ST