CVS Flashcards
S3 is usually heard in ______
S3: usually in HF, early diastole “ventricular gallop” - Kentucky
• Can be normal in kids, pregnancy, some athletes
S4 is usually heard in ______
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
what grade of murmur do you first feel a thrill?
grade 4
3 diagnostic tests for afib?
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
black box warning for amiodarone?
Amiodarone black box of pulmonary toxicity, hepatic injury, hyper/hypothyroidism, visual impairment, peripheral neuropathy, worsening arrhythmia
warfarin
what is the therapeutic range?
- 0-3.0
2. 5-3.5 for synthetic valves
initiating warfarin
Frequency of INR?
check q2-4 days until 2 consecutive therapeutic values, then weekly
every 4 weeks when stable
how is pulsus paradoxus defined?
• Fall in SBP of > 10 mm during inspiration
pulmonary causes of pulsus paradoxus?
asthma
emphysema
cardiac causes of pulsus paradoxus?
cardiac tamponade
cardiac effusion
pericarditis
*anything that decreases movement of L ventricle
AHA definition of stage 1 and stage 2 hypertension?
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
physical exam finding of coarctation of aorta?
SBP higher in ARMS (normal to be higher in legs) with bounding pulse.
Delayed/decreased femoral pulses when radial and femoral pulses palpated together
when to suspect secondary hypertension?
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)
examples of causes of secondary hypertension?
Renal (renal artery stenosis, polycystic kidneys, CKD)
Endo (hyperthyroid, hyperaldosteronism, pheochromocytoma)
Other (OSA, aortic coarctation)
what class of antihypertensive is contraindicated in bilateral renal artery stenosis?
ACE-I or ARB –> will precipitate renal failure
HTN
what is the dietary Na and K recommendations?
Sodium <1.5 g/day
Potassium >3.5 g/day if normal kidney function
HTN
what is the alcohol recommendation?
men 1 oz, 2 or less/day
women 0.5 oz 1 or less per day
what is considered normal BMI range
18.5 to 24.9
what are the “hyper” side effects for thiazide diuretics?
“Hyper”
- glycemia: caution DM
- uricemia: CI gout
- TG and cholesteremia
what are the “hypo” side effects for thiazide diuretics?
“Hypo”
- K: potentiates digoxin
- Na: hold, restrict water
- Mg
name 3 contraindications to thiazide diuretics
- hypokalemia
- gout
- renal failure
- lithium
- allergy to sulfa
3 examples of cardioselective beta blockers?
- bisoprolol
- atenolol
- metoprolol
where are beta 1 and beta 2 receptors located?
B1 receptors: cardiac
B2 receptors: lungs, vascular smooth muscle
which blood pressure medication class is contraindicated in DM II with microalbuminuria
mineralocorticoid receptor antagonist
eg spironolactone
contraindications to beta blockers?
- LUNG: asthma, COPD, emphysema
- HEART: second and third degree heart block
- sinus bradycardia
which class of HTN medications is contraindicated in heart failure?
CCB
side effects of ACE-I and ARB?
- dry cough (10% ACE-I)
- hyperK
- serious angioedema
contraindications to ACE-I and ARB?
- renal disease
- renal stenosis
- pregnancy
first line HTN medication for DM?
ACE-I/ARB
first line HTN medication for CKD?
ACE-I or ARB
African American may be less sensitive to _____ (BP med class) –> try _______ instead
less sensitive to ACE-I and ARB
try thiazides or CCB
what class of HTN medications are recommended after acute MI?
BB
ACE-I
MRA (spiro)
what medications can increase BP?
NSAIDs, steroids, decongestants, oral contraceptives
what are the retinopathy findings in hypertension?
copper and silver wire arterioles
AV nicking
what are the retinopathy finding in diabetic retinopathy?
neovascularization
cotton-wool spots
microaneurysms
what is a side effect of spironolactone?
gynecomastia
galactorrhea
hyperkalemia
HFrEF vs HFpEF
LV ejection fraction
HFrEF: LVEF <40%
HFpEF: LVEF >50%
what is the ABI cut-off for PAD?
0.9 or less
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
what are the best medications for lowering triglycerides?
Niacin and fibrates
two examples of high intensity statin?
atorvstatin 40-80 mg/d
rosuvastatin 20-40 mg/d
what is the Waist-to-hip ratio definition of obesity?
Males: 1.0 or higher
Females: 0.8 or higher
ECG changes seen on patient who is on therapeutic level of digoxin?
prolonged PR interval
curved / cupping of ST
