Diagnosis and Management of Cardiovascular Disorder Flashcards
What are the semilunar valves?
Pulmonic Valve and Aortic Valve
What are the AV valves?
Tricuspid Valve and Mitral Valve
Heart sound that exemplifies increased fluid states (i.e. HF, pregnancy)
S3
Heart sounds that exemplifies stiff ventricular wall (MI, LVH, Chronic HTN)
S4
Rate the murmur: moderately loud, easily heard
III/VI
Rate the murmur: Audible but faint
II/VI
Rate the murmur:
Loud; associated with a thrill
IV/VI
Rate the murmur: very loud; heard with one corner of stethoscope off the chest wall
V/VI
Systolic mumur at 5th ICS MCL (apex)
Mitral Regurgitation
Systolic, “blowing,” rough, harsh murmur at 2nd right ICS usually radiating to the neck
Aortic stenois
Loud S1 murmur, low pitched, mid-diastolic; apical “crescendo” rumble
Mitral stenosis
Diastolic, “blowing” murmur at 2nd left ICS
Aortic regurgitation
Inability to contract results in decreased cardiac output (HFrEF, HFpEF, and or diastolic systolic failure)
HFrEF, systolic failure
Inability to relax and fill results in decreased cardiac output (HFrEF, HFpEF, and or diastolic systolic failure)
HFpEF, diastolic failure
left or right HF: S3 gallop, murmur of mitral regurgitation
Left Failure
left or right HF: frothy cough, appears generally healthy, except for the acute event
Left Failure
left or right HF: JVD, S3 and/or S4, paroxysmal nocturnal dyspnea
Right failure
what class of NYHA functional classification of the heart failure is this?
Marked limitation of physical activity but comfortable at rest
NYHA Class III
what class of NYHA functional classification of the heart failure is this?
Inability to carry out any physical activity without discomfort (s/s while at rest).
NYHA IV
what class of NYHA functional classification of the heart failure is this?
Slight limitations of physical activity but comfortable at rest
NYHA II
what class of NYHA functional classification of the heart failure is this?
No limitations of physical activity
NYHA I
Lab/Diagnostics for HF?
Hypoxemia and hypocapnia, BMP, BNP, UA, chest xray, Echo, ECG, pulmonary function tests for wheezing
Management for Hypertension Non-African American
- Thiazide diuretic
- ACEI
- ARB
- CCB
Management for Hypertension African American
- Thiazide diuretics
- CCB
Management for Hypertension Diabetic
ACEI or ARB
Management for > or equal with CKD
ACEI
What HTN drug is recommended as first line?
Thiazide-type diuretics
What is angina?
Decreased blood flow through the vessel leads to tissue ischemia
What type of angina occurs at various times, including rest
Prinzmetal’s (variant/vasospastic)
What are the criteria of unstable angina?
(1) occur at rest; (2) become more frequent, severe, or prolonged than the usual pattern of angina; (3) change from the usual pattern of angina; or (4) not respond to rest or nitroglycerin
Physical exam finding for angina
Levine’s sign
“clenched fist sign”
physical finding for angina
EKG representation of myocardial ischemia
ST-depression
Goal for LDL for patients with DM or CAD
<70
Goal of HDL
> 60
Management for angina
- reduction of risk factors when possible
- manage diet (low saturated fats and low unsaturated fats)
- Low dose enteric coated ASA
- pharmacotherapy
- optimize lipid panel
- Statin therapy
Pharmacotherapy for angina
nitrates, BB, CCB
Who may benefit from statin therapy?
- clinical evidence of ASCVD
- LDL >190
- DM 40 - 75 years of age with LDL between 70-189 without clinical evidence of ASCVD
- Without DM or hyperlipidemia, but with an estimated 10-year ASCVD risk of 7.5% or highter
What agents could be used other than HMG-CoA reductase inhibitors?
- bile acid sequestrants (low LDL, may increase triglycerides)
- fibrates (low triglycerides, slightly low LDL and possibly increase HDL)
- Cholesterol absorption inhibitor (used in combo with statin to lower LDL)
- Niacin (lower LDL and triglycerides and increase HDL)
Example of cholesterol absorption inhibitor
Ezetimibe (Zetia)
what is the disease of “clot on plaque”
MI/ACS
Which leads are the lateral leads
I and aVL
which leads are anterior
V3 and V4
which leads are inferior
III, II, AVF
What are ECG changes that may be noted
Peaked T waves, ST elevations, Q wave development
What enzymes are elevated during an MI or ACS?
troponin T, toponin I (cardiac selective), and CK-MB (cardio selective)
Indications for pharmacologic revascularization
- unrelieved chest pain (>30 minutes and <6 hours) WITH
- ST segment elevation in two or more contiguous leads
ABSOLUTE CONTRAINDICATIONS TO REVASCULARIZATION
active bleeding or risk thereof, including abnormal coagulation values
What is the most common cause of pericarditis
virus
s/s” Very localized retrosternal/precordial chest pain
pericarditis
s/s: pleuritic pain
pericarditis
s/s: SOB secondary to pain with inspiration, pain increased by deep inspiration, coughing, swallowing, or recumbent
pericarditis
s/s: pain relieved by sitting forward
pericarditis
Pericardial friction rub
pericarditis
ST segment elevation in all leads, return of ST segment to normal in few days/ depression of PR segment
pericarditis
Management of pericarditis
NSAIDS, corticosteroids (only when there is a total failure of high dose NSAIDs over several weeks and with relapsing pericarditis bx it can increase viral replication), abx (if bacterial infection)
hypotension, JVD, muffled/distant heart sounds, pulsus paradoxus
tamponade
dependent rubor, ulcerations, pallor
PVD
statis leg ulcers, trophic changes with brownish discoloration
Chronic venous insufficiciency
when would we use ankle-branchial index (ABI)?
diagnostic test for PVD
what is the most definitive test for PVD
anteriography
aching of the lower extremities relieved by elevation
chronic venous insufficiency
night cramps of the lower extremities. edema after prolonged standing
chronic venous insufficiency
c/o calf pain (claudication)
PVD
cold/numbness to extremities, progresses to pain at night
PVD
risk factors for PVD
- HLD
- Smoking
- DM
Management for PVD
- stop all tobacco use
- exercise (stop during pain and resume when pain subsides)
- cilostazol in combo with aspirin/clopidogrel
- weight reduction
- manage DM and HLD
- angioplasty
- bypass surgery
- amputation
Manageemet for CVI
- bed rest with legs elevated
- support stockings
- weight reduction in the obese
- treat dermatitis or ulcers
- acute weeping dermatitis - tap water compresses, hydrocolloid dressings, hydrocortisone cream
in the elderly, what physiologic changes could cause syncope?
baroreceptors that monitor blood pressure become less sensitive
geriatric: what are possible findings?
hypertension (increased risk for CVA, MI, and renal failure and/or dysrhythmias