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PDX 1 > Exam 1 - CV packet > Flashcards

Exam 1 - CV packet Flashcards

1
Q

What is the nature of cardiac pain?

A

Visceral

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2
Q

What are the problems with visceral pain?

A

Hard to localize, hard to describe, can be due to disorders of nearby structures

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3
Q

Is visceral pain made worse by palpation or changing the patient’s body position?

A

No

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4
Q

Is pericarditis harder or easier to localize than cardiac pain?

A

Easier

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5
Q

Is pericardial pain made worse by palpation or changing patient’s position?

A

NOT by palpation; made worse by lying supine, better by sitting up/leaning forward

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6
Q

Is musculoskeletal chest pain made worse by palpation?

A

Yes

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7
Q

Potential indicators of heart disease? (6)

A
  1. Hx of PAD 2. Dyspnea on exertion/SOB 3. Pre-syncope/syncope 4. Palpitations 5. Normal variant in heart rhythm 6. More serious disturbances in pulse rate
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8
Q

What is the usual cause of pre-syncope?

A

Global reduction of cerebral perfusion

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9
Q

Is pre-syncope specific to heart disease?

A

No

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10
Q

What are the benign forms of pre-syncope? (3)

A

Vasovagal syncope, orthostatic hypotension, situational syncope

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11
Q

When is syncope cause for concern?

A

When it is recurrent

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12
Q

How is cardiogenic syncope different from benign forms?

A

Few prodromal symptoms

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13
Q

What is a palpitation?

A

Disagreeable awareness of a heartbeat

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14
Q

Are palpitations specific to heart disease?

A

No

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15
Q

What question should you ask when a patient presents with palpitations?

A

Was the pulse rhythm irregular when pt felt the palpitations?

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16
Q

What does a combo of palpitations and pre-syncope tend to indicate?

A

Cardiac arrhythmia

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17
Q

Who is normal arrhythmia seen more often in?

A

Children and aerobically fit young adults at rest

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18
Q

What is a “regularly-irregular” heartbeat?

A

Increases with inspiration and decreases with expiration

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19
Q

Are “regularly-irregular” heartbeats normal?

A

Can be normal or abnormal

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20
Q

What are “bigeminal” and “trigeminal” pulses due to?

A

Premature beats

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21
Q

What is “irregularly-irregular” heart rate associated with?

A

Atrial fibrillation

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22
Q

What is the most common form of arrhythmia?

A

Atrial fibrillation

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23
Q

Who is atrial fib most often seen in?

A

Patients over 60, esp. with coronary heart disease, HTN, COPD, etc

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24
Q

Non-modifiable risk factors for CVD? (3)

A
  1. Increasing age 2. Male gender 3. Family history
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25
Q

Starting ages for CVD risk for men and women?

A

Men = 45 Women = 55

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26
Q

what is normal arterial wall stress called?

A

“high” wall stress

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27
Q

What does normal high wall stress lead to?

A

Local expression of nitric oxide/relaxant factors

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28
Q

What does the expression of NO/relaxant factors promote?

A

vasodilation, inhibits clot formation

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29
Q

Why is decreased arterial stress a major pathophysiological problem?

A

endothelium now favors vasoconstriction and platelet aggregation

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30
Q

What does vasoconstriction/platelet aggregation lead to, with decreased wall stress?

A

Increased endothelial permeability and accelerated plaque formation

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31
Q

Why are sudden “spikes” in BP in dysfunctional endothelium a problem?

A

Increase in wall stress with increased BP can lead to destabilization of established, existing plaque

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32
Q

What increases the risk of endothelial dysfunction?

A

Factors that decrease arterial stress

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33
Q

What is a built-in problem with regards to endothelial dysfunction?

A

Bifurcations - disrupt laminar flow

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34
Q

Modifiable cardiovascula risk factors? (6)

A
  1. HTN 2. Tobacco smoking 3. Diabetes 4. Sedentary lifestyle 5. Body weight/obesity 6. Pathologic left ventricular hypertrophy
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35
Q

What is the residual risk of HTN?

A

Damage to arterial endothelium, left ventricular hypertrophy

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36
Q

What is the residual risk of tobacco smoking?

A

Vasoconstriction

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37
Q

What is the residual risk of diabetes?

A

Increased vascular permeability

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38
Q

What is the residual risk of pathologic left ventricular hypertrophy?

A

Presumed change to ventricular myocardium

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39
Q

Blood pressure classification: Normal

A

Systolic < 80

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40
Q

Blood pressure classification: Pre-hypertension

A

Systolic 120-139 Diastolic 80-89

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41
Q

Blood pressure classification: Stage 1 HTN

A

Systolic 140-159 Diastolic 90-99

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42
Q

Blood pressure classification: Stage 2 HTN

A

Systolic >160 Diastolic > 100

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43
Q

Which reading should you record if pt’s BP is higher in one arm than the other?

A

Record the higher reading

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44
Q

When SBP and DBP fall into different categories, which should be used to classify the pt’s BP?

A

The higher category

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45
Q

What is the classification of hypertension based on?

A

Average of 2 or more properly measured BP readings on 2 or more separate occasions

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46
Q

What BP readings would you not require serial confirmation before making decisions regarding intervention?

A

SBP >180 or DBP >110

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47
Q

Examination factors that could affect accuracy of BP readings? (8)

A

Cuff too narrow, cuff not centered, cuff over thick clothing, cuff too loose, elbow too low, arm in dependent position, back unsupported, arm unsupported

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48
Q

Examinee factors that could affect accuracy of BP reading? (6)

A

White coat HTN, recent tobacco use, recent caffeine use, distended bladder, talking during procedure, having legs crossed

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49
Q

What is primary hypertension?

A

No identifiable cause found

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50
Q

How many HTN cases are due to primary HTN?

A

90-95%

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51
Q

When does the onset of primary HTN usually occur?

A

Between age 25-55

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52
Q

What can exacerbate primary HTN? (4)

A

obesity, lack of exercise, alcohol, smoking

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53
Q

What is secondary HTN?

A

underlying cause is identified

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54
Q

What is the most common form of secondary HTN?

A

Renal vascular HTN

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55
Q

4 cases of target organ damage (TOD) due to HTN?

A
  1. retinal damage 2. left ventricular hypertrophy/CVD 3. renal damage 4. CNS disorders/stroke
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56
Q

What is orthostatic hypotension?

A

Brough on by sudden change in body position, usually from lying down to standing

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57
Q

Guidelines for “true” orthostatic hypotension?

A

Persistent fall in SBP/DBP of more than 20/10 mmHg within 3 minutes of assuming upright position

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58
Q

What is neurally-mediated hypotension associated with?

A

Long periods of standing

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59
Q

Who is neurally-mediated hypotension more common in?

A

Children/young adults

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60
Q

What brings in severe hypotension?

A

sudden loss of blood, infection, or severe allergic reaction

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61
Q

Contributing factors in low blood pressure? (3)

A

Dehydration (esp in elderly), alcohol use, medications

62
Q

Common symptoms of low BP? (5)

A

blurry vision, confusion, dizziness, fainting, light-headedness

63
Q

What is considered the prime target in HTN therapy?

A

LDLs

64
Q

When is a patient with high LDLs considered very high risk?

A

Prior heart attack or stroke

65
Q

When is a patient with high LDLs considered low risk?

A

0 or 1 of the “traditional” risks

66
Q

What is the target goal in LDL therapy in a pt that is very high risk?

A

<70 mg/dL

67
Q

What is the target goal in LDL therapy in a pt that is high risk?

A

<100 mg/dL

68
Q

What is the target goal in LDL therapy in a pt that is moderate risk?

A

<130 mg/dL

69
Q

What is the target goal in LDL therapy in a pt that is low risk?

A

<160 mg/dL

70
Q

What is the normal triglyceride level?

A

<150 mg/dL

71
Q

What is “borderline” triglyceride level?

A

150-199 mg/dL

72
Q

What is high triglyceride level?

A

200-499 mg/dL

73
Q

What is very high triglyceride level?

A

> 500 mg/dL

74
Q

Factors that can lead to hypertryglyceridemia? (3)

A
  1. poorly controlled diabetes 2. obesity 3. excessive alcohol consumption
75
Q

What 2 diseases have long-term hypertriglyceridemia been linked to?

A
  1. fatty liver disease 2. pancreatitis
76
Q

What is the most common problem seen with heart disease?

A

Transient myocardial ischemia/typical angina

77
Q

When does the myocardium have a limited ability to increase O2 extraction?

A

During episodes of increased demand

78
Q

How is the increased demand for O2 met?

A

proportional increase in blood flow through the coronary arteries

79
Q

What is the coronary flow reserve (CFR)?

A

ability of coronary arteries to increase blood flow in response to increased cardiac metabolic demand

80
Q

What is the maximal coronary blood flow after full dilation of coronary aa in healthy people?

A

4-6 times the resting blood flow

81
Q

In normal blood flow, is there much resistance to blood flow?

A

No - only about 5% of the arterial resistance

82
Q

What happens when someone with >50% coronary artery plaque exerts themselves (increases demand)?

A

Typical angina and Levine’s sign

83
Q

What could cause an angina in someone with coronary artery plaque >90%?

A

Little or no exertion needed = possible angina at rest

84
Q

What is the most common type of angina?

A

Typical angina

85
Q

What is a typical angina due to?

A

coronary artery plaque (“fixed” lesion)

86
Q

What is the most common trigger of typical angina?

A

Exertion/exercise

87
Q

How do angina attacks start?

A

Abruptly, “seize” the patient

88
Q

Where is the discomfort in typical angina?

A

deep to sternum

89
Q

How is the discomfort in typical angina described?

A

poorly-localized, visceral

90
Q

How long do attacks of typical angina usually last?

A

1-5 minutes

91
Q

What usually relieves a typical angina?

A

rest, sublingual nitrogen

92
Q

What is Levine’s sign?

A

clenched fist over the sternum, “classic” radiates to left shoulder/arm

93
Q

What does Levine’s sign suggest?

A

angina pectoris

94
Q

Within a group of angina patients, is the location of discomfort always in the same place?

A

No, varies from pt to pt

95
Q

Is a given individual’s angina location usually in the same place?

A

Yes, usually predictable and unvarying

96
Q

What does the term “umbilicus to eyebrows” refer to?

A

Suspect angina when pt with CV risk factors describes ANY discomfort ABOVE THE WAIST that is provoked by exercise and relieved by rest

97
Q

What is atypical angina the result of? (2)

A
  1. problems with coronary aa (“conduction” vessels) 2. problems with intramyocardial aa (“resistance” vessels)
98
Q

What is a Prinzmetal angina?

A

coronary vasospasm in near-normal coronary aa.

99
Q

What causes prinzmetal anginas?

A

sudden elevation in BP, cigarettes

100
Q

What can prinzmetal angina lead to?

A

Angina at rest

101
Q

In normal intramyocardials, is there much resistance?

A

Yes, 95% of arterial resistance

102
Q

What happens with dysfunctional intramyocardials?

A

increased resistance -> less exertion needed -> possible angina AT REST

103
Q

What makes an angina “atypical”?

A

Absence of typical presentation

104
Q

Common symptoms of atypical angina? (4)

A
  1. SOB 2. nausea 3. diaphoresis 4. discomfort not located in chest
105
Q

Who is atypical angina more common in? (2)

A
  1. Older, female patients 2. Diabetic patients
106
Q

What might atypical angina be associated with? (2)

A
  1. Prinzmetal angina 2. Microvascular angina
107
Q

What diseases are believed to cause microvascular abnormalities? (3)

A
  1. DIABETES 2. HTN 3. systemic collagen vascular disease
108
Q

What is acute coronary syndrome (ACS)?

A

umbrella term used to cover a spectrum of clinical conditions, from unstable angina to MI

109
Q

What should you do if your pt is experiencing ACS?

A

Call 911

110
Q

Possible end results for ACS? (3)

A

unstable angina, myocardial infarction, sudden cardiac death

111
Q

What causes “classic” ACS?

A

obstruction of coronary aa

112
Q

S/Sx of “classic” ACS?

A

visceral chest pain/angina of abrupt onset

113
Q

What percentage of MI pts present with pleuritic pain?

A

14%

114
Q

What percentage of MI pts do NOT have chest pain?

A

33%

115
Q

Non-pain angina “equivalents” that can present in ACS? (8)

A
  1. nausea 2. SOB 3. neck pain 4. jaw pain 5. arm pain 6. fatigue 7. syncope 8. diaphoresis
116
Q

Can physical exam results be normal even when a pt is experiencing ACS?

A

Yes

117
Q

Symptoms of ACS dut to intramyocardial artery disease? (4)

A

SOB, nausea, diaphoresis, discomfort not in chest

118
Q

How do many CHF patients appear?

A

comfortable at rest

119
Q

CHF risks? (3)

A
  1. hx of previous MI/abnormal heart valves 2. congenital heart defects 3. idiopathic, infectious, toxic or familial pathologies involving myocardium
120
Q

What is “compensated” CHF?

A

heart failure with relatively normal cardiac output

121
Q

What are the compensatory mechanisms? (3)

A
  1. catecholamine release/stim of symp. Nervous system 2. retention of sodium and water 3. cardiac “remodeling” (dilation or hypertrophy of L ventricle)
122
Q

What is “decompensated” CHF?

A

inadequate cardiac output even at rest

123
Q

What does dilated cardiomyopathy and systolic heart failure result in?

A

Reduced L ventricular contractility

124
Q

What is the most common form of chronic heart failure?

A

dilated cardiomyopathy

125
Q

What is the most common cause of dilated cardiomyopathy?

A

Chronic ischemia

126
Q

What are the best physical findings in severe systolic failure? (2)

A

Abnormal apical impulse (cardiac heave) and radiographic evidence of cardiomegaly

127
Q

What is the point of maximal impulse (PMI)?

A

brief succinct impulse overliying the apex of L ventricle

128
Q

Normal PMI?

A

apical beat is succinct, brief, and covers an area <2 cm in diameter

129
Q

Abnormal PMI?

A

prolonged contraction/cardiac heave that covers area >3 cm in diameter

130
Q

What happens with hypertrophic cardiomyopathy and diastolic heart failure?

A

myocardium becomes inelastic and non-compliant. Muscle can’t relax => slow rate of ventricular filling

131
Q

What are the best physical findings in severe diastolic failure? (2)

A

Jugular distension and radiographic evidence of pulmonary venous HTN

132
Q

Which jugular vein should you examine for abnormal distension if you suspect diastolic failure?

A

RIGHT internal (and external) jugular vein

133
Q

What is the cardinal sign of L ventricular CHF?

A

breathlessness

134
Q

Will all pts with L ventricular CHF show dyspnea on exertion (DOE)?

A

may be absent in sedentary pts

135
Q

Is DOE specific to heart disease?

A

No

136
Q

What is orthopnea?

A

Have to be upright to breathe

137
Q

What does orthopnea indicate?

A

pulmonary HTN/pulmonary congestion. Possible early symptom of CHF

138
Q

When does orthopnea occur?

A

When pt is awake

139
Q

When does orthopnea usually resolve?

A

Rapidly when pt sits up

140
Q

How is orthopnea measured?

A

by number of pillows needed to make pt comfortable

141
Q

What does paroxysmal nocturnal dyspnea (PND) indicate?

A

pulmonary edema

142
Q

When does PND occur?

A

When pt is asleep

143
Q

When does PND resolve?

A

might take 30+ minutes in seated position

144
Q

Is PND more specific for heart disease?

A

more specific but not absolute

145
Q

Other S/Sx of L ventricular CHF? (4)

A
  1. fatigue/weakness 2. nocturia 3. oliguria 4. cerebral symptoms in advanced/late stage
146
Q

S/Sx of R ventricular CHF? (4)

A
  1. peripheral edema 2. ascites 3. hepatomegaly 4. anasarca
147
Q

Does R or L ventricular failure usually come first?

A

L usually first.

148
Q

What is the most common cause of R ventricular failure?

A

continuation of L ventricular failure

149
Q

What is the second most common cause of R ventricular failure?

A

Cor pulmonale (= heart failure due to chronic lung disease)

150
Q

What is the most important factor in a cardiac exam?

A

History and risk factors

151
Q

In a cardiac exam, what do really obvious clinical findings usually indicate?

A

Something ominous in nature

152
Q

What are 2 major concerns in cardiac exams?

A

Symptomatic arrhythmias, symptomatic cardiac murmurs

PDX 1 (7 decks)

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