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Adult Cardiac > General Cardiac > Flashcards

General Cardiac Flashcards

1
Q

Severe Left Ventricular Hypertrophy

A

Apical Impulse >3cm, NOT 5th intercostal mid-clavicular line

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2
Q

Tricuspid Valve Location

A

Right Heart

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3
Q

Mitral valve location

A

Left heart

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4
Q

Valves that cause S1 heart sound

A

Mitral, Tricuspid (these are AV valves)

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5
Q

Valves that cause the S2 heart sound

A

Aortic, Pulmonic (these are semilunar valves)

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6
Q

S3 is indicative of?

A

Heart Failure, Early diastole, “Kentucky”, abnormal if greater than 40 years old.

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7
Q

S4 is indicative of?

A

LVH, “atrial gallop”. “atrial kick”, “Tennessee”, Best heard using the bell. Can be normal in the elderly. Will have no signs of valvular disease if this is the case.

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8
Q

Erb’s Point

A

3rd-4th ICS left sternal border

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9
Q

Mitral Regurgitation sounds like what?

A

S1, Pansystolic, apex area, radiates to axillae, loud, blowing high pitched

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10
Q

Aortic Stenosis sounds like what?

A

Midsystolic ejection, 2nd ICS, radiates to neck, Harsh and noisy!

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11
Q

What does Mitral stenosis sound like?

A

Low pitched rumbling in diastole, heard at apex, opening snap, heard with the bell

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12
Q

What does aortic regurgitation sound like?

A

high pitched, erb’s point

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13
Q

What is felt with a grade IV murmur?

A

Thrill

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14
Q

How to distinguish a grade V murmur?

A

Obvious thrill + half of diaphragm is off the chest

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15
Q

Grade VI murmur is heard?

A

With the stethoscope off the chest!

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16
Q

Mitral Regurgitation radiates where?

A

The Axilla

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17
Q

Aortic stenosis radiates where?

A

The Neck

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18
Q

What tool or scoring system is used to see if a patient with a. fib. needs coagulation?

A

CHA2DS2VASc

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19
Q

What does CHA2DS2VASC stand for?

A

C-CHF, H-HTN, A-Age>75, D-Diabetes, S-stroke or TIA, V- vascular disease, A-age 65-74, S-sex female

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20
Q

CHA2DS2VASc score requires anticoagulation?

A

1-2

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21
Q

What will an EKG of a person with A. Fib. Show?

A

Irregularly irregular, no distinct p waves

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22
Q

A patient presents with A. Fib. What labs will I order?

A

TSH. BNP. Electrolytes (calcium, mg, na, potassium). Kidney function. Troponin.

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23
Q

A patient presents with a. fib what tests will I order?

A

Holter monitor if paroxysmal, ECHO

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24
Q

What foods/drugs should people with a. fib avoid?

A

Caffeine, nicotine, decongestants, alcohol

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25
Q

What is a normal starting dose of coumadin?

A

5mg or less

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26
Q

What is a normal starting dose of coumadin in the elderly (>70 years)?

A

2.5mg or less

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27
Q

How often do we check the INR in patients who start coumadin?

A

Q 3 days

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28
Q

What INR range is considered stable for a patient on coumadin?

A

2-3

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29
Q

How often do we check an INR on a patient taking coumadin who is stable?

A

Monthly

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30
Q

Which drugs increase the INR when taken with warfarin?

A

Glucocorticoids, Tramadol, Fenofibrate, Bactrim, Fluroquinolones, Macrolides, PCNs, SSRIs, SNRIs, Statins, Azoles

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31
Q

What is first line therapy for non-valvular A. Fib.?

A

DOACs

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32
Q

What are examples of DOACs?

A

Dabigatran (Pradaxa), Rivaroxaban (Xarelto), Edoxaban (Savaysa), apixaban (Eliquis)

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33
Q

Plavix works how?

A

Inhibits platelets.

34
Q

Why should I worry about warfarin?

A

Intracerebral Hemorrhage

35
Q

What is the antagonist to Rivaroxaban (Xarelto) and Apixaban (Eliquis)?

A

Andaxanet Alfa (andexxa)

36
Q

What is the antagonist to Dabigatran (pradaxa)?

A

Idarucizumab (Praxbind)

37
Q

Which high in Vitamin K foods do patients need to be cautious of when taking warfarin?

A

“Greens”, only one serving per day

38
Q

If the INR is <4.5 and there is no bleeding what do I do?

A

skip a dose and check once or twice that week or slightly decrease the maintenance dose

39
Q

What do I do if the INR is 4.5-10 and I see no significant bleeding?

A

Hold 1-2 doses. maybe give 1-2.5 mg of oral vitamin K (low- dose), Monitor INR every 2-3 days. Decrease the warfarin maintenance dose.

40
Q

What increases the risk of SVT?

A

digitalis toxicity, alcohol, hyperthyroidism caffeine, illegal drug use

41
Q

Anterior wall MI shows ST elevation in what two leads?

A

V2 to V4

42
Q

Ventricular tachycardia looks like what on a EKG strip?

A

Jagged irregular QRS

43
Q

Anterior MI shows what changes on an EKG?

A

Q waves, Tombstoning (wide QRS complexes), ST elevation in V2-V4

44
Q

Sinus arrythmia looks like what on an EKG?

A

P waves all look the same but they change in the interval between each other during inspiration and expiration.

45
Q

What is Pulsus Paradoxus?

A

A fall in SBP of more than 10 mmhg during inspiration.

46
Q

What does Pulsus Paradoxus indicate?

A

Cardiac Tamponade

47
Q

Two common side effects of amlodipine are?

A

Headache and ankle swelling

48
Q

An example of a Non-dihydropyridine antihypertensive drug is?

A

Diltiazem (Cardizem)

49
Q

Taken together fluconazole and azithromycin may do what to the heart?

A

Prolong the QT interval

50
Q

After starting a new medication for HTN in how long should the patient RTC?

A

1 month

51
Q

Pseudoephedrine does what to the arteries?

A

Vasoconstricts

52
Q

Which part of the lipid panel is most affected by fasting vs. non-fasting?

A

Triglycerides

53
Q

If the triglyceride level returns greater than what number on a non-fasting sample should the sample be re-ordered?

A

400

54
Q

What populations are most at risk for angioedema from ACE inhibitors?

A

Those allergic to NSAIDS, African ancestry, and Latino ancestry

55
Q

What 7 labs should be ordered on a patient diagnosed with new HTN?

A

Serum Electrolytes (esp. NA+, Ca++, K+), CBC, Lipid panel, UA (check for protein), TSH, Fasting blood glucose, Serum creatinine with eGFR.

56
Q

What 7 labs should be ordered on a patient diagnosed with new HTN?

A

Serum Electrolytes (esp. NA+, Ca++, K+), CBC, Lipid panel, UA (check for protein), TSH, Fasting blood glucose, Serum creatinine with eGFR.

57
Q

Persons with sulfa allergies should avoid which two hypertensive drugs?

A

Thiazides & Loop diuretics

58
Q

What is the first line thiazide diuretic for those with HTN?

A

Chlorthalidone

59
Q

Which electrolyte do diuretics preserve making them a good choice for people with osteoporosis?

A

Calcium

60
Q

Which electrolytes do diuretics deplete?

A

Na+, K+, Mg+

61
Q

Diuretics may raise what contributing to gout flares?

A

Uric Acid

62
Q

Combining a fibrate and a statin could dangerously cause what?

A

Rhabdomyolysis

63
Q

Before starting statin therapy I should check the function of which organ?

A

Liver (Hepatic enzymes)

64
Q

The width of the BP cuff bladder should be?

A

40% or 2/3 of arm

65
Q

The length of the BP cuff bladder should be?

A

80-100%

66
Q

What BP value indicates Hypertensive urgency or potentially hypertensive emergency?

A

> 180/120

67
Q

What distinguishes between hypertensive emergency and hypertensive urgency?

A

TOD: Target Organ Damage

68
Q

Your patient on a statin complains of muscle aches what statins are less lipophilic and would be a better option for them?

A

Rosuvastatin & Pravastatin
“Running Proud”

69
Q

If your patient on a statin complains of muscle aches what other lab might you check to determine if there is a deficiency?

A

Vitamin D

70
Q

The Fibrates Fenofibrate and Feno fibric Acid lower triglycerides by what percent?

A

50%

71
Q

Omega-3 fatty acids lower triglycerides by what percent?

A

30%

72
Q

Ezetimibe (Zetia) lowers cholesterol by what percent?

A

20%

73
Q

BempEdoic acid reduces cholesterol by what percent?

A

15-25%

74
Q

Omega-3 can increase risk of what?

A

Bleeding

75
Q

Atrial flutter makes what pattern on an EKG?

A

sawtooth

76
Q

An LDL of >190 requires treatment with what statin?

A

High intensity

77
Q

Persons with diabetes between the ages of 40-75 require which statin?

A

moderate intensity

78
Q

Mitral valve prolapse is common in person’s which what syndrome?

A

Marfan’s Syndrome

79
Q

Pregnant women can take which three antihypertensive drugs?

A

New Little Momma:
Nifedipine, Labetalol, Methyldopa

80
Q

A split s2 can be considered pathologic if the patient does what?

A

Holds their breath and the split does NOT close

Adult Cardiac (5 decks)

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