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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
What is a normal starting dose of coumadin?
5mg or less
26
What is a normal starting dose of coumadin in the elderly (>70 years)?
2.5mg or less
27
How often do we check the INR in patients who start coumadin?
Q 3 days
28
What INR range is considered stable for a patient on coumadin?
2-3
29
How often do we check an INR on a patient taking coumadin who is stable?
Monthly
30
Which drugs increase the INR when taken with warfarin?
Glucocorticoids, Tramadol, Fenofibrate, Bactrim, Fluroquinolones, Macrolides, PCNs, SSRIs, SNRIs, Statins, Azoles
31
What is first line therapy for non-valvular A. Fib.?
DOACs
32
What are examples of DOACs?
Dabigatran (Pradaxa), Rivaroxaban (Xarelto), Edoxaban (Savaysa), apixaban (Eliquis)
33
Plavix works how?
Inhibits platelets.
34
Why should I worry about warfarin?
Intracerebral Hemorrhage
35
What is the antagonist to Rivaroxaban (Xarelto) and Apixaban (Eliquis)?
Andaxanet Alfa (andexxa)
36
What is the antagonist to Dabigatran (pradaxa)?
Idarucizumab (Praxbind)
37
Which high in Vitamin K foods do patients need to be cautious of when taking warfarin?
"Greens", only one serving per day
38
If the INR is <4.5 and there is no bleeding what do I do?
skip a dose and check once or twice that week or slightly decrease the maintenance dose
39
What do I do if the INR is 4.5-10 and I see no significant bleeding?
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
What increases the risk of SVT?
digitalis toxicity, alcohol, hyperthyroidism caffeine, illegal drug use
41
Anterior wall MI shows ST elevation in what two leads?
V2 to V4
42
Ventricular tachycardia looks like what on a EKG strip?
Jagged irregular QRS
43
Anterior MI shows what changes on an EKG?
Q waves, Tombstoning (wide QRS complexes), ST elevation in V2-V4
44
Sinus arrythmia looks like what on an EKG?
P waves all look the same but they change in the interval between each other during inspiration and expiration.
45
What is Pulsus Paradoxus?
A fall in SBP of more than 10 mmhg during inspiration.
46
What does Pulsus Paradoxus indicate?
Cardiac Tamponade
47
Two common side effects of amlodipine are?
Headache and ankle swelling
48
An example of a Non-dihydropyridine antihypertensive drug is?
Diltiazem (Cardizem)
49
Taken together fluconazole and azithromycin may do what to the heart?
Prolong the QT interval
50
After starting a new medication for HTN in how long should the patient RTC?
1 month
51
Pseudoephedrine does what to the arteries?
Vasoconstricts
52
Which part of the lipid panel is most affected by fasting vs. non-fasting?
Triglycerides
53
If the triglyceride level returns greater than what number on a non-fasting sample should the sample be re-ordered?
400
54
What populations are most at risk for angioedema from ACE inhibitors?
Those allergic to NSAIDS, African ancestry, and Latino ancestry
55
What 7 labs should be ordered on a patient diagnosed with new HTN?
Serum Electrolytes (esp. NA+, Ca++, K+), CBC, Lipid panel, UA (check for protein), TSH, Fasting blood glucose, Serum creatinine with eGFR.
56
What 7 labs should be ordered on a patient diagnosed with new HTN?
Serum Electrolytes (esp. NA+, Ca++, K+), CBC, Lipid panel, UA (check for protein), TSH, Fasting blood glucose, Serum creatinine with eGFR.
57
Persons with sulfa allergies should avoid which two hypertensive drugs?
Thiazides & Loop diuretics
58
What is the first line thiazide diuretic for those with HTN?
Chlorthalidone
59
Which electrolyte do diuretics preserve making them a good choice for people with osteoporosis?
Calcium
60
Which electrolytes do diuretics deplete?
Na+, K+, Mg+
61
Diuretics may raise what contributing to gout flares?
Uric Acid
62
Combining a fibrate and a statin could dangerously cause what?
Rhabdomyolysis
63
Before starting statin therapy I should check the function of which organ?
Liver (Hepatic enzymes)
64
The width of the BP cuff bladder should be?
40% or 2/3 of arm
65
The length of the BP cuff bladder should be?
80-100%
66
What BP value indicates Hypertensive urgency or potentially hypertensive emergency?
>180/120
67
What distinguishes between hypertensive emergency and hypertensive urgency?
TOD: Target Organ Damage
68
Your patient on a statin complains of muscle aches what statins are less lipophilic and would be a better option for them?
Rosuvastatin & Pravastatin "Running Proud"
69
If your patient on a statin complains of muscle aches what other lab might you check to determine if there is a deficiency?
Vitamin D
70
The Fibrates Fenofibrate and Feno fibric Acid lower triglycerides by what percent?
50%
71
Omega-3 fatty acids lower triglycerides by what percent?
30%
72
Ezetimibe (Zetia) lowers cholesterol by what percent?
20%
73
BempEdoic acid reduces cholesterol by what percent?
15-25%
74
Omega-3 can increase risk of what?
Bleeding
75
Atrial flutter makes what pattern on an EKG?
sawtooth
76
An LDL of >190 requires treatment with what statin?
High intensity
77
Persons with diabetes between the ages of 40-75 require which statin?
moderate intensity
78
Mitral valve prolapse is common in person's which what syndrome?
Marfan's Syndrome
79
Pregnant women can take which three antihypertensive drugs?
New Little Momma: Nifedipine, Labetalol, Methyldopa
80
A split s2 can be considered pathologic if the patient does what?
Holds their breath and the split does NOT close

Adult Cardiac (5 decks)

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