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Clin Med-Cardio pt 2 > Green PANCE book > Flashcards

Green PANCE book Flashcards

1
Q

Primary (essential) hypertension causes ___% of cases of elevated BP

A

90 to 95%

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2
Q

More prevalent with increased age and in blacks

A

Hypertension

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3
Q 
Parenchymal renal dz
Renal artery stenosis
Coarctation of aorta, Pheochromocytoma
Cushing Syndrome, hyperthyroidism
primary hyperaldosteronism
chronic steroid therapy, estrogen use
NSAID use, sleep apnea
A

Secondary causes of HTN

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4
Q

Essential HTN is exacerbated in…

A

Males
Blacks
Sedentary individuals
Smokers

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5
Q

BP persistently elevated higher than 220 mmHg systolic or higher than 125 mmHg diastolic or accompanied by complications

A

Hypertensive urgencies!! Must be reduced within hours

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6
Q

Encephalopathy, nephropathy, intracranial hemorrhage, aortic dissections, pulmonary edema, unstable angina, or MI in the presence of strikingly elevated pressures defines…

A

Hypertensive emergency

must be reduced within 1 hour

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7
Q

HTN is diagnosed when the pt has elevated BP of over 140 mmHg systolic and/or 90 mmHg diastolic during..

A

at least 2 visits

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8
Q

a BP reading 120-139 mmHg systolic and/or 80-89 mmHg diastolic

A

Prehypertension

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9
Q

What abnormality might you see on an EKG in a patient with HTN

A

left ventricular hypertrophy

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10
Q

Once HTN is diagnosed, the treatment goal should be to achieve a BP reading of less than…

A

140/90 mmHg

in a pt w diabetes or CKD, 130/80

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11
Q

Low saturated fat, cholesterol, total fat describes what kind of diet?

A

DASH
Dietary Approaches to Stop Hypertension

(includes fruits, veggies, fat free or low fat milk products, increased fiber)

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12
Q

Initial therapy for essential HTN?

A

Diuretics

Thiazide diuretics most consistently effective

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13
Q

Clinical syndrome characterized by abnormal retention of water and sodium. Resulting venous congestion causes typical symptoms such as dyspnea and edema

A

CHF

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14
Q

Results from pathologic changes in one or more of the following: myocardial contractility, structural integrity of valves, preload or after load of the ventricle, HR

A

CHF

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15
Q

CHF adversely affects left atrial pressure and…

A

cardiac output

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16
Q

….causes exertional pulmonary vascular congestion leading to exertional dyspnea plus cough, fatigue, orthopnea, PND, basilar rales, gallops and exercise intolerance

A

Left sided failure

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17
Q

…causes systemic vascular congestion and is characterized by distended neck veins, tender or non tender hepatic congestion, decreased appetite/nausea and dependent pitting edema

A

Right sided failure

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18
Q

Predominant features of R sided failure

A

Peripheral edema

Hepatomegaly

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19
Q

Most common cause of R sided HF

A

L sided HF

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20
Q

CXR may show:
cardiomegaly and bilateral or R sided pulmonary effusions, perivascular or interstitial edema (Kerley B lines), venous dilation and cephalization and alveolar fluid

A

CHF

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21
Q

ECG may show:
non specific changes (i.e. low voltage), underlying arrhythmias, intraventricular conduction defects, left ventricular hypertrophy, non specific depolarization changes, new or old MI

A

CHF

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22
Q

What is the most useful diagnostic in CHF?

A

Echocardiography

*it is able to assess size and function of the chambers, valve abnormalities, pericardial effusion, shunting and segmental wall abnormalities

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23
Q

Echocardiography can measure…

A

Ejection fraction (EF)

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24
Q

What is a key diagnostic and prognostic indicator in CHF?

A

Ejection fraction (EF)

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25
Q

When is cardiac catheterization indicated?

A

if atherosclerosis is suspected

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26
Q

initial therapy of most CHF patients chinless early initiation of…

A

ACE inhibitors

*have been shown to decrease L ventricular wall stress and slow myocardial remodeling and fibrosis

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27
Q

Ca channel blockers are used to treat associated..

A

angina or HTN

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28
Q

When the ejection fraction falls below 35, what can be implemented?

A

Implantable cardioverter-defibrillators (ICD)

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29
Q

…is characterized by insufficient oxygen supply to cardiac muscle, most commonly caused by atherosclerotic narrowing and less often by constriction f coronary arteries

A

Ischemic heart disease

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30
Q

Levine sign, which is a clenched fist over the stern, and clenches teeth when describing chest pain may be seen in patients with…

A

Ischemia

31
Q

Stable angina lasts for less than…

A

3 minutes

32
Q

What is the most sensitive clinical sign of angina seen on an ECG?

A

horizontal or downsloping ST segment depression

33
Q

1/5 of MI patients will die of..

A

V fib

34
Q

MIs in…women, diabetics, elderly…

A

more likely to have atypical symptoms

35
Q

..includes pericarditis, fever, leukocytosis and pericardial or pleural effusion usually 1-2 weeks post MI

A

Dressler syndrome (post MI syndrome)

36
Q

Most specific marker myocardial damage?

A

Troponin

37
Q

This scoring system is the quickest and easiest and can be completed at bedside. One point is given for each:

  • 65 yo plus
  • 3 or more risk factors of CAD
  • use of ASA in last 7 days
  • known CAD with stenosis 50% or more
  • more than 1 episode of rest angina within last 24 hours
  • ST segment deviation
  • elevated cardiac markers

**score of 3 or more=high risk

A

TIMI (Thrombolysis In Myocardial Infarction)

38
Q

More complex scoring method..
age, gender, vital signs, ST segment changes, and historical factors are included to predict 6 mo risk of death after discharge

A

GRACE (Global Registry of Acute Coronary Events)

39
Q

Which drugs should be given at once to a pt with an acute STEMI

A

Aspirin and clopidogrel

40
Q

What should be done within 90 minutes in an MI patient

A

Angiography

41
Q

______ cardiomyopathies are the most common type and are associated with reduced strength of ventricular contraction, resulting in dilation of the L ventricle

A

Dilated

42
Q

This cardiomyopathy demonstrates massive hypertrophy (particularly of the septum), small left ventricle, systolic anterior mitral motion and diastolic dysfunction

A

Hypertrophic cardiomyopathy

43
Q

This cardiomyopathy results from fibrosis or infiltration of the ventricular wall because of colleges-defect diseases, most commonly: amyloidosis, radiation, postoperative changes, diabetes and endomyocardial fibrosis

A

Restrictive cardiomyopathy

44
Q

Most common presentation of dilated cardiomyopathy

A

Dyspnea

45
Q

Acute pericarditis is most commonly..

A

idiopathic or due to viral infection

46
Q

Pericardial effusion (secondary to pericarditis, uremia, or cardiac trauma) produces restrictive pressure on..

A

the heart

47
Q

primary presenting symptom of acute pericarditis is sharp, pleuritic substernal radiation chest pain often relived by sitting upright and leaning forward; a cardiac friction rub is characteristic

A

Acute pericarditis

48
Q

this occurs when fluid compromises cardiac filling and impairs cardiac output

A

Cardiac tamponade

49
Q

this presents with slowly progressive dyspnea, fatigue and weakness accompanied by edema, hepatomegaly and ascites

A

constrictive pericarditis

50
Q

typically presents with tachycardia, tachypnea, narrow pulse pressure, jugular venous distention and pulsus paradxus

A

cardiac tamponade

51
Q

which diagnostics are useful in determining the extent of cardiac effusion

A

chest radiography

echocardiography

52
Q

Most cases of native valve infective endocarditis are…

A

S. viridans
S. aureus
enterococci

53
Q

Most common bacteria and valve involved in drug users with endocarditis

A

S. aureus, tricuspid valve

54
Q

Prosthetic valve endocarditis most often caused by…

A

S. aureus

55
Q

gram negative organisms or fungi cause endocarditis if the disease develops during the first…

A

2 months after implantation

later dz due to strep or staph

56
Q

Most patients present with: fever (although may be absent in elderly) and non specific symptoms (i.e. cough, dyspnea, arthralgia, back or flank pain, GI complaints)

A

endocarditis

57
Q

aprox 90% of endocarditis patients will have a stable murmur, but this may be absent in..

A

R sided infections

58
Q

25% of patients have…palatal, conjunctival or subungal petechiae; splinter hemorrhages; olser nodes; janeway lesions and roth spots

A

Endocarditis

59
Q

painful, violaceous, raised lesions of the fingers, toes or feet

A

Olser nodes

endocarditis

60
Q

painless red lesions of the palms or soles

A

Janeway lesions

endocarditis

61
Q

exudative lesions in the retina

A

Roth spots

endocarditis

62
Q

pallor and splenomegaly are common; strokes and emboli may occur

A

endocarditis

63
Q

3 sets of blood cultures at least 1 hour apart should be obtained before…

A

starting antibiotics

64
Q

_____ is essential to make the diagnosis of infective endocarditis and identify the specific valves involved

A

Echocardiography

65
Q

The presence of ______ is diagnostic for infective endocarditis

A

vegetation

66
Q

Which echocardiography is best for endocarditis dx

A

Transesophageal echo (TEE)

67
Q
  • 2 positive blood cultures of a typical causative microorganism
  • echocardiographic evidence of endocardial involvement, including new valvular regurgitation
A

Major Criteria for endocarditis

68
Q
  • predisposing factors (i.e. drug use, abnormal valves)
  • fever higher than 100.4 F (38 C)
  • vascular phenomena (ie embolic dz or pulmonary infarction)
  • immunologic phenomena (ie glomerulonephritis, olser nodes, roth spots)
  • positive blood cultures not meeting major critera
A

Minor criteria for endocarditis

69
Q

Gentamicin with ceftriaxone or vancomycin is appropriate initial therapy for pts with suspected..

A

infective endocarditis

70
Q

valve replacement, especially of the ____ valve may be necessary if endocarditis does not resolve w antibiotic therapy

A

aortic

71
Q

systemic immune response occurring usually 2-3 weeks following a beta-hemolytic strep pharyngitis

*most common in recent immigrants

A

Rheumatic fever

72
Q

Major criteria: carditis, erythema marginatum, subcutaneous nodules, chorea, and polyarthritis

A

rheumatic fever

73
Q

Minor criteria: fever, polyathralgias, reversible prolongation of the PR interval, rapid ESR or CRP

A

rheumatic fever

74
Q

ECG change most commonly associated with acute pericarditis

A

diffuse ST segment elevation

Clin Med-Cardio pt 2 (11 decks)

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