Module 3 Flashcards
Cardiology
Describe the pathophysiology of stable angina
occurs when the heart cannot support the increasing O2 myocardial demands
What are the clinical manifestations of stable angina?
tightness, squeezing, clenched fist over the chest
often increases with activity or exertion
decreases in discomfort during rest
short duration, <3min
What are the treatment options of stable angina
short term nitroglycerin sprays or SL tablets to be taken 5 min prior to activity
long acting nitrates also an option
beta blockers-good effect and decreases mortality
antiplatelets
Describe how you would manage stable angina and when it is appropriate to refer to ER
medication treatment
refer to ER if ongoing pain despite usage of short term nitrates and beta blockers
Describe unstable angina and progression into NSTEMI
worsening chest pain
no oxygen to supply heart
NSTEMI is less concerning than a STEMI
NSTEMI vs. STEMI
similar in characteristics; ECG ST waves will be depressed or elevated.
increased ST wave= potential myocardial infarction due to rupture of plaque causing blockage
Clinical presentation of myocardial infarction
racing heart, increasing chest pain, nausea/vomiting, radiating chest pain to shoulder or jaw
women present differently
Describe the etiology of CHF
heart is unable to meet the demands of the body
usually caused by a structural concern of the heart (valve problems, poor ventricular filling, ejection fraction)
can be caused by other factors such as HTN, a fib, cardiomyopathy
abnormal vessels of the heart trigger the RAAS because there is not enough demand on the heart
What are some clinical findings of CHF/
SOB, fluid overload, edema, fatigue, nausea/vomiting loss of appetite, impaired mental status, anemia, tachycardia/bradycardia
What are the diagostic tools used for CHF?
not one good diagnostic echocardiography- looks at the structures of the heart and how it flows CXR MRI CT scan labs - BNP (brain nautureitic peptide)
What is the management of CHF? (dependent on stages)
stage A- no structural changes treat underlying condition ie a fib, HTN
stage b- structural abnormality but mild, asymptomatic, treat underlying condition plus beta blocker
stage c- structural abnormalities plus symptoms; meds and symptom management inc. fluid restrictions, decrease sodium intake
stage d- LVAD, surgical intervention, end of life care
DEscribe the etiology of A fib
common, irregular electrical impluses
greater risk of stroke
valvular and non valvular a fib (structural heart changes/ mechanical heart valve vs. opposite of that)
what are the clinical findings of a fib?
palpitations, irregular HR, rapid, may be induced by exercise
What is the diagnostic evaluation for afib?
ECG
echocardiogram -show size of the hart
holter
stress test
Describe the management of a fib
unstable? - to ER
stable- may not be needed in asymptomatic individuals <65 years of age and asymptomatic
may consider an anticoagulant if hx of other cardiac concerns
valvular afib- treat with warfarin only
non valvular a fib- warfarin or NOAC
Describe the etiology of HTN
increased pressure to the vessels causes the blood to flow harder, cardiac output is affected due to straining and stretching of the vessels
rks factors: obesity, smoking, diet, sedentary lifestyle
Primary vs. secondary (primary-idiopathic) secondary- due to disease process
What are the clinical manifestations of HTN?
often asymptomatic
assess for other things- sleep apnea, headache, family hx and lifestyle
What is the managgement of HTN?
often clinic BPs higher, consider looking at home BPs bfore starting meds
start with thiazide, acei or arb depending on pt factors, cost, and renal function
What is the patho behind dyslipidema?
elevateed cholesterol, LDL, or low HDL = potentially causes coronary artery disease
What are the diagnostic tools for dylipidemia and management?
dx tools= bloodwork (complete lipid profile), usually screening done in pts that have increased family hx of CV risl
DM or prev. CV concerns warrant testing
framingham score
What is the management for dyslipdemia?
statins for secondary reasons (prev. MI, HTN, DM) are useful in preventing plaque buildup
no real reason to use in primary prevention or just based on LDL levels
diet, smoking cessation
Common side effects of statins
increased risk of DM
increased risk of muscle pains
increased risk of GI effects
rhabdomylosis or myositis as severe side effects
Alternative options to statins for treatment of dyslipidemia
niacin
resins
ezetimibe
What is the risk of high blood triglyercerides?
unknown patho but can cause increased risk of pancreatitis
diet modification, restricting fatty foods
S/s of aortic dissection
patho- tears in the intima of the aortic wall, blood enters the aortic space causes a secondary pathway for blood flow
hypertension is a risk factor and is an emergency
severe chest pain with a ripping or tearing quality
radiating down back or anterior chest
hypertension, paralysis, kidney failure or injury, ischemia to the lower peripherals
S/S of abdominal aortic aneurysm
patho- dilation of renal aorta to >5cm, unable to handle pressure causing possible rupture
hypotension, pulsing abdoiminal mass (caused by acute rupture) pain that radiates from abdomen to the back, could be asymptomatic, fevers, chills
S/S of DVT
patho- triad of virchow (venous stasis, venous injury, hypercoagulation)
asymptomatic
unilateral leg pain with or without mass
tender to touch, hot to touch
edema
PE- SOB, chest pain, cough, tachycardia, syncope - ER
define anemia
decrease in hgb or hemtocrit, women <120, men <135
describe the types of different anemia (microcytic, normocytic, macrocytic)
micro- iron deficiency (most common), thalassemia, inflammation or infection
normo - sickle cell anemia, aplastic anemia
macro - vitamin b12 or folic deficiency
Describe the causes, management and treatment of iron deficiency
microcytic anemia- most common
causes: mennstrual loss, pregnancy, trauma, malabsorption
clinical findings: fatigue, tachycardia, palpitations, pallor, headaches, pica
treatment: parentarel or oral iron (empty stomach, vitamin c faciliatates absoprtion)
Describe the causes, management and treatment of thalassemia
genetic disorder, more common in asians, changes in the genetic makeup of the RBCs
clinical findings: may depend on the severity of the condition (similar to iron deficiency anemia), more severe - requires iron transfusions frequently
Describe the causes, management and treatment of vitamin b12 deficiency
primary care of macrocytic anemia, needed for development of DNA
usually because of dietary restrictions or those who cannot absorb vitamin b12
more common in vegans
clinical findings: anemia traits, fatigue, tiredness, palpiations, brain fog, neurological defects if severe (parasthesias, ataxia, loss of sensory vibration, romberg may be pos. sore mouth, loss of taste)
treatment: oral vitamin b12, injectable vitamin b12 , may require transfusion if severe
Describe the causes, management and treatment of folate deficiency
causes- dietary, pregnancy
needs to increase during pregnancy, occurs in those who can’t absorb folate
clinical findings: often absent, may have anemia type symptoms
management: daily folate, increase dose during pregnancy
Describe the difference between stable and unstable angina
stable angina- relieved by rest, short term nitrates
unstable- cardiac chest pain that is unrelieved with rest or medications
What is the management for unstable angina
refer to ER- o2, nitro, antiplatement
long term beta blocker or statin
Describe the difference between type A and type B aortic dissection
type A- worse prognosis, involves aortic arch
Type B- proximal descending arch
