Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Cardio - Lippincott > Objectives ?s > Flashcards

Objectives ?s Flashcards

1
Q

Extremity rubor usually indicates what?

A

Chronic arterial insufficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Extremity palor usually indicates what?

A

vasoconstriction, anemia, or ACUTE ARTERIAL INSUFFICIENCY

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

cyanosis on the extremities usually indicates what

A

decreased O2 supply - arterial insufficiency, hypoxemia, venous stasis, arterial obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

NY Heart association functional classification of heart disease

A

Class 1: no limitations, no sx.
Class 2: slight limitations of physical activity
Class 3: Marked limitation - comfy at rest but less than ordinary activity causes sx.
Class 4: Unable to engage in any physical activity without discomfort, sx may be present even at reat
Class 5: symptoms that are atypical and can occur either at rest or exertion.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

BP goal per JNC7

A

under 140/90 or 130/80 if CKD or DM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

initial treatment for HTN (JNC 7)

A
  • Thiazide (stage 1, 140-159/90-99)

- Drug combo (stage 2, 160+/100+)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

JNC 8 recommendations for HTN

For those 60+?
For those under 60?
For those 18+ with CKD?
For those 18+ with DM?

A

60+: initiate tx at 150 SBP or 90 DBP, treat to les than this. A recommendation.

Under 60, initiate at 140SBP or 90DBP, treat to less than this. Grade A rec for DBP, grade E for SBP and for those 18-29.

18+ with CKD: treat at 140/90 (either), treat to less than this, grade E recommendation

18+ with DM: treat at 140/90 (either #) to less than this, grade E recommendation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

JNC8 recommendations for non-black HTN tx?

For black HTN treatment (inc. DM)?

For 18+ with CKD

A

For non-black: one of - Thiazide, CCB, ACE/ARB –> B rec

For black: Thiazide OR CCB –> B rec (or C for DM)

CKD: ACE or ARB –> B recommendation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What to do if the drug doesn’t work?

A
  • If goal BP not reached in one month, increase dose or add another drug
  • If not reached with 2, add one more
  • Use other drugs if contraindication or if more than 3 drugs are needed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Can you prescribe an ACE and an ARB together?

A

NO WAY JOSE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Isolated Systolic Hypertension - definition and typical patient

A

Systolic > 140, Diastolic less than 90

-Older man with atherosclerosis and DM, obesity, alcohol use, smoking, sedentary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Sx and complications of isolated systolic HTN

A

Sx: really, non. headaches?

Complications: stroke, MI, HF, kidney failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Essential hypertension - definition and typical patient

A

No clear cause, 140/90 BP

more common in blacks than whites
-obesity, salt intake, smoking, alcohol, NSAIDs, metabolic syndrome, sleep apnea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

S/Sx of essential HTN

A

Mostly asymptomatic! HA most frequent. Later HTN can show retinopathy (copper/silver wiring, exudates, hemorrhages, papillidema)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

End organ damage possible with HTN

A 
Heart: LV hypertrophy--> heart failure
Brain: stroke, TIA, dementia
CKD
PAD
Aortic dissection
reinopathy
nephrosclerosis (particularly in african americans)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Workup for HTN pt

A

Hg, UA, Serum creatanine, fasting blood glucose, lipids, serum uric acid, serum electrolytes

(Dr. S - ECG, UA, HCT, K, CBG, GFR, Lipids)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Primary aldosteronism

A
  • cause of secondary hypertension
  • adrenal hyperplasia or aldosterone producing adenoma
  • risks=fam hx, hypokalemia
  • s/sx: mm weakness, polyuria, nocturia
  • complications: organ damage (cerebral hemorrage, MI, cardiomegaly, arrhytmia, renal insufficiency), hypokalemia, metabolic alkalosis, supression of renin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

CKD

A
  • MOST COMMON cause of secondary hypertension
  • increased intravascular volume or increased renin-angiotensin-ald system activity
  • risks: elderly, nephrotoxic drugs, DM, CVD, HTN, SLE
  • S/sx: sleep disturbances, fatigue, anorexia, N/V
  • CAUTION - Kidney failure
  • Workup: GFR, albumen, creatine ratio
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Renovascular disease

A
  • renal arter stenosis or fibromuscular dysplasia
  • decreased renal perfusion pressure, excess renin release
  • complications: end-stage renal disease, pulmonary edema, unstable cornary syndromes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Coarction of the aorta:

A

congenital localized narrowing of the aortic arch just distal to the left subclavian artery. Collateral circulation develops.

RADIAL FEMORAL DELAY.

Cardiac failure usually occurs in infancy, if not, pt is generally asymptomatic until HTN produces LV failure or cerebral hemorrhage.

Continuous murmur on back and left anterior chest.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Pheochromocytoma

A

Rare - catecholamine producing tumor within adrenal medulla, causes vasoconstriction and leads to a reduction in plasma volume.

  • Postural hypotension
  • Risks: TCAs, antidopaminergic agents can cause hypertensive crisis.
  • S/sx: orthostatic drop of 20/10 mmHg, TRIAD of headachee, sweating, palpitations, glucose intolerance.
  • SCREEN those at risk via genetics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Drug induced hypertension

A

Drugs that can exacerbate HTN, usually due to renal vasocontriction or sodium retention
(nsaids, cocaine, erythropoeitin, stimulants, OCPs, cyclosporine, alcohol).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Thyroid/Parathyroid

A

familial, acquired, autoimmune.

END ORGAN: CHF, exaggeated with levothyroxine tx.

s/sx - forceful heartbeat, PACs, sinus tac, exertional dyspnea, afib (hyper)
weakness, fatigue, cold intolerance, depression (hypo)
-TSH/T4/T3 echo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Sleep apnea and HTN

A

Elevated sympathetic activity, CV variability, intrathoracic pressure changes, inflammation, oxidative stress.

PT: male, older age, increased BMI/neck girth, snoring, pauses

CPAP!

complications - CV disease, AAA, HTN, DM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Hypertensive urgency vs. hypertensive emergency

A

Urgency: 220/125 (either one) usually does not requre emergency therapy unless organ damage is evidence. Reduce within a few hours.

Emergency: BP diastolic >130. Reduce within an hour. HOSPATILIZE! encelopathy, neuropathy, intracranial hemorrhage, aortic dissection, preeclampsia, pulmonary edema, agina, MI.

  • Reduce BP by 25% within minutes to hour, then the next goal is less than 160/110 in 2-6h. Don’t drop too quickly.
  • use nitroprusside, NG, lalbetalol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

malignant hypertension

A

HTN much like hypertensive emergency–NEEDS HOSPITALIZATION, encephalopathy or neuropathy with accompanying papilledema in addition to htn

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Hypercholesterolemia

A

Reduce saturated fats, cholesterol, increase fiber, lose weight, exercise. Treat with statins for total cholesterol <200mg/dL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Elevated LDL

A

-diet & lifestyle change, weight loss, quit smoking.

tx goals:
high risk, is >100, treat to less than 100
mod high, goal=130, start tx at 130
mod, goal=130, start tx at 160, lifestyle changes 130
low=less than 160, consider drug therapy at 190

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

hypertriglyceridemia

A

can be caused by obesity, DM, alcohol, CKD, COPs, diuretics. Diet is primary therapy. Statin, fibrates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

low HDL

A

reach LDL first, focus on weight and exercise.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Familial hypercholesterolemia

A

GENETIC, total cholesterol >500 usually. Warning: sudden death can happen. Family hx is important, cut saturated fat from diet, lose weight, exercise. No prevention. Use statins.

32
Q

Ankle Brachial Index

A

upper and lower extremity BP comparison, indicates CAI. less than .9 is abnormal, .5 indicates significant disease.

33
Q

risks of CAI

A

coronary artery insufficiency - ulcerations, acute ischemia, amputation (worse in diabetics and smokers)

34
Q

Occlusive cerebrovascular disease

A

-due to emobli occluding cerebral artery: TIAs
-most emboli originate from the proximal internal carotid (unless Afib)
-Sudden weakness/numbness of extremity, aphasia, dysarthria, unilateral blindness.
-bruit loudest in neck
-can last few mn (or seconds for TIA) to 24 hrs
STENT

35
Q

Aorta and Iliac Occlusive Dz

A
  • distal abdominal aorta and iliac arteries - atherosclerosis.
  • obstruction of blood to lower extremities
  • Men 50-60yr, smokers, claudication, dimished femoral pulses, tissue loss
  • Pain in low/back buttock!!!, pain with exercise, ED, weak pulses, low ankle brachial index
  • No meds, control risk factors. Angioplasty, stenting, antiplatelet therapy.
36
Q

Mesenteric Insufficiency AKA visceral artery insufficiency

A

Postprandial abdominal pain, weight loss with “fear of eating,” embolic occlusion of one major mesenteric vessel.
Tx - determine bowel viability, bypass, resection,
for chronic: angioplasty and stenting

37
Q

Acute arterial occlusion (embolism/thrombosis)

A

Loss of blood supply to distal extremities due to:

-thrombus formation of a disease vessel (ruptured plaque) –> most common.

arterial emboli: 80% arise from heart, emboli come from another location in the body, secondary to Afib, etc.

acute thromboses: likely if other evidence of chronic obstructive disease present. Thrombus formation of diseased vessel.

38
Q

5Ps of compartment syndrome and other features of acute arterial occlusion

A

pain pallor parasthesias pulselessness, pain
veins collapsed
blue toe syndrome

39
Q

clinical presentation of acute arterial occlusion

A

50% with sudden onset of severe, unrelenting leg pain
50% have insidious onset of pain over several hours

sharp demarcation between perfused and ischemic tissues

40
Q

treatment of acute arterial occlusion

A

HOSPITAL! Heparin, tpa

41
Q

Thromboangiitis Obliterans (Buerger Dz or TAO)

A

SMOKING disease, generally in young males

  • multiple segmental occlusions of obliterating tibial and pedal arteries, can also affect UPPER EXTREMITIES
  • more common in Japan and SE asia
  • small/medium arteries and veins, CLOTTING
42
Q

Superficial thrombophlebitis

A
  • hardening, tenderness, redness along vein
  • most commonly from IV placement, can also be trauma, varicose, TAO, or spontaneous.
  • Inflammation subsides 1-2weeks and “firm cord remains.
  • Usually benign and brief, treated with NSAIDs, but can lead to post phlebitic syndrome if untreated.
43
Q

DVT

A
  • Pain or aching in affected limb, swollen/red/tender with distended veins, pitting edema, Homan’s sign. 50% asymptomatic in early stages.
  • DOPPLER/VENOGRAPHY*/D-Dimer
  • Low dose heparin and compression socks (proph)
  • Heparin+3 mos oral warfarin (tx)
44
Q

Varicose Veins

A
  • Hereditary, associated with prolonged standing/lifting, highest incidence after pregnancy
  • Dull, aching heaviness
  • Compression stockings, elevation, stripping, sclero (better hope you don’t need cardiac surgery!)
45
Q

Chronic venous insufficiency

A
  • Veins are dilated or valve leaflets scarred/thickened
  • can result from trauma, obesity, or secondary to thrombophlebitis
  • progressive pitting edema (can be unilateral), brawny pigmentation, taught/shiny ankle skin, ulcerations just above ankle (medial/anterior aspect of leg), fibrous subQ for longstanding cases
  • COMPRESSION STOCKINGS and treat any DVT
46
Q

AAA

A
  • Widening of the AAA (normal is 2cm)
  • Normal part of aging, can be caused by inflammation, more common in men
  • Most are asymptomatic, pain and tenderness indicate impending rupture
  • 90% below renal arteries at bifurcation
  • ULTRASOUND and elective repair if >5.5cm or rapidly expanding.
47
Q

Thoracic Aortic Aneurysm

A
  • Most due to atherosclerosis, CT disorders, trauma
  • Most asymptomatic, can cause back/neck pain or pressure on trachea and associated sx
  • CXR, CT scan (gold standard)
  • Surgical repair if 6cm or larger
48
Q

Aortic Dissection

A
  • Spontaneous tear in aorta, may be from repetitive torque from cardiac cycle
  • SEVERE chest pain, radiating to back. Syncope/hemiplegia/paralysis, diminshed pulses, diastolic murmur in ascending aorta
  • LVH on EKG, CT (gold standard)
  • Control BP, surgical graft
49
Q

Stable angina

A

Under the patient’s control –> predictable triggers and relief

50
Q

Probable angina

A

Classic discomfort, not exertional, not relieved by rest/NG

51
Q

Unstable angina

A

Out of pt’s control –> more severe episodes, at lower workload, rest, barely relieved by NG

52
Q

3 determinants of oxygen demand

A

Heart rate, myocardial contractility, ventricular wall stress

53
Q

Determinants of oxygen supply

A

Low ambient O2, inadequate O2 transfer from lungs to blood, inadequate O2 transfer from blood to tissues, inadequate blood supply to myocardium

54
Q

Labs for angina

A

CK-MD, troponin, hyperlipiedmia labs. 3 serial cardiac enzyme tests to r/o MI. EKG shows ST degment depression for unstable.

55
Q

TX for angina

A

Nitrates, bblockers, aspirin. Treat HTN, avoid triggers.

56
Q

variant (prinzmetal) angina

A

Common in smokers, caused by coronary spasm, causes ST segment elevation. Occurs without precipitating factors, early in the AM. Normal labs. Nitrates, CCB to treat.

57
Q

MI, Two types of MI

A

MI: rise of cardiac biomarkers with evidence of myocardial eischemia (EKG)

NSTEMI - non-occlusive thrombus with no ST elevation but cardiac enzyme elevation

STEMI - ST elevation with cardiac enzyme elevation

58
Q

Etiology of MI

A

COMMON: Occlusive coronary thrombus at the site of a pre-existing atherosclerotic plaque.

Rare: downstream embolus mobilizes, vasculitis, dissection, cocaine (consider if young with no risk factors)

59
Q

Symptoms of MI

A

-Unstable angina, JVD, kussmaul, soft heart sounds, S4 sounds, mitral regurg, rales in lungs –> both types

Prolonged chest disconfort with little/no effect of NG, acute death –> STEMI

60
Q

Labs for MI

A

Gold standard: troponin I, troponin T, CK-MB, myoglobin, Total CPK, ECG

61
Q

Managment of MI

A

ASA, O2, LMWH, thrombolysis for STEMI, beta blockers post MI

62
Q

Silent MI

A

occlusive thrombus with no pain, ST elevation, and cardiac enzyme elevation

  • more common in women, older, those with DM
  • tx directed at underlying problem - CHF usually
    tx: ACE/ARBs, other health lifestyle things
63
Q

Post MI treatment:

A

1) Cardiac cath if pt has recurrent ischemia, imparied LV function, heart failure, ventricular arrythmias, hemodynamic instability
2) ACE inhibitors, Aldosterone blockade if LV EF less than 40%
3) Lipid management (statins), smoking cessation, BP control, BETA BLOCKERS, antiplatelets (aspirin and clopidogrel), cardiac rehab/exercise
4) Cardiac revascularization in those with LV dysfunciton, NSTMI with high risk, risk factors, those who underwent thrombotic therapy

64
Q

Right heart failure vs. Left heart failure

A

Left: Exertional dyspnea, cough, fatigue, orthopnea, PND, cardiomegaly, rales, gallop, pulmonary venous congestion
*symptoms of low cardiac output and elevated pulmonary venous pressure

Right: Elevated venous pressure, nocturia hepatomegaly, dependent edema –> Usually due to LEFT HEART FAILURE
*signs of fluid retention

65
Q

CHF

A

Condition in which the blood cannot adequely pump blood to the body, most are a combiation of left and right failure.
-a disease of aging

Systolic dysfunction:
-heart function based on depression of myocardial contractility (most common cause, often MI related), elevated preload of ventricle (valvular regurg, etc), excessive afterload (impeded LV ejection), and heart rate.

Diastolic dysfunction: can lead to heart failure when filling of LV or RV is abnormal (impaired relation, noncompliant chamber)

66
Q

Tx of CHF

A

Diuretics+Acei, B-blockers can be added.

Poor prognosis - 5 yr mortality rate of 50%

67
Q

Endocarditis

A
  • bacterial or fungal infection of the valves/endocardium
  • fever, splinter hemorrhages, osler nodes, janeway lesions, roth spots, stroke/emoblic events
  • get CXR, echo, 3x blood cultures on hr apart
  • vanco+cephtriaxone before specific culture back
  • surgery often necessary
68
Q

myocarditis

A

Viral and non-viral causes (cocaine, chemicals, radiation, SLE, chemo)

  • can present days to weeks after acute febrile
  • dyspnea, chest pain, arrythmias, heart failure, sinus tach, cardiomegaly
  • EKG, CXR, requires confirmational bx
  • Ace inhibitors and Bblockers if LV EF <40%, treat arrythmias, NSAIDs for pain
69
Q

pericarditis

A

viral, neoplasm, radiation, drug, dressler syndrome (post surgery), kidney failure

  • chest pain, dyspnea, fever, pericardial friction rub
  • Complication: Cardiac tamponade
  • Elevated WBC,BUN, pericardiocentesis, EKG
  • NSAIDs, cholchisine, steroids
70
Q

Dilated cardiomyopathy

A
  • Idiopathic, alcoholism, myocarditis, postpartum
  • sx of HF (dyspnea, elevated JVP, cardiomgealy, edema, ascities), if severe-chene stokes, pulsus alternans, ventricular arrythmias
  • S3 gallop, sinus tach, left BBB, arrhythmias
  • CXR shows cardiomegaly and pleural effusion, BNP to show severity
  • Treat with ACEI, B-blockers, diuretics, digoxin is second line, avoid CCBs
  • Pacing
71
Q

HOCM

A

Hypertrophic cardiomyopathy, LV hypertrophy unrelated to pressure/volume overload.

  • Autosomal dominant, presents in early adulthood with dyspnea/chest pain/post-exertional syncope, arrythmia
  • dyspnea, chest pain, syncopy; symptoms related to diastolic dysfuntion, Lous S4 sound, Mitral regurg
  • septal hypertrophy, which reduces LV systolic stress, increases EF, and can result in empty ventricle at end of systole.
  • Tx: bblockers, CCBs, diuretics, defibrillation, surgical excision
72
Q

Restrictive cardiomyopathies

A

Impaired diastolic filling with preserved contractile funtion; rapid early filling with diastolic dysfunction.

  • Right heart failure dominates over left heart failure
  • pulmonary HTN present, Kussmaul sign
  • Amyloidosis is the most common cause
  • EKG, diuretics, chemo if amyloidosis
73
Q

Tako-Tsubo cardiomyopathy

A
  • Occurs after major catecholamine discharge
  • Chest pain and shortness of breath, most commonly in postmenopausal women
  • Presents as acute MI, imaging reveals left ventricular ballooning - most pts recover completely
  • aspirin, bblockers, ace.
74
Q

Rheumatic fever

A

Jones criteria - two major or one major/two minor.

major criteria: carditis, erythema, sydenham chorea, polyarthritis
minor: fever, polyarthralgias, reversible PR intervals, elevated ESR/CRP

75
Q

rheumatic fever can lead to rheumatic heart disease and damage in which valves?

A

mitral, aortic, tricuspid (high pressure valves affected most). Early lesion is mitral valve regurg, late is mitral stenosis.

Cardio - Lippincott (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions