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CV > PCM > Flashcards

PCM Flashcards

1
Q

normal blood pressure

A

120/80

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2
Q

preHTN

A

120-139 / 80-89

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3
Q

stage 1 HTN

A

140-149 / 90-99

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4
Q

stage 2 HTN

A

> 160 / >100

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5
Q

Classification of HTN if diabetes or renal disease

A

bad if higher than 130/80

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6
Q

where is S3 heard?

A

apex of the heart using the bell (heard in early diastole)

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7
Q

where is S4 best heard?

A

diaphragm over ICS2 (ask pt to lean forward, also good for hearing pericardial friction rubs)

  • marks atrial contraction
  • heard late in diastole right before S1
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8
Q

if you have congenital aortic stenosis when will you usually develop symptoms?

A

before you are 30

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9
Q

degenerative valve disease is _____________xs more frequent in men than women

A

3-4 times

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10
Q

what does an aortic stenosis murmur sound like?

A 
loud crescendo-decrescendo
systolic
harsh
heard best @ right ICS2
radiates to carotids (delayed upstroke)
softer w/ valsalva
S4 heart sounds often heard in asymptomatic pts
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11
Q

risks for calcific aortic stenosis

A 
hypercholesterolemia
DM I and II
HTN
cigarette smoking
paget disease of bone
ESRD
rheumatic fever
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12
Q

what is the most common valvular disease in the developed world?

A

aortic stenosis

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13
Q

what is the prognosis once an aortic stenosis becomes symptomatic

A

poor, untreated 3 yr mortality rate

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14
Q

what are 3 causes of aortic stenosis?

A

degenerative calcification of aortic cusps
rheumatic inflammation
progressive valvular calcification on congenital bicuspid valve

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15
Q

when do we refer pts with aortic stenosis?

A

when they start to develop symptoms

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16
Q

severe Aortic stenosis

A

when it becomes severe enough the systolic murmur may become inaudible
-aortic closure of S2 absent
S4 often present
also see delayed carotid upstroke

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17
Q

name the murmur:

holosystolic murmur heard best at apex of heart
loud S3 and quiet first heart sound are seen since mitral valve doesnt snap closed
louder w/ valsalva

A

mitral regurgitation

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18
Q

name the murmur:
diastolic blowing murmur along the L. sternal border
-increases w/ handgrip or squatting

A

aortic regurg.

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19
Q

name the murmur:
apical, rumbling diastolic murmur
accentuated in L. lateral decubitus position or w/ exercise
-first heart sound often loud

A

mitral stenosis

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20
Q

name the murmur:

continuous machinery murmur heard best over L. 2nd ICS

A

PDA

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21
Q

what is the most common structural cardiac palpitations

A

mitral valve prolapse

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22
Q

what is the most common cause of non-cardiac palpitations

A

panic disorder

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23
Q

a normal resting ECG cant rule out what

A

can’t rule out an arrhythmia (just a snapshot)

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24
Q

who most often gets mitral valve prolapse

A

women, young women

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25
Q

which pts have the highest rate of complications of MVP

A

men over 50

26
Q

what is the hallmark finding in MVP

A

mid-systolic click and a late -systolic or pansystolic murmur

27
Q

what percentageof pts w/ MVP have no increased morbidity or mortality?

A

75%

28
Q

what is the most common arrhythmia in clinical practice

A

atrial fibrillation

29
Q

what is the median age of A. fib

A

75

30
Q

which arrhythmia is known by an irregularly irregular pulse

A

atrial fibrillation

31
Q

what are the risk factors for atrial fibrillation

A 
HTN
hyperthyroidism
CAD
HF
diabetes
32
Q

Is A. fib more common in men or women?

A

1.5-3x more common in women

33
Q

what is the major complication of A. Fib

A

stroke

34
Q

what is CHADs

A

tool for determining the stroke risk and guides the need for anticoagulation

35
Q

what is the most common cause of Heart failure

A

CAD (particularly systolic HF)

36
Q

what is the most common cause of diastolic heart failure?

A

HTN

37
Q

which pts get diastolic HF?

A

women over 50

38
Q

is mortality same or different with diastolic HF vs. systolic HF

A

same

39
Q

what is one of the strongest risk factors for HF in women

A

DM

40
Q

Which 2 findings most effectively rule in systemic heart failure?

A

displaced cardiac apex
S3 heart sound

other signs:
peripheral edema
PND
JVD
orthopnea
murmur
crackles
41
Q

what things are helpful in ruling out HF?

A

absence of dyspnea on exertion

reduced BNP

42
Q

Class I heart failure

A

no limitations, asymptomatic

43
Q

class II heart fialure

A

mild limitations, HF w/ significant exertion

44
Q

Class III HF

A

marked limitation of physical activity, only comfortable at rest

45
Q

Class IV HF

A

discomfort with any activity; HF symptoms occur at rest

46
Q

________ pain accounts for 20% of chest pain in primary care

A

chest wall pain

47
Q

Costochondritis accounts for ________% of chest pain in primary care.

A

13%

48
Q

GERD accounts for __________% of chest pain in primary care

A

13%

49
Q

what is the most common cause of death in women

A

CVD

50
Q

what is different about the way women experience heart attacks

A

have other heart attack symptoms:

  • upper body pain
  • SOB
  • N/V
  • fatigue
  • cold sweats
  • lightheadedness
51
Q

are men or women more likely to have delayed dx and receive fewer interventions to prevent and tx heart disease

A

women

52
Q

what things are less accurate in women than men

A

diagnostic test

53
Q

women with acute MI’s (3 things)

A
  1. older
  2. have more comorbid conditions
  3. more likely to die than men with same disease
54
Q

initial care of a suspected acute MI includes administration of MONA

A
  1. morphine
  2. oxygen
  3. nitroglycerine
  4. aspirin
55
Q

which drug does choby say improves survival in women with heart attacks?

A

beta-blocker

56
Q

what is the clinical triad in pericarditis?

A
  1. pleuritic chest pain (symptoms lessened when leaning forward)
  2. pericardial friction rub (ask pt to lean forward)
  3. diffuse ST wave changes on ECG
57
Q

sick a couple wks ago (cold/cough), now pleuritic chest pain, reproducible chest pain

A

costochondritis

58
Q

how do you treat costochondritis?

A

couple weeks NSAIDs follow up in a few weeks

59
Q

who is at high risk of aortic dissection?

A

HTN
cocaine
younger pts
tertiary syphilis

60
Q

motivational interviewing

A
  • uses pt insight as means for exploring attitude/behavioral changes that would benefit their health
  • useful in many settings
  • can be done in very short segments and incorporated into routine medical visits
  • pts usually appreciate the rapport
  • pt controls the interaction

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