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ABOMS OCE > Sound Bites/One Liners > Flashcards

Sound Bites/One Liners Flashcards

1
Q

What is hypertension?

A

A pathologic dysregulation of homeostatic mechanisms resulting in elevated blood pressure levels in peripheral vessels.

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2
Q

What are the ACC/AHA/JNC8 classifications for HTN?

A

Normal: <120/80
Elevated: 120-129/<80
Stage I: 130-139 or 80-89
Stage II: >140 or >90
HTN urgency: >180/120 without signs of end organ dysfunction
HTN emergency: >180/120 with signs of endo organ dysfunction

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3
Q

What are the types of HTN

A
  1. Essential (no identifiable cause); 90%
  2. Secondary (identifiable cause: renal, endocrine, cardiovascular)
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4
Q

What is sequelae of uncontrolled/poorly controlled HTN?

A
  1. Left ventricular hypertrophy
  2. Ischemic disease
  3. CHF
  4. Renal insufficiency
  5. Retinopathy/vision loss
  6. Cerebrovascular accident
  7. Peripheral vascular disease
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5
Q

How do you treat HTN?

A

Lifestyle modifications
Pharmacotherapy:
1. Calcium channel blockers
2. ACE inhibitors
3. ARBs
4. Beta blockers
5. Thiazide diuretics
6. Direct renin inhibitors
6. Alpha-2 agonists

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6
Q

How do you manage HTN patients for sedations?

A
  1. Continue all with exception of ACE inhibitors and diuretics.
  2. Avoid ketamine (sympathomimetic)
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7
Q

What perioperative considerations do you have for patients who use ACE inhibitors or ARBs?

A
  1. Pre-operative BMP to evaluate for hypokalemia
  2. More prone to perioperative hypotension
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8
Q

How would you manage HTN emergency?

A
  1. Active EMS.
    Any signs of end organ dysfunction (MI, dyspnea, AMS, seizures, HD instability)
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9
Q

What is atherosclerosis?

A

Hardening of the arteries due to lipid accumulation on the arterial wall

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10
Q

What is angina?

A

Reversible hypoperfusion of the coronary arteries leading to chest pain

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11
Q

What are the classifications of angina?

A
  1. Stable angina: symptoms on exertion, relieved with rest. (atherosclerosis & indication that vessels are ~70% stenotic, supply ischemia)
  2. Unstable angina: symptoms not relieved at rest (atherosclerosis and thrombus, demand ischemia)
  3. Variant angina: symptoms at rest, caused by vasospasm (supply ischemia)
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12
Q

What are the classifications of Acute Coronary Syndrome (ACS)?

A
  1. Unstable angina: chest pain not relieved at rest
  2. NSTEMI: EKC con show ST depression or T wave inversion
  3. STEMI: ST elevation
  4. MI: infarct of myocardium secondary to hypoperfusion of coronary arterial system
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13
Q

How do you manage ACS in your office?

A
  1. Activate EMS
  2. Chew ASA, administer nitroglycerin (0.3-0.6mg SL q5m x3)
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14
Q

What are METS?

A

Metabolic equivalents used to assess cardiac functional capacity. 1 MET is basal oxygen consumption of a 40 YO 70kg Male.

Less than 4= poor functional capacity, discuss need to optimize/ pre-surgery cardiac testing. Consider tx in hospital setting

> 4: speed walking, climbing flights of stairs, light yardwork
10: sports, strenuous exercise

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15
Q

When do you proceed with treatment after ACS event?

A

Per ACC/AHA guidelines, recommend deferring non-emergency, non-time sensitive surgery for at least 6 months after DES and BMS.

Risks prior to tx time include: Ventral wall free rupture, acute mitral regurgitation, interventricular septum rupture.

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16
Q

How would you manage a patient after recent ACS?

A
  1. Anxiolysis preoperatively
  2. Profound local with <40 mcg of epi
  3. BP and HR within 20% of baseline
17
Q

What is the Revised Cardiac Risk Index (RCRI)?

A

An index for cardiac risk stratification. Points are allotted for:
1. High risk surgery
2. Hx of ischemic cardiac disease
3. Hx of CHF
4. Hx of cerebrovascular disease (CVA or TIA)
5. DM with insulin management
6. Pre-operative sCr >2.0 mg/dL

1 = low risk
2= moderate risk
3= high risk

18
Q

What is CHF?

A

A condition characterized by the inability of the heart to pump enough blood to meet the metabolic demands of the body

19
Q

What is the classification system for CHF?

A

New York Heart Association
Class I: heart disease w/ no symptoms or limitations of physical activity
Class II: no symptoms at rest and slight limitation to ordinary activity
Class III: Marked limitation of activity with minimal exertion
Class IV: symptoms at rest. Severe limitations of activity

20
Q

What heart sounds do you expect to hear with CHF?

A

S3 (ventricular gallop in early diastole- sign of HFrEF) and rales (indicate volume overload)

S4 (atrial gallop in late diastole- sign of HFpEF), almost always pathologic

21
Q

How does your physical exam change for CHF patients?

A

Looking for JVD, peripheral edema, S3/S4 heart sounds, SOB/dyspnea, rales on auscultation.

Consider preoperative work up: EKG, echo, CXR, labs, cardiology communication

22
Q

How do you treat CHF?

A
  1. Diuretics to tx systemic & pulmonary congestion
  2. Beta blockers to decrease myocardial oxygen consumption
  3. Digoxin to increase cardiac contractility
  4. Ace-I to decrease afterload and prevent aberrant cardiac remodeling
23
Q

Describe S1, S2, S3, S4 hearts sounds

A

S1: mitral/tricuspid valve closure (loudest at apex of the heart)
S2: aortic/pulmonic valve closure (loudest at right sternal border
S3: Ventricular gallop right after S2 caused by large amount of blood striking left ventricle. Can be a sign of HFrEF 2/2 dilated ventricle but can be normal in kids, athletes, pregnancy
S4: Atrial gallop right before S1 caused by atria force blood into the left ventricle when ventricle in non-compliant. A sign of HFpEF or active MI. Almost always pathologic.

**S3 and S4 are low pitched sounds best heard at the cardiac apex w/ bell stethoscope

24
Q

What is cardiomyopathy?

A

A disease process affecting the myocardium that impairs the hearts ability to pump or fill

25
Q

What are the 4 types of cardiomyopathy?

A
  1. Hypertrophic
  2. Hypertrophic obstructive
  3. Dilated
  4. Restrictive
26
Q

What is hypertrophic cardiomyopathy vs hypertrophic obstructive cardiomyopathy?

A

Hypertrophic (non-obstructive) usually major comorbidity is HTN resulting in thickened walls and reduced space for blood.

Hypertrophic obstructive is obstruction from outflow by interventricular septum blocking blood flowing out of the aorta. Genetic AD. Common in young athletes dying

Both are problems filling the heart due to adequate space for blood 2/2 muscle growth

27
Q

What is dilated cardiomyopathy?

A

Heart fills but cannot pump appropriately. Main comorbidities are EtOHism and MI

28
Q

What is restrictive cardiomyopathy?…………………………

A

Both filling and pumping issues usually 2/2 myocardial rigidity. Main comorbidities are: sarcoidosis, scleroderma, malignancy.

29
Q

What is atrial fibrillation?

A

Abnormal electric foci in the atrium leading to an IRREGULARLY IRREGULAR arrhythmia`

30
Q

What is Virchow’s Triad?

A

Endothelial damage, stasis of flow, hypercoagulable state

31
Q

How do you treat atrial fibrillation?

A
  1. Rate or rhythm control
  2. Ablation

..

ABOMS OCE (1 decks)

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