Test 3 Flashcards
Due to coronary vessel spasm. Discomfort occurs mainly at rest
variant angina
Pain may occur with less provocation, be prolonged, more sever, associated symptoms
Unstable angina non-STEMI
Chest pressure, heaviness, squeezing, crushing. May be associated with N/V, diaphoresis, SOB
acute STEMI
Microvascular angina is more often seen in
women
May be d/t insufficient dilation of coronary arteries
microvascular angina
symptom not typically recognized as a symptom of chest pain
headache
EKG markers for hypokalemia
U waves, peaked T waves, wide QRS, prolonged PR
changes on EKG with ischemia include
T wave inversion
angina pain is caused by myocardial irritation from
lactic acid
At risk for HF but w/o structural heart disease or symptoms of HF
Stage A
Structural heart disease but w/o S&S of HF
Stage B
Structural heart disease with prior or current symptoms of HF
Stage C
Refractory HF requiring specialized interventions
Stage D
No limitation of physical activity. Ordinary physical activity doesn’t cause symptoms of HF
Functional status I
Slight limitation of physical activity. Comfortable at rest, but ordinary physical activity results in symptoms of HF
Functional status II
Marked limitation of physical activiity. Comfortable at rest, but less than ordinary activities caused symptoms of HF
Functional status III
Unable to carry out any physical activity w/o symptoms of HF, or symptoms at rest
Functional status IV
adverse effect of ACEI in blacks
angioedema
class of drugs used to trx isolated systolic hypertension
calcium channel blocker
when men should be screened for dyslipidemia
age 35 and older, age 20-35 if at high risk for CHD
when women should be screened for dyslipidemia
age 45 and older if at increased risk for CHD
parameters in Framingham scale
age, gender, total cholesterol, HDL, systolic BP, smoking, diabetes, BP treatment
statins are contraindicated in
pregnancy
initiate moderate to high intensity statin if 10 year ASCVD risk is
> 7.5%
start fenofibrate if
TG > 500 and at risk for pancreatitis
rechecking cholesterol level 4-12 weeks after starting a statin are to
assess for adherence, not to titrate.
4 groups to treat with statins
- clinical ASCVD
- LDL > 190
- Diabetics 40-75 with LDL 70-189
- LDL 70-189 with 10 year risk > 7.5% w/o ASCVD or DM
this does not need to be routinely measured with statins
CK
measure this baseline before starting statins
ALT
according to ACA/AHA 2014, if muscle symptoms develop
temporarily d/c statin, evaluate for other conditions, rechallenge with lower dose or same statin.
side effect of CCB
peripheral edema
drug of choice for isolated systolic HTN
CCB
avoid giving this drug in patients with HF
CCB
beta blockers can block signs of
hypoglycemia in diabetics
which HTN drug can increase lipid levels?
HCTZ
drug class of choice for CHF
ACEI
screen these people for AAA
those 65-75 year old men who have ever smoked one time
a decreased risk of AAA is those who are
women and diabetics
direct factor Xa inhibitor
Xarelto and Eliquis
direct thrombin inhibitor
Pradaxa (dabigatran)
direct thrombin and direct factor Xa inhibitors are contraindicated in
prosthetic heart valves and renal disease
preferred anticoagulant in pregnant women
LMWH
screening for BP begins in people age
18 and older
USPSTF screening for high blood pressure
every 2 years for people who have normal BP and every year for those who are prehypertensive
goal BP for those > 60
less than 150/90
med for all people with CKD present
initiate ACEI or ARB
med for black people with diabetes
CCB or thiazide
med for white people with diabetes
thiazide, ACEI, ARB, CCB
screening for carotid artery stenosis
NOT recommended to screen for those asymoptomatic
this test should not be a screening tool for diagnosing CHD
coronary artery calcium scoring
The USPSTF recommendations for exercise ECG testing
against routine screening for those at low risk for CHD
The USPSTF recommendations for nontraditional risk factors for CHD
insufficient evidence to help screen for CHD
nontraditional risk factors
CRP, ABI, fasting glucose, homocysteine
USPSTF recommendation for ABI
insufficient in screening for PAD
contraindication for exercise ECG stress test
baseline ECG abnormality
golden standard in diagnosing CHD
angiography
stable angina occurs
predictably and at a certain level of exertion and is relieved with rest
drugs for angina
beta blockers, CCB, nitrates
reduce HR and contractility
beta blockers
only antianginal drug that is proven to prevent reinfarction and improve survival in patients who had an MI.
beta blocker
beta blockers should not be used in those with
variant (prinzmetal) angina
cause coronary and peripheral vasodilation and reduce contractility.
CCB
do not use this CCB with beta blockers for angina
nifedipine
add this on if initial trx for angina with beta blockers fail
CCB
first line for acute angina
nitrates
atypical sign of MI in elderly
exertional dyspnea
consider starting statin therapy in children > 10 years old with elevated LDL after
6 months of lifestyle counseling.
first DOC for HF with LVEF less than 40%
ACE or BB
drugs for HF
diuretic, ACE/ARB, beta blocker
may lead to an increase in symptoms of HF for 4 to 10 weeks before any improvement is noted.
beta blockers
Prehypertension
120-139, 80-90
Stage 1 HTN
140-159, 90-99
Stage 2 HTN
> 160, >100
Diastolic pressure is better predictor of mortality in those
under age 50
BP percentiles for children are based on
age, gender, height
Both systolic and diastolic BP less than 90th percentil
Normal BP
Systolic and/or diastolic BP ≥90th percentile but but less than 95th percentile or if BP exceeds 120/80
Prehypertension
Systolic and/or diastolic BP between the 95th percentile and 5 mmHg above the 99th percentile
Stage 1 HTN
Systolic and/or diastolic BP ≥99th percentile plus 5 mmHg
Stage 2 HTN
primary HTN is caused by
genetic and environmental factors
Prepubertal children generally have some form of
secondary HTN
adolescents and postpubertal children usually have
primary HTN
Primary HTN is associated with
being overweight and having a positive family hx of HTN
meds for HTN should be started in children if
they are in stage 2 HTN or if stage 1 persists after 4-6 months of nonpharm therapy
first DOC for HTN in children
ACEI, BB, CCB
HTN meds contraindicated in pregnancy
ACEI and ARB
these kids should be restricted from high-static sports.
Stage 2 HTN
secondary HTN is caused by
medical conditions or medications
meds that can cause secondary HTN
OCP, NSAIDs, antidepressants, steroids, stimulants
administer BB cautiously in patients with
DM and asthma
hypertensive crisis is when
diastolic greater than 120 mmHG
new goals for cholesterol is
basing off CVD risk rather than LDL goal
Framingham risk calculator
age, gender, smoking, trx of HTN, total cholesterol, HDL, systolic BP
Pooled cohort risk calculator
gender, age, race, total cholesterol, HDL, systolic BP, diabetes, smoking, on HTN meds
when to check LDL when starting statins
6 weeks after starting then every 6-12 months
these are NOT recommended as primary prevention for high cholesterol
nonstatins as they have high cardiovascular mortality
changes in lipid therapy
NO LDL goals
patients with ACS should be treated with
atorvastatin 80 mg
statin with the least risk of myopathy
pravastatin
The major effect of fibrates are to
lower triglycerides and raise HDL levels
lowers the LDL-C when used alone and may be helpful for avoiding high doses of statins
ezetimibe
Acceptable values for cholesterol in children
below the 75th percentile, except for HDL, which is being above the 20th percentile
Normal total cholesterol in children
less than 170
Normal LDL in children
less than 110
normal HDL in children
greater than 45
normal TG in children 0-9 years old
less than 75
normal TG for children 10-19 years old
less than 90
High LDL for children
greater than 130
Bad HDL in children
less than 40
High TG in children 0-9
greater than 100
High TG in children 10-19
greater than 130
abnormal cholesterol values in children
more than 95th percentile, except for HDL which is less than 10th percentile
marker for children for pediatric dyslipidemia
first degree relative with CAD less than 55 years old
when to screen for dyslipidemia in children
at 9-11 years old, then at 17-21 years old.
Pharmacotherapy for dyslipidemia should not be used in children less than
10 years old
niacin is effective in
raising HDL levels
A key difference between the pediatric and adult primary prevention approach is that
adults use 10 year risk and children use lifetime risk
self-limited condition that lasts up to 12 days
Kawasaki disease
Incidence of kawasaki disease
Asian descent; boys less than 5
kawasaki disease mainly affects
coronary arteries
s/s of kawasaki disease
fever more than 5 days, conjunctivitis, red lips/strawberry tongue, rash, cervical lymphadenopathy
labs for kawasaki disease
high ESR and CRP, leukocytosis, thrombocytosis, high ferritin
elderly and warfarin
require smaller dose
elderly should not take warfarin with
NSAIDs and Plavix
direct thrombin inhibitor
pradaxa
large aneurysms are more than
5.5 cm
risk factors for AAA
smoking, male gender, advanced age, caucasian, atherosclerosis, HTN, family hx of AAA
imaging of choice for AAA
nonruptured- US; ruptured- CT
s/s of ruptured AAA
hypotension, severe back pain, pulsatile abd mass
s/s of nonruptured AAA
abdominal/back pain, limb ischemia, fever
For patients with suspected ruptured AAA who are hemodynaically stable this is done
urgent abdominal imaging
trx for asymptomatic AAA less than 5.5 cm
watchful waiting
PVC in children
benign
PVCs can turn into
Vtach
sinus tachycardia is related to
anxiety or activity that has a gradual onset and termination
trx for acute proximal DVT
anticoagulation
trx for distal DVT
surveillance with US over 2 weeks
outpatient treatment for DVT
LMWH and warfarin for 5 days, then once INR is therapeutic for 2 days, LMWH can be d/c. Continue warfarin for at least 3 months
ambulation with DVT
strongly recommended; compression stockings within 2 weeks AFTER starting anticoagulant
intermittent claudication
pain during activity and relieved within 10 min of rest.
arterial ulcers are found
tips of toes and between toes
arterial ulcers
painful, wound is necrotic,
PAD
skin is shiny and hairless, decreased pulses, pale/cool
PVD
thickened skin, aching/heaviness in legs, edema, brownish discoloration
venous ulcers are found
lateral and medial malleoli
venous ulcers
not as painful, weeping, scaling, exudate
most common valvular disorders in elderly adults.
aortic stenosis and mitral regurgitation
s/s of aortic stenosis
dyspnea on exertion, syncope
aortic stenosis murmur
systolic ejection heard after s1 before s2.
aortic stenosis is best heard
at second right ICS and carotid arteries
s/s of aortic regurgitiation
usually asymptomatic; later symptoms are wide pulse pressure, thrill
aortic regurgitation murmur
high-pitched, blowing diastolic murmur
aortic regurgitation is best heard at
left sternal border b/t 3-4th ICS when patient is leaning forward, squatting, or valsalva
aortic regurgitation is caused by
rheumatic heart disease
s/s of mitral prolapse
palpitations, dyspnea, dizziness
mitral prolapse murmur
nonejection systolic click
those with mitral prolapse have high risk of having
mitral regurgitation
mitral regurgitation trx for elderly
better outcome with mitral valve repair than replacement
rheumatic fever remains the leading cause
mitral stenosis
s/s of mitral stenosis
dyspnea and afib
mitral stenosis murmur
low pitched, diastolic murmur heard at apex; best heard when pt lying on left side with bell
opening snap is seen in
mitral stenosis
evidence to support antimicrobial prophylaxis for prevention of endocarditis
weak
high risk conditions that need atbx prophylactically for procedures
prosthetic heart valves
atbx prophylaxis for procedures
amoxicillin 30-60 min prior
abtx prophylaxis for procedures who are allergic to PCN
cephalexin or clindamycin
this pediatric murmur decreases in intensity when the child stands
Still’s murmur
venous hum should disappear when
the head is turned or when lying supine, or when pressure is applied over jugular vein
signs of a pathologic murmur
grade III or higher, diastolic murmur, increase in intensity when standing.
stills murmur is best heard when
child is lying down
which HTN medication can increase triglycerides?
beta blockers
