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FNP Review > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

What is acute myocardial infarction

A

known as ST elevation myocardial infarction (STEMI) and acute coronary syndrome (ACS)

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2
Q

A classic case for MI

A

A middle-aged or older man c/o gradual onset of intense and steady chest discomfort or pain that is described as squeezing, tightness, crushing, heavy pressure (an elephant sitting on my chest), or band-like

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3
Q

What is MI characteristics

A

pain or discomfort may radiate to the left side of the neck, jaw, and left arm.

diaphoretic with cool, clammy skin

Women & elderly present with SOB, dyspnea, weakness, nausea and vomiting, fatigue, and syncope.

could also have back pain

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4
Q

CHF sxs

A

older patients complains of acute onset of dyspnea, fatigue, dry cough, and swollen feet and ankles

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5
Q

CHF characteristics

A

Lung exam reveal crackles on both the lung bases along with an S3 heart sound.

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6
Q

CHF risk factors

A

HX of CAD, angina, prior MI, previous episode of CHF

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7
Q

What is infective endocarditis

A

Known as bacterial endocarditis

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8
Q

Patient presentation with endocarditis

A

patient presents with fever, chills, and malaise that is associated with onset of a new murmur

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9
Q

Endocarditis skin findings

A

Found mainly on the fingers/hands and toes/feet

Known as sublingual hemorrhages (splinter hemorrhages on the nail bed)

Petechiae on the palate

painful violet- colored nodes on the fingers or feet (Osler nodes)

Nontender red spots on the palms/soles (Janaway lesions)

fundoycopic exam- rote spots or retinal hemorrhages

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10
Q

Abdominal Aortic Aneurysm (AAA)

Presentation

A

sudden onset of severe, sharp excruciating pain located in the abdomen, flank, or back.

accompanied by a distended abdomen and abnormal vital signs (hypotension)

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11
Q

AAA risk factors

A

older male patients who are smokers with hypertension are at higher risk

Chest x-ray- widened mediastinum, tracheal deviation, and obliteration of aortic knob

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12
Q

where is apical impulse located

A

5th intercostal space by the midclavicular line on the left side of the chest

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13
Q

what can cause displacement of the point of maximal impulse

A

Severe left ventricular hypertrophy and cardiomyopathy (PMI displaced laterally on the chest, larger in size (3 cm

Pregnancy 3rd trimester-PMI located slightly upward on the left side of the chest, may hear S3 heart sound during pregnancy

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14
Q

Where does deoxygenated blood enter the body

A

enters the heart through superior vena cava and inferior vena cava

then flows through right atrium>tricuspid valve>right ventricle>pulmonic valve>pulmonary artery>the lungs>alveoli

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15
Q

where does oxygenated blood exit the body

A

exits the lungs through the pulmonary veins and enters the heart

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16
Q

Systolic murmurs

A

MR.ASS (mitral regurgitation/aortic stenosis-systolic)

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17
Q

Diastolic murmurs

A

MS.ARD (mitral stenosis/aortic regurgitation =diastolic

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18
Q

Mitral area

A

AKA apex or the apical area of the heart

5th left ICS (8-9cm from the midsternal line and slightly medial to the midclavicular line

PMI/apical pulse is located here

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19
Q

Aortic area

A

2nd ICS to the right side of the upper border of the sternum

location also described as 2nd ICS by the right side of the sternum at the base of the heart. Also described as a murmur that is located on the right side of the upper sternum

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20
Q

Erb’s point

A

located at 3rd & 4th ICS on the left sternal border

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21
Q

MR.ASS (systolic murmurs mnemonics)

A

Described as occurring during S1, or as holosystolic, pansystolic, early systolic, late systolic, or midsytolic murmurs

louder and can radiate to the neck or axillae

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22
Q

MS.ARD (diastolic murmurs mnemonics)

A

Diastole AKA as the s2 heart sound, early diastole, late diastole, or middiastole

indicative of heart disease

indicated abnormal

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23
Q

Grade I heart murmur

A

very soft murmur heard only under optimal conditions

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24
Q

Grade II heart murmur

A

Mild to moderate loud murmur

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25
Q

Grade III heart murmur

A

loud murmur that is easily heard once the stethoscope is placed on the chest

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26
Q

Grade IV heart murmur

A

louder murmur, 1st time that a thrill is present, thrill is a palpable murmur

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27
Q

Grade V heart murmur

A

very loud heart murmur heard with edge of stethoscope off chest. Thrill is more obvious

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28
Q

Grade VI heart murmur

A

murmur is so loud that it can be heard even with the stethoscope off the chest. thrill is easily palpated

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29
Q

R/O AAA in an older male who has a pulsatile abdominal mass that is more than 3cm in width, what test is ordered

A

Abdominal ultrasound and CT

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30
Q

Mnemoic (MOTIVATED APPLES)

A 
Motivated
M-mitral valve
T-tricuspid valve
AV-atrioventricular valves
(lub sound of Lub-dub), closure of the mitral and tricuspid valves
Apples
A-aortic valve
P-pulmonic valve
S-semilunar valve
(dub sound of Lub-dub), closure of the aortic and pulmonic valves
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31
Q

S3 sound indicates what heart disease

A

CHF

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32
Q

S4 sound indicates what heart disease

A

LVH

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33
Q

What is the most common cardiac arrhythmia in the United States

A

Atrial fibrillation

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34
Q

Risk factors for atrial fibrillation

A

HTN, CAD, ACS, caffeine, nicotine, hyperthyroidism, alcohol intake (holiday heart), heart failure, LVH, pulmonary embolism (PE), chronic obstructive pulmonary disease (COPD), sleep apnea, paroxysmal AF

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35
Q

AF classic case

A

patient reports the sudden onset of heart palpitations accompanied by feelings of weakness, dizziness, dyspnea/dyspnea on exertion, and reduction in exercise capacity. May complain of chest pain and feelings of passing out (presyncope to syncope). Rapid and irregular pulse may be more than 110 beats/min with hypotension.

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36
Q

AF Treatment plan

A

1st determine underlying cause.

Tx depends on patient type and risk factors for stroke

Tool used is CHA2DS2VASc score

Diagnostic test=12 lead EKG (does not show P waves, irregularly rhythm)

New onset- EKG, TSH, electrolytes (calcium, potassium, magnesium, sodium), renal function, B-type natriuretic peptide

24 hour holter monitor

lifestyle: avoid stimulants (caffeine, nicotine, decongestants) and alcohol

37
Q

AF treatment for new onset stable patients

A

cardio version within for 48 hours or rate control

38
Q

AF rate control medications are?

A

beta-blockers, calcium channel blockers, & digoxin

39
Q

What is the target goal INR for AF

A

2.0-3.0

40
Q

What is the proper procedure to check for pulses paradoxus

A

measured by using the BP cuff and stethoscope.

41
Q

What do you do if the INR <5.0

A

skip next dose and reduce the maintenance dose. Check INR once/twice a week when adjusting dose. Do not give vitamin K

42
Q

What do you do if the INR 5.0-9.0

A

hold one or two doses; with or without administration of low-dosed vitamin K. Monitor INR every 2-3 days until it is stable. Decrease the Coumadin maintenance dose.

43
Q

JNC 8 HTN TX goal

60 years or younger

A

<140/90, Same BP goal for all (including DM/CKD)

44
Q

JNC 8 HTN

60 years or older

A

<150/90

systolic BP goal increased by 10mm Hg except if DM and/or CKD

45
Q

JNC 8 HTN goal

Black

A

<140/90, thiazide diuretics and CCBS (alone or combined with another drug class)

if DM/CKD choose ACEI or ARB

46
Q

JNC HTN goal

Non-black

A

<140/90, thiazide diuretics ACEI, ARB, or CCB (alone or combined with another drug class)

47
Q

JNC HTN goal

CKD age 18 or older

A

<140/90, initiate ACEI or ARB

Applies to everyone regardless of race

48
Q

JNC HTN goal

DM age 18 or older

A

<140/90, include ACEI or ARB

49
Q

1st line therapy for HTN, hyperlipidemia, and type 2 DM

A

Lose weight, normal weight (18.5-24.9
stop smoking
reduce stress level
reduce dietary sodium (less than 2.4 g/2400 mg)
maintain adequate intake of potassium, calcium, and magnesium
limit alcohol intake (1oz or less per day for men, 0.5 oz or less per day for women)
eat fatty-cold water fish (salmon, anchovy) three times a week

50
Q

HTN diet

A

DASH diet recommended for prehypertension, HTN, weight loss. Goal is to eat foods rich in potassium, magnesium, and calcium. Reduce red meat and processed foods. Eat more whole grains, legumes. Eat more fish and poultry.

51
Q

Thiazide diuretics

A

Action: change the way that the kidney handles sodium, which increases output.
Have a favorable effect with osteopenia/osteoporosis (slows down demineralization).
Contains sulfa, should be avoided in patients with sulfa allergy.

SE: “Hyper”
Hyperglycemia ( caution with diabetics),
hyperuricemia (can cause a gout attcack)
Hypertriglyceridemia and hypercholestermia (check lipid profile)

Hypo
Hypokalemia (potentiates digoxin toxicity, increases risk of arrhythmias)
Hyponatremia ( hold diuretic, restrict water intake, replace K+ loss)
Hypomagnesimia

Contraindications: sensitivity to sulfa drugs and thiazides

Examples: hydrochlorothiazide 12.5 to 25 mg to PO daily
chlorthalidone (hygroton) 12.5 to 25 mg PO daily
indapamide (lozol) PO daily

52
Q

Loop diuretics

A

Action: inhibit the sodium-potassium-chloride pump of the kidney in the loop of Henle.

SE: hypokalemia (potentiates digoxin toxicity, increase risk of arrhythmias)
Hyponatremia (hold diuretic, restrict water intake, replace K+ loss)
Hypomagnesemia
Possibly altered excretion of lithium and salicylates

Contraindications: sensitivity to loop diuretics

Examples: furosemide (lasix) PO BID, bumetanide (bumex) PO BID

53
Q

Hypertensive retinopathy

A

copper and silver wire arterioles, arteriovenous nicking

AV nicking occurs when a retinal vein is compressed by an arteriole that causes the venue to collapse

54
Q

Diabetic retinopathy

A

neovascularization, cotton wall spots, micro aneurysms

55
Q

What are the preferred medication treatment in elderly patients with isolated systolic HTN

A

low-dose thiazide diuretic or CCB (long-acting dihydropyridine)

56
Q

What is the side effect of spironolactone

A

gynecomastia

57
Q

What is a main complaint from patients on ACEIs or ARBS

A

dry cough

58
Q

What should the NP be cautious when prescribing ACEIs with potassium-sparing diuretics (triamterene & spironolactone)

A

Increase risk of hyperkalemia

59
Q

What effect does ACEIs or ARBs have on patient with bilateral renal artery stenosis?

A

predicate acute renal failure

60
Q

Alpha-blockers are not 1st line drugs for HTN except if patient has_____

A

preexisting BPH

61
Q

Why should women with HTN and osteopenia/osteoporosis receive thiazides?

A

Thiazides help bone loss by slowing down calcium loss (from the bone) and stimulating osteoclasts

62
Q

Left side heart failure

A

Remember lung. SXs are lung related such as dyspnea, orthopnea, and paroxysmal nocturnal dyspnea

63
Q

right side heart failure

A

remember heart failure sxs are GI related( anorexia, nausea, and right upper quadrant abdominal pain)

64
Q

NYHA class II heart disease

A

ordinary physical activity results in fatigue, exertion dyspnea

65
Q

1st line treatment for stable HF

A

start on ACEI or ARB, then add a beta-blocker, aldosterone-receptor antagonist

66
Q

Risk factors for DVT

A

Stasis: prolonged travel, inactivity (more than 3 hours), bed rest, CHF

Inherited coagulation disorders: Factor C deficiency, Leiden,

Increased coagulation due to external factors: oral contraceptive use, pregnancy, bone fractures especially of the long bones, trauma, recent surgery, malignancy

67
Q

Classic case of DVT

A

A patient with risk factors for DVT c/o gradual onset of swelling on a lower extremity after a history of travel (more than 3 hours) or prolonged sitting. The patient c/o a painful and swollen lower extremity that is red and warm. If patient has PE, it may be accompanied by abrupt onset of chest pain, dyspnea, dizziness, or syncope. Many patients are asymptomatic.

68
Q

Tx plan for DVT

A

Homan’s sign: lower leg pain on dorsiflexion of the foot
CBC, platelets, clotting time (PT/PTT, INR), D-dimer level, chest x-ray, EKG
ultrasonography
Heparin IV then warfarin PO for 3-6 months

69
Q

Raynaud phenomenon

A

reversible vasospasm of the peripheral arterioles on the fingers and toes. Associated with an increased risk of autoimmune disorders (thyroid disorder, pernicious anemia, rheumatoid arthritis).

70
Q

Raynaud classic sxs

A

Think of the colors of the American flag.

Classic case: middle-aged woman complains of chronic and recurrent episodes of color changes on her fingertips in a symmetric pattern (both hands and both feet). The colors ranges from white (pallor) and blue (cyanosis) to red (repurfusion). C/o numbness and tingling. Attacks last for several hours. Hands and feet become numb with very cold temps. Ischemic changes may be present after a severe episode such as shallow ulcers on some of the fingertips.

71
Q

Raynaud tx plan

A

Avoid touching cold objects, cold weather; avoid stimulants (caffeine)
smoking cessation is important; nifedipine or amlodipine
check distal pulses, ischemic signs
do not use any vasoconstriction drugs; avoid nonselective beta-blockers

72
Q

1st line tx for hyperlipidemia

A

Lifestyle modifications, if presence of ASCVD or equivalents, need drug therapy

73
Q

Statin treatment for adult 21-75 years

A

Any type of ASCVD (CAD, PAD, stroke, TIA, etc). is given high intensity statins such as atorvastatin 40 to 80 mg or rosuvastatin 20 to 40 mg.

74
Q

what type of statin treatment is needed for an adult with LDL greater than 190?

A

high-intensity statins such as atorvastatin 40 to 80 mg or rosuvastatin 20 to 40 mg

75
Q

what type of statin treatment is recommended for an adult (up to 75 years age) with 10 year estimated ASCVD risk is 7.5% or higher

A

high intensity statin dosing

76
Q

if ASCVD risk is between 5%-7.5% what type of statin treatment is recommended?

A

lifestyle changes 1st

77
Q

patient with markedly high triglycerides >500 what treatment is recommended

A

lower triglyceride first with niacin or vibrate before treating high cholesterol and LDL levels.

78
Q

High triglycerides increase risk for what disease?

A

acute pancreatitis

79
Q

what education should be provided in patients with high triglycerides?

A

avoid alcohol, acetaminophen (hepatotoxic)

obese patients: encourage weight loss and reduce simple carbohydrates, sugars, junk foods. Tx 1st before treating high LDL

advise patient to reduce intake of simple carbohydrates, junk foods, fried foods

80
Q

What are the best agents to lowering triglycerides

A

niacin & vibrates

81
Q

ex’s of bacterial endocarditis

A

splinter hemorrhages on nails

Janeway lesions (red macules palms/soles not painful)

Osler’s nodes (painful violaceous nodes found mostly on pads of the fingers and toes, thenar eminence

82
Q

What can statins cause

A

memory loss, confusion, cognitive effects, which are reversible upon discontinuation of statin therapy

83
Q

what food and drugs should be avoided if patient is on simvastatin and lovastatin

A

grapefruit juice and macrocodes

84
Q

what are the sxs of rhabdomyolysis

A

muscle pain located on the calves, thighs, lower back, and shoulders, urine will be darker than normal (reddish-brown color). usually happen if patients are on statins

85
Q

Criteria for metabolic syndrome

A

abdominal obesity (>40 in men, >35 in women)

HTN

hyperlipidemia

fasting plasma glucose>100

elevated triglycerides >150

decreased HDL <40

86
Q

What labs are considered for diagnose of metabolic syndrome

A

fasting blood glucose from 9-12 hours

lipid profile (focusing on triglycerides and HDL)

87
Q

What are the risk factors for nonalcoholic fatty liver disease

A

obesity, diabetes, metabolic syndrome, HTN, certain drugs

88
Q

What are symptoms of nonalcoholic fatty liver disease

A

asymptomatic

hepatomegaly

mild-mod elevations of ALT & AST

fatigue & malaise with RUQ pain

FNP Review (4 decks)

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