chronic CV pt 2

Question 1

left sided HF symptoms

Answer 1

dyspnea
cough
crackles
respiratory distress
A fib
S3
murmurs
pulm congestion on CXR

Question 2

right sided HF

Answer 2

edema
fluid retention
hepatic congestion
nausea
increased CVP
JVD
ascites
S3/S4

Question 3

HF cardinal features

Answer 3

parasternal lift
displaced PMI
diminished S1
S3 gallop
S4 gallop (diastolic HF)

Question 4

BNP indicative of HF

Answer 4

> 400

Question 5

HFrEF meds

Answer 5

vasodilators - ACE/arb
diuretics - loop
B-blockers (later)

Question 6

non-pharm mgmt for HFrEF

Answer 6

na restriction <2300
case mgmt
palliative care

ICD/pacer if EF <35
LVAD/RVAD
coronary revascularization
transplant

Question 7

HFpEF mgmt

Answer 7

correct reversible causes

manage BP, A fib

SGLT2, diuretics, ACE/ARB

Question 8

murmur grading

Answer 8

I - barely audible
II - audible but faint
III - moderately loud; easily heard
IV - loud, associated with a thrill
V - loudest (off chest)

Question 9

diastolic murmurs

Answer 9

mitral stenosis
aortic regurg

Question 10

systolic murmurs

Answer 10

mitral regurg
aortic stenosisi

MRASS

Question 11

mitral regurg

Answer 11

s3 with systolic murmur at apex (5th ICS MCL)
may radiate to base or left axilla
musical, blowing, high pitched
decreased with standing, valsalva, increased with squatting

Question 12

aortic stenosis

Answer 12

2nd right ICS
usually radiates to neck
blowing, rough, harsh

Question 13

mitral stenosisi

Answer 13

5th ICS, MCL
loud s1, mid-diastolic, low-pitched, crescendo rumble
increased in L lateral, squatting, valsalva

Question 14

aortic regurg

Answer 14

2nd L ICS, RSB
blowing

Question 15

basic principles for valvular HD

Answer 15

manage RF! HTN, HLD, DM

lifestyle

oral health

vaccinations

Question 16

mitral stenosis mgmt

Answer 16

anticoagulation (warfarin) if A fib, or embolic event

HR control

valve replacement/repair or balloon valvotomy

Question 17

diagnostic for valvular disorders

Answer 17

TTE

Question 18

aortic stenosis mgmt

Answer 18

diuretics

AVR - definitive

Question 19

aortic regurg mgmt

Answer 19

htn mgmt - CCB, ACEI/ARB

AVR - definitive

Question 20

mitral regurg mgmt

Answer 20

control HF symptoms and HTN
MV repair if severe (primary)

Question 21

Pulm HTN diagnosis

Answer 21

mean PAP >25 mg Hg at rest

Question 22

pulm HTN initial treatment

Answer 22

vasoreactivity testing at time of RHC

positive following nitric oxide admin - give high dose calcium channel blocker

negative - treatment determined by risk:
high risk - combo therapy w IV prostacyclin
low/intermediate -oral endothelin receptor antagonist and PED5 inhibitor

triple therapy: epoprostenol, bosentan, sildenafil

Question 23

PAD symptomatology

Answer 23

claudication
cold extremities
numbness
pain exacerbated by activity, relieved by rest

skin ulcerations - punched out edges, well-defined, pale/necrotic, low exudative, PAINFUL

Question 24

ABI interpretation

Answer 24

normal 1-1.4
noncompressible >1.4 (calcified vessel)
borderline 0.91-0.99
abnormal <0.9 duplex US

Question 25

PAD gold standard diagnosis

Answer 25

ABIs, then CTA

Question 26

PAD mgmt

Answer 26

lifestyle modifications (smoking cessation, exercise, glycemic control) HLD - statin HTN - ACEI or ARB antiplatelets (aspirin, clopidogrel) revascularization surgery

Question 27

venous insufficiency s/s

Answer 27

dull, achy legs leg swelling itching, tingling, burning, cramping, heaviness dependent edema trophic changes chronic cellulitis irregular edges, slough minimal pain in ulcers

Question 28

venous insufficiency dx

Answer 28

duplex U/S

Question 29

venous insufficiency mgmt

Answer 29

supportive measures - elevation & compression weight reduction, exercise stenting/reconstructive

Question 30

commonly affected organs of HTN

Answer 30

heart - LVH, angina, MI, HF brain - stroke, TIA, dementia eyes - retinopathy kidney - CKD peripheral artery disease

Question 31

HTN symptomatology/exam findings

Answer 31

asymptomatic pulsating HA epistaxis lightheadedness visual disturbances LHF symptoms S4 end organ damage

Question 32

HTN screening guideliens

Answer 32

annually for adults >40 or risk factors every 3-5 years for adults with normal BP and no RF

Question 33

HTN stages

Answer 33

normal <120 and <80 elevated 120-129 and <80 stage 1 130-139 or 80/89 stage 2 140 or >90

Question 34

HTN first line agents

Answer 34

- ACEI/ARB & CCB - ACEI/ARB & CCB & thiazide - ACEI/ARB & CCB & thiazide & spironoactone

Question 35

2nd line HTN agents

Answer 35

diuretics - loop, K sparing, aldosterone antagonists B-blockers Alpha-blockers alpha 2 agonists vasodilators renin inhibitors

Question 36

HTN dx

Answer 36

140>90, goal <130/80 in special populations

Question 37

HTN tx for HF

Answer 37

HFrEF - ACEI/ARB, diuretics, B-blockers, NO NONDIHYDROPYROIDINE CCBS HFpEF - diuretics, ACEI/ARB, beta blockers

Question 38

HTN tx for CKD

Answer 38

stage 1-2 w albuminuria or stage 3 - ACEI (or ARB if not tolerated)

Question 39

HTN tx for DM

Answer 39

all first line agents consider ACEI/ARB in presence of albuminuria

Question 40

HTN tx for blacks

Answer 40

thiazide or CCB first line

Question 41

HTN tx in pregnancy

Answer 41

methyldopa, nifedipine, labetalol NO ACEI, ARB, or direct renin inhibitors

Question 42

geriatric HTN tx

Answer 42

<140/90

Question 43

NYHA HF classes

Answer 43

I - no limitation of physical activity, ordinary activity does not cause fatigue, dyspnea, or angina II - slight limitation of physical activity. ordinary physical activity results in symptoms III - marked limitation on physical activity. comfortable at rest, but less than ordinary activity causes symptoms IV - unable to engage in any physical activity without discomfort, symptoms may be present even at rest V - used by some experts to describe symptoms that are typical and can occur either at rest or with exertion

Question 44

cha2d2s vasc score

Answer 44

used to predict thromboembolic events in patients with nonvalvular A fib ischemic stroke greatest risk Congestive HF Hypertension Age>75 DM Stroke/TIA/TE -2 Vascular disease Age 64-74 Sex category (female)