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PANCE review > Cardio 1 > Flashcards

Cardio 1 Flashcards

1
Q

What are 3 types of cardio myopathies? What is most common?

A

Dilated (95%)
Hypertrophic (4%)
Restrictive (1%)

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2
Q

Pathophysiology of a dilated cardiomyopathy

A

heart becomes weak and unable to empty the ventricles -> leads to dilation of left ventricle

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3
Q

Signs of dilated cardiomyopathy and CHF

A 
Elevated JVP
Rales
S3 gallop
Cardiomegaly
Mitral/tricuspid regurg
Peripheral edema
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4
Q

Signs of CHF on ECHO

A

Cardiomegaly
Reduced systolic function
High diastolic pressure
Low cardiac output

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5
Q

Treatment of dilated cardiomyopathy and CHF

A

ACE inhibitors
Beta Blockers
Diuretics
Aldosterone Inhibitors

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6
Q

Cause of sudden cardiac death in young athletes. Imaging reveals LVH.

A

Hypertrophic cardiomyopathy

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7
Q

Characteristics of murmur heard with Hypertrophic cardiomyopathy

A

systolic murmur that decreases with squatting

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8
Q

Causes of Hypertrophic cardiomyopathy

A

autosomal dominant inheritance

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9
Q

Pathophysiology of Hypertrophic cardiomyopathy

A

septal wall thickening resulting in left ventricle outflow obstruction and LVH

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10
Q

Hypertrophic cardiomyopathy treatment

A

BBs or CCBs

Surgical removal of hypertrophic tissue

May need pacemaker

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11
Q

Pathophysiology of Restrictive Cardiomyopathy

A

good ventricular contractions, but poor diastolic filling

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12
Q

What is primary (essential) HTN?

A

HTN with no identifiable cause; 95% of cases

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13
Q 
What are BP ranges for the following:
Normal
Pre-HTN
Stage 1 HTN
Stage 2 HTN
HTN urgency
A 
Normal BP: less 120/80
Pre-HTN: less 140/90
Stage 1: less 160/100
Stage 2: > or = 160/100
Severe: >180 / >110
Urgency:	>220 / > 125
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14
Q

Clinical definition of HTN

A

BP > 140/90 on two or more separate occasions

  • BP > 150/90 if 60 or older
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15
Q

Behavior modifications to reduce primary HTN

A 
Weight reduction
DASH diet
Reduce sodium intake
Increase aerobic activity
Limit alcohol consumption
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16
Q

Method for most accurate in-office BP reading

A

Two readings 5 min apart, sitting in chair with feet resting on floor

Confirm elevated reading in contralateral arm

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17
Q

How should BP be eval’d in patient with “white coat HTN?”

A

ambulatory BP monitoring

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18
Q

BP goals for patients with HTN

A

less 140/90

less 130/80 with DM or CKD

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19
Q

First line therapy for patients with mild HTN (140-150/90-99)?

A

thiazide diuretics

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20
Q

MOA of thiazide diuretics

A

inhibiting Na+/Cl- transporter in distal convoluted tubule -> decrease Na+ resabsorbtion -> loss of NaCl and fluid (also loss in K+)

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21
Q

Long term effects of thiazide diuretics

A

lower peripheral vascular resistance

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22
Q

Most common thiazide diuretics used and their dosing

A

Hydrochlorothiazide – HCTZ
Dose – 12.5 mg or 25 mg po daily

Chlorthalidone (Longer acting with better 24 hour BP control than HCTZ)
Dose – 12.5 mg or 25 mg po daily

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23
Q

Side effects of thiazide diuretics

A

Decrease in serum K, Na, Mg
Increase in serum Ca
Increase Uric acid (think gout)
Increase glucose (pay attention in diabetics)

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24
Q

Powerful diuretic to use ACUTE cases of pulmonary edema, hyperkalemia, and renal failure?

A

loop diuretics

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25
Q

How do loop diuretics decrease renal vascular resistance?

A

Inhibit Na/K/Cl transporter in ascending Loop of Henle where most Na is reabsorbed making this medication very powerful!

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26
Q

Side effects of Loop diuretics

A 
Hypotension
Ototoxicity (reversible)
Hyperuricemia (gout)
Decreased serum Na, K, Mg
Increased serum Ca
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27
Q

Common examples of Loop diuretics

A

Furosemide - Lasix

Ethacrynic Acid

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28
Q

MOA of potassium sparing diuretics

A

block production of key protein for Na/K exchange in collection tube

No loss of K+

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29
Q

What are catecholamines and where do they bind?

A

Catecholamines (mostly epinephrine and norepinephrine) bind to alpha and beta receptors

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30
Q

What is a secondary agent to use in combo therapy for HTN?

A

potassium sparing diuretic

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31
Q

Side effects of potassium sparing diuretic

A

HYPERKALEMIA
Ototoxicity (reversible)
Hyperuricemia (gout)
Decreased Mg

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32
Q

Commonly used potassium sparing diuretics

A

Spironolactone

Amiloride

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33
Q

Where are beta 1 and beta 2 receptors located?

A

beta-1 in heart and kidneys

beta-2 in lungs, GI, liver, vascular smooth muscle, and skeletal muscle

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34
Q

Beta blockers effect on the heart

A

prevent sympathetic cardiac stimulation - decrease HR and cardiac output

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35
Q

Indications for beta blockers

A

HTN, angina, MI, CHF

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36
Q

Why should BBs be avoided in asthma patients? If need to use BB which one?

A

Common side effect of BB is asthma exacerbation due to Beta-2 blockage increasing airway resistance

If BB necessary use one with high affinity to Beta-1 receptor in heart (metoprolol, atenolol)

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37
Q

What drug class prevents sympathetic vasoconstriction?

A

alpha blockers

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38
Q

Indications for alpha blockers

A

Secondary med for HTN

1st line for BPH

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39
Q

Where are alpha receptors located?

A

vascular smooth muscle throughout body

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40
Q

Main side effect of alpha blockers

A

hypotension

41
Q

Renin is secreted from ______ in response to low ______.

A

juxtaglomerular cells

blood volume

42
Q

Describe process of how renin increases blood volume?

A

RAAS vasoconstricts and increases plasma volume

Renin -> Angiotensin I -> Angio I + ACE -> Angio II -> vasoconstriction and stimulates aldosterone -> kidneys reabsorb more Na and water

43
Q

How do ACE inhibitors reduce BP?

A

inhibit enzyme that produces angiotensin II

reduces vasoconstriction (lower resistance)

reduces aldosterone secretion and thus Na and water reabsorption (lower blood volume)

44
Q

Indications for ACE inhibitors?

A

HTN, CHF, DM

45
Q

Side effects of ACE inhibitors

A

cough
hyperkalemia
teratogenic

46
Q

Why would ARBs be used over ACE-I?

A

patient unable to tolerate cough of ACE

47
Q

How do CCBs treat HTN and arrhythmias?

A

block voltage gated calcium channels in blood vessels and cardiac muscles, decreasing muscle tone and vasoconstriction

Reduce HR and contractility

Reduce AV node conduction to treat arrhythmias (esp. SVT)

48
Q

Examples of CCBs

A

Verapamil
Diltiazem
Amlodipine – less effective on cardiac tissue
Nifedipine – less effective on cardiac tissue

49
Q

How do central sympatholytic acting drugs work (Clonidine, Methyldopa)?

A

centrally working alpha-2 agonist decrease sympathetic activity - decrease HR and BP

  • work same as BBs
50
Q

MOA of Hydralazine and Nitroprusside

A

Direct arterial smooth muscle dilators

work by releasing nitric oxide

51
Q

HTN treatment protocol for patient over 55 or African American

A

start with CCB or thiazide

52
Q

HTN treatment protocol for patient under 55 and not African American

A

start with ACE inhibitor

53
Q

What is used for dual therapy for HTN? When is it used?

A

ACE + CCB or thiazide

used in stage 2 HTN or if BP goal not met with mono therapy

54
Q

Suggested therapy for pregnant woman with HTN

A

hydralazine and clonidine

or methyldopa

55
Q

You are looking to add a second medication to help a patient better control their blood pressure. The patient has a history of asthma and benign prostatic hypertrophy. Which anti-hypertensive would be a poor choice?

A

beta blocker due to possible asthma exacerbation

56
Q

Clinical definition of orthostatic hypotension?

A

decrease in systolic BP of 20 mm Hg or decrease in diastolic blood pressure of 10 mm Hg when going from lying to sitting or sitting to standing

57
Q

How to treat hypotension?

A

treat underlying cause; i.e. give fluids for fluid depletion, check BP meds

58
Q

_____ is the inability of the heart to pump enough blood to meet the needs of the body.

A

CHF

59
Q

Physiological changes that cause CHF

A

fluid overload/retention
decreased cardiac contractility
decreased cardiac output

60
Q

What is pulsus alternans?

A

alternating strong and weak beats

61
Q

Characteristics of pulse of patient with CHF

A

tachycardia, weak, thready, pulsus alternans

62
Q

Cheyne-Stokes respiration seen in CHF

A

abnormal breathing pattern of progressively deeper and faster breathing, followed by gradual decrease in breathing

hyperapnea-hypopnea separated by periods of apnea

63
Q

Kussmaul breathing seen in what conditions?

A

metabolic acidosis (DM)
diabetic ketoacidosis
hyperapnea
sepsis

64
Q

How to determine elevated venous pressure seen in CHF?

A

Jugular Venous Distention test

patient sitting at 45 deg; jugular vein pulsation higher than 4 cm above sternal angle is elevated

65
Q

Hepatojugular reflex

A

patient sitting at 45 deg; pressure applied to abdomen for about a minute and if the neck vein height increases by 3 cm the test is positive

66
Q

Heart sounds of CHF patient

A

possible murmurs, S3 or S4 sounds, diminished first heart sound

67
Q

What lung sound suggests fluid at alveolar level?

A

rales/crackles

68
Q

Likely treatment if you hear wheezing on exam

A

Nebulizer tx

Steroids

69
Q

Left-sided CHF causes

A

pulmonary edema

70
Q

Right-sided CHF cause

A

Hepatomegaly

Abdominal edema

71
Q

Signs of CHF

A 
Cyanosis
Dyspnea
Tachycardia
Weak/thready pulse
Cheyne-Stokes breathing
JVD
Displaced apical impulse 
Dullness to percussion of lung bases
Possible S3 or S4 heart sounds
Rales or wheezing
Hepatomegaly
Hepatojugular reflex
Lower leg edema
72
Q

What is batwing or butterfly shadow on CXR?

A

enlarged hila and alveolar edema

73
Q

Findings on chest x-ray that suggest CHF

A

Cardiomegaly
Pleural effusion = ground glass appearance from fluid build up
Kerley B lines = short parallel lines at lung periphery near bases
Peribronchial cuffing
Batwing or Butterfly shadow
Water bottle or boot shaped heart

74
Q

How can you asses ejection fraction, ventricular function, and valves of the heart?

A

ECHO

75
Q

Which lab is a good indicator of CHF, however maybe not that specific?

A

elevated BNP

76
Q

Treatment of CHF

A

Low sodium diet

Meds:

  • Diuretics (thiazide or loop diuretic with ACEI)
  • Beta blockers
  • Digitalise (inotropic agents)
77
Q

__________ is the number one cause of cardiac-related death and disability.

A

Atherosclerosis

78
Q

Risk factors of atherosclerosis

A 
HTN
Dyslipidemia
Smoking
Diabetes
Advancing age
Family history
Male (4:1)
79
Q

What allows the visualization of arteries under x-ray?

A

angiogram

80
Q

What is an ankle-brachial index used for?

A

compares systolic BP in upper vs lower extremity; useful in peripheral vascular disease

81
Q

What is heard over an artery that is partially occluded?

A

bruit

82
Q

How is Doppler U/S more advantageous than regular U/S for atherosclerosis eval?

A

sees changes in blood flow

83
Q

Medical treatment of atherosclerosis

A

Blood thinners - Aspirin 81 mg or 325 mg daily

84
Q

When should routine cholesterol screening be done?

A

begin at 35 for men and 45 for women

85
Q

Low and high levels of HDL

A

low less than 40

high over 60

86
Q

optimal level of LDL

A

less than 100

87
Q

What is high level LDL?

A

> 160

88
Q

Optimal total cholesterol level

A

less than 200

89
Q

Normal and high triglycerides

A

normal less than 150

high over 200

90
Q

Ways to manage dyslipidemia without medication?

A
  • Weight reduction
  • Reduce dietary fats to 30% and saturated fats to less than 10%
  • Mediterranean diet
  • Increase aerobic exercise (increase HDL)
91
Q

Medications for elevated cholesterol?

A

81 mg or 325 mg of Aspirin daily to lower LDL

Statins (HMG-CoA inhibitors): lovastatin, pravastatin, simvastatin, atorvastatin

Postmenopausal estrogen replacement helps lower LDL and raise HDL

Niacin is effective but not well tolerated

Bile acid binding resins: Cholestyramine, Colestipol

Fibric acid derivatives: Gemfibrozil, Fenofibrate

92
Q

MOA of statins

A

Inhibit rate-limiting step in hepatic cholesterol production

93
Q

Most common side effect of statins

A

myositis (muscle inflammation)

94
Q

A 68 yo female presents to your office c/o worsening SOB with stairs. When questioned you find she sleeps up on three pillows. On PE where might you find her apical impulse? What is the most common location of the apical impulse?

A

hers likely at 6th intercostal space between midclavicular line and axillary line (LVH)

common location of apical pulse is 5th intercostal space in the midclavicular line

95
Q

A 79 yo male presents to your office with his daughter. She is concerned because he seems to be light headed and dizzy more frequently and even passed out for a short period of time yesterday after getting up from his chair. You suspect he is fluid depleted. If that is the case, what should his BP and HR do when going from sitting to standing?

A

orthostatic hypotension

systolic BP down at least 20 and diastolic at least 10 mmHg

HR increase 15 BPM

96
Q

Which drug class decreases afterload? How?

A

ACE inhibitors and hydralazine by arterial dilation

97
Q

What drug class decreases preload? How?

A

Nitrates dilate veins and slows amount of blood going into heart, decreasing cardiac work

98
Q

LDL and HDL transport cholesterol to what areas in the body?

A

LDL - cholesterol to periphery (bad)

HDL - cholesterol from periphery back to liver (good)

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