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FNP Review > Cardiac > Flashcards

Cardiac Flashcards

1
Q

BP formula

A

BP= HR x SV x PR (peripheral resistance)

* Increase in any part of the formula, BP rises. Decrease in any part of the formula BP falls

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2
Q

Cardiac output

A

Amount of blood the heart pumps through the circulatory system in 1 minute.

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3
Q

BP goal for pts >60

A
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4
Q

BP goal for pts

A
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5
Q

HTN treatment for pts for non-black pts

A

Thiazide-type diuretic or ACEI or ARB or CCB, alone or in combination

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6
Q

HTN treatment for black pts

A

Thiazide-type diuretics, or CCB, alone or in combination.

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7
Q

HTN treatment for CKD pts with or without DM

A

ACEI or ARB, alone or in combination

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8
Q

Thiazides

A

HCTZ, chlorthalidone

*monitor Na+, K+, Mg+ depletion.
Less effective with advanced renal impairment.
Contraindicated with GOUT due to increases in Uric acid

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9
Q

ACEI

A

“Prils” Lisinopril, enalapril
*pregnancy category D
Modest hyperkalemia risk , ACEI related cough

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10
Q

ARBS

A

“Sartans” losartan, telmisartan

Pregnancy category D

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11
Q

CCB

A

Dihydropyridine (DPH) “Ipines”amlodipine

Non DPH- Ditalazem, verapamil

*caution with non DPH use due to CYP450 3A4 inhibition (especially with the use of select statins
Avoid use in presence of heart failure, renal or hepatic impairment

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12
Q

Malignant HTN

A

Rapidly progressive HTN
Diastolic usually >140
Can lead to encephalopathy

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13
Q

Dyslipidemia

A

A disorder of lipoprotein metabolism.
Increased total cholesterol, LDL, decreased HDL.
Excess circulating cholesterol can lead to plaque formation.

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14
Q

Meds that can cause secondary dyslipidemia

A

Beta-blockers
Thiazide diuretics
Antiretroviral drugs
Hormonal agents

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15
Q

Recommend 4 groups for statin therapy

A

Adults with clinical ASCVD
Adults with LDL-C >190mg/dl
Adults 40-75 years with DM
Adults with >7.5% estimated 10 year risk of ASCVD

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16
Q

LDL classifications

A

190 Very high

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17
Q

HDL classifications

A

60 High

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18
Q

Medications for dyslipidemia

A
  1. HMG-CoA reductase inhibitor (Statin)
  2. Bile acid resins (sequestrants)
  3. Niacin
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19
Q

Classification of triglycerides

A

500 Very high (diet & intensive meds)

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20
Q

Causes of elevated triglycerides

A 
Overweight & obesity
Physical inactivity
Cigarette smoking 
Excess ETOH 
High carb diets 
T2DM, CKD, nephrotic syndrome 
Steroids, estrogens, retinols, beta blockers
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21
Q

Drug of choice for high triglycerides

A

Fibrin acid derivatives (fibrates)

Ex- Gemfibrozil (Lopid), fenofibrate (Tricor)

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22
Q

Other meds for high triglycerides

A

Niacin (ex-niacin, niaspan) decreases 20-50%

Fish oil (omega-3 fatty acid) decreases 20-30%

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23
Q

Mgmt For very high triglycerides

A

Goal is to prevent acute pancreatitis.

Treat triglycerides before LDL

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24
Q

Low-intensity statin therapy

A

LDL reduction approx.

25
Q

Moderate intensity statin therapy

A

LDL reduction approx. 30-49%

Atorvastatin 10-20mg
Rosuvastatin (Crestor) 5-10mg
Simvastatin 20-40mg 
Pravastatin 40-80 mg 
Lovastatin 40mg
26
Q

High intensity statin therapy

A

LDL reduction >50%

Atorvastatin 40-80mg
Rosuvastatin (Crestor) 20-40mg

27
Q

Diagnostic tests for arrhythmias

A

ECG
Electrical physiology studies (EPS)
Tilt table test, autonomic testing
Transesophageal echocardiography (TEE)

28
Q

Atrial fibrillation sx

A 
Palpitations
Fatigue
Pre-syncope or syncope
Dizziness
Generalized weakness
EKG shows irregular narrow complexes with absence of P waves
29
Q

Mgmt of A-fib

A

Heart rate control
Correction of rhythm disturbances
Prevention of thromboembolic complications
*cardioversion if ventricular rate 120-200
Anticoagulant therapy (monitor INR)
Conversion meds- amiodarone, disopyramide & ibutilide

30
Q

Peripheral vascular disease

A

Manifests as insufficient tissue perfusion caused by existing atherosclerosis that may be acutely compounded by either emboli or thrombi.

31
Q

Physical findings of PVD

A

Diminished or absent pedal pulses, presence of femoral artery bruit, abnormal skin color, & cool skin temperature.

32
Q

Treatment of PVD

A
  • Antiplatelet therapy- ASA/Plavix/Pletal- reduces the risk of serious vascular events
  • Aggressive treatment of hyperchlosterolemia, diabetes, HTN
33
Q

Acute rheumatic fever

A

Inflammatory multi-system immunologic disease occurring 10 days to 6 weeks after group A streptococcus infection.

34
Q

Dx criteria for scarlet fever

A

Positive throat culture for strep, increased titer of antistreptococcal antibodies. Plus
Minor criteria- high ESR, or CRP, prolonged P-R interval, fever, arthralgias
Major criteria- carditis, arthritis, Sydenham chorea, subcutaneous nodules, erythema marginatum.

35
Q

Patients at risk for heart failure

A

HTN, atherosclerotic disease, DM, obesity, metabolic syndrome.
Structural heart disease- previous MI, LV remodeling, including LVH & low EF, asymptomatic valvular disease.

36
Q

Sx of left heart failure (acute)

A

Heart & lungs “breathe through water” excess fluid retention into lungs (alveoli), dyspnea, wheeze, rales, “S3”
*Follows AMI

37
Q

Sx of right heart failure (chronic)

A

HTN long period of time leads to hypertrophy. Fluid backs up. Fluid shunts to the right ventricle. Leads to peripheral edema, JVD & hepato-spleenomegaly.

*most common cause of right heart failure is left heart failure.

38
Q

Limitations with heart failure (by stages)

A

Stage I- no limitations
Stage II- slight limitation, comfortable at rest.
Stage III- marked limitations, still ok at rest.
Stage IV- severe, always symptomatic.

39
Q

Management of heart failure

A

Non-pharm. tx- sodium restriction, rest/activity balance, weight reduction.

Pharm. tx- ACEI (standard of care), often with loop diuretic, anti coagulation if A-Fib

40
Q

S1 sound

A 
AV valves (tricuspid/mitral) CLOSED
Semilunar valves OPEN
41
Q

S2 heart sound

A 
Semilunar valves (pulmonic/aortic) CLOSED
AV valves OPEN
42
Q

S3 heart sound

A

“Kentucky”

Heard with increased fluid- pregnancy, CHF

43
Q

S4 heart sounds

A

“Tennessee”

Heard with stiff ventricular wall (MI, left ventricular hypertrophy, HTN)

44
Q

Where do u hear Aortic and pulmonic sounds?

A

Aortic- right 2nd ICS

Pulmonic- left 2nd ICS

45
Q

Where do u hear tricuspid and mitral sounds?

A

Tricuspid- 5th ICS sternal border

Mitral- 5th ICS mid-clavicular line

46
Q

Ms. ARD

A

Mitral stenosis/Aortic regurg.

DIASTOLIC

47
Q

Mr. ASS

A

Mitral regurg./aortic stenosis

SYSTOLIC

48
Q

Murmur of MVP

A

Mitral valve prolapse=mitral regurgitation SYSTOLIC

Classic finding “mid-systolic click”

49
Q

Murmur that “radiates to the neck”

A

Aortic stenosis

50
Q

Lateral leads on EKG

A

I, aVL, v5, v6 LATERAL

51
Q

Inferior leads on EKG

A

II, III, aVF INFERIOR

52
Q

Anterior leads on EKG

A

V3, v4 ANTERIOR

53
Q

Septal leads on EKG

A

V1, v2 SEPTAL

54
Q

Microcytic hypochromic anemias

A

MCV

55
Q

Macrocytic anemias

A

MCV >100
Megaloblastic anemia (B12, folate)
Non-megaloblastic anemia (ETOH abuse, hypothyroid, liver ds, myelodysplastic syndrome).

56
Q

Normocytic anemias

A 
MCV 80-100
Early IDA
Bone marrow suppression/invasion by malignancy
Aplastic anemia 
Thyroid disease
57
Q

Hbg/Hct ratio

A

1:3

58
Q

High Retic count indicates?

Low Retic count?

A

High- anemia due to RBC’s being destroyed (hemolytic)?

Low- bone marrow failure (drug toxicity, cirrhosis)

FNP Review (15 decks)

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