AAFP Flashcards
Caution is necessary when prescribing TZDs in patients with:
known heart failure or other heart diseases, those with preexisting edema, and those on concurrent insulin therapy (SOR C).
Metformin is often contraindicated because of:
renal insufficiency or heart failure
Danger of sulfonylureas and other insulin secretagogues
hypoglycemia
The 2002 joint guidelines of the American College of Cardiology, the American Heart Association (AHA), and the North American Society of Pacing and Electrophysiology endorse the use of cardiac resynchronization therapy (CRT) in patients with:
medically refractory, symptomatic, New York Heart Association (NYHA) class III or IV disease with a QRS interval of at least 130 msec, a left ventricular end-diastolic diameter of at least 55 mm, and a left ventricular ejection fraction (LVEF) ≤30%.
What is CRT?
Using a pacemaker-like device, CRT aims to get both ventricles contracting simultaneously, for example overcoming the delayed contraction of the left ventricle caused by the left bundle-branch block.
The American Heart Association recommends a goal blood pressure of 130/80 mm Hg or less for the treatment of hypertension in patients with:
diabetes mellitus, chronic kidney disease, or coronary artery disease.
Management of dissecting aortic aneurysm
Initial management should reduce the systolic blood pressure to 100-120 mm Hg or to the lowest level tolerated. The use of a β-blocker such as propranolol or labetalol to get the heart rate below 60 beats/min should be first-line therapy. If the systolic blood pressure remains over 100 mm Hg, intravenous nitroprusside should be added.
Most common cause of HTN in children under 6 yo
renal parenchymal disease
When is surgery indicated?
Dissecting aortic aneurysm
only for complications such as occlusion of a major aortic branch, continued extension or expansion of the dissection, or rupture
Who should get screened for AAA?
men 65-75 yo who have ever smoked
Management of SVT
If supraventricular tachycardia is refractory to adenosine or rapidly recurs, the tachycardia can usually be terminated by the administration of intravenous verapamil or a β-blocker. If that fails, intravenous propafenone or flecainide may be necessary. It is also important to look for and treat possible contributing causes such as hypovolemia, hypoxia, or electrolyte disturbances. Electrical cardioversion may be necessary if these measures fail to terminate the tachyarrhythmia.
Monotherapy for hypertension in African-American patients is more likely to consist of:
diuretics or calcium channel blockers than β-blockers or ACE inhibitors. It has been suggested that hypertension in African-Americans is not as angiotensin II-dependent as it appears to be in Caucasians.
Still’s murmur
systolic heart murmur. It is heard best in the lower precordium and has a low, short tone similar to a plucked string or kazoo. It does not radiate to the axillae or the back and seems to decrease with inspiration. may be due to vibrations in the chordae tendinae, semilunar valves, or ventricular wall.
Venous hum
continuous low-pitched murmur caused by the collapse of the jugular veins and their subsequent fluttering, and it worsens with inspiration or diastole.
Murmur of physiologic peripheral pulmonic stenosis
The murmur of physiologic peripheral pulmonic stenosis (PPPS) is caused by physiologic changes in the newborns pulmonary vessels. PPPS is a systolic murmur heard loudest in the axillae bilaterally that usually disappears by 9 months of age.
Metoprolol and carvedilol are metabolized by the __.
liver; therefore do not need renal dosage adjustment
Which needs renal dosage adjustment? Enoxaparin vs clopidogrel
enoxaparin; clopidogrel can be given at standard dosage
What about tPA?
Renal dosing
can be given at standard dosage in renal failure, although hemorrhagic complications are increased
Most useful diagnostic tool for evaluating patients with heart failure
2-D echocardiography w/ Doppler
Diagnosis of MI on EKG
Myocardial infarction is diagnosed by ST elevation ≥1 mm in two or more limb leads and ≥2 mm in two or more contiguous precordial leads.
New left bundle branch block suggests occlusion of:
left anterior descending artery
Isolated systolic HTN in the elderly responds best to:
diuretics, and to a lesser extent, beta blockers
Benefits of thiazides
highly effective at preventing CVA >> MI improved BP control in African-Americans inexpensive, widely available kidney stone risk reduction preservation of calcium stores (could help w/ osteoporosis) loss of "water weight"
Most common associated etiologic factor of spontaneous axillosubclavian vein thrombosis (ASVT)
compressive anomaly in the thoracic outlet, usually bilateral
