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FNP: Systems Review > Cardiac > Flashcards

Cardiac Flashcards

1
Q

Systolic BP 140-159 and Diastolic BP 90-99 is what stage of hypertension

A

Stage I Hypertension

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2
Q

Risk factors for Coronary Heart Disease (CHD) includes:

A
  • Hypertension
  • High/Elevated LDL
  • Cigarette Smoking
  • Low HDL
  • Family Hx of premature CHD
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3
Q

Medications that has proven efficacy in reducing elevated lipids

A
  • Statins (HMG Co-A reduc Inhib)
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4
Q

Patients with dyslipidemia should be screened for what?

A
  • Diabetes (BG)
  • Renal Disease (BUN and Cre)
  • Hypothyroidsim (TSH)
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5
Q

The primary effect eating has on a lipid profile is the:

A
  • Triglycerides - Triglyceride levels occurs 3-4 hours after eating, but may peak during a 12 hour period.
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6
Q

CHD risk equivalents include:

A
  • Diabetes
  • Symptomatic C.A.D
  • P.A.D
  • Abdominal Aortic Aneurysm
  • Multiple risk factors that confer a 10 year risk of CHD > 20 percent
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7
Q

Stage II Hypertension is diagnosed when?

A
  • Systolic BP > 160

* Diastolic BP > 100

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8
Q

Statins are most beneficial when taken:

A
  • In conjunction with diet and exercise
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9
Q

1st line treatment for hypertension is:

A
  • Weight loss

* Lifestyle Modifications

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10
Q

If a patient, taking a statin drugs, complains of muscle or joint pains, which labs should be drawn?

A
  • CPK or…
  • CK or…
  • CK-MG
  • ** Any lab that will show that a breakdown in muscle tissue has occurred***
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11
Q

Treatment for stage II hypertension includes:

A
  • Dual Therapy - usually a:
  • Thiazide Diuretic and…
  • CCB, ACE-I, or ARB
  • ACE-I and ARB cannot be a combo*
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12
Q

Systole/S1, which is the lub sound, is considered the closure of which valves

A
  • Mitral and…

* Tricuspid

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13
Q

A holosystlic or pansystolic murmur, best heard at the apex, and can possibly radiate to the axillae, is suggestive of ____

A
  • Mitral Regurgitation
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14
Q

An audible S3 sound heard in middle age and elderly adults is suggestive of

A
  • Systolic Dysfunction (CHF)
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15
Q

The “GOLD STANDARD” for diagnosing hypertension is:

A
  • An elevated SBP or DBP on 3 different occasions (days)

* An extremely elevated (>200 SBP & >110 DBP, with symptoms)

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16
Q
  • An acute or sudden onset of “Tearing” severe low back/abdominal pain.
  • Presents with abdominal bruit with abdominal pulsation.
A
  • Dissecting Aortic Anyeursm
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17
Q

1st line pharmacological treatment for Stage I hypertension includes:

A
  • Thiazide Diuretics (1st choice)
  • CCB
  • ACE-I
  • Beta-blockers
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18
Q

A midsystolic murmur heard at the 2nd intercostal space, on the right side of the sternum, that can radiate to the neck is suggestive of _____

A
  • Aortic Stenosis
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19
Q

In Diastole/S2, which is the “Dub” sound, which valves are closing?

A
  • Aortic, and…

* Pulmonic

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20
Q

Symptoms of “DECREASED” cardiac output includes:

A
  • Dypsnea on exertion
  • Chest Pain
  • Orthopnea
  • Syncope
  • Near Syncope
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21
Q

The main cause of “Mitral Stenosis” is:

A
  • Rheumatic Infection (Strep Infection)
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22
Q

In diabetics, at what BP should pharmacological treatment begin

A
  • 140/80 or greater
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23
Q

How often should a fasting lipid profile be done in diabetic patients

A
  • Annually

* For patients with levels at or under goal, every 2 years is fine.

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24
Q

Diabetics with increased for Cardiovascular Disease (CVD), should be placed on _______, as primary prevention.

A
  • Aspirin (75mg-162mg/day)

* Plavix 75mg/day (for Aspirin Allergy)

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25
Q

Primary cause of hyper/dyslipidemia

A
  • Familial genetic defect
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26
Q

How does “Mitral Regurgitation” effect cardiac output

A
  • “DECREASES” cardiac output
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27
Q

When starting on an ACE-I, what is lab is most important to monitor?

A
  • Potassium (K+)
  • ACE-I can impair renal excretion of K+ with normal kidney function, and can increase the risk of hyperkalemia with impaired renal function.
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28
Q

Secondary causes of hyper/dyslipidemia include:

A
  • ↑ intake of cholesterol, trans, and saturated fats (do lipid profile)
  • Diabetes (do BG check)
  • Hypothyroidism (do TSH, or thyroid panel)
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29
Q

Medications that is frequently used to improve long-term outcomes in patients with “SYSTOLIC DYSFUNCTION”

A
  • ACE- Inhibitors
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30
Q

The initial evaluation of intermittent claudication would include:

A
  • Ankle and Brachial BP checks before and after exercise
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31
Q

When heart block is present, which hypertensive medications are contraindicated

A
  • Alpha-blockers
  • Beta-blockers
  • Calcium-blockers
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32
Q

Which class of medications affects smooth muscle

A
  • Calcium Channel blockers

* Examples: Amlodipine (Norvasc), Nifedipine (Procardia), Verapamil

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33
Q
  • A condition in which the two valve flaps of the mitral valve do not close smoothly or evenly.
  • Also known as “Click-Murmur Syndrome”, “Barlow’s Syndrome” or “Floppy Valve Syndrome”.
A
  • Mitral Valve Prolapse
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34
Q

Treatment for mild pre-eclampsia includes:

A
  • Bedrest with bathroom privileges
  • Close monitoring of weight and BP
  • Monitor of urine protein, creatinine, and platelets counts
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35
Q
  • Antihypertensive medication that can exacerbate COPD and CHF
A
  • Beta-blockers
36
Q

A cough noted with heart failure is usually described as:

A
  • Wet
  • Worse when lying down (recumbent)
  • Worse at night
37
Q

Which hypertensive medication has a sulfa ring attached to it

A
  • Hydrochlorothiazide
38
Q

Patient with long standing poorly controlled hypertension, will have a PMI located where?

A
  • 5th intercostal space, to the left
39
Q

This is of greatest value when evaluating heart valves, chamber size, cardiac output, and overall function of the myocardium

A
  • Echocardiogram
40
Q

The most common arrhythmia from valvular heart disease is:

A
  • Atrial Fibrillation
41
Q

Systolic Murmurs include:

A
  • Aortic Stenosis
  • Mitral Regurgitation
  • Pulmonic Stenosis
  • Tricuspid Regurgitation
42
Q
  • This arrhythmia is considered intermittent or self-terminating.
  • Episodes usually terminate within 7 days.
  • It is usually asymptomatic
A
  • Paroxysmal Atrial Fibrillation
43
Q

Secondary Hypertension causes include:

A
  • Renal (Renal Stenosis, Renal Failure)

* Endocrine (Adrenal Tumors, Hyperthyroidism)

44
Q

Medication that helps HTN and BPH

A
  • Alpha 1 - Blockers

* Example (Tarazosin, Tamsulosin)

45
Q

What symptoms are found in Hypertensive retinopathy

A
  • AV nicking

* Copper and Silver wire arterioles

46
Q

Side effects of Thiazide diuretics include:

A
  • Hyperglycemia
  • Hyperuricemia
  • Hypertriglyceremia
47
Q

Treatment for Isolated Systolic Hypertension in the Elderly includes:

A
  • Thiazide diuretic (1st choice)

* If needed, add CCB (Amlodipine, Nifedipine)

48
Q

Women with hypertension and osteopenia/osteoporosis should receive _____ because they help bone loss by slowing down calcium loss

A
  • Calcium Channel blockers (1st choice)

* Thiazide Diuretics

49
Q
  • Jugular vein distention
  • Enlarged spleen and liver
  • Lower extremity edema
    The above signs and symptoms are indicative of:
A
  • Right-sided Heart Failure
50
Q

Abrupt discontinuation of beta-blockers could cause what?

A
  • Rebound Hypertension
  • Palpitations
  • Chest Pain (Angina Pectoris)
51
Q

S3 heart sound can be benign in which populations

A
  • Athletes
  • Youth
  • Pregnancy
52
Q

Side Effects of Calcium Channel Blockers

A
  • Edema of the Ankle
  • Dizziness
  • Headaches
  • Flushing
  • Weakness
53
Q

Pulse deficit is the difference between _____ and ______

A

Apical and Radial pulse, which is taken at the same time (subtract radial from the apical)

54
Q

What grade of murmur can be felt during palpating

A

Grade 4 or higher

55
Q

In hypertensive target organ damage, the organs commonly affected include:

A
  • Kidneys (Renal failure and Proteinuria)
  • Eyes (Retinopathy, AV Nicking, Bleeding, and Blindness)
  • Heart (Heart Disease, CHF, LVH, and MI)
  • Brain (Stroke, TIA)
56
Q

Signs and Symptoms are this disorder include:

  • Shortness of breath especially during activities of daily living or when lying down
  • Fatigue during times of exercise,
  • Coughing especially when lying down
  • Palpitations and Pedal edema
  • Heart murmurs,
  • Polyuria
  • Syncope, dizziness, chest pain, angina type like squeezing, crushing, and pressure tightness.
A

AORTIC STENOSIS

57
Q
  • Types of QT syndrome in which the heart cardiac muscle takes longer than normal to recharge between heart beats.
A
  • Jervell and Lange Neilson Syndromes
58
Q

In Bacterial Endocarditis, skin finding are mostly found where?

A
  • Fingers, hands, toes, and feet
  • Subhungual heomorrages (splinter hemorrhages)
  • Petechiae on the palate
  • Pain violet-colored nodes on the fingers or feet (Osler Nodes)
  • Tender red spots on the palms/soles (Janeway Lesions)
59
Q

Low tone heart sounds (S3 or S4) or Mitral Stenosis can be heard with which side of the stethoscope?

A

Bell Side

60
Q

Mid and High pitch heart sounds and Lung Sounds, along with Mitral Regurgitation and Aortic Stenosis can be heard with which side of the stethascope

A

Diaphragm Side

61
Q

Diastolic Murmurs are ALWAYS indicative of:

A

Heart Disease

62
Q
  • Described by the location of “on the apex” or “apical area” of the heart, or…
  • On the 5th ICS on the left side of the sternum, medial to the midclavicular line
A
  • Mitral Murmurs
63
Q

What is the “CHADS2” Scoring system used for?

A
  • To determine if treatment for atrial fibrillation is needed (2 CHADS2 factors required anticoagulation)
64
Q

Causes of Paroxysmal Atrial Tachycardia (Paroxysmal Supratachycarida) include:

A
  • Digoxin Toxicity
  • Alcohol
  • Hyperthyroidism
  • Caffeine Intake
  • Illegal Drugs
65
Q

How can Paroxysmal Atrial Tachycardia/Paroxysmal Supratachycardia be interrupted or stopped

A
  • Valsalva maneuver
66
Q

What action is to be taken with an INR of 3.0 to 5.0

A
  • Skip 1 dose. ↓ maintenance dose. Check INR in 1 to 2 days until normal.
67
Q
  • This is when the apical pulse can still be heard, even thought he radial pulse is no longer palpable.
  • It is measured by using a BP cuff and stethoscope
A
  • Pulsus Paradoxus (Paradoxical Pulse)
68
Q

Causes of Pulsus Paradoxus/Paradoxical Pulse include:

A
  • Asthma and Emphysema (↑ positive pressure)

* Cardiac Tamponade, Pericarditis, Cardiac Effusion (↓ movement of the LV)

69
Q

What action is to be take with an INR of 5.0 to 9.0

A
  • Omit a dose and give a small dose of Vitamin K, or…
  • Omit next 1 to 2 doses
  • Decrease maintenance dose
  • Daily INR monitoring until normal
70
Q

The INR for Atrial Fibrillation should be

A
  • 2.0 to 3.0
71
Q

The INR for Prosthetic Heart Valve should be

A
  • 2.5 to 3.5
72
Q
  • A person age 60 or older with a systolic BP of 160 or higher, but has a normal diastolic B/P
  • It is due to reduced vascular compromise in large arteries (stiffened vessels as we age)
  • It is a significant predictor of cardiovascular events in the elderly (↑ risk of strokes and M.I’s)
A
  • Isolated Systolic Hypertension
73
Q

Treatment for Isolated Systolic Hypertension includes:

A
  • Thiazide (1st line)

* May add a D-CCB (Amlodipine, Nifedipine, or ACE-I

74
Q

Side effects of Aldosterone Receptor Agonists Diurectics (Spironolactone/Aldactone)

A
  • Gynecomastia
  • Hyperkalemia
  • GI irritation (Nausea/Vomiting, Diarrhea, Cramping)
  • Post menopausal bleeding
  • Erectile Dysfunction
75
Q

Gold standard for diagnosis for of DVT

A
  • Venography/B-Mode ultrasound with Doppler flow, or MRI
76
Q

Gold standard for diagnosis of PVD or PAD

A
  • Angiography
77
Q

What is the most sensitive marker for “Myocardial Damage”

A

Troponin-I (cTnI)

78
Q

Absolute Contraindications for Fibrinolysis are:

A
  • Any prior history of intracranial hemorrhage
  • Known structural cerebral vascular lesion (AV Malformation)
  • Known Malignant Neoplasm (Primary or Metastatic)
  • Ischemic Stroke within 3 months “EXCEPT” acute ischemic strokes within 3 hours
  • Suspected Aortic Dissection
  • Active bleeding or bleeding Diathesis
  • Significant closed-head or facial trauma within 3 months
79
Q
  • Which lifestyle modification has the greatest reduction effect on blood pressure?
A
  • Weight Reduction (Reduces it by 5-20mmHg/per 10Kg)
80
Q
  • Which population of people are Mitral Valve Prolapse commonly found in?
A
  • People with Thoracic Disorders or Scoliosis

* Women in their “Child-Bearing” Years (Age 18-35)

81
Q
  • 1st line pharmacological therapy for hypertension patients with diabetes includes:
A
  • ACE-I or A.R.Bs (they ↓ progression of renal damage)
82
Q
  • How much can weight reduction reduce B/P?
A
  • 5-20mmgHg per 10kg
83
Q
  • How much can diet reduce B/P?
A
  • 8-14mmHg
84
Q
  • In patient with bilateral renal artery stenosis, which medications with precipitate/cause “Acute Renal Failure”
A
  • ACE-I (Ace-Inhibitors)
85
Q
  • What physical assessment can be done to assess for a DVT?
A
  • Homan’s Sign (If +, very highly of DVT)

FNP: Systems Review (10 decks)

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