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FNP Review > Cardiac > Flashcards

Cardiac Flashcards

(58 cards)

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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

Study These Flashcards
A

LDL reduction approx.

25
Moderate intensity statin therapy
LDL reduction approx. 30-49% ``` Atorvastatin 10-20mg Rosuvastatin (Crestor) 5-10mg Simvastatin 20-40mg Pravastatin 40-80 mg Lovastatin 40mg ```
26
High intensity statin therapy
LDL reduction >50% Atorvastatin 40-80mg Rosuvastatin (Crestor) 20-40mg
27
Diagnostic tests for arrhythmias
ECG Electrical physiology studies (EPS) Tilt table test, autonomic testing Transesophageal echocardiography (TEE)
28
Atrial fibrillation sx
``` Palpitations Fatigue Pre-syncope or syncope Dizziness Generalized weakness EKG shows irregular narrow complexes with absence of P waves ```
29
Mgmt of A-fib
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
Peripheral vascular disease
Manifests as insufficient tissue perfusion caused by existing atherosclerosis that may be acutely compounded by either emboli or thrombi.
31
Physical findings of PVD
Diminished or absent pedal pulses, presence of femoral artery bruit, abnormal skin color, & cool skin temperature.
32
Treatment of PVD
- Antiplatelet therapy- ASA/Plavix/Pletal- reduces the risk of serious vascular events - Aggressive treatment of hyperchlosterolemia, diabetes, HTN
33
Acute rheumatic fever
Inflammatory multi-system immunologic disease occurring 10 days to 6 weeks after group A streptococcus infection.
34
Dx criteria for scarlet fever
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
Patients at risk for heart failure
HTN, atherosclerotic disease, DM, obesity, metabolic syndrome. Structural heart disease- previous MI, LV remodeling, including LVH & low EF, asymptomatic valvular disease.
36
Sx of left heart failure (acute)
Heart & lungs "breathe through water" excess fluid retention into lungs (alveoli), dyspnea, wheeze, rales, "S3" *Follows AMI
37
Sx of right heart failure (chronic)
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
Limitations with heart failure (by stages)
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
Management of heart failure
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
S1 sound
``` AV valves (tricuspid/mitral) CLOSED Semilunar valves OPEN ```
41
S2 heart sound
``` Semilunar valves (pulmonic/aortic) CLOSED AV valves OPEN ```
42
S3 heart sound
"Kentucky" | Heard with increased fluid- pregnancy, CHF
43
S4 heart sounds
"Tennessee" | Heard with stiff ventricular wall (MI, left ventricular hypertrophy, HTN)
44
Where do u hear Aortic and pulmonic sounds?
Aortic- right 2nd ICS | Pulmonic- left 2nd ICS
45
Where do u hear tricuspid and mitral sounds?
Tricuspid- 5th ICS sternal border | Mitral- 5th ICS mid-clavicular line
46
Ms. ARD
Mitral stenosis/Aortic regurg. | DIASTOLIC
47
Mr. ASS
Mitral regurg./aortic stenosis | SYSTOLIC
48
Murmur of MVP
Mitral valve prolapse=mitral regurgitation SYSTOLIC Classic finding "mid-systolic click"
49
Murmur that "radiates to the neck"
Aortic stenosis
50
Lateral leads on EKG
I, aVL, v5, v6 LATERAL
51
Inferior leads on EKG
II, III, aVF INFERIOR
52
Anterior leads on EKG
V3, v4 ANTERIOR
53
Septal leads on EKG
V1, v2 SEPTAL
54
Microcytic hypochromic anemias
MCV
55
Macrocytic anemias
MCV >100 Megaloblastic anemia (B12, folate) Non-megaloblastic anemia (ETOH abuse, hypothyroid, liver ds, myelodysplastic syndrome).
56
Normocytic anemias
``` MCV 80-100 Early IDA Bone marrow suppression/invasion by malignancy Aplastic anemia Thyroid disease ```
57
Hbg/Hct ratio
1:3
58
High Retic count indicates? | Low Retic count?
High- anemia due to RBC's being destroyed (hemolytic)? Low- bone marrow failure (drug toxicity, cirrhosis)

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