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Flashcards in Cardiac for dummies Deck (61):
1

If a patient doesn't tolerate an ace inhibitor, you can next try them on an_______.  This class of medication should NEVER be given in combination with an ACE inhibitor.

 

ARBs

-sartans (losartan)

for people who don't tolerate ACE inhibitors

 

2

First line agents for HTN are:

thiazide diuretics

3

SBP >180 or DBP>110 is hypertensive____

and is treated with ______ 

urgency

oral antiHTN

4

swelling of the optic disc with blurred margins

papilledema

emergency, requires IV antiHTN and BP monitoring

5

What EKG changes are seen with classic anginal pain?

ST depression

6

stable/exertional angina

chest pain with exertion

goes away with NTG/rest

typically ST depression

tightness pain of chest

7

Printzmetals angina is caused by:

vasospasm

(NOT BY CAD, these people have a clean angio)

treated with calcium channel blockers

typically ST elevation on EKG

8

Levine's sign is more than 90% diagnostic of angina.

Levine's sign is when:

the patient has their hand clenched over their chest

9

What is normal total cholesterol?

<200

10

What is normal triglycerides?

<150

11

What is optimal LDL?

<100

12

When is HDL high? 

>60

this is good bc it cancels the preHTN risk

13

Patients with angina should modify their diet by decreasing:

saturated and unsaturated fats

14

30% of patients with MI have no initial _____ changes

12-lead EKG

15

Which troponin is 100% cardio selective?

troponin I

16

Per Barkley, the treatment for acute MI IN ORDER is:

1st ASA

2nd nitro

(unblock the vessel before trying to get O2 to it)

3rd oxygen

17

What is the timeframe for cardiac fibrinolytics?

30 minutes of chest pain, within 6 hours of onset

18

Why do patients with claudication need to exercise?

To develop collateral circulation

 

19

What is first line therapy for dermatitis?

wet compress and hydrocortisone

(NOT antibiotics)

20

What is the leading cause of heart failure in America?

HTN

21

What heart sound is heard suring systole and is the closing of the AV valves?

S1

22

What heart sound is head during diastole and is the closing of the pulmonic and aortic valves?

S2

23

Name three causes of S3?

pregnancy (normal)

CHF

fluid overload

24

Name three causes of S4?

HTN

stiff ventricular wall

MI

25

Which heart sound sounds like Kentucky?

S3

26

Which heart sound sounds like Tennessee?

S4

27

What is the grading system for cariac murmurs 0-6/6?

1/6 very faint

2/6 faint

3/6 AUDIBLE

4/6 AUDIBLE + THRILL you can feel

5/6 part of stethascope off

6/6 from the door

28

If you hear a low-pitched diaslotic murmur at the APEX, apical crescendo, what is it?

*remember APEX is the bottom = mitral

*MS ARD

mitral stenosis

29

A systolic cardiac murmur at the 5th ICS MCL (apex), radiates   to left axilla, blowing, musical.

*MR ASS

*radiates to left axilla

 

mitral regurg

30

systolic murmur, right 2nd ICS, radiates to the neck

*MR ASS

aortic stenosis

31

diastolic murmur at 2nd left ICS (base)

MS ARD

 

aortic regurg

32

MS ARD

MR ASS

Mitral stenosis

Aortic regurg 

Diastolic

 

mitral regurg

aortic stenosis

systolic

33

According to Dr. Barkley, standard pharmacologic treatment for heart failure includes:

ace-inhibitors and thiazide diuretics

 

34

Beta blockers can cause what pulmonary side effect?

wheezing

35

Name 3 Secondary causes of HTN 

Renal failure

renal artery stenosis

pheochromocytoma

hyperthyroidism

36

NYHA functional classifications of heart failure

I: no limitations of physical activity

II: slight limitations of physical activity but comfortable at rest

III: marked limitations of funcitonal activity but comfortable at rest

IV: severe; inability to carry out any physical activity without discomfort, signs and symptoms while at rest

37

A patient with what NYHA classification will need pillows for orthopnea at night?

Class 4 because they have signs and symptoms while at rest

38

What differentiates NYHA HF class II from Class III?

both are comfortable at rest,

but class II has SLIGHT limitations of physical activity

and class III has MARKED limitation of physical activity

39

Name three signs/symptoms of HTN

S4 (r/t ventricular hypertrophy and stiff ventricular wall)

suboccopital pulsing HA

epistaxis

*often silent killer without any signs and symptoms

40

How does the use of NSAIDS exacerbate HTN?

bc they effect prostaglandins and the kidneys

41

A chest x-ray of a patient with HF may show what three things?

pulmonary edema

Kerley B lines

effusions

42

According to JNC 8 recommendations, pharmacologic treatment for HTN in African-Americans includes which two drugs first?

1st thiazide diuretics

2nd calcium channel blockers

43

According to JNC 8, goal BP for a patient 60 or older is:

SBP<150

DBP<90

44

According to JNC 8, goal DBP for any adult regardless of age is:

DBP<90

45

According to JNC 8, goal BP for patients less than 60 is

SBP<140

DBP<90

46

According to JNC 8, the goal BP for any adult with CKD or DM

SBP<140

DPB<90

47

According to JNC 8, what is the drug class of choice for the treatment of HTN for adults with CKD regardless of race or other medical conditions? 

ACE inhibitor

ARB if they don't tolerate ACE

*never ACE-I and ARB together

48

According to JNC 8, when do you refer a patient to a HTN specialist?

if 3 or more drugs are needed

49

How do Thiazide diuretics work to reduce morbidity and mortality and patients with HTN and what are their side effects?

Thiazide diuretics increase the exrection of sodium AND water

they may cause hyponatremia, hypokalemia, hypomangesemia, HYPERcalcemia and Hyperglycemia

50

ACE inhibitors (or ARBs if ACE not tolerated) are recommended 1st line for the treatment of HTN in patients with CKD despite age or ethnicity.  What female condition and what electrolyte imbalance is an ACE-I/ARB contraindicated in?

ACE inhibitors are contraindicated in pregnancy

Do not initiate ACE-I if K>5.5

51

What anti-HTN drug class should be avoided in patients with asthma/COPD?

beta blockers because beta 2 stimulates bronchoconstriction and can cause wheezing

52

What antiHTN class is used for Printzmetal's angina and migraines?

calcium channel blockers

53

What central alpha-2 agonist is the drug of choice in pregnancy and can also be used in Parkinsons?

methyldopa (aldomet)

54

If you see a patient with BP >180/120 and fondoscopic changes which include flame-shaped retinal hemorrhages, soft exudates, and papilledema (swelling of the optic disk with blurred margins), what is the diagnosis and how long do you have to correct the BP?

hypertensive emergency/malignant HTN

within 1-2 hours redue BP by 25%

55

Satins are contraindicated in patients with

liver disease

56

If you diagnose a patient with angina, what medication would you prescribe daily

ASA 81mg PO daily

57

When treating a patient with statin therapy, which level are you targeting?

the goal of statin therapy is to reduce the LDL by at least 50%

58

If you have a patient with liver problems who can't take statins, what is a cheap pharmacologic treatment option that decreases LDL and increases HDL?

niacin

59

HMG-CoA reductase inhibitors are:

statins

60

Exam findings/signs of MI

S4

low grade fever 48 hours

Troponin I elevate within 4-6 hours

leukocystosis 10-20 on the second day due to inflamation/damage of the necrotic tissue

61