CARDIO

Question 1

What is our goal BP in an elderly pt with HTN without CKD or DM?

Answer 1

<150/90

Question 2

What is our goal BP in an elderly pt with HTN and/or CKD?

Answer 2

<140/90

Question 3

What does the initial eval involve for HTN?

Answer 3

2 or more reading at 2 or more visits

CBC, UA, electrolytes, Cr, HbA1c, total cholesterol, HDL cholesterol, and ECG

Question 4

What are some aggravating factors for HTN?

Answer 4

stress, lack of exercise, nicotine, excessive alcohol or sodium intake, low potassium or calcium intake

Question 5

Is the goal of <120/80 recommended in the elderly?

Answer 5

NO

Question 6

What are non-pharm treatments for HTN?

Answer 6

lots of fruits/veggies, aerobic exercise MOST days of week, Na intake (<2.4g/day; optimal <1.5g), SMOKING CESSATION, and weight reduction

Question 7

Where do we start for treating HTN with meds?

Answer 7

HCTZ - ACE/ARBS - CCB

Question 8

What are some ACE’s?

Answer 8

Lisinopril, Captopril, Enalopril

Question 9

What are some ARBS?

Answer 9

Losartan or Valsartan

Question 10

If a pt has angina, how do we treat their HTN?

Answer 10

BB, CA (Calcium agonists AKA CCB)

Question 11

If a pt has Afib and HTN how do we treat them?

Answer 11

BB & NDCA

Question 12

What are 2 examples of non-dihydropyradine calcium channel blockers?

Answer 12

Diltiazem & Verapamil

Question 13

If a patient has bronchospasm and HTN what should we avoid?

Answer 13

BB

Question 14

Besides metoprolol, what are 2 other beta-blockers?

Answer 14

Atenolol & Propranolol

Question 15

In diabetics, CKD, and HF how do we treat their HTN?

Answer 15

ACEI, ARB’s

Question 16

How does ischemic heart disease present in a young person vs. the elderly?

Answer 16

Young = CP & heaviness

Elderly = vague – dyspnea, abdominal pain, fatigue, confusion or malaise

Question 17

How do we tell the difference between a STEMI & NSTEMI?

Answer 17

BOTH have elevated cardiac markers

NSTEMI has NONELEVATED ST segments

Question 18

In the presence of a STEMI how do we treat?

Answer 18

door to balloon in 90 minutes

Give NTG, morphine, and BB

Question 19

: In the presence of NSTEMI how do we treat?

Answer 19

ASA, BB, and full anti-coag

If everything is normal after 24 hours do stress testing

Question 20

If you heard a crescendo-decrescendo systolic murmur that radiates to the carotids and is heard best over the right 2nd intercostal space – dx?

Answer 20

Aortic stenosis

Question 21

If a pt with Afib is unstable – how do we treat?

Answer 21

Cardioversion

Question 22

What is rate control for Afib?

Answer 22

CCB (non-dihydros)

Question 23

What is rhythm control for Afib?

Answer 23

Cardioversion – if longer than 48 hours must anticoagulated x3-4 weeks or get TEE to show no atrial thrombi

Question 24

What is the one murmur that gets louder with standing from a squat or Valsalva?

Answer 24

mitral valve prolapse

Question 25

What are our 2 diastolic murmurs?

Answer 25

Mitral stenosis & Aortic regurg

Question 26

Which 3 murmurs cause holosystolic murmurs?

Answer 26

Mitral regurg, tricuspid regurg, and VSD

Question 27

What murmur is associated with rheumatic fever or HF?

Answer 27

Mitral regurg

Question 28

What murmur has an opening snap followed by a low diastolic rumble heard best in the left lateral decubitis position?

Answer 28

Mitral stenosis

Question 29

What murmur is blowing holosystolic heard radiating from the apex to the axilla?

Answer 29

Mitral regurg

Question 30

What murmur is blowing holosystolic heard best at the left sternal border and on inspiration?

Answer 30

Tricuspid regurg

Question 31

What murmur has a diastolic blowing decrescendo heard best over the left sternal border while sitting, leaning forward and exhaling & holding breath?

Answer 31

Aortic regurg

Question 32

What diagnosis causes lower extremity exertional pain/fatigue (aka claudication)?

Answer 32

Peripheral vascular disease

Question 33

What are the 5 aspects of controlling vascular disease?

Answer 33

``` Quit smoking BP control DM control Lipid lowering agents ASA ```

Question 34

What are some common sxs of HF in the elderly?

Answer 34

confusion, irritability, sleep disturbance, anorexia, N/d Cough, orthopnea, dependent edema

Question 35

How do we diagnose HF?

Answer 35

- BNP! Most useful test, but specificity declines with age - XR for increase heart size - Echo & EKG (Q waves or LVH)

Question 36

What are the two main components of HF we treat?

Answer 36

Reduce preload & afterload

Question 37

How do we reduce preload?

Answer 37

Diuretics

Question 38

What must we always check before/after prescribing diuretics?

Answer 38

K levels!

Question 39

How do we reduce afterload?

Answer 39

ACE inhibitors

Question 40

What must we watch before/after prescribing Lisinopril?

Answer 40

Cough & K levels

Question 41

If a pt experiences a cough with Lisinopril, what can we change to?

Answer 41

ARB (losartan)