Cardiovascular Flashcards

Question

Arterial vasodilators

Answer 1

-3rd or 4th line therapy. -Directly relaxes the vascular smooth muscle resulting in arterial vasodilation. -Adjust dose for renal impairment. -Contraindicated in patients with CAD, anginal syndromes, or aortic aneurysms. -May cause reflex tachycardia, flushing, dizziness, SLE, orthostatic hypotension, and fluid retention. -Hydralazine, minoxidil

Answer 2

-Does not appear to offer any advantage over other current available agents. -Inhibits renin, which decreased plasm renin activity and inhibits the conversion of A1 to A2. -Contraindicated in pregnancy. -Do not use if potassium >5.5 -Do not use in combo with ACEi and ARBs -May cause dizziness, headache, diarrhea, high potassium and renal impairment. -Only one available: Aliskinen

Answer 3

Ventricular contraction AV valves close (tricuspid and mitral valves) and semi lunar valves open (pulmonic and aortic) Period between S1 and S2

Answer 4

Semilunar valves close (pulmonic and atrial) and AV valves open (tricuspid amd mitral). Rapid venticular filing (75%) Atrial contraction/kick (left over 25% into ventricles) Period between S2 and S1

Answer 5

Aortic: 2nd right ICS right of sternum Pulmonic: 2nd left ICS left of sternum Erbs: 3rd ICS left of sternum Tricuspid: 5th ICS left lower sternum Mitral: 5th ICS midclavicular at apex

Answer 6

S1: Signifies closure of AV valves (semilunar valves are open) -Coincides with R wave on EKG S2: Signifies closure of semilunar valves (AV valves open) -Occurs at onset of diastole

Answer 7

Transient split occurs during inspiration due to late closure of pulmonic valve and early closure of aortic valve. -Late closure of pulmonic valve is associated with increased in venous return to the right ventricle with inspiration. -Early closure of the aortic valve is associated with decreased venous return to the left ventricle related to an increase in pulmonary capacity during inspiration. -Heard best in the pulmonic auscultation area -If the patient hold his or her breath the sound dissapears -Normal physiologic findings in children and young adults. -May occur every 4th beat.

Answer 8

Referred to as ventricular gallop, "Kentucky." -Due to passive filling of blood into a noncomplaint left ventricle. -Occurs with heart failure and cardiomyopathies when **fluid overload** is present. -Normal sound associated with pregnancy (due to hyperdynamic states)

Answer 9

Reffered to atrial of presystolic gallop. -Produced by blood entering **a non compliant left ventricle **during atrial kick. -Associated with increased ventricular diastolic pressures. -Heard late in diastol immediately before S1 and sounds like "Tennessee" -Occurs in conditions such as MI, HTN, ventricular hypertrophy, and HF. -Not heard when patient is in a-fib due to loss of atrial kick. *When S3 and S4 are heard together it's indicative of severe myocardial failure.*

Answer 10

1: Barely audible 2: Audible but faint 3: Moderately loud, easily heard ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 4: Loud, associated with a thrill. "if you dont have a thrill you arent at a 4" 5: Very loud, heard with one corner of stethoscope off the chest wall 6: Loudest, no stethoscope needed

Answer 11

Superior vena cava> Right atrium> Tricuspid valve> Right ventricle> Pulmonic valve> Pulmonary artery> Lungs> Pulmonary veins> Left atrium> Mitral valve> Left ventricle> Aortic valve> Aorta> Body

Answer 12

* Stenosis- forward flow issue d/t calcification of the valve * Regurgitation- Back up into previous chamber

Answer 13

Loud S1 murmur, low pitched, mid diastolic; apical "crescendo" rumble. Soft sound

Answer 14

Systolic murmur at 5th ICS MCL, may radiate to base or left axilla; musical blowing or high pitched; may follow S3. Harsh sound Associated with a holosystolic murmur Systolic murmurs radiate

Answer 15

Systolic, blowing, rough harsh murmur at 2nd right ICS usually radiating to the neck. Soft sound. Systolic murmurs radiate.

Answer 16

Diastolic, blowing murmur at 2nd left ICS.

Answer 17

A syndrome that results when the cardiac ouput is insufficient to meet the metabolic needs of the body.

Answer 18

**Heart failure with reduced ejection fraction** -Also known as systolic failure -Due to the inability of the heart to contract and results in decreased cardiac output.

Answer 19

Heart failure with preserved ejection fraction Also known as diastolic failure Inability of the heart to relax and fill, results in decreased cardiac output.

Answer 20

* Abrupt onset, usually follows acute MI or valve rupture. * Blood backs up from the left ventricle to left atrium and into the lungs. * Will have s/s of left HF: -Dyspnea at rest -Coarse rales over all lung fields -Wheezing, frothy cough -Appears generally healthy except for the acute event. -S3 gallop (kentucky) -Murmur of mitral regurgitation (systolic murmur loudest at apex)

Answer 21

Develops as a result of inadequate compensatory mechanisms that have been employed overtime to improve cardiac output. Right ventricle has to compensate from left ventricle not doing it's job and leads to failure. Will have signs of right HF: -JVD -Hepatomegaly, splenomegaly **-Dependent edema as a result of increase capillary hydrostatic pressure** -Paroxysmal noctural dyspnea (PND) -Appears chronically ill -Diffuse chest wall heave -Displaced point of maximal impulse (PMI) -Abdominal fullness -Fatigue on exertion -S3 and/or S4

Answer 22

Right ventricular hypertrophy

Answer 23

New York Heart Association (NYHA) Functional Classification of Heart Failure: 1- No limitations or physical activity 2- Slight limitations of physical activity. First class where pt is symptomatic. 3- Marked limitations of physical activity 4- Severe inability to carry out any physical activity. Symptomatic all the time.

Answer 24

* Non-pharmacological: -Sodium restriction -Rest/activity balance -Weight reduction * Phamacological: -ACE inhibitor or ARB (for pts unable to take ACE due to renal insufficiency, couch, angioedema. -Beta blocker -Diuretics

Answer 25

Any disorder that affects the heart muscle. An idiopathic disorder causing cardiac muscle dysfunction that may result in systolic or diastolic heart failure not due to atherosclerosis, HTN or valve disease. S/S are just like heart failure

Answer 26

Management is just like heart failure For symptomatic relief: ACEi or ARBS Diuretics Beta blockers

Answer 27

* Dilation of the heart muscles, the most common type. * Abnormal systolic pump function also known as HFrEF. * Systolic heart failure.

Answer 28

Hypertrophy of the left ventricle and occasionally the right ventricle. Diastolic heart failure also known as HFpEF. Stiff left ventricle during diastole that restricts ventricular filling.

Answer 29

Scarring/stiffening of the heart muscle, the least common type. Inadequate diastolic filling.

Answer 30

Primary/essential: Most common 95% Secondary: 55, secondary to other known causes such as estrogen use, renal disease, pregnancy, endocrine disorders, renal artery stenosis (#1 cause).

Answer 31

* Often none, known as silent killer. * Elevated BP * Suboccipital pulsating headache occuring early in the morning and resolving throughout the day, with severe HTN. * Epistaxis * Dizziness/lightheadedness * S4 related to left ventricular hypertrophy * AV nicking * Tearing chest pain may indicate aortic dissection.

Answer 32

Order tests to rule out other causes of -HTN such as: -Renovascular disease studies -CXR -Aldosterone levels to rule out aldosteronism -Cortisol levels to rule out cushings -UA, CBC, BMP, etc. If all is normal, then it's primary/essential HTN

Answer 33

2-3 BP measurements on 2-3 seperate occasions Normal: <120 AND <80 Elevated: 120-129 AND <80 Stage 1: 130-139 OR 80-89 Stage 2: >140 OR >90

Answer 34

* Restrict dietary sodium (where Na+ goes water goes, making the heart work harder) * Weight loss if overweight * DASH diet (dietary approaches to stop HTN) * -Rich in fruits, veggies, low fat products. * Exercise * Stress management * Reduction or eliminate alcohol * Smoking cessation * Maintenance of adequate potassium, mag, calcium

Answer 35

* Normal BP: <120 AND <80 -Promote optimal lifestyle habits and reassess in 1 year * Elevated: 120-129 AND <80 -Nonpharmalogical therapy and reasses in 3-6 months. * Stage 1: 130-139 OR 80-89 -W/O ASCVD risk- Nonpharmacological therapy and reasses in 3-6 months. -With ASCVD risk- Nonpharmacological therapy plus BP lowering med, reassess in 1 month. * Stage 2: >140 OR >90 -Nonpharmacological therapy plus 2 BP meds from 2 different classes.

Answer 36

Thiazide diuretic CCB

Answer 37

ACEi or ARB

Answer 38

>180/110 * Situations associated with severe BP elevation in otherwise stable pts without acute or impending change in target end organ damage or dysfunction. * May be due to noncompliance with HTN meds * May or may not be associated with severe headaches, SOB, epistaxis or severe anxiety. * Treatment: restarting or revamping HTN therapy or captopril, clonodine, labetalol.

Answer 39

>180/120 * Associated with evidence of new or worsening target organ damage. * Requires immediate (w/in 1 hour) BP reduction to prevent or limit target organ damage. * Blood pressure may be lower with any of the following: -HTN encephalopathy -Malignant hyperthermia -ICH -Unstable angina -Acute MI -Acute HF -Dissecting aortic aneurysm -Eclampsia Treatment: -ICU admission -Nicardipine, nitroprusside -Do not decrease too quickly unless there is a compelling condition (above). --<140 over 1st hour and <120 if aortic dissection. -For no compelling condition, no more than 25% reduction in BP w/in 1st hour then if stable <160 within next 2-6 hours then normal next 24-48 hours.

Answer 40

"Squeezing and choking of the chest" related to **ischemia.** Types: * Stable (classic or chronic) * Prinzmetal's angina * Unstable * Microvascular

Answer 41

* Intermittent chest pain or discomfort with a predictable pattern: the same onset, intensity and duration. * Most often induced by exercise, but also can be induced by emotional distress. * May last 1-2 min to 10-20 min, and looks like a heart attack. * **EKG demonstrates ST depression** * Can result from rupture of athersclerotic plaques that develop over time or a coronary spasm. * Nitro may relieve pain by vasodilation and rest by decreasing oxygen consumption. * Controlled with lifestyle changes and medications.

Answer 42

* Precipitating event is coronary artery spasm and may occur in the absence of atherosclerosis. * Can occur anytime including rest. **EKG should ST elevation** * Due to sudden influx of intracellular calcium, so CCB is prescribed as treatment.

Answer 43

* Chest pain that lasts longer than 20-30 min. * Pattern of attacks usually progresses with increased frequency, duration and intensity. * EKG shows ST depression with T wave inversion. * Sublingual nitro helps relieve pain. * Increased incidence of MI within 6 months after onset of angina.

Answer 44

A metabolic syndrome Chest pain that mimics angina No evidence of abnormal angiogram, CT or coronary spasms. Evidence o coronary microvascular function impairment.

Answer 45

Leads 2, 3, avf Sites: Right Coronary Artey

Answer 46

Leads 2, 3, AVF, V5, V6 Right coronary artery Left circumflex artery

Answer 47

Leads V3, V4 Left anterior descending artery

Answer 48

Leads 1, AVL, V3, V4 Left anterior descending Left circumflex

Answer 49

Leads V1, V2, V3, V4 Left anterioir descending artery

Answer 50

Troponin is cardiac specific, troponin I rises slightly faster than troponin T. -normal 0-0.04 CK-MB Myoglobin

Answer 51

Goal is to get LDL to goal by maximal dose of statin, not by a specific LDL number. * High Intensity Statin Therapy: -Daily dose lowers LDL by <50% -Atorvastatin 40-80mg -Rosuvastatin 20-40mg * Moderate Intensity Statin Therapy -Daily dose lowers LDL by 30-50% -Atorvastatin 10-20mg -Rosuvastatin 5-10mg * Low Intensity Statin Therapy -Daily dose lowers LDL by <30% -10mg statins

Answer 52

* Bile acid sequestrants -Lowers LDL, may increase triglycerides -Cholestyramine -Colesevelam -Colestipol * Fibrates -Decrease triglycerides, lowers LDL and increased HDL -Gemfibrozil -Fenofibrate -Fenofibric * Cholesterol absorption inhibitors -Used in combo with a statin to lower LDL -Esetimibe * Niacin -Decreases LDL and triglycerides and increases HDL -Immediate release and extended release preparations -High doses of niacin may cause flushing sensation

Answer 53

Leading cause of death in U.S. Necorsis of myocardial tissue * Most common causes: CAD and cardiomyopathies * S/S: Most have history of anginal pain -Most infarcts occur at rest -Nitro has little effect -Cold swear, weakness, impending doom, apprehension, light headedness, syncope, dyspnea, cough, N/V. Physical exam findings: -Dysrhythmia common -S4 very common -Wheezing -Pulmonary crackles -Low grade fever -Tachycardia

Answer 54

PR interval >0.20 seconds

Answer 55

Wenckebach or mobitz type 1 Longer longer longer drop then you have a wenckebach PR interval gradually gets longer until a QRS complex is dropped

Answer 56

Mobitz type 2 Atrial rhythm is regular, the PR interval is constant, but the ventricular rhythm is irregular and dropped QRS complexes occur.

Answer 57

Complete heart block Atrial and ventricular rhythms are regular but there is not relationship between the P wave and QRS complex.

Answer 58

If unstable, cardiovert If stable, do a TEE before cardiovert to rule out left atrial appendage thrombus, if no thrombus proceed to cardiovert. Anticoagulation for 4 weeks after cardiovery due to atrial stunning and not contracting normally. If pt has been on uninterrupted anticoagulants for 3 weeks a TEE is not warranted before cardiovert. After conversion to NSR, antiarrhythmics may be nessesary to sustain rhythm.

Answer 59

Used to assess the risk of strokes in Afib pts. 1-Congestive heart failure 1-Hypertension 2-Age >75 (doubled) 1-Diabetes 2-Stroke (doubled) 1-Vascular disease 1-Age 65-74 1-Sex category (female) Score of 0=no anticoagulation Score of 1= oral anticoagulation or antiplatelet Score of >2= oral anticoagulation

Answer 60

Helps assess bleeding risk in afib pts. Hypertension Abnormal liver and renal function Stroke Bleeding tendency/predisposition Labile INR for pts taking warfarin Elderly Drugs/alcohol A score of 1= low risk of bleeding A score of 2= moderate risk and anticoagulation should be considered A score of 3 or more= high risk for major bleeding and the pt should be routinely assessed for risk vs benefits of anticoagulation.

Answer 61

Arteriosclerotic narrowing of the lumen of arteries resulting in decreased blood supply to extremities. Usually caused by atherosclerosis, hyperlipidemia, smoking, DM. S/S: -Complaints of calf pain (claudication) -Cold/numbness in extremities -Progresses to pain at rest Physical findings: -Shiny/hairless skin -Dependent rubor -Pallor upon elevation -Cyanosis -Ulcerations Reduced pulses Lab/diagnostics: -Ankle brachial index (1 is normal, <1 is abnormal) -Arteriography is most definitive test Management: -Stop smoking and all tobacco use. -Exercise, walk 1 hour a day to increase collateral circulation -Cilostazol- antiplatelet drug and vasodilator -Weight reduction -Manage diabetes and hyperlipidemia -Angioplasty -Bypass surgery -Amputation

Answer 62

Impaired venous return due to either destruction of valves, changes due to deep thrombophlebitis, leg trauma, or sustained elevation of venous pressure (HF) More common in women than men S/S: -Aching of lower extremities relieved by elevation -Edema after prolonged standing -Night cramps of the lower extremities Physical findings: -Trophic changes with brownish discoloration -Stasis leg ulcers -Edema of lower extremities -Dermatitis may be common -Cool to touch Lab/diagnostics: -Nonspecific diagnostics -R/O edema due to heart failure and other causes such as May Thurner syndrome which is compression of left common iliac vein by overlying right common iliac artery=LLE DVT Management: -Bedrest with legs elevated to diminish chronic edema -Use of heavy duty elastic support stockings -Weight reduction -Treat dermatitis or ulcers as indicated -Acute weeping dermatitis: --Tap water compresses --Hydrocolloid dressing --For less acute use hydrocortisone cream.

Answer 63

Accumulation of blood and/or fluid in the pericardial space, resulting in a life threatening decrease in cardiac output. Physical exam findings: -Becks triad: --JVD --Narrow pulse pressure --distantheart tones -Tachycardia -Pulsus paradoxus -change in LOC Lab/diagnostics: -ECHO is gold standard -CXR may show widened mediastinum Management: -pericardiocentesis -treat shock

Answer 64

For subacute endocarditis, empiric therapy is usually not started until blood cultures identify pathogen. For acute endocarditis, usually due to staphylococcus aureus, streptococci and enterococci. So empiric therapy is started with vancomysin until culture results are avilable.

Cardiovascular Flashcards

(90 cards)