Cardiovascular Flashcards Preview

joy's deck for FNP > Cardiovascular > Flashcards

Flashcards in Cardiovascular Deck (53):
1

MI s/s

male: heavy chest, left shoulder/jaw pain, clammy
women: unusual fatigue, back pain, n/v

2

AAA (dissecting abd aortic aneurysm)

elderly white male
pulsating sensation in abdomen or low back
impending rupture- "sudden" sharp pain to chest/low back.

high risk: HTN/smoker

3

CHF

elderly pt c/o sob, "dry cough", swollen ankles, increase weight
crackles
s3 heart sound
hx: cad, prior MI

4

bacterial endocarditis s/s

check their fingers/toes
janeway lesions- tender red spots on the palms/soles
splinter hemorrhage- splinter hemorrhage on nailbed

5

pregnant PMI

located upward on the left side

6

Deoxygenated blood

SVC, right atrium, tricuspid, right ventricle, PULMONIC VALVE, lungs, alveoli (RBC pick p02 and release co2)

7

oxygenated blood

left atria, mitral valve, left ventricle, , AORTIC VALVE, aorta, general circulation

8

s1 sound

s2 sound

closure of mitral/tricuspid valve
3 leaflets

s2- aortic/pulmonic valves
semilunar valves- 2 leaflets

9

s3

CHF! or heart failure
occurs during "early diastole"
aka" ventricular gallop"
alway abnormal if >35yo
normal in young children and athletes if no other s/s

In older individuals it indicates the presence of congestive heart failure. The third heart sound is caused by a sudden deceleration of blood flow into the left ventricle from the left atrium.

10

s4

LVH
stiff left ventricle
The fourth heart sound (S4), when audible, is caused by vibration of the ventricular wall during atrial contraction. This sound is usually associated with a stiffened ventricle (low ventricular compliance), and therefore is heard in patients with ventricular hypertrophy, myocardial ischemia, or in older adults.

aka "atrial gallop" or "atrial kick"

11

summation gallop

s1-s4 heart

12

benign split s2

best heard over pulmonaic area (left sternum). normal finding if it occurs during inspiration, disappears expiration

13

bengin s4 in elderly

if no s/s of heart/valvular disease it is normal

14

MR ASS


mitral regur- best heart apex. axilla, high pitched (use diaphragm to listen)

aortic stenosis- radiates to neck
noisy murmur- use bell

systolic murmurs- loud, radiate to neck or axilla

15

MS. ARD


mitral stenosis- use diaphragm
aortic regurg- use bell
diastolic

16

heart murmur grading

I-VI

IV- louder murmur, first time a thrill is present "palpable mur mur"

17

ALL diastolic (MS AR)= abnormal

all benign mumurs occurring during systole (s1)
benign murmur do NOT have a thrill

true

18

Mitral valve location

apex of the heart
apical area
5th ICS on the left side of the sternum medial to the midlclavicular line

19

only systolic murmur radiate

mitral regurg- axilla
aortic stenosis- neck

20

s3 is a sign of what

CHF

21

s4 is a sign of what

LVH

22

s2 split heard best heard where

pulmonic area

23

afib tx

use CHADs2 score (2 or more requires anticoag)
C (CHF)
H (HTN)
A (>75yo)
D (DM)
S (hx Stroke/TIA)
2 (2 or more)

classic case: pt c/o heart palpitations, sob, chest pain, syncope.
tx: ecg, tsh, electrolytes, 24 hr holder, digoxin level, echo (r/o vavular pathology)

lifestyle: avoid stimulants and alcohol

24

afib medications

rate: CCB, BB or dig
rhythm: amiodaron (cordarone) . black box: pulmonary and liver damage

**SIMVASTATIN with AMIODARONE"= rhabdo

anticoag with warfarin, baseline INR and CBC

patient education -eat Vit K in food

25

paroxysmal atrial tachy

peaked qrs.

ie: abrupt onset palpitations, sob, anxiety, HR 150-250
management: hold one's breath, carotid massage, splash ice cold water (valsalva maneuvers)

26

pulsus parodoxus (paradoxical pulse)

pericarditis
cardio effusion

apical pulse heard, radial pulse no longer palpable

27

jnc 8 blood pressure

> 60 yo, 18 yo with CKD or DM

28

HTN medications for blacks

CCB or thiazaide (BB cause angioedema)

29

HTN medications with CKD

ace/arb

30

rule out organ damage in HTN

eyes: silver/copper wire arterioles, AV junction nicking, flame shaped hemorrhages, papilledema

kidneys: microalbumin, proteinuria
elevated creatine, gfr, edema

heart: s3 (CHF), s4 (LVH)
carotid vruits

31

CCB medications












"pine"
nifedipine ( procardia)
amlodipine (norvac)
verapamil (calan)
dilt (cardizem)

32

thiazide diuretics

good for osteoporosis
hyperglycemia
hyperuricemia
hypokalemia
hyper triglyceriemia ( check lipids)

don't use if allergic to sulfa

33

side effects of spironolactone

gynecomastia

34

left ventricular failure

Left = L (lungs)
crackles, cough, sob

35

right ventricular failure

GI

JVD (normal mvd is 4cm or less)
enlarged spleen, enlarged liver, lower extremity edema

36

tx for CHF

lasix 20mg, nitro, ace/arb

37

DVT assessment

positve humans sign (pain with dorsiflexion of the foot)

gold standard- contract venography

38

PVD or PAD gold standard dsg

angiography

low tech- ankle/brachial BP before and after exercise

39

raynauds tx

CCB (vasodilate)- nifedepine, amlodipine
avoid BB, vasoconstriction drugs (decongestants, amphetamines), smoking cesession

* think american flag, red/white/blue

40

if triglicerides >500

priority before lowering LDL dt risk of acute pancreatitis
tx with niacin or vibrate
low fat dient (

41

statin interactions

increase risk for rhabdo:

grapefruit juice
fibrates ( except fenofibrate)
antifungals! (intraconazole, ketonazole)
macrolide
amiodarone
CCB (dilt, amloidipine, verapamil)

42

tx plan for high cholesterol

lifestyle (weight loss, exercise most days, smoking cession ), dash (low salt, low sat fat)
soluble fiber (inulin, guar gum, fruit, veges)
beneficial stanols and sterols (benecol, smart balance margarine)
** If not changes 6 months of lifestyle, consider anti lipid drugs if more than 2 risk factors

43

risk factors for heart disease (CHD)

htn
family hx of premature heart disease (women with MI 45, women>55)
smoking
BMI>30
microalbuminuria
CAD, PVD

44

albuminuria values

ln a single urine specimen, a level of more than 30 mg of albumin per gram of creatinine is considered positive.

For a 24-hour urine collection, 30 to 300 mg of albumin means albuminuria.

CA: >1:30

45

agents to HDL (no impact on LDL)

nicotinic acid (niacin) OTC, niaspan
fibrates: fenofibrate (tricor)
alternate: bile acide séquestrants

high trig- avoid junk food
low HDL- exercise

46

rhabo labs

>CK: 10,000-25,000
proteinuria in up to 45% LFT
pain, weakness, dark urine

47

advice if low HDL

aerobics
niacin OTC
or tx niacin (niaspan) or fibrates

48

waist circumference in obese

females: >35 inches or 88cm
males: >40 or 102cm

49

metabolic syndrome critieria

3 must be present;
abdominal obesity (>40 male, >35 females)
HTN
hyerlipidemia

hypertension: fasting glucose >100, triglerides >150,

50

trigleride level normal

less than 150

51

increase triglerceride level can cause

fatty liver (steatosis) aka nonalcoholid fatty liver disease

look for >ast/alt, negative hep a, b, c.

educate: decrease simple carbs

52

bmi calculations

weight divided by height

53

PEF calculations

hag,

height, age, gender