Cardiovascular Flashcards
(186 cards)
1
Q
s/s of MI in women
A
dyspnea, fatigue, back pain, nausea
2
Q
s/s of AAA
A
pulsating-type sensation in abd or lower back
3
Q
risk factors for AAA
A
elderly white male, hx of HTN, smoker
4
Q
s/s of CHF
A
dyspnea, fatigue, swollen feet/ankles, lung crackles, S3 heart sound
5
Q
painful violet-colored nodes on the fingers or feet in those with bacterial endocarditis
A
Osler nodes
6
Q
tender red spots on the palms/soles in those with bacterial endocarditis
A
Janeway lesions
7
Q
where is the apical pulse
A
5th intercostal space at midclavicular line
8
Q
flow of blood in the heart
A
vena cava–> right ventricle –> tricuspid valve –> right ventricle –> AV valve –> pulmonary artery –> the lungs –> pulmonary veins –> left atrium –> mitral valve –> left ventricle –> aorta
9
Q
S1 is the
A
closure of the mitral and tricuspid valves
10
Q
S2 is the
A
closure of the pulmonic and aortic valves
11
Q
mneumonic to remember type of valves
A
MOTIVATED APPLES:
Mitral
Tricuscpid
AV valves (3 leaflets)
Aortic
Pulmonic
Semilunar valves (2 leaflets)
12
Q
S3 sounds like
A
KENTUCKY
13
Q
S3 is only abnormal in those
A
greater than 35
14
Q
S4 is caused by
A
stiff left ventricle
15
Q
Sign of left ventricular hypertrophy
A
S4
16
Q
atrial gallop or atrial kick
A
S4
17
Q
ventricular gallop
A
S3
18
Q
S4 sounds like
A
Tennessee
19
Q
the bell of the stethoscope is to hear for
A
extra heart sounds (S3 or S4), mitral stenosis
20
Q
heart sound that can be normal in the elderly
A
S4
21
Q
Mnemonic for systolic murmurs
A
Mr. Peyton Manning AS MVP (Mitral regurgitation, Physiologic murmurs, aortic stenosis, mitral valve prolapse)
22
Q
Mnemonic for diastolic murmurs
A
ARMS (aortic regurgitation, mitral stenosis)
23
Q
These murmurs are ALWAYS indicative of heart disease
A
diastolic murmur
24
Q
Also called the “opening snap” and is best heard with ___
A
mitral stenosis; bell of stethescope
25
murmur grade where a thrill is first heard
grade IV
26
____ murmurs are always abnormal; whereas ____ murmurs are usually benign
diastolic; systolic
27
mitral regurgitation murmur radiates to the
axilla
28
aortic stenosis murmur radiates to the
neck
29
A split S2 is best heard at the
pulmonic area
30
When afib is intermittent and terminates in 7 days or less; asymptomatic
paroxysmal afib
31
amiodarone has a black box warning for
pulmonary and liver damage
32
simvastatin and amiodarone together can cause
rhabdomyolysis
33
INR for those with prosthetic valves
2.5-3.5
34
diet teaching for those on coumadin
only one serving per day of foods high in vitamin K ("greens": kale, collards, mustard, turnip, spinach, romaine lettuce, brussel sprouts)
35
treatment for paroxysmal atrial tachycardia (PSVT)
Valsalva, carotid massage, splashing cold water on face
36
what is paradoxical pulse
when the apical pulse is still heard but no radial pulse can be palpated
37
If INR is between 3-5, then
skip one dose, may need to decrease maintenance dose, recheck every 1-2 days until normal
38
If INR is between 5-9, then
hold dose and give either small dose of oral vitamin K OR skip the next 1-2 doses. Recheck INR daily until normal.
39
screening in BP for those with normal BP
every 2 years
40
screening in BP for those with prehypertension
every year
41
Prehypertension
SBP 120-139, DBP 80-89
42
Stage I HTN
SBP 140-159, DBP 90-99
43
Stage II HTN
SBP greater than 160, DBP greater than 100
44
eye changes in those with HTN
copper and silver arterioles; AV nicking; papilledema
45
can cause HTN in young adults
renal artery stenosis
46
how to check for coarctation of the aorta
check radial and femoral pulse at same time
47
Goal BP for those greater than 60 without hx of DM or CKD
less than 150/90
48
Goal BP for those less than 60 without hx of DM or CKD
less than 140/90
49
Goal BP for those with DM or CKD
less than 140/90
50
first line of trx in those with HTN and CAD
ACE or ARB
51
first line of trx in those with HTN post-MI
beta blocker
52
first line of trx in those with HTN with hx of heart failure or CHF
thiazide
53
dietary source of magnesium
dried beans, whole grains, nuts
54
where loop diuretics have effect
Loop of Henle
55
ex of loop diuretics
furosemide (Lasix), bumetanide (Bumex)
56
ex of aldosterone receptor antagonist diuretics
spironolactone
57
MOA of spironolactone
antagonizes effect of aldosterone --> increase water elimination and conserves potassium
58
Side effect of spironolactone
gynecomastia, hyperkalemia, vomiting/diarrhea
59
contraindications to spironolactone
high K+, renal insufficiency, DM with microalbuminuria
60
avoid abrupt discontinuation of this BP med
beta blockers: can cause rebound HTN
61
Beta1 receptors are specific to the ____ ; and beta2 receptors are specific to the ____
heart; lungs and peripheral vasculature
62
contraindications to beta blocker use
asthma, COPD, second/third degree block
63
Do not use this beta blocker to treat HTN as it has a short half-life
propranolol (Inderal)
64
side effects of CCB
headaches, ankle edema, bradycardia
65
one side of effect of nifedipine is
reflex tachycardia
66
The nondihydropyridine CCBs MOA
Decrease HR, a little BP
67
The dihydropyridine CCBs MOA
Decrease BP, doesn't hurt pulse
68
ex of nondihydropyridine CCB
verapamil and diltiazem
69
ex of dihydropyridine CCB
nifedipine and amlodipine
70
MOA of ACEI and ARBS
block conversion of angiotensin I to II (a potent vasoconstrictor)
71
BP med that is contraindicated in pregnancy
ACEI and ARB
72
side effects of ACEI and ARB
dry hacking cough, hyperkalemia, angioedema
73
This med is contraindicated in renal artery stenosis
ACEI or ARB
74
ex of ARB
losartan
75
MOA of alpha-adrenergic blockers
vasodilation
76
common side effects of alpha-adrenergic blockers
dizziness and hypotension
77
first dose orthostatic hypotension is common in this medication
alpha-adrenergic blocker
78
administration of alpha-adrenergic blockers
give a bedtime, start at low doses and titrate slowly
79
first choice medication for a male with HTN and BPH
alpha-adrenergic blockers
80
MOA of diuretics
decrease volume and preload
81
This BP medication has a sulfa component and should be avoided in patients with sulfa allergy
thiazide diuretics
82
Has a favorable effect for those with HTN and osteopenia/osteoporosis
thiazide diuretics
83
side effects of thiazide diuretics
hyperglycemia, hyperuricemia, high cholesterol, hypokalemia, hyponatremia
84
examples of thiazide diuretics
HCTZ, chlorthalidone
85
these two BP med combinations can increase risk of hyperkalemia
ACEI and spironolactone
86
CHF is an EF less than
40%
87
normal JVD is less than
4 cm
88
If a patient with CHF has no limitations of physical activity, they are classified as
Class I
89
If a patient with CHF has ordinary physical activity that results in fatigue, and exertional dyspnea, then they are classified as
Class II
90
If a patient with CHF has marked limitation in physical activity, then they are classified as
Class III
91
If a patient with CHF has symptoms at rest with or without physical activity, then they are classified as
Class IV
92
risk factors of DVT
oral contraception use, inactivity for more than 3 hours, CHF, pregnancy, bone fx in long bones, trauma, recent surgery
93
s/s of DVT
swelling of extremity that is painful, red, and warm.
94
gold standard to diagnose DVT/PE
contrast venography
95
Trx for DVT/PE
heparin IV, then warfarin PO for at least 3-6 mo
96
risk factors for superficial thrombophlebitis
catheter, IV potassium, Staph aureus infection
97
s/s of superficial thrombophlebitis
indurated, cordlike vein that is warm, red, and tender to touch
98
trx for superficial thrombophlebitis
NSAIDS (ibuprofen, Anaprox DS/naproxen), warm compresses
99
intermittent claudication
worsening pain on ambulation that is relieved by rest
100
golden standard for dx of peripheral vascular/arterial disease
angiography
101
Pentoxifylline (Trental) is indicated for
peripheral vascular/arterial disease
102
reversible vasospasm of the peripheral arterioles on fingers and toes
Raynaud's
103
s/s of Raynaud's
color changes that occur symmetrically in hands and feet, numbness/tingling with cold temperatures.
104
treatment for Raynaud's
nifedipine or amlodipine
105
important not to use these drugs in those with Raynaud's
Imitrex, decongestants, amphetamines
106
subungual hemorrhages
splinter hemorrhages on nailbed
107
s/s of endocarditis
subungual hemorrhages, Osler nodes, Janeway lesions, fever/chills
108
endocarditis prophylaxis is given to those with
prosthetic valves, heart transplant, invasive dental procedures
109
endocarditis prophylaxis is NO longer given to those with
mitral valve prolapse, GU/GI invasive procedures
110
endocarditis prophylaxis medication
amoxicillin 2 g PO x 1 (adults); amox 50 mg/kg (children) one hour before procedure;
111
treatment for MVP with symptoms
beta blockers, avoid caffeine/alcohol/smoking
112
normal cholesterol is less than
200
113
normal HDL is
greater than 40
114
normal triglycerides
less than 150
115
high risk of pancreatitis
triglycerides greater than 500
116
simvastatin drug interactions
grapefruit juice, antifungals, macrolides, amiodarone
117
serious complication of statins
rhabdomyolosis and drug-induced hepatitits
118
MOA of statins
decrease LDL and raise HDL
119
MOA of fibrates and nicotinic acid
reduces triglycerides and increases HDL
120
SE of fibrates
dyspepsia, gallstones
121
patient education for those with high triglycerides
reduce simple carbs, "junk food" and fried foods
122
patient education for those with low HDL
increase exercise, trial of OTC niacin
123
gemfibrozil (Lopid), Tricor
fibrate
124
Cholestyramine (Questran)
bile acid sequestrant
125
work on the small intestine and interfere with fat absorption (including fat-soluble vitamins A, D, E, and K).
bile acid sequestrant
126
side effects of bile acid sequestrant
bloating, gas, abd pain
127
labs for cholesterol meds
baseline LFTs
128
triad of rhabdomyolosis
muscle pain, weakness, red-brown urine
129
labs in rhabdomyolosis
high CK, proteinuria
130
high waist circumference in males
greater than 40 in
131
high waist circumference in females
greater than 35
132
criteria for metabolic syndrome
abdominal obesity, HTN, HLD
133
fatty liver or nonalcoholic fatty liver disease is caused by
triglyceride deposits in the liver
134
labs for fatty liver
elevated ALT and AST; Hep A, B, and C negative
135
treatment for fatty liver
weight loss, avoid hepatotoxic drugs (statins, tylenol), vaccination for Hep A&B
136
BMI calculation
weight/height2
137
when to screen for lipid disorders
men: 35, women: 45
138
normal BP in children
both systolic and diastolic are less than 90th percentile for gender, age, and height
139
when should BP meds be started in children
if lifestyle modifications fail in 6 months
140
management for statin therapy
baseline LFTs, CK does not need to be routinely measured
141
normal cholesterol in children is
below 75th percentile
142
abnormal cholesterol values in children
above 95th percentile
143
when to screen for dyslipidemia in children
age 9-11 and again at 17-21
144
systemic inflammatory illness that particularly affects medium-sized arteries, especially the coronary arteries
Kawasaki disease
145
s/s of Kawasaki disease
fever, conjunctivitis, strawberry tongue, rash, swelling of hands and feet
146
diagnostic for kawasaki disease
high ESR/CRP, thrombocytosis, leukocytosis.
147
screening for AAA
one time screening for all men 65-75 who have smoked
148
outpatient trx for DVT
LMWH then add warfarin for at least 5 days, can d/c LMWH once INR is therapeutic for at least 2 consecutive days
149
management of DVT
compression stockings after anticoagulant therapy initiated; early ambulation
150
s/s of arterial ulcers
painful; mostly on toes; necrotic
151
abnormal ABI
less than 0.90
152
s/s of venous ulcers
located between knee and ankle; mild pain; scaling, weeping, erythema
153
aortic regurgitation is best heard when
leaning forward or during Valsalva
154
location best heard for venous hum
under right clavicle
155
quality of venous hum
continuous murmur
156
location best heard for stills murmur
2-4th left ICS
157
quality of stills murmur
musical
158
characteristic of hypertropic cardiomyopathy
systolic murmur that gets louder when the patient stands
159
therapeutic range for digoxin
0.5-2.0
160
s/s of digoxin overdose
anorexia, N/V, abd pain, confusion, visual changes
161
examples of potassium sparing diuretics
triamterene, amiloride
162
adverse effects of beta blockers
bronchospasm, blunts hypoglycemic response, depression
163
med choices for african american with HTN
thiazide or CCB
164
med choices for non-black person with HTN
thiazide, CCB, ACEI, ARB
165
thiazide diuretic is good to treat
mild HTN
166
these people are known to have high renin states causing HTN
young white males
167
First line treatment for isolated systolic HTN
CCB
168
Side effect of HCTZ
erectile dysfunction
169
-pine drugs are
DHP CCB
170
DHP Calcium channel blockers decrease ____ and not the _____.
BP; pulse (Don't Hurt Pulse)
171
These people should be placed on a moderate to high statin
Hx of CHD or stroke;
LDL greater than 190;
DM, age 40-75;
10-year risk score greater than 7.5%
172
High potency statins
atorvastatin (Lipitor), rosuvastatin (Crestor)
173
Moderate potency statins
simvastatin (Zocor), pravastatin (Pravachol)
174
med contraindicated to give in heart failure
TZDs, CCB, naproxen
175
Areas of heart valves
Aortic;
Pulmonic;
Tricuspid;
Mitral
176
These valves don't open properly
stenotic valves
177
these valves don't close properly
regurgitant valves
178
s/s of aortic stenosis
syncope, angina, HF
179
murmur with an audible "click"
mitral valve prolapse
180
mitral valve prolapse can be common in
pregnant women; women 15-30.
181
causes of peripheral artery disease
diabetic, smoker, dyslipidemia, no exercise
182
trx for kawasaki disease
aspirin daily x 2 months to prevent MI
183
innocent murmur clues
less than grade II, softer when sitting than lying, musical quality
184
pathologic murmur clues
grade III or higher, harsh quality, increased intensity when standing
185
foods high in folic acid
spinach, liver, whole wheat bread
186
this BP med can increase blood sugars
thiazide diuretics
