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cardiovascular Flashcards

1
Q

AV valves

A

tricuspid and mitral

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2
Q

S1 Atria Ventria valves are

A

closed

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3
Q

S2 semilur valves

A

pulmonic and

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4
Q

S3 leading abnormal heart sound in

A

heart failure, normal in pregnancy kentucky

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5
Q

S4 tennesse

A

stiff ventricular wall (MI, LVent hypertrohy) uncontrolled HTN

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6
Q

Mitral stenosis

A

loud S1 murmur, low pitched a

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7
Q

Aortic stenosis radiates to neck

A

systolic blowing

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8
Q

Acute heart faillure is

A

L sided

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9
Q

chronic heart failure is

A

R sided

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10
Q

left failure look for problems in the

A

Lungs

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11
Q

Order of R heart failure

A

JVD-hepatosplnomeegaly- peripheral edema

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12
Q

outpatient managment of heart failure

A

na and water restriction
rest and activity balance
weight reduction

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13
Q

pharma management of heart failure

A 
ace inhibitors (prils) 
and diuretics
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14
Q

manageent of acute plum edema

A

O2

morphine and lasix 40 repete q20 or 30

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15
Q

definition of HTN

A

sustained elevation of sys BP >140 or diastolic BP >90

3times on two different occasions

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16
Q

primary HTN

A

95% onset usually less than the age of 55

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17
Q

secondary HTN

A

classic presentations- estrogen use, renal disease, pregnancy, endocrine disorders RENAL ARTERY STENOSIS

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18
Q

HTN exacerbates

A

smoking, oeisity, too much booze, nsaids

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19
Q

suboccipital HA HTN

A

HTN gets better over the course of the day

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20
Q

S and S of HT

A 
often silent 
EPISTAXIS 
elevatedBP
dizzy light headed
S4related to left ventricular hypertrophy
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21
Q

HTN labs and diagnostic

A

primary HTN is a diagnosis of exclusion

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22
Q

Normal BP

A

less than 120 and less than 80

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23
Q

pre hypertension

A

120-139/or 80-89

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24
Q

HTN stage 1

A

140-159/or 90-99

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25
Q

HTN stage 2

A

more than 160 or more than 100

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26
Q

patients over 60yo

A

less than 150 less than 90

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27
Q

patients less than 60yo

A

less than 140 less than 90

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28
Q

non pharma management HNT

A 
low salt
weight loss if overweight 
exercise 30mins most days
dash diet
streee reduction 
low booze
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29
Q

pharma management of of HTN thiazide diruetics

A

screen for sulfa allergy, pee sowatch lytes

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30
Q

jnc 7

A

stage 1 thiazide diuretics

stage 2 thiazide diuretic and another agent

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31
Q

no BB for dm or

A

asthma or copd

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32
Q

ace inhibitors

A

prils - contraindicated in pregnancy

not with an arb watch for cough

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33
Q

angiotensisin II ARB

A

reserved for patients intolerant to ACE I

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34
Q

lasix particularly effective in

A

african americans and elderly with isolated systoic hypertension 162/74 kind of thing

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35
Q

hypertensive urgency

A

180/110 w/o target organ dysfunction
po clonadine(alpha 2 agonist)/catopril(ace I)
may have ha
rarely

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36
Q

hypertensive emergency

A 
>180/120 with nd organ dysfunciton 
malignant hypertension with changes in the eyes
htn 
pappilidema, swelling of potic disc and blurred lid margins. 
unstable angina
acute MI
acute LV failure with edema
dissecting aneurysm
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37
Q

hypertensive emergency

A

nitro gtt, unit admission, and a line

38
Q

hypertensive emergency

A

cardne gtt, unit admission, and a line

39
Q

hypertensive emergency

A

shoot for 160-180 or less than 105diastolic - no more than 25% withing 2hrs

40
Q

angina at rest

A

prinzmetals vs unstable

41
Q

levines sign

A

clinched fist sign (sqeezing my heart=angina)

42
Q

angina ecg

A

downsloping of ST or T wave peak inversion
ST depression +ischemia
ST elevation is infarction

43
Q

angina after exercis ecg

A

serum lipid levels

44
Q

angina desired serum lipid levels

A

total less than 200
trigs less than 150
ldl less than 100
hld over 40

45
Q

lipid goals for DM or CAD

A

LDL less than 70
HDL over 40
TRI less than 150

46
Q

angina angiography

A

coranary angioagraphy is definitive but not indicated soley for diagnosis

47
Q

angina meds

A 
low dose asa 81enteric coated
then 
nitrates
BB
CCB 3 classes of meds
48
Q

optomizing lipids who gets a statin

A

clinical evidence of athlerosclerotic CVD
elevated LDL-C over 190
diabetics 40-70 with LDL between 70-189 but with an estiated athlersclrotic rsik of 7.5% or higher

49
Q

statin goal

A

try and get 50% LDL reduction after you max statin dos u can try and non statin adjunct

50
Q

mi

A

alteration intypical anginal pain, most occur at rest, pain is like angina
s4 is common

51
Q

mi ecg

A

30% have nothing on ECG
peaked T
ST elevation
maybe Qwave

52
Q

1-avl

A

lateral mi

53
Q

2-3-avf

A

inferior MI

54
Q

V 3-4

A

anterior mi

55
Q

troponin I and CKMB are

A

100% cardioslective

56
Q

leukocytosis after mi

A

10-20k on the second day

57
Q

mobtz II

A

regulr A and PR interval but vent rythm is irregular and complexes are droped

58
Q

III block

A

no relationship between p and qrs complexes. PR interval varies with no regularity

59
Q

MI mangemnt

A 
ASA 325 to chew
NItro s q5x3
02 
IV kvo 3 
12 lead
morphine 2-4
lasix 40 for pulm edema
BB if not contraindicated
ACE I for failure or large infarction to prevent ventricular remodeling
hep
60
Q

INR mormal vs

A

0.8 -1.2

61
Q

INR goal in MI

A

2.5-3.5 of normal 2-2.8—4.2 (2-3)

62
Q

door to fibriniltyics is

A

30 mins

63
Q

door to cath lab is

A

90 ins

64
Q

lovenox dose in MI

A

1mg/kg

65
Q

indications for pharmacologic recascularization

A

unreleived chest pain more than thirty mins and less than six hours with st seg elevation of greater than .1 in two or more contiguous leads

66
Q

contraindications for pharmacologic therapy ie TPA

A 
Prior ICH
malignant neoplasm of brain or cerebral vascualr lesion
ischemic stroke within 3 months 
suspected aortic discetion
active bleeding
closed head or facial trauma within 3 months
spinal or brian sx wihting 2 months 
uncontrolled htn over 185/110
abnormal coags
67
Q

DVT management

A 
bed rest for 7-14days with leg elevated
gradually re-introduce walking
lovonox 1mg/kg q12 
heparin for 7-10 days
coumadin for 12 weeks 
consult when antigoag is needed
68
Q

DVT while walking and distal edema

A

DVT

69
Q

PVD

A

40-70years of age
high lipids
smoker
dm

70
Q

PVD s and s

A

claudication
cold or numb to extremities
progress to pain at rest

71
Q

PVD physical findings

A

shiny hairless skin
dependant rubor
elevational white feet or pallor

72
Q

PVD lab dx

A

doppler us, ABI ateriography is most definitive test

73
Q

PVD treatment

A 
stop smoking 
walk 1hr per day stop on pain
resume when it stops to develo colateral circ
trental 
pletal
angioplasty or bipass
74
Q

CVI

A

womman greater than men,
may be genetic
history of leg trauma or vericosities

75
Q

cvi symptoms

A

aching of LE releived by elevation, edema after stadnign, night cramps in LE

76
Q

CVI findings

A 
trophic changes iwth brownish redish hue
stasis leg ulcers
dermatitis
cool to tocuh
LE
77
Q

CVI dx

A

non specific, R/O HF

78
Q

CIV management

A

bed rest with legs up
support stockings
weight reduction

79
Q

CVI treatment of acute weeping dermtis

A

wet compress
0.5 hydrocortisone cream after comress
systemic abx only if central infection is suspected

80
Q

heart murmur with fever

A

must rule out endocarditis

81
Q

pericarditis vs endo

A

peri is virus endo is bacterial

82
Q

pericarditis

A

pain is localized and retrosternal
rub is present
hurts on ispiration releived when leaning forward
may not have fevers
ST ELEVATION IN ALL LEADS IWTH DEPRESSION OF PR SEGMENT

83
Q

pricarditis

A

hihg dose nsads advil 400-600 q 6
steroids only on total failure of nsaids
monitor for tampanod

84
Q

endocarditis

A

fever malaise, night sweats and weight loss

85
Q

endocarditis blood cultures

A

3 cultures at three sperate sites in one hour

86
Q

endocarditis oslar nodes

A

painful red nodules in the distal phalanges

87
Q

endocarditis janewa lesion

A

small not painful macul on palm and sole

88
Q

endocarditis abx 1

A

penicillin g 2million units IV q4 in combo with gnetimycin

89
Q

endocarditis

A

nafcillinn (unipen) 2g q4

90
Q

endocarditis mrsa

A

vanc

issues and policy (22 decks)

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