Cardiovascular & Intro to Blood Chemistry Flashcards
(265 cards)
1
Q
Which marker is more likely to rise during early MI; ALT or AST?
A
AST; “A sick heart can beat f-AST”
L is for Liver
2
Q
CPK elevation indicates what?
A
- often done to document acute MI; after 12 hours but before 24 hours
- CPK-MB can also be elevated with PE
3
Q
When is LDH released by cells?
A
Increased amounts of hypoxic metabolism; reduces lactate back to pyruvate
4
Q
What is your first step after an elevated LDH?
A
Fractionate the LDH; multiple conditions with tissue damage cause elevated LDH and you need to differentiate
5
Q
What LDL isoenzyme ratio is seen in MI?
A
LDH-1 > LDH 2
(in normal states, LDH-1 is lower)
6
Q
How to differentiate liver dz from cardio pathology utilizing LDH isoenzymes?
A
in liver dz LDH < AST & ALT
7
Q
LDH may be up to 50x normal in what pathology?
A
pernicious anemia
8
Q
What LDH isoenzyme is increased in muscle disease?
A
LDH-5
9
Q
Increased levels of homocysteine may indicate what?
A
increased myocardial risk
10
Q
What is the most common cause of elevated ammonia (NH3) levels?
A
severe liver disease
11
Q
what would be markers consistent with methylation defects?
A
elevated MCV
low reticulocyte
hyper segmented neutrophils (5+)
high MMA
<200pg/mL B12 (can aso be low in pernicious anemia and alcoholism)
12
Q
normal folate levels
A
200-640 ng/ml
13
Q
folate is decreased in which conditions
A
megaloblastic anemia and alcoholism
14
Q
folate is increased in which conditions
A
acute renal failure
liver dz
non fasting status (plasma)
15
Q
Apoprotein A1 vs B vs lipoprotein a
A
A1: >140, associated with HDL, higher = better
B: 70-110, associated with LDL; higher = more myocardial risk
a: indicateds CAD risk; <30
16
Q
Hyperlipidemia Genotypes (2 most common)
A
IV: most common
- chol 200+
- HDL = low, LDL = high
- TG > chol
II: second most common
- chol > 200
- TG normal
17
Q
How does a higher level of LDL associate with inflammation?
A
LDL carry oxidants
18
Q
Higher triglycerides carry an association with what other type of pathology
A
insulin - sugar biochemistry disorders (can’t burn fats and sugars at same time; if sugars are blocking transporter after carb ingestion, TG get released into blood)
19
Q
HMG-coA reductase inhibitors are what commonly used drug? how does blocking HMG-coA reductase cause a clinical effect?
A
statins; blocking the mevalonic to cholesterol pathway (also blocks coQ10 so need to replenish)
20
Q
Adverse effects of statins
A
GI distress
headache
dizziness
abdominal cramps
rash
liver toxicity
rhabdomyaloysis
21
Q
pre-prescribing and monitoring considerations for statins
A
check AST and ALT prior to rx and at 6 weeks post rx
monitor liver function
rx with 75-100 mg coq10 minimum
discontinue if pt has muscle pain concomitant to RX - EVEN if LFTs are normal
22
Q
simvastatin MOA
A
HMG CoA reductase
23
Q
atorvastatin MOA
A
HMG CoA reductase
24
Q
Lipitor/Atorvastatin typical and max dose
A
10-20 mg qd (in severe cases 40mg)
max dose 80 mg
25
Questran is what type of drug? What other name is it known by?
Cholestyramine; bile sequesterant used for hyperlipidemia
26
Cholestyramine/questran MOA
combines with bile acid to form an insoluble compound that is excreted
27
Cholestyramine/questran adverse effects
constipation
fecal impaction
abominal pain
nausea
def of fat soluble vitamins (reduces absorption)
28
What vitamin can be used as a lipid lowering agent? What is the MOA?
niacin; stimulates hepatic lipid metabolism; lowers TC/LDL/TG, raises HDL
29
niacin adverse effects
niacin flush
rash
GI distress
liver toxicity (give with vit C to avoid hepatic effect)
30
which form of niacin is more hepatotoxic?
slow release
31
dosing of niacin for hyperlipidemia
alone or with low dose statin
1500-2000mg daily
rx with vit c and high potency B complex (gram per gram)
32
drugs that end in -fibrate are what type of drug? how are they dosed?
fibrates; TG lowering drugs
48-145 mg qd, max dose 145 mg
33
what is lovaza?
high dose estherized omega 3 - 4 grams daily
TG lowering; alone or with statins in high/very high TG
34
Classifications of BP/HTN
- normal: <120 AND <80
- preHTN: 120-139 OR 80-89
- stage 1: 140-159 OR 90-99
- stage 2: 160+ OR 100+
systolic goes by 20 mmHg jumps, diastolic by 10 mmHg jumps
35
top causes of secondary HTN
renal artery stenosis
chronic renal dz
primary hyperaldosteronism
thyroid dz
pheochromocytoma
preeclampsia
aortic coarctation
36
basic tests for HTN evaluation
- urine for protein, blood, glucose, and microscopic exam
- hemoglobin or hematocrit; leukocyte ct
- serum potassium
- serum calcium, phosphate
- serum creatinine or BUN
- fasting glucose
- total, HDL, and LDL cholesterol; TGss
- ECG
- TSH
37
what are first line pharmaceuticals for HTN?
diuretics and beta blockers
38
diuretics MOA
loop diuretics: affects the thick asc loop of henle (inhibits Na re-absorption)
thiazide diuretics: affects dital tubule/CD (Na reabsorption/excretion, Na-Cl cotrasnporter)
39
where do carbonic anhydrase inibibitors act?
proximal tubule of nephron and blocks HCO3 reabsorption
40
what diuretics are potassium wasting?
chlorothiazide (HCTZ)
furosemide (lasix)
41
chlorothiazide MOA
inhibits sodium and chloride re-absorption in distal tubule = decrease GFR
42
furosemide MOA
loop diuretic; inhibits sodium and chloride reabsorption in the loop of henle
43
diuretic uses
HTN, edema
44
what adverse effects do thiazide and loop diuretics have in common?
**hypokalemia (potassium wasting)
hyperglycemia**
oliguria
anuria
GI disturbance
hypercalcemia
hyperuricemia
45
adverse effects unique to thiazide diuretics
renal failure
46
adverse effects unique to loop diuretics/furosemide
ototoxicity
hypovolemia
47
CI thiazide diuretics
hypersensitivity to thiazide or sulfonamide drugs
48
what two diuretics/anti-hypertensives are potassium sparing?
triamterene and spironolactone
49
triamterene MOA and uses
potassium sparing diuretic acting on distal tubules
HTN/edema (often used with HCTZ to balance k levels)
50
spironolactone MOA and uses
aldosterone antagonist
HTN, edema, endocrine uses
51
triamterene adverse effects
hyperkalemia
nausea/vomiting
diarrhea
may turn urine blue
52
spironolactone adverse effects
hyperkalemia
breast deformity/tenderness
53
list the antihypertensive drugs
- beta blockers (-OLOL)
- ACE inhibitors (-PRIL)
- ARBS (-SARTAN)
- Alpha2 central agonist (clonidine)
- catecholamine agent (reserpine)
- CCBs (all the rest)
54
what antihypertensive drug class ends in -OLOL
beta blockers
55
what antihypertensive drug class ends in -PRIL
ACE inhibitors
56
what antihypertensive drug class ends in -SARTAN
ARBs
57
what antihypertensive drug is an alpha2 central agonist
clonidine
58
what antihypertensive drug is a catecholamine agent
reserpine
59
what are the two types/MOA of Beta blockers?
Specific, newer B1 adrenergic receptor blockers
Nonspecific, older B1 + B2 adrenergic receptor blockers
60
what are the specific B1 blockers?
atenolol
metoprolol
61
what are the nonspecific B1& B2 blockers?
propanolol
carvediolol
62
specific B1 blocker uses
HTN, angina
63
specific B1 blocker adverse effects
fatigue
vertigo/dizziness
bradycardia
hypotensino
bronchospasm
CHF
64
specific B1 blocker CIs/cautions
enhances effects of digitalis
abrupt discontinuation is dangerous
65
nonspecific B1 & B2 blocker uses
HTN, angina, arrythmias, migraines, essential tremors
66
nonspecific B1 & B2 blocker adverse effects
fatigue
bradycardia
hypotension
nausea/vomiting
diarrhea
CHF
67
nonspecific B1 & B2 blocker CIs/cautions
abrupt discontinuation is dangerous
68
What is a general guideline on if a drug may require a tapering schedule?
if it has a significant suppresive effect on physiology; rebound sx or bronchospasm may occur
69
types of ca channel blockers
verapamil
diltiazem
amlodipine
70
CCBs uses
angina, HTN
afib/flutter (-zems)
71
CCB (-ils) adverse effects
constipation
hypotension
dizziness
edema
nausea
CHF
72
CCB (-zems) adverse effects
headache
edema
dizziness
arryhtmias
CHF
nausea
constipation
rash
73
CCB (-pines) adverse effects
dizzinesss
CHF
MI
edema
headache
weakness
nausea
74
CCB CI/cautions
AVOID IN CHF (AE), pregnancy
ils/zems: increased levels with cimetidine
-pines: capsule passed in stool, medicine released in gut
75
angiotensin agents are all potassium-___
sparing (downstream block of aldosterone)
76
ACE-is names
lisinopril
ramipril
77
ACE-is uses
HTN
HF
78
ACE-is adverse effects
**dry persistent cough
hyperkalemia
angioedema**
tachycardia
hypotension
urticaria
rash
renal dysfunction
headache
79
ACE-is CI
pregnancy (potential effect on fetal lungs)
80
ARBs drug names
valsartan
irbesartan
losartan
81
ARBs MOA
blockage of ang-2 receptors
82
ARBs uses
HTN in those with ACE intolerance due to cough
83
ARBs adverse effects
hypotension
renal dysfunction
hyperkalemia (reabs Hcl, excretes K)
84
clonidine MOA / uses
stimulates alpha 2 adrenoreceptors in brain stem ; emergency BP lowering
85
reserpine/rauwolfia MOA
peripheral anti-adrenergic; depletes catecholamines tores in PNS (and maybe CNS)
86
reserpine/rauwolfia adverse effects
drowsiness
sedation
nervousness
depression
dec HR
nasal congestion
nausea/diarrhea
PS predominance
**DEPRESSION/SUICIDALITY**
87
# ****
reserpine/rauwolfia CI/cautions
do NOT administer MAO inhibitors and reserpine within 2 weeks of each other
88
standard dose of reserpine
.1- .25 mg qd to bid
89
The cause of heart failure is the area that the heart is ____. The sx are ___.
The cause of heart failure is the area that the heart is pumping into. The sx are the area drained into the side of heart.
right heart (causes: pulm, left heart; sx: JVD)
left heart (causes: CAD, sys HTN; sx: pulm edema/HTN, rhonchi)
90
classification of CHF
A: RFs
B1: left ventricular dysfunction
B2: mild limitations, fatigue, dyspnea with normal activities
C: moderate limitations, sx with ADL
D: severe, sx at rest
91
sx of CHF
dyspnea on exertion
paroxysmal nocturnal dyspnea
orthopnea
92
diagnostic tool used in CHF
echocardiogram
- distinguishes systolic and diastolic dysfunction
- identifies underlying valve disease or ischemic heart damage
- quantifies CHF severity
- assess chamber sidze, EF, wall thickness
93
adaptive mechanisms in CHF
- ventricular dilation > inc diastolic pressure and PE (L HF) and/or systemic edema (R HF)
- reduced kidney blood flow > inc salt/water retention > inc blood volume > inc HBP > inc afterload
- symp stimulation > peripheral tissue blood to heart > inc BP
- tachycardia and inc contractility
94
left CHF sx
DOE
chronic dry cough
fatigue
teachycardia, cardiac asthma, rust sputum, rales, displaced apical impulse, nocturia, pallor, low BP
95
right CHF sx
fatigue
distended neck veins
pedal/pitting edema
ascites
large liver
triscupid regug
orthopnea
PND
96
pathologies that produce right CHF sx
lung dz
pul embolus
volume overload
mitral stenosis
97
what is cor pulmonale
pulmonary heart dz; right ventricular hypertrophy and eventual failure from pulmonary dz
98
causes of cor pulmonale
COPD
pulm fibrosis or emboli
scleroderma
primary pulm HTN
alveolar hypoxia
99
cor pulmonale sx
chronic cough
exertional dyspnea
wheezing
fatigue
weakness
cyanosis
clubbing
epigastric pulsations
hepatomegaly
polycythemia
100
what is the ankle brachial index used for?
assessing peripheral/vascular disease
101
normal achkle-brachial ratio vs PVD
> 0.95 is normal
< 0.95 = PVD
102
if a carotid bruit is heard on examination, what would be your next step?
carotid ultrasound
103
a carotid bruit is indication of what
stenosis by atherosclerotic plaque; increased risk of stroke at 1 year
104
name the large-vessel vasculitis'
giant cell arteritis
takayasu's disease
105
name the medium-vessel vasculitis'
polyarteritis nodosa
kawasaki's disease
106
name the small-vessel vasculitis'
ANCA associated SV vasculitis
non-ANCA SV vasculitis
107
Small vessel vasculitis will often present as what?
dermatologic presentation; palpable purura > 24 hours, urticaria
with systemic sx
108
most common etiology of aortic aneuryms
atheroma
most are adominal
109
signs/sx aortic aneurysm
pain in abdomen or low back
<5 cm asx
pulsatile mass with tenderness and bruit over mass
110
where does aortic dissection occur?
asc aorta
111
what is aortic dissection caused by?
a break in the intima allowing blood to flow in a plane between the media and adventitia
112
signs/sx aortic dissection
severe chest or neck pain, may radiate to back and later abdomen
peripheral pulses and BP may be unequal
syncope, hemiplegia, paralysis of lower extremities may occur
113
what imaging is best for aortic dissection?
CT and transesophageal echocardiography
114
pain that is sharp, constant, and unrelated to movement is typically associated with what pathology?
aortic dissection
115
signs/sx of atrial tachycardia/SVT
originate at atrial pacemarker at rate of 140-250 / min
QRS narrow but shape normal
common
116
signs/sx of atrial flutter
originate at atrial pacemarker at rate of 240-340 / min but some are blocked at AV node; multiple p waves "irregularly irregular"
saw tooth like deflections (flutter waves)
palpitations, sweating, weakness, dizziness, syncope
117
differentiating if extra beats are atrial or ventricular
if there is a P wave = extra beat from atria
no P wave, bizarre complexes = ventricular
118
ventricular fibrillation
multiple sites in ventricle fire impulses in uncoordinated fashion; terminal
119
presenting sign of heart block
sudden onset of syncope
120
what types of murmurs are almost always indicative of heart disease?
diastolic murmurs
121
what might a midsystolic murmur indicate?
aortic/pulmonic stenosis
122
what might a pansystolic/holosystolic murmur indicate?
mitral/tricuspid regurg
VSD
123
what could a diastolic rumble murmur indicate?
mitral stenosis
124
what could a decrescendo-immeidate diastolic mumur indicate?
aortic regurgitation
125
in what situations would thrombolysis be indicated?
arrythmias
prosthetic valves
hypercoaguable (thick) blood: high fibrinogen, dehydration
126
warfarin (coumadin) drug class and MOA
anti-thrombotic
vitamin K antagonist (extrinsic 2, 7, 9, 10)
127
warfarin adverse effects
prolonged bleeding
hemorrhage
diarrhea
fever
128
warfarin monitoring
monitor prothrombin time
129
heparin drug class and MOA
anti-thrombotic (usually IV/inpatient)
inhibits clotting factors by binding to antithrombin 3 (AT3) and enhancing thrombin blockade of AT3
129
heparin uses
prevention of DVT, embolism, DIC
130
heparin adverse effects
hemorrhage, cutaneous necrosis, chills, pruritis, fever
131
heparin CI/caution
caution with menstruating people, pts with liver dz, or pts with blood dz
132
clopidogrel and aspirin MOA
antithrombics that prevent formation of platelet aggregating substance; thromboxane A2
133
clopidogrel & aspirin uses
reduce risk of MI/stroke
134
clopidogrel & aspirin adverse effects
salicylism (ASA)
GI distress
bleeding
tinnitus
rash
occult blood
135
preventative aspirin dosing
75-162 mg
(avg is one baby aspirin 81 mg)
136
classes of arrythmics
Class 1 & 3: specific to antiarrhytmics
class 2 & 4: also anti-hypertensives
137
class 1 antiarrythmics
digoxin (glycoside)
lidocaine (blocks Na channels)
flecainide (blocks Na channels)
138
digoxin MOA
inhibits sodium/potassium pump to inc intracellular calcium (ca drives the cardiac AP plateau)
139
digoxin adverse effects
fatigue
arrthymias
muscular weakness
agitation
blurred vision
anorexia
nausea
140
digoxin cautions
**monitor blood levels**; toxicity may be life threatening, can have flu like sx
yellow halo around vision may develop
monitor K levels (hypokalemia inc digoxin MOA)
141
quinidine MOA
dec automaticity, conduction velocity; and prolongs refractory period
has anticholinergic effects
142
quinidine adverse effects
arrythmia
nausea/vomiting
diarrhea
**cichonism**
fever
vertigo
headache
143
quinidine caution/CI
prolongs QRS and QT intervals on EKG
144
what is cinchonism?
toxicity of quinine and quinidine (cinchona alkaloids) causing meiniers like sx:
- tinnitus and hearing loss
- headache
- nausea
- dizziness/vertigo
- visual changes
145
class II antiarrythmics
beta blockers
146
class IV antiarrythmics
CCBs
147
class III antiarrythmics
amiodarone
148
amiodarone MOA
- delay in repolarization
- prolongation in AP
- slowing of electricl conduction
- reduction in SA node fct
- dec conduction through accessory pathways
K channel blocker
149
amiodarone adverse effects
common to have significant side effects
most significant: lung toxicity
hyper/hypothyroid
AV nodal block
bradycardia
rare: liver toxicity
150
CCBs and BBs are used for what purposes within cardiology?
anti-hypertensive
anti-arrythmic
anti-anginal
151
signs/sx endocarditis
petechiae on palate or conjunctiva on nail beds, splinter hemorrhages
cough, dyspnea, arthralgia, diarrhea, pallor, splenomegaly, abd/flank pain
murmurs
152
dx endocarditis
blood cultures are definitive dx tool
echo confirms the vegetations
153
how is ST segment elevation differentiated between an MI and pericarditis?
pericarditis: diffuse
MI: regional
154
nitroglycerin relieves chest pain from what condition(s)
ONLY angina
155
anti-anginal drugs
vasodilators
CCBs, BBs
156
nitroglycerin MOA
inc blood supply to heart, dec preload and afterload
157
nitroglycerin adverse effects
headache
dizziness
hypotension
tachycardia
bradycardia
rash
158
amyl nitrate uses and MOA
anti-anginal: unknown; thought to be dilution of arterial and venous system
antidote for cyanide poisoning
159
NTG acute angina dosing
1 SL tablet every 5 mins for 3 doses
160
what other supplements may be used for angina?
L-arginine
magnesium glycinate
zinc
161
MI sx occur ____
(constantly, occassionaly, cyclically)
cyclically; on a 3-5 min cycle
162
MI workup: cardiac enzyme timeline
**2-4 hours post MI: tropinin 1 inc**
4-6 hours post: CK/MB inc
4-8 hours post: myoglobin inc
6-36 hours post: AST
**12-48 hours post: LDH1 > LDH 2**
163
Class I antiarrythmics MOA
blockade of fast Na channels/delay in ventricular depolarization
164
Class II antiarrythmics MOA
delayed atrial > ventricular depolarization
165
Class III antiarrythmics MOA
blockade of potassium channels/delayed repolarization
166
Class IV antiarrythmics MOA
delayed atrial > ventricular depolarization
167
what type of drug are doxazosin and terazosin?
alpha 1 antagonists
168
what drug acts as a sympathomimetic on the CV system? what are its uses?
epinephrine (beta agonist); HF, bradycardoa, cardiac stabilization before pacemaker implantation
169
what type of drug is colesevelam? what does it do?
bile sequestrant; cholesterol lowering
170
what type of drug is gemfibrozil? what does it do?
fibrate; lowers cholesterol/TG
171
what drugs are the vasodilators?
hydralazine
nitroglycerin
isosorbide mononitrate
172
potassium chloride uses
electrolyte (IV)
173
BBs CI/cautions
AVOID in asthma, diabetes
taper d/c to avoid rebound HTN
174
first choice drug class for HTN in pts over 55
CCB or thiazide diuretic
175
for a pt under 55 with uncomplicated HTN, what would the first choice drug class be?
ACEis
176
ARBs CI
pregnancy
177
clonidine AEs
vasodilation
dec peripheral resistance (mental depression, swelling of lower limbs/feet)
178
alpha 1 antagonists MOA
bind to alpha 1 rec > dec norepi > dec vascular resistance systemically
179
alpha 1 antagonists AEs
syncope (first dose)
asthenia
rare priapism or ED
180
alpha 1 antagonists uses
HTN, BPH
181
adverse effects gemfibrozil
inc homocysteine
DVT
SOB
PE
hemopytsis
182
MOA gemfibrozil
fibrate; inhibits liver uptake of FFas > inhibits VLDL secretion, may inc HDL
183
digoxin CI
BB
CCB
antibiotics
verapamil
amiodarone
quinidine
K wasting diuretics
184
vasodilators AEs
headache
185
hydralazine caution
prolonged tx may cause lupus
depletes B6
intensifies hypotension with alcohol/other BP drugs
186
nitroglycerin dosing
SL 1 tab every 5 mins, max 3 doses
187
isosorbide mononitrate CI
phosphodiesterase inhibitors (sildenafil)
188
potassium chloride caution
can cause death due to cardiac AP termination
189
what herbs are used for angina?
allium sativa
crataegus oxycantha
leonarus cardiaca
190
what herbs are used for atherosclerosis
allium cepa
allium sativum
ginkgo biloba
191
what herbs are used for afib
convallaria majalis
leonarus cardiaca
192
what herbs are used for atrial premature beats
crataegys oxycantha
leonarus cardiaca
193
what herbs are used for capillary fragility
aesculus hippocastanum
arnica montana
194
what herbs are used for CHF
convallaria majalis
crataegus oxycantha
digitalis purpura
195
what herbs are used for chronic venous insufficiency
aesculus hippocastanum
centella asiatica
hamamelis virginiana
vaccinium myrtillus
196
what herbs are used for edema
aesculus hippocastanum
taraxacum officinale
197
what herbs are used for bradycardia
glycyrrhiza glabra
rosmarinus officinalis
198
what herbs are used for hypotension
convallaria majalis
glycyrrhiza glabra
199
what herbs are used for HTN
allium cepa (mild)
allium sativum (mild)
crataegus oxycantha
rauwolfia serpentina (severe)
veratrum viride (severe)
200
what herbs are used for hyperlipidemia/dyslipidemia
allium sepa
allium sativum
cynara scolymus
201
what herbs are used for post ischemic stroke recovery
ginkgo biloba
rosmarinus officinalis
202
what herbs are used for raynaud's dz
**CV stimulants**
capsicum frutescens
rosmarinus officinalis
rauwolfia serpentina
zingiber officinale
203
what herbs are used for thrombophlebitis
aesculus hippocastanum
hamamelis virginiana
204
what herbs are used for varicose veins
**venous tonics**
aesculus hippocastanum
centella asiatica
vaccinum myrtillus
205
CV tonics
crataegus laevigata (hawthorn)
ginkgo bilboa
206
positive inotropes/neg chronotrope herbs
convallia majus (lily of the valley)
digitalis purpurea (foxglove)
207
rhythm balancing herbs
selenicerus glandiflorus (night blooming cerus/cactus grandiflorus)
leonurus cardiaca (motherwort)
208
hypotensive herbs
Coleus forskohlii (coleus) – gentle
Olea europaea (olive)
Rauvolfia serpentina (Indian snakeroot) – potent
Veratrum viride (false hellebore), V. album – dangerous
209
venous tonics
Aesculus hippocastanum (horse chestnut) – moderate
Hamamelis virginiana (witch hazel) – gentle
Vaccinium myrtillus (bilberry)
210
Indications for atenolol
B1 BB - HTN angina
211
AE atenolol
Tiredness, hypotension, bradycardia, cold extremities
212
Interactions atenolol
Nitrates/antihypertensives (inc hypotensive effect)
Digoxin (inc bradycardia > inc risk AV block)
DM meds (dec glycemic control)
213
CI atenolol
Don’t discontinue abruptly
Bradyardia
Sinus node dysfunction
AV heart block >1
HF
Cardiogenic shock
Preg (cat D)
Caution in DM
214
Drug class/purpose atenolol
Beta blocker (b1) - antihypertensive, antianginal
215
Carvedilol drug class/purpose
Beta blocker (b1,b2, alpha1) - antihypertensive, adjunct tx for heart failure
216
Work up for ACS/MI
ECG - ST-elevation, Q waves, T inversion
CKMB - peaks day 1, lasts 3 days (marker of reinfarction)
troponin - peaks day 1, lasts 2 weeks
217
Etiology, pathophys, presentation of dilated cardiomyopathy
4 chamber hypertrophy, unexplained dilation, impaired systolic function
Idiopathic, alcoholism (B1 def), myocarditis, doxorubicin(chemo), cocaine, heroin, glue sniff, peripartum
Mitral/tricuspid regurg
L/R S3 + S4, narrow PP due to dc SV
218
Work up and tx of dilated cardiomyopathy
BNP (monitor fluid overload)
ECG - T wave inversion, pathological Qs
CXR - pleural effusion, enlarged heart
Tx: ARBS, BB, aldosterone antagonists, cardiac glycosides, vasodilators, antiarrythmics
219
Etiology, pathophys, presentation of Hypertrophic/obstructive cardiomyopathy
Unexplained hypertrophy of ventricles
AD, chromosome 14 missense that codes for cardiac sarcomere proteins
Palpitations, dizziness w/ rapid standing/valsalva, angina w exercise/DOE
Split S2, S4, harsh systolic ejection (C-D) at left sternal border or apex (inc w valsalva)
CAN CAUSE SUDDEN CARDIAC DEATH IN YOUNG ATHLETES
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Work up and tx for hypertrophic/obstructive cardiomyopathy
ECG - prom Q, short P-R
Echo, cardiac MRI - assessing severity
Tx: BB, amiodarone
AVOID DRUGS THAT DEC PRELOAD (DIURETICS) OR INC FORCE OF CONTRACTION (DIGITALIS)
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Etiology, pathophys, presentation of Restrictive/infiltrative cardiomyopathy
Impaired ventricular filling, dec ventricular compliance, normal systolic function (stiffening of heart)
Caused by amyloidosis, sarcoidosis, myocardial fibrosis post surgery, radiation
SOB, exercise intolerance, CHF itch normal LV systolic function, elevated JVP
S3, Mitral/tricuspid regurg if secondary to myocardial dz
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Work up/tx restrictive/infiltrative cardiomyopathy
ECG - low QRS
Ventricular biopsy to determine etiology
Tx underlying dz, diuretics, vasodilators, ACEi, anticoag (if not CI)
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R CHF etiology/RF, sx
Cause: LHF, cor pulmonale (Pulm cause)
Anorexia/GI distress, wt gain, dependent edema, hepatosplenomegaly, inc peripheral venous pressure
S3, rates, JVD, pitting edema
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R CHF complications
Portal HTN, ascites, pleural effusion
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R CHF work up and tx
Nutmeg liver
Tx: digitalis purpurea, convallaria majalis, crataegus OxyCantha
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L CHF etiology/RF, sx
Elevated Pulm capillary wedge pressure, pulmonary congestion
RF: CAD, HTN, DM, cardiomyopathy, valvular heart dz
SOP when supine (orthopnea), paroxysmal nocturnal dyspnea
S3, JVD, rales, crackles, cough, pitting edema, cyanosis
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L CHF work up, tx
HF cells in lungs
tx: same as RHF
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Most common etiology of subacute endocarditis
Strep viridans in CHD or pre-existing valvular heart disease
229
Most common etiology of acute endocarditis
Staph aureus, secondary infxn occurring elsewhere in body
** high mortality rate
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Etiology pericarditis
Idiopathic
Viral (coxsackie B)
Bacterial (staph A, strep pneumo, TB)
Fungal (histoplasmosis, blastomycosis)
Post MI d/t inflammation
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Dx and tx pericarditis
Chest pain, friction rub, ST elevation/PR depression
Tx: pericardiocentesis, NSAIDS
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Etiology, dx, presentation, tx of rheumatic heart disease
Group A BH strep
Carditis, polyarthritis, chorea, subQ nodules, erythema mariginatum (JONES)
Tx: penicillin, prednisone
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Name the difference between the types of Afib
Acute: new onset <48 hours
Paroxysmal: recurrent <48 hours, converts spon to normal
Permanent: cannot be converted
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Afib sx, work up, tx
Irregularly irregular HR, often sx but can cause palpitations, weakness, SOB
Inc stroke risk
ECG - irregular R-R, narrow QRS, no organized P waves
Tx: rate, rhythm, stroke prevention. Anticoag, BB, CCB, digitalis, amiodarone, convallaria majalis, leonurus cardiaca
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Briefly describe budd chiari syndrome
IVC or hepatic vein blocked > abdominal pain, hepatomegaly, ascites
236
DVT tx
Coumarin, Vit K antagonists
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Sx and complications of embolism
Pain, numbness, NO pulse below blockage, muscle spasm
Complications: PE, gangrene
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Describe etiology and tx of Thromboangiitis obliterans
“Buergers dz”
Inflammation and necrosis of BV > tissue ischemia / infarction in hands/feet
Highly associated with smoking
Tx: corticosteroids, immunosuppressants, smoking cessation
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Sx and work up PAD
Pain in legs when walking and relieved by rest (intermittent claudication), cyanosis of LEs, ulcer formation (toe tips, top of feet, lat malleolus), hair loss on legs
Work up: ABI
240
Tx atherosclerosis
Avoid RF (diet)
Smoking cessation
Inc physical activity
Aspirin (antiplatelet)
ACEI/ARB
Allium cepa/sativum
Ginkgo biloba
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What is hypovolemic shock?
Dec blood volume > shock (hemorrhage, burns, heavy sweating, diarrhea, vomiting, meds, vasodilation)
Dec BP, compensatory tachycardia, oliguria, confusion, pale/clammy skin
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Presentation, etiology, and RF aortic aneurysm
Dilation of aorta due to atherosclerosis, Marfans, vasculitis, infections (syphilis, fungal), bicuspid aortic valve, AAA most common
RF: smoking, HTN, fhx, >70, M
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orthostatic hypotension is a drop of ____ SBP and ____ DBP
20
10
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Types of heart block
First degree - normal or pathological; slowed A>V signals, regular R/R, asx (long PR, remains constant)
Second (mobitz 1 - wenckebach) - progressive PR and dropped beat
Second (mobitz 2) - poor prog; fixed PR and dropped beat, multiple irregular P waves
Third - EMERGENCY - ventricles creating own signals with no input from atria. No relationship between P waves and QRS
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PAC pathophys/tx
Common in healthy pt, asx
Tx: BB if palpitations
Crataegus oxycantha
Leonurus cardiaca
246
PVC pathphys, work up, tx
Heart beat initiated in ventricles by purkinje fibers instead of SA node
Can be in healthy hearts or dec oxygen to myocardium, alcohol, drugs, smoking, cardiomyopathy, Mg or K def, stress, lack of sleep
QRS >120 msec
Tx: BB/CCB if palpitations, electrolytes
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super ventricular tachycardia pathophys/sx
Rapid HR (100-300) originates in AV node or within atria, returns to normal after time/tx
Unclear cause; conduction, digoxin, COPD, pneumonia, Wolff Parkinson’s white, theophylline
Sx: palpitations, pounding pulse, syncope, dizziness, SOB, chest discomfort, narrow QRS
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Super ventricular tachycardia tx
Valsalva, carotid massage, adenosine
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Vtach
V tach: wide, regular QRS, abnormal P waves.
3 consecutive VPB = v tach
Sustained >30 s = EMERGENCY
250
Vfib
EMERGENCY
Ventricular quivering, most common arrythmia in cardiac arrest
Erratic ECG, no identifiable waves
251
Etiology and tx of aortic stenosis
Atherosclerosis, bicuspid valve, rheumatic dz
Valve replacement
252
Etiology and tx of Pulmonic stenosis
Congenital
Balloon valvuloplasty
253
Etiology and tx of Tricuspid regurgitation
Dilation RV, infective endocarditis, RF, congenital
254
Etiology and tx of Mitral regurg
most common valvular dz!
MVP, infective endocarditis, marfans
255
What is distinct about the murmur of MVP?
Mid systolic click
256
Etiology and tx of Aortic regurg
Congenital bicuspid valve, syphilis, marfans, SLR, CT dz, trauma, infective endocarditis
tx: ACEs delay need for valve replacement
257
Etiology of Pulm regurg
Pulm HTN, RF, infective endocarditis, surgical repair tetralogy of fallot
258
Etiology and murmur of mitral stenosis
Rheumatic cause
High pitched opening snap at apex
259
Etiology of tricuspid stenosis
Rheumatic dz
260
AST is increased in what conditions?
early MI, viral hepatitis, fatty liver
261
AST > ALT in what condition(s)
alcoholic hepatitis
262
GGT is increased in what condition(s)
obstruction to bile flow
alcoholism
if GGT and ALP both inc = liver cholestasis
263
if ALP >>> ALT rule out
bone disease
264
hypoalbuminemia is indicative of
cirrhosis; albumen is made in the liver
