chronic CV pt 2 Flashcards Preview

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Flashcards in chronic CV pt 2 Deck (44)
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1
Q

left sided HF symptoms

A

dyspnea
cough
crackles
respiratory distress
A fib
S3
murmurs
pulm congestion on CXR

2
Q

right sided HF

A

edema
fluid retention
hepatic congestion
nausea
increased CVP
JVD
ascites
S3/S4

3
Q

HF cardinal features

A

parasternal lift
displaced PMI
diminished S1
S3 gallop
S4 gallop (diastolic HF)

4
Q

BNP indicative of HF

A

> 400

5
Q

HFrEF meds

A

vasodilators - ACE/arb
diuretics - loop
B-blockers (later)

6
Q

non-pharm mgmt for HFrEF

A

na restriction <2300
case mgmt
palliative care

ICD/pacer if EF <35
LVAD/RVAD
coronary revascularization
transplant

7
Q

HFpEF mgmt

A

correct reversible causes

manage BP, A fib

SGLT2, diuretics, ACE/ARB

8
Q

murmur grading

A

I - barely audible
II - audible but faint
III - moderately loud; easily heard
IV - loud, associated with a thrill
V - loudest (off chest)

9
Q

diastolic murmurs

A

mitral stenosis
aortic regurg

10
Q

systolic murmurs

A

mitral regurg
aortic stenosisi

MRASS

11
Q

mitral regurg

A

s3 with systolic murmur at apex (5th ICS MCL)
may radiate to base or left axilla
musical, blowing, high pitched
decreased with standing, valsalva, increased with squatting

12
Q

aortic stenosis

A

2nd right ICS
usually radiates to neck
blowing, rough, harsh

13
Q

mitral stenosisi

A

5th ICS, MCL
loud s1, mid-diastolic, low-pitched, crescendo rumble
increased in L lateral, squatting, valsalva

14
Q

aortic regurg

A

2nd L ICS, RSB
blowing

15
Q

basic principles for valvular HD

A

manage RF! HTN, HLD, DM

lifestyle

oral health

vaccinations

16
Q

mitral stenosis mgmt

A

anticoagulation (warfarin) if A fib, or embolic event

HR control

valve replacement/repair or balloon valvotomy

17
Q

diagnostic for valvular disorders

A

TTE

18
Q

aortic stenosis mgmt

A

diuretics

AVR - definitive

19
Q

aortic regurg mgmt

A

htn mgmt - CCB, ACEI/ARB

AVR - definitive

20
Q

mitral regurg mgmt

A

control HF symptoms and HTN
MV repair if severe (primary)

21
Q

Pulm HTN diagnosis

A

mean PAP >25 mg Hg at rest

22
Q

pulm HTN initial treatment

A

vasoreactivity testing at time of RHC

positive following nitric oxide admin - give high dose calcium channel blocker

negative - treatment determined by risk:
high risk - combo therapy w IV prostacyclin
low/intermediate -oral endothelin receptor antagonist and PED5 inhibitor

triple therapy: epoprostenol, bosentan, sildenafil

23
Q

PAD symptomatology

A

claudication
cold extremities
numbness
pain exacerbated by activity, relieved by rest

skin ulcerations - punched out edges, well-defined, pale/necrotic, low exudative, PAINFUL

24
Q

ABI interpretation

A

normal 1-1.4
noncompressible >1.4 (calcified vessel)
borderline 0.91-0.99
abnormal <0.9 duplex US

25
Q

PAD gold standard diagnosis

A

ABIs, then

CTA

26
Q

PAD mgmt

A

lifestyle modifications (smoking cessation, exercise, glycemic control)

HLD - statin
HTN - ACEI or ARB

antiplatelets (aspirin, clopidogrel)

revascularization surgery

27
Q

venous insufficiency s/s

A

dull, achy legs
leg swelling
itching, tingling, burning, cramping, heaviness

dependent edema
trophic changes
chronic cellulitis
irregular edges, slough
minimal pain in ulcers

28
Q

venous insufficiency dx

A

duplex U/S

29
Q

venous insufficiency mgmt

A

supportive measures - elevation & compression

weight reduction, exercise

stenting/reconstructive

30
Q

commonly affected organs of HTN

A

heart - LVH, angina, MI, HF
brain - stroke, TIA, dementia
eyes - retinopathy
kidney - CKD
peripheral artery disease

31
Q

HTN symptomatology/exam findings

A

asymptomatic
pulsating HA
epistaxis
lightheadedness
visual disturbances
LHF symptoms

S4
end organ damage

32
Q

HTN screening guideliens

A

annually for adults >40 or risk factors
every 3-5 years for adults with normal BP and no RF

33
Q

HTN stages

A

normal <120 and <80
elevated 120-129 and <80
stage 1 130-139 or 80/89
stage 2 140 or >90

34
Q

HTN first line agents

A
  • ACEI/ARB & CCB
  • ACEI/ARB & CCB & thiazide
  • ACEI/ARB & CCB & thiazide & spironoactone
35
Q

2nd line HTN agents

A

diuretics - loop, K sparing, aldosterone antagonists
B-blockers
Alpha-blockers
alpha 2 agonists
vasodilators
renin inhibitors

36
Q

HTN dx

A

140>90, goal <130/80 in special populations

37
Q

HTN tx for HF

A

HFrEF - ACEI/ARB, diuretics, B-blockers, NO NONDIHYDROPYROIDINE CCBS

HFpEF - diuretics, ACEI/ARB, beta blockers

38
Q

HTN tx for CKD

A

stage 1-2 w albuminuria or stage 3 - ACEI (or ARB if not tolerated)

39
Q

HTN tx for DM

A

all first line agents
consider ACEI/ARB in presence of albuminuria

40
Q

HTN tx for blacks

A

thiazide or CCB first line

41
Q

HTN tx in pregnancy

A

methyldopa, nifedipine, labetalol

NO ACEI, ARB, or direct renin inhibitors

42
Q

geriatric HTN tx

A

<140/90

43
Q

NYHA HF classes

A

I - no limitation of physical activity, ordinary activity does not cause fatigue, dyspnea, or angina

II - slight limitation of physical activity. ordinary physical activity results in symptoms

III - marked limitation on physical activity. comfortable at rest, but less than ordinary activity causes symptoms

IV - unable to engage in any physical activity without discomfort, symptoms may be present even at rest

V - used by some experts to describe symptoms that are typical and can occur either at rest or with exertion

44
Q

cha2d2s vasc score

A

used to predict thromboembolic events in patients with nonvalvular A fib

ischemic stroke greatest risk

Congestive HF
Hypertension
Age>75
DM
Stroke/TIA/TE -2

Vascular disease
Age 64-74
Sex category (female)