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CV ( primary and secondary HTN) Flashcards

1
Q

What is the 1st line dx test for murmurs?

A

echo w/ doppler

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2
Q

Systolic Murmurs

A

MR ASS is a MVP

  • mid to late holosystolic
  • MR - mitral regurg
  • AS - aortic stenosis
  • S - systole
  • MVP - mitral valve prolapse –> will become MR , will hear a “click”
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3
Q

MR

A

blowing or high-pitched
May radiate to the LEFT AXILLA

location: apex, apical area, mitral area, 5th ICS by mid-clavicular line

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4
Q

Aortic Stenosis

A

systolic ejection murmur
May radiate to the NECK

end stage - heart failure, syncope, agina, high risk for sudden death

Location:
- aortic area , at the “base” of heart

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5
Q

MVP

A

mid-systolic click with late systolic murmur at the mitral area

sx: usually asymptomatic or may complain of palpitations chest discomfort, dixxy, sob
labs: echo, TEE

Loacation : “ apex” apical area

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6
Q

Diastolic Murmurs

A

MS ARDe

MS: mitral stenosis

AR - Aortic regurgitation

e; erbs point ( AR can be heard here

  • always indicative of heart disease*
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7
Q

MS

A

low pitched - diastolic rumbling murmur that is loudest at the apex (use bell)

sy: DOE, dypnea *, afibb *
location: apex, apical area, mitral area,

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8
Q

When to use the bell of stethescope

A

MS and listening for extra heart sounds

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9
Q

AR

A

early diastolic decresendo blowing murmur. Aterial pulses could be abnormal

location: 3rd 4th ICS at the left sternal border ( erbs point)

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10
Q

Heart sounds

S1, S2,

A 
s1 = systole
s2 = diastole
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11
Q

S3

A

early Diastole “ ventricular gallop”

  • normal in pregnancy
  • more common in children and young adults
  • Abnormal if found after age 40 , may indicate heart failure
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12
Q

S4

A

Late diastole ( atrial kick)

LVH ( stiff)

can be a normal finding in elderly

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13
Q

Grading Murmurs

A

Grades 1-3 ( no thrill)
Grade 4 - first time thrill is palpated
Grade 5-6 - heard thrill)

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14
Q

A-fibb

A

can be paroxysmal or persistent
its a reduction in cardiac output and increased risk of emboli formation

key to evaluate pt need for antithrombotic therapy ( heart valve abnormality raises risk)

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15
Q

A- fibb presentation , dx, tx, avoid

A

complains of sudden onset heart palpitations, accomplanied by weakness, dizziness, fatigue, dyspnea.

may have rapid pulse and hypotension

dx: EKG ( no discrete P waves, irregularly irregular)

refer to cards

avoid: caffiene, nicotine, decongestants, alchol

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16
Q

What is the CHA2DS2- VASC score

A

assess for afibb stroke/emboli score

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17
Q

what are the two biggest risk factors in developing a stroke/ emboli

A
  • hx of a stroke/TIA/thromboemolism

- 75 or older

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18
Q

what is first line anticoagulation therapy for people with valvular abnormalities? what are the drug interactions?

A

warfarin

  • Sulfa drugs
  • Macrolides
  • NSAIDS
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19
Q

what is first line anticoagulation therapy for people with NO valvular abnormalities? what are the drug interactions?

A

Factor Xa inhibitors

PPI, antacids, H2 blockers, NSAIDS, clopidogrel

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20
Q

How long does it take on warfarin for the INR to change?

A

2-3 days

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21
Q

Pt education for warfarin

A

eat the same amount of vitamin K rich food daily
too much will decrease INR

high vitamin K foods: green-leafy vegetables, broccoli, brussel sprouts, cabbage, mayonnaise

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22
Q

What is the INR goal for anticaogulation?

A

2-3

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23
Q

what to do if INR is 3.1-4.0

A

check for any presence of bleeding

decrease maintaince dose 10% per week

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24
Q

what to do if INR is 4.1-5.0

A

check for bleeding

hold one dose. decrease weekly dose by 10

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25
Length of therapy for first episode of provoked ( surgury) / unprovoked ( venous thromboembolism)
minimum 3 months
26
When will a pt be on anticoagulation for life?
with recurrent VTE, VTE w/ risk factors, unprovoked isolated distala DVT, VTE w/ malignacy
27
Pulse deficit
count the apical and radial pulses at the same time then subtract the difference
28
Pulsus Paradoxus
a decrease in the systolic BP of > 10 during inspiration ( must be more than 10, causes: cardiac tamponade, pericardial effusion, acute MI, constrictive pericarditis pulmonary causes: asthma, tension pnuemo, emphysema
29
Othrostatic hypotension
a decrease in the systolic BP of at least 20 or the diastolic of 10 in 3 min best ways to check bp : supine then standing
30
Impending AAA rupture presentation
elderly man who is a smoker, complains of sudden onset of severe abdominal pain accompanied by severe low back pain, will appear shock like or incidental finding on cxr
31
What is the most common cause of sudden death in young healthy athletes?
Hypertrophic Cardiomyopathy as it causes VT - want to ask about congential CVD in sports phsycials
32
Acute Infective Endocarditis ( bacterial) presenation
fevers, chills, weight loss, heart murmur w/ petechie, splinter hemmorages, janeway lesions, oslers nodes,
33
Acute Infective Endocarditis ( bacterial) PE
splinter hemmorages : non blanching reddish lines on nailbed NONtender erythematous macules on the palms and soles ( jameaway lesions) subcutaneous TENDER violaceous nodules on the pads of fingers and toes (oslers nodes) hemmorahagic lesions on retina w/ pale centers ( roth spots)
34
Endocarditits prophaylsis
Amox 2 gm 1 -hour prior to procedure | if PCN allergy - Keflex
35
who is at high risk for endocarfitis
prosethic heart valve hx of infectious endocarditis cyanotic congetial heart dx, CHF
36
what are the high risk procedures?
dental work, colonoscopy, bronchocopy w/ biopsy, TTE
37
What is HTN a major risk factor for?
stroke, MI, Vascular disease, CKD
38
What is the most common cause of secondary HTN
renal artery stenosis - renovascular
39
What is end organ damage in HTN
``` Heart failure Carotid plaques PVD/PAD LVH Kidney UA ```
40
Heart Failure end organ damage
s3, s4, dyspnea, edema, rales, elevated JVD
41
Carotid plaques end organ damage
carotid bruits, high risk CAD
42
PVD/PAD end organ damage
decreased or absent peripheral pulses
43
LVH end organ damage
left ventricular heave, or increased size of PMI
44
Kidney end organ damage
hypertensive nueropathy
45
UA end organ damage
may show RBC, protein
46
Renal artery Stenosis
cause of secondary HTN, called also Polycystic kidney dx - will hear a bruit in upper abdomen or will have englarged kidneys doesnt mean they have CKD dont use an ACE
47
Other causes of secondary HTN
- Hyperthyroidism - Pheochromocytoma ( tumor on adrenal gland) - Primary Hyperaldosteronism ( HTN w/ low K, and elevated NA) - Cushing syndrome - Addisions ( will see HYPO) - Coactation of aorta ( picked in infancy - sleep apnea
48
Pheochromocytoma
tumor on adrenal gland triad of : headache, sweating and tachy w/ hypertension. the severe HTN will resolve in hours Labs: 24 urine for metanephrines, and catecholamines
49
Primary Hyperaldosteronism
HTN w/ hypokalemia and slightly hypernaturemia Labs: plasma renin activiation and aldosterone concentration in AM
50
Cushing syndrome
too much cortisol - abdominal obesity, with skinny arms , round face with acne, straie red to purple color in breasts, dorsal hump labs: lare night salivary cortisol and 24 hour urine free cortisol normal caused by steroid use
51
Addison disease
adrenal insufficency , hypo corticolism craving of salty foods, diffuse hyperpigmentation on face, low BP labs will show elevated K, low NA , DX; morning cortisol levels
52
Other factors that affect BP
NSAIDS Estrogens Stimulents Diet
53
what type of decongestants increase BP
pseeudophedrine / sudafed
54
what is a cough supressent?
Dextromethorphan
55
What is a normal BP
120/80 or less
56
what is the biggest difference in the guidelines
the stages and the amounts
57
how should you measure BP
emptied bladder, support arm on a table, measure in both arms use higher reading arm for measurement. take 2 readers per visit one to two minute apart and average the readings
58
How to dx HTN
two readings at least one min apart (average) taken on two or three separate visits if above 130/80 = HTN can use out-of office self monitoring BP to confirm dx and for the titration of medication or if you suspect white coat
59
what is the goal BP
130/80
60
what is first line tx for HTN
lifestyle - weight loss - DASH ( can lower 11 off SBP) - sodium restriction - potassium increse - reduce alchol - 150 min of aerobic activity per week
61
which pts get lifestyle + meds
DM< CKD< MI
62
what drugs to avoid in people with HTN, CAD, SZ, mania
Decongestants : OTC cold and sinus drugs Methylxanthines : theophylline , caffiene Amphetamines Appetitie Supressants : sibutramine
63
what is goal for healthy older adult over 60
150/90
64
goal BP for CKD or DM over 60
140/90
65
first line tx for CKD
include ACEI or ARB
66
First line tx for DM (ALL)
include ACEI or ARB
67
first line tx for blacks
CCB and thiazide diuretic
68
first line tx for non-blacks
Thiazide diuretic ACE, ARB or CCB
69
when to recheck BP for goal of therapy
1 month
70
goal for people with CV dx and ASCVD 10% or more
130/80
71
goal for people with HFpEF
130/80 and start with and ACE / ARB or BB
72
first line tx for people with Afibb
ARB
73
first line tx for pregnancy
methyldopa, nifedipine, labetolol avoid ACE ARB and aliskiren
74
Examples of Thiazide diuretics
chlorthalidone ( highest potency) HCTZ indapamide
75
exmaples of CCB
amilodipine, diltizem ER, nitredipine
76
examples of ACE
catopril enalapril, lisinopril
77
examples of ARB
eprosartan, losrtan, calsartan, candesarten
78
Thiazide MOA
works on kidneys by increasing secretion of NA and chloride , loss of K, MG and decreases urinary calcium excretion
79
Thiazide S/e
" think HYPER VS HYPO" hyperglycemia ( don't give to DM) hyper triglyceridemia / hyper cholestrol Hyperuriecemia hypokalemia hyponaturmia hypomag caution w/ people with severe sulfa allergy contraindication: gout Give to people with osteopenia/osteoporosis as it slows down urinary secretion of calcium. can decrease risk of hip fractures
80
Loop diuretics
quick and potent ( lasix, Bumex) dont give to people who are lithium - can increase kidney damage na depletion
81
Potassium sparing diuretics
interferes with the sodium-potassium exhange in the distal tube of kidneys - spironoactone, amiloride, triamterene - causes hyperkalemia ( dont combine with ACE-ARBS
82
side effects of spironoactone
hirtisum | Galactorrhea, hyperkalemia, GI effects
83
ACE and ARBS
preferred in DM, CKD Adverse: dry cough , hyperkalemia
84
Beta blockers
decreases vasomotor activity and cardiac output and inhibits norepinephrine release B1 = heart and kidney B2: - lungs, GI, uterus, vascular smooth muscles Do not discontinue abruptly, wean
85
beta blockers a/e and contraindications
Adverse effects: - broncospasm - bradycardia, HF, - PAD exacerbations - depression, sexual dysfucntion - avoid if they have chronic lung disease contraindiaction; - heart failure , 2nd or 3 rd heart block, bradycardia, DM - can blunt or worsen hypoglycemia response
86
CCB what type
blocks calcium channels in the heart and arterioles causing vasodilations depresses AV node First line for blacks, raynaud's dx Dihydropyrdines : "pine" more potent, no negative effect on the cardiac contractility or conduction. use for HTN and stable angina Non-dihydropyridines - more effect on the cardiac conduction and contractility. Less potent vasodilator. used for HTN, chronic stable angina, arrythmias
87
CCB contraindiactions and a/e
grapefruit juice ( it will increase serum level causing toxcity) 2nd 3rd heart block, CHF Adverse : - headache flushing, ankle edema, constipation
88
Alpha-blockers
blocks alpha receptors in peripheral arterioles resulting in profound vasodilation - terazosin (hystrin) / doxasozin (cardura) - can work for both BPH and HTN

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