CVD Flashcards
(237 cards)
1
Q
Acute MI aka
A
STEMI
ACS
2
Q
S3 heart sound may indicate
A
Heart failure
3
Q
Infective endocarditis can present with
A
new murmur
- subungal hemorrhages
- Osler nodes
- Janeway lesions
- Roth spots or retinal hemorrhages
4
Q
Osler nodes
A
painful violet-colored nodes on fingers or feet
5
Q
Janeway lesions
A
-nontender red spots on palms/soles
6
Q
AAA presentation
A
- elderly white male
- sudden severe, sharp, excruciating pain in abdomen, flank, and/or back
- distended abdomen
- abnormal vitals
7
Q
Which ventricle is closest to sternum
A
right ventricle
8
Q
Displacement of the PMI can occur due to
A
- severe LVH
- pregnancy in third trimester
9
Q
S3 heart sound during pregnancy is normal
A
true
10
Q
S1 valves
A
- Systole
- MoTiVAted
- Mitral, tricuspid closure
- these are AV valves
11
Q
S2 valves
A
- diastole
- APpleS
- Aortic, pulmonic closure
- these are semilunar valves
12
Q
S3 heart sounds are also called
A
- ventricular gallop
- S3 gallop
13
Q
What does S3 sound like
A
kentucky
14
Q
When is S3 normal
A
- children
- pregnant
- some athletes
15
Q
When is S3 never normal
A
-if it occurs after age 35-40
16
Q
What does S4 indicate
A
LVH
17
Q
When is S4 normal
A
-normal in some elderly due to stiffened left ventricle
18
Q
When does S4 happen
A
-late diastole
19
Q
What is S4 also called
A
- atrial gallop
- atrial kick
20
Q
What does S4 sound like
A
-Tennessee
21
Q
What is the bell of the stethoscope used for
A
- low tones such as S3 S4 sounds
- Mitral stenosis
22
Q
What is the diaphragm used for
A
- mid to high pitched tones like lung sounds
- mitral regurg
- aortic stenosis
23
Q
Physiologic S2 benign or pathologic
A
-benign
24
Q
Where is split S2 best heard
A
-pulmonic area
25
When is split S2 normal
-appears during inspiration and disappears at expiration
26
Erb's point
-third to fourth ICS on the left sternal border
27
Mitral regurg description
- pansystolic or holosystolic
- loud blowing and high-pitched
- use diaphragm
28
Where is mitral regurg best heard
-apex
29
Where can mitral regurg radiate to
-axillae
30
Aortic stenosis description
- midsystolic ejection murmur
- harsh noisy murmur
- use diaphragm
31
Aortic stenosis location
- second ICS at right side of sternum
| - aortic region
32
Where can aortic stenosis murmur radiate to
-neck
33
Plan for patients with aortic stenosis
- avoid physical overexertion
| - refer to cardiologist
34
Mitral stenosis description
- low-pitched diastolic rumbling murmur
- aka opening snap
- use bell
35
Mitral stenosis location
-apex
36
Aortic regurg description
- high-pitched diastolic murmur
| - use diaphragm
37
Aortic regurg location
-Located at Erb's point
38
Grade I murmur
-very soft only heard under optimal conditions
39
Grade 2 murmur
-mild to moderately loud
40
Grade 3 murmur
-loud murmur easily heard with stethoscope on chest
41
Grade 4 murmur
- louder murmur
| - first time a thrill is present
42
Grade 5 murmur
- very loud
- heard with edge of stethoscope off chest
- thrill more obvious
43
Grade 6 murmur
- murmur so loud, can be heard with stethoscope off chest
| - thrill easily palpated
44
Stenotic valves don't ___ properly
open
45
Regurgitant valves don't ___ properly
close
46
Identifying murmurs
1. where in the cardiac cycle is it audible
2. where is it the loudest
3. any associated findings
47
Second most common cause of aortic stenosis
-rheumatic fever
48
Rheumatic fever can cause what
- aortic stenosis
| - mitral stenosis
49
Aortic regurg findings
- PMI displacement
- dilated left ventricle
- X-ray shows evidence of LVH
50
How many stages of mitral stenosis
4
1: asymptomatic, then gradual reduction in exercise tolerance
2: onset of pulmonary congestion
3: pulmonary HTN
4: severe state of low CO
51
MVP associated findings
- palpitations
- CP
- CLICK
52
MVP is most common in which population
women 14-30 years old
53
MVP findings
-midsystolic click best at apex and left sternal border
54
S3 is a sign of
CHF
55
S4 is a sign of
LVH
56
Which grade of murmur is a thrill palpated for the first time
4
57
What to do if a man has a pulsatile abdominal mass >3 cm in width
order abdominal US and CT
58
Most common arrhythmia in US
afib
59
Class of afib
supraventricular tachyarrhythmia
60
Paroxysmal afib
- episodes terminate within 7 days
| - usually asymptomatic
61
Afib treatment tool
-CHADS VASc score
62
New onset afib treatment plan
- EKG
- TSH
- electrolytes
- renal function
- BNP
- troponin
- refer to cardio
63
Lifestyle modifications for afib
- avoid caffeine
| - avoid alcohol
64
afib medications
- rate control: BB, CCB, digoxin
- antiarrhythmics: amiodarone BBW pulmonary and liver damage
- Simvastatin with amiodarone: rhabdomyolysis
- anticoagulation: warfarin
- nonvalvular afib: direct thrombin inhibitor or factor Xa inhibitors
65
Reversal agent for clopidogrel (Plavix)
Pradaxa
66
INR for syntheithic and prosthetic valves
2.5-3.5
67
INR < 5.0
- skip next dose
- or reduce slightly the maintenance dose
- check INR once or twice a week when adjusting dose
- no vitamin K
68
INR >5.0
- hold one or two doses
- with or without vitamin K
- monitor INR every 2-3 days until stable
- decrease maintenance dose
69
Paroxysmal SVT EKG
- tachycardia with peaked QRS with P waves
| - more common in children
70
PVST presentation
- acute onset of palpitations
- rapid pulse
- lightheadedness
- SOB
- anxiety
71
PVST treatment
- cardio referral
- if hemodynamically unstable, call 911
- Vagal maneuvers
- hold breath and strain hard, or splashing cold water on face
72
Pulsus paradoxus
- aka paradoxical pulse .
- apical pulse can be heard even though radial pulse no longer palpable
- status asthmaticus
73
Pulmonary cause of pulsus paradoxus
- asthma
| - emphysema
74
Cardiac cause of pulsus paradoxus
- tamponade
- pericarditis
- cardiac effusion
75
Anterior wall MI EKG
- Wide QRS, ST segment elevation
| - wide QRS looks like tombstones
76
Afib causes
- alcohol intoxication
- CAD
- CHF
- history of MI
- older age
- HTN
- stimulants
77
Suspected bleeding with warfarin, what to order
- INR
| - PT, PTT
78
How long can it take to see changes in INR with warfarin dose change
-3 days
79
PVR x CO
BP
80
Sodium and BP
increased: water retention increases vascular volume, increase CO
81
Normal BP
<120/80
82
Prehypertension
- 120-139
| - 80-89
83
Stage 1 HTN
- 140-159
| - 90-99
84
Stage 2 HTN
- >160
| - >100
85
Angiotensin I to angiotensin II
- increased vasoconstriction will increase PVR
| - younger patients have higher renin than elderly
86
Sympathetic system stimulation
-epinephrine causes tachycardia and vasoconstriction
87
Alpha blockers, beta blockers, CCB
-decrease PVR through vasodilation
88
Pregnancy and BP
-Systemic vascular resistance lower due to hormones
89
HTN and microvascular damage
- eyes
| - kidneys
90
Eye exam with HTN
- silver, copper wire arterioles
- AV junction nicking
- Flamed shaped hemorrhages
- papilledema
91
Kidney exam with HTN
- microalbuminuria and proteinuria
- elevated serum creatinine and eGFR
- peripheral or generalized edema
92
Macrovascular damage with HTN
- Cardiac: S3, S4, bruits, CAD, acute MI, PAD
| - Brain: TIA, strokes
93
Classes of secondary HTN
- renal
- endocrine
- other
94
Renal causes of secondary HTN
- renal artery stenosis
- PCOS
- CKD
95
Endocrine causes of secondary HTN
- hyperthyroidism
- hyperaldosteronism
- pheochromocytoma
96
Other causes of secondary HTN
- obstructive sleep apnea
| - coarctation of aorta
97
Primary hyperaldosteronism labs
- HTN with hypokalemia
| - normal to elevated sodium
98
Hyperthyroidism labs and presentation
- weight loss, tachycardia, fine tremor, moist skin, anxiety
- new onset afib
- check TSH
99
Pheochromocytoma presentation
- excessive secretion of catecholamines
- labile increase in BP with palpitations
- sudden onset anxiety, sweating, severe headache
100
Diagnosing HTN
- confirm with subsequent visit 1-4 weeks later
- check BP at home with diary
- If home BP lower --> white coat HTN
101
BP goal for everyone
<140/90
102
BP goal for <60
<150/90
| only if without DM or CKD
103
BP goal for CKD >18 years old
-<140/90
104
BP goal for DM >18 years old
<140/90
105
Hypertensive emergency
-diastolic >120 with findings of target organ damage
106
Isolated systolic HTN in elderly
- loss of recoil in arteries (atherosclerosis)
| - Pulse pressure increased
107
HTN, HLD, T2DM lifestyle recommendations
- weight loss
- stop smoking
- reduce stress
- reduce sodium <2.4g
- adequate K, Ca, Mg
- limit alcohol
- eat fatty cold-water fish three times a week
108
DASH diet is recommended for
-prehypertension, HTN, weight loss
109
DASH goal
- eat more K, Mg, Ca
- reduce red meat and processed foods
- eat more whole grains legumes
- eat more fish and poultry
110
What kind of exercise reduces LDL and BP
aerobic
3-4x/week
at least 40 minutes
111
Thiazide diuretics
- increase urine output
- monitor K
- avoid with sulfa allergy
112
Side effects of diuretics
- hyperglycemia
- hyperuricemia
- hyperTG and cholesterol
- hypokalemia
- hypnatremia
- hypomag
113
Aldosterone receptor antagonist diuretics action
- antagonizes aldosterone
| - increase water elimination while sparing K
114
Aldosterone receptor antagonist diuretics indications
- HTN
- HF
- hirsutism
- precocious puberty
115
Aldosterone receptor antagonist diuretics side effects
- gynecomastia
- galactorrhea
- hyperkalemia
- GI
- postmenopausal bleeding
- ED
116
Aldosterone receptor antagonist diuretics examples
spironolactone
| -Eplerenone (Inspra)
117
BB action
-decrease vasomotor activity, CO, inhibit renin and norepinephrine release
118
BB contraindications
```
-asthma
COPD
-chronic bronchitis
-emphysema
--2nd, 3rd degree heart block
-sinus brady
```
119
BB and post-MI
decreases mortality
120
CCB action
- blocks calcium channels in cardiac smooth muscle
- systemic vasodilation
- nondihydropyridines: depress muscles of heart (inotropic)
- dihydropyridines: slow down HR (chronotrope)
121
Nondihydropyridines
depress heart muscle
| inotropic
122
Dihydropyridines
decrease HR
| chronotrope
123
CCB side effects
HA
ankle edema
heart block or bradycardia
reflex tachycardia
124
CCB contraindications
- 2nd, 3rd degree HB
- Bradycardia
- CHF
125
Dihydropyridine examples
-Pine
-nifedipine
amlodipine
felodipine
126
Nondihydropyridine examples
verapamil
| diltiazem
127
Pregnancy category for ACE/ARB
C
128
ACEI and ARB contraindications
- mod to severe CKD
| - renal artery stenosis
129
ACEI ends with
-pril
130
ARBs end with
-sartan
131
Alpha-1 blockers suffix
-zosin
132
Alpha-1 blockers side effects
- dizziness
- hypotension
- give at HS and titrate up
133
Used for both HTN and BPH
- Terazosin (Hytrin)
| - Doxazosin (Cardura)
134
Alpha-1 blockers used ONLY for BPH
Tamsulosin (Flomax)
135
Diabetic retinopathy findings
- neovascularization
- cotton wool spots
- microaneurysms
136
Preferred meds for isolated systolic HTN in elderly
-low dose thiazide or CCB
137
COmbining ACEI with K-sparing duretic
watch for hyperkalemia
138
Which antihypertensive helps females with HTN and osteopenia/osteoporosis
Thiazide diuretic
| slows calcium loss by stimulating osteoclasts
139
Systolic heart failure EF
<40%
| HFrEF
140
Diastolic heart failure EF
>40%
| HFpEF
141
Left ventricular failure findings
- crackles, bibasilar rales, cough, dyspnea, decreased breath sounds, dullness
- paroxysmal nocturnal dyspnea, orthopnea, nocturnal nonproductive cough, HTN, fatigue
142
Right ventricular failure findings
- JVD (normal <4 cm)
- enlarged spleen, enlarged liver
- LE edema with cool skin
143
Paroxysmal nocturnal dyspnea may indicate left or right HF
left
144
Other findings with HF
- S3 gallop
| - anasarca: generalized edema
145
Treatment for stable HF with HTn
-start ACEI/ARB, add BB
limit sodium
-refer to cardiologist
-ED if in distress
146
NYHA class I
-no limitations on physical activity
147
NYHA class II
ordinary physical activity results in fatigue, exertional dyspnea
148
NYHA class III
marked limitation in physical activity
149
NYHA class IV
symptoms present at rest
150
DVT stasis etiology
- prolonged travel
- prolonged inactivity >3 hours
- bed rest
- CHF
151
DVT inherited coagulation disorder etiology
- Factor C deficiency
| - Factor V Leiden
152
DVT increased coagulation due to external factors
- OC
- pregnancy
- bone fractures of long bones, trauma, recent surgery, malignancy
153
DVT Homan's sign
- lower leg pain on dorsiflexion of foot
| - low sensitivity
154
DVT labs
- CBC
- platelets
- clotting time
- D-dimer level
- CXR
- EKG
- US
- hospital admission for IV heparin and PO coumadin for 3-6 months
155
Superficial thrombus patho
- inflammation of superficial vein due to local trauma
| - higher risk with indwelling catheters, IV drugs, secondary bacterial infection
156
Superficial thrombophlebitis findings
- indurated cord-like vein
- warm and tender
- surrounding area with erythema
- should be no swelling or edema of entire limb --> DVT
157
Superficial thrombophlebitis treatment
- NSAIDs
- warm compress
- elevate limb
- If septic cause --> ED
158
Peripheral arterial disease patho
- gradual narrowing and/or occulsion of medium to large arteries in LE
- blood flow decreases over time
- permanent ischemic damage
159
Risk for PAD
- HTN
- smoking
- DM
- HLD
- previously known PVD
160
PAD presentation
- worsening pain on ambulation (intermittent claudication)
- instantly relived by rest
- atrophic skin changes
- gangrene on toes
161
Ankle-Brachial Index (ABI) diagnosis for PAD
-<0.9
162
Normal ABI
0.91-1.3
163
ABI procedure
- systolic BP of ankle and arm checked after being supine for 10 minutes
- ABI done for each leg
- ABI=SBP of eat foot divided by SBP of both arms
164
PAD skin findings
- atrophic
- shiny and hyperpigmented ankles
- hairless and cool
165
PAD CVD findings
- decreased to absent dorsal pedal pulse
- increased capillary refill time
- bruits over partially blocked arteries
166
PAD treatmnet
- smoking cessation --> vasoconstriction
- daily ambulation exercise
- Cilostazol (Pletal): phosphodiesterase inhibitor, direct vasodilator
- Percutaneous angioplasty or surgery for severe cases
167
Raynaud's association
increased risk of autoimmune disorders
168
Raynaud's presntation
- women
- chronic and recurrent episodes of color changes on fintertips in symmetric pattern
- white, blue, and red
- numbness and tingling
- attacks last for hours
169
Raynaud's treatment
- avoid cold
- avoid stimulants
- smoking cessation
- CCB: nifedipine, amlodipine
- check distal pulses and ischemic signs
- no vasoconstricting drugs
- avoid nonselective BB
170
ASCVD score to start statin
>7.5%
| if diabetic, start immediately
171
Statin recommendation for history of CHD or stroke
high potency statin
172
Statin recommendation for LDL >190 (familial)
High potency statin
173
Statin recommendation for DM
Mod potency statin
174
Statin recommendation for global 10-year risk score >7.5
mod potency statin
| primary prevention
175
High potency statins
- rosuvastatin 20, 40
| - atorvastatin: 40, 80
176
Bacterial pathogens for bacterial endocarditis
- viridans streptococcus
- s. aureus
- usually gram +
177
Bacterial endocarditis treatment plan
-stat referral to ED for IV abx
178
Bacterial endocarditis prophylaxis is recommended for
- previous history of IE
- prosthetic valves
- certain congenital heart disease
- cardiac transplant
for
- dental procedures of mucosa, gingiva, periapical area
- invasive procedures of respiratory tract
179
IE prophylaxis medication
- Amoxicillin 2 G PO x 1 does (adults)
| - amoxicillin 50 mg/kg 1 hour before produce x one dose (children)
180
MVP is at higher risk for
- thromboemboli
- TIA
- afib
- ruptured chorade tendinae
181
Treatment for MVP
- asymptomatic does not need treatment
- MVP with palpitations: BB, avoid caffeine, alcohol, cigarettes
- Holtor monitor
182
When to start screening for HLD
20
| every 5 years
183
HLD screening for <40
every 2-3 years
184
Screening for preexisting HLD
every year
185
Normal total cholesterol
<200
186
Borderline total cholesterol
200-239
187
High total cholesterol
>240
188
HDL in men
>40
189
HDL in women
>50
190
Low HDL is associated with
increased risk of CAD even with normal LDL
191
What diet is associated with low HDL
high carb and low-fat diets
| smoking
192
Optimal LDL
<100
193
LDL for low-risk patients and <2 risk factors
<130
194
Very high LDL
>190
195
LDL level for heart disease or DM
<100
196
Normal TG
<150
197
High risk of acute pancreatitis
>1000
198
Treatment plan for TG >500
- treat TG with fibrate (fenofibrate or niacin), OTC niacin, or high-dose fish oil
- prescription fish oil: Lovaza 4f/day
- once TG under control, switch to LDL lowering
199
HLD treatment
- lifestyle changes
- DASH diet
- increase soluble fiber
- treat LDL or TG first
200
HLD treatment for >75 with ASCVD
-mod intensity statin
201
Best at reducing LDL
-HMG COA reductase inhibitors
| statins
202
Niacin should not be combined with
statins
203
Fibrates should not be used with
severe renal disease
204
Good agents for lowering TG and elevating HDl
nicotinic acid and fibrates
205
Bile acid sequestrant mechanism
works in small intestine, interfere with fat absorption, including fat soluble vitamins
206
fat soluble vitamins
A, D, E, K
207
When are bile acid sequestrants used
-when patients cannot tolerate statins, fibrates, and niacin
208
Bile acid sequestrant examples
-Cholestyramine, colestipol, colesevelam
209
Combination regiment for lipid-lowering
should be avoided
210
Rhabdomyolysis labs
```
-creatine kinase if markedly elevated
at least 5x upper limited of normal
-urine will be reddish-brown
proteinuria
LFTs elevated
```
211
Acute drug induced hepatitis presentation
- nausea
- anorexia
- dark urine
- jaundice
- fatigue
- flu like symptoms
212
Acute drug-induced hepatitis labs
-elevated ALT and AST
213
Any adult with history of ASCVD must be treated with
high dose statin
214
Any adult with LDL> 190 without ASCVD or DM must be treated with
high dose statin
215
Patient with ASCVD risk score 5-7.5% initial treatment
lifestyle modifications
216
Statins may cause which neurologic symptoms
memory loss
confusion
d/c statin
217
Which statins should not be mixed with macrolides
simvastatin
| lovastatin
218
Which body types are at risk for metabolic syndrome
apple body more at risk than pear shaped body
219
Obesity waist circumference in males
>40 inches
220
Obesity WC in females
>35 inches
221
Waist to hip ratio obesity males
->1
222
Waist to hip ratio obesity females
>0.8
223
Metabolic syndrome increases risk for
DM and CVD
224
Criteria for metabolic syndrome
- abdominal obesity
- HTN
- HLD: FPG(>100), elevated TG (>150), decreased HDL (<40)
225
NAFLD patho
- TG fat deposits in hepatocytes
| - most asymptomatic
226
NAFLD labs
- LFTs
| - hepatitis panel
227
NAFLD treatment
- lose weight, exercise
- d/c alcohol permanently
- avoid hepatotoxic drugs
- vaccine for hepatitis A and B
228
BMI
ratio of weight (kg) to height (Meters^2)
229
Overweight BMI
>27
230
AAA screening
- men aged 65-75 who have ever smoked
| - one time with US
231
Physiologic split S2
split increases on inspiration
found in most adults <30
benign
best heard in pulmonic region
232
Heart sound found in poorly controlled HTN or recurrent MI
S4
233
High-dose statin therapy can reduce LDL by how much
50%
234
What is pulsus paradoxis
- decrease in systolic BP on inspiration
- systolic pressure drops due to increased pressure
- asthma, emphysema
235
What is ankle brachial index used to measure
severity of arterial blockage in LE
| -Peripheral arterial disease
236
Normal ABI score
1-1.4
237
ABI score for severe PAD
<0.5
