Green PANCE book Flashcards by Cassidy Ruocco

Primary (essential) hypertension causes ___% of cases of elevated BP

90 to 95%

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More prevalent with increased age and in blacks

Hypertension

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Parenchymal renal dz
Renal artery stenosis
Coarctation of aorta, Pheochromocytoma
Cushing Syndrome, hyperthyroidism
primary hyperaldosteronism
chronic steroid therapy, estrogen use
NSAID use, sleep apnea

Secondary causes of HTN

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Essential HTN is exacerbated in…

Males
Blacks
Sedentary individuals
Smokers

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BP persistently elevated higher than 220 mmHg systolic or higher than 125 mmHg diastolic or accompanied by complications

Hypertensive urgencies!! Must be reduced within hours

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Encephalopathy, nephropathy, intracranial hemorrhage, aortic dissections, pulmonary edema, unstable angina, or MI in the presence of strikingly elevated pressures defines…

Hypertensive emergency

must be reduced within 1 hour

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HTN is diagnosed when the pt has elevated BP of over 140 mmHg systolic and/or 90 mmHg diastolic during..

at least 2 visits

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a BP reading 120-139 mmHg systolic and/or 80-89 mmHg diastolic

Prehypertension

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What abnormality might you see on an EKG in a patient with HTN

left ventricular hypertrophy

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Once HTN is diagnosed, the treatment goal should be to achieve a BP reading of less than…

140/90 mmHg

in a pt w diabetes or CKD, 130/80

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Low saturated fat, cholesterol, total fat describes what kind of diet?

DASH
Dietary Approaches to Stop Hypertension

(includes fruits, veggies, fat free or low fat milk products, increased fiber)

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Initial therapy for essential HTN?

Diuretics

Thiazide diuretics most consistently effective

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Clinical syndrome characterized by abnormal retention of water and sodium. Resulting venous congestion causes typical symptoms such as dyspnea and edema

CHF

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Results from pathologic changes in one or more of the following: myocardial contractility, structural integrity of valves, preload or after load of the ventricle, HR

CHF

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CHF adversely affects left atrial pressure and…

cardiac output

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….causes exertional pulmonary vascular congestion leading to exertional dyspnea plus cough, fatigue, orthopnea, PND, basilar rales, gallops and exercise intolerance

Left sided failure

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…causes systemic vascular congestion and is characterized by distended neck veins, tender or non tender hepatic congestion, decreased appetite/nausea and dependent pitting edema

Right sided failure

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Predominant features of R sided failure

Peripheral edema

Hepatomegaly

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Most common cause of R sided HF

L sided HF

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CXR may show:
cardiomegaly and bilateral or R sided pulmonary effusions, perivascular or interstitial edema (Kerley B lines), venous dilation and cephalization and alveolar fluid

CHF

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ECG may show:
non specific changes (i.e. low voltage), underlying arrhythmias, intraventricular conduction defects, left ventricular hypertrophy, non specific depolarization changes, new or old MI

CHF

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What is the most useful diagnostic in CHF?

Echocardiography

*it is able to assess size and function of the chambers, valve abnormalities, pericardial effusion, shunting and segmental wall abnormalities

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Echocardiography can measure…

Ejection fraction (EF)

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What is a key diagnostic and prognostic indicator in CHF?

Ejection fraction (EF)

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When is cardiac catheterization indicated?

if atherosclerosis is suspected

initial therapy of most CHF patients chinless early initiation of...

ACE inhibitors *have been shown to decrease L ventricular wall stress and slow myocardial remodeling and fibrosis

Ca channel blockers are used to treat associated..

angina or HTN

When the ejection fraction falls below 35, what can be implemented?

Implantable cardioverter-defibrillators (ICD)

...is characterized by insufficient oxygen supply to cardiac muscle, most commonly caused by atherosclerotic narrowing and less often by constriction f coronary arteries

Ischemic heart disease

Levine sign, which is a clenched fist over the stern, and clenches teeth when describing chest pain may be seen in patients with...

Ischemia

Stable angina lasts for less than...

3 minutes

What is the most sensitive clinical sign of angina seen on an ECG?

horizontal or downsloping ST segment depression

1/5 of MI patients will die of..

V fib

MIs in...women, diabetics, elderly...

more likely to have atypical symptoms

..includes pericarditis, fever, leukocytosis and pericardial or pleural effusion usually 1-2 weeks post MI

Dressler syndrome (post MI syndrome)

Most specific marker myocardial damage?

Troponin

This scoring system is the quickest and easiest and can be completed at bedside. One point is given for each: - 65 yo plus - 3 or more risk factors of CAD - use of ASA in last 7 days - known CAD with stenosis 50% or more - more than 1 episode of rest angina within last 24 hours - ST segment deviation - elevated cardiac markers **score of 3 or more=high risk

TIMI (Thrombolysis In Myocardial Infarction)

More complex scoring method.. age, gender, vital signs, ST segment changes, and historical factors are included to predict 6 mo risk of death after discharge

GRACE (Global Registry of Acute Coronary Events)

Which drugs should be given at once to a pt with an acute STEMI

Aspirin and clopidogrel

What should be done within 90 minutes in an MI patient

Angiography

______ cardiomyopathies are the most common type and are associated with reduced strength of ventricular contraction, resulting in dilation of the L ventricle

Dilated

This cardiomyopathy demonstrates massive hypertrophy (particularly of the septum), small left ventricle, systolic anterior mitral motion and diastolic dysfunction

Hypertrophic cardiomyopathy

This cardiomyopathy results from fibrosis or infiltration of the ventricular wall because of colleges-defect diseases, most commonly: amyloidosis, radiation, postoperative changes, diabetes and endomyocardial fibrosis

Restrictive cardiomyopathy

Most common presentation of dilated cardiomyopathy

Dyspnea

Acute pericarditis is most commonly..

idiopathic or due to viral infection

Pericardial effusion (secondary to pericarditis, uremia, or cardiac trauma) produces restrictive pressure on..

the heart

primary presenting symptom of acute pericarditis is sharp, pleuritic substernal radiation chest pain often relived by sitting upright and leaning forward; a cardiac friction rub is characteristic

Acute pericarditis

this occurs when fluid compromises cardiac filling and impairs cardiac output

Cardiac tamponade

this presents with slowly progressive dyspnea, fatigue and weakness accompanied by edema, hepatomegaly and ascites

constrictive pericarditis

typically presents with tachycardia, tachypnea, narrow pulse pressure, jugular venous distention and pulsus paradxus

cardiac tamponade

which diagnostics are useful in determining the extent of cardiac effusion

chest radiography | echocardiography

Most cases of native valve infective endocarditis are...

S. viridans S. aureus enterococci

Most common bacteria and valve involved in drug users with endocarditis

S. aureus, tricuspid valve

Prosthetic valve endocarditis most often caused by...

S. aureus

gram negative organisms or fungi cause endocarditis if the disease develops during the first...

2 months after implantation | later dz due to strep or staph

Most patients present with: fever (although may be absent in elderly) and non specific symptoms (i.e. cough, dyspnea, arthralgia, back or flank pain, GI complaints)

endocarditis

aprox 90% of endocarditis patients will have a stable murmur, but this may be absent in..

R sided infections

25% of patients have...palatal, conjunctival or subungal petechiae; splinter hemorrhages; olser nodes; janeway lesions and roth spots

Endocarditis

painful, violaceous, raised lesions of the fingers, toes or feet

Olser nodes | endocarditis

painless red lesions of the palms or soles

Janeway lesions | endocarditis

exudative lesions in the retina

Roth spots | endocarditis

pallor and splenomegaly are common; strokes and emboli may occur

endocarditis

3 sets of blood cultures at least 1 hour apart should be obtained before...

starting antibiotics

_____ is essential to make the diagnosis of infective endocarditis and identify the specific valves involved

Echocardiography

The presence of ______ is diagnostic for infective endocarditis

vegetation

Which echocardiography is best for endocarditis dx

Transesophageal echo (TEE)

- 2 positive blood cultures of a typical causative microorganism - echocardiographic evidence of endocardial involvement, including new valvular regurgitation

Major Criteria for endocarditis

- predisposing factors (i.e. drug use, abnormal valves) - fever higher than 100.4 F (38 C) - vascular phenomena (ie embolic dz or pulmonary infarction) - immunologic phenomena (ie glomerulonephritis, olser nodes, roth spots) - positive blood cultures not meeting major critera

Minor criteria for endocarditis

Gentamicin with ceftriaxone or vancomycin is appropriate initial therapy for pts with suspected..

infective endocarditis

valve replacement, especially of the ____ valve may be necessary if endocarditis does not resolve w antibiotic therapy

aortic

systemic immune response occurring usually 2-3 weeks following a beta-hemolytic strep pharyngitis *most common in recent immigrants

Rheumatic fever

Major criteria: carditis, erythema marginatum, subcutaneous nodules, chorea, and polyarthritis

rheumatic fever

Minor criteria: fever, polyathralgias, reversible prolongation of the PR interval, rapid ESR or CRP

rheumatic fever

ECG change most commonly associated with acute pericarditis

diffuse ST segment elevation

Green PANCE book Flashcards

(74 cards)