Jack's Cardiololgy Flashcards
(200 cards)
Define Orthostatic Hypotension?
-a decrease in systolic BP of 20 mm Hg or a decrease in diastolic BP of 10 mm Hg when going from lying to sitting or sitting to standing
Why is orthostatic hypotension a problem with elderly?
-syncope and especially falls
You have a 75 y.o. male with orthostatic hypotension. In addition when evaluating him his heart rate increases more than 15 beats per minute when he stands from a sitting position. What does this indicate?
-indicates that the problem is probably low blood volume
How do you tx a patient with orthostatic hypotension?
-tx the underlying cause ie. fluids for depletion, check PB meds
An elderly patient presents with exertional dyspnea and can’t walk more than a block without SOB. He also says he occationally wakes up at night with dyspnea. He describes a chronic nonproductive cough. What is the likely Dx?
-CHF
An elderly patient’s wife says he stops breathing when he naps in the afternoon. What is this called?
-Cheyne-Stokes breathing
How do you assess Jugular Venous Distension (JVD) ?
- sit the patient at 45 degrees
- jugular vein pulsation higher than 4 cms above the sternal angle is considered to be elevated venous pressure
A displaced apical impulse can be seen in CHF. Describe how to find this on PE?
-found on the midclavicualr line in the 5th intercostal space
A positive Hepatojugular Reflex may be seen in CHF. How do you check for this on PE?
- patient sitting at 45 degrees
- pressure is applied to the abdomen for 1 min and if the neck vein height increases by 3 cm the test is positive
What are the x-ray findings of CHF ?
- cardiomegaly : boot or water bottle heart
- pleural effusion : ground glass, fluid build up in pleural space
- Kerley B lines : short parallel lines at the lung perifpery near the bases
- Batwing or Butterfly shadow-enlarged hila or alveolar edema
What lab values might be positive in CHF ?
-Beta natriuretic peptide (BNP) : is a good indicator of CHF however it may not be as specific in patients who are old or have COPD
What meds do you use for CHF?
- thiazide diuretic for long term tx along with a ACEI
- loop diuretic with for acute situation tx
What PE, and other studies do you do for atherosclerosis?
- PE : listen for bruit
- U/S Doppler for blood flow
- Ankle Brachial Index
- Angiogram/Heart cath
A 47 y.o. male presents without c/o and you notice yellow crust on the skin of his eyelids (Xanthomas). What might this be an indication of?
-Dyslipedemia, but over half of the people with them have a normal lipid profile
When should you begin screening patients for dyslipidemia?
-35 for men and 45 for women
What are the numbers for total cholesterol?
- Optimal < 200
- Borderline 200 -239
- High > 240
What are the numbers for HDL cholesterol?
-Low 60
What are the numbers for LDL cholesterol?
- Optimal < 100
- Near Optimal 100-129
- Borderline high 130-159
- High >160
What are the number for Triglycerides?
- Normal <150
- Borderline 150-199
- High 200-499
What are the nonpharmacological tx for dyslipidemia?
- wt reduction
- reduce dietary fat to 30% and saturated fat to <10%
- Mediterranean diet
- increase aerobic exercise
How do statins work?
-lnhibit rate limiting step in cholesterol production
Most common side effect of statins?
-myositis
Ways to lower cholesterol in postmenopausal women include?
-estrogen replacement helps lower LDL and raise HDL
Name 2 Bile acid binding resins for lowering cholesterol?
- Cholestyramine
- Colestipol