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Cardiopulm > Midterm > Flashcards

Midterm Flashcards

1
Q

Normal BP

A

120/80

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2
Q

Pre HTN BP

A

120-140/80-90

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3
Q

Stg 1 BP

A

140-160/90-100

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4
Q

Stage 2 BP

A

> 160/>100

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5
Q

When pt has uncontrolled HTN, what end organ damage could potentially occur?

A

Heart: chest P, dyspnea, LVH, MI
Brain: confusion, neuro deficits, stroke
Kidneys: renal failure
Eyes: retinal damage

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6
Q

What is more common: primary or secondary HTN?

A

Primary

Don’t know why it happens, exacerbated by “bad habits”

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7
Q

What are potential causes of 2˚ HTN?

A
  • Obstructive sleep apnea
  • Medication induced or drug related
  • Kidney or renal vascular disease
  • Hormonal abnormalities (cushings, aldosteronism, pheochromocytoma, thyroid, PTH disease)
  • Coarctation of aorta
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8
Q

Management plan for a patient with Stage 1 HTN

A

Confirm within 2mo, home or ambulatory monitor, rec lifestyle mods and nonpharm txmt,
check BP 2-4 weeks, referral if increase in ASCVD risk

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9
Q

Management plan for a patient with Stage 2 HTN

A

Confirm within 1 mo, refer to pharm txmt complement w/ lifestyle mods and non pharm txmt

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10
Q

Regular sodium dietary recommendation?

BP improvement sodium dietary recommendation?

A

<2400 mg/day (~ 1 tsp)

<1500 mg/day

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11
Q

What is hypotention?

A

<90/<60

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12
Q

Causes of hypotension

A

Dehydration (elderly), standing for long periods of time, medicine

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13
Q

Orthostatic hypotension

A

Fall in SBP of >20 mm Hg

and/or a

Fall in DBP of > 10mm Hg within 3 minutes of going from supine to an upright position

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14
Q

Causes of orthostatic hypotension

A

Medications, prolonged bed rest, autonomic nervous system dysfxn, cardiovascular disorders, anemia

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15
Q

What is bradycardia?

A

HR <60 bpm

  • exception is athletes who may have a trained lower HR
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16
Q

What is tachycardia HR

A

> 100 bpm

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17
Q

What conditions are likely if a patient has a regularly-irregular rhythm to their pulse?

A
  • Physiologic sinus arrhythmia: when you inhale your heart beats faster
  • Bigeminal pulse: 2 beats caused by premature beat
  • Trigeminal pulse: 3 beats, otherwise the same
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18
Q

What is suggested by an irregularly-irregular pulse?

A

Atrial fibrillation

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19
Q

Sx and PE findings suggestive of peripheral arterial disease (PAD)

A 
Decreased pulses
Coolness to touch
Color changes
Loss of hair growth
Poor blood supply (ulcers/gangrene)
Diabetes
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20
Q

Correlate the likely location of lower extremity pain depending on the location of artery narrowing in a patient with PAD.

A

Aorta-Iliac PAD

  • Sx: buttocks, thighs, calves — usually bilateral
  • Exam: decreased or absent femoral, popliteal, pedal pulses

Femoral-popliteal PAD

  • Sx: calf — usually unilateral
  • Exam: decreased or absent popliteal and pedal pulses (femoral pulses intact)
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21
Q

What is the initial test of choice to evaluate for PAD?

A

Ankle-brachial index (ABI)

Abnormal <1.0

Systolic BP at ankle should be equal or slightly higher than systolic BP at brachial artery

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22
Q

Is PAD a risk factor for heart disease?

A

Yes

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23
Q

Recognize the physical exam findings associated with Raynaud’s.

A

Digital ischemia due to reversible arterial vasospasm, usually digital. Commonly occurs after cold exposure or with emotional stress.

Exam findings: normal, peripheral pulses intact.

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24
Q

5 Ps of acute arterial occlusion:

A 
Pain
Pulselessness
Paresthesia
Paralysis
Pallor —mottling
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25
Q

What are risk factors for AAA?

A

Male >60 yo, cigarette smoking, HTN, atherosclerosis, familial incidence, Caucasian, diabetes

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26
Q

What are Sx and signs of ruptured AAA?

A
  • Pain of recent onset or recent progression in intensity
  • Pain is severe and ‘piercing’
  • Palpation is very tender
  • 50% of those with ruptures will have: hypotension, back pain, pulsatile abdominal mass
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27
Q

What is diagnostic test to order to eval possible AAA?

A

US, CT, MRI

28
Q

Compare and contrast PE findings in PAD vs DVT vs CVI (chronic venous insufficiency)

A

PAD: decreased pulses, coolness to touch, color changes, loss of hair growth, poor blood supply

DVT: 1 sided LE —> swelling, warmth/redness, edema, pain C.

CVI: unilateral or bilateral; chronic edema and skin changes (thickened, dusky colored)

29
Q

What is the diagnostic test of choice to evaluate for a DVT?

A

Urgent US

30
Q

Know the 4 categories of cardiovascular disease (CVD) and what clinical conditions they result in.

A
  • Coronary artery disease > myocardial infarctions
  • Cerebrovascular disease > strokes
  • Peripheral artery disease > ischemic limb(s)
  • Aortic aneurysm > aortic rupture or dissection
31
Q

Coronary artery disease results in

A

myocardial infarctions

32
Q

Cerebrovascular disease results in

A

strokes

33
Q

Peripheral artery disease results in

A

ischemic limb(s)

34
Q

Aortic aneurysm results in

A

aortic rupture or dissection

35
Q

Pathogenesis of atherosclerosis

A
  1. Lipid deposition in artery walls
  2. Plaque formation
  3. Cardiovascular disease
  4. Normal endothelium forms active layer b/w blood and potentially thromobogenic subendothelial tissues
  5. Atherosclerosis is set in motion when there is damage to cells lining artery walls: leads to endothelial cell activation
36
Q

Risk factors for CVD

A 
Age
Sex
Race
Smoking history
Lipid levels
BP
Whether or not pt has diabetes
37
Q

What level of LDL is “bad”

A

> 190 LDL

38
Q

What causes hypertriglyceridemia?

A

Diabetes, smoking, excessive alcohol consumption

39
Q

Define family history of premature heart disease.

A

1st degree relative who had a CVD even before age 55 (male), or 65 (female)

Most people with a strong family history of heart disease have 1 or more other risks for CVD

40
Q

What benefits does smoking cessation have in terms of reversing CVD risk?

A

Starts to decrease right away but will take about 15 years to fully revert to that of a non-smoker

41
Q

Recommendations for lowering CVD risk in terms of exercise

A

Exercise at least 150 min of moderate intensity aerobic exercise a week, or 75 min vigorous intensity each week

Needs to be aerobic!

42
Q

Recommendations for lowering CVD risk: aspirin use.

A

Take 81 mg aspirin daily

43
Q

Are there any potential adverse effects of taking aspirin?

A

Yes

Inhibit endothelial inflammation, inactivated platelets (can’t clot), 2x increases upper GI bleed, increase stroke by 1.7x

44
Q

How does the dosage of aspirin for prophylaxis differ from that used in acute coronary syndrome (ACS)?

A

CVS: 81 mg/Aspirin day for prevention of CVD in adults aged 50-59;

ACS: 75-162 mg/Aspirin day
(current), 162/325 mg/day (prior)

45
Q

What causes S1 heart sound?

A

Closure of mitral and tricuspid valves

46
Q

What causes S2 heart sound?

A

Aortic and pulmonary valves

47
Q

Mitral regurgitation:

A

Systolic, best heard over apex (auscultation point M), may radiate to axilla or posterior lung bases, occurs from S1 to S2 & intensity of murmur does not change, backwards flow of blood from LV into LA during systole

48
Q

Mitral valve prolapse:

A

Systolic, best heard over apex, mid-systolic click / late systolic murmur, causes an upward displacement of mitral valve leaflets during systole

49
Q

Aortic Stenosis:

A

Systolic, best heard over 2nd right intercostal space, can radiate to the neck and/or apex, cresendo-decresendo murmur during systole, resistance to flow leaving LV (ejection murmur)

50
Q

Aortic Regurgitation:

A

Diastolic, best heard over lower left sternal border (patient may need to sit, lean forward, and hold their breath), covers a large area, early diastolic decrescendo murmur, due to retrograde flow of blood from the aorta back into the LV

51
Q

Mitral Stenosis:

A

Diastolic, best heard over the apex (patient may need to lie on his/her left side), doesn’t radiate, may have an opening snap followed by a decrescendo diastolic rumble, caused by a partially obstructed flow of blood from LA to LV

52
Q

What positions allow you to better hear aortic verses mitral murmurs?

A

Aortic: lean forward, exhale and hold their breathe
Mitral: position patient on the left side

53
Q

Is there such a thing as an innocent heart murmur?

A

Yes, in young people. Benign and no Tx needed

54
Q

What is the classic triad of aortic stenosis?

A

Dyspnea of exertion 75%
Angina 10%
Presyncope 10%
Syncope 5%

55
Q

What is test of choice for evaluating pt with heart murmur?

A

ECHO

56
Q

Sx/si of infectious endocarditis

A
  • Fever
  • Murmur
  • Skin lesions (osler nodes, janeway lesions, splinter hemorrhages
  • Roth spots in the eyes
  • Diagnosis via ECHO & blood cultures (elevated ESR/CRP)
57
Q

What are the classic sx/si of angina?

A
  1. Substernal
  2. Brought on by exertion
  3. Relieved by rest
  4. Pressure or heaviness; dull or aching 5. Radiates to the arms, neck/jaw, back, upper abdomen
  5. Lasts minutes
58
Q

What radiation patterns are common with angina?

A
  • Localized in mid chest area
  • Combo of mid chest, neck, and jaw
  • Mid chest w/ left arm
  • Upper abdomen
59
Q

What associated symptoms are common with angina?

A

Diaphoresis, dyspnea, nausea/vomiting, lightheadedness, palpitations, sense of uneasiness

60
Q

Which patients are more likely to present with atypical angina?

A

M>W

Typical will answer yes to:

1) substernal
2) brought on by exertion
3) relieved by rest

Atypical will say yes to that plus

1) Pressure or heaviness; dull or aching
2) Radiates to the arms, neck/jaw, back, upper abdomen
3) Lasts minutes

61
Q

What are the key factors that distinguish stable angina from unstable angina?

A

Stable angina is predictable; same amount of exertion (or stress) brings it on

Unstable angina if not predictable:
1 - New onset
2 - Cresendo pattern
3 - Progressed to occur with minimal activity or at rest

62
Q

What’s the pathophysiology in most myocardial infarcts (MIs)?

A

2/3’s of MIs (NSTEMI):
—Partial thickness myocardial death, T-wave inversion on EKG

1/3rd of MIs (STEMI)
—Full thickness myocardial death, ST elevation on EKG

63
Q

Know the 3 conditions that can occur in a patient with ACS. Know which of these are more common that the other and how to distinguish between them.

A
  1. Unstable angina: 60%
  2. Non-ST elevation Myocardial Infarction (NSTEMI)
    A. Less severe
  3. ST-elevation myocardial infarction (STEMI)
    A. More severe
64
Q

Non-ST elevation Myocardial Infarction (NSTEMI) EKG wave pathology

A

T-wave Inversion

65
Q

ST-elevation myocardial infarction (STEMI) EKG wave pathology

A

ST elevation

66
Q

What is the management plan for a patient with suspected ACS?

A

Call ambulance and chew on aspirin

Then 
- EKG: tells you what the electric is doing
- ECHO (AKA US of heart)
- Blood work for troponin
15 minutes)
67
Q

Know the alleviating verses aggravating factors for chest pain associated with pericarditis.

A

Alleviating: sitting and leaning forward

Aggravating: taking a deep breathe and lying down

Cardiopulm (11 decks)

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