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Midterm Flashcards

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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
What are risk factors for AAA?
Male >60 yo, cigarette smoking, HTN, atherosclerosis, familial incidence, Caucasian, diabetes
26
What are Sx and signs of ruptured AAA?
- 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
27
What is diagnostic test to order to eval possible AAA?
US, CT, MRI
28
Compare and contrast PE findings in PAD vs DVT vs CVI (chronic venous insufficiency)
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
What is the diagnostic test of choice to evaluate for a DVT?
Urgent US
30
Know the 4 categories of cardiovascular disease (CVD) and what clinical conditions they result in.
* Coronary artery disease > myocardial infarctions * Cerebrovascular disease > strokes * Peripheral artery disease > ischemic limb(s) * Aortic aneurysm > aortic rupture or dissection
31
Coronary artery disease results in
myocardial infarctions
32
Cerebrovascular disease results in
strokes
33
Peripheral artery disease results in
ischemic limb(s)
34
Aortic aneurysm results in
aortic rupture or dissection
35
Pathogenesis of atherosclerosis
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
Risk factors for CVD
``` Age Sex Race Smoking history Lipid levels BP Whether or not pt has diabetes ```
37
What level of LDL is “bad”
>190 LDL
38
What causes hypertriglyceridemia?
Diabetes, smoking, excessive alcohol consumption
39
Define family history of premature heart disease.
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
What benefits does smoking cessation have in terms of reversing CVD risk?
Starts to decrease right away but will take about 15 years to fully revert to that of a non-smoker
41
Recommendations for lowering CVD risk in terms of exercise
Exercise at least 150 min of moderate intensity aerobic exercise a week, or 75 min vigorous intensity each week Needs to be aerobic!
42
Recommendations for lowering CVD risk: aspirin use.
Take 81 mg aspirin daily
43
Are there any potential adverse effects of taking aspirin?
Yes Inhibit endothelial inflammation, inactivated platelets (can’t clot), 2x increases upper GI bleed, increase stroke by 1.7x
44
How does the dosage of aspirin for prophylaxis differ from that used in acute coronary syndrome (ACS)?
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
What causes S1 heart sound?
Closure of mitral and tricuspid valves
46
What causes S2 heart sound?
Aortic and pulmonary valves
47
Mitral regurgitation:
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
Mitral valve prolapse:
Systolic, best heard over apex, mid-systolic click / late systolic murmur, causes an upward displacement of mitral valve leaflets during systole
49
Aortic Stenosis:
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
Aortic Regurgitation:
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
Mitral Stenosis:
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
What positions allow you to better hear aortic verses mitral murmurs?
Aortic: lean forward, exhale and hold their breathe Mitral: position patient on the left side
53
Is there such a thing as an innocent heart murmur?
Yes, in young people. Benign and no Tx needed
54
What is the classic triad of aortic stenosis?
Dyspnea of exertion 75% Angina 10% Presyncope 10% Syncope 5%
55
What is test of choice for evaluating pt with heart murmur?
ECHO
56
Sx/si of infectious endocarditis
- Fever - Murmur - Skin lesions (osler nodes, janeway lesions, splinter hemorrhages - Roth spots in the eyes - Diagnosis via ECHO & blood cultures (elevated ESR/CRP)
57
What are the classic sx/si of angina?
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 6. Lasts minutes
58
What radiation patterns are common with angina?
- Localized in mid chest area - Combo of mid chest, neck, and jaw - Mid chest w/ left arm - Upper abdomen
59
What associated symptoms are common with angina?
Diaphoresis, dyspnea, nausea/vomiting, lightheadedness, palpitations, sense of uneasiness
60
Which patients are more likely to present with atypical angina?
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
What are the key factors that distinguish stable angina from unstable angina?
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
What’s the pathophysiology in most myocardial infarcts (MIs)?
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
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.
1. Unstable angina: 60% 2. Non-ST elevation Myocardial Infarction (NSTEMI) A. Less severe 3. ST-elevation myocardial infarction (STEMI) A. More severe
64
Non-ST elevation Myocardial Infarction (NSTEMI) EKG wave pathology
T-wave Inversion
65
ST-elevation myocardial infarction (STEMI) EKG wave pathology
ST elevation
66
What is the management plan for a patient with suspected ACS?
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
Know the alleviating verses aggravating factors for chest pain associated with pericarditis.
Alleviating: sitting and leaning forward Aggravating: taking a deep breathe and lying down

Cardiopulm (11 decks)

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