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117 Cards in this Set
- Front
- Back
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Risk factors for heart disease between men and women differ by how many years?
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10
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What is the most common symptom of women presenting with an MI?
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fatigue
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What is the first line of defense against chronic stable angina?
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Beta-blockers
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ACE inhibitors, Beta-blockers, and Aspirin all do what?
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-increase longevity
-decrease mortality |
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What are the ABCDEs of contraindications of the use of beta-blockers?
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-Asthma
-Block (heart) -COPD -Diabetes -Electrolyte (K) - |
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HOw do you get pulse pressure?
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-systolic minus diastolic
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Low pulse pressure can indicate what murmur?
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aortic stenosis
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High pulse pressure can indicate what murmur?
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aortic regurgitation
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WHat are the 2 main questions you ask yourself when you treat HTN?
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-Where do you wanna go?
-How fast do you wanna get there |
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Hypertension commonly causes what in the heart?
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LVH
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Anterior spasm leading to "copper wire" or "silver wire" appearance of vessels
Grade? Duration or severity of HTN? |
-Grade I
-recent onset of HTN |
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Changes of Grade I, plus arterio-venous nicking (A-V nicking) impingement of a vien by sclerotic arteriole.
Grade? Duration or severity of HTN? |
-Grade II
-HTN for many months, probably years |
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Changes of Grade I and II, plus hemorrhages (diffuse or flame-shaped) and exudates: soft exudates or "cotton wool" spots----fibrinoid changes. Hard exudates---lipid deposits from healing of old lesions
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-Grade III
-Severe or accelerated HTN |
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Papilledema: Blurred optic disk margins, especially on temporal side
Grade? Duration or severity of HTN? |
-Grade IV
-HTN emergency |
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HOw does isotonic exercise affect BP?
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-increases systolic BP
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How does isometricl exercise affect BP?
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-increases systolic and diastolic BP
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How can alcohol affect BP?
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increases systolic and diastolic BP
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How does coffee affect BP?
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increase BP slightly
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How does smoking affect BP?
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Chronic use doesn't increase BP
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ACE and ARB work better when taken when?
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at night
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Why do we treat HTN?
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-to reduce morbitity and mortality
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What can HTN do to the eyes?
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-retinal damage
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What can HTN do to the heart?
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-LVH
-CHF |
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Isolates systolic BP?
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-disease of elderly
-stiffining of arteries and need to treat aggressively |
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What are some causes of secondary HTN? (CREEP)
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-Coarctation of the aorta
-Renal artery medial fibromusclular dysplasia -Endocrine -Eclampsia -Pill or Phreocromocytoma |
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What are some endocrine causes of HTN? (CHAP)
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-Chushings
-Hyperaldosteremia -Acromegaly -Phoecromocytoma |
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What are some factors that favor secondary hypertension?
7 of them |
-age of onset (before 30 or after 50)
-present w/ severe HTN or people that is suddenly accelerated -patients who have end organ damage when HTN is discovered -Patients w/ hyperkalemia w/out diuretic use -Abdominal bruit on exam -Labile HTN, tachycardia, sweating, tremers -Poor response to HTN meds |
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What is Renal Pericimal Disease and who is it common in?
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-stenosis of renal artery
-Seen in young women |
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The string of beads feature is seen in what?
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-medial fibromuscular dysplasia
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Rib notching on an x-ray is seen in what disease?
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-coarctation of the aorta
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What are the three zones of the cortex?
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-Zona Glomerulosa
-Zona Fasciculata -Zona Reticularis |
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Zona Glomerulosa is associated with what?
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-salt (mineral coricoids)
-aldosterone |
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Zona Fasciculata is associated with what?
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-sugar (cortisol)
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Zona Reticularis is associated with what?
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-sex steroids
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Phoechromocytoma is caused by what?
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-excess amounts of epinephrine and norepinephrine
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What medication should you not use in Phoechromocytoma?
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beta-blockers
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Chushings disease is caused by what?
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-too much cortisol in the adrenal cortex
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Symptoms of eye damage from HNT are?
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Blurry vision and new visual field defects
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What are some symptoms of heart damage from HTN?
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Heart Failure that presents with dyspnea
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What are some symptoms of kidney damage from HTN?
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Hematuria in the urine
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What are some symptoms of CNS damage from HTN?
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changes in mental status
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What are some signs to look for in the neck with HTN?
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-JVD
-Carotid bruit -makes sure carotid upstroke is good |
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In HTN you want to make sure the apex of the heart is now what?
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-displaced (if it is displaced think RVH)
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In HTN, S3 can mean what?
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-LVH
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What do you want to look for in the abdomen in HTN?
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-abdominal bruits
-pulsations (AAA) |
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What do you want to look for in the extremities in HTN?
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-adema
-other abnormalities |
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In a neuro exam, what do you want to look for in HTN?
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-neuromuscular loss
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Why do you want to do a BMP for HTN?
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-get sugar levels
-BUN/Creat -CO2 -Electrolytes |
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What do you look for in a UA for HTN?
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-hematuria
-albumin/protein -proteinuria |
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What do you want to check in a CBC for HTN?
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-elevated heme and hematocrit
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What do you look for in an EKG for HTN?
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-LVH
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WHat drugs should you not take if you have HTN?
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-NSAIDS
-decongestives -antihystamines |
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What do you wanna look for on a CXR for HTN?
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-LVH
-cardiomegaly -Rib notching |
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Why do you want to do an echo for HTN?
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-see heart size
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Why do you not want to stop adrenergic inhibitors quickly?
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-because of rebound HTN
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Weakness of left ventricle that causes back up of fluid to the lungs
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Left sided heart failure
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Swelling of the feet.
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Pedal Edema
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Restriction of movement of the heart b/c pericardial sac is full of fluid.
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Pericardial Tamponade
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Filling pressure of the heart.
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pre-load
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Difference between systolic and diastolic blood pressure.
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Pulse pressure
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Crackling sound heard on inspiration. There is fluid in the interstitial space of lungs
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Rales
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Failure of R-side and there is back up of fluid in the abdomen and lower limbs
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Right side heart failure
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HOw does CAD cause left sided heart failure?
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don't let the heart pump correctly
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What murmurs are most commonly seen in L-sided heart failure?
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-Mitral regurgitation and ortic stenosis
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How can HTN lead to left-sided heart failure?
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-makes the left ventricle very stiff, which causes poor diastolic filling
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Which is more common diastolic or systolic dysfunction?
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Diastolic
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Why does dilated cardiomyopathy lead to left sided heart failure?
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-because of the thin, floppy walls
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What are some causes of dilated cardiomyopathy?
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-Iatrogenic
-Alcohol -rheumatic fever -tyroid disorders -post partum -drugs (chemo) |
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What dysrrhythmia is most common in left-sided heart failure?
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-A Fib
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What causes high output heart failure?
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-Anemia
-Thyrotoxicosis -thiamine deficiency |
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Right sided-heart failure can show what chronic lung diseases?
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-asthma
-copd -Cystic fibrosis -bronchietisis |
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Right-sided heart failure can show what two main heart murmurs?
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-pulmonary stenosis
-tricuspid insuffiency |
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Cardiac temponade is when you can't do what do the blood in the heart?
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-get it out
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What is the most common pediatric heart disease?
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-Ventricular Septal Defect (VSD) aka right to left shunt
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Whe do you get lung problems with L-sided heart failure?
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-b/c of sputum back up in the lungs
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HTN, Diabetes, and obesity are associated with what sided heart failure?
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left
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Pitting adema and swelling are associated with what sided heart failure?
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right
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History of COPD or Pulmonary HTN is usually seen with what sided heart failure?
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right
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SOB is seen in what sided heart failure?
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-left
-sometimes right |
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Paroxysmal Nocturnal Dyspnea is associated with what sided heart failure?
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-left
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Orthopnea is associated with what sided heart failure?
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-left
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Swelling in the feet or abdomen is associated with what sided heart failure?
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right
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What are the ABCDEs that you should look for on a CXR?
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-A-alveolar edema
-B-Kerley B-lines -C-Cardiomegaly -D-Dilated prominent upper lobe vessles -E-Pleural effusion |
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What is the most common cause of HR in America?
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-diastolic dysfunction
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When you suspect CHF, what do you listen for in the lungs?
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-rhales and crackles
-wheezes -dullness to percussion - |
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When you suspect CHF, what do you listen for in the heart?
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-mirtral regurgitation
-aortic stenosis -S3/S4 |
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JVD is seen in what sided heart failure?
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-right
-sometimes left |
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HJR is seen in what sided heart failure?
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-right
-sometimes left |
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Rales are seen in what sided heart failure?
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-right (dry) sometimes
-left (wet) |
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Wheezes are heard in what sided heart failure?
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-right
-sometimes left |
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S3 at the apex is heard in what sided heart failure?
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-Left
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Pedal edema is seen in what sided heart failure?
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-right
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Ascites is seen in what sided heart failure?
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-right
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In left sided heart failure, what is the first thing that you seen on a CXR?
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-cardiomegaly
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What is the flow of enlargement on a CXR for left-sided heart failure?
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-cardiomegaly
-pulmonary vessels get engourged and lungs get bigger at the apex -fluid goes to the interstisium -then to the lumphatics -then to the alveoli |
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What do you look for on an EKG in CHF?
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-ischemia
-dysrrhythmias -P-pulmonale -LVH -RVH |
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On a CBC, what are you looking for in CHF?
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-MCV>100
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What is a very sensitive test for CHF?
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BNP
|
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Tell me about BNP.
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-good test
-L-atrium and L-ventricle release in response to stretch -It is an anti-renin hormone |
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WHy do yo do an ECHO for a CHF patient?
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-to get wall motion
-hypertrophy -valve stenosis -valve hypertrophy -ejection fracture |
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What are some advantages of doing a TEE for CHF?
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-image quality superior to echo
-better visualization of valves and atria -particularly useful in assessing prosthetic valves, vegetation,s arotic disease, and intracardiac masses -can be used during cardiac surgery |
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What are some disadvantages of doing a TEE for CHF?
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-invasive
-requires conscious sedation -risk of aspiration -risk of trauma to teeth, pharynx, and esophagus |
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MUGA is a good test to get what?
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-ejection fracture
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In CHF, as ventricles become floppy what happens?
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-you lose ejection fracture and get PVCs
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What is the formula for ejection fracture?
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end-diastolic volume (-) end-systolic volume divided by end-diastolic volume
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CAPTOPRIL (contraindications for ACE inhibitor uses)
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C-cough
A-angioedema P-protein uria T-Taste changes O-Hypotenstion P-pregnancy R-rash I-increased renin levels L-lower angiotension II's |
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Adaquate perfusion means what? (3 things)
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1-normal mentation
2-adequate urine output 3-warm extremities |
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Nitro decreases what?
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-preload
|
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What are the 6 main objectives in the pharmacoligical management of HF?
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1-control excess H20
2-reduce afterload 3-improve dontractibility 4-normalize pressure volume curve 5-compensated patients can use oral drugs 6-de-compensated patients require IC and other therapies |
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What are six medications (classes) that can help treat HF?
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-diuretics
-vasodilators -digoxin -nitrates -beta-blockers -surgical therapy |
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What are 4 non-pharmicological therapies for the treatment of HF?
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-watch Na intake
-watch ETOH and fluid intake -exercise -aerobic and isometric exercise |
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For diastolic heart failure, you want to treat what?
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-the underlying cause
|
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The initial management of patients with decompensated heart failure should be aimed at what?
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-normalizing volume status
-improving systemic perfusion |
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Therapies that have been shown to decrease moratlity in all patients with systolic heart failure include what?
|
-ACE inhibitors
-Beta-blockers -and spironolactone in class III and IV symptoms |
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What drugs are used primarliy for symptoms control?
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-digoxin
-nitrates -diuretics |
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Patients with progressive HF symptoms despite optimal medial therapy should be considered for what?
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-cardiac replacement therapy (VAD or transplant)
|
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The management of diastolic HF primarily consists of treatment with what?
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-negative inotropes and limited diuresis
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