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100 Cards in this Set
- Front
- Back
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hypertension def |
•Elevationof blood pressure at two or more office visits after an initial screening •With two or more readings ateach office visit |
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Class 1 NYHA functional classification |
No limitations, ordinary activity does not causesymptoms |
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Class 2 NYHA functional classification |
Slight limitation with physical activity, ordinaryphysical activity results in symptoms. |
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Class 3 NYHA functional classification |
Marked limitation of physical activity, comfortable at rest. Less than ordinaryactivity causes symptoms. |
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Class 4 NYHA functional classification |
Unable to engage in physical activity without discomfort, symptoms atrest. |
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AHA objective classification A |
No evidence of cardiovascular disease, nosymptoms of limitation with physical activity. |
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AHA objective classification B |
Evidence of minimal cardiovascular disease, slight limitation with physical activity. No symptoms with rest. |
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AHA objective classification C |
Evidence of moderate to severe cardiovascular disease, marked limitation with less than ordinary limitation. Only comfortable with rest |
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AHA objective classification D |
Evidence of severe cardiovascular disease, symptoms at rest |
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CHF lifestyle modifications |
require annual influenza and pneumococcal vaccines.. Low Na diet, fluid restrictions, weight loss, stop smoking, ETOH reduce, exercise, monitor wt. |
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CHF medications |
diuretics- loop diuretics like furosemide. Loops are the most potent. Can give thiazides. or aldosterone antagonist like spironolactone, eplerenone. Diuretics, ACE inhibitors, BB's, digoxin and other inotropes. |
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aldosterone antagonists examples and advantages |
spironolactone and eplerenone. Spare potassium and have diuretic effects. |
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why gives ACE I's in CHF? |
reduces mortality! decreases LV stress which reduced preload and afterload. It slows remodeling in the heart. causes arterial and venous dilation. |
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green halos around the lights |
digoxin side effect |
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CHF medicaiton contraindications and why? |
Metformin- lactic acidosis. NSAIDs- damages kidneys Sotalol (CCB)- never give to CHF pt Thiazolidinediones - fluid retention antiarrhythmics like: Quinidine ,procainamide, Flecainide |
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HCM is what? definition? |
Hypertrophic Cardiomyopathy . •Hypertrophy of the left ventricular septum |
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hypertrophic obstructive cardiomyopathy (HOCM) definition |
Blockageof blood flow for the left ventricle. Form of HCM. |
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who gets HOCM |
•Most cases inherited. Common cause of sudden death in people younger than 30 years |
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HCM s&s |
•Dyspnea •Chest pain •Palpitations •Syncope •Sudden death •Arrhythmias •Systolic ejection murmur at LLSB that Decreases squatting, lying down and Increases with Valsalva and standing. •Increased carotid pulse (bisferious pulse) |
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memorize murmurs |
memorize murmurs |
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dx HCM |
EKG and echocardiogram |
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Restrictive Cardiomyopathy definition |
•Collagen defect disease infiltrating the ventricular wall causing reduced relaxation•“stiffening”of the ventricle •Less common |
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causes of restrictive cardiomyopathy |
•Amyloidosis •Sarcoidosis •Hemochromatosis (iron deposit in cardiac tissue). •Scleroderma •Carcinoid Syndrome •Radiation/chemotherapy •Idiopathic |
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restrictive cardiomyopathy s&s |
Right sided heart failure. Exercise intolerance Dyspnea . RED |
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Dx of restrictive cardiomyopathy |
•EKG :•Low voltage •Echocardiogram •Endomyocardial biopsy |
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dilated cardiomyopathy definition? who gets it? How common is it? |
dilation of the ventricle/atria causing a reduction in strength and contraction. Most common cardiomyopathy. men>women |
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what causes dilated cardiomyopathy? Clip pig mac DTT |
cocaine, lyme disease, idiopathic, post-partum, prolonger tachycardia, ischemia, genetic (30%), thyroid, diabetes, myocarditis, alcohol, chemotherapy. bolded is alcohol, and geneti inheritance |
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JNC HTN standards for cardiology |
normal <120/<80 pre-HTN 120-139 / 80-89 HTN 1 140-159 / 90-99 HTN 2 >160 >100 |
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# 1 risk factor for heart disease |
HTN |
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primary or essential hypertension is how much of the HTN? % ? |
90% |
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what can exacerbate HTN? |
DAAM PANT diet, alcohol, male, polycythemia vera, african american, NSAID's, Tobacco. |
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secondary HTN accounts for how many HTN patients? |
5-10% |
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causes of secondary HTN |
PHEO'S PRCC Pheochromocytoma, hyper or hypothyroidism, estrogen, obstructive sleep apnea, steroids, parenchymal renal disease, renal artery stenosis, cushing's, coarctation of the aorta. |
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HTN dx |
2 consecutive HTN, ekg showing LVH, use electrocardiogram to verify LVH. Get labs to rule out secondary causes like potassium, blood glucose, creatinine, BUN or spironolactone. If they are in HTN crisis get CT or MRI to rule out head bleed. |
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HTN tx. first line? 2nd line? |
non-pharmacological modifications before meds. DASH diet, aerobic exercise, weight loss, smoking cessation and limit alcohol. |
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HTN tx without comorbitidites |
1st line is diuretics |
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HTN with DM tx? |
Ace inhibitors, or ARB, beta blockers |
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HTN with CKD tx? |
ACE inhibitors or ARB |
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HTN with CAD post MI tx? |
Beta blockers, ACE inhibitors or ARB's. |
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HTN with Cerebral vascular disease tx? |
ACE inhibitors or ARB |
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HTN with HF tx? |
Diureitcs, beta blockers, ACE inhibitors or ARB, aldosterone antagonist. |
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ACE inhibitor side effects |
CHAR cough. hyperkalemia. angioedema (can happen at any point). Renal impairment |
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ARB's side effects |
CHAR Cough. Hyperkalemia. Angioedema. renal impairment. |
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Beta blocker side effects |
bronchospasm. bradycardia. hypotension. fatigue. |
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CCB's side effects |
hypotension. peripheral edema. (not harmful) fatigue. muscle cramps. |
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Diuretics side effects |
hypokalemia, hypochloremia. hypotension. pancreatitis. renal failure. |
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Alpha blockers side effects? |
SHOD somnolence. headache. orthostatic hypotension. dizziness. |
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HTN emergency defintion |
BP >220 with end organ damage |
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what end organ damage to look for in HTN emergency? |
A Camera pipe Aortic dissection CHF. AMS. MI . Encephalopathy. Renal failure. Angina. Pulmonary edema. Intracranial hemorrhage. papilledema Encephalopathy. |
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causes of HTN emergency |
Phrenic V polycystic kidney disease. hyperaldosteronism. renal artery stenosis. •Eclampsia. Non-compliance Illicit drug use. cushing's syndrome. vasculitis. |
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HTN emergenct tx goal and meds? |
reduce MAP by 25% in 1-2 hours. esmolol, labetalol, hydralazine, nitroglycerin, nitroprusside. |
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what ahppens when you lover BP rapidly from HTN emergency patient? |
can lead to ischemic CVA |
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hypotensive emergency defintion? |
systolic <90 or diastolic <60 with signifiicant symptoms. |
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causes of hypotension |
beta blockers alpha blockers calcium channel blockers. nitrates. blood loss. diuretics. dehydration. anemia MI. bradycardia. cardiogenic shock. |
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orthostatic hypotension definition |
decrese BP >20 systolic >10 diastolic from supine to sitting/standing. |
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orthstatic hypotension |
meds like alpha blockers. TCA's MAOI's. parkinsons(remove to stop sysmptoms) |
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cardiogenic shock defintion |
cardiovascular failure due to lack of or loss of tissue perfusion. systolic <90 with urine output <20. |
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cardiogenic shock causes? Most common? |
most common is AMI. cardiac tamponade. pneumothorax. arrhythmia. PE. cardiomyopathies. heart failure. cardiac contusion. valvular and septal abnormalities |
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clinical features of cardiogenic shock |
hypotension AMS tachycardia oliguria. and more, much more.... |
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cardiogenic shock tx? |
1st step is ABC's. 2 large bore IV's. positive inotropic agents like dopamine, dobutamine or norepinephrine. ID underlying cause AMI tx with aspirin and heparin and get emergent revascularization. pericardial tamponade tx with pericardial window. arrhythmias tx with ACLS. |
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CHF defintion and who has it? |
abnormal retention of fluid causing venous congestion due to a pathologic leading to the inability to meet circulatory demans of the body. 10% of population older than 80 has CHF. |
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dry beriberi is what? |
caused by thiamine (B1) deficiency). Dry beriberi causes wasting and partial paralysis resulting from damaged peripheral nerves. It is also referred to as endemic neuritis. |
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Wet beriberi |
Thiamine (B1) deficiency. Wet beriberi affects the heart and circulatory system. It is sometimes fatal, as it causes a combination of heart failure and weakening of the capillary walls, which causes the peripheral tissues to become edematous. |
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high output CHF cause mneumonic PHAT WAP |
pregnancy. hemochromatosis. anemia. thyrotoxicosis. wet beriberi. AV fistulas. paget's disease. |
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low output CHF mnemonic DVD? |
low outout CHF is more common. decreased myocardial contractility. vascular disease diastolic dysfunction. |
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normal LVEF = ? |
55-60% |
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what is systolic failure in terms of LVEF? |
40% |
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what causes LVHF? |
MI. HTN. valvular disease. myocarditis. alcohol abuse. radiation tx. |
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diastolic heart failure defintion? |
preserved LVEF with impaired ventricular filling due to difficult relaxing the myocardium. |
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causes of diastlic HF? |
LVH (most common). valvular disease. restrictive cardiomyopathy live amyloidosis and sarcoidosis. also hemochromatosis. |
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s&s of left sided heart failure? |
dyspnea, orthopnea, paroxysmal nocturnal dyspnea, nocturnal cough, confusion/memory impairment. signs are rales, decreased breath sounds at bases, S3 heart sound (ventricular gallop) |
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right sided heart failure s&s? |
anorexia, nocturia. signs are JVD, hepatomegaly, ascites, peripheral pitting edema. |
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what is the most common cause of right sided heart failure? |
left sided heart failure. |
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is HF a clinical dx? |
sure is |
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where is BNP made? |
natriuretic hormone initially identified in the brain but released primarily from the heart, particularly the ventricles. |
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Labs to get with CHF |
CBC. CMP. TFT's. BNP. |
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Kerly B lines indicate what? |
interstitial edema shown as horizontal lines at the periphery of the lungs. |
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what can be seen on radiograph with CHF? |
pulmonary dilations. pleural effusions shown as blunting of the costophrenic angles. |
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why not do cardiac cath on CHF patients |
they will drown in their own fluid |
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what can raise BNP levels? |
lots of things. HF. CAD, pulmonary diseases. neurologic disorders, toxins, critical illnesses and many others. |
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2nd line tx for A fib and HF |
digoxin, |
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CHF tx with devices? what are they? |
ICD. given when LVEF <35%. LVAD's for heart transplant candidates. Need constant anticoagulation therapy. Cardio MEM's. |
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what are carido MEM's |
monitor placed in pulmonary artery to monitor BP. |
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is metformin contraindicated in CHF? |
yes, it can cause lactic acidosis. |
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what medications are contraindicated for CHF patients? why are they contraindicated |
metformin causes lactic acidosis. antiarrhythmics like quinidine, sotalol. procainamide and flecainide. thiazolidinediones cause fluid retention. NSAIDS cause kidney damage. |
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sx of dilated cardiomyopathy |
HF. S3 and S4. cardiomegaly. sudden death. |
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dilated cardiomyopathy dx |
CXR. echocardiogram. genetic testing. |
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water bottle heart means what? |
pericardia effusion often enlarging the pericardial sack. |
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cardiomyopathy hypertrophic tx |
avoid strenuous exercise, beta blockerspr CCB's. Septal myomectomy. alcohol septal abaltion. |
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cardiomyopathy dilated and restritive tx |
treat underlying cause. supportive tx of CHF |
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all cardiomyopathy get one of these 3 things for tx? |
dual chamber pacemaker. ACID. cardiac transplantation. |
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•81y/o male with progressive dyspnea with BP 150/80, HR 87 bpm, RR 16, Sp02 90%with new EF of 40% and pulmonary congestion on chest x-ray. What medicationbelow will decrease his risk of mortality? •A.Oxygen• B.Nitrates (2nd line dilator) •C.ACE inhibitors •D.Diuretics |
C. Ace inhibitors |
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•52y/o male with PMHx oftype II DM and hyperlipidemia is found to have elevated blood pressure readingson more than 2 occasions. Today his BP is 162/80 and 157/82. What bloodpressure medication should this patient start? •A. Hydochlorothiazide' •B. Carvedilol(Coreg)•C.Amlodipine (Norvasc) •D.Ramipril (Altace) |
D. Ramipril (Altace) |
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•Patientwith PMHx ofsystolic heart failure has difficulty walking up a flight of stair. What is hisclassification based on NYH Classification? •A.Two •B.One •C.Three •D.Four |
A. two |
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•Whichof the following is most likely to cause restrictive cardiomyopathy? •A.Alcohol •B.Genetic inheritance •C.Ischemic heart disease •D.Amyloidosis |
D. Amyloidosis |
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•Whichof the following is side effect/adverse reaction of ACE inhibitors?• A.Hyperkalemia• B. Hypermagnesemia •C.Hyperkalemia, cough, angioedema •D.A and B |
•C. Hyperkalemia, cough, angioedema |
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CHF medication medicatino that is most effective with symptomatic releif? Reduce mortality. |
most effective at symptomatic releif is diuretics. Ace inhibitors reduce mortality. |
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•Systolic ejection murmur at LLSB that |
Decreases squatting, lying down. Increases with Valsalva and standing. |
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x=dx that dyspnea, orthopnea, paroxysmal nocturnal dyspnea, nocturnal cough, confusion/memory impairment.signs are rales, decreased breath sounds at bases, S3 heart sound (ventricular gallop) |
left sided heart failure. |
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dx that •Systemicvascular congestion •Symptoms •Anorexia Nocturia •Signs•Jugularvenous distention •JVD reflex •Hepatomegaly(fromfluid backflow) •Ascites(usuallyfluid overloaded) •Peripheralpitting edema |
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