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27 Cards in this Set

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What are the physiologic changes of pregnancy? (5 things)
-Blood volume increases by 50%
-CO increases by 30-50%
-HR increases by 10-15 bpm
-Stroke volume increases the first and second trimester, but usually decreases during the third trimester due to IVC compression by gravid uterus
-BP decreases usually 10 mm Hg
What are some cardiac complications from pregnancy?
MOST COMMON = Pulmonary edema
-Preeclampsia (HTN with proteinuria)
-Peripartum cardiomyopathy (can cause maternal death)
-Vascular Abnormalities (include: atherosclerotic CAD, coronary artery dissection, coronary emboli, dissection of the aorta and other arteries).
What are the associated factors of Peripheral Arterial Disorders (PAD)?
a. Coronary Artery Disease (CAD)
b. Cerebrovascular Disease
c. Peripheral Artery Disease (PAD)
What are the the risk factors for PAD?
a. Smoking
b. Diabetes
c. Hypertension
d. Hypercholesterolemia
e. Hyperhomocysteinemia (specific for cardiac)
f. C-reactive protein
*Men 2:1 ratio over women
*most common sites: Carotid, Iliac, Femoral, Popliteal (commonless common)
How do you make the diagnosis for PAD?
a. History and Physical
i. Distal pulse exam
b. Non-invasive study
i. ABI (Ankle Brachial Index) Must do to diagnose PAD
ii. Segmental pressures, Exercise ABI, Carotid Scan, Aortic Scan, CT/MRI
What's the treatment for PAD?
a. Prevent foot injury (proper shoe fit, support hoses
b. Daily vigorous walking (promote collateralization)
c. Anti-platelets (ASA)
d. Percutaneous Clinical Intervention/Surgery if incapacitating claudication, pain at rest, evidence of tissue necrosis
i. Note: Beta Blockers may aggravate claudication, Vasodilators give little help, and CCBs ACEIs, and ARBs usually don’t help
What are the signs and symptoms of acute arterial occlusion? (The 6 P's)
a. The 6 P’s of acute arterial occlusion
i. Pulselessness
ii. Pallor
iii. Pain
iv. Paresthesias (burning, prickling, tingling)
v. Paralysis
vi. Poiklothermia (cold skin)
What are the signs and symptoms of Reynaud's phenomenon?
a. Primary
-Clearly demarcated changes in extremities of white-blue-red on exposure to cold
-White- lack of blood flow
-Blue- venostaisis
-Red- increased blood flow
--Painful, Bilateral, arterial vasospasm, most commonly in young women
- Usually benign course
Tx: CCB
b. Secondary (to CAD or PAD)
-Usually unilateral, Older Men, Limited to hands, may be associated with digital necrosis
What are the clinical manifestation of thromboangitis obliterans (Buerger's disease)?
a. vasculitis of small and medium-sized vessels
b. related to cigarette smoking
c. young men < 45 yrs of age
i. Claudication
ii. Raynauld’s Phenomenon
iii. Migratory Superficial thrombophlebitis (blood clots superficially in legs)
How do you make the diagnosis for pulmonary hypertension?
ECHO
What are the clinical manifestations of idiopathic pulmonary hypertension?
i. Dyspnea (60%)
ii. Weakness (19%)
iii. Recurrent syncope (13%)
iv. Often cyanosis
v. Typically, younger women of childbearing age. Can effect women in their 5th & 6th decades of life.
vi. Rare
vii. No Cure
What is the treatment for pulmonary hypertension?
a. O2
b. Vasodilators (sildenafil (Viagra))
c. Anticoagulants
d. Treat right heart failure: diuretics, fluid restriction, salt restriction
e. Treat underlying disease
f. Lung transplant
What's the etiology of pulmonary hypertension?
a. Hypoxic Vasoconstriction
b. Decreased area of the pulmonary vascular bed
c. Volume/Pressure Overload
i. Ventricular septal defect (VSD) or Patent ductus arteriosus (PDA)
ii. Rheumatic FeverSever MS (later in life)Pulmonary HTN
What's the definition of systemic hypertension (SH)?
Greater than or equal to 140/90.
What's the etiology of systemic hypertension (SH)?
a. Primary HTN (95%)
i. Idiopathic
1. End up only treating the symptoms
b. Secondary HTN (5%) (Has a demonstrable cause)
i. Renovascular HTN- Most common correctable cause of secondary HTN
ii. Genetic
iii. Medication induced: estrogens, adrenal steroids, cocaine, sympathomimetics i.e. amphetamines, excessive sodium.
iv. Other risk factor: smoking, diabetes, dyslipidemia, physical inactivity, alcohol,
v. Psychosocial factors: support structure, work status, educational stressors.
vi. Diseases: Cushing’s, pheochromocytoma, coarctation of the aorta.
What is the treatment for systemic hypertension (SH)?
Begin Thiazide-type diuretics (HCTZ)

Since JNC 7 Thiazide or ACE I

African Americans- CCBs

DM- ACE Inhibitors (life sparing med) (remember causes birth defects)

CAD/MI- Beta Blocker

See the JNC7 for specifics. They are the same that we learned in therapeutics.
What are the risk factors for systemic hypertension (SH)?
a. Major Risk factors
i. Cigarette smoking
ii. Obesity (BMI greater than 30)
iii. Physical inactivity
iv. Dyslipidemia
v. Diabetes mellitus
b. Microalbuminuria
c. Age greater than 55 for men and 65 for women.
d. Family hx. of premature coronary disease. Men less than 55 and women less than 65.
What are the key history points for systemic hypertension (SH)?
a. Duration of HTN?
b. Prior treatment of HTN?
c. Meds? (are any of their meds causing the HTN?)
d. Family Hx?
e. Any symptoms of secondary causes? Or Target organ damage?
f. Risk Factor?
g. Dietary Hx?
h. Psychosocial factors (Stress? and how is it dealt with?)
i. Any features of Sleep Apnea? (early morning headaches, daytime somnolence, loud snoring, erratic sleep)
What are the most common etiologies of pericarditis?
READ pages 395-398
a) Anaerobes (were isolated in 40% of pediatric patients)
- Pneumococcus and gram (-) species
b) Viral accounts for 1-10% of cases (IMPORTANT!)
- Coxsackie B, influenza (seasonal), HIV (frequent)
c) Idiopathic 26-86% (IMPORTANT!) ... most likely due to undiagnosed viral infection... seasonal peaks in Spring and Fall.
d) Rheumatoid arthritis (pericarditis found in 11-50% of patients with RA)
e) lupus erythematosus (25% patients with lupus have pericarditis)
f) Scleroderma (5-10% have pericarditis)
g) Renal failure (12% of cases)
f) Hypothyroidism (4% of cases)
What are the common findings in acute pericarditis?
-Pericardial friction rub (heard at LSB or apex when leaning forward)
- CHEST PAIN (precordial or retrosternal) when patient is supine, relieved when leans forward while sitting
-Water bottle shaped (HUGE) heart on X-RAY.
-Fever, elevated ESR, Diffuse ST segment elevation with associated PR depression on ECG (Tall, short, tall, short QRS segment) Page 400
What are complications of pericarditis?
-Pericardial temponade (due to the viral/bacterial infection)
-Pericarditis may recur in 15-32%
-Noncompressive effusion
-Chronic constrictive pericarditis
What are the common presentations of tamponade?
-BECK TRIAD (JVD, hypotension and muffled heart sounds)
-Pulsus paradoxus (pg. 405)
-Cyanosis
-Various degrees of consciousness
-ALSO: dypsnea, fatigue, anxiety, altered mental status, waxing and waning with these presentations
Which dietary supplements have adequate evidence for recommendation in CVD reduction?
a. Niacin
b. Fish Oil
What is the emphasis of the Portfolio Diet?
a. Plant Sterols
b. Viscous Fibers
c. Soy Proteins
d. Almonds
What are the recommendations for the TLC- step 2 diet?
a. More aggressive approach for LDL-C goals
b. Saturated Fatty Acid <7% of total calories/day
c. Cholesterol <200mg/day
What are the AHA treatment recommendations for elevated LDL cholesterol after 6 weeks on a lifestyle regime? Apply it to a scenario...
a. Reinforce reduction in saturated fat and cholesterol
b. Consider adding plant stanols/sterols
c. Increase fiber intake
d. Consider referral to a dietician
What are the recommendations for simple sugar intake for a 55 year old woman with cardio vascular disease?
-5 tsp/day (80kcal) for a daily expenditure