Cardiovascular Am

Front 1

CARDIOVASCULAR ADULT MED

Back 1

CARDIOVASCULAR ADULT MED

Front 2

What is the most important diagnostic factor in the approach to a pt with CP

Back 2

history! Ask OPQRST questions

Front 3

Specify several symptoms that would help exclude angina from consideration in a person with chest pain.

Back 3

Duration lasting days.
Pain that occurs with recombancy or bending over.
Pain relief with antacids, H2 antagonists, PPIs

Front 4

Distinguish typical angina pectoris from other causes of chest pain by characteristics related to:
onset and precipitating factors


•
•
Quality.

Back 4

Quick onset, associated with stress or exertion, occurs more commonly after meals and with exposure to the cold

Front 5

Distinguish typical angina pectoris from other causes of chest pain by characteristics related to:
Duration

Back 5

Short, lasting less than 3 minutes. Lasts longer if patient is angry or develops angina after meal

Front 6

Distinguish typical angina pectoris from other causes of chest pain by characteristics related to:
Characteristics

Back 6

Tightness, squeazing, aching, bursting, gas, indigestion Location

Front 7

Distinguish typical angina pectoris from other causes of chest pain by characteristics related to:
Relief

Back 7

rest with Nitroglycerin

Front 8

Distinguish typical angina pectoris from other causes of chest pain by characteristics related to:
Quality

Back 8

Stabbing, tightness, squeazing, aching, bursting, gassy, indigestion

Front 9

Distinguish typical angina pectoris from other causes of chest pain by characteristics related to:
Location

Back 9

Felt directly behind or slightly left of the sternum

Front 10

Compare and contrast teh typical presentation of: Variant or Prinzmental's Angina

Back 10

Affects women under 50, Occurs early in the AM, Involves the RCA, Pain at rest for no apparent reason, Associated with arrythmias and conduction defects

Front 11

Compare and contrast teh typical presentation of: Unstable angina

Back 11

Increasing duration, Progressively getting worse, Coronary thrombosis may be to blame

Front 12

Differentiate by symptoms other diseases/conditions besides coronary artery disease that may cause chest pain.

Back 12

•Costrochondritis
•Pneumonia
•Esophageal spasm
•Reflux esophagitis
•Cervical or thoracic pathology
•Intercostal neuritis

Front 13

Differentiate by symptoms other diseases/conditions besides coronary artery disease that may cause radiation of chest pain.

Back 13

•Splenic rupture
•Gallbladder

Front 14

Be able to differentiate several common chest-wall syndromes.

Back 14

Tietze's, Intercostal neuronitis, Costrovertebral syndrome (Posterior chest wall pain), Thoracic disk herniation (Unusual cause of posterior chest pain), Psychogenic (Anxiety, stress)

Front 15

Summarize the following common test ordered for patients with chest pain, their possible indications, and their limitations: EKG

Back 15

•Conduction, ischemia, injury, infarcts, rhythm disturbances
•Pace makers, bundle branch block, no baseline for comparison

Front 16

Summarize the following common test ordered for patients with chest pain, their possible indications, and their limitations: Cardiac panel: Troponin

Back 16

Cardiac damage,
Specific to cardiac muscle

Front 17

patients with chest pain, their possible indications, and their limitations: Cardiac panel: Myoglobin

Back 17

Unspecific,
Can be elevated in cardiac damage

Front 18

patients with chest pain, their possible indications, and their limitations: Cardiac panel: CK-MB

Back 18

Specific for cardiac damage

Front 19

patients with chest pain, their possible indications, and their limitations: Cardiac panel: CBC

Back 19

r/o anemia, infection, hypovolemia

Front 20

patients with chest pain, their possible indications, and their limitations: Cardiac panal: Lipid Panel

Back 20

Hypercholesterolemia

Front 21

patients with chest pain, their possible indications, and their limitations: Cardiac panal: Chemistry panel

Back 21

Scintigraphy
Radionuclitide angiography

Front 22

Explain the general role of each of the following in the management of angina pectoris: coronary angiography

Back 22

To visualize the coronary arteries, looking for narrowing of the vessels

Front 23

Explain the general role of each of the following in the management of angina pectoris: coronary artery surgery

Back 23

Uses a graft to bypass the blockage

Front 24

Explain the general role of each of the following in the management of angina pectoris: long-acting nitrates

Back 24

Same effect as nitro but lasts longer

Front 25

Explain the general role of each of the following in the management of angina pectoris: beta blockers

Back 25

Decrease myocardial oxygen consumption, Slows HR

Front 26

Explain the general role of each of the following in the management of angina pectoris: sublingual nitroglycerin

Back 26

Vasodilitation, Decreases preload

Front 27

Explain the general role of each of the following in the management of angina pectoris: calcium channel blockers

Back 27

Slow HR, Peripheral vasodilation (mild)

Front 28

Explain the general role of each of the following in the management of angina pectoris: aspirin

Back 28

Decreased platelet, aggregation

Front 29

Explain the general role of each of the following in the management of angina pectoris: risk factor modification

Back 29

Lowers LDL cholesterol, Decreases sodium intake, Quit smoking, Lose weight, fatty!

Front 30

Explain the general role of each of the following in the management of angina pectoris: Exercise

Back 30

Lowers BP
Increase HDL, decrease LDL
Assists in weight loss

Front 31

Describe the patient presentation and common important causes of acute pleuritic chest pain

Back 31

Presentation: stabbing CP, worse on inspiration, pleural rub. Causes: autoimmune (SLE) pleuritis

Front 32

Describe the differential that would be appropriate for a patient presenting with the following complaint: Dyspnea

Back 32

•Asthma
•COPD
•Pneumonia
•Pleural effusion
•Hypovolemia
•MI

Front 33

Describe the differential that would be appropriate for a patient presenting with the following complaint:

Back 33

•Palpitations
•Caffiene
•Arrythmias
•Valvular defect
•hyperthyroidism

Front 34

Describe the differential that would be appropriate for a patient presenting with the following complaint: Drugs or ETOH

Back 34

•Psycho
•Hypotension

Front 35

Describe the differential that would be appropriate for a patient presenting with the following complaint: Edema

Back 35

•CHF
•Hypoalbuminemia
•Kidney failure
•Allergic reaction
•Liver failure
•Nephrotic syndrome
•Venous stasis

Front 36

Describe the differential that would be appropriate for a patient presenting with the following complaint: Syncope

Back 36

•Arrhythmia
•Seizure
•Vertebrobrasilar TIA

Front 37

Explain the role and limitations of the following enzyme in making the diagnosis of acute myocardial infarction, including recognition of their initial and peak elevation times: CK and CK-MB

Back 37

•Become positive in 4 hours
•Peak from 12-24 hours, normal by 48-72h
•CK-MB is specific for cardiac damage
•Must be greater than 10% of total CK

Front 38

Explain the role and limitations of the following enzyme in making the diagnosis of acute myocardial infarction, including recognition of their initial and peak elevation times: Troponin I & T

Back 38

•More sensitive and specific
•Stays elevated for days, making acute diagnosis hard
•Peaks at 12 hours, normal after 7-12 days
•Shows up in 6 hours

Front 39

Briefly explain the general use and limitations of the following: ECG

Back 39

•Ischemia, injury, ST segment elevation, inverted Ts
•No baseline makes analysis difficult

Front 40

Briefly explain the general use and limitations of the following: Echocardiography

Back 40

•Heart wall motion
•Shows heart valves
•Estimates ejection fraction
•Does not show coronary anatomy
•Thickened chest wall or if you are tubby make visualization difficulty

Front 41

Briefly explain the general use and limitations of the following: Radionuclide heart scan

Back 41

•Demonstrates akinesis or dyskinesis in areas of infart
•Calculates EF

Front 42

Define "congestive heart failure."

Back 42

The inability of the heart to pump blood out of it as quickly as it comes in

Front 43

Describe the basic pathologic mechanisms that may result in heart failure and list one or two common examples of each for the following: alteration in the contractile state of the myocardium

Back 43

MI, Tamponade

Front 44

Describe the basic pathologic mechanisms that may result in heart failure and list one or two common examples of each for the following: Preload of the ventricle

Back 44

Valvular regurg

Front 45

Describe the basic pathologic mechanisms that may result in heart failure and list one or two common examples of each of the following: Afterload applied to the ventricles

Back 45

Aortic stenosis, hypertension

Front 46

Describe the basic pathologic mechanisms that may result in heart failure and list one or two common examples of each of the following: Heartrate

Back 46

Atrial fibrillation w/ rvr or lvr, WPW

Front 47

Define Preload

Back 47

Amount of blood left in the heart directly after diastole

Front 48

Define Afterload

Back 48

SVR

Front 49

Define ejection fraction

Back 49

Percentage of blood ejected from the ventricle during a single heart beat

Front 50

Define cardiac output

Back 50

Cardiac output = amount of blood ejected from the left side of the heart over one minute.

Front 51

Define stroke volume

Back 51

Stroke volume = amount of blood ejected from the heart in a single beat

Front 52

Determine the role of the following as compensatory mechanisms in CHF:
Frank-Starling relationship

Back 52

More afterload, the harder the heart will beat. All related to stretch.

Front 53

Determine the role of the following as compensatory mechanisms in CHF: ventricular dilatation

Back 53

Result of chronic end-diastolic filling.

Front 54

Determine the role of the following as compensatory mechanisms in CHF: ventricular hypertrophy

Back 54

Enlargement of the heart r/t increased workload causing muscle to enlarge

Front 55

Determine the role of the following as compensatory mechanisms in CHF: increased sympathetic nervous system activity

Back 55

•Stimulate myocardial contractility
•Increase heart rate
•Increase venous tone
•Increased PVR or SVR

Front 56

Determine the role of the following as compensatory mechanisms in CHF: excess salt and water retention

Back 56

•Due to decreased cardiac output
•Aldosterone released to retain sodium and water
•The body thinks it is dehydrated

Front 57

Distinguish the following form of heart failure, causes and PE: acute heart failure

Back 57

Causes: AMI, ischemia, volume overload of LV, mitral stenosis. PE: dyspnea, pink frothy sputum, rales, diaphoresis, cyanosis, hypoxemia

Front 58

Distinguish the following form of heart failure, causes and PE: chronic heart failure

Back 58

causes: damage from MI, HTN, leaky valves, viral infection, congenital. PE: SOB, weight gain, edema, fatigue, nocturia, PND

Front 59

Distinguish the following form of heart failure, causes and PE: Left sided heart failure

Back 59

low cardiac ouput and elevated pulmonary venous pressure, dyspnea predominant feature

Front 60

Distinguish the following form of heart failure, causes and PE: Right sided heart failure

Back 60

Signs of fluid retention predominate in right heart failure, with the patient exhibiting edema, hepatic congestion, and, on occasion, ascites

Front 61

Distinguish the following form of heart failure, causes and PE: low output

Back 61

Inadequate ability to pump blood effectively form the ventricles

Front 62

Distinguish the following form of heart failure, causes and PE: high output

Back 62

cardiac pump function may be supranormal but inadequate when metabolic demands or requirements for blood flow are excessive. though uncommon, tends to be specifically treatable

Front 63

Compare and contrast the following common precipitating or aggravating factors in heart failure:
Patient related factors

Back 63

i.Exertion
ii.Emotional stress
iii.Excess fluid or sodium intake
iv. Medication Non-compliance

Front 64

Compare and contrast the following common precipitating or aggravating factors in heart failure: Physician related factors

Back 64

i.Use of salt and water retaining drugs
ii.Use of negative inotropic agents (CCB's)

Front 65

Compare and contrast the following common precipitating or aggravating factors in heart failure: Heart failure related disease states

Back 65

i.Uncontrolled hypertension
ii.Angina or MI
iii.Arrhythmias
iv.PE

Front 66

Compare and contrast the following common precipitating or aggravating factors in heart failure: Other disease states

Back 66

i.Systemic infection
ii.Renal or hepatic failure
iii.High-output states (anemia, pregnancy, hyperthyroidism)

Front 67

Review, discuss and explain the role of each of the following laboratory studies and diagnostic procedures in CHF: CBC

Back 67

Anemia r/t high output failure

Front 68

Review, discuss and explain the role of each of the following laboratory studies and diagnostic procedures in CHF: BUN and creatinine levels

Back 68

elevated

Front 69

Review, discuss and explain the role of each of the following laboratory studies and diagnostic procedures in CHF: electrolyte levels

Back 69

Hypokalemia, hyperkalemia, hyponatremia

Front 70

Review, discuss and explain the role of each of the following laboratory studies and diagnostic procedures in CHF: EKG

Back 70

May provide info to the nature of the heart failure. Can see LVH or left atrial enlargement on an EKG.

Front 71

Review, discuss and explain the role of each of the following laboratory studies and diagnostic procedures in CHF: chest X-ray

Back 71

Size and shape of cardiac silhouette, Eveidence of, Pulmonary venous hypertension, Interstitial edema, Pleural effusions

Front 72

Review, discuss and explain the role of each of the following laboratory studies and diagnostic procedures in CHF: echocardiography

Back 72

Gold standard and the most useful. Reveals the size and function of both atria and ventricles, Detects: pericardial effusion, Valvular abnormalities
Intracardiac shunts,
Segmental wall motion

Front 73

Review, discuss and explain the role of each of the following laboratory studies and diagnostic procedures in CHF: radionuclide angiography

Back 73

Measures LVEF and regional wall motion. Used if echo is suboptimal

Front 74

Review, discuss and explain the role of each of the following laboratory studies and diagnostic procedures in CHF: cardiac catheterization

Back 74

Necessary to r/o significant valvular disease, Presence of CAD must be determined

Front 75

Review, discuss and explain the role of the following laboratory study and diagnositic procedure: ANP and BNP

Back 75

Released by the ventricles when overstretched. Hormone released that stimulated diuresis

Front 76

Compare and contrast in general terms the role of each of the following in the treatment of CHF: rest

Back 76

Decreases the metabolic demand of the heart

Front 77

Compare and contrast in general terms the role of each of the following in the treatment of CHF: diet

Back 77

Reduction of dietary sodium

Front 78

Compare and contrast in general terms the role of each of the following in the treatment of CHF: diuretics

Back 78

By reducing the water and sodium retention, edema improves and symptoms improve

Front 79

Compare and contrast in general terms the role of each of the following in the treatment of CHF: digitalis

Back 79

Improves cardiac contractility

Front 80

Compare and contrast in general terms the role of each of the following in the treatment of CHF: vasodilators (especially ACE inhibitors)

Back 80

Blocks ACE, allows the heart to beat against less systemic vascular resistance

Front 81

Define and distinguish the following:
pre-hypertension

Back 81

120-139/80-89

Front 82

Define and distinguish the following: stage I hypertension,

Back 82

140-159/90-99

Front 83

Define and distinguish the following: Stage II hypertension

Back 83

>160/100

Front 84

Define and distinguish the following: isolated systolic hypertension,

Back 84

Elevated systolic pressure >140 and diastolic <90

Front 85

Define and distinguish the following: hypertensive emergencies

Back 85

Contigent on presence of relative blood pressure increases combined with evidence of injury to the "target" organs

Front 86

Define and distinguish the following: hypertensive urgencies

Back 86

Risk for imminent target organ damage although acute injury hasn't occured

Front 87

Identify and explain the effects of prolonged uncontrolled hypertension on the following "target organ"
Heart

Back 87

LV hypertrophy causing MI, sudden death, CHF, arrhythmias, LV diastolic dysfunction

Front 88

Identify and explain the effects of prolonged uncontrolled hypertension on the following "target organ" Brain

Back 88

Hemorrhagic CVA, ischemic cerebral infarct, dementia

Front 89

Identify and explain the effects of prolonged uncontrolled hypertension on the following "target organ" Kidney

Back 89

Nephrosclerosis

Front 90

Identify and explain the effects of prolonged uncontrolled hypertension on the following "target organ"
Retina/eyes

Back 90

Hypertensive retinopathy

Front 91

Name the 4 "target" organs that prolonged uncontrolled HTN can effect

Back 91

Heart, brain, kidney and retina/eye

Front 92

List diseases that can result from hypertension.

Back 92

o Organ failure
o Stroke
o CAD
o Retinopathy

Front 93

Compare and contrast the most common causes of secondary hypertension by their characteristic signs and symptoms, or lab values uncovered on routine tests for the following: Estrogen use

Back 93

Discontinue meds

Front 94

Compare and contrast the most common causes of secondary hypertension by their characteristic signs and symptoms, or lab values uncovered on routine tests for the following: Primary hyperaldosteronism

Back 94

Screen with aldosterone levels

Front 95

Compare and contrast the most common causes of secondary hypertension by their characteristic signs and symptoms, or lab values uncovered on routine tests for the following: Pheochromocytoma

Back 95

Orthostatic decreases in BP

Front 96

Compare and contrast the most common causes of secondary hypertension by their characteristic signs and symptoms, or lab values uncovered on routine tests for the following: Cushing's

Back 96

Angiotensinogen levels 2X normal

Front 97

Compare and contrast the most common causes of secondary hypertension by their characteristic signs and symptoms, or lab values uncovered on routine tests for the following: Pregnancy

Back 97

Preeclampsia, eclampsia

Front 98

Compare and contrast the most common causes of secondary hypertension by their characteristic signs and symptoms, or lab values uncovered on routine tests for the following: Renal vascular hypertension

Back 98

Below age 20 or after 50, Epigastric or renal bruit, Athersclerotic dx of aorta, Abrupt decline in renal function due to ACEI use

Front 99

Establish which laboratory tests should be obtained on a patient with newly discovered hypertension, and explain the reason why each one is necessary.

Back 99

1.Hemoglobin, UA, & renal function studies for proteinuria, hematuria, casts
2.Serum potassium 3. Aldosterone 4.Renin to detect mineralcorticoid excess 5.FBS to r/o DM, pheochromocytoma 5. Lipids, Indicator for athersclorosis
6.Uric acid: Contraindication diuretic therapy

Front 100

Outline general principles of non-pharmacologic treatment of hypertension.

Back 100

Loose weight, Reduce salt, Diet Rich in fruits, vegis, and low fat dairy and low in saturated fats, excercise, Reduce ETOH, No smoking, Calcium and Potassium supplements

Front 101

List Differential diagnosis of valvular heart disease.

Back 101

Mitral Stenosis
Mitral Regurgitation
Aortic Stenosis
Aortic Regurgitation
Tricuspid Stenosis
Tricuspid Regurgitation

Front 102

Describe the typical presentation, and complications for infective endocarditis

Back 102

Fever, New, changing murmer, Evidence of systemic emboli, Positive blood cultures, Evidence of vegetation on Echo, Destruction of infected valves with subsequent regurg, Infection extends into the myocardium leading to conduction disturbances, Invades aortic wall causing sinus of Valsalva aneurysms, Preexisting heart lesions

Front 103

Describe the most common causative organisms for infective endocarditis.

Back 103

•Staphylococcus aureus
•Enterococcus
•Viridan's Strep
•Usually tricuspid valve

Front 104

Describe the diagnostic studies for infective endocarditis

Back 104

•Echocardiogram
•Blood cultures
•CXR

Front 105

Determine who is at increased risk for developing infective endocarditis and explain the importance of antibiotic prophylaxis before certain medical or dental procedures in this population.

Back 105

IV drug users, Prosthetic heart valves, People with murmurs, Immunocompromised, Rheumatic heart disease, Prior hx of endocarditis, Any structural abnormalities of the heart, These people should use antibiotics before invasive procedures