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117 Cards in this Set

  • Front
  • Back
Risk factors for heart disease between men and women differ by how many years?
10
What is the most common symptom of women presenting with an MI?
fatigue
What is the first line of defense against chronic stable angina?
Beta-blockers
ACE inhibitors, Beta-blockers, and Aspirin all do what?
-increase longevity
-decrease mortality
What are the ABCDEs of contraindications of the use of beta-blockers?
-Asthma
-Block (heart)
-COPD
-Diabetes
-Electrolyte (K)
-
HOw do you get pulse pressure?
-systolic minus diastolic
Low pulse pressure can indicate what murmur?
aortic stenosis
High pulse pressure can indicate what murmur?
aortic regurgitation
WHat are the 2 main questions you ask yourself when you treat HTN?
-Where do you wanna go?
-How fast do you wanna get there
Hypertension commonly causes what in the heart?
LVH
Anterior spasm leading to "copper wire" or "silver wire" appearance of vessels

Grade?
Duration or severity of HTN?
-Grade I
-recent onset of HTN
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
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
-Grade III
-Severe or accelerated HTN
Papilledema: Blurred optic disk margins, especially on temporal side

Grade?
Duration or severity of HTN?
-Grade IV
-HTN emergency
HOw does isotonic exercise affect BP?
-increases systolic BP
How does isometricl exercise affect BP?
-increases systolic and diastolic BP
How can alcohol affect BP?
increases systolic and diastolic BP
How does coffee affect BP?
increase BP slightly
How does smoking affect BP?
Chronic use doesn't increase BP
ACE and ARB work better when taken when?
at night
Why do we treat HTN?
-to reduce morbitity and mortality
What can HTN do to the eyes?
-retinal damage
What can HTN do to the heart?
-LVH
-CHF
Isolates systolic BP?
-disease of elderly
-stiffining of arteries and need to treat aggressively
What are some causes of secondary HTN? (CREEP)
-Coarctation of the aorta
-Renal artery medial fibromusclular dysplasia
-Endocrine
-Eclampsia
-Pill or Phreocromocytoma
What are some endocrine causes of HTN? (CHAP)
-Chushings
-Hyperaldosteremia
-Acromegaly
-Phoecromocytoma
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
What is Renal Pericimal Disease and who is it common in?
-stenosis of renal artery
-Seen in young women
The string of beads feature is seen in what?
-medial fibromuscular dysplasia
Rib notching on an x-ray is seen in what disease?
-coarctation of the aorta
What are the three zones of the cortex?
-Zona Glomerulosa
-Zona Fasciculata
-Zona Reticularis
Zona Glomerulosa is associated with what?
-salt (mineral coricoids)
-aldosterone
Zona Fasciculata is associated with what?
-sugar (cortisol)
Zona Reticularis is associated with what?
-sex steroids
Phoechromocytoma is caused by what?
-excess amounts of epinephrine and norepinephrine
What medication should you not use in Phoechromocytoma?
beta-blockers
Chushings disease is caused by what?
-too much cortisol in the adrenal cortex
Symptoms of eye damage from HNT are?
Blurry vision and new visual field defects
What are some symptoms of heart damage from HTN?
Heart Failure that presents with dyspnea
What are some symptoms of kidney damage from HTN?
Hematuria in the urine
What are some symptoms of CNS damage from HTN?
changes in mental status
What are some signs to look for in the neck with HTN?
-JVD
-Carotid bruit
-makes sure carotid upstroke is good
In HTN you want to make sure the apex of the heart is now what?
-displaced (if it is displaced think RVH)
In HTN, S3 can mean what?
-LVH
What do you want to look for in the abdomen in HTN?
-abdominal bruits
-pulsations (AAA)
What do you want to look for in the extremities in HTN?
-adema
-other abnormalities
In a neuro exam, what do you want to look for in HTN?
-neuromuscular loss
Why do you want to do a BMP for HTN?
-get sugar levels
-BUN/Creat
-CO2
-Electrolytes
What do you look for in a UA for HTN?
-hematuria
-albumin/protein
-proteinuria
What do you want to check in a CBC for HTN?
-elevated heme and hematocrit
What do you look for in an EKG for HTN?
-LVH
WHat drugs should you not take if you have HTN?
-NSAIDS
-decongestives
-antihystamines
What do you wanna look for on a CXR for HTN?
-LVH
-cardiomegaly
-Rib notching
Why do you want to do an echo for HTN?
-see heart size
Why do you not want to stop adrenergic inhibitors quickly?
-because of rebound HTN
Weakness of left ventricle that causes back up of fluid to the lungs
Left sided heart failure
Swelling of the feet.
Pedal Edema
Restriction of movement of the heart b/c pericardial sac is full of fluid.
Pericardial Tamponade
Filling pressure of the heart.
pre-load
Difference between systolic and diastolic blood pressure.
Pulse pressure
Crackling sound heard on inspiration. There is fluid in the interstitial space of lungs
Rales
Failure of R-side and there is back up of fluid in the abdomen and lower limbs
Right side heart failure
HOw does CAD cause left sided heart failure?
don't let the heart pump correctly
What murmurs are most commonly seen in L-sided heart failure?
-Mitral regurgitation and ortic stenosis
How can HTN lead to left-sided heart failure?
-makes the left ventricle very stiff, which causes poor diastolic filling
Which is more common diastolic or systolic dysfunction?
Diastolic
Why does dilated cardiomyopathy lead to left sided heart failure?
-because of the thin, floppy walls
What are some causes of dilated cardiomyopathy?
-Iatrogenic
-Alcohol
-rheumatic fever
-tyroid disorders
-post partum
-drugs (chemo)
What dysrrhythmia is most common in left-sided heart failure?
-A Fib
What causes high output heart failure?
-Anemia
-Thyrotoxicosis
-thiamine deficiency
Right sided-heart failure can show what chronic lung diseases?
-asthma
-copd
-Cystic fibrosis
-bronchietisis
Right-sided heart failure can show what two main heart murmurs?
-pulmonary stenosis
-tricuspid insuffiency
Cardiac temponade is when you can't do what do the blood in the heart?
-get it out
What is the most common pediatric heart disease?
-Ventricular Septal Defect (VSD) aka right to left shunt
Whe do you get lung problems with L-sided heart failure?
-b/c of sputum back up in the lungs
HTN, Diabetes, and obesity are associated with what sided heart failure?
left
Pitting adema and swelling are associated with what sided heart failure?
right
History of COPD or Pulmonary HTN is usually seen with what sided heart failure?
right
SOB is seen in what sided heart failure?
-left
-sometimes right
Paroxysmal Nocturnal Dyspnea is associated with what sided heart failure?
-left
Orthopnea is associated with what sided heart failure?
-left
Swelling in the feet or abdomen is associated with what sided heart failure?
right
What are the ABCDEs that you should look for on a CXR?
-A-alveolar edema
-B-Kerley B-lines
-C-Cardiomegaly
-D-Dilated prominent upper lobe vessles
-E-Pleural effusion
What is the most common cause of HR in America?
-diastolic dysfunction
When you suspect CHF, what do you listen for in the lungs?
-rhales and crackles
-wheezes
-dullness to percussion
-
When you suspect CHF, what do you listen for in the heart?
-mirtral regurgitation
-aortic stenosis
-S3/S4
JVD is seen in what sided heart failure?
-right
-sometimes left
HJR is seen in what sided heart failure?
-right
-sometimes left
Rales are seen in what sided heart failure?
-right (dry) sometimes
-left (wet)
Wheezes are heard in what sided heart failure?
-right
-sometimes left
S3 at the apex is heard in what sided heart failure?
-Left
Pedal edema is seen in what sided heart failure?
-right
Ascites is seen in what sided heart failure?
-right
In left sided heart failure, what is the first thing that you seen on a CXR?
-cardiomegaly
What is the flow of enlargement on a CXR for left-sided heart failure?
-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
What do you look for on an EKG in CHF?
-ischemia
-dysrrhythmias
-P-pulmonale
-LVH
-RVH
On a CBC, what are you looking for in CHF?
-MCV>100
What is a very sensitive test for CHF?
BNP
Tell me about BNP.
-good test
-L-atrium and L-ventricle release in response to stretch
-It is an anti-renin hormone
WHy do yo do an ECHO for a CHF patient?
-to get wall motion
-hypertrophy
-valve stenosis
-valve hypertrophy
-ejection fracture
What are some advantages of doing a TEE for CHF?
-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
What are some disadvantages of doing a TEE for CHF?
-invasive
-requires conscious sedation
-risk of aspiration
-risk of trauma to teeth, pharynx, and esophagus
MUGA is a good test to get what?
-ejection fracture
In CHF, as ventricles become floppy what happens?
-you lose ejection fracture and get PVCs
What is the formula for ejection fracture?
end-diastolic volume (-) end-systolic volume divided by end-diastolic volume
CAPTOPRIL (contraindications for ACE inhibitor uses)
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
Adaquate perfusion means what? (3 things)
1-normal mentation
2-adequate urine output
3-warm extremities
Nitro decreases what?
-preload
What are the 6 main objectives in the pharmacoligical management of HF?
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
What are six medications (classes) that can help treat HF?
-diuretics
-vasodilators
-digoxin
-nitrates
-beta-blockers
-surgical therapy
What are 4 non-pharmicological therapies for the treatment of HF?
-watch Na intake
-watch ETOH and fluid intake
-exercise
-aerobic and isometric exercise
For diastolic heart failure, you want to treat what?
-the underlying cause
The initial management of patients with decompensated heart failure should be aimed at what?
-normalizing volume status
-improving systemic perfusion
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
What drugs are used primarliy for symptoms control?
-digoxin
-nitrates
-diuretics
Patients with progressive HF symptoms despite optimal medial therapy should be considered for what?
-cardiac replacement therapy (VAD or transplant)
The management of diastolic HF primarily consists of treatment with what?
-negative inotropes and limited diuresis