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89 Cards in this Set
- Front
- Back
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What are good supplement tx of angina
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arganine, Mg add Zn
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What is the main drug tx for stable angina
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nitroglycerine
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What is the main side effect of nitroglycerine
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Migraine like HA
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What are the main CI for nitroglycerine
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Erectile dysfnx drugs such as sildenafil
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What is the main problem in type 4 hyperlypidemia and what other conditions are similar or the same problem
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Insulin is the problem
It is the same as pre-diabetic or syndrome X |
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What is the main problem in type 2 hyperlypidemia
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fat is the problem
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What is the side effect of statin drugs
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Reduce CoQ10 - need to supplement if taking a statin
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What is the main concerns with statin drugs and how do you monitor this
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Liver fnx decreased leading to rabdomyalisis - monitor liver enzymes and if they get joint or mm pain. Take off if liver enzymes raise or if they develop mm or joint pains
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In addition to statin drugs what is another way to reduce cholesterol
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increase fiber so cholesterol won't be absorbed
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What supplement will reduce lipids (LDL, cholesterol and TGs) and increases HDL
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Niacin (must dose 1.5-2 g/d)
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What effect on the Liver does niacin have when dosed at high levels, how can this be avoided
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it can increase liver enzymes. Need to give other B vitamins with Vit C to avoid this.
Don't give to people with poor liver fnx |
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What sharp stabbing chest pain is better with sitting up and leaning forward, worse with deep breathing
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pericarditis, pancreatitis and sometimes ulcers
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What should be at the top of the DDX with sharp stabbing pain that isn't better with any movement. Often begins as upper back pain and can radiate from abdomen to back. Asymmetry of BP from right to left.
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Dissecting Aortic Aneurysm
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What non-MI condition causes chest pain and is associated with collagen dz states
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Pulmonary HT
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What non-MI condition causes chest pain with a plural rub and dyspnea
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pleural embolisum
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What non-MI condition causes chest pain that is worse with movement and palpation and pushing on the chest wall
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musculoskeletal disorders
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What non-MI conditions cause chest pain but are related more to food consumption
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Some GI disorders
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What non-MI condition causes chest pain and unilateral location; sharp, localized; sudden onset lasting many hrs; dyspnea, SOB, painful breathing
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spontaneous pneumothorax
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What does a P wave abnormality on an EKG usually indicate
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Atrial Depolarization problems
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P wave base line abnormalities are usually what type of problem on an EKG
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Atrial electrical problems
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Problems on an EKG with QRS complex is usually indicative of a problem of what
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Ventricular systole
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What do T wave abnormalities usually indicate on an EKG
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Damage to the electrical system of the hear usually d/t ischemia and therefore restricting ventricular repoloarization
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What do the V leads in EKG tell you
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They are indicative of what part of the heart is damaged, if you see an abnormality in VI and/or V2 you want to think of R side of the heart, V3 V4 lower left side etc.
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What do many different V leads on an EKG showing abnormalities indicated
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Either an MI with a very large area effected or pericarditis
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What is seen in R wave progression with heart muscle damage
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There will be an abnormal progression - they won't get bigger
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What is the one thing you need to look for with an extra beat when looking at an EKG
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Is there a p wave
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What is an extra beat with a P wave preceding it indicate
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it indicates an extra atrial beat
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What is an extra beat without a P wave preceding it indicate
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it indicates an extra ventricular beat
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What two things can cause extreme right sided axis deviation
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Massive mm damage in the Left side of the heart or reversing the limb leads of the EKG
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What causes left axis deviation
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Hypertrophy of the heart
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What does T wave inversion indicate
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Ischemia
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What are the most common infections in a newborn
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Beta strep
lesteria E coli |
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What are the characteristic presentations of Parkenson's Dz
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SMART
Shuffling gate Mask face Akanesia Rigidity (cog wheel rigidity) Tremor |
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Pn or discomfort jaw, neck pain
Weakness in arm or shoulder Shortness of breath Feeling weak or lightheaded |
MI - specifically in a male
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Nausea
Kidney like back and abd pn Pn will come and go 3-5 min cycles Neck or arm pn not usually any chest pain |
MI - pattern seen in a woman
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What is the biggest cause of L sided heart failure
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Circulatory problems like athrelosclerosis
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What is bradycardia
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HR < 60 bpm, unless peds or an athlete
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What is tachicardia
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HR > 100 bpm
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What does a sawtooth EKG coupled with palpitations, sweating weakness, dizziness, syncope suggest
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A-Flutter, if more severe it can be A-Fib - Both are at risk to throw clots
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What does the EKG look like in PVCs
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No P wave
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When do PVCs become Ventricular tachacardia and why is this occurring
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It is when the PVCs are >5/min
This is d/t cardiac cell death and will lead to an MI |
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What is the 1st sign of heart block
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syncope
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What does a dermatiolgical finding that is a lacy purpura with other systemic signs suggest.
Can have liver, renal or neuro involvement. |
Vasculitis!!! Usually small vessel
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What are the systolic murmurs
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Either a normal varient -or-
Aortic/Pulmonic stenosis Mitral/Tricuspid regurge |
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What are the diastolic murmurs
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ALWAYS BAD!!!
Mitral stenosis Atrial regurge |
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how does Endocarditis present
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Nonspecific symptoms of cough, dyspnea, arthralgia, diarrhea, pallor, splenomegaly, abd./flank pain from emboli
Rapid sn/sx of infection |
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How do you test for endocarditis
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Blood cultures - best to send to hospital to do this
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How does myocarditis present
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Usually viral, can presents as chest pn. When MI ruled out usually assumed to be this.
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What is pre-hypertension
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120-139/80-89
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What is HTN Stage I
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140-160/90-99
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What is HTN Stage II
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>160/>100
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What are the dietary & lifestyle recommendations for HTN
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DASH diet, Low Na (inc K), Exercise, loose wt, low alcohol consumption
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What are causes of secondary HTN
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Renal artery stenosis
Chronic renal disease Primary hyper-aldosteronism Hyper or hypo thyroidism Pheochromocytoma Pre-eclampsia Aortic coarctation BCP use |
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What is the 1st line drug tx for HTN
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thiazide - diuretics
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Severe pn in the chest and neck radiating to the back and then the abd
BP &/or pulses unequal in R and L arms Syncope, hemiplegia or paralysis of the lower extremities may occur |
Dissecting Abdominal Aorta
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According to AFI 36-2618, into what three tiers is the enlisted structure divided?
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Airman, NCO, and senior NCO.
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How does a dissecting abdominal aorta present in xray
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widened mediastinum
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What position is paracarditis better in and what is the pathognomic finding in this condition
What test should be run |
Better with leaning forward and pericardial friction rub
ECHO |
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What 3 conditions are better with leaning forward or the fetal position
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Pericarditis
Pancreatitis Gastric Ulcer |
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What is significant for an elevated AST
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- Identify and monitor HEART (a sick heart can beat f-AST), kidney, liver
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What does LDH tell you
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Elevated inflammation in the body - doesn't show you where.
It is elevated when there is a lot of hypoxic activity in a tissue. |
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What do you do after seeing LDH elevated
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Add isoenzymes to lab rec
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WHen is the only time LDH-1 > LDH-2
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MI
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When is the only time you will see a 50x LDH elevation
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pernicious anemea
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When is LDH-5 elevated
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mm dz
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How long does it take AST to elevate post MI
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6-36 hours
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How long does it take Troponin 1 to elevate post MI
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2-4 hours
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How long does it take CK/MB or myoglobin to elevate post MI
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4-6 hours - CK/MB
4-8 hours - myoglobin |
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How long does it take for LDH-1 to be > than LDH-2
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12-48 hours
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What is lipo A1 associated with
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A1 is good - it means high activity HDL
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What is lipo A2 associated with
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A2 is bad - it means high activity LDL
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What does Lipo a mean
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the lower it is the lower the inflammation in the body
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What does a high homocysteine signify
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it is associated with increased mycardial risk - it either means they are a poor methylator or a ... (add from slide)
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What studies can we do to evaluate the heart
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EKG - electrical
U/S - vasculature |
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What can be done in office to evaluate the heart
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Resting EKG
Stress EKG - exercise or drug |
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What monitoring can be done out of the office to determine cardiac events
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Holter monitor - 3 leads and data collector, records all day long
Event monitor - know when it will occur and begin recording when it starts to occur |
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What is a diastolic murmur associated with
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Aortic Stenosis- crushendo decreshendo
Mitral regurge - plateau |
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Opening Snap
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Stenotic mitral valve
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Midsystolic murmur
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Mitral valve prolapse and insufficiency
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Thromboangititis obliterans is what condition
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Beurger's dz
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What does a midsystolic murmur heard best over the R intercostal space when pt leans forward in the upright position with T wave abnormalities
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L ventricular hypertrophy 2ary to aortic stenosis
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What does a plateau murmur suggest
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Suggest regurgitation
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What does a midsystolic click suggest
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Mitral valve prolapse
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What is bisferiens pulse seen in
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aotric regurgitation
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What type of pulse is seen in constrictive pericarditis
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abnormal paradoxical pulse
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Stenotic aortic or pulmonic valve is usually associated with what sound
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ejection click (right after S1)
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Mitral stenosis causes what sound
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Opening snap (right after S2)
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What is stasis dermatitis associated with
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venous insufficiency
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What vessels is affected in intermitted Claudication
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Arteries
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