Blueprints 2- Cardiology

Front 1

CHF is a clinical syndrome characterized by what (3)?

Back 1

Dyspnea, Abnormal Retention of water and sodium

Front 2

CHF results from a change of one or more of the following

Back 2

Contractile ability of the heart muscle, preload, afterload, and HR

Front 3

CHF adversely affects what 2

Back 3

LA pressure and cardiac output

Front 4

Clinical features of left sided heart failure

Back 4

Exertional dyspnea, non-productive cough, fatigue, orthopnea, paroysmal nocturnal dyspnea, basilar rales, gallops, and exercise intolerance

Front 5

Clinical features of right sided heart failure

Back 5

JVD, tender or nontender hepatic congestion, nausea, pitting edema

Front 6

What activity in CHF produces pallor and cold, clammy skin

Back 6

Sympathetic activity

Front 7

CHF electrolyte embalances

Back 7

Hyperkalemia and hyponatremia

Front 8

CHF CXR may show

Back 8

cardiomegaly, bilateral or right-sided pulmonary effusions, perivascular or interstitial edema (Kerley B lines), venous dilation, and alveolar fluid

Front 9

What lab values might be elevated in CHF?

Back 9

BNP or N-terminal pro-BNP

Front 10

How do we assess the severity of CHF?

Back 10

Angiography, cardiac cath,

Front 11

Older patients should have what other testing to rule out hemochromatosis?

Back 11

Thyroid function tests, iron studies

Front 12

What is the initial treatment in CHF?

Back 12

Thiazide or loop diuretic and an ACEI

Front 13

What are CCB (preferably amlodipine) used in CHF?

Back 13

To treat angina or HTN

Front 14

CCBs- Dihydropyridines (mechy of action, not used for what? which drugs are they?)

Back 14

-Decrease resistance and arterial pressure. Not used to treat angina (except amlodopine) because vasodilation can lead to reflex tachycardia. All end in -pine

Front 15

CCBs- Non-dihydropyridines (mechy of action? 2 examples?)

Back 15

Myocardial selective. Reduces myocardial O2 demand and reserves coronary vasospasm. Causes less reflex tachycardia. Verapamil and Diltiazem.

Front 16

HTN- causes

Back 16

Genetic predisposition, increased age, african americans, excessive salt intake, obesity

Front 17

Exacerbating factors of HTN

Back 17

-Alcohol use, cigarette smoking, lack of exercise, polycythemia, use of NSAIDs, and low K intake

Front 18

Metabolic Syndrome

Back 18

Truncal obesity, hyperinsulinemia and insulin resistance, hypertriglyceridemia, HTN

Front 19

Secondary Causes of HTN

Back 19

-Sleep apnea, estrogen use, pheo, coarction of the aorta, pseudotumor cerebri, parenchymal renal disease, renal artery stenosis, chronic steroid therapy, Cushing'sm thyroid and parathyroid disease, primary hyperaldolsteronism, pregnancy

Front 20

Having Metabolic Syndrome is associated with the development of:

Back 20

Diabetes and increased risk of cardiovascular complications

Front 21

Prehyperatension

Back 21

120-139 (systolic) 80-89 (diastolic)

Front 22

Stage 1 Hypertension

Back 22

140-159 (systolic) 90-99 (diastolic)

Front 23

Stage 2 Hypertension

Back 23

>160 (systolic) or >100 (diastolic)

Front 24

New York Heart Association Functional Classification of Heart Disease- Class I

Back 24

No limitation of physical activity;

Front 25

New York Heart Association Functional Classification of Heart Disease- Class II

Back 25

Slight limitation of physical activity; ordinary physical activity results in symptoms

Front 26

New York Heart Association Functional Classification of Heart Disease- Class III

Back 26

Marked limitation of physical activity; comfortable at rest but less than ordinary activity causes symptoms

Front 27

New York Heart Association Functional Classification of Heart Disease- Class IV

Back 27

unable to engage in physical activity without discomfort; symptoms may be present even at rest

Front 28

Hypertensive Urgencies- treatment?

Back 28

Blood pressure must be reduced within hours

Front 29

Hypertensive Emergenicies- treatment

Back 29

Blood pressure must be reduced within 1 hour in order to prevent end-organ damage

Front 30

Definition of Malignant Hypertension

Back 30

Elevated blood pressure associated with papilledema adn either encephalopathy or nephropathy.

Front 31

If malignant HTN goes untreated, what occurs?

Back 31

Progressive renal failure

Front 32

Essential diagnostic criteria for HTN

Back 32

Systolic pressure >140 or a diastolic pressure >90 measured on three seperate occasions

Front 33

Most commonly voiced symptom of HTN

Back 33

nonspecific headache

Front 34

End-organ damage in untreated HTN includes what?

Back 34

Heart failure, renal failure, stroke, dementia, aortic dissection, atherosclerosis, and retinal hemorrhage

Front 35

In hypertensive urgencies the systolic pressure is > ____ OR the diastoilc pressure is > ___

Back 35

220 OR 125

Front 36

In Hypertensive Emergencies the diastolic pressure is usually greater than what?

Back 36

130

Front 37

What lab is important for ascertaining the associated risk for atherosclerosis?

Back 37

Lipid proflie

Front 38

What is the first treatment for HTN?

Back 38

D- dietary
A- approaches to
S- stop
H- hypertension

Front 39

In pts with HTN-- when should loop diuretics be used?

Back 39

Only in those with renal dysfunction and when close electrolyte monitoring is assured

Front 40

Which type of diuretic is most consistently effective in pts with HTN?

Back 40

Thiazide type

Front 41

What might need to be taken when patients are on diuretics?

Back 41

K supplements

Front 42

B-adrenergic antagonists are used to do what?

Back 42

Decrease heart rate and cardiac output. Are more effective in younger white patients.

Front 43

Intial DOC for pts with HTN and diabetes?

Back 43

ACEI

Front 44

Mechy of action of ACEI

Back 44

-Inhibit bradykinin degradation and stimulate synthesis of vasodilating prostaglandings.

Front 45

Major side effect of ACEI

Back 45

Cough

Front 46

Mechy of action of ARBs

Back 46

- Block the interaction of angiotension II on receptors.

Front 47

Why do ARBs not cause a cough?

Back 47

Because they do not increase bradykinins

Front 48

What type of drug might be preferred in AA and elderly patients and is used for peripheral vasodilation

Back 48

CCBs

Front 49

What is the drug Aliskiren?

Back 49

A renin inhibitor that was recently approved for mono or combo therapy in HTN.

Front 50

What are the preferred agents for treating hypertensive emergencies and urgencies?

Back 50

Nitroprusside
Nitroglycerine or a BB (if ischemia is present)

Front 51

Oral agents for less severe hypertensive emergencies include what?

Back 51

-Clonidine, captopril, and nifedipine

Front 52

Causes of cardiogenic shock?

Back 52

MI, dysrhythmias, heart failure, defects in the valves or septum, HTN, myocarditis, cardiac contusion, rupture of the ventricular septum, or myocardiopathies

Front 53

Cause of postural hypotension:

Back 53

Reduced cardiac output, paroxysmal cardiac dysrhythmias, low blood volume, medications, various endocrine and metabolic disorders.

Front 54

What is a major cause of falls in the elderly that is reversible?

Back 54

Orthostatic hypotension

Front 55

What is the definition of orthostatic hypotension?

Back 55

GReater than 20 drop in systoilc pressure between supine and sitting and or standing measurements