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Cardiovascular
Barkley Review
| Question | Answer |
|---|---|
| S1 | AV valves close and semilunar valves open |
| S2 | Semilunar valves close and AV valves open |
| Systole | Period between S1 and S2 |
| Diastole | Period between S2 and S1 |
| S3 | "Ken-tuck-y" increase in the hearts fluid state, seen in CHF and pregnancy |
| S4 | "Ten-ne-ss-ee" stiff ventricular wall seen in MI, left ventricular hypertophy, chronic uncontrolled HTN |
| Murmurs scale | 1-6 depending upone the sound quality |
| I/VI | Barely Audible |
| II/VI | Audible but faint |
| III/VI | Moderately loud, easily heard |
| IV/VI | Loud, associated with a thrill |
| V/VI | Very loud, heard with one corner of the stethoscope off the chest |
| VI/VI | Loudest |
| Mitral Stenosis | Loud S1 murmur, low pitched, mid-diastolic, apical "crescendo" rumble |
| Mitral Regurgitation | S3 with systolic murmur at the 5th ICS MCL (apex), may radiate to base of the left axilla, musical , blowing or high pitched |
| Aortic Stenosis | Systolic, "blowing", rough harsh murmur at 2nd left ICS, radiating to the neck |
| Aortic Regurgitation | Diastolic , blowing murmur at the 2nd left ICS |
| Heart Failure | A syndrome that results when the cardiac output is insufficient to meet the metabolic needs of the body |
| Systolic Heart Failure | Inability to contract that results in decreased cardiac output |
| Diastolic Heart Failure | Inability to relax and fill resulting in decreased cardiac output |
| Acute | Left sided heart failure usually occurs following an MI or valve damage |
| Chronic | Right sided heart failure that resilts of inadequate compensatory mechansims that have been employed over time , if you have right sided heart failure you have left sided |
| Signs and symptoms of Left sided heart failure | PULMONARY: dyspnea at rest, course rales, wheezing, S3 gallop, mitral regurgitation , frothy cough |
| Signs and symptoms of Right sided heart failure | JVD, Hepatomegaly, Dependent edema, Paroxysmal nocturnal dyspnea, chonically ill, diffuse chest wall heave, discplaced PMI, abdominal fullness, fatigue with exertion, S3 and /or S4 |
| ABG findings with heart failure | Hypoxemia and hypocapnia |
| Chest x-ray for patient with heart failure | Pulmonary edema, Kerley B lines, effusions |
| Non-pharmacological management for CHF | Weight loss, sodium restriction, rest, activity, water restriction , medication compliance |
| Pharmacological management for CHF | Ace, Diuretics, Anticoagulation for AFib |
| Hypertension | A sustained elevation of systolic blood pressure >140 or diastolic blood pressure >90 |
| Exacerbating factors for HTN | smoking, obesity, excessive alcohol, use of NSAIDS |
| Signs / Symptoms of HTN | Elevated BP, suboccipital pulsating headache that occurs int he morning and resolves through the day, epistaxis, dizzy, lightheaded, S4 from left hypertrophy |
| Test needed for diagnosing HTN | REnovascualr studies, CXR, ECG, UA |
| Lab work for HTN | CBC, BMP, Calcium, Phosphorus, Uric Acid, Cholesterol, Triglycerides |
| JNC 7 normal BP | SBP: <120 DBP: <80 |
| JNC 7 Pre-hypertension | SBP: 120-139 DBP: 80-89 |
| JNC 7 Stage 1 HTN | SBP: 140-159 DBP: 90-99 |
| JNC 7 Stage 2 HTN | SBP: >160 DBP: >100 |
| Blood pressure standards treatment recommendations for after 18 years old | Pt over 60 year: <150/ <90 Pts under 60 <140/<90 |
| Adults <60 BP per JNC 8 | SBP: <140 DBP: <90 |
| Adults >60 BP per JNC 8 | SBP: <150 DBP: <90 |
| Adults >18 HTN with CKD | SBP: <140 DBP: <90 |
| Adults >18 HTN with DM | SBP: <140 DBP: <90 |
| Non-African-American HTN Management | Thiazide diuretic, CCB, ACE, ARB |
| African American HTN Management | Thiazide diuretic, CCB |
| CKD age >18 HTN management | ACE, ARB, (REGARDLESS of RACE) |
| Treatment Goal | See changes in 1 month, if not increase dose or add second medication, monthly assessment until goal is reached, NO ACE and ARB together , refer after 3 medications |
| Non-Pharmacological treatment for HTN | Sodium restriction, Weight loss, DASH Diet, Exercise, reduce Alcohol, smoking cessation, adequate electroylte. |
| Thiazide Diuretics | First line of choice for HTN, Increases excretion of sodium and water, may cause hypokalemia, hypomagensium, hyperglycemia |
| Examples of Thiazide Diuretics | Chlorothiazide (Diuril), Hydrochlorothiazide, Indapamide, Metolazone, Chlorthaldone ( Hygroton) |
| ACE Inhibitors | Cause vasodilation and block sodium and water retention , not allowed in pregnancy, K has to be less than 5.5 to start |
| ACE Inhibitor Examples | Benzapril Lotensin), Captopril (Capoten), Enalapril (Vasotec), Lisinopril (Zestril), Quinapril (Accupril) |
| ACE Inhibitor side effects | Cough, rash, taste disturbance, hyperkalemia, renal impairment |
| ARB: Angiotension II-receptor Blockers | Causes vasodilation and block sodium and water retention, contraindicated in pregnancy, |
| ARB examples | Losartan (Cozaar), Valsartan (Diovan), Candesartan (Atacand), Olmesartan (Benicar) |
| ARB side effects | Cough, hyperkalemia, headache, taste disturbances, renal impairment |
| CCB: Calcium Channel Blocker | Used for angina, arrythmias, and migraines, monitor heat rate |
| CCB potential side effects | Headache, flushing, bradycardia |
| CCB examples | Verapamil, Diltiazem, Amlodipine, Nifedipine, Nicardipine |
| beta-blocking agents | Directly relax the heart, may also be used for angina and arrythmias, monitor heart rate and avoid in patients with COPD/asthma |
| Beta- blocking agents examples | " lol" Metoprolol (Lopressor) , Carvediol (Coreg), bisoprolol (zebeta), nadolol (Corgard), Timolol |
| Side effects of Beta-blocking agents | dizziness, bradycardia, heart block, fatigue, insomnia, nausea |
| Peripheral Alpha-1 Antagonist | Cause Vasodilation, take first dose at bedtime, used for adjunctive therapy |
| Examples of Peripheral Alpha-1 Antagonist | "Zosin" Prazosin (minipress), Terazosin (Hytrin), Doxazosin (Cardura) |
| Side effects of Peripheral Alpha-1 Antagonist | May cause first dose syncope, dry mouth, orthostasis, dizziness and headache |
| Central Alpha-2 agonists | Prevent vasoconstriction, cause vasodilation, and slow the heart rate , do not discontinue rapidly |
| Examples of Central Alpha-2agonist | Clonidine (Catapres), Methyldopa (Aldomet)- preferred for Pregnancy |
| Side effects of Central Aplha-2 agonst | Dry mouth, sedation, depression, headahce, bradycardia |
| Arterial Vasodilators | Directly relax the vascular smooth muscle resulting in arterial vasodilation , wil also help reduce the frequency in renal dysfunction , primary a adjunctive therapy |
| Arterial Vasodilator examples | Hydralazine (Apresoline) Miniozidil (Loniten) |
| Direct Renin Inhibitors | Inhibits the renin, which decrease plasma renin activity (PRA) and inhibits the conversion of angiotensinogen I to angiotensin I, avoid with pregnancy |
| Examples of Direct Renin Inhibitors | Aliskiren (Tekturna) |
| Side effects of Direct Renin Inhibitors | Diarrhea, Dizziness, Teratogenic, Headache , Hyperkalemia |
| Hypertensive Urgencies | Severe elevation in blood pressure, resulting in BP >180/110 without progressive target organ dysfunction |
| Symptoms of Severe Hypertensive Urgency | chest pain, Severe SOB, N/V, headache, anxiety, pot seizures |
| Management of HTN urgency | OraL: Clonidine (Catapres), Captopril , Nifedipine (Procardia), loop diuretics |
| Hypertensive Emergencies | Incidents that require immediate within the hour blood pressure reduction to prevent target organ damange |
| Example of HTN Emergencies | Unstable angina, MI, Eclampsia, DAA, Lventriculat failure with pulmonary edema , intracranial hemorrhage, MAlignant hypertension, htn encephalopathy |
| Management of HTN emergencies | ICU, Artial pressure line, Blood pressure should be lowered to 160-180 or to less than 105 diastolic and then gradulally lowered overthe next few dats with oral therapy |
| Blood pressure should not be drooped more than ___% within ___ | 25%, within minutes to 1-2 hours |
| Common agents for emergent HTN | Nicardipine, Sodium Nitroprusside (Nipride) |
| Angina | Decreased blood flow through the vessel results in tissue ischemia |
| Prinzmetals angina | Angina that occurs at rest that occurs in cycles, varient |
| Symptoms of angina | Chest discomfort lasting ofr severeal minutes can result from exertional or physical activity, subsides with rest, symptosm shorten with Nitro |
| Levine's sign | "Clench fist sign" 90% diagnostic for angina, Tightness rather than "elephant pressure" seen in angina |
| ECG changes with angina | down sloping ST segments, peaked T-wave or inversion |
| VLDL levels | normal <150 |
| LDL levels | <100 |
| HDL levels | need to be higher than 60 is desired , normal 40-60 |
| Levels for DM patient with angina | LDL: <70, HDL>40, TG <150 |
| What is the definitive diagnostic procedure for angina | Coronary angiography |
| Diet for Angina | Decrease in fats, increase in plant base products |
| Pharmacotherapy for Angina | Low dose ASA daily, Nitrates, Beta Blockers, Calcium Channel Blockers |
Created by:
ktebbin
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