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Barkley Review

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