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FNP~Cardiac

Assessment, Dx, Tx

QuestionAnswer
In S1, which valves are open/closed semilunar open...mitral/tricuspid (AV) valves closed
In S2, which valves are open/closed AV open...arotic/pulmonic (semilunar) closed
Systole = the period between S1 and S2
Diastole = the period between S2 and S1
S3 = "Kenn-tuck-y" sound; associated with ^ fluid states (pregnancy, CHF)
S4 = "Ten-ne-ssee" sound; associated with previous MI, chronic HTN, L Ventricular hypertrophy, stiff wall
Pnuemonic~MS.ARD Mitral Stenosis Aortic Regurg = Diastolic Murmur
Pnuemonic~MR.ASS Mitral Regurg Aortic Stenosis = Systolic Murmur
Aortic Stenosis is heard where? 2nd R ICS usually radiating to the neck
When is Aortic Stenosis heard and what sound best describes it? Systolic, "blowing", rough and harsh
Aortic Regurg is heard where? 2nd L ICS
When is Aortic Regurg heard and what sound best describes it? Diastolic "blowing"
Mitral Stenosis is what kind of murmur? loud S1 murmur, low pitched, mid-diastolic; apical "crescendo" rumble
Mitral Regurg is heard where? 5th ICS MCL (apex); may radiate or left axilla; musical, blowing, or high pitched
What is Mitral Regurg? S3 with systolic murumur
Acute Heart Failure? abrupt onset usually following an acute MI or valve rupture
Chronic Heart Failure? usually develops over time as a reult of inadequate compensatory mechanisms
Systolic Heart Failure? inability to contract = decrease in cardiac output
Diastolic Heart Failure? inability to relax and fill = decrease in cardic output
Non-Pharmacological management of CHF Na+ reduction, rest/activity balance, wt reduction
CHF labs and diagnostics ABG, UA, CXR (pulm edema), Echo (contractile/relaxation, valve function, ejection fraction), ECG (acute MI, dysrhythmia), BMP (normal unless chronic failure present)
What is Pharm management of CHF? ***Diuretics, ACE inhibitors...Digitalis (systolic failure), CCB's, Vasodilators, BB's, Angiotensin II/Alpha adrenergic receptor antagonists
What sound is heard during LVH? S4
Describe H/A related to "Severe HTN" (location/duration)? subocciptal and pulsating, present early in AM and resolving throughout the day
Normal B/P? S <120 & D <80
Pre~HTN S 120-139 or D 80-89 (>120/80)
HTN Stage 1 S 140-159 or D 90-99 (>140/90)
HTN Stage 2 S > or equal to 160 or D > or equal to 100 (> 160/100)
HTN baseline studies LABS: UA, BMP, CBC, CA+, Phos, uric acid, chol, triglycerides, BUN/Cr...ECG (dysrhythmias, LVH)...CXR (PA and lateral)
HTN Stage 1 Pharm Management thiazide-diuretic; consider ACEI, ARB, BB, CCB, or combo
HTN Stage 2 Pharm Management 2 drug combo; usually thiazide type diuretic + ACEI, or ARB, or BB, or CCB
Recommended Meds for HTN + Heart Failure thiazides, BB, ACEI, ARBs, aldosterone antagonists
Recommended Meds for HTN + Post MI BB, ACEI, aldosterone antagonists
Recommended Meds for HTN + ^CVD risk thiazides, BB, ACEI, CCB
Recommended Meds for HTN + DM thiazides, BB, ACEI, ARBs, CCB
Recommended Meds for HTN + CKD ACEI, ARBs
Recommended Meds for HTN + Recurrent stroke prevention thiazides, ACEI
Examples of BBs... "~ol"...Propranolol (Inderal), Atenolol (Tenormin), Nadolol (Corgard), Acebutolol (Sectral)
BBs are usually effective with... ~African Americans ~migraines ~angina ~part of 1st line therapy or in combo with diuretics
Examples of CCBs... "~ine"...Diltiazem (Cardizem), Verapamil (Calan/Isoptin SR), Amlodipine (Norvasc), Nicardipine (Cardene SR), Felopidine (Plendil)
CCBs are usually effective with... ~Caucasians ~monotherapy when BBs are contraindicated ~A-Fib/Tach ~migraines ~DM
An example of a Loop Diuretic is... Furosemide (Lasix)
Examples of ACE inhibitors... "~pril"...Captopril (Capoten), Enalopril (Vasotec), Benzapril (Lotensin), Ramipril (Altace)
ACE inhibitors are effective with... ~Caucasians <65 yrs old ~usually drug of choice with DM ~***watch for cough and bronchospasms, if cough occurs switch to ARB
Examples of Adrenergic inhibitors... Clonodine (Catapress), Methyldopa (Aldomet), Prazosin (Minipress), Labetalol (Normondyne/Trandate), Carvedilol (Coreg)
What classifies a Hypertensive Urgency? B/P S >220 or D >125 or symptomatic patients with S >200 & D >120 (or lower) + H/A, heart failure, angina, etc
Management of Hypertensive Urgency Oral therapy...Clonodine (Catapress), Captopril (Capoten), Nifedipine (Procardia), loop diuretics, etc...*parenteral therapy is rarely required
What classifies a Hypertensive Emergency? D > 130...immediate pressure reduction (within 1 hour) to prevent or limit target oragn damage
How is Hypertensive Emergency managed? IV agents (Hydralazine/Apresoline)...*avoid rapid drop, may result in cerebral infarction
Stable Angina classic or chronic- exertional(most common)
Printzmetal's Angina variant- occurs at various times, including rest
Unstable Angina pre-infarction, rest or crescendo, coronary syndromes
Microvascular Angina metabolic syndrome
Management of Angina ~reduction of risk factors ~lowering LDL ~low dose of EC ASA (81mg) daily ~nitrates ~BBs ~CCBs
If rest and Nitro don't work what is the probable diagnosis? MI
MI PE findings... ~dysrhythmia common ~presence of S4 common ~wheezing ~rales 2' to edema ~low grade fever first 48 hours ~tachycardia
ST elevation in MI = infarct
ST depression in MI = ischemia
DVT sx's... ~sudden onset of pain (superficial) ~pain or tenderness esp when walking (deep) ~pain may be dull, achey or tight feeling (deep)
DVT PE findings... ~localized heat ane erythema (superficial) ~*edema distal to occulsion (deep) ~low temp ~palpable cords in calfs ~skin may be cyanotic if severe ~skin cool
Management of "Superficial" DVT... ~elevation ~warm compress ~non-steroidal agents ~D/C oral contraceptives
Management of "Deep" DVT... ~bed rest & elevation until local tenderness subsides (7-14 days) ~walking slowly reintroduced ~Anticoagulants> Lovenox, Heparin, Coumadin with MD consult
What is Peripheral Vascular Dz? arteriosclerotic narrowing of the lumen of arteries resulting in decreased blood supply to extremities
Sx's of PVD... ~calf pain (claudication) *usually 1st sx ~cold/numb extremities ~progression to pain at rest
PVD PE findings... ~*shiny hairless skin ~pallor (when LE elevated) ~cyanosis ~ulcerations ~dependent rubor (redness when LE is down) ~reduced pulses
What is DVT... partial or complete occlusion of a vein by a thrombus with inflammation to the vessel wall
What is Chronic Venous Insufficiency? impaired venous return due to destruction of valves or changes due to deep thrombophlebitis, leg trauma, or sustained elevation of venous pressure (CHF)
Sx's of Chronic Venous Insufficiency... ~aching LE relieved by elevation ~edema after prolonged standing ~night cramps of LE
Chronic Venous Insufficiency PE findings... ~*trophic changes with brownish discoloration ~stasis leg ulcers ~edema of LE ~dermatitis ~cool to touch
Management of Chronic Venous Insufficiency... ~bedrest with LE elevated ~TED hose ~wt reduction if obese ~treatment of dermatitits or ulcers if indicated
What is the action of ACEI's expansion of blood vessels and decrease of resistance by lowering levels of angiotensin II. Allows blood to flow more easily & makes work easier for the heart
What is the action of ARB's (Beta-Andrenergic Blocking Agents)? keeps blood pressure from rising by prevention Angiotensin II from having any affects on the heart
What is the action of BB's? decreases the heart rate and cardiac output; makes the heart bet more slowly and with less force
What is the action of CCB's? interupts movement of Ca+ into cells of the heart and blood vessels; may decrease the heart's pumping strength and relax blood vessels
What is the action of diuretics? rids the body of excess fluids and Na+ through urination; helps relieve workload of the heart
What is the action of vasodilators (nitrates)? relaxes blood vessels and increases the supply of blood and oxygen to the heart while reducing its workload; often given to pt's who can't tolerate ACE
What is the action of digitalis (digoxin)? increases the force of the heart's contractions, which can be beneficial in systolic heart failure and for irregular heart beats
Created by: KimmiNP