| Question | Answer |
| What valves are open during S1 | Aortic/pulmonic (semilunar) |
| What vales are closed during S1 | Mitral/tricuspid (AV) |
| What valves are open During S2 | Mitral/tricuspid (AV) |
| What valves are closed During S2 | Aortic/pumonic (semilunar) |
| When does systole occur | between S1 and S2 |
| When does diastole occur | S2-S1 |
| What is associated with an S3 | CHF, pregnancy, essentially increased fluid states |
| What is associated with an S4 | Stiff ventricular wall- MI, LVH, chronic HTN |
| A I/VI Murmur is | Barely audible |
| A III/VI Murmur is | Moderately loud; easily heard |
| A IV/VI Murmur is | loud associated with a thrill |
| a V/VI Murmur is | very loud heard with one corner of stethoscope off the chest wall |
| VI/VI Murmur | Loudest |
| What type of Murmur can be heard at the 5th intercostal space | Mitral |
| Murmur heard at 2nd or 3rd intercostal space | Aortic |
| MSARD | Mitral
Stenosis
Aortic Regurgitation
Diastolic |
| MRASS | Mitral Regurgitation
Aortic Stenosis
Systolic |
| What is Primary HTN | a diagnosis of exclusion with onset being <55. 95% of all cases |
| Leading cause of secondary HTN | Renal artery stenosis
Other causes include: estrogen use, renal disease, pregnancy, endocrine disorders |
| What labs/studies would you order to rule out particular causes of HTN | Renovascular
AM/PM cortisol (cushing's R/O)
CXR if suspicion of cardiomegaly
Plasma aldosterone to R/O aldosteronism
ECG
Pa/lateral |
| BP treatment Recs | > or = 60 <150 SYS and 90 DYS
< 60 <140 SYS and 90 Dys |
| What should you screen for before admin of thiazide diuretics? | sulfa allergy |
| electrolyte abnormality that can occur with thiazide diuretics | hypo K; hypo Na; hypo Mg; hyper Ca; hyperglycemia |
| Can Ca++ blocker be used as mono therapy? | NO |
| What do kersey B lines represent | interstitial edema |
| NYHA Class I HF | No limitations oh physical activity: normal activity does not cause S/S |
| NYHA Class II HF | Slight limitations oh physical activity but comfortable at rest; physical activity results in fatigue, palpations, dyspnea and agina |
| NYHA Class III HF | Marked limitations of physical activity but comfortable at rest |
| NYHA IV HF | Severe; inability to carry out any physical activity without discomfort with signs and symptoms at rest |
| Non Pharmacologic MGMT of HF | Na restriction
Rest/activity balance
weight reduction |
| Pharmacologic MGMT of HF | Ace inhibitors
Diuretics
Anticoag therapy in the setting of afib |
| Tx of Pulmonary | Provide O2 and acquire ABG
semi fowlers position
Morphine 2-4 PRN q20-30 stop if hypercapnia
Lasix 40mg IV repeat in 10 minutes if no response |
| Your pt has pulmonary edema with bronchospasm what should you give | Inhaled sympathomimetics |
| your patient has severe pulmonary edema. What medications would reduce the afterload and preload | nitroprusside
hydralazine |
| Your pt has pulmonary edema and there cardiac index is low what you would choose the following drug ________ | dobutamine 5-20 ug/kg/min |
| SE's of ACEIs | cough, rash, taste disturbances, hyperkalemia, renal impairment |
| First Line Tx for HTN | Thiazide diuretics |
| SEs of Thiazide Diuretics | Hypo K
Hypo Mg
hyperglycemia
hypo Na
Hyper Ca |
| Both ACEI and ARBs are contraindicated in which electrolyte abnormality | K+ >5.5 |
| First dose syncope is a possible SE in which class of antihypertensives | Peripheral alpha-1 antagonists |
| dry mouth, sedation, depression, headache, and bradycardia are SEs of which antihypertensive class | Central alpha 2 agonists
(clonidine, methyldopa) |
| Arterial vasodilators are used primarily as ___________ therapy | adjunct |
| SE or arterial vasodilators | reflex tachycardia, orthostatic hypotension, flushing dizziness |
| Decreased blood flow through the vessel causing tissue ischemia is | Angina |
| Stable angina | exertional; can be acute or chronic |
| Prinzmetal's angina | variant angina; occurs at various times to include rest |
| Unstable angina | pre-infaction, rest or crescendo, coronary syndromes |
| Serum Lipid levels should be | Total Cholesterol <200
Triglycerides (VLDLs) <150
LDLs Optimal <100
HDLs <40 Low > or equal to 60 high |
| Serum lipids goals in CAD/DM | LDL <70
HDL >40
TG <150 |
| What factors is ASCVD risk based on? | Age
Sex
Race
Total Cholesterol
SBP
DM status
Smoking Status |
| What is the foundation of ASCVD prevention | heart healthy lifestyle |
| What groups with ASCVD would benefit from statin therapy | Those with clinical evidence of ASCVD
Those with LDL-C >190mg/dl
Diabetics 40-75 years of age w/ LDL-C between 70-189 w/estimated 10 year risk of 7.5 or higher |
| in the adult >21 but less than or equal to 75 years of age with clinical ASCVD ________ should be initiated | High dose stating therapy |
| High dose statin therapy medications would be | atorvastatin 40-80mg
rosuvastatin 20-40mg |
| if high statin therapy is contraindicated or there are associated adverse effects then initiate _________ | Moderate statin therapy
Atorvastatin 10-20
rosuvastatin 5-10
simvastatin 20-40mg
pravastatin 40-80
fluvastatin 80mg |
| the goal of high intensity statin therapy is to | reduce LDL-C by 50% |
| S/s of MI | Feeling of impending doom
syncope
NV
dyspnea
cough
cold weather/weakness |
| The physical exam of a patient undergoing an MI commonly reveals an S3 or an S4? | S4 |
| Peaked ST waves in I, aVL suggest | lateral MI |
| Peaked T waves in II, II, aVF suggest | inferior MI |
| peaked ST waves in V leads suggest | anterior MI |
| A first Degree AV block is indicated by | PR interval >0.20 sec |
| Type I second degree AV block (Wenckebach or Mobitz type I) is indicated by | PR interval gradually gets longer until a QRS complex is dropped |
| Type 2 second degree AV block (Mobitz II) is indicated by | A regular atrial rhythm with constant PR interval. however the ventricular rhythm is irregular and dropped QRS complexes occur |
| Third degree AV block is indicated by | regular atrial and ventricular rhythms with varied PR interval (no regularity) no relationship to P and QRS |
| MGMT MI | ASA 325 decrease PLT agregation
NTG SL q5 x3 open coronaries
O2 therapy
IV at KVO
12 lead and cardiac monitor
morphone IV 2-4
if pulmonary edema is present then lassie 40mg IVP
If not not contraindicated metoprolol 5mg IV x 3 doses q2min |
| Door to fibrinolytic therapy the for MI | 30 minutes |
| Door to cath lab time | 90 minutes |
| INR normal and therapeutic levels | Normal 0.8-1.2
Therapeutic 2-3 |
| APTT normal and therapeutic times | Normal 28-38
therapeutic 1.5-2.5 times normal |
| What are the indications for pharmacologic revascularization | unrelieved CP >30 minutes and <6 hours with
ST segment elevation > 0.1 mV in two or more contagious leads |
| Contraindications to TPA | prior ICH
CV session or malignant intracranial neoplasm
ischemic stroke
suspected aortic dissection
Active bleeding
Significant close head trauma/facial trauma in last 3 months
Severe uncontrolled HTN
Active bleeding/risk thereof |
