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